Three primary care-related association existed in Japan. These 3 societies are Japanese Medical Society of Primary Care, Japanese Academy of Family Medicine and Japanese Society of General Medicine. From 2007 we started discussing a merger agreement of 3 academies into one association in order to train primary care physicians in the coming generation. The New Japan Primary Care Association (JPCA) was established in 2010. The Japanese Association of Medical Sciences accepted JPCA as a member in 2011. The specialty of general physician is approved by the Japanese Medical Specialty Board.

Bio-psycho-socio-ethical approaches in psychosomatic medicine have significant meaning as the core of holistic therapy in primary medicine, but it has been difficult to fully implement such an approach at exhausted medical sites in recent years. Therefore, in Yamanashi Prefecture, Japan, we are conducting an educational campaign focusing on the following topics as a new approach related to knowledge and technologies of psychosomatic medicine. Furthermore, for pathological conditions, which are likely to be avoided by general practitioners and hospital departments for outpatients, including not only psychosomatic disorders but also indefinite complaints and social withdrawal, we believe that dissemination of a versatile, stratified approach via information sharing and cooperation to deal with a situation based on the cooperative efforts of multiple occupations, different types of clinics (clinic-clinic), and general hospitals and clinics (hospital-clinic) exploiting the latest information technology are important due to the currently limited medical resources : therefore, we actively engage in these practices. We aim to enhance the collaborative area and make psychosomatic medicine in community medicine more satisfactory by improving medical practice and training. ・Elucidation of psychosomatic correlations by observing living environments in detail ・Utilization of positive halo effects and placebo effects ・Check rapport on a daily basis and also use cathartic effects ・Be with patients for adequately long periods based on general psychotherapy ・Strive to achieve early improvement of pathological conditions by swiftly solving problems (e. g., adjustment of human relations) ・Support patients in accepting anxiety by applying the approach used in Morita therapy ・Take a cognitive therapeutic approach suited to the occasion, rather than being manual-based ・Aim for mental growth and personality change via non-directive counseling ・Keep oneself therapeutically up-to-date and fill the gap between medicine as science and interpersonal contact based on evidence-based medicine as well as narrative-based medicine.

Background : I adopted new techniques of psychosomatic medicine, and then investigated how these techniques had an influence on the medical treatment contents. Methods : The items which I considered to improve medical treatment contents are as follows: Medical interview, Method of communication, Space of medical treatment, Discovery and development of the ability of the medical-staff, Modified sand play, Autogenic training and Non-nutritional diet. Results : I summarize these attempts based on my impression. The methods judged to be effective are as follows: ①We made an effort to find a person having the remedial ability and give her position of our medical staff, ②Every patient needs some incentives, and then gets a deep satisfaction. ③Feeling of satisfaction after the consultation leads their diseases to the healing. Considerations and conclusions : The medical treatment is based on a contract and has contrastive character in comparison with a service industry. Techniques similar to economics and business administration sometimes gains successful result in the medical fields. These results introduce some transformation of my view of the world and view of life.

The significant feature of Division of General Internal Medicine in Kansai Medical University is that it belongs to Department of Psychosomatic Medicine. In the division, we instruct student doctors and residents not only in psychosomatic medicine itself, but on how to utilize it in the clinical practice of general internal medicine. To acquire the basic psychosomatic approach for primary care physicians is considered to be as material as that physicians acquire the skills of BLS/ACLS. Japanese Board of Medical Specialties will certificate general internal medicine as one of the fundamental training areas for specialties, and which can be a golden opportunity to spread the base of psychosomatic medicine to primary care physicians. In this article, we introduce such activities for education and enlightenment of psychosomatic medicine in details.

There are several common thoughts between psychosomatic medicine and primary care, such as holistic approach, health promotion, and mental health. It is important to consider the role and importance of psychosomatic medicine in the field of primary care, because it helps to promote the development of psychosomatic medicine. Furthermore, by reconsidering the learning subjects and the common point between psychosomatic medicine and primary care, we think about the theory needed in primary care.

The psychosomatic medicine regards Kampo medicine as an important tool of the treatment because they have similar points of view of humanity. The examination of prescription in outpatients for 3 months in Kansai Medical University Hospital indicated that 26.0% of Kampo medicine was prescribed by the department of psychosomatic medicine. Gynecology (10.9%), digestive surgery (6.5%), and general internal medicine (5.8%) also prescribed relatively a lot of Kampo medicine. The department that made the most number of prescriptions of Kampo medicine per patient was psychosomatic medicine (0.63). General internal medicine (0.15) and psychiatry (0.12) were after that. The variety of prescription is highest in the department of psychosomatic medicine which used equally many kinds of Kampo medicines like general internal medicine. On the other hand, the department of psychiatry and digestive surgery had a tendency to use a large amount of a few kinds of Kampo medicines. Regarding the education of Kampo medicine we have given students in the grade 3 lectures of oriental medicine in eight fiftieth periods as undergraduate education. We also sponsored a clinical conference once a year, and furthermore the cooperation group composed of several departments has held a seminar once a year and beginners seminar twice a year.

