Cervical spondylosis is a degenerative disease primarily characterized by neck pain, limited mobility, upper limb numbness, and even functional impairment. It falls within the scope of traditional Chinese medicine classifications such as “neck impediment syndrome,” “bone impediment syndrome,” and “sinew impediment syndrome.” Traditional Chinese medicine predominantly addresses this condition through macro-level differentiation and treatment approaches such as liver and kidney deficiency, invasion by wind-cold-damp pathogens, and blood stasis obstructing collaterals. While these methods yield reliable therapeutic outcomes, they offer relatively limited systematic interpretation of the local microstructures and functional states of the cervical spine. Based on the theory of Bone Xuanfu-Collaterals-Marrow, this paper explores the pathogenesis and treatment approaches of cervical spondylosis from an integrated perspective of macroscopic holism and microscopic structure. The theoretical connotations of “Bone Xuanfu”, “Collaterals” and “Marrow” are elaborated, as well as their internal relationships in the physiology and pathology of the cervical spine. After that, the pathogenesis and progression of cervical spondylosis are analyzed from three aspects: “obstruction of Bone Xuanfu,” “stasis of collaterals,” and “deficiency and malnourishment of marrow.” Finally, a staged treatment approach of “opening Xuanfu, nourishing collaterals, and replenishing bone marrow,” is proposed, which is discussed with corresponding therapeutic methods and herbal formulas. This aims to provide a novel theoretical perspective for the syndrome differentiation and treatment of cervical spondylosis within traditional Chinese medicine.