［Objective］We examined whether DHEA-S correlates with patients' subjective feeling of “meaning of life.”

［Methods］Subjects were women aged 30-49 years (n = 80). They were divided into two groups: a Fibromyalgia syndrome (FMS) group (n = 41) and a healthy group (n = 39). Serum DHEA-S levels of less than100 μg/dL in the FMS group were classified into an FMS low value group (F-L group: n = 14), and serum levels of 100 μg/dL or more were classified into an FMS high value group (F-H group: n = 27). Serum DHEA-S levels of less than 100 μg/dL in the healthy group were classified into a healthy low value group (H-L group: n = 7), and serum levels of 100 μg/dL or more were classified into a healthy high value group (H-H group: n = 32).

［Results］The F-H group had the highest correlation coefficient between DHEA-S and “meaningfulness” and was positively correlated (rs = 0.5425, p＜0.01). DHEA-S was positively correlated with three values: creative values, experiential values, and attitudinal values (p＜0.01). There was a negative correlation between DHEA-S and “social factors” in the H-H group (p＜0.05). There was a negative correlation between DHEA-S/cortisol ratio and ‘physical factors’ (p＜0.05).

［Discussion］In functional pathology, it is suggested that the proportion of “meaning of life” contributes as a factor affecting DHEA-S values. Changes in factors related to DHEA-S are thought to be related to the processes of “health, functional disease, organic disease, lethal disease, and death” in salutogenesis.

Medical education in Japan has improved systematically and efficiently and now provides training on basic clinical procedures and techniques along with classroom lectures. While, the liberal arts education period has decreased from two years to one year. The hilosophy of medicine, which was established by philosopher Hisayuki Omodaka, aims to reflect on medicine and clarify the overall picture and essence of medicine to enhance its practice. In this article, medicine is defined as one of the applied and practical sciences that aims to cure the sick, prevent disease, and promote health. It is supported by three subjects: sciences, philosophy of human beings, and medical ethics and policy. V.E. Frankl understood humans as existential beings searching for meaning in life, rather than reducing them to mere biological substances. Frankl also provided the concept of “dimensional anthropology”, which regards humans as constituting unity in spite of multiplicity. In Japan, based on Frankl's existential analysis, K. Nagata, Y. Ikemi et al. clarified the concept of “Comprehensive Medicine”, which is premised on providing comprehensive healthcare, by emphasizing individual meaning in life. The practice of comprehensive medicine requires an essential and philosophical understanding of human beings, which demonstrates the importance of a philosophical attitude among medical professionals even in clinical settings. Therefore, a “philosophy of medicine,” which reflects on medicine and imbues medical students with the passion and courage to provide comprehensive and better medicine, is indispensable to modern medical education as it encourages medical practitioners to consider human beings from a biopsychosocial-existential perspective.

The aim of this paper is to determine how to effectively apply salutogenesis to clinical pain medicine and medical education.

Salutogenesis is a new idea on health advocated by Aaron Antonovsky, an Israeli health sociologist.

We provide the following medical education: (1) In overview of Oriental Medicine for first- and second-year students of our medical department, we endeavor to help students understand how salutogenesis differs from traditional pathogenesis with regard to the idea of health; (2) In the medical program for junior residents we teach traditional oriental medicine, with a particular emphasis on Chinese medicine, representing the salutogenetic approach to pain medicine; and (3) In the outpatient pain clinic for anesthesiology specialists, we teach the application of pathogenesis and/or salutogenesis from the practical clinical standpoint of pain medicine, considering applications and limitations in medical methodologies. There are cases in which pathogenesis alone does not provide relief. In such cases, we propose the application of salutogenesis; namely, identifying and activating the patient's resources so as to obtain the desired outcome. Our final goal is to develop medical practitioners capable of practicing comprehensive medicine based on the biopsychosocial-existential medical model. In this paper, we consider salutogenesis in a case of fibromyalgia syndrome in which comprehensive medicine was practiced.

In conclusion, it is our belief that the salutogenetic manner of thinking is essential in understanding and practicing comprehensive medicine.

In recent years, the paradigm of clinical understanding of pain and fatigue has shifted to small fiber neuropathy (SFN). SFN is a disorder in which the small fibers (A-delta and C-fibers) of the peripheral nerves are affected. The small fibers are preferentially affected and are responsible for rapid detection and response to threats in the external and internal environment. Persistent SFN causes chronic pain due to sensory neuropathy and pathological fatigue, and multiple organ damage due to autonomic neuropathy. Idiopathic SFNs (iSFNs), which account for approximately 50% of SFNs, are caused by homeostatic distortion. Effective therapeutic intervention at the initial iSFN (iiSFN) stage can not only prevent the onset of chronic disabling bodily distress (CDBD), which is intractable chronic pain and chronic fatigue, but also lead to recovery of health and disease prevention.

