2022 年 59 巻 1 号 p. 1-9
The various environmental stresses can be broadly divided into external environmental stress and internal environmental stress. The hypothalamus controls the homeostasis of the internal environment. Environmental stress hypersensitivity and environmental stress intolerance are not opposing concepts, but rather the same condition viewed from the front or the back, and are clinical conditions, hypothalamic stress intolerant and exhaustive syndrome or circumventricular organs dysregulation syndrome. This syndrome is characterized by the multilayered appearance in individual patients of autonomic symptoms, affective/cognitive symptoms, pain/sensory hypersensitivity symptoms, and immune hypersensitivity symptoms. Typical diseases that cause this syndrome include cerebrospinal fluid leak, myalgic encephalomyelitis/chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity, and HPV vaccination-associated neuroimmune disorder syndrome (HANS). The hypothalamus covers multidimensional biological functions such as circadian rhythms, autonomic functions, immune responses, endocrine functions, instinctive behaviors, thermal energy metabolism (deep body temperature, nutrient metabolism), emotion and memory, pain and sensory thresholds, gait and movement, and circulatory dynamics. The hypothalamus, with its complex control circuits, surprisingly consists of a very simple bipolar system: emergency mode (sympathetic, short-distance race type) and normal mode (parasympathetic, long-distance race type). Traumatic events in cerebrospinal fluid leak, inflammatory events in myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia, massive chemical exposure events in multiple chemical sensitivity, and HPV vaccination events in HANS, are assumed to be pathogenic factors, resulting in a similar clinical picture via some “common pathway”. The “common pathway” of hypothalamic stress intolerant and exhaustive syndrome at the molecular pathological level remains to be elucidated.