Psychosomatic medicine should develop into comprehensive medicine. This is expressed by both Franz Alexander, who is a founder of psychosomatic medicine in the U.S., and Yujiro Ikemi, who began psychosomatic medicine in Japan. They had a similar view about the future of psychosomatic medicine. Terms like comprehensive medicine and patient-oriented medicine are so attractive that a number of universities and hospitals are led to incorporate them into their mission statements. Nevertheless, such medical practice is rarely found. Here in Japan, our predecessors made a valuable contribution towards integrating treatment methods, which can be traced to Kunihiko Hashida who proposed “Zenki” medicine(integrated medicine)before the war. On the other hand, the need for general practitioners has been voiced. General practitioners must be able to practice comprehensive medicine. It is therefore desired to set up a graduate school for the education, research and practice of comprehensive medicine. Following are the requirements for general practitioners:

1. Giving equal weight to pathogenesis and salutogenesis.

2. Seeing a patient as a whole person by taking account of all the aspects of his/her life(intrapersonal communication).

3. Understanding a patient along the birth-death continuum.

4. Being prepared for diagnosis of and treatment for functional somatic syndrome.

5. Making an early diagnosis when symptoms of organic disease are noticed, making a referral to a specialist, and using complementary methods that help to reduce side effects.

6. Giving care to terminal patients.

7. Acting as a leader in team care medicine.

8. Establishing a doctor-patient relationship(interpersonal communication).

9. Educating patients to help them understand the need for behavioral change.

10. Undertaking clinical research.

11. Polishing skills and knowledge : philosophy of health, medicine, and life and death, and medical ethics.

Recently, functional foods have attracted attention as more consumers are oriented towards health. Among all, health benefits of lactic acid bacteria are widely recognized. Now lactic acid bacteria are added to a wide range of food such as yogurt, chocolate and instant noodles. The reason why lactic acid bacteria are extensively used is that their effects on health have been proved by many studies. Researchers also found that even heat-killed lactic acid bacteria had beneficial effects on health, and that lactic acid bacteria were easy to mix with food.

In this paper, the author explains basic properties of lactic acid bacteria and other intestinal bacteria. Their health benefits are also illustrated with R037, LAB4 and R30-lactic acid bacteria developed by KANEKA COPORATION.

●R037(Pediococcus acidilactici R037) :

Anti-allergic and triglyceride-lowering effect of lactic acid bacteria

●LAB4(Lactobacillus delbrueckii LAB4) :

The suppressive effect of lactic acid bacteria on postprandial glucose elevation

●R30(Enterococcus faecium R30) :

The promotive effect of lactic acid bacteria on blood flow in capillaries present in muscles

Our health is influenced by lifestyle and various types of stress from birth until death. However, it is generally hard to reduce stress in life. On the other hand, recent studies show that positive emotions and behavior act as a buffer against psychological stress and negative emotions. We think that laughter is a modifiable factor because laughter is “behavior”, not “emotion”. We examined 4, 780 men and women in two distinct localities and characterized the frequency of laughter according to sex and age. It turned out that women tended to laugh more often than men and the frequency of laughter declined with age. Furthermore, the low frequency of laughter was associated with a decrease in cognitive function and a high risk of developing diabetes mellitus. We also researched the effects of rakugo (comic storytelling) on salivary cortisol levels, a biomarker of stress. It was discovered that mean salivary cortisol levels of participants who would laugh often or “every day” decreased significantly after watching rakugo. Therefore, laughter is considered to be potentially effective for prevention and management of a variety of diseases, including both stress-related and lifestyle-related diseases.

When we get sick, we try to recover from it as soon as possible. However, when a full recovery is impossible, what would strike us? We would be seized by an inescapable surge of despair and anxiety, and even regard illness as a disaster striking our life.

Viktor E. Frankl (1993) described the meaning and value of life. According to him, one is asked by life and has to answer it because to live one's life is to take responsibility for it. ^* While counselling patients daily, I experience the moment when patients stop asking why they should suffer from illness and begin to change their focus. In other words, I share the moment when they achieve what Frankl calls existential shift. Existential shift is a change of attitude from fighting against illness to living with illness. It is also the power to give illness a new meaning, or hope that rises from suffering.

*English translation was made by the author.

