Clinical study on treatment of cervical spondylotic radiculopathy (Qi stagnation and blood stasis syndrome) with Gao's nape needle and Shentong Zhuyu decoction.

BACKGROUND: Cervical spondylotic radiculopathy is currently one of the common orthopedic diseases, mainly characterized by neck pain, stiffness, limited mobility, and related symptoms of nerve root compression, which seriously troubles people's work and life. METHODS: Ninety cases of cervical spondylotic radiculopathy (Qi stagnation and blood stasis syndrome) were randomly divided into treatment group and control group, 45 cases in each group. The control group was treated with western medicine (nerve nutrition, pain relief, and circulation improvement drugs), and the treatment group was treated with Gao's nape needle combined with modified Shentong Zhuyu decoction on the basis of the control group. Before and after 2 weeks, TCM syndrome score, TCM curative effect, visual analogue scale score, numbness score, neck disability index score, related serum inflammatory factors (interleukin-10 [IL-10], interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α]), related hemorheological indexes (plasma viscosity, high shear whole blood viscosity, low shear whole blood viscosity level) were used as evaluation indexes to evaluate the effect. RESULTS: After treatment, the total effective rate of the treatment group was 91.11%, which was better than that of the control group (78.78%), and the TCM syndrome scores of the 2 groups were decreased, the treatment group was better than that of the control group, and the differences were statistically significant (P < .05). After treatment, the visual analogue scale score, numbness score, and neck disability index score were decreased in both groups, and the decrease in the treatment group was more significant than that in the control group, and the differences were statistically significant (P < .05). After treatment, the related serum inflammatory factors (IL-10, IL-6, TNF-α) and related hemorheological indexes (plasma viscosity, high-shear whole blood viscosity, low-shear whole blood viscosity) were decreased in both groups, and the decrease in the treatment group was more significant than that in the control group, and the differences were statistically significant (P < .05). CONCLUSION: The treatment of cervical spondylotic radiculopathy (Qi stagnation and blood stasis syndrome) with Gao's nape needle and modified Shentong Zhuyu decoction can improve the curative effect of traditional Chinese medicine, improve the related discomfort symptoms (neck tenderness, adverse activity, numbness, etc), improve the neck function, reduce IL-10, IL-6, TNF-α, and other related serum inflammatory factors, and improve hemorheological indicators.

Study on the mechanism of Shujin Tongluo granules in treating cervical spondylosis based on network pharmacology and molecular docking.

BACKGROUND: To investigate the potential active ingredients and possible mechanisms of Shujin Tongluo granules (SJTLG) in the treatment of cervical spondylosis (CS) by network pharmacology and molecular docking. METHODS: The active ingredients and potential targets of SJTLG were obtained through databases such as traditional Chinese medicine system (TCMSP) and BATMAN-traditional Chinese medicine (TCM), and the relevant human targets of CS were identified through databases such as OMIM, GeneCards, and DisGeNET. The intersection targets were imported into STRING for protein-protein interaction (PPI) analysis. The obtained data were imported into Cytoscape 3.9.0 software for visualization, and module analysis was performed using the MCODE plug-in. The representative targets were screened through the Metascape website for pathway enrichment analysis in Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). Cytoscape software was used to build networks such as "drug-compound-target" and "drug-compound-target-pathway." Finally, the key targets were selected for molecular docking with the corresponding compounds by Autodock Tools 1.5.7 and visualized by PyMol. RESULTS: A total of 132 active compounds and 996 targets from SJTLG and 678 targets from CS were screened with 116 intersection targets. The key targets were AKT1, GAPDH, ALB, IL-6, TP53, TNF, VEGFA, IL-1ß, EGFR, HSP90AA1, ESR1, and JUN. The results of GO and KEGG enrichment analysis showed that the treatment of CS was mainly related to biological processes such as cellular response to nitrogen compound, cellular response to organonitrogen compound, and positive regulation of locomotion, and the targets were mainly focused on pathways in cancer, Kaposi sarcoma-associated herpesvirus infection, PI3K-Akt signaling pathway, lipid, and atherosclerosis. Molecular docking results showed that the minimum binding energy between the core targets and the corresponding compound was <-5.0 kcal·mol-1. CONCLUSION: This study preliminarily elucidates the potential active ingredients and mechanism of anti-inflammatory, analgesic, microcirculation improvement, vasodilation, osteoporosis inhibition and nerve nutrition effects of SJTLG in the treatment of CS and provides a reference for its clinical application.

