Qi-energy concerns with 3 regions, i. e., mind, body and material environment. In the psychological region, qi-energy relates to various emotions in the unconscious, and propagates its influences on the whole body. Meditative training of qi stabilizes the emotions by activating the endcrine system or others. Then, masculinity and femininity in the mind develop and mature personality is formed. As to the view of body, we ought to pay attention to the relation between emotions and meridians. Waves of qi-energy transmit the emotions to the whole body throughtout the meridian system. So, we can see the human body as the holistic resonant system of the unificated mind-matter energy. So, we can say that qi is the fundamental energy which maintains the health of body, and also develops the harmonized personality in human relations.

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[in Japanese]

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The French psychosomatic medicine has been developing in an original way along with psychoanalysis as the Paris psychosomatic school (Ecole de Paris) . At first, in order to offer criticism on the Chicago school's characterology or psychogenesis, Pierre Marty and his colleagues, founders of the Paris psychosomatic institute (L'Insitute psychosomatique : IPSO) , have been elucidating the common essential structures among various psychosomatic diseases. Operatory thinking, Iack of emotional expressions, Iack of fantasies and dreams, essential depression prior to symptoms and white relation (difficulty of transferences) were pointed out. And the psychosomatic classification was proposed in a psychodynamic bidimentional way. Second, under the influence of the psychosomatic conversion theory of Valabrega, many French psychosomaticians play an active part. Thirdly, in the Balint group, the Lacanians also play an active role. Lastly, heated debates between psychosomaticians and psychoanalysts at the Paris psychoanalytic society are now worty of notice.

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The present conditions of psychosomatic medicine in Germany are outlined. In Germany each of the university faculties of medicine has the departments of psychosomatic medicine and/or those of psychotherapy, where they are engaged in studies and education of psychosomatics and medical psychology. At the lectures of medical psychology students learn about personalities, developments, doctor-patient relationship, coping with the disease, movement of population and diseases, and so on. In 1992 the further education system of psychotherapeutic medicine was established. The first level of this system is the education of basic psychosomatic health care. The second level is the education in psychotherapy and psychosomatics after having been qualified as a specialist in the other medical field. At the third level the doctors who have completed the second level can be a specialist in psychotherapeutic medicine after at least 5 years training. There are many societies of psychosomatics or psychotherapy m Germany and "The German Society of Psychosomatic Medicine (Das deutsche Kollegium ftr Psychosomatische Medizin : DKPM) " plays the central role of German psychosomatics since 1974. Many journals of psychosomatics are also published, for example, "Journal of Psychosomatic Medicine and Psychoanalysis". The Bad Neustadt Psychosomatic Hospital, which has 340 beds, is the biggest psychosomatic hospital in Germany. At this hospital the patients of neurosis, borderline and narcissistic personality disorders, eating disorders, obesity, pain disorders, alchoholism, morbid gambling and psychosomatic diseases in a narrow sense, for example, gastroduodinal ulcer, essential hypertension, ulcerative colitis, Crohn's disease, and so on, are treated according to the idea of "depth-psychological psychosomatics". For all the patients personal psychotherapy, grou.p psychotherapy and body therapy are done. Especially this hospital obtains good results with the origimal body therapy or "body related psychotherapy" which prompts the psychosomatic patients to recover their own body sensations through verbalisation of the feelings during physical exercises. The history of German psychosomatics has many physicians who constructed unique psychosomatic theories. Georg Groddeck was a general practitioner who treated incurable patients with balneotherapy, diet, massage and psychotherapy and who was therefore called as "father of psychosomatics". Under the influence of psychoanalysis Groddeck insisted that each symptom can be interpreted as a symbol and created the original word "It (Es) " which controls both body and mind. Viktor von Weizsacker constructed "the medical anthropology". He insisted the importance of "introducing the subject" into the medicine and proposed "the structual cycle (Gestaltkrers) theory" Thure von Uexkull, the present leader of German psychosomatic medicine, created the situation cycle (Situationskreis) model which explains the mechanism of symptom formation and the relationship of doctor and patient. And now a new medical concept "salutogenesis" is one of the topics in German psychosomatics. Under this concept they don't attach importance to the pathogenesis of the diseases but the patient's potential to be healthy. To respect the theories and to construct indispensable systems steadly is the style of psychosomatic medicine in Germany.

