In order to determine the age of onset of the post menopausal stage in women, the parameters selected were the age of the last menstrual period, the fertility of women in their forties and the age of onset of menopausal symptoms. Last menstrual periods were seen from the age 36 to 56 in our series, showing a wide divergence in ages. The most frequent age group were women in their early fifties, with 86.6% falling between the ages of 45-54. The average age for the last menstrual period was 49.1 yrs. Our findings are in close agreement with those of other investigators, and a tendency toward an increased age at last menstrual period is suggested. Fertility stufies of women in their forties revealed an induced abortion rate of 9.0% of the total, and a birth rate of 0.5% of the total of these figures, 90.0% and 96.0% respectively were in the age group of 40-44. These data reveal a persistent fertility among women in their 40's. An incidence of menopausal syndromes by age revealed 11.6% for the 40-44 age group, 82.4% for the 45-54 age group and 6% for the 55-59 age group. From these findings, we proposed an age for the onset of the menopause as being from 40-59 and suggest a classification in accordance with individual "life cycle" as follows. Ages 20-39 as the "mature period", 40-44 as the "late mature period" as well as be the "premenopausal period", 40 55 as the "menopausal period" and 55 59 as the "late menopausal period" Further, we propose that 60-64 be called the "preold age", and 65 and over as the "old age". From the above listed material, we suggest the classification of the "Menopausal Syndrome", as those cases in which the women being in their menopause, are subjected to an alteration in ovarian function, accompanied by various and numerous psycho-vegetative symptoms. Manifestation of the "Menopausal Syndrome" is dependent upon the individual's innate ability to compensate for the altered (decreased) varian function, as well as her inherent physiological and psychological personality, all of which play an important role in the presence or lack of symptoms. Symptoms which appear in the menopausal period which are overt manifestations of psycho-vegetative disorders are not limited to the so called "Menopausal Syndrome". Other entities which may be present are masked depression, psychosomatic disorders, psychoneurotic problems (anxiety reactions, hypochondriasis), all of which are common during the menopause. Thus we suggest that all these problems be classified under a broader category which we propose to call the "Menopausal-Psycho-vegetative Syndrome". A differential diagnosis of these various entities is made possible only through an approach based on psychosomatic clinical techniques.

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Our approach is to integrate both psychosomatic and somatopsychic approaches like the two wheels of a cart for reaching the goal of healthy self-realization in the true sense of the term by introducing new concepts and techniques of humanistic psychology. in addition to traditional somatic treatment. To my understanding, the Oriental approach to life can contribute to the development of psychosomatic medicine in three major ways, revolving around its realization of the illusion of mind-body dualism, it's development of practical somatopsychic techniques for learnnig self-control, and it's orientation towards realizing our true nature. Students of psychosomatic medicine have long propagated the unity of the mind and body, and unitary concepts are nice ways of speaking, but in fact, the Cartesian dualism is still with us and is the basis of our thinking in psychopathology, psychophysiology, psychopharmacology and even in psychosomatic treatment. In Western culture, the development of which has rested on the foundation of Cartesian mind-body dualism, the spirit (psyche) has been separated from the body, the human body being degraded to the level of animal body or machine. In Oriental thought, the body has been considered to be the sacred seat of the soul or spirit, and the "wisdom of the body" has been highly appreciated. Mind and body have been viewed as two phases of a single process, not as independent entities. The basic principle of traditional Oriental Medicine is the maintenance or stimulation of the natural "wisdom of the body". According to Oriental thought, self-identification is a process that is based upon an awareness of body feeling which is directly in touch with nature under it's command. Such a self-identification helps the maintenance of lucid sensory awareness and an actual feeling of the law of nature in one's own body, an understanding which is qualitatively different from conceptual understanding. This attitude does not contradict the concepts of natural science.