A systematic review of Tuina for cervical hypertension: A protocol for systematic review and meta-analysis.

BACKGROUND: Cervical hypertension is a secondary form of hypertension with a high incidence rate. As the main etiology of cervical hypertension is related to cervical spondylosis, commonly used antihypertensive drugs have poor efficacy in the treatment of cervical spondylosis, and improving the symptoms of cervical spondylosis can effectively reduce blood pressure. Massage can effectively improve the symptoms of patients with cervical hypertension, but there has been no systematic review of massage treatment for cervical hypertension. This study aimed to evaluate the efficacy and safety of massage in patients with cervical hypertension. METHODS: Before February 10, 2022, a systematic literature search was conducted using the following databases: Embase, SinoMed (previously called the Chinese Biomedical Database), China Science and Technology Journal Database for Chinese Technical Periodicals, Chinese National Knowledge Infrastructure, and Wanfang Data. Review Manager software (version 5.3) will be used for statistical analysis. Quality and risk assessments of the included studies were performed, and the outcome indicators of the trials were observed. RESULTS: This meta-analysis further confirmed the beneficial effects of massage in patients with cervical hypertension. CONCLUSION: This study investigated the efficacy and safety of massage therapy in patients with cervical hypertension, providing clinicians and patients with additional options for the treatment of this disease.

[Mechanism of Panlongqi Tablets intervening in vertebral artery type of cervical spondylosis in rats through PI3K/AKT signaling pathway based on network pharmacology and experimental verification].

This study aimed to further explore the relevant mechanism of action by network pharmacology integrated with animal experimental verification based on previous proven effective treatment of vertebral artery type of cervical spondylosis(CSA) by Panlongqi Tablets. Bionetwork analysis was performed to establish drug-disease interaction network, and it was found that the key candidate targets of Panlongqi Tablets were enriched in multiple signaling pathways related to CSA pathological links, among which phosphatidylinositol 3-kinase(PI3 K)/serine-threonine kinase(AKT/PKB) signaling pathway was the most significant. Further, mixed modeling method was used to build the CSA rat model, and the rats were divided into normal, model, Panlongqi Tablets low-, medium-and high-dose(0.16, 0.32, 0.64 g·kg~(-1)) and Jingfukang Granules(positive drug, 1.35 g·kg~(-1)) groups. After successful modeling, the rats were administered for 8 consecutive weeks. Pathological changes of rat cervical muscle tissues were detected by hematoxylin-eosin(HE) staining, and the content of interleukin-1ß(IL-1ß), tumor necrosis factor-α(TNF-α), vascular endothelial cell growth factor(VEGF) and chemokine(C-C motif) ligand 2(CCL2) in rat serum and/or cervical tissues was determined by enzyme-linked immunosorbent assay(ELISA). Western blot was employed to detect the protein expression levels of chemokine(C-C motif) receptor 2(CCR2), PI3 K, AKT, phosphorylated AKT(p-AKT), I-kappa-B-kinase beta(IKK-beta/IKKß), nuclear factor kappa B(NF-κB P65) and phosphorylated nuclear factor kappa B(NF-κB p-P65) in rat cervical tissues, and positive expression of p-NF-κB P65 in rat cervical muscle tissues was detected by immunofluorescence. The results showed that Panlongqi Tablets at different doses improved the degree of muscle fibrosis and inflammation in cervical muscle tissues of CSA rats, and reduced the content of inflammatory factors IL-1ß, TNF-α, VEGF, CCL2 and CCR2 in serum and/or cervical tissues. The protein expression levels of PI3 K, p-AKT, IKKß and p-NF-κB P65 as well as the nuclear entry of p-NF-κB P65 in cervical tissues were down-regulated. These findings suggest that Panlongqi Tablets can significantly inhibit the inflammatory response of CSA rats, and the mechanism of action may be related to the down-regulation of the activation of PI3 K/AKT signaling pathway.

