情報：農と環境と医療18号

Allow me to make a few remarks as representative of the organizer in relation to Kitasato University's 1st Agromedicine Symposium.

One of the trends of modern science is a move away from specialization (partial optimization) towards a more holistic approach (overall optimization). In the past, this was not always the case. For example, the increasing segmentation of a university into individual faculties and departments was considered vital to the development of various fields of study. In physics for example, this approach led to the identification of quarks as the ultimate building blocks of matter, while in biology this approach led to dramatic advances being made in elucidation of cells at the DNA level. This reductionismーbreaking things down into ever smaller, ever more basic unitsーserved as the backbone of modern science and, particularly in the 20th century, produced astounding results. However, from the second half of the 20th century, we have witnessed the emergence of an array of issues of global scaleーenvironmental pollution, resource depletion, famine, population explosion, and so forthーthat reductionism is ill-equipped to address. While these each have their own fields, they are all part of the same chaotic current; looking at each issue individually would be like investigating individual waves and eddies in the flow of a huge river, and failing to grasp the underlying forces involved. In other words, reductionism with its endless segmentation and compartmentalization can cause one to lose sight of the ties between different issues and at times fall into the trap of drawing dichotomies and seeing things in terms of binary oppositions. The vicious circle that arose in 20th century society between economic growth and environmental degradation is a prime example. What is required is an ecological approach that looks at relationships between the different components of a single ecosystem. And in the present time of increasing interplay between science and technology, the integration of science with ethics is also a crucial requirement. Environmental ethics and bioethics are 2 key examples. I feel that it is only natural for science in the 21st century not so much to reject reductionism, but rather to seek to go beyond it to arrive at a new intellectual paradigm.

Such is my basic understanding of the current shift in intellectual paradigms. At this university, in the tradition set by our founder Shibasaburo Kitasato, we are beginning to integrate agriculture, environment, and medicine as a model for the development of a unified intellectual approach. It is my fervent hope that this symposium will serve as a forum for valuable and pragmatic discussion that gives birth to new ideas and hints for a higher-level holistic approach to food, environment, and health issues. I would also like to express my heartfelt thanks to Chiba University and Tokyo University of Agriculture for their support of this event, and to all of the Nihon University faculty who have helped.

Foreword

Geared to mass production and economic efficiency, modern agriculture has become an intensive system that, with the use of chemical fertilizers, agricultural chemicals, and synthetic materials, has been able to produce large quantities of food for the growing human population. However, the enormous resources and energy poured into this system of mass production have caused environmental headaches of various kinds, from localized problems such as heavy metal contamination, to more widespread problems such as the eutrophication of rivers, lakes, and marshes due to runoff of nitrogen and phosphorus, and global warming caused by methane and N2O emissions. More recently, problems such as dioxin emissions with impacts that span generations have emerged, bringing grave implications for human health and the global environment.

Along with progress in fields of medicine such as microbiology, immunology, clinical medicine, and pharmacology, advances in nutrition science have enabled many people to surmount illness and improve their health. At the same time, the many different chemical substances invented or discovered in the process have given rise to drug-related diseases and other problems, providing insights that have driven the further evolution of clinical medicine. There are also unresolved issues related to "human healing" and so forth.

The goals of preventive medicine in the 21st century include the assessment, management, and communication of risk, prevention of disease, and the improvement of health. To address the expectations of society today, it is vital now to investigate and establish common ground between these medical issues and agriculture.

The outcomes of 20th century scientific and technological advances suggest very strongly that research and education in agromedicine will be absolutely vital to human society in the 21st century. The need for such research and education to prevent disease, promote health, ensure food safety, practice environment-friendly agriculture, benefit from the therapeutic value of agriculture, and otherwise ensure human happiness cannot be overstated. Considering the veracity of the saying "We are what we eat", I feel that not enough attention has been paid to agromedical research and education.

A major problem in modern society is disjunction in its various formsーdisjunction between people, between teachers and students, between soil and nature and people, between facts, between culture and history and the present time, and so forth. The list could go on and on, but disjunction illness could be divided roughly into 4 categories: disjunction between knowledge from knowledge, between knowledge and action, between knowledge and feelings, and between past and present knowledge. Disjunction exists also between agriculture and medicine, and surmounting this disjunction requires an all-embracing, multi-disciplinary approach to research and education in areas of overlap between agriculture and medicine.

