Herbal medicine for cervicogenic dizziness: A protocol for a systematic review and meta-analysis

Subcutaneous stretching enlarges adjacent vertebral artery instantly in patients with cervicogenic dizziness: Two case reports

RATIONALE

Fu's subcutaneous needling (FSN) is effective for cervicogenic dizziness (CGD), which is often a result of vascular problems. Here, we attribute the positive treatment effect of FSN for CGD to improvements in vascular problems.

PATIENT CONCERN

Two patients were experiencing low quality of life due to reproducible dizziness.

DIAGNOSIS

Two patients with cervical spine disorder, presented with neck pain and reproducible dizziness. Other causes of dizziness were excluded.

INTERVENTIONS

Case 1 received 1 session of FSN treatment, while case 2 received 3 sessions of FSN treatment in a month.

OUTCOMES

The dizziness and neck pain experienced by both patients instantly improved significantly after FSN treatment, and the luminal diameter of the vertebral artery (VA) measured by carotid and VA ultrasound enlarged simultaneously up to 1.29-fold and 1.09-fold for both cases. According to the Hagen-Poiseuille equation, the blood flow volume increased 2.77-fold and 1.43-fold, respectively. Case 2 recovered from CGD with 1.19-fold VA luminal diameter increment and about 2.01-fold increase of blood flow volume in a month.

LESSONS

Subcutaneous stretching provides a safe, convenient and immediate solution to CGD, and supports the diagnosis and treatment of CGD under carotid and VA ultrasound. This study suggests that stretching subcutaneously can influence adjacent VA, which may also help improve some cerebrovascular diseases.

Chinese Herbal Medicine for Cervicogenic Dizziness: A Systematic Review and Meta-Analysis

Background

Chinese herbal medicines (CHMs) have been widely used in the treatment of cervicogenic dizziness (CGD) based on their empirical effectiveness and safety. Herein, we reviewed and evaluated the clinical evidence of the efficacy and safety of CHMs for CGD.

Methods

Among the relevant studies published in 11 electronic databases up to December 2021, only randomised controlled trials were included. Methodological quality was assessed using the revised Cochrane risk-of-bias tool for randomised trials, and the strength of evidence for the main outcomes was evaluated using the grading of recommendations assessment, development, and evaluation system.

Results

All 35 included randomised controlled trials with 3,862 participants were conducted with six types of modified CHM and four types of active controls. More than half of the included studies were of low quality because of the high risk of bias due to deviations from intended interventions. CHM plus active control was more effective in the treatment of CGD than active control alone. CHM plus anti-vertigo drugs, CHM plus manual therapy, CHM plus acupuncture therapy, and CHM plus manual and acupuncture therapy were all effective in treating CGD, with CHM plus manual and acupuncture therapy showing the most reliable effect. All CHMs were effective for specific patterns of CGD when administered with active controls, with Dingxuan Tang and Yiqi Congming Tang demonstrating the most reliable effects. No serious adverse events were reported in any of the included studies.

Conclusion

The current evidence suggests that CHM may enhance the treatment of CGD when combined with other treatments without serious adverse events. Further high-quality evidence is needed to draw definitive conclusions.