Pueraria lobata Targeted Preparation Improves the Clinical Symptoms of Cervical Spondylosis by Regulating the Balance of Gut Microbiota.

BACKGROUND: Nanotargeted preparations can enhance the safety and effectiveness of medication by altering the pharmacokinetic behavior of drugs in the human body, and Pueraria lobata is shown to be effective in the treatment of neck and back pain. PURPOSE: This study prepared a nano-Pueraria targeted preparation, in order to analyze its effect on improving the clinical symptoms of cervical spondylosis by adjusting the balance of intestinal flora. METHODS: A total of 200 patients with cervical spondylosis admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine were enrolled and divided into an observation group and a control group. The control group was given Tuina therapy, and the observation group was given nano-Pueraria targeted preparation + Tuina therapy. The clinical symptoms and intestinal microflora of the two groups were examined before intervention. RESULTS: It was found that the markedly effective of treatment efficacy of the observation group (98%) was higher than that of the control group (78%) after 15 days of intervention, and the clinical symptoms were obviously fewer than those of the control group. The distribution of gut microbiota showed that there were significant differences in the composition of gut microbiota between the two groups. Compared with the control group, the abundance of Firmicutes in the observation group was significantly higher, while the abundance of Bacteroidetes and Proteobacteria was significantly lower. CONCLUSION: The targeted preparation of nano-Pueraria can improve the clinical symptoms of patients with cervical spondylosis by adjusting the balance of gut microbiota.

Investigation on the mechanisms of guiqi huoxue capsule for treating cervical spondylosis based on network pharmacology and molecular docking.

BACKGROUND: Guiqi huoxue capsule (GQHXC) is a patented Chinese medicine used for treating a liver and kidney deficiency and blood stasis syndrome due to qi deficiency. It is caused by cervical spondylosis (cervical spondylotic radiculopathy (CSR), mixed cervical spondylosis mainly composed of nerve root type). Its underlying mechanisms need, however, to be further clarified. METHODS: In this study, collecting compounds, predicting therapeutic targets, constructing networks, and analyzing biological functions and pathways were based on network pharmacology analysis. In addition, molecular docking verification was engaged to assess the binding potential of selected target-compound pairs. RESULTS: We established 5 networks: compound-putative target network of GQHXC, protein-protein interaction (PPI) network related to CSR, compound-CSR target network, potential therapeutic targets PPI network, and herb-compound-target-pathway network. Network analysis indicated that 7 targets (tumor necrosis factor [TNF], interleukin 6 [IL6], nitric oxide synthase 3 [NOS3], Interleukin-8 [CXCL8], prostaglandin-endoperoxide synthase 2 [PTGS2], vascular endothelial growth factor A [VEGFA], and AP-1 transcription factor subunit [JUN]) might be the therapeutic targets of GQHXC in CSR. Moreover, molecular docking verification showed that TNF, IL6, NOS3, CXCL8, PTGS2, VEGFA, and JUN had a good is interaction with the corresponding compounds. Furthermore, enrichment analysis indicated that GQHXC might exert a curative role in CSR by regulating some important pathways, such as TNF signaling pathway, NF-kappa B signaling pathway, AGE-RAGE signaling pathway in diabetic complications, and so on. CONCLUSION: Our study preliminarily explained the underlying mechanisms of GQHXC for treating CSR, and molecular docking verification was adopted as an additional verification. These findings laid a valuable foundation for experimental research and further application of GQHXC in the clinical treatment of CSR.

Clinical effect of cervical paravertebral nerve block combined with Mailuoning and Angelica sinensis in treatment of nerve-root type cervical spondylosis.