1. World trends

Kitasato University has long dedicated itself to the comprehensive pursuit of life sciences, but agromedicine is nevertheless a relatively new field for us. Overseas, the North American Agromedicine Consortium (NAAC) has been publishing the Journal of Agromedicine and a newsletter since it was established in 1988, and there are a number of other publications which I will skip owing to lack of space. I want to look here at a number of different international initiatives and topics in agromedicine, and try to identify the underlying trends in this discipline.

(1) International Nitrogen Initiative (INI)

A century has gone by since the Haber-Bosch process was first used to fix atmospheric nitrogen, and currently 270 Tg (1012 g) of nitrogen is being fixed every year. Surplus fixed nitrogen is beginning to have major impacts on the natural environment and human communities, such as nitrate-polluted groundwater, eutrophication, destruction of the ozone layer, global warming, blue baby syndrome, nitrate-polluted crops and livestock, effects on human health, and so forth. There is an urgent need for research on the effects on human health of surplus nitrogen in food and the environment, and for the implementation of appropriate countermeasures. The International Nitrogen Initiative was launched to address this issue. (http://www.initrogen.org/)

(2) European Nutrigenomics Organization (NuGO)

Nutrigenomics is the study of how nutrients from food affect the expression and regulation of genes. Nihon University's Professor Takafumi Kasumi gives a detailed presentation of the field in his talk. There has never been a greater need than there is now for research in combined fields, and nutrigenomics is one such combined field. Nutrigenomics combines elements of genomics, computer science, immunology, pathology, agriculture, oceanography, environmental science, analytical chemistry, and life sciences in relation to various foodstuffs to assess health, illness, and stages in between from the viewpoint of diet. As such, nutrigenomics is a combined field that feeds into agromedicine.

(3) Persistent organic pollutants (POPs)

POPs are not only highly toxic, but also degrade only very slowly in the environment, and tend to accumulate within living organisms. POPs circulate through the atmosphere, soil, water, and organisms to contaminate manufactured foodstuffs. Currently aldrin and eleven other substances are subject to the Stockholm Convention on POPs. (http://www.pops.int/)

(4) Codex Alimentarius Commission

Created jointly by the FAO and WHO, the Codex Alimentarius Commission is an international food standards organization dedicated to protecting the health of consumers and ensuring fair trade practices in the food trade. For example, the Commission's Ad Hoc Intergovernmental Task Force on Food Derived from Biotechnology (host country: Japan) handles such issues as latent risks to human health of consuming food products derived from genetically modified (GM) animals, food products derived from GM plants that can contribute to nutrition or health, GM adulteration, and GM plant-derived foods containing pharmacological ingredients and bioactive substances. (http://www.codexalimentarius.net/)

(5) Global Environmental Change and Human Health (GECAHH)

One of the components of the International GeosphereーBiosphere Programme (IGBP) is the Earth System Science Partnership (ESSP). ESSP activities include joint projects, one of which, Global Environmental Change and Human Health (GECAHH), emphasizes the need for linkage between agriculture, environment, and medicine.

(6) Avian influenza virus (AIV)

AIV was up until recently carried naturally by waterfowl, curlews, and plovers, but owing to factors such as international trade and the industrialization of poultry farming, AIV ecosystems, distribution, range of hosts, and pathogenicity have changed extensively. The global pet bird trade; duck farms; open-range poultry farms; the transport and sale of live poultry, pet birds, and fighting cocks; and the increasing scale of poultry farms have all played a part. According to the WHO, as of July 20, 2006, 230 persons in 10 countries had been infected by H5N1 AIV, with 133ーalmost halfーdying as a result.

