Efficacy of Three-Needle Dazhui and Electroacupuncture for Cervical Spondylosis With Wind-Cold Syndrome

Three-Needle Dazhui Combined With Electroacupuncture for Cervical Spondylotic Radiculopathy and Wind-Cold Syndrome: A Randomized, Single-Blind, Controlled Trial Evaluating Pain and Neck Disability

Cervical spondylosis is a prevalent health issue that significantly impacts quality of life, with Cervical Spondylotic Radiculopathy (CSR) accounting for 60-70% of cases

• While modern medicine offers various treatments, the frequent use of painkillers often leads to undesirable side effects
• In Traditional Chinese Medicine, electroacupuncture is a safe and effective method recognized by the Ministry of Health for treating this condition
• The "Three-Needle Dazhui" technique is a specialized acupuncture method that simultaneously uses three needles at the Dazhui (GV14) point to strongly activate Yang Qi and dispel cold, making it particularly suitable for the Wind-Cold syndrome. This study aims to evaluate whether the combination of the Three-Needle Dazhui technique and electroacupuncture yields better results in pain reduction and functional improvement compared to electroacupuncture alone in patients with cervical spondylosis and Wind-Cold syndrome.

This study is designed as a randomized, single-blind, controlled trial. A total of 74 patients meeting the diagnostic criteria for cervical spondylotic radiculopathy with Wind-Cold syndrome will be recruited and randomly assigned into two groups using a block randomization method.

• Intervention Group: Patients will receive the "Three-Needle Dazhui" technique (using three needles at specific angles and depths at the Dazhui point) combined with the standard electroacupuncture protocol authorized by the Ministry of Health and basic treatment.
• Control Group: Patients will receive only the standard electroacupuncture protocol and basic treatment.

Treatment Procedure:

• Both groups will undergo treatment for 14 consecutive days, with one 20-minute session per day.
• Basic treatment includes the administration of traditional herbal medicine (Phong te thap HD New) and education on proper posture and cervical spine exercises.
• Paracetamol (500mg) will be provided only for acute, high-intensity pain (VAS > 7/10).

Data Collection and Evaluation: Outcome measures will be assessed at three time points: T0 (baseline), T1 (after 1 week), and T2 (after 2 weeks/end of treatment). The primary and secondary outcomes include:

1. Pain Intensity: Measured by the Visual Analog Scale (VAS).
2. Functional Movement: Measured by the Neck Disability Index (NDI).

2. Safety: Recording adverse events such as needle fainting, bleeding, or localized pain throughout the study period.

To ensure objectivity, evaluations will be conducted by blinded physicians who are not involved in the treatment or group allocation processes.

Inclusion Criteria:

• Consent: Participants must voluntarily agree to participate and sign a written informed consent form.

• Age: Individuals aged 18 years or older.

• Pain Intensity: Patients with a baseline pain score of VAS ≥ 50 mm on the Visual Analog Scale.

• Modern Medicine Diagnosis (Cervical Spondylotic Radiculopathy - CSR) Patients must meet the diagnostic criteria for CSR due to cervical spondylosis according to Decision 361/QD-BYT, including:

  • Cervical Spine Syndrome: Localized neck pain, restricted range of motion, and tenderness upon palpation of the spinous processes or paravertebral areas.

Radicular Syndrome: Neck pain radiating to the occipital region, shoulder, arm, or hand.

• Physical Examination: At least one positive result from the following tests: Bell-ringer sign, Spurling's test, Shoulder abduction test, or Cervical distraction test.

• Imaging Criteria: X-ray findings (straight, lateral, or 3/4 oblique views) showing at least one of the following:

  1. Osteophytes (bone spurs) on the vertebral body.
  2. Intervertebral disc space narrowing ≥ 25%.
  3. Subchondral bone sclerosis.
  4. Spondylolisthesis. - Traditional Chinese Medicine (TCM) Diagnosis (Wind-Cold Syndrome) Patients must satisfy at least one primary symptom and reach a total symptom score of ≥ 50% based on the following criteria:

• Primary Symptoms: Pain in the neck and shoulder radiating to the arm accompanied by numbness; pain is the dominant feature; pain increases with cold and decreases with warmth.

• Secondary Symptoms: Aversion to cold, aversion to wind, cold extremities, and presence or absence of sweating.

• Tongue and Pulse: Pale tongue with a thin white coating; floating-tight or slow pulse.

Exclusion Criteria:

• History of neck trauma.
• Diagnosed with specific bone or joint diseases: Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Down syndrome, cervical spina bifida, or Scheuermann's disease.
• Severe neurological deficits: Progressive muscle weakness (motor loss) or acute, severe sensory loss indicating advanced nerve compression.
• Vertebral-basilar artery syndrome: Headache, dizziness, tinnitus, loss of balance, or fatigue.
• Autonomic nervous system disorders: Pain accompanied by tinnitus, visual disturbances, or vasomotor disorders in the occipital-shoulder region or arms.
• Central motor neuron lesions: Presence of Hoffmann's sign, Babinski's sign, hyperreflexia, spasticity, urinary/fecal incontinence, or sexual dysfunction.
• Symptoms suggesting systemic or malignant disease: Unexplained weight loss, fever, loss of appetite, personal or family history of malignant tumors, or diffuse pain and stiffness.
• Symptoms suggesting infection: Fever, meningeal signs, or photophobia.
• Symptoms suggesting serious acute medical conditions: Myocardial infarction (chest pain + sweating + shortness of breath) or arterial dissection (tearing pain sensation + headache + blurred vision).
• Local or systemic contraindications: Infection or ulceration at the acupuncture site; patients who are exhausted, emaciated, or suffering from severe accompanying internal medical diseases.
• Substance abuse: Alcohol or drug addiction.
• Recent medication use (within the past month): Currently using analgesics or anti-inflammatory drugs that may affect results, such as Opioids, NSAIDs, Corticosteroids, Gabapentin, Pregabalin, or tricyclic antidepressants.
• Other ongoing treatments: Currently undergoing other therapies such as acupressure, massage, or physical therapy for the neck area.