Since the fourth Congress of ICPM (1977,Kyoto) psychosomatic medicine has advanced to a core approach in clinical medicine which follows the biopsychosocioethical medical model. I wish to focus my speech to the holistic awareness which can be the root of holistic medicine and the root of Oriental somatopsychic self-control which plays an essential part in the enlargement of experiential level by the dissolution of alexithymia, alexisomia and alexicosmia. Soon after I introduced Prof. P. Sifneos's concept of "alexithymia" to Japan, I noticed that in many cases of alexithymia there also seemed to be a difficulty in the awareness and expression of bodily feelings and the natural order implicit in the body. I have coined the term "alexisomia" to designate a condition, where certain persons have difficulty in expressing how their bodies feel, and the term "alexicosmia" to designate a condition marked by a lack of awa-reness to the natural order. Recent development of biofeedback has revealed that the facilitation of bodily feelings by means of biofeedback system helps the conscious self-control of visceral organs. Through such a research it has been found that Oriental systems of concentration help our healthy self-control through the similar psychophysiological mechanism to biofeedback. On the other hand, various ASC methods have been used for the purpose of deepening the experiential level since Freud's psychoanalysis under the hypnotic state. We have found that Oriental meditations such as Zazen, Qi-gong etc. induce the normal state of consciousness instead of altered states of consciousness induced by hypnosis, autogenic trainilng, TM etc.. "The full awakening of the whole person to reality" (E. Fromm) which is the basis of the true health and self-actualization can be achieved through the normal state of consciousness. Since the fourth Congress of ICPM, I have proposed that various Western psychotherapies such as counseling, behavior therapy, psychoanalysis, existential analysis etc. become truly effective when they are performed in combination with Oriental systems of selfcontrol which enlarge the experiential level under the normal state of consciousness. For this purpose we have developed a system of self-regulation by introducing three secrets of Zazen (regulation of posture, breathing and mind) which consists of static, dynamic and artistic styles. Dynamic and artistic styles are often far superior to a static style in the dissolution of alexithymia, alexisomia and alexicosmia. In recent years, more and more Western people are becoming interested in Oriental philosophy and meditation which help us realize the true nature of human beings without much contradication to modern sciences. Under these circumstances, we are making efforts to formulate a Japanese system of holistic medicine on the foundation of Oriental philosophy and methods of self-control which may contribute to the exploitation of a way to the solution of world crisis in this century.

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The biological rhythms of gastric secretion, blood corticosteroid, and sleep-wake rhythm in in-patients with peptic ulcers, irritable bowel syndrome, and bulimia nervosa were analysed. Next, the influence of psychosomatic treatment (minor tranquilizer therapy and fasting therapy) on the biological rhythms was studied. Further an attempt was made to establish the state immediately prior to the onset of psychosomatic disorders in healthy subjects, to use the circa-dian rhythms to determine the neural mechanism of psychosomatic patients. l. Basal gastric acid secretion at night was significantly higher than the morning in 12 cases with duodenal ulcers (p<0.05). 2. Out of 21 cases with gastric ulcers, 7 cases with psychosocial stress showed abnormal patterns of blood corticosteroid circadian rhythm, whereas 14 cases without psychosocial stress showed normal pattern. The difference between the two groups was statistically significant (p<0.05). The abnormal patterns in 6 of 16 cases with gastric ulcers were normalized by minor tranquilizer therapy for one month. Of 21 cases with irritable bowel syndrome, 18 (86%) showed abnormal patterns of blood corticosteroid circadian rhythm. 3. All of 20 cases with bulimia nervosa had sleep disturbance, especially disturbance of sound sleep and nocturnal & early morning awakenings. Out of 490 students in a junior high school, 199 suffered from psychic distress and anxiety that influenced the sleepwake circadian rhythm. Out of the 199 cases with psychic distress and anxiety, irregular bedtime were observed in 45% of the 55 first-year, 64% of the 59 second-year, and 81% of the 85 third-year students, regular bedtime was observed in 54%, 36% and 19% respectively. The differences between the two groups were statistically significant (p<0. 01). In conclusion, the neural process to psychosomatic patients from healthy subjects may be illustrated by the following schema

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Although several investigators have suggested the close relationship between the organ specificity involved with emotional stress and individual predisposition, the previous studies by the authors showed that the electrocardiographic abnormalities were observed with high incidence in the group suffering from peptic ulcer in the past compared with the group without gastrointestinal disorders. These results indicate that the organ specificity in psychosomatic diseases depend on the environmental factors rather than the individual predisposition. The purpose of the present studies is to investigate the modification of biorhythm under the environmental factors which include a number of daily activities and individual characteristics obtained from personal background in social life. Then, diurnal change of blood pressure, pulse rate and CV values were provided as the parameters of biorhythm. The different situations of individual social background by occupation, activities of daily life and family make-up exert the significant influence on biorhythm. On the other hand, we were unable to find any evidence of a relationship between the results in diverse psychological tests and chracteristic changes of biorhythm. There were also minimum changes in blood pressure, heart rate and CV values in the bedfast aged group. Furthermore, it is known that micturition and feeding, as a factor related to pressor responses in daily life, can elevate blood pressure. However, to what extent the patient with cardiovascular psychosomatic disease may be more susceptible to the development of hypertension is still unknown. Blood pressure was measured serially in each cardiac pulsation. Blood pressure elevated immediately after the start of micturition and sustained during the micturition. The afterfall of blood pressure was usually observed. These pressure responses induced by micturition were significant in patients with hypertension and coronary insufficiency, in which arrhythmia was frequently encountered, whereas those in control subjects were scarcely observed. Similarly, pressure responses followed by feeding resembled those of micturition for the most part. It was proved that these evidences were due to the increase of sympathetic outflow to controlling organs by experimental studies. The present findings suggest that the analysis of individual environmental factors and of pressure responses induced by the activities of daily life is a very important proposition. Furtheremore, it plays an important role in daily life and makes a valuable principle for the treatment of cardiovascular psychosomatic diseases.

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Various types of circadian rhythm disorders have been so far reported in human subjects. Almost all of them are due to disordered entrainment of the circadian rhythms of behaviors and physiological functions. Entrainment to socio-environment cycles and/or entrainment between various circadian rhythms in the same individual are impaired. The etiology of the circadian rhythm disorders is divided into two categories : 1) interactions between socioenvironmental cycles and circadian system which induce the disorders even in normal subjects, e.g., desynchronosis induced by jet lag or work-shift, self-imposed irregular schedules, and photoperiodic disorders of circadian rhythm;and 2) intrinsic defects in circadian system which induce the disorders even on normal socio-environmental cycles, e.g., non-24-hour sleep-wake syndrome, delayed or advanced sleep phase syndrome, and endogenous depression. Zeitgebers, which include bright light, social time cues and sleep-wake schedule, can be used for the treatment of the entrainment disorders, where the strength and timing of zeitgebers imposed are crucial. Some drugs (e.g., lithium and clomipramine) which can alter the intrinsic period of circadian rhythm, are used for correcting abnormally delayed or advanced phase of circadian rhythm. Insight based on circadian principles is important to understand the etiology of circadian rhythm disorders and to develop their treatments..