(Joho: NouーKankyoーIryo[Newsletter: Agriculture, Environment, and Medicine] No. 16, pp. 10ー11, pub. Kitasato University)

2. Domestic (Japanese) trends

(1) ChibaUniversityCenter for Environment, Health, and Field Studies

Since Chiba University President Toyoki Kozai introduces the Center's activities in his talk, I will skip details here. (Joho: NouーKankyoーIryo[Newsletter: Agriculture, Environment, and Medicine] No. 1 pp. 10ー12, No. 2 pp. 4ー5, pub. Kitasato University)

(2) ShimaneUniversity MedicineーIndustryーAgriculture Project for a Long and Healthy Life

Committed to research in areas of overlap between medicine, industry, and agriculture Shimane University has launched its "MedicineーIndustryーAgriculture Project for a Long and Healthy LifeーDeveloping a New System for Analyzing Human Health and Functional Foods Derived from Local Produce", a journal for which is already being published.

(Joho: NouーKankyoーIryo[Newsletter: Agriculture, Environment, and Medicine] No. 8 pp. 18ー19, pub. Kitasato University)

(3) Science Council of Japan: Consolidation of 7 divisions into 3

The Science Council of Japan's 3 humanities divisions (Literature, Law Economics) and 4 natural sciences divisions (Physical Sciences, Engineering, Agriculture, Medicine) have been consolidated into 3 divisions (Humanities, Life Sciences, Physical Sciences and Engineering), and jurisdiction has been transferred from the Minister of Public Management, Home Affairs, Posts and Telecommunications to the Prime Minister. The consolidation of physical sciences, agriculture, and medicine into a new Life Sciences division signals the need for collaboration between agriculture, environment, and medicine.

(Gakujutsu no Doko[Trends in Academia] November 2005; Joho: NouーKankyoーIryo[Newsletter: Agriculture, Environment, and Medicine] No. 9 pp. 3ー4, pub. Kitasato University; Science Council of Japan website: http://www.scj.go.jp/en/)

(4) Animal-assisted therapy (AAT) and animal-assisted activity (AAA), companion animals

Topics include the influence of companion animals on child development, companion animals and elderly people, influence of companion animals on human physiology, and the use of companion animals in therapy.

(Joho: NouーKankyoーIryo[Newsletter: Agriculture, Environment, and Medicine] No. 5 pp. 8ー15, pub. Kitasato University)

(5) 2005 White Paper on Agriculture: Food Safety, Health, and Medicine

The Ministry of Agriculture, Forestry and Fisheries submits a white paper to the Prime Minister every year, and its 2005 White Paper on Food, Agriculture, and Rural Areas contains a number of new items pointing to the need for collaboration between food safety (agriculture) and health (medicine), including: "Ensuring Food Safety and Consumer Confidence: BSE and Highly Pathogenic Avian Influenza", "Food in Relation to Health and Healthcare", "Improving Dietary Habits", "Dietary Education", "Initiatives to Ensure Food Safety", and "New Initiatives for Rural Areas Focused on Health and Welfare".

3. Affinity between agriculture and medicine

Agriculture and medicine were once intimately tied, and are taking the same path even today. The following is an outline of this affinity from a historical perspective.

(1) It can be surmised from burial remains when people started to use rituals, and it was from these rituals that possibilities for the medical act of cleansing emerged. Agriculture, too, demanded the use of rituals to beseech the gods for the protection of crops from storms, drought, and other calamities.

(2) As civilization emerged, it gave rise to the study of medicine. Civilization in turn owes its emergence to agriculture, and in what was a synergic relationship, civilization prompted the further growth of agriculture as it developed.

(3) Hippocrates established medicine as a discipline that has served humankind ever since by teaching that disease is not caused by supernatural forces, but is rather a natural phenomenon that can be understood by utilizing rational concepts and learning from experience. In the same way, people came to learn that wheat and barley, which are among the most ancient grain crops, could be cultivated practically, rather than just left to propagate naturally.

(4) Religions such as Confucianism, Taoism, Buddhism, Hinduism, Christianity, and Islam emerged to have immeasurable impacts on medicine, both materialistically and spiritually. Various types of agriculture, including Mediterranean, savannah, root cultivation, New World, and rice cultivation, also emerged to influence the science of agriculture.

(5) The "live" fields of surgery, anatomy, and physiology developed during the European Renaissance, leading to a flowering of hospital-based medical care. Meanwhile, field studies led to the development in European agriculture of the 3-field system and other crop rotation systems.