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The author reviewed the various theories on the problem of organ choice or symptom formation in psychosomatic diseases. As the factors of symptom formation, the individual somatic disposition, the personality specificity, the emotional conflict (Alexander), the conditioned reaction and especially the hypersensitivity of the hypothalamic-limbic system will play an important role; however, multifactorial genesis in the individual patient should be considered

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The author conducted a research in order to introduce a psychosomatic approach to the field of education for young children. The tool used for investigation was the egogram check list which was designed by Sugita et al. on basis of transactional analysis theory. The subject consisted of 130 parents of kindergarten children (age 4), 101 5th and 8th graders (ages 11 and 14 respectively) and their parents. The resuls were summarized as follows : 1. A total of 26 types of egograms were identified. After observing the parents of preadolescent children with psychosomatic disorders and behavior problems, egograms were grouped into 2 major types, that is 1) the desirable type consisting of 6 subtypes and 2) the undesirable type consisting of 20 subtypes. 2. Out of 16 problem children in kindergarten, 93.7% of their fathers and 81.3% of their mothers showed undesirable egograms, whereas 6.3% of their fathers and 18.7% of their mothers showed desirable ones. A markedly significant difference was found between these 2 types. 3. Undesirable egograms were examined in the parents of 5th and 8th graders. A correlation was found between parents and children. In the 8th graders, a correlation of egograms between parents and children was higher than that found in the 5th graders. These are the results of one research which are now under way. It is suggested that psychosomatic consideration can improve the effect of education for kindergarten as well as school children. The author hopes to continue with the present research in order to confirm the signification of a psychosomatic approach of young children.

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In order to estimate a tendency of researchers' interest in psychosomatic diseases (PSD) in gastroenterology in Japan, the author calculated the number of papers that had been read at the congresses of the Japanese Society of Psychosomatic Medicine for the past twenty years. The number of total papers amounted 2,120,in which 237 (11.2%) dealt with gastro-enterological diseases. These 237 papers were classified into 30 items. Anorexia nervosa and peptic ulcers were in the first group. Irritable conlon syndrome and so-called peritoneal adhesion belonged to the second group. The third group was composed of five diseases including inflammatory bowel diseases, IBD. The author and his co-workers in Hirosaki University also reported 79 papers including the current topics read at the provincial meetings of the JSPSM. Of these papers, 29 were on clinical tests, examinations and therapies. In the remaining 50,PSDs of the digestive tracts were found in 35(70%). In this paper, the author presented four typical cases in which psychic or emotional stress was proven to play the most important part in the etiology of their disorders. Case 1 was a female student of 21 years of age. The main complaint was severe weight loss, from 37 kg to 19. When she was elected leader of a student-circle, a sub-leader stood against her in every dicision the patient wished to make. This conflict was the cause of anorexia nervosa. Family history revealed that her father was quite dominant, especially toward her mother. Hospitalization for five weeks was enough for her recovery. Case 2 with peptic duodenal ulcer was the author himself. When he was 46 years old, gastrectomy was performed because of profuse hemorrhage. His history of ulcer, however, had been repeated for about 30 years long, and the main cause of each recurrence was emotional stress. The autor reported his own protocol in detail. Case 3 was a 60-year-old male professor of a national university with a typical irritable colon syndrome. Before the syndrome occurred, two daughters were admitted to a hospital, the elder one for brain tumor and the younger for ulcerative colitis. The patient recovered from the disease soon after he became aware of the cause. Case 4 was a 26-year-old female. The initial attack of her ulcerative colitis came just after her marriage. After the first recurrence she was admitted to Komagome Hospital and died six months later. She had a very complicated history in her birth and family relations. The author reported clinical and social data in detail, showing many slides.

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Psychosomatic medicine is important, by all means, in all practical phases of clinical medicine. Although too expanded study in the research of psychosomatic medicine may cause a confusion, all the doctors including general practitioners should know the relation between mental problems and physical problems concretely, not just idealy. In this paper, the author attempted to discuss the general trend in this field, referring to the history of the Japanese Society of Psychosomatic Medicine for the past 20 years. Furthermore, the author touched on the general symptomatology and hemophilia from the standpoint of psychosomatic medicine, and the mechanism of organ inferiority.

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A case report was made concerning a 21-year-old male patient who had shown episodes of excessive binge-eating associated with habituated vomiting. He had been entirely well until February, 1973,when he suffered a traffic accident in which he was hit severely on the head and remained unconscious for about half an hour. About 9 months after the head injury the patient began to show frequent, episodes of gorging and vomiting, gradually losing weight in the process. When admitted to our hospital in June, 1974,he weighed 43 kg (ideal bodyweight : 64 kg). It was confirmed that his maximal caloric intake amounted to as much as 14,000 Kcal per day during the ad lib. diet for the first week after hospitalization. Laboratory examinations demonstrated markedly low potassemia along with ECG abnormalities such as T wave flattening, sinusbradycardia and shortend QTc time, which were understood as a manifestation of heavy vomiting. Endocrine examinations revealed such abnormalities as low BMR, delayed pattern of glucose tolerance curve, higher basal level of serum GH and its delayded response to both arginine and L-DOPA. However, he was euthyroid and showed normal basal levels of serum FSH, LH and testosterone, although the 24-hour urinary hypophyseal gonadotropin excretion was slightly decreased. No space occupying lesion in the brain was observed by CAG and CT-scanning, but the following EEG findings were obtained : for about 2 months during the posttraumatic period, the patient indicated alpha wave slowing with sporadic theta-burst (symmetrical); this was followed by nearly the same patterns during the emaciated period. These abnormalities improved gradually after restoration of normal body weight. In addition to abnormal eating behavior, changes in emotion and personality to a certain extent were also found after the head trauma. These findings suggest that the head trauma presumably acted as an initiating factor in some functional disorder in the vicinity of the satiety center and/or amygdala. The patient was able to entirely resume his social life again about 5 years later, mainly through behavior modification with operant-conditioning and self-control. Although the etiological problems of dysorexia nervosa are still controversial, this rare case seems to contribute toward discussion of the pathogenesis of the disease from the view point of primary hypothalamic disturbance in the sense of minor brain damage.

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The digital plethysmographic patterns of 40 patients (18 males, 22 females) with mild depression, 20 patients with vegetative dysfunction (NCA and climacteric disturbance) and 10 normal subjects as controlled groups, were analyzed from the standpoint of cardiovascular and autonomic nervous system function. The results were as follows : 1) In patients with mild depression, the normal dicrotic waves appeared only in 32.5%, the sclerotic waves in 27.5%, the monophasic waves in 7.5%, the anacrotic waves in 7.5% and the peripheral plateau waves in 25.0%. The pulse wave height ranging more than 4.0 mv/v was found in 40.0%, between 2.0〜3.9 mv/v in 32.5% and less than 1.9 mv/v in 27.5%. These distributions of digital plethysmographic patients with mild depression were far different from the patterns in normal subjects and similar to those in patients with vegetative dysfunction. In these depressive patients, blood pressure and ECG findings were normal and clinically they seemed to have no heart diseases. It was therefore assumed that, in patients with mild depression, their digital plethysmographic patterns were probably infiuenced by the dysfunction of the autonomic nervous system. 2) In patients with mild depression, after having changed their position from the supine to the upright, many showed changes in their wave patterns and a marked decrease in their wave height. A T_<II> wave height decrease, which is more than 0.12 mv in ECG records after changing position from the supine to the upright, is recognized as an indicator of the autonomic nervous system dysfunction (by Abe and Tsutsui). This T_<II> height decrease of more than 0.12 mv appeared 16 patients with mild depression, 10 with vegetative dysfunction and 1 normal subject. A correlation between the T_<II> height decrease and the plethysmographic wave height decrease was found in depressive patients. These plethysmographic patterns after changing position suggested the autonomic nervous system dysfunction affects the plethysmographic patterns. Examination of digital plethysmograph is useful for the clinical judgement of depressive patients.

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