But it was a far different Matsuzaka who faced the Royals at Fenway Park, as Kansas City took the first game of a four-game set from Boston, 4-3.
Matsuzaka (3-2, 5.77 ERA) lasted just 4 2/3 innings, giving up three runs on two hits, matching a career high with eight walks, while notching one strikeout and uncorking a wild pitch. He walked five in the Royals' three-run fifth, a career high for one inning. Darren Oliver was the last Red Sox pitcher to walk five in one frame, a 3-1 loss to the Mariners on May 11, 2002, in Seattle.
"Obviously, he was struggling with his command and his release point," said catcher Jason Varitek. "At different times, he was able to throw through me, and at other times, his arm would drag or his arm would be in front. I don't know what the answer is, but I know he'll do the work to try and figure it out."
Matsuzaka was wild from the start, walking leadoff hitter Scott Podsednik in a nine-pitch at-bat.
"He seemingly lacked command pretty much from start to finish tonight," said pitching coach John Farrell. "He did a great job of pitching out of a bases-loaded, no-out situation in the fourth. But the walks in the end were catching up to him. We had to have our bullpen come in early and bail him out."
Boston's relievers -- Joe Nelson, Manny Delcarmen, and Ramon Ramirez -- threw a combined 4 1/3 innings, giving up one run on two hits and two strikeouts.
Royals starter Brian Bannister (4-3, 4.70 ERA) earned the win, going six innings, giving up three runs on nine hits with no walks and four strikeouts. Joakim Soria earned his 12th save, throwing a perfect ninth on seven pitches.
In the fourth, Matsuzaka loaded the bases, issuing a leadoff walk to David DeJesus, giving up a single to Billy Butler -- Kansas City's first hit -- and hitting Jose Guillen with a pitch. But as has become Matsuzaka's knack, he got out of the bases-loaded jam unscathed as Alberto Callaspo lined out to Kevin Youkilis, Mitch Maier lined out to Dustin Pedroia and Jason Kendall flied out to Bill Hall.
"I'd have to say that command was an issue," said manager Terry Francona. "Obviously, eight walks [and a] hit batsman. Saying that, we're sitting at the edge of our seat with the seat belt on. He wiggles out of one inning, and pretty close the next inning -- got to two outs and the ball in the dirt. It's a hard way to pitch successful. He has a unique ability to get out of some of those situations. But that's a difficult way to pitch."
The Royals were undaunted by their inability to push across a run in the inning.
"I just told them when they came in, 'Load 'em up again,'" said Kansas City manager Ned Yost. "And they did."
The Sox gave Matsuzaka a one-run edge in their half of the fourth. With one out, Youkilis singled up the middle. J.D. Drew's sharp comebacker bounced off the mound, appearing to be destined for a certain double play. Instead, the carom hit second-base umpire Paul Schrieber, with Youkilis and Drew both safe. Adrian Beltre, who had six RBIs in Wednesday's game against the Rays in St. Petersburg, added another, scoring Youkilis with a single to left.
The Sox had hoped his ability to get out of the fourth inning would settle Matsuzaka. That was not the case.
The Royals finally got to Matsuzaka in the fifth when they sent nine batters to the plate. No. 9 hitter Chris Getz opened with a walk and stole second. Podsednik struck out looking on a 91-mph fastball. Mike Aviles walked and DeJesus singled to center, scoring Getz. Butler and Guillen walked in consecutive at-bats, loading the bases. Callaspo hit into a 5-2 force out. A wild pitch to Maier scored Butler, with Maier eventually walking, ending Matsuzaka's outing. Nelson relieved, getting Kendall to fly out to Hall to end the inning.
"We went into the game and felt like he was going to try to hit his spots and try to nibble on us," Butler said. "And that's exactly what he did and we didn't give in. We battled him and we got him out of there. We could've done more damage there with the bases loaded and he got out of it. But all in all, we never gave up and grinded it out and never gave any at-bats away."
The Sox added a run in the fifth with Hall leading off with a homer into the Monster Seats in left, his fourth roundtripper of the season.
But the Royals got the run back in the sixth. With two outs, Aviles singled to short, scoring on DeJesus' double off the wall in left, putting Kansas City ahead, 4-3.
For much of his season -- which was delayed by a disabled-list stint with back and neck ailments -- Matsuzaka has hurt himself with one big inning. Of the 22 earned runs he has allowed, 18 have come in four innings.
"In my good outings, I can throw the ball without overthinking too much and still be able to pitch well," he said. "But when things are going bad, no matter what I try to get out of it, things just don't click and I can't build that momentum. But in general, I know that I can't be overly conscious of that. I still need to pitch. As for tonight, I just need to look back at my performance and find those bad elements and hopefully clear them up."
Despite his struggles, Matsuzaka (112 pitches, 60 strikes) has allowed just three hits in his past two outings.
"That's kind of part of the pitcher that he is," Farrell said. "While the overall strike percentage might not have been the highest, [he was] somewhat effectively wild to his advantage. Tonight, they laid off some pitches and there were some at-bats where he never really gave himself a chance to get into the count and make a pitch to get an out."
Boston had finished a 5-1 road trip with division leaders Philadelphia and Tampa Bay. Losing at home to Kansas City, which entered the series opener nine games below .500, could have been disappointing.
"Not really," Varitek said. "That's a really good team with some real good pitching. If we went out and played horribly, you could say that. I don't think we played bad. We just were a run short."
Maureen Mullen is a contributor to MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.