To observe and analyze the clinical effect of cervical paravertebral nerve block combined with Mailuoning and Angelica sinensis injection in treatment of nerve-root type cervical spondylosis. 120 patients who have been accepted by our hospital for nerve-root type cervical spondylosis were selected as research objects. They were randomly divided into a research group and a control group, each containing 60 patients. The control group was applied with glucocorticoid nerve block therapy, while the research group was treated by cervical paravertebral nerve block combined with Mailuoning and Angelica sinensis injection. The total therapeutic response rates of two groups were compared. The total therapeutic response rate of the research group was relatively higher,P<0.05. Through comparing various clinical effect scores between two groups, the research group also had advantages over control group, P<0.05. The treatment satisfaction degree of the research group was also higher than that of control group, P<0.05. The application of cervical paravertebral nerve block combined with Mailuoning and Angelica sinensis injection can achieve better medical results and achieve higher treatment satisfaction degree.

Neuroprotective Potential of Gentongping in Rat Model of Cervical Spondylotic Radiculopathy Targeting PPAR-γ Pathway.

Cervical spondylotic radiculopathy (CSR) is the most general form of spinal degenerative disease and is characterized by pain and numbness of the neck and arm. Gentongping (GTP) granule, as a classical Chinese patent medicine, has been widely used in curing CSR, whereas the underlying mechanism remains unclear. Therefore, the aim of this study is to explore the pharmacological mechanisms of GTP on CSR. The rat model of CSR was induced by spinal cord injury (SCI). Our results showed that GTP could significantly alleviate spontaneous pain as well as ameliorate gait. The HE staining and Western blot results showed that GTP could increase the quantity of motoneuron and enhance the activation of peroxisome proliferator-activated receptor gamma (PPAR-γ) in the spinal cord tissues. Meanwhile, immunofluorescence staining analysis indicated that GTP could reduce the expression of TNF-α in the spinal cord tissues. Furthermore, the protein level of Bax was decreased whereas the protein levels of Bcl-2 and NF200 were increased after the GTP treatment. These findings demonstrated that GTP might modulate the PPAR-γ pathway by inhibiting the inflammatory response and apoptosis as well as by protecting the cytoskeletal integrity of the spinal cord, ultimately play a neuroprotective role in CSR.

Evaluation of a granulated formula for the nerve root type and vertebral artery type of cervical spondylosis: a multicenter, single-blind, randomized, controlled, phase â ¢ clinical trial.

OBJECTIVE: To evaluate the effectiveness and safety of cervical spondylosis formula granules in reducing the symptoms of patients with the nerve root type and the vertebral artery type of cervical spondylosis. METHODS: This was a multicenter, single-blind, randomized, controlled trial. From April 2002 to November 2003, 499 patients were randomly assigned to either the treatment or the control group. The treatment group was orally administered granules prepared with a formula for cervical spondylosis, while the control group was given Jingfukang granules. The treatment course was 1 month for both groups. RESULTS: In patients with the nerve root type of cervical spondylosis, the total effect rate in the treatment group (87.21% ) was significantly higher than that in the control group (80.70%, P < 0.01). After the treatment period in both groups, the treatment group had a significantly greater rate of resolution of pain, numbness of the upper limbs, muscle strength of the upper limbs, and fatigue than the control group (all P < 0.05). In patients with the vertebral artery type of cervical spondylosis, the total effect rate in the treatment group (82.07%) was similar to that in the control group (71.21% , P > 0.05). After the treatment period in both groups, the treatment group had a significantly greater rate of resolution of weakness of the waist and knees than the control group (P < 0.05). CONCLUSION: The cervical spondylosis formula granules significantly improve numbness, muscle strength, and fatigue, and reduce pain in patients with the nerve root type of cervical spondylosis, and improve the weakness of the waist and knees in patients with the vertebral artery type of cervical spondylosis.

[Effects of Huoxue Dingxuan Capsule Glare on Vertebral Artery Blood Flow,Plasma PAI and t-PA in CSA Rat Models.]

