Volume 8, Number 2 | Summer 2013

Clinical Report 3 (Kampo Medicine)
A Case in which a Recurrent Tonsillitis in a Six-year-old
Girl Suspected of PFAPA Was Resolved by Ogikenchuto
and Shosaikotofunction was related to the immunoregulatory
function, so ogikenchuto was also used.
This type of condition has been thought to symbolize
an infectious disease, but in recent years, it isHideaki Yamaguchi

frequently classified as an abnormality of the innate

Tosei General Hospital

immune system caused by PFAPA. This implies that
inflammation resembling an infection occurs andabates naturally.

Case: Six-year-old girl with recurrent tonsillitis
Thepatientbegan

todevelop

tonsillitis

repeatedly from the age of three. It occurred at aReference 1: PFAPA (Syndrome of periodic fever,frequency of almost once a month, accompanied

aphthous stomatitis, pharyngitis, and adenitis)by a fever that would last three to six days. It

A medical condition which starts in young

required her to be hospitalized three times. The

children below the age of five, in which a fever

patient had no other problems except for theoccurs regularly and is accompanied by stomatitis,tonsillitis, but she developed a fever easily andadenoiditis or cervical lymphadenitis. It is not an

was frequently absent from school. Recurrent

infectious

tonsillitis was suspected, and a tonsillectomy was

however. No symptoms are evident during theconsidered, but the patient’s family requested

interval stage, and growth and development areKampo therapy.

unaffected. It is a disease with a good prognosis,

diseaseorautoimmune

disease,and resolves in about four to five years in mostInterview and observations
The patient had a small appetite from earlycases. It is classified as an autoinflammatory

childhood, and complained of poor physicaldisease in the broad sense.

strength and a tendency to become tired easily.

The fever is treated with a steroid, and prevention

Cervical lymph nodes of small-finger thickness

is achieved by tonsillectomy.

were felt, with the result that her tonsil displayed
second-degree hypertrophy. The tongue, pulse,

Reference 2: Autoinflammatory disease

and abdomen were normal.

Definition:A

diseaseinwhichsystemicinflammation (fever, arthritis, rash, etc.) occurs

Therapy and course
Heat accumulation in the liver meridian and qi

repeatedly. It is not caused by an infection ordeficiency in the spleen were suspected, so theautoimmune disease, but is considered an

combineduseof

shosaikoto

extract

andabnormality of the innate immune process.

ogikenchuto extract were begun.

Classification - Genetic: Familial Mediterranean

Episodes of fever thereafter occurred for one tofever, TRAPS, hyper-IgD syndrome, etc.

two days in three months, and disappeared afterNon-genetic: PFAPA, systemic JRA, Crohn's

six months. The prescription was terminated afterdisease,a year and six months. In terms of Western
medicine, this case corresponded to the definition
PFAPA.
Observation
In Japan, shosaikoto has conventionally beenused for children with recurrent tonsillitis. In thiscase, it was thought that the decrease in digestive

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

19