(6) The quality of life and health of workers deteriorated under the capitalism of the Industrial Revolution, prompting the rapid development of public hygiene and social medicine studies. Crop rotation enabled the feeding of the Industrial Revolution's growing urban population. Landowners adopted the Norfolk system of crop rotation in increasing numbers.

(7) Lab-based medical research focused on the cause and prevention of epidemics began to develop in earnest from the latter half of the 19th century. In 20th century, Biochemistry merged with molecular biology to become a powerful tool for investigating life processes. In agriculture, crop yields increased considerably as the manufacture and use of chemical fertilizers and agricultural chemicals took off. Later advances in molecular biology led to the birth of genetically modified crops.

(8) Just as there is alternative agriculture, there is also alternative medicine. The former covers alternatives to agrochemical-based intensive cultivation methods, while the latter covers alternative treatment methods to the "Western" medicine that has become the mainstream today. Both alternative agriculture and alternative medicine incorporate the holistic approach of life sciences.

(9) The mapping of both the human genome (medicine) and the rice genome (agriculture) was completed at the start of the 21st century.

4. Cooperation between Agriculture and Medicine

As explained above, agriculture and medicine share the same roots and have followed similar paths historically. They also both have a vital role to play in today's disjointed society. The following is a listーin no particular orderーof areas of overlap and cooperation between agriculture and medicine:

Physiology, endocrinology, nutrition and vitamins, infectious diseases, biochemistry and molecular biology, environmental pollution, medicinal plants, use of eco-friendly agricultural produce, functional foods, animal therapy, diagnosis with positron emission tomography (PET), and facilities such as Kitasato Research Center of Environmental Sciences that will become increasingly essential for the way they enable integrated agricultural, environmental, and medical analysis.

Closing comments

The 11th chapter of the Tao Te Ching, a seminal ancient Chinese work said to have been penned by philosopher Lao Tsu, the father of Taoism, contains the following words:

"Thirty spokes join together in a wheel, but it is the centre hole that makes the wagon move. We shape clay into a pot, yet it is the emptiness that we use. We fashion wood for a house, but it is the inner emptiness where we live, and the empty holes of windows and doors that makes it livable. Therefore, being is what we have, but non-being is what we use."

This passage points to a fundamental principle for integrating diversity. Put another way, it could be interpreted as expressing the essence of the relationship between agriculture, environment, and medicine; or between food, soil and water, and health. The lump of clay, or the windows and doors represent specialization and differentiation, whereas the wheel, pot, and house represent the integration of diversity. You could say that the presentations being giving at this symposium are like the clay and windows, and we still have not made the wheel, pot, or house. The "house" of agromedicine cannot be built overnight, but is rather something, I feel, that will develop gradually through the enthusiasm, cooperation, support, and efforts of a great many people. I see this symposium as a door of a house that will someday come into being. It is my hope that you will all pass through this door and go on to help build the house as you see fit.

I would be delighted if this symposium serves as a new forum for the communication of information on research and education in the field of agromedicine. Hopefully it will lead to the creation of a "house" of agromedicine, even if only a very modest one.

References

Joho: NouーKankyoーIryo（in Japanese）[Newsletter: Agriculture, Environment, and Medicine] pub. Kitasato University. Available at the following Kitasato University web page:http://noui.kitasato-u.ac.jp/spread/newsletter/

1. Foreword: The various stresses of present-day urban living

People living in modern society, particularly urban environments with high population densities and the latest technology, face an array of emotional and environmental stress. Emotional stress can lead to such conditions as a loss of the will to live, loss of contact with others, social withdrawal, NEET (Not in Education, Employment or Training) status, and depression, while environmental stress manifests itself as increasing waste output, pollution, loss of nature, resource depletion, and such like. These phenomena are related to a breakdown in social norms, increase in crime, growing poverty, and increasingly fierce competition. In countries with declining and increasingly graying populations, moreover, rising healthcare costs and taxes further complicate the above issues. These different stresses are related to and affect each other in complex ways, which means that rather than trying to eliminate them singly, we need to take measures to identify and tackle common underlying factors.