OBJECTIVES: To determine the effects of Huoxue Dingxuan Capsule on vertebral artery blood flow,plasma plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI) in rats with cervical spondylosis of vertebral artery type (CSA). METHODS: Ninety healthy male Wistar rats were equally and randomly divided into control,model and treatment groups.The rats in the model and treatment groups were subject to composite modeling manufacturing CSA.The treatment group was given six-week interventions with Huoxue Dingxuan capsule 4 weeks after the modeling.Vertebral artery blood flow,plasma PAI,and t-PA contents were detected before modeling,prior to the interventions,and post interventions. RESULTS: Before the interventions,the rats in the model and treatment groups had significantly lower blood flow of vertebral artery than the controls (P<0.05).The model rats also had increased serum PAI and t-PA contents (P<0.01).After the interventions,significantly higher vertebral blood flow was found in the treatment group compared with the controls (P<0.05).After the interventions,increased serum PAI and t-PA contents were observed in the rats in the model group (P<0.01);whereas,decreased serum PAI and t-PA contents were observed in the rats in the treatment group (P<0.01).The treatment group had lower levels of serum PAI and t-PA contents than the model group (P<0.01). CONCLUSIONS: Huoxue Dingxuan Capsule glare can improve the blood flow of vertebral artery and reduce serum PAI and t-PA contents.

[Injection techniques in the cervical spine]. / Injektionstechniken an der Halswirbelsäule.

Spinal injections are a treatment option in the conservative management of degenerative spinal disorders. The indications must be critically reviewed for every patient. Treatment with injections for painful spinal disorders should be a part of interdisciplinary treatment regimes. The diagnostic value varies between injection procedures. A large number of imaging techniques are used to achieve a precise and safe needle placement in interventional procedures. The following article presents an overview of common fluoroscopy-guided spinal injection techniques for the cervical spine.

[Of clinical reseach on cervical spondylosis treated with acupoint injection in recent five years].

Electronic retrieval was carried out on literatures from the period of May 1, 2006 and June 1, 2011 in databases of PubMed, ISI web of knowledge and CNKI. The selected literatures were summarized and classified from three aspects of acupoints selection, medication selection and manipulations. It is concluded that cervical Jiaji (EX-B 2) points, Fengchi (GB 20) and Ashi points, etc. are common acupoints. The medications contain simple Chinese herbs (Danggui injectio, etc.) and compound Chinese herbs (compound Danggui injectio, etc.), simple western medicine (vitamin B family, etc.) and Chinese herbs combined with western medicine (compound Danggui injectio combined with vitamin B12, etc.). Disposable syringes are used for injection equipment. Acupoint injection in treating cervical spondylosis is effective. However, mechanism studies is still in deficient since most of the researches focus on clinical observation. Manipulation of acupoint injection is not standardized. Laws of clinical effect are not clear. Thus, the above mentioned defects are still remained for further improvement.

[Experimental study of eliminat dampness resolv phlegm method in treating cervical spondylopathy of the vertebral artery type].

OBJECTIVE: To detect the velocity and viscosity of blood flow of the vertebral arteries, the apoptotic cell and apoptotic related protein in the brain in order to offer theoretical foundation for the treatment of cervical spondylopathy of the vertebral artery type with the eliminat dampness resolv phlegm method. METHODS: Sixty male Japanese big ear rabbits were divided randomly into normal sodium group (A), Flunarizine group (B), low dosage Wendantang group (C), large dosage Wendantang group (D), Flunarizine group combined with large dosage Wendantang group (E), normal group (F). Each group had 10 rabbits. Xiaozhiling injection was injected around the vertebral arteries of rabbits in group A, B C, D, E to make the model of the cervical spondylopathy of the vertebral artery type. Normal sodium (20 ml x kg(-1)d(-1)) was apply through intragastric administration in group A, F; Flunarizine (0.8 mg x kg(-1)d(-1)), low dosage Wendantang (1 g x ml(-1)d(-1)), large dosage Wendantang (2 g x ml(-1)d(-1)), Flunarizine combined with large dosage Wendantang were respectively apply through intragastric administration in group B, C, D, E. The velocity and viscosity of blood flow of the vertebral arteries, the apoptotic cell and apoptotic protein in the brain were detected before and after the treatment. RESULTS: Satisfactory animal model were obtained in group A, B, C, D, E. The rabbits of group E had the most improvement of the velocity and viscosity of blood flow of the vertebral arteries while at meantime, which had the lowest apoptotic index and apoptotic related protein expression in the brain. CONCLUSION: The routine treatment for the cervical spondylopathy of the vertebral artery combined with eliminat dampness resolv phlegm method could improve velocity and viscosity of blood flow of the vertebral arteries, which maybe relate with reduction of apoptosis in the brain.