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"The diagnostic classification of sleep and arousal disorders" was proposed as a new sleep disorders nosology by the Association of Sleep Disorders Centers and the Association of the Psychophysiological Study of Sleep in the North America 1979. It has been commonly used for the research of sleep disorders and for the coding of diagnosis in the clinical practice, and has the succeeding four major clusters of disorders within the classification system : Insomnias, Hypersomnias, Sleep-Wake Schedule Disorders and Parasomnias. Sleep-wake schedule disorders such as the delayed sleep phase syndrome (DSPS) and the non-24-hour sleep-wake syndrome (hypernychthemeral syndrome) have been described as new types of sleep-wake disorders in the last decade. It has also been reported that nondrug "chronotherapy" can reset the circadian clocks of patients with DSPS and that the administration of vitamin B_<12> : a was effective in maintaining the circadian rhythms of patients with hypernychthemeral syndrome. We treated 11 patients (8 adults; 3 adolescents) of DSPS with chronotherapy which could reset the circadian clocks of all of the patients, but it is not so easy to maintain the reset rhythm without any other therapy. We tried to maintain the circadian rhythm after resetting with pharmacotherapy using some agents such as triazolam and methylphenidate, considered to advance the biological rhythm. DSPS patients had some characteristics of behavior and personality. All of them were extreme "evening" individuals from their early childhood prior to chronotherapy. Although clinical observations have failed to relate this specific insomnia to psychiatric diagnocis, some specific personality traits were confirmed by the study using Rorschach test. A 17-year-old high school student with hypernychthemeral syndrome complained of not being able to attend school was treated with vitamin B_<12> 3000 μg per day. His γ before administra-tion of the drug was 24.6 hours and it was reset to 24.02 hours after treatment, computed by a periodogram. Every period when a gradual delay reappeared in his sleep-wake cycle, phototherapy of 2500 lux or more was added in the early morning. The patient reported a slightly depressive mood during phototherapy. After the administration of Vitamin B_<12> the patient's body temperature cycle became more regular and more distinct than before treatment. This patient was finally able to return to his classes after a year's absence. All the psychosomatic symptoms such as headache, headheaviness, appetiteloss, gastrointestinal discomfort, general fatigue, ruminative thinking, attention deficit, etc. disappeared or ex-tremely reduced after resetting the circadian clocks in every case of these sleep-wake schedule disorders. The investigation of relationships between psychological and chronobiological aspects of the sleep-wake disorders may be an important subject in psychosomatic medicine.

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In modern society, different working shifts have evolved to enhance productivity and provide diversification. As a result, the "work shift" system, which ensures 24-hour productivity, accounts for 30% of the working population, making appropriate health management an issue. Many studies have been reported on the relationships between shift work and various diseases. The best-documented health consequences of shift work are the three major symptoms, i.e. -fatigue, gastrointestinal disorders and sleep-wake disorders. Recently, it has been increasingly noted, as a results of advances in chronobiology, that symptoms related to rotating shift work are psychosomatically morbid conditions based on the circadian rhythm disorders. In particular, a disturbance in the sleep-wakefulness rhythm resulting from irregular working hours is reported to cause physical, psychological and social stress, and gastrointestinal, cerebrovascular and musculoskeletal disorders. In the present study subjects who worked continuous or irregular shifts and who visited psychiatric departments with physical symptoms resulting fro!n sleep disorders were examined from the view point of the disturbed circadian rhythms. The subjects were 174 rotating shift workers (39 male and loa female) who were examined in a psychiatric setting for somatic including disturbed sleep and wakefulness. Of them, 142 (36 male and 106 female) had physical symptoms such as insomnia, autonomic dysfunction, gastrointestinal, musculoskeltal and so on, and required psychiatric examination (Psychosomatic group-group PS). Thirty-two (3 male and 29 female) were diagnosed as having neurosis and/or depression. (Neurotic group-group N). The PS group was examined for clinical features, course and prognosis, and 20 of them who showed characteristic features received (1) psychological tests, (2) investigation of the sleep-wake rhythm through a long-term sleep diary, and (3) determi-nation of body temperature rhythm. In the PS group, incidence of immodithymia was the highest, followed by nervous, syntonic, narcissistic and histrionic, viscous, autistic personalities, in order. A disorder in sleep and wakefulness was the most significant symptoms, gastrointesti-nal, cardiovascular, respiratory, muscular and skeletal symptoms, in this order. In addition, PS group showed higher psychosomatic scores than the established norms in the psychological test (MMPI). Initial analysis of the body temperature data indicated that the PS group exhibited more irregular desynchronization in comparison to the control group.

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Chronopharmacologic findings were demonstrated in this paper, suggesting that some drugs such as phenobarbital, theophylline, gentamicin, diazepam, arrLitriptyline, and maprotiline show time-dependent changes in pharmacokinetics andlor pharmacodynamics. The consideration of the timing of dosing of drugs including the agents described above might improve a rational drug therapy, increasing its efiEcacy and safety. Chronopharmacotherapy will be an interesting and important research field in the future pharmacotherapy.

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