Mind-body medicine focuses on the interactions between mind and body. These techniques include self-awareness, relaxation, meditation, exercise, diet, biofeedback, visual imagery, self-hypnosis and group support. This is one of the major domains of the Complementary and Alternative Medicine (CAM) in the US. These approaches are also included in the treatment of "Shinryo-naika", which is one of the specialties of physician in Japan. Integrative medicine in Japan is conducted by medical doctors (M.D.), who use mind-body interventions in the hospital. The objective of this paper is to explore current efforts to integrate CAM modalities into conventional western medicine in Kansai Medical University Hospital. Medical students at Kansai Medical University receive some exposure to CAM during rotation for Dept. of Mind-Body Medicine. We have a 2 hour seminar of the holistic and integrative medicine for medical students. Dept. of Mind-Body Medicine has been developing a program that incorporates CAM approaches to the treatment of psychosomatic diseases, such as functional gastrointestinal disorder, chronic pain disorder and eating disorder. Practitioners involved in this collaboration include physicians who were certified in mind-body medicine, aromatherapies, acupuncturists, qi-gong trainer, energy healers. Our results have been excellent, with satisfied patients, a number of whom were able to avoid medication. The Japanese health care system was westernized in the 20^<th> century. But there are many alternative therapies in Japan, such as kampo medicine, acupuncture, moxibustion, shiatsu-amma, judo-seihuku, biwa-onkyu and reiki. "Shinryo-naika" aims at integrative medicine, which mostly uses a mind-body approach. We are trying to include other CAM modalities into "Shinryo-naika".

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This report is concerned with our attempt to practice complementary and alternative medicine at Yamamoto-Kinen Hospital. Our hospital is located at the north of Yokohama City. We have 131 patients in the hospital and out-patients number 300 a day. We assume the responsibility of public health of neighborhood communities. About 10 years ago, the auther started practicing complementary and alternative medicine to realize integrated medicine. The number of patients has increased during these 10 years. At first, the auther had to respond to all the requests of the patients by herself. But now she has two colleagues, a physician, and an anesthesiologist and has established a department of total health. We use many methods such as homeopathy, Ayur Veda, Qi-gong, acupuncture, Kampo medicine and spiritual healing, etc.

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We performed thermal therapy using a far-infrared ray dry sauna system together with cognitive behavioral therapy, rehabilitation, and exercise therapy for patients with chronic pain. Compared with the non-thermal therapy group (n=24), the thermal therapy group (n=22) showed (a) significantly lower numbers of pain behaviors, (b) significantly improved anger scores in emotional state, (c) higher rates of satisfaction for treatment, (d) higher rate of return to work (82% in the thermal therapy group vs. 58% in the non-thermal therapy group). These results suggest that thermal therapy may be a promising method for treatment of chronic pain.

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The main methodology of modern medicine is pathogenetic, and that of traditional Oriental medicine, CAM, and mind-body medicine is salutogenetic. Health in pathogenesis is an absolute concept, whereas health, disease and death consist of their own separate concept. However, from the viewpoint of salutogenesis, the human condition in pathology progresses continuously from health to disease (functional, organic and fatal one) and disease to death, and in its each level the subject can create relative health according to the condition. The diachronic evaluation of human body reaction is seen in general adaptation syndrome. The evaluation of human body reaction consists of evaluating wear and tear and the repair and restoration of the body. The general adaptation syndrome, 17-KS-S (S), 17-OHCS (OH), the S/OH ratio, and traditional Oriental medicinal evaluation are clearly inter related. It may be said that medical care in the new era (comprehensive medicine) consists of pathogenesis faced by modern medicine, salutogenesis by traditional Oriental medicine, CAM and mind-body medicine, and the patient's individual autonomy (self-determination by self-responsibility). Fibromyalgia is relatively difficult to treat because of patient's complaint of chronic pain. For the care of this disease, pathogenesis, salutogenesis and self-control were performed in this order to relieve pain. A good result was obtained by the teamwork of medical doctor and co-medicals (CAM practitioners).

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Objectives : There are many patients with physical symptoms that are not explained by examinations. Recently, these physical symptoms are called "medically unexplained symptoms" or "medically unexplained physical symptoms" in the Western countries. The aim of this study was to investigate the clinical course and relationship with other psychiatric disorders of the medically unexplained symptoms of the patients in adolescence. In this study, we considered that the undifferentiated somatoform disorder is the most common disease, which shows medically unexplained symptoms. Method : The subjects were Eighty-one young patients (36 males and 45 females) with undifferentiated somatoform disorder in DSM-IV. Accompanying other psychiatric disorders, frequency of personality disorders, period of visiting hospital for treatment, treatment conditions, outcomes, and suspension of business or absence from work were examined from the first inspection inquiry and clinical records. Results : Other psychiatric disorders were observed in 48% of all patients, and 21% were classified into the region of psychotic disorders. Personality disorders were found in 36% of all patients and the rate was higher in the patients of undifferentiated somatoform disorder with other psychiatric disorders. There were a few patients who continued to visit hospital for treatment for a long period. Improved physical symptoms were indicated in 25% of all patients and the absence from school or job was observed in 37% of all patients. Conclusion : The patients with undifferentiated somatoform disorder showed accompanying psychiatric disorders and social function was liable to be decreased. These patients with psychiatric disorders more often accompany personality disorders than the patients without psychiatric disorders.

