中药治疗脊髓型颈椎病的临床思辨OA

Cervical spondylotic myelopathy(CSM)is a common clinical condition characterized by spinal cord dysfunction,predominantly affecting middle-aged and elderly individuals,with a high risk of disability.Based on the pathogenesis of CSM and traditional Chinese medicine(TCM)theory,the core pathogenesis of moderate to severe CSM is deduced as"obstruction of Yang Qi in the governor vessel as the root,and phlegm-stasis interbinding obstructing the collaterals as the manifestation".Spinal cord compression leads to stagnation of governor vessel Qi dynamics,preventing the free circulation of Yang Qi,resulting in Qi stagnation,blood stasis,and phlegm-dampness coagulation,forming a vicious cycle of"phlegm-stasis and Yang obstruction".Treatment should focus on unblocking the governor vessel,activating Yang,transforming phlegm,resolving stasis,and dredging the collaterals.Additional herbs for boosting Qi,replenishing essence,or warming Yang may be combined according to the patient's constitution or comorbidities.TCM therapy plays a role in alleviating symptoms,delaying disease progression,and improving the quality of life in patients with CSM.Notably,it plays an important role in promoting the recovery of spinal cord function following decompression surgery for moderate to severe CSM.Efficacy evaluation of TCM should integrate JOA functional scores and MRI changes(e.g.,extent of T2 hyperintensity and degree of spinal cord atrophy),with an observation period of at least 6 months.Future high-quality clinical studies using a dual assessment system of spinal cord function and imaging are needed to validate the pathogenesis model of"Yang obstruction in the governor vessel with phlegm-stasis blocking collaterals",thereby providing evidence for the effective application of TCM in postoperative rehabilitation of CSM.