A forum entitled “Patientology,” which we started in October 2014, marked its 50th anniversary of gathering at the end of the year 2018. The Patientology Open Forum is attended by nursing and medical students, various medical professionals, patients and citizens. The forum is on “patientology” because we intend to make it a place where students and health professionals meet and talk with patients and the public, and where they learn from each other. Our main aim has been to review the relationship between patients and health care providers by offering them an opportunity to communicate with each other. Knowing theories is not enough for health professionals to understand the necessity of communication with patients and acquire communicative skills and attitude. The forum allows both medical professionals and patients to learn together because it is where they can talk and share goals. In the years ahead, when countless and even unimaginable social changes are expected to come, a better understanding and cooperation between patients and health professionals will be of greater importance. Our activity will continue with the intension of facilitating it.

Despite advances in medical science, pain including mental suffering is an eternal issue. Pain experienced by patients with fibromyalgia is hardly understood. Why? Whether we are pain patients or not, we express ourselves through our bodies. Patients have to realize that they are responsible for communicating, and that knowing themselves is a first step. The author has so far researched the following : 1. what patients with fibromyalgia have on their mind, 2. poor communication between doctors and patients, and 3. the realities told by patients.

The previous research led the author to discover 5 abilities that contributed to the power of patient. This paper provides detailed thought into each ability.

1. The ability to learn about oneself as a communicator : patients need to understand that they have important information (i.e. facts) and stories to tell, and that there is not a single correct answer to life because their symptoms are the reflections of their life that is complex and diverse.

2. The ability to describe symptoms and communicate how they are experienced to a doctor.

3. The ability to explain one's condition to others and ask for help.

4. The ability to judge one's situation and overcome obstacles : it allows a patient to manage his/her symptoms. This is a growth model.

5. The ability to review one's situation constantly and live without losing sight of existential meaning : this is resilience.

Hikikomori, or social withdrawal is defined as a phenomenon exhibited by a person who avoids social contact as a result of various factors and stays at home for more than six months. It is critical to adopt a comprehensive medical approach when a patient is socially withdrawn and has severe dental phobia and a deep mistrust of dental treatment.

This particular case involved a male patient in his 20s. He was undergoing psychiatric treatment for panic disorder, depression and social withdrawal which he had developed several years previously. Although he had toothache, he had a strong fear of dental treatment because of his past dental experience and suffered from posttraumatic stress disorder(PTSD). As his toothache became unbearable, he decided to visit our clinic where patients can receive dental treatment under general anesthesia. Since he was unable to go outside, we first made a house call. However, as we treated the patient, he experienced strong nausea as if he had refused treatment and could not open his mouth.

After a comprehensive physical, psychological, social and existential evaluation of the patient, we determined treatment methods. While asking his family to persuade the patient to visit our dental clinic, we focused our effort on the creation of rapport with him.

As a result, the patient gradually became able to go outside and even come to see us for a pre-anesthesia testing. The patient finally received dental treatment under general anesthesia, which freed him from his toothache. Currently, we are giving him preventive dentistry so that similar problems will not occur again.

We learnt from this case that ordinary treatment methods were not enough to treat a hikikomori patient with severe dental phobia, and that the use of general anesthesia should be necessarily considered as an option. Furthermore, it was deemed necessary to continuously remind a patient of the importance of preventative oral care that could prevent recurrence of dental problems.

No one would deny that eating habits are related to health at all times and places. As I did multidisciplinary research into dietary habits, I became convinced that brown rice, vegetarian diets and eating in moderation would keep the intestines in good condition, and would be the best for healthy longevity. Brown rice and miso soup with a lot of ingredients not only provide all the necessary nutrients for our bodies, but also enable us to consume many functional substances with antioxidative activity. While ageing affects our bodies, we are always allowed to achieve emotional maturity. Macrobiotic is a traditional Japanese diet with brown rice as a mainstay. It is also close to vegetarian diets. The composition of human intestinal bacterial flora varies with diets. Brown rice diet promotes the growth of many butyrate-producing bacteria, and it helps keep the intestinal environment healthy. The study of longevity revealed that desirable bacteria were Faecalibacterium and Bifidobacterium that produced acetic acid and butyric acid. To increase these bacteria, it is important to eat more dietary fiber, vegetables and brown rice, and eat less meat. Since I have focused on the functionality of rice, I am promoting the concept of medical rice. Low protein brown rice is considered an ideal food that can suppress the progress of renal failure while retaining beneficial nutrients of brown rice.