Volume 5, Number 1 | Spring 2010

Clinical Report 3 (Japan)
One Case that had Effect of Daibofuto on RA with High Level ofManiphalanx Deformation

Hiromichi Yasui

Japan Institute of TCM Research[Case]
Female of 79 years old
Initial visit: November 4, 2009
Chief complaint: With deformed finger joints on
both hands, unable to open them.
Current medical history:
Since the diagnosis of rheumatoid arthritis ofabout 20 years ago, the patient had receivedtreatment. The daily dose of 5mg of prednisolone
was started six years ago. The deformation ofboth hands began to progress about 5 years ago.
About a year ago, the fingers of both hands
drifted into the ulnar-deviated positions, in which
they (fingers) pointed toward little fingers. All
fingers became bent with pains, and graduallyadvanced to the inability of their extension. The
deformation of toes was prominent. From a week
ago, hand fingers were being unable to open at all,causing her great difficulty in carrying out
normal activities of daily living, such as using
chopsticks at mealtimes and using the toilet. Dueto pains in both shoulders, upper limbs could not
be raised. Toes on both feet were also deformed.
Loxoprofen relieved morning pains, so that it wasroutinely used.
Appetite: Ordinary
The patient always had dry mouth. She
frequently drank water.
Sleep: She had difficult in falling asleep, but it
was not a special problem.
Defecation: Once/day
Urination: 10-12 times/day
Present condition: 134cm (as her back washunched, the height was inaccurate.) and 42kg.
Because of the deformed lumbar spines, herback was greatly hunched over.
Pulse: Sunken and thin
22Tongue: Pale red with no furs. Smooth without
lingual papillae.
Diagnosis: Deficiency of qi and blood and weak
constitution / liver-kidney deficiency / wind-cold
dampness causing accumulation and stagnationof excess fluids.
Method of treatment: To tonify qi and blood/todispel wind and disperse swelling
Prescription: daibofuto decoction with adjustment
Angelicae Acutilobae Radix 4g
Paeoniae Radix 4g
Rehmanniae Radix 4g
Astragali Radix 4g
Saposhnikoviae Radix 4g
Eucommiae Cortex 4 g
Atractylodis Lanceae Rhizoma 4g
Zingiberis Rhizoma 1g
Cnidii Rhizoma 3g
Ginseng Radix 2g
Notopterygii Rhizoma 2g
Achyranthis Radix 2g
Glycyrrhizae Radix 2g
Ziziphi Fructus 2g
Aconiti Radix Processa 2g
Course: The pain in the fingers on the hands
improved within 2 weeks and they could be opened
slightly. After 4 weeks, they could be further opened
with the pain in the right shoulder resolved,
allowing the right arm to be elevated. However thepain in the left shoulder still remained. At this point,
non-prepared Aconiti Radix 0.5g was added. The
patient showed CRP0.3 and KL-6 188 on December
17. On January 13 of year X+1, the fingers on bothhands could be opened further wider and the pain in
the left shoulder disappeared and no problems wereleft with both upper limbs. On March 18, the level ofCRP was 0.00 whilst that of RF was 201. In May, thepatient resumed his farm work. In the visit to thehospital of August 18, she showed further recovery
and was more cheerful.

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

Volume 5, Number 1 | Spring 2010

[Discussion]
The patient with the history of RA for 20 years
could not open fingers of both hands, causing thedifficulty in carrying out her daily living.
Furthermore, she had the back hunched andpains in the joints of both shoulders, so that evenmotions gave her excruciating pains and she wasat a complete loss. Thus she visited our clinic.
Unlike in the initial stage of RA development,
disabilities and limits to motions due to thedeformation as well as continuing pains as everthreatened her daily living.
The patient had the long time stagnation ofwind-dampness which obstructed the flows of qi
and blood, resulting in deficiency at the sametime. Because of this, strong medicines for
disorders in the acute stage cannot appropriately
be used. Wind-dampness must be eliminatedwhile qi and blood are being tonified andreplenished to allow for their flows to berecovered. The patient disease was long-standing,leading to the deficiency of the liver-kidney, whichfurther caused the inability of producing
nutrients for muscles and bones. Therefore, theliver and kidney needed to be replenished.

How could such conditions of the chronic phasebe improved in a short period of time, and even if
possible,improvements

wouldbelimited.

Notwithstanding, only a little improvement could
improvethequalityof

thepatient’slife.

Especially whether or not she could open andclose the hand fingers did matter a lot to her.

Daibofuto has the action of replenishing
deficientqi

andbloodandeliminating

wind-dampness being stagnant in muscles andbones.

Twoweeks

afterthestartofadministration, the hand fingers became able toopen and close, and then general pains became
gradually improved, making the patient’s dailyliving less difficult. Some functional recovery inother patients with RA that has progressed todevelop deformity over an extended period of time
can be expected to a certain degree, if notcomplete, and the quality of life will be enhancedby means of identifying the etiology to provide
appropriate

procedures.

Daibofutoisarecommendable medication for such cases.

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

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