A 46-year-old woman with a half-year history of severe vertigo, nausea, and neck stiffness triggered by prolonged mahjong playing was successfully managed using a Qi-tonifying herbal strategy combined with spinal adjustment and acupuncture.

Case ID: CHC-0063

Case Summary

This case describes a 46-year-old woman who presented with a half-year history of chronic neck stiffness, severe dizziness, and a “room-spinning” sensation (vertigo) accompanied by nausea and vomiting. The original report documented a conventional diagnosis of vertebral artery type cervical spondylosis and a TCM assessment of Neck Impediment (Xiang Bi) driven by Qi and Blood Stagnation with Liver and Kidney Deficiency. She was managed through a highly integrative approach combining “Zhao’s Balanced Spinal Adjustment” to mechanically stabilize her cervical spine, acupuncture, and a targeted herbal decoction to tonify Qi, move blood, and settle the dizziness.

Patient Presentation

• Patient: 46-year-old female (Surname: Chen).
• Main Complaint: Neck stiffness and discomfort accompanied by dizziness, nausea, and vomiting for half a year.
• History: The patient sought consultation on July 28, 2013. For the past six months, due to playing mahjong for prolonged periods, she developed a stiff and uncomfortable neck. This was accompanied by severe episodes of vertigo where she felt the “world was spinning” (天旋地转), along with nausea, vomiting, tinnitus, insomnia with frequent dreams, and fatigue in her limbs.
• Physical Exam: The neck was notably stiff. There was localized tenderness (+), 1.0cm lateral to the left side of the C3-C4 spinous processes. Neck mobility was restricted. The neck rotation test was positive (+), but the intervertebral foramen compression test (Spurling’s test) was negative (-), indicating the nerve roots were not compressed.

Examination and Diagnosis

• Imaging (X-ray): Showed a straightened cervical physiological curvature, segmental instability at the C3-C5 vertebrae, and uncovertebral joint hypertrophy (bone spurs) at C4-C5 and C5-C6. The intervertebral spaces were slightly narrowed. The open-mouth view (C1-C2) showed no abnormalities.
• Conventional Diagnosis: Vertebral artery type cervical spondylosis.
• TCM Tongue and Pulse: The tongue body was red with a thin, white coating. The pulse was fine (脉细).

TCM Assessment

The original practitioner interpreted the presentation as Neck Impediment driven by Qi and Blood Stagnation, with Liver and Kidney Deficiency (项痹 – 气血凝滞，肝肾不足).

According to the holistic principles of yin and yang Chinese Medicine maintaining a static posture (like playing mahjong) for prolonged periods severely damages the local Qi and blood circulation in the neck. Over time, this chronic stagnation weakens the structural integrity of the cervical spine, rooted in an underlying Liver and Kidney deficiency (as the Liver governs sinews and Kidneys govern bones).

Because the localized Qi and blood were severely congealed, the clear Yang energy and fresh blood could not ascend to nourish the brain. This lack of upward nourishment directly caused the severe “room-spinning” vertigo, tinnitus, and insomnia. The red tongue and fine pulse provided objective textbook confirmation of this internal deficiency failing to properly nourish the upper orifices, complicated by localized structural blockage.

Treatment Approach

The primary treatment principle was to tonify Qi and invigorate blood, dispel wind and unblock the collaterals (补气活血，祛风通络). The strategy utilized a dual mechanical-internal approach: mechanically realigning and stabilizing the cervical spine to relieve the reflex irritation on the blood vessels, while using herbs to push fresh blood to the head and extinguish the internal wind causing the vertigo.

Interventions and Herbal Formulas

• Zhao’s Balanced Spinal Adjustment (Manipulative Therapy):
  • Muscle Relaxation: The practitioner first applied muscle-relaxing and sinew-smoothing techniques to release the cervical spasms.
  • Supine Adjustment: With the patient lying face up, the practitioner supported the jaw and occiput, applying a slow, rhythmic, soft traction toward the top of the head. At maximum traction, the head was gently rotated to one side and returned, then to the other.
  • Seated Adjustment: The patient then sat upright. The practitioner stood slightly to the side behind her, lifting the jaw and occiput to apply traction. The neck was rotated to a point of fixed resistance, followed by a quick, controlled rotational thrust. A crisp “popping” sound indicated successful realignment.
• Acupuncture Therapy:
  • Points selected: Dazhui (GV14), Tianzhu (BL10), Cervical Jiaji points, Yanglao (SI6), Houxi (SI3), Baihui (GV20), Shenting (GV24), Fengchi (GB20), Ganshu (BL18), Shenshu (BL23), Geshu (BL17), and Zusanli (ST36).
  • Administration: Retained for 30 minutes, once daily.
• Internal Herbal Formula (July 28, 2013): A 14-herb decoction to boost Qi, move blood, and settle the dizziness.
  • Settling Vertigo and Dispersing Wind: Tian Ma (Gastrodia, 6g) and Gou Teng (Uncaria, 12g) are a vital classical pair used to extinguish Liver wind and immediately stop the “room-spinning” dizziness.
  • Tonifying Qi and Moving Blood: Huang Qi (Astragalus, 10g) powerfully boosts Qi to push the blood upward. Dan Shen (Salvia, 10g), Dang Gui (6g), Chuan Xiong (6g), and Yan Hu Suo (Corydalis, 10g) forcefully unblock the localized stasis in the neck and stop pain.
  • Relaxing the Neck and Sinews: Ge Gen (Pueraria, 12g) specifically directs fluids to the neck to relieve stiffness. Bai Shao (10g) and Mu Gua (Papaya, 10g) soften the tense sinews and relieve spasms.
  • Unblocking Orifices and Draining Dampness: Bai Zhi (6g) and Xi Xin (Asarum, 3g) scatter cold-dampness and open the sensory orifices. Fu Ling (10g) and Bai Zhu (10g) strengthen the Spleen to prevent the herbs from causing nausea.
  • Administration: 5 doses prescribed, water decocted, taken warm morning and evening.

Follow-Up

• After the initial round of treatment, the patient’s dizziness was significantly reduced, and her neck mobility greatly improved.
• She continued with the manual spinal adjustments to consolidate the therapeutic effect. After a total of four manual therapy sessions, she was completely cured. She was instructed to rest, keep her neck warm, and avoid prolonged desk/mahjong postures.
• A one-year outpatient follow-up confirmed she experienced no relapses.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is Professor Zhao’s mechanical explanation for why cervical spondylosis causes vertigo (the “vertebral artery type”).

Historically, many doctors believed this type of dizziness was caused primarily by bone spurs mechanically pinching the vertebral artery at the top of the neck (C1-C2). However, Professor Zhao’s clinical observation reveals that the true culprit is often instability in the middle of the neck (C3-C5). The vertebral artery in this section is densely wrapped in sensitive sympathetic nerve fibers. When the C3-C5 vertebrae become unstable (from bad posture like playing mahjong), the resulting inflammation and micro-shifting constantly irritate these nerve fibers. This triggers a reflex spasm of the vertebral artery, cutting off blood supply to the brain and causing severe vertigo. By using manual bone-setting to perfectly stabilize the C3-C5 segments, and combining it with Tian Ma and Gou Teng to settle the nervous system, the practitioner addressed both the mechanical root and the neurological symptom simultaneously.

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Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine Original title: 【以案说医】招仕富：补气活血，祛风通络法治疗椎动脉型颈椎病案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: 2024-08-31 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation