A 59-year-old woman with severe neck pain, limb numbness, and a clumsy “stepping on cotton” gait caused by spinal cord compression was successfully managed using a Yang-warming herbal strategy combined with spinal adjustment and acupuncture.

Case ID: CHC-0061

Case Summary

This case describes a 59-year-old woman who presented with a half-year history of progressive neck and shoulder pain complicated by severe neurological deficits, including lower limb weakness and a sensation of “stepping on cotton” while walking. The original report documented a conventional diagnosis of cervical spondylotic myelopathy (spinal cord compression) and a TCM assessment of Wilting and Impediment (Wei Bi) driven by Qi and Blood Impedance and Liver/Kidney Deficiency. Rejecting immediate surgical intervention, she was managed through a highly integrative approach utilizing “Zhao’s Balanced Spinal Adjustment” to mechanically relieve the compression, alongside acupuncture, acupoint injections, and a heavy Yang-warming, Kidney-tonifying herbal decoction to restore neurological function.

Patient Presentation

• Patient: 59-year-old female (Surname: Yang).
• Main Complaint: Neck pain, left upper limb numbness, and a clumsy gait with a “stepping on cotton” sensation for half a year.
• History: The patient sought consultation on March 27, 2014. Six months prior, she developed neck pain and numbness/pain in her shoulder and upper limb. The condition gradually progressed to include a clumsy gait, a distinct sensation of “stepping on cotton” (踏棉感) when walking, and lower limb numbness and weakness. She did not experience a “banding” (corset-like) sensation around her trunk. After being evaluated at multiple hospitals and ruling out other systemic diseases, she was diagnosed with cervical spondylotic myelopathy.
• Physical Exam: The neck was stiff and painful. She experienced numbness and pain in the left shoulder and arm, weakness in her legs, and cold extremities. There was localized tenderness next to the C3-C6 spinous processes. Neck extension and lateral bending were restricted. Neurological exams showed hyperactive knee jerk reflexes and a positive Hoffman’s sign (+), but a negative Babinski’s sign (-).

Examination and Diagnosis

• Imaging (X-ray & MRI): X-rays showed a straightened cervical curvature, narrowed C4-C6 intervertebral spaces, marginal vertebral osteophytes, uncovertebral joint hypertrophy, and spinal canal stenosis. T2-weighted MRI revealed low-signal disc protrusions at C3-C5 pushing into the spinal canal and visibly compressing the dural sac and spinal cord.
• Conventional Diagnosis: Cervical spondylotic myelopathy.
• TCM Tongue and Pulse: The tongue body was pale and dark (舌黯淡) with a thin, white coating. The pulse was stringy and choppy (脉弦涩).

TCM Assessment

The original practitioner interpreted the presentation as Wilting and Impediment driven by Qi and Blood Impedance and Liver/Kidney Deficiency (痿痹 – 气血痹阻，肝肾亏虚).

According to the holistic principles of yin and yang Chinese Medicine the Liver governs the sinews (tendons/ligaments) and the Kidneys govern the bones and marrow (which includes the spinal cord). In an aging patient, the natural decline of Liver and Kidney essence leads to the degeneration of the cervical spine—loss of disc elasticity and the formation of bone spurs.

When this structural decay is compounded by external Wind-Cold-Dampness or trauma, localized Qi and blood severely stagnate. Because the spinal cord is deprived of blood and mechanically compressed, it loses its ability to nourish the limbs. This directly results in the progressive muscle weakness (Wilting/Wei), the sharp radiating pain (Impediment/Bi), and the classic neurological “stepping on cotton” sensation. The patient’s cold extremities, pale-dark tongue, and choppy pulse provided objective textbook confirmation of this deep Yang deficiency and chronic blood stasis.

Treatment Approach

The primary treatment principle was to warm Yang and transform Qi, unblock the blood vessels, and tonify and benefit the Liver and Kidneys (温阳化气，宣通血脉，补益肝肾). The strategy utilized a dual mechanical-internal approach: manually adjusting the cervical spine to immediately relieve the physical pressure on the spinal cord, while using acupuncture and herbs to flood the damaged nervous system with fresh, warm blood.

Interventions and Herbal Formulas

• Zhao’s Balanced Spinal Adjustment (Manipulative Therapy):
  • The practitioner first applied gentle myofascial release to the neck to soften the deep, spasmodic muscles.
  • With the patient seated, the practitioner applied a specialized rotational and traction maneuver (lifting the jaw and occiput, tractioning to a neutral position, and applying a swift, controlled rotational release). A crisp “popping” sound indicated successful realignment.
  • The session concluded with soothing massage techniques to realign the muscle fibers. Note: Because myelopathy involves spinal cord compression, the commentary stresses these maneuvers must be extraordinarily gentle, steady, and precise.
• Acupuncture & Acupoint Injection Therapy:
  • Acupuncture: Systemic points were used to unblock the meridians, including Dazhui (GV14), Cervical Jiaji points, Jianjing (GB21), Quchi (LI11), Hegu (LI4), Zusanli (ST36), Xuanzhong (GB39), and Kunlun (BL60), with Ganshu (BL18) and Shenshu (BL23) added to tonify the Liver and Kidneys.
  • Acupoint Injection: Every two days, 2ml of a compound containing bone-strengthening solution, Rhodiola extract, and cobamamide (Vitamin B12 analog) was injected directly into two affected Cervical Jiaji points to forcefully nourish the damaged local nerves.
• Internal Herbal Formula (March 27, 2014): A 14-herb decoction to warm Yang, rebuild the bones, and unblock the collaterals.
  • Warming Yang and Tonifying Qi: Huang Qi (Astragalus, 15g) and Gui Zhi (Cinnamon Twig, 10g) powerfully boosted the central Qi and warmed the Yang to push cold out of the limbs.
  • Tonifying Liver, Kidneys, and Marrow: Shu Di Huang (15g), Shan Yu Rou (10g), Lu Jiao Jiao (Deer Antler Glue, 10g), Du Zhong (10g), and Niu Xi (10g) formed a heavy, essence-building core. Lu Jiao Jiao is a vital animal-derived medicinal used to directly replenish the Marrow and repair deep spinal degeneration.
  • Nourishing Blood and Relaxing Spasms: Dang Gui (10g), Bai Shao (10g), and Zhi Gan Cao (6g) nourished the blood and softened the rigid neck muscles.
  • Dispersing Wind-Damp and Unblocking Collaterals: Du Huo (10g) and Bai Jiang Can (Silkworm, 10g) scoured out the deep wind-dampness and unblocked the micro-circulation. Bai Zhu (10g) and Fu Ling (15g) strengthened the Spleen to prevent the heavy tonics from causing digestive stagnation. (3 doses prescribed, taken morning and evening).

Follow-Up

• Three Days Later: After just the initial manual adjustment and 3 doses of herbs, the patient’s neck and shoulder pain was significantly relieved. Most notably, the dangerous “stepping on cotton” sensation had improved, and her lower limb muscles felt noticeably stronger.
• Discharge: After a total of five manual adjustment sessions (alongside continued herbs and acupuncture), her symptoms had basically disappeared, and she was able to walk easily and normally. She was instructed to rest and perform specific restorative neck exercises (like “Crane Pecking Water” and “Turning the Head to Look at the Moon”).

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the successful conservative management of the most dangerous type of cervical spondylosis. Cervical spondylotic myelopathy involves direct, physical compression of the spinal cord (unlike nerve root compression which only causes arm pain). In conventional medicine, once a patient develops gait clumsiness, weakness, and a positive Hoffman’s sign, surgery is almost always strictly recommended to prevent permanent paralysis.

Professor Zhao’s approach is remarkable because it safely integrates highly skilled, gentle bone-setting to mechanically expand the spinal canal space, combined with targeted acupoint injections (B12) to physically repair the nerve myelin. Internally, recognizing the profound weakness of the patient’s system, he utilized heavy Marrow-filling medicinals like Lu Jiao Jiao (Deer Antler Glue) alongside Yang-warming herbs to completely reverse the severe neurological deficits without the need for invasive spinal surgery.

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Source Original source: 湛江市第二中医医院 / 广东省中医药局 Original title: 【以案说医】招仕富：温阳化气，宣通血脉，补益肝肾法治疗脊髓型颈椎病案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: 2024-09-02 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation