Volume 12, Number 3 | Fall 2017

Type 1 Case of Yasui Classification
Nijutsuto with Added Aconite Root Ameliorated
Severe Symptoms of the Frozen Shoulder:
A Case Report

Case presentation
A 56-year-old office clerk woman visited ourdepartment in June for complaints of her right

Mitsuyuki Takamura

Kampo Medicine Outpatient Clinic
Mie University Hospitalshoulder pain deteriorating due to frozen shoulder.
Around seven months before the visit, she had felt anagging pain in her right shoulder and wasdiagnosed as frozen shoulder at the orthopedic clinic
after X-ray exam and physical exam. Administration

Introduction
Frozen shoulder, also referred to as adhesive
capsulitis, painful stiff shoulder, and periarthritis isa condition of uncertain origin characterized byspontaneous pain and stiffness of the shoulder. The
condition is thought to be usually self-limiting
although some patients have symptoms such as pain
and/or functional loss for several years, moreover,complete resolution does not occur in many patients1), 2). Effective standard pharmacological treatment
offrozenshoulderacetaminophen

isnotand/or

establishedyet,nonsteroidalantiinflammatory drugs (NSAIDs) may be used forpain control. However, there are no randomized
controlled trials that confirm the effectiveness of
NSAIDs in treatment of this pain. Sometimes evenopioid analgesics may be required3). On the otherof a few NSAIDs, and several times of intra-articular
injections by the previous doctor did not relieve her
symptom. She could not continue to take pregabalin
and duloxetine for their side effects. Her pain was
getting severe enough to interfere with her daily
activity (such as sleep disturbance, having trouble tohold a computer mouse at the job). She had a history
of inactive old intracerebral hemorrhage and Rathke
cleft

cyst

detected

incidentallyonmagnetic

resonance imaging at age 54 and appendicectomy at
16. Her height was 159cm, body weight was 45kg,
blood pressure was 122/76mmHg and pulse rate was
88. Visual Analogue Scale (VAS) of shoulder pain
was 30mm. Complexion and skin color was normal.
Physicalexamination

revealed

significant

restriction of both active and passive range ofhand, in Japanese traditional Kampo medicine,

movement of her right shoulder, the other shoulder

nijutsuto has been used for treatment of frozen
shoulder. Many anecdotes about nijutsuto have been

abdominal palpation revealed no abnormal mass ordescribed in some Kampo textbooks and frozen
shoulder is only one disease which is applicable for

nijutsuto extract by medical insurance in Japan,
however, there is no published peer-reviewed reportabout efficacy of nijutsuto. Besides, processed
aconite root is one of the most important crude drugin Kampo treatment, it is used because of its
analgesic action and ability to generate heat in thebody. Aconite root is usually included in Kampo
formula already or be added to some other formulas
for modification. We report a case of woman who
suffered from frozen shoulder and was successfully
treated with nijutsuto with added processed aconiteroot.

was intact. Auscultation of chest was normal,
signs but operation scar of appendicectomy. Noabnormal findings on blood analysis. In Kampo
manners, abdominal strength was intermediate;
brisk pulsation in the supra-umbilical region, rightlower abdominal tenderness, weakness of lower
abdominal region and fluid retention in stomach
were detected. Tongue was moist, pink and covered
with thin white coating by tongue inspection. Pulse
inspection revealed sunken, smooth and slightly
string-like pulse. Sensitivity to cold, malaise andoccasional headache were listed as her subjective
symptoms. We diagnosed her as phlegm-fluid
retention with spleen qi deficiency and prescribed
7.5g of nijutsuto (TSUMURA Co., Tokyo, Japan)
added 6 tablets of aconinsan tablet (made fromThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

5

Volume 12, Number 3 | Fall 2017

Processa,a source book “Manbyou-Kaishun ( 万 病 回 春 wan

Kakenshoyaku Co., Tokyo, Japan) per day. Herbing hui chun, Restoration of Health from thesymptoms

medication,myriad Diseases)” which is written in 1587 at Ming

especially sleep disturbance was improved. After

dynasty by Ting Xian Gong of China4). “Manbyou-increasing dose of aconite root to 1.5g per day atkaishun” has been widely read in Japan, Japanese

second visit, VAS decreased to 4mm on her next visit.

Kampo specialists also described about effectiveness

Until sixteen weeks later since first visit, sheof nijutsuto in their books5). Gyuzan Katsuki wrote

sometimes forgot to take Kampo medicine because ofthat many pains in shoulders and arms belong toobtaining almost remission of her symptoms, wephlegm then nijutsuto is adaptive for it in “Gyuzan

prescribed no more medication from that time. WeKatto”. Teian Azai described that nijutsuto iscould ascertain that her symptoms completelyeffective for treatment of pain in hands and arms due

improved 4 weeks later then we finished theto phlegm in his book6). Koyama wrote that he wouldtreatment. No side effect was observed during

add aconite root to nijutsuto if the condition of frozentreatment.

shoulder was at chronic phase7). He explains thatpowdered

1.0g

Aconitiameliorated

Radix

soon

after

adding Aconiti Radix Processa meaning of activation
Discussion

and resolving old blood stasis. We added it for theThe prevalence of frozen shoulder is estimated topurpose of enhancing analgesic effect and relievingbe 2 to 5 percent of the general population; thecold in this case, it can also be thought that bloodcondition is with the peak age in the mid-50s. Frozen

stasis existed.

shoulder occurs predominantly unilaterally and isusually

self-limiting,althoughevidenceabout

Conclusion

prognosis is limited1), 2). According to UPTODATE3),
frozenshoulderiscommonlydescribed

asWe report about a case in which refractory frozen
shoulderwasameliorated

immediately

after

progressing through three phases; initial painfuladministration of nijutsuto adding aconite root.

phase with development of shoulder pain that isNijutsuto with added aconite root can be one therapy

worse at night, increasing stiffness that lasts for 2 tofor the treatment of frozen shoulder.

9 months. Followed by an intermediate phase withstiffness and severe loss of shoulder motion, but with

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S. Russell, A. Jariwala, R. Conlon, et al. A

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UpToDate Inc. http://www.uptodate.com (Accessed

has been used for pain in the arm or arms due toon April 16, 2018.)

phlegm-dampness, that adaptation is mentioned in6

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

Volume 12, Number 3 | Fall 20174)

Ting Xian Gong, Manbyou kaishun. Kyoto
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