Volume 12, Number 4 | Winter 2017

Type 2 Case of Yasui Classification
Two Cases of Acute or Subacute Polyarthralgia
Successfully Treated with Boiogito Extract

Hiroshi Kakuto

Department of East Asian Traditional Medicine
Ehime Prefectural Central Hospital, JAPANBecause of elevation of WBC (15,490/µL) and CRP(7.94mg/dL), moreover, limited effect of Celecoxib for
his arthralgias made another local doctor introduced
us on May 26, 20XX.
[Physical findings]
His body temperature hovered around 37 degrees(Celsius).

Background
Many patients with polyarthralgias see doctors

He had limitations on range of motion of bilateralevery day all over the world. We must exclude many

shoulders, elbows, and knees.

differential diagnoses such as collagen diseases,

His legs were slightly edematous.

especially rheumatoid arthritis; however, it is

He had no tenderness of upper extremities, no nailsometimes difficult to identify the causes. In thechanges, no rushes.

cases of acute or subacute stage in particular, it is[Urinalysis] protein (-) , sugar (-)

assumed that some sort of viruses cause these[CBC] WBC 13,840/µL, RBC 512×104/μL, HBG

symptoms. Nevertheless, we sometimes prescribe

15.1g/dL, PLT 45.0×104/μL

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)[Biochemistry] ESR 46mm/h, AST 15U/L, ALT10U/L,

only because it is difficult to identify the causes,

LDH 157U/L, γGTP 31U/L, ALB 3.6g/dL, CK <24U/L,

moreover, most of antiviral drugs are ineffective for

BUN 18.3mg/dL, CREA 0.85mg/dL, Na 139mEq/L, K

these viruses. We experienced two cases of acute or

4.1mEq/L, Fe 28µg/dL, CRP 5.64mg/dL, HbA1c 5.8%,

subacute polyarthralgia successfully treated with

TSH 1.249µIU/mL, Ferritin 209ng/mL

boiogito extract. It is suggested that boiogito extract[Antibody] Parvovirus B19 IgM (-), RF (-), CCP (-)

is useful for nonspecific polyarthralgia.

[Treatment]
We diagnosed non-specific polyarthralgia by viral

Case report

infection. There was a possibility of reactive arthritis

Case1: 39 year-old maleas a differential diagnosis, however, symptomatic[Main complaint]

treatments were recommended anyway. We added

Polyarthralgia, fever

7.5g/day[Past history]

extract to 200mg/day of Celecoxib on his first visit.

Operated on testicular torsion when in junior highHis symptoms gradually improved within two weeks.

schoolHe continued that medications for a months.

ofboiogito(Fang-Yi-Huang-Qi-Tang)[Medicine(/day)]Celecoxib (100mg) 2T, Famotidine (20mg) 1T

Case 2: 55 year-old female[Life history][Main complaint]

Non-smoker, social drinker, doesn’t have any pets,

Polyarthralgia

no overseas travelling.

[Past history]

Job: a nurse of mental hospital

Type[Present illness]

hyperlipidemia, hypertension

He felt arthralgias on his wrists and knees from a2

diabetes

mellitus,

hyperthyroidism,(these were well-controlled)

few weeks ago. He supposed they were due to the[Medicine(/day)]training at fitness club at first; however, his legs got

Thiamazole(5mg)

3T,

Alogliptin(25mg)

1T,

swollen from knees to feet. A local orthopedist said

Pioglitazone(15mg)

0.5T,

Glimepiride(1mg)

1T,

to him that hisPitavastatin(1mg)

1T,

Amlodipine(5mg)

1T,14

X-ray examination had no problems.

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

Volume 12, Number 4 | Winter 2017

Irbesartan(100mg)

1T,Azosemide(30mg)

0.5T,[Antibody] U1RNP (-) , Sm (-) , SS-A (-) , SS-B(-) , Scl-Metformin(500mg)

2T,

Loxoprofen(60mg)

3T,

70 (-) , MPO-ANCA (-) , PR3-ANCA (-) , CCP (-) , RF

Troxipide(100mg) 3T(-) , ANA 40times (SPECKLED)[Life history][Treatment]

Non-smoker, non-drinker, doesn’t have any pets.

