Recent years, our medical understanding of unexplained abdominal symptoms has been progressing within the framework of functional gastrointestinal disorders. On the other hand, about half of the symptoms still stay in an empirical understanding. I assume the reason of this delay is derived from the complexity of mind-body interaction. In order to reconstruct their medical understandings, I focused my attention on the important point of clinical experiences and named them with my brief clinical comments. The names of these symptoms include gastrointestinal gas, nausea and vomiting, biliary dyskinesia, chronic pancreatitis, nervous abdominal tonic distention, pain of the gastrointestinal adhesion, gynecological abdominal pain, and abdominal symptom of the psychiatric disease.

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In the 18^<th> century, the Belgian chemist J. B. van Helmont created the word "gas" from the Greek "khaos", and the gaseous symptoms of patients can indeed be chaotic. In this paper, the physiology of gastrointestinal gas is studied. It can be quite difficult to solve the problems related to the distressing symptoms caused by gas, and we must care for these unfortunate patients with a sympathetic and compassionate attitude. Cases of the belching and flatus are presented and some observations are made.

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Nausea with/without vomiting is a common symptom relating to gastro-intestinal illness. However, many causes can evoke these symptoms and the mechanisms of such condition are usually very complicated. Psychosomatic medicine has challenged to approach the "sickness of the individual patient", through acknowledging the illness narratives, telling and listening of the subjective and singular experience of patients' suffering. In the present paper, a text of dialogue is demonstrated, between a female university student with chronic nausea and the author on the Web, and the "narrative acts" in this interaction are inspected and examined. The author concludes that the most important rules of thumb in this area may be; 1) Each patient lives his/her individual, different world of experience, 2) Patients' suffering can only be approached through careful attention and listening to their illness narratives, 3) Simple application of a given rule of thumb to an individual patient may be usually of no use, and, 4) Co-creation of new stories through sincere and carful exchange of the text (i.e. dialogue) can be effective in this kind of clinical practice.

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Both possible chronic pancreatitis and biliary dyskinesia are disorders which show no organic abnormalities, and their chief complainant is upper abdominal pain. Sphincter of Oddi dysfunction (SOD), which is caused by abnormal sphincter of Oddi manometry, may include the above two diseases. They are quite often affected by psychosomatic factors, and many of them accompany other functional gastrointestinal disorders. They can be considered as functional somatic syndrome, and coefficient of variation of R-R intervals (CV_<R-R>), which is an index of parasympathetic function, is useful to assess the condition of the patients. To evaluate CV_<R-R> on various states makes it easy to turn their eyes to their own daily life, and leads to practice psychosomatic medical treatment.

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Neurotic Abdominal Distention occurs often paroxysmally due to hypertension of abdominal muscles, and eventually causes partial elevation of lower abdomen. This phenomenan is related with psychological and emotional factors. It is regarded as somatoform disorder or conversion disorder from the standpoint of psychosomatic diagnosis. In other words, various inner cofliction, anxiety, anger, sadness and etc. inside the patients that are still not expressed seem to cause abdominal distention as a kind of somatization. Therefore, psychosomatic approach is thought to be useful to verbalize uncleared emotions of the patient with this disease. Finally, the therapeutic goal is facilitating the patients to notice and understand the relationship between mind and body. In this paper the author will outline Neurotic Abdominal Distention reviewing past literatures, and suggest the therapeutic points, showing one case with this disease who have examined and treated by the author.

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Functional chronic post-surgical pain (CPSP) is an unrecognized clinical condition. Several decades ago, CPSP after abdominal surgery was thought to be caused by occlusion, which in turn was due to peritoneal adhesion, even in patients without findings like ileus. Such patients who underwent frequent surgeries were called ploy-surgery patients, and their symptoms were more complicated. However, the recent effort to avoid unnecessary surgery has decreased the number of poly-surgery patients. Several possible risk factors for CPSP have been reviewed. These factors also include preoperative psychological factors, such as depression and anxiety; however, different studies have reported different findings. The intensity of acute post-surgical pain is the most consistent factor. Analgesic techniques for acute post-operative pain may be useful for preventing CPSP. If CPSP is aggravated, the treatment of some patients by conventional clinical approach alone becomes difficult. In such cases, treatment using the psychosomatic approach is often required. We treated 2 patients with CPSP in our hospital. The first patient was a typical CPSP patient whose psychological stress was somatized as abdominal pain. In the second patient, organic diseases caused abdominal pain, and psychological factors acted as promoting factors. However, understanding the interaction between the 2 factors is difficult for the patients. In conclusion, the preoperative psychological symptoms are not necessarily risk factors of CPSP; however, the psychosomatic approach is essential for the treatment of CPSP patients with such symptoms.

