心身の環境因子と精神 ― 自律神経 ― 内分泌系 Psychoneuroendocrine Aspects in Psycho- and Somatic Environmental Factor
人間の寿命は70年±10年であり, 無限の空間と久遠の宇宙実存において思惟するならば, 人間の一生は瞬時の生命に過ぎない。しかし, その間, 先天的な素因, および, 環境要因に加えて, 感情や意志, すなわち, 人間の大脳皮質, とくに, 新皮質の神経細胞の機能が, 個体のhomeostasisを司る内分泌一自律神経系に種々の影響を及ぼして疾病が発生し, また, 多様な予後を示すので, 心身相関の問題は, 疾病の発生, 経過, および, 治癒の上に極めて重要である。したがって, 疾患の発生機序について, 心理学, 内分泌学, ならびに, 自律神経学の3方面から, 系統的な研究, ならびに, 考察を行い, 疾患のとらえ方に新しい概念を導入した。そして, この概念に基づいて疾患の診断と治療を行なう意義の重要性を提起した。その具体例として, 内分泌疾患, 自律神経失調症, および, 分娩における, 心身の環境因子と精神－自律神経－内分泌系との関連について研究を行った成績を述べた。
The limblic system and the hypothalamus appear to mediate the somatic manifestations of emotion by acting as a bridge between the neocortex, the autonomic nervous system and the endocrine glands. In this manner, emotions may cause a multitude of endocrine and autonomic reactions, such as increased or decreased secretion of hormones, increase in blood pressure, increased smooth muscle activity of the uterus, and other organic or functional changes. The purpose of this presentation was to investigate the psychoneuroendocrine aspects in diseases, namely, endocrine diseases, vegetative disturbance, and childbirth. New Concept of Diseases － Systematic considerations have been made regarding the mechanism of development of diseases from three points of view, viz., psychology, endocrinology, and neurology, in an attempt to view diseases as a whole from a new concept, as shown in table 1. The f<sub>1</sub> stands for psychogenic fitness, f<sub>2</sub> for somatic fitness, x for genetic factor, y for situational factor, t for time factor, and z for disease. For example, the endocrine disorder that develops from the x under f<sub>1</sub> is of a congenital nature, and anorexia nervosa belongs to this group. Mental conflict at home and anxiety at work may be cited as y under f<sub>2</sub>. The endocrine disorder indicatated by the x under f<sub>2</sub> is a case of chromosomal disorder, such as Turner's syndrome and testicular feminization syndrome. Inadequate use of hormones, dietary restriction (for weight reduction), and massive postpartum hemorrhage may be cited as y under f<sub>2</sub>. The t under f<sub>1</sub> means the period after a psychological load (mental stress)has been applied, and the t under f<sub>2</sub> indicates the period after a somatic situational load has been applied. Effects of Autogenic Training by Schulz & Luthe － The therapeutic results of autogenic training for gynecological disorders were as follows : (1) Ovulation occured in all cases of 3 anovulatory cycles. Two of these patients became pregnant. (2) Menstruation appeared in 12 cases of 16 amenorrheas. (3) It has been possible to achieve a definite improvement of the vegetative syndrome in 45 cases of 53 vegetative disturbances. Psychoneuroedocrine Aspect in Childbirth － The main part of autogenic training of pergnant women is education prior to labor. Through this education, pregnant women come to understand the physiological aspects of pregnancy, Iabor, and its pains, so that fear and anxiety can be eliminated. At the same time, pregnant women receive instruction in antenatal bodily exercises, that is, supplemental gymnastics. The results of autogenic training were as follows: (1) Labor pain was decreased in the group treated with autogenic training. (2) Consideration should be directed towards what influence autogenic training has on the plasma concentration of 11-OHCS immediately after delivery. From these results it was concluded that for women who had attained adequate relaxation and whose fear and anxiety had been eliminated, the levels of plasma 11-OHCS remained low immediately after delivery, and the length of labor was shortened, indicating a beneficial influence from autogenic training on the mechanics of childbirth. Since successful therapy must be directed to the emotional factors, one must possess a good knowledge of the patient's physical and mental environments as they interact to produce symptoms.
産業医大誌 1(1), 91-102, 1979