We diagnosed non-specific polyarthralgia by viral

Job: a stuff of a welfare office

infection, not collagen diseases such as rheumatoid[Present illness]arthritis. We prescribed 7.5g/day of boiogito (Fang-She felt both coxalgia a few years ago but didn’t

Yi-Huang-Qi-Tang) extract on her first visit. Her

have any medication because a rheumatologist she

polyarthralgia disappeared immediately in a few

consulted excluded rheumatoid arthritis.

days. We completed this medication within two

Thereafter she had pain of both knees and ankles

months.

from one year ago, which sometimes disabled her towalk only 50 meters. Furthermore, both coxalgia andDiscussion

shoulder pains occurred but other rheumatologist in

When examining the patients with arthralgias, it

the city hospital she consulted diagnosed as nois necessary to distinguish severe or emergency

problems. Non-steroidal anti-inflammatory drugs

diseases such as pyogenic arthritis, gouty arthritis,(NSAIDs) that her home doctor prescribed was notor pseudogout. And then we survey autoimmune

effective, moreover, she presented finger pains. Herdiseases;

home doctor referred her to us.

systemic lupus erythematosus, psoriatic arthritis[Physical findings]

and Reiter syndrome among other things. Moreover,

Her blood pressure was 130/80 mmHg, pulse

inparticularrheumatoid

arthritis,

viral infections also cause polyarthralgias. The

87/min, body temperature 36.5 degrees (Celsius).

following kinds of viruses are common as the causes;

She had no morning stiffness, perspired a lot, andhepatitis B/C virus, rubella virus, parvo virus B19,

was not constipated.

dengue virus, mumps virus, coxsackie virus, herpes

She had spontaneous pains of her shoulders, hips,
knees, and ankles without tenderness, swelling nor
heat.

simplexvirus,varicellazostervirus

andchikungunya virus.
Viralarthritis

commonly

has

symmetrical

Tongue signs: Pale red, scalloped, thin white coating,arthritis like rheumatoid arthritis but no destroying

overswelling of veins.

thePulse signs: Strong, slippery

lengthening of the symptoms nor recurrences except

Abdominal pattern: Soft, fat

for rubella virus, parvo virus B19, chikungunya

Skin: Edematous

virus and alpha virus. It is difficult to identify the[Urinalysis] protein (-) , sugar (-)

virus causing polyarthralgia unless patients have[CBC] WBC 7380/µL, RBC 466×104/μL, HBG

rashes or other distinctive symptoms. Medical

14.3g/dL, PLT 27.6×104/μL

treatments for viral polyarthraligas are usually only

[Biochemistry] ESR 16mm/h, AST 20U/L, ALT

symptomatic therapies, for which NSAIDs are used

31U/L, LDH 183U/L, γGTP 33U/L, CREA 0.67mg/dL,

as standard medicines. We have to pay attention toNa 141mEq/L, K 4.1mEq/L, Fe 93µg/dL, CRP

adverse effect of NSAIDs, for example gastric ulcer

0.07mg/dL, HbA1c 7.9%, TSH 7.480µIU/mL, Ferritin

and renal injury if patients take for a long time

86ng/mL

period. Furthermore, effect of NSAIDs alone isjoints.

It

usually

doesn’thaveneithersometimes insufficient. Combination therapy of

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

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Volume 12, Number 4 | Winter 2017

NSAIDs and kampo medicine is expected to be safe

Referencesand effective.

1) Nishizawa Y et al. Pharma Medica 25 (10): 15 -21.

Boiogito (Fang-Yi-Huang-Qi-Tang) extract is from
“Jin Gui Yao Lue”, which says that boiogito treats
the patient with wind-dampness, floating pulse,
heavy sensation of body, sweating, aversion to wind.
In general, Japanese criteria of choosing boiogito aresoft and wet skin, edematous skin, excessive
sweating, heavy sensation of body, and getting worse
when bad weather. It improve Bi syndrome thatmeans arthralgia, numbness and dyskinesia in
traditional Chinese medicine’s theory to tonify qi,

2007 (In Japanese)
2) Majima T et al. Therapy & Technology 4: 1-6. 2012
(In Japanese)
3) Nishizawa Y et al. Pain and Kampo Medicine 8:17-32. 1998 (In Japanese)4) Ono S. Orthopaedics 28 (5):101-105. 2015 (InJapanese)5) Tanaka K et al. Pain and Kampo Medicine 17:1115. 2007 (In Japanese)
6) Yasui.H. KAIM 10:1:2-7. 2015

promote diuresis, dispel wind.
There are some randomized controlled trials(RCTs) of boiogito about the effects for polyarthralgia.
1)-3)Moreover, other RCTs suggest that boiogito

suppresses

productionofinterleukin

6 or8dramatically in synovial membrane cells.4)-5) On the
one hand there are no studies of boiogito about theeffects for acute arthralgias or viral arthritis.
In this case report, we diagnosed both cases aspolyarthralgias caused by viral infection because we
couldn’t find any evidence of other differential
diagnosis. Both were treated insufficiently with
NSAIDs alone, and then improved by combining
with boiogito. These cases suit Type 2 “The effects ofstandard Western medical treatment and Kampo
treatment are both strengthened when the two areused in combination” that Dr. Yasui propounds.6)
Kampo is very safe and useful therapy if it can suit
critera to symptoms.
Conclusion

Boiogito can be the first line drug for acute or
subacute polyarthralgias caused by viral infection or
unkown pathophysiology.

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