In a previous study, we found that students at an acupuncture and moxibustion vocational school formed their individual identity as practitioners while observing actual practices by instructors, learning about communication techniques, relationships between therapists and patients, and acquiring techniques to improve their awareness as specialists during clinical acupuncture and moxibustion training. In other words, what they learned included three domains of learning; namely, the knowledge, skills, and attitudes that B.S. Bloom proposed as a taxonomy of educational objectives, and specifically contributed to the cultivation of proper attitude. However, as there is a lack of studies focusing on learning processes during clinical training, we examined and analyzed their learning processes in this study.

Subjects were 42 third-year students at an acupuncture and moxibustion vocational school, 21 male and 21 female students (average age: 31.8 ± 6.9 years (mean ± SD)). Subjects were given essay assignments twice during the clinical training period, data from the 71 subjects essays were collected for exploratory analysis using a qualitative study method from the viewpoint of three steps of comprehensive medicine; namely, prompt relief of pain (Step 1), determining of the onset and focus of pain (Step 2), and measures for disease prevention and health creation through self-control (Step 3).

Based on the results of analysis, we extracted 8 categories, 22 sub-categories, and 195 codes. Among the 8 categories, I) “recognizing the need for good manners,” II) “being unaccustomed to performing face-to-face medical examinations,” III) “listening to patients talking about their condition,” and IV) “having counseling skills” were classified into Step 1 while V) “psychological and physical approaches to patients” was classified into Step 2, VI) “patient self-control ability” was classified into Step 3, VII) “forming identities” and VIII) “improving skills” were classified into Other.

Our study clarified that the three steps of comprehensive medicine comprise the process of patients' being released from pain and achieving recovery. It also revealed that students learned professional knowledge, skills, and attitude through the experience of comprehensive medicine while gradually formed their identity. Results also suggested we need to identify categories related to learning processes as the effects of practical training to employ as indicators of the effectiveness of instruction and evaluation for practical training.

The results suggested that students learned the importance of face-to-face medical examinations and counseling skills as well as psychological and physical approaches to patients. Results also clarified that students learned that patients have the ability to exercise self-control. In addition, results showed that students attempt to improve their skills and form their identities as acupuncture and moxibustion practitioners.

[Background] At our clinic, we employ a transdisciplinary (TD) team approach centered on doctors, acupuncturists, and physical therapists for the patient's bodily distress (BD) without organic disease. We report a case of BD in which cognitive behavior change was observed through a TD team approach from the standpoint of an acupuncturist. [Case] In mid-June of 20XX, the patient, a female in her 30s, developed numbness in her left lower extremity. The numbness subsequently appeared in her left upper limb, right hand, and right lower limb accompanied by various functional symptoms. Later that month, a diagnosis of BD was made at our clinic because the patient had homeostatic distortion and was highly anxious. [Progress] The acupuncturist performed acupuncture and manual therapy, and listened attentively while conducting a parallel Balint method medical interview for the psychological problems. Over time, the patient's cognitive behavior changed and her comprehensive condition improved. [Conclusion] Ensuring that all members of the TD team listen as much as possible during professional physical treatment may be of benefit to the patient's self-growth.

I arrived at the following views by comparing and realizing a dialogue between the book, “Existential Counseling,” by the late Katsutaro Nagata, former president of the International Foundation of Comprehensive Medicine, and a chapter in my book, “Vision Brings the World,” in which I examined my own experience with hospitalization. In other words, the “Comprehensive Medicine” advocated by the International Foundation of Comprehensive Medicine, and in particular, the unique practice of “art therapy,” is a “mind-body correlation” therapy that attempts to activate the body's immunity against disease by making patients keenly aware that we exist as a “microcosm” surrounded by beautiful, pleasant, encouraging, and poignant experiences (letting us live mentally), and that by making ourselves keenly aware that the meaning of life is to realize and develop ourselves as such a “microcosm” through our bonds with others, we are able to transform the disease currently being treated into an opportunity to realize “the paradox that a single illness can give us whole good health.”

As Hippocrates said, “Our food should be our medicine. Our medicine should be our food,” food is an element in forming the basis of our overall health. Although we seem nowadays to have more than enough food, homemade cooking culture has declined significantly. In addition, warm human relationships developed through food culture are rapidly being lost. At certified day-care centers and kindergartens, elementary, junior-high, and high schools, we are encountering serious issues rooted in the dietary environment, issues such as unbalanced diets, excessive increase in appetite, and refusal of food. In particular, infants and young children who do not seem to be excited about deliciousness are increasing. Food distortion seen in such dietary environments is definitely connected to the distortion of life. Nutritionists including those with national certification (hereinafter “Nutritionists”) play an important role in contributing to the improvement of functional diseases caused by distortion of life. In addition, everyone has a desire to continue eating food orally until the end of life, therefore, Nutritionists also have a major role to play for people with serious illnesses. In this article, I would like to explain what is expected from Nutritionists from the standpoint of nutritionists and vocational culinary schools.