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There were few reports on the influence on the Tokai-village Radiation Accident in 1999, especially those focused on school children (pupils) from the point of view of psychosomatic medicine. A survey was conducted by an unregistered and self-rating questionaire with regard to physical and mental post traumatic symptoms, especially on the state and change of emotion or feeling, on 479 children and students (grade school, junior and senior schools) who lived within the area of 10km in diameter and met with the accident. The first survey, retrospective one, was conducted soon after the Accident and second one was conducted one year later to investigate the present state. The questionnaire was composed of 17 items with 3 selective answers, which are "yes", "no" and "none of both". The main results were as follows : 1. There were few pupils or students who had fundamental knowledge of radiation before the Accident. 2. Among various symptoms, mental symptoms such as strong anxiety, fear, astonishment, were found more in girls than in boys of all schools. In high schools, some physical symptoms were also found more in girls than in boys, with significant differences. However, many school children had few physical symptoms with no significant differences according to sex. 3. We still find some post traumatic symptoms even one year after the Accident. This indicates that adequate mental care and a follow-up study are indispensable.

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It is almost 5 years since selective serotonin reuptake inhibitors (SSRI) became available in Japanese pharmaceutical market and now it plays a central role in pharmacotherapy for depression. The present case report shows that a 26 year-old Japanese man with depressive state was switched his medication from paroxetine 10mg to amitriptyline 50mg for financial reason after he took the SSRI for 4 months. Three to four days after the SSRI was switched, he became agitated and irritable especially against noise, but SSRI discontinuation syndrome was not diagnosed because the clinical symptoms were masked by accompanying symptoms associated with depressive state such as irritability, nausea, and headache. Although the impulsiveness and agitation disappeared shortly, he was greatly confused and annoyed by the sudden onset of the syndrome and came to distrust the physician responsible for his treatment. He canceled his appointments to see the physician, and the physician-patient relationship was worsened. It was guessed that symptoms of SSRI discontinuation syndrome might aggravate patient's anxiety and generate a depressive-driven distrust of the physician. The physician tried to keep supportive attitude and explained the nature of SSRI discontinuation syndrome until he understood it. Meanwhile, the underlying depressive state got alleviated and he started keeping medical appointments. Critical appraisal of epidemiological studies on SSRI discontinuation syndrome has shown that the syndrome is self-limiting and abates relatively shortly. Furthermore, no evidence has been statistically proven concerning associations of SSRI discontinuation syndrome with suicidal ideation and dose at the time of discontinuation. Through the experience of the present case, it was implied that a physician who plans to terminate or reduce SSRI should provide adequate information about any possible adverse effects of SSRI beforehand. By doing this, the better physician-patient relationship might be established which is helpful to continue the treatment in the clinical practice.

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Phantom limb pains in amputees require a long time until spontaneous resolution, and various treatments that have been attempted have not produced sufficient effects. We encountered a case of phantom pain of the lower limb that appeared after amputation due to traffic trauma but was improved by the administration of milnacipran. The patient was a 27-year-old male. He was admitted to the orthopedic department of our hospital due to tear of the right limb below the knee, traumatic hemopneumothorax, and atelectasis sustained in a traffic accident, and underwent right above-the-knee amputation. Hemopneumothorax and atelectasis could be managed successfully by conservative treatments. However, phantom limb pain appeared immediately after amputation with insomnia and dyspnea, which was unlikely to be due to organic causes. After the patient was administered paroxetine (20mg), he was referred to our department. At the initial examination, the patient was not depressed, but anxieties over the use of a prosthetic leg and the future were noted. In combination with supportive psychotherapy, paroxetine was increased to 40mg. This resolved the dyspnea and anxiety, but phantom limb pain persisted while it was alleviated, and bradyspermatism appeared. When the drug was replaced with milnacipran (100mg), phantom limb pain was further alleviated, and a feeling of residual urine, which appeared newly, could be managed by the administration of naftopidil. Although both paroxetine and milnacipran were effective, milnacipran was more effective and tolerable and was useful for the treatment of phantom limb pain. Although phantom limb pain in this patient is considered to have been caused by many factors, the effect of milnacipran may have been derived primarily from its direct analgesic effect by activation of both the noradrenergic and serotonergic neurons, which consist descending inhibitory nerves of the central nervous system. In addition, the early starts of pharmacotherapy and psychotherapeutic intervention were also considered to be effective.

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