In the fields of psychosomatic medicine, the number of case reports and evidence reports using Kampo medicine has been increasing, and many psychosomatic physicians are interested in the efficacy of Kampo therapy. But in clinical practice, Kampo is used still within the share of evidence based medicine (EBM) or simply used as a complementary and alternative medicine (CAM) among the psychosomatic physicians. Thus, there is little opportunity to discuss about Kampo therapy as a psychosomatic therapy. When we use Kampo therapy psychosomatically, we would get merits as follows. 1 : Strengthening and facilitating the therapeutic relationship through the examinations. 2 : Efficacy as a Biological Response Modifier (BRM). 3 : We can use somatic approach, when the case is difficult to treat with the psychic or verbal approach. 4 : Usefulness of reducing psychotropic drugs. 5 : Synergy effect by combining with the traditional psychosomatic approach. In this paper, while explaining about these five benefits along with the case presentation, we would like to outline the Kampo treatment as a psychosomatic therapy.

In Kagoshima University Hospital, Kampo Medical Center was established in 2012. There, we try to perform several achievement to improve clinical, research, and educational performance. Kampo Medical Center is consist of the member from several departments, including obstetrics and gynecology department, pain department, dentistry department as well as psychosomatic medicine department. Kampo Medical Center has the function to cooperate each department and cross-sectional work, then act in the field of clinical, research, and education. We induce the simulated training and problem based learning to learn Kampo medicine. In research field, we publish several paper and reported the mechanism and the effect of Rikkunshito in cancer. Herein, we discuss about the works Kampo Medical Center has done for the development of Kampo medicine.

Objectives : Patients with eating disorders may have numerous dental caries and intraoral diseases such as dental erosion. The aims of this study were to investigate the experience of dental caries in patients with eating disorders and to elucidate factors affecting dental caries. Subjects : The study population included 87 patients with eating disorders (86 women, 1 man ; mean age, 31.6 years) who visited our clinical center of psychosomatic dentistry, a psychosomatic internal medicine department, or were hospitalized at a psychiatric hospital. Methods : Experiences of dental caries were assessed by oral examination using the Decayed, Missing, and Filled Teeth (DMFT) index. Patients were then categorized into a group with higher DMFT index scores (high group, n=63) or lower DMFT index scores (low group, n=23) based on the results of a 2011 survey of dental diseases. One patient whose DMFT index score was the same as the average score determined in the survey of dental diseases was excluded. Intraoral status, daily habits, and other parameters were compared between the two groups using the Student’s t-test and chi-square test. Results : No significant differences were found between the two groups in eating disorder duration, frequency of tooth brushing, or amount of residual plaque. However, the prevalence rates for bulimia, self-induced vomiting, and daily consumption of sugar-sweetened foods were significantly higher in the high group than in the low group (p<0.05, p<0.01, and p<0.01, respectively). Patients in the high group also had significantly more severe tooth erosion than did patients in the low group (p<0.01). Conclusions : Dental caries experiences in patients with eating disorders were more strongly associated with eating disorders symptoms than lack of daily dental care. In addition to providing patients with eating disorders with ordinary oral hygiene instruction, it may be necessary to monitor eating disorders symptoms and provide treatment in close cooperation with other medical professionals.

Adrenocortical insufficiency presents non-specific symptoms including anorexia, nausea/vomiting, fatigue and depressive mood. Here we report three cases whose diagnosis was initially depressive disorder but finally pituitary adrenocortical insufficiency referred to department of psychosomatic medicine. Case 1 : A 59-year-old man was admitted to our hospital with severe nausea, vomiting, depressive mood, and weight reduction. Biochemical examination showed hypoglycemia and hyponatremia. Serum cortisol was 1.03 μg/dl and plasma adrenocorticotropic hormone (ACTH) level was below 5.0 pg/ml. He was definitely diagnosed as isolated ACTH deficiency. Case 2 : A 77-year-old man was hospitalized due to depression and lower back and extremity pain appeared from the death of his dog. Cortisol and ACTH levels were 4.21 μg/dl and 5.7 pg/ml, concomitant with Rathke’s cleft cyst in the brain magnetic resonance imaging. Secondary adrenocortical insufficiency was diagnosed. Case 3 : A 47-year-old man was admitted to our hospital with nausea, vomiting, anorexia, and depressive mood appeared from the Great East Japan Earthquake. Biochemical examination showed normal findings but cortisol was and ACTH levels were cortisol<0.8 μg/dl, ACTH<2.0 pg/ml respectively. He was diagnosed as partial pituitary adrenocortical insufficiency complicated by hyperthyroidism. If a patient presenting non-specific somatic symptom or depression was referred to psychosomatic medicine, it is necessary to examine the adrenocortical function for differential diagnosis.