2. Keywords for the relief of stress: Oriental philosophy and culture, horticulture and plants

The various issues and stresses mentioned above are spreading worldwide, and becoming increasingly serious. Many different countries have come up with ideas and methods for resolving themーideas and methods that can often be encapsulated by such keywords as recycling, low-impact, eco-friendly, sustainable development, resource-efficient, return to nature, slow life and slow food, finding fulfillment and a sense of community, working together, safety and peace of mind, intellectual value, "What a waste!", "Let's do something about it!", and so forth. We at our Center have added the keywords of horticulture and plants, and oriental philosophy and culture to this list.

3. Mission and goals

The goals of the Center were defined as follows when it was founded:
 (1) Creation of an environment that ensures human health, and particularly the health of children, the aged and handicapped, and following generations (2) Creation of a symbiotic society in which health, welfare, caregiving, education, and production are approached from a unified mindーbody approach (3) The practice of healthcare that utilizes life force and natural recuperative powers, and the practice of resource efficiency, protection of the environment, recycling of materials, cultural creation, bioproduction, and horticulture, along with the emotional satisfaction that derives from the above practices (4) Practical research and education and training of human resources based on interaction with industry and local communities

4. The Center's research areas

The key areas of research envisaged at the time of founding of the Center are as follows:
 (1) Use of the beneficial effects of contact with plants and nature in the practice of oriental medicine and caregiving, and the practice of preventive medicine, environmental education, and horticultural therapy
 (2) Universal design and use of facilities and equipment for caregiving, rehabilitation, and crop production
 (3) Development of agricultural production systems that put priority on health and producer satisfaction
 (4) Resource efficiency and environmental protection in a "garden city" that incorporates agriculture, horticulture, and resource recycling
 (5) Cultivation, propagation, and utilization of health-promoting functional plants
 (6) Development of functional plant species and resource-efficient, eco-friendly urban horticulture systems employing cutting edge technology
 (7) Integration of environmental policies with welfare and caregiving policies, and environmental auditing required to achieve the above goals.

5. The Center's organization, location, and facilities

(1) Organization and location

The Center was established in April 2003 through expanding and converting the Horticulture Department's farm into a joint education and research facility. The Center is located in the Kashiwanoha district of the city of Kashiwa in Chiba Prefecture, and boasts an area of 17 ha over which the main building, lecture halls, Kashiwanoha Clinic, small-scale fields, orchards, greenhouses, processing facilities, and so forth are scattered.

The Center has 15 fulltime faculty members, 10 farm technicians, 3 fulltime and several part-time office staff members, and about 50 joint faculty members. Of the 15 fulltime faculty, 6 came from the Horticulture Department, 3 from the attached farm, 2 from the Medical Department, 2 from the Education Department, and 1 from the Pharmacology Department. A fulltime teacher in traditional herbal medicine was recruited from Toyama Medical and Pharmaceutical University. There are probably very few research centers in Japan and even worldwide that combine such a range of disciplines.

(2) Kashiwanoha Clinic

In June 2004, 14 months after the Center was launched, Kashiwanoha Clinic, a single-storey, 500 m2 clinic located in verdant surroundings within the Center's campus opened as a clinic specializing in treatment based on oriental medicine. Equipped with examination rooms, waiting room, pharmacy, horticultural therapy room, bathroom, and other facilities, the clinic also boasts a medicinal herb and horticultural therapy garden outside on the south side of the horticultural therapy room, and pursues research in the relationship between human health and the environment, with an emphasis on prevention and caregiving.

(3) Chemical-free housing and town model(sick building syndrome treatment facility)

To contribute to future community design, a model town will be built in 2006 within the Center's campus to conduct research into environmental improvement-based preventive medicine related to sick building syndrome.

An Environmental Medicine Department will be established within the Kashiwanoha Clinic to conduct (1) research in the treatment of sick building syndrome based on various housing models (detached house, tenement, condominium); (2) research into the reduction of chemicals used in housing; (3) research on evaluating and reducing the chemical contents of building materials, furniture, household appliances, cars, etc.; and (4) training of specialists.

6. Examples of ongoing research

(1) Integration of oriental medicine with horticultural therapy

Horticultural therapy aims to improve both physical and emotional wellbeing through horticulture. Horticulture is known from experience not only to improve bodily functions without undue exertion, but also to nourish the soul and encourage positive attitudes. One of the