Volume 2, Number 4 | Winter 2007

Clinical Report 2
A Patient Suffering from Rheumatism
Yoichiro Ebe
Takao Hospital, Kyoto

Patient: 28 years, female
First visit: June 29, 2007
Past history: head injury at the age of 14
Family history: nothing warranting special
mentioning
Present illness: At the end of February 2007
development of exanthema over the entire body.
By the end of April with the disappearance of theexanthema a fever (in the range of 37ºC) andarthralgia developed. The patient visited a certain
medical university hospital for consultation.
There she was told that this is not RA, but when
she went to a different clinic in June, she wasdiagnosed with RA. At that time CRP value was
12.3 mg/dl and MMP-3 1053. Chest x-ray films
were said to show no anomalies.
Current status etc.: height: 155 cm, weight: 44 kg
She has a constant low grade fever around 37.1ºC.
Chilliness (+), headache ( － ), cough (+) (sinceJune), dry mouth ( － ), easy fatigability (+),
lassitude (++), restlessness (+), depressive mood(+), insomnia (+), wakes up during the night due
to pain, night sweat (+), chilling of finger- and toetips (+) and due to a marked degree of lassitude,
generalized pain she moved awkwardly.
Pale facial complexion (forehead: bluish-yellowhue)
Neck pain (+)
Arthralgia PIP of both hands (all), pain (+),
swelling (+), fever (－)
Bilateral shoulders pain (+), flexionand extension of both elbows (↓)
Arthralgia of both hands (+)、swelling(+)、deformities (+)
Pain of right hip joint (+)
Bilateral gonalgia (+)、swelling on
the left (+), fever (+)
Bilateral ankle pain (+), swelling (+),
fever (+)

20Stiffness of the fingers of both hands; continues
either through morning or even the entire day.
Bowel movements twice/day (soft stools –diarrhea)
Pulse findings:

LeftRight

Thin/rapid uponThin/rapid upon
Inch palpation thin and palpation thin andweak
weak
Thin/rapid upon
Deep and rapid,Bar
palpation thin and upon palpation thinslightly slipperyand weakDeep and rapid,
Cubit upon palpation
Weakslightly slippery
Tongue findings: slightly red tongue, white – yellow
fur, sublingual veins were engorged.
Abdominal findings

Laboratory dataCRP: 8.75
SAA: 718
RF: 5
Hh: 8.3
Diagnosis: struggle between wind and dampness,
deficiency of both qi and blood.
Prescription 1: Cinnamomi Cortex 12, Paeoniae
Radix 12, Anemarrhenae Rhizoma 9, Ephedrae
Herba 5, Atractylodis Lanceae Rhizoma 12,
Atractylodis Rhizome 12, Coicis Semen 30,
Stephaniae tetrandrae Radix 12, Gentianae
Macrophyllae Radix 10, Clematidis Radix 10,
Bombyx Batryticatus 10, Astragali Radix 30,

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 2, Number 4 | Winter 2007

Angelicae Radix 9, Zingiberis Rhizoma
Processum 6, Glycyrrhizae Radix 6, Aconiti

September 14
Healthy
Pain 100→10%,
Prescription 1: same as before
Prescription 2: same as before, for 21 days

Radix Processa 6
Prescription 2: Uzugan (one pill contains 0.1 g ofAconiti Kusnezof fii Radix powder), 21 pills,
three times a day, medication for 14 days

Table: Changes in the laboratory data
CRPSAARF

07.6.13

12.3

6.29

8.75

718

5

8. 8

5.67

442

1

9.14

1.05

78.2

1CourseJuly 13 (second visit)
Pain 100→30% reduction, cough (－), chillinessof the body (+), low grade fever (－).
Prescription 1: same as before
Prescription 2: Tsumura Bushi (Aconiti RadixProcessa) powder 3.0g, three times a day,medication for 14 days
July 27
Prescription 1: same as before, for 14 days
Prescription 2: same as before, for 14 days
August 3
Pain (↓), 100→30%, low grade fever ( － ), easy
fatigability (+)
CRP: 5.07↓ SAA: 442↓
Prescription 1: increased the amount of roasted
aconitum in the above described prescription to9g and that of Astragali Radix to 40g,additionally adding 10g of Psoraleae Semen.
Prescription 2: same as before, for 14 days
August 24
The patient had become so healthy, she could hardly
be recognized.
Pain 100→20%, chilling of the body (↓↓), appetite (↑),
skin moisture (±)
Prescription 1: same as before
Prescription 2: same as before, for 21 days

MMP-3

HbW

PLT

1053

8.0

5100

50.9

8.3

4800

43.2

8.4

4600

44.2

8.9

4800

27.1

800

Other
他医 clinic

Discussion
This patient was a case, in which a sudden
aggravation occurred a few months after the onsetof the RA. The Kampo medical diagnosis indicatedinvasion by wind cold evil, the resistance to thisinvasion by the protective qi, where the evil partial
transformed into heat creating a situation of"struggle between wind dampness". Yet, since thefundamental nature of the condition was a
deficiency of qi and blood, the basic therapeutic aim
was to dispel wind dampness, simultaneously
clearing the heat that had been generated by thepartial heat transformation of the evil, while thedeficiency of qi and blood required somesupplementation.
The author regularly prescribes for thetreatment of RA Cassia Twig Peony andAnemarrhena Decoction as base formula andbelieves, that minor modifications depending on thepathological condition allow the patient to cope with
it in most cases. This patient is one such example,
where the treatment consisted of heat clearing,
dispelling of dampness and strengthening of
unblocking the collateral vessels.
As can be seen here, after about 2 months oftreatment a remarkable improvement was observed.
This is an effect that will be difficult to obtain withextract preparations. In order to obtain short-term
effects and depending on the disease condition
somewhat larger amounts of crude drugs need to be
combined and administered.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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