[Observation on therapeutic effect of digital acupoint pressure for treatment of the nerve root type of cervical spondylosis].

OBJECTIVE: To observe the therapeutic effect of digital acupoint pressure for treatment of the nerve root type of cervical spondylosis. METHODS: Four hundred cases were randomly divided into a digital acupoint pressure group (DAP group) and a medicine group, 200 cases in each group. Acupoints of Quepen (ST 12), Jianjing (GB 21) and Tianzong (ST 11) etc. were used for digital pressing in the DAP group; and Chinese herb medicine of Gentongping was routinely taken in the medicine group. After three treatment courses, the symptoms of pain and numbness, the signs of pressure measurement by compression of head, brachial plexus drawer test and arm myodynamia, as well as the total cumulative scores of daily living capability, were compared. RESULTS: After treatment, the total cumulative scores of numbness, pressure measurement by compression of head, brachial plexus drawer test, arm myodynamia and daily living capability in both groups were obviously better than those of before treatment (all P<0.01); but there was a significant difference on the total cumulative score of the symptoms and signs between the two groups. The cured rate of 78.0% and total effective rate of 99.0% in the DAP group were better than those of 61.0% and 87.0% in the medicine group, respectively (both P<0.01). CONCLUSION: Digital acupoint pressure plays an active role in improving the symptoms and signs on patients with nerve root type of cervical spondylosis, which is better than Chinese herb medicine of Gentongping.

[Clinical efficacy of pishen bingbu recipe in patients with sympathetic cervical spondylosis and its impact on heart rate variability].

OBJECTIVE: To investigate the clinical effect of Pishen Bingbu Recipe (PBR) in treating patients with sympathetic cervical spondylosis (SCS) of qi-blood deficient syndrome type and its impact on heart rate variability (HRV). METHODS: Fifty patients were randomized into the control group and the treatment group equally. Both were treated with mecobalamin, vitamin B1, neurotropin, and occipital - jaw band traction in the sitting posture, but to patients in the treatment group, PBR was given additionally. The course of treatment was 60 days. Therapeutic effect and changes of HRV indexes were observed. RESULTS: After treatment, in the treatment group, 5 patients (20%) were clinically cured, treatment was markedly effective in 12 patients (48%), effective in 7 (28%) and ineffective in 1 (4%), while the corresponding data in the control group were 2 (8%), 4 (16%), 18 (72%) and 1 (4%) respectively, demonstrating the efficacy in the treatment group was superior to that in the control group (P <0.05). Before treatment, the HRV indexes in the two groups were insignificantly different respectively (P >0.05). But after treatment, difference between groups was observed in terms of either time domain or frequency domain. Those of time domain were: standard deviation of NN intervals (SDNN, ms) 133.41 +/- 8.61 vs 115.61 +/- 13.49, average standard deviation of 5 min NN intervals (SDANN, ms) 126.90 +/- 9.99 vs 106.20 +/- 8.84, HRV trigonometric index (HRVTI) 35.10 +/- 4.48 vs 25.51 +/- 2.24; and those of frequency domain: low frequency (LF, ms2) 379.90 +/- 159.07 vs 477.70 +/- 396.91 high frequency (HF, ms2) 157.10 +/- 28.18 vs 122.10 +/- 101.90, and LF/HF ratio 2.37 +/- 0.52 vs 4.27 +/- 2.84. All were superior in the treatment group (P < 0.05). CONCLUSION: PBR shows evidently clinical efficacy on SCS, it can significantly improve the functional activities of sympathetic nerve in patients.