The Experience of Senior Physician Ling Yunpeng and the Author in Treating Rigidity of the Cervical Spine After Surgery or Radiotherapy

Patients with tumors of the head, neck, or nasopharynx often have sequelae after surgery or radiotherapy, such as headache, rigidity of the cervical spine, and numbness of the upper limbs. These sequelae are difficult to relieve, and patients suffer considerably in later life. In senior physician Ling Yunpeng's work Linzhen Yide Lu (Record of Clinical Insights), he recounts a case in which he treated rigidity of the cervical spine and upper-limb numbness that followed surgery for a lipoma. This case report can serve as a reference for patients and other physicians.

The patient was a 13-year-old child who first visited Dr. Ling Yunpeng on May 12, 1971. In autumn 1970, the child had undergone surgical removal of a lipoma located slightly to the right of the sixth cervical vertebra at the back of the neck. One month after surgery, the child began to feel difficulty turning the neck, and this gradually worsened; by early 1971, the neck was rigid and movement of both upper limbs was already restricted. On palpation, a slight induration could be felt at the surgical scar, with mild tenderness on pressure; otherwise there was no discomfort.

Dr. Ling Yunpeng prescribed the following formula at the time: Cang'er Gen (Xanthium strumarium root) 12 g, Hongmeixiao (Rubus parvifolius) 9 g, Gougu Gen (Ilex cornuta root) 15 g, Pugongying (dandelion) 15 g, Chuanxinlian (Andrographis) 9 g, Zhi Jiangcan (processed Bombyx batryticatus) 9 g, Wugong (centipede) 1 strip. A capsule of Banxia (Pinellia) powder was taken with the decoction.

After taking 8 doses, the child's range of neck movement increased. Dr. Ling removed Chuanxinlian from the initial formula and added Jixueteng (Spatholobus) 12 g; after another 11 doses, the symptoms improved markedly, with only the right hand still feeling numb and weak in grip. Weilingxian (Clematis) 9 g was then added to the second-visit formula, and by June 16 the child was basically cured.

I have frequently encountered the same problem Dr. Ling Yunpeng came across in my own clinical work; for instance, a recent patient of mine with nasopharyngeal carcinoma also developed cervical rigidity after radiotherapy. The patient was a 52-year-old man from Taizhou, Jiangsu, diagnosed with nasopharyngeal carcinoma in 2015; after surgery and chemoradiotherapy, he was left with the sequela of cervical rigidity. He reported that after radiotherapy his neck was as stiff as a steel plate, with pulling pain on both sides of the shoulder and neck when turning. He also had aversion to cold, headache, dizziness, spontaneous sweating, dry mouth, and night sweats. His bowels were normal, 1–3 movements daily, and his urine was clear and abundant.

Based on his symptoms, I felt this patient was suited to Guizhi Jia Gegen Tang combined with Yuping Feng San, modified. I advised him to take the following: Sheng Huangqi (raw Astragalus) 30 g, Gegen (Pueraria) 30 g, Guizhi (Cinnamomum twig) 15 g, Baishao (white Paeonia) 15 g, Baizhu (Atractylodes) 10 g, Fangfeng (Saposhnikovia) 10 g, Manjingzi (Vitex) 30 g, Dangshen (Codonopsis) 30 g, Huangjing (Polygonatum) 15 g, Danggui (Angelica) 10 g, Shayuanzi (Astragalus complanatus seed) 10 g, Tusizi (Cuscuta seed) 10 g, Mohanlian (Eclipta) 10 g, Nvzhenzi (Ligustrum lucidum fruit) 10 g, Chuanxiong (Ligusticum) 10 g, Zhi Gancao (honey-fried Licorice) 6 g, Shengjiang (fresh ginger) 7 slices, Dazao (jujube) 7 pieces; he was also given the patent medicine Baihe Gujin Wan (Lily Bulb Metal-Securing Pill) for his night sweats.

After three days, the patient reported that his symptoms had improved markedly, the night sweats had basically disappeared, and cervical stiffness had eased, though the shoulder and neck were still a continuous stiff mass. He mentioned he had forgotten to tell me about another main symptom: he always felt there was phlegm in his throat that he could not cough up, which left his central qi deficient; if he could cough the phlegm up, he would feel much better. So I added heat-clearing, phlegm-expelling herbs to the initial formula.

Second-visit formula: Sheng Huangqi 30 g, Gegen 30 g, Guizhi 15 g, Baishao 15 g, Baizhu 10 g, Fangfeng 10 g, Manjingzi 30 g, Dangshen 30 g, Huangjing 15 g, Danggui 10 g, Shayuanzi 10 g, Tusizi 10 g, Mohanlian 10 g, Nvzhenzi 10 g, Chuanxiong 10 g, Zhi Gancao 6 g, Fabanxia (processed Pinellia) 6 g, Dannanxing (bile Arisaema) 6 g, Zhuru (bamboo shavings) 6 g, Yuxingcao (Houttuynia) 6 g, Jiegeng (Platycodon) 6 g, Shengjiang 7 slices, Dazao 7 pieces.

After taking the above for a week, the patient reported that the phlegm-in-throat symptom had improved a great deal. Considering that herbs like Guizhi are warm and drying and should not be taken long-term, I had him switch to a simplified formula: Gegen 30 g, Baishao 30 g, Sheng Gancao (raw Licorice) 10 g, Bohe (mint) 1 g, Gouteng (Uncaria) 3 g, Chanyi (cicada slough) 6 g, Chao Jiangcan (stir-fried Bombyx batryticatus) 10 g, Pianjianghuang (Curcuma aromatica) 6 g, Sangzhi (Morus twig) 30 g. I also advised him to alternate this with a small medicinal-tea formula to compare efficacy. The tea formula: Baishao 3 g, Gancao 3 g, Jiegeng 3 g, brewed with boiling water as a tea.

After taking the adjusted decoction and the tea, the patient's symptoms continued to ease; both formulas were effective, and it was hard to tell which worked better. I then told him to solve the problem in the simplest way, just brewing Baishao, Gancao, and Jiegeng as a tea. Later, after reading Dr. Ling Yunpeng's case records, I told this patient to add Cang'er Gen to the Baishao-Gancao-Jiegeng tea (note: this is Xanthium root, not Cang'erzi, the cocklebur fruit, which is toxic and unsuitable for long-term use), and to keep brewing it as tea; I also advised him to persist in a Gegen-powder dietary therapy. Dr. Ling himself believed that the main active ingredient in his own formula was Cang'er Gen.

For cervical rigidity, two classical formulas have a certain effect. One is Guizhi Jia Gegen Tang, the other is Shaoyao Gancao Tang. When I first treated this patient I used Guizhi Jia Gegen Tang because he had spontaneous sweating and aversion to cold; later I had him take a medicinal tea made from a combination of Shaoyao Gancao Tang (composed of Baishao and Gancao) and Jiegeng Paiyong Tang (composed of Jiegeng and Gancao), drawing on Shaoyao Gancao Tang's action of softening the liver and relieving urgency (alleviating spasmodic pain) together with Jiegeng Paiyong Tang's phlegm-expelling effect. The combination happened to address this patient's main problem, and the medication was simple and easy to take. This experience can be combined with that of Dr. Ling Yunpeng.