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The psychosomatic medicine in Great Britain appears inferior to those in USA or Germany at first sight. The reason of that is that the medical system in Britain is unique, not that clinical practice of psychosomatic medicine itself is underdeveloped. It could be said that the psychosomatic medicine in Britain is mature in clinical practice, after detailed examination of its current situation. First, a holistic, multifactorial and humanistic approach is performed naturally in the primary care setting. In primary care, general practitioners diagnose and practice by examining patients as a whole existence, Iooking for biopsychosocial etiologies, and using patient-therapist relationship. Secondly, comprehensive treatment is carried out by teamwork of medical doctors and other co-professionals under thorough professionalism. There is no room for dogmatism and sectionalism in both primary care and special hospitals in very pragmatic British medicine, even at the hand of powerful consultant doctors. Lastly, principle of the psychosomatic medicine is prevailed in the British mind as the general attitude toward medical profession. British doctors do not have to care patients as authoritarian or protective figures. However, the weak point of psychosomatic medicine in Britain is that the practice tends to be underestimated and research studies have not been accumulated, as the integrated activity of psychosomatic medicine is lacking.

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The present study investigated the potential ability for the simultaneous use of heart rate variability and pulse-wave velocity in order to provide a quantitative evaluation of the autonomic nervous system. We found that 6 parameters are useful for diagnosing diabetic neuropathy and dizziness or vertigo as follows : the mean and CV of resting heart rare, the mean and CV of standing heart rate, the change of mean heart rate, and the change of the mean pulse-wave velocity.

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Multi-cellular organisms developed the autonomic nervous system to cooperate one cell with others when they behaved for one purpose. Many cells, therfore, bear adrenergic or cholinergic receptors on the surface. Leukocytes are also not the exception for this rule. Two major leukocyte components of granulocytes and lymphocytes, which developed from macrophages in phylogeny, bear adrenergic receptors and cholinergic receptors, respectively. In this regard, granulocytes activate in number and function under sympathetic nerve stimulation, whereas lymphocytes do under parasympathetic nerve stimulation. We also herein propose a new concept on the cooperation of neuro-endocrine-immune systems. Because the functions of cells in these systems (the secretion of cytoplasmic granules) developed from the excretion of used metabolites, parasympathetic nerves govern these functions (i.e., cooperation with each other). These new concepts are extremely important for understanding the intimate relationship between our physical conditions, immune system and others.

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We have long done cognitive-behavioral therapy (CBT) for eating disorder patients, especially anorexia nervosa (AN), and have found it to be effective. Patients with binge eating have recently increased. However, the evidence for the effectiveness of the CBT in reducing binge eating is not strong. An appropriate therapeutic goal, not only for reducing binge eating but also for reducing a variety of psychopathology including anxiety, dysthymia and self-esteem, is important. Although it is reasonable to use CBT as the first line of approach, a more effective treatment or combination of treatments is needed. To resolve the problem, we studied 43 binge eating patients, from the 130 eating disorder patients admitting to our outpatient clinic during the year after March 1997 : 7 AN, 33 bulimia nervosa (BN), and 3 eating disorder not otherwise specified, according to DSM-IV. Their clinical characteristics were as followed : age (22.0±5.7 yr, 14〜48 yr), body mass index (BMD (19.5±3.1 kg/m_2,12.2〜33.1 kg/m_2) body werght changes (13.9±7.6 kg, 0〜32 kg), difference from ideal body welght (4.5±6.2 kg, 6.5〜22.4 kg), duration (41.3±53.8months, 2〜300 months), and inappropnate compensatory behaviors (vomitmg, n=32 : misuse of laxatives, n=4 ; both, n = I : fasting, n = 6). Treatment outcomes showed that only one third of the patients improved after at least 3 months of therapy. In comparing those who improved (n= 15) and those who did not or who were drop-outs (n=28), no significant differences were found in characteristics between the 2 groups, except that the longer the duration from onset to the first admission to the clinic, the higher the drop-out rate (p= 0. 07). By factorial analysis, using the results of the Eating Disorder Inventory questionnaire, the body welght changes highly correlated wrth the followmg psychologrcal problems "meffectrveness" , "maturity fears" , "interpersonal distrust" , and "lack of interoceptive awareness" , or "alexithymia". Based on these findings, it is necessary to prevent patients from attempting to force themselves to quit binge eating immediately, and consequently to learn to feel, both physically and psychologically, contentment from their main meals. The clinical implications for the future treatment are that we should clearly focus on helping patients recover interoceptive awareness and improve lowered self-esteem.

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