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Lower abdominal pain, especially pelvic pain, is one of the main symptoms of clinical medicine in the department of Obstetrics and Gynecology. In cases with lower abdominal pain due to diseases originated from the female reproductive organs, incidence of pelvic endometriosis, ovarian swelling and clamydia infection are usually high. Dysmenorrhea and chronic pelvic pain are observed as the high frequency of disease without organic abnormality in practical gynecologic medicine. They often constantly have a medical examination namely doctor shopping. Therefore, they may need psychosomatic clinical technique as well as common counseling for the medical treatment.

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There are many patients with depression and panic disorder who are suffering from somatic symptoms such as abdominal complaints. We showed a report of stress related disorders which are consistent with other reports. We find nothing special in these patients at somatic service, but their symptoms do not improve only by medication or counseling. Especially it is not good for the patients to be addicted to benzodiazepine, and co-dependent in the doctor-patients relationship. It is necessary for them to be treated by psychosomatic approach as those with functional dyspepsia. In this paper, we introduce proper medication, CBT, breathing, Health-art theory (propounded by Yujiro Ikemi), and complementary-alternative therapy for them.

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In the history of behavior therapies for inpatient treatment of anorexia nervosa (AN), behavior restrictions have been used in an attempt to remove various stimuli that sustain a vicious cycle of abnormal behavior. This is also aversive conditioning, whose aim is to guide the patient toward appropriate behavior. However, Fukamachi adopted a psychotherapeutic method where a daily self-report is incorporated into a traditional operant-conditioning inpatient protocol, which includes behavior restriction. He named this "Behavior-Restriction Therapy". In two books (1987, 1989), he hypothesized that the protocol's dual structure could disrupt an AN inpatient's rigidly fixd ideas about food and weight. In this study, we examined the Fukamachi's hypothesis with a questionnaire and the follow-up survey. The "Behavior-Restriction Therapy" was applied to 31 serious and moderate female anorectics (AN-restricting type [n=13] and AN-binge eating and purging type [n=18]) who were admitted to the internal medicine and rehabilitation wards of our hospital between 1998 and 2004. The questionnaire was administered upon discharge. When asked what contributed most to their recovery, 18 of the 31 people (58.1%) said the behavior restriction, four people (12.8%) said the removal of the restriction, 8 people (25.8%) said both, and one patient (3.2%) credited another factor. Most of anorectics commented that although the restriction caused them anguish at first, it also brought them relief and respite, either at the time it was applied or in the long run. The follow-up surveys were administered for at least three years, on each occasion to assess eating behavior and social adaptation. Twenty-nine of the 31 former patients were able to be tracked in this way. The surveys revealed that 14 out of 16 anorectics among those who had felt that the restriction contributed most to their recovery were able to normalize their eating behavior. But all four people who had attributed their recovery to the removal of the restriction suffered a recurrence of abnormal eating behavior. These findings suggest that the use of the behavior restriction, as applied in Fukamachi's inpatient protocol, is more than simply aversive conditioning, it can actually help anorectics change dysfunctional thinking patterns responsible for their abnormal food intake and weight control behavior.

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The effects of cognitive behavior therapy on Meniere's disease were examined through conducting cognitive behavior therapy by a clinical psychotherapist, inner ear treatment and psychotropic drug therapy. The patient was a 52-year-old woman with agoraphobia without panic disorder that was affected by the psychosomatic symptoms of Meniere's disease. Though her psychosomatic symptoms got better after inner ear treatment and psychothropic drug therapy, anticipatory anxiety persisted. Decreasing psychoactive drugs resulted in the worsening of her anxiety and physical symptoms. Therefore, she was treated with cognitive behavior therapy using phased exposure to eliminate avoidance behavior and cognitive restructuring to change her cognitions about the dangers of her physical symptoms. The result indicated that anticipatory anxiety, which caused aggravation of symptoms and relapses improved, agoraphobia disappeared, and psychosomatic symptoms were remarkably improved to the extent that medication could be stopped. This case study suggests the effectiveness of cognitive behavior therapy for the treatment of Meniere's disease associated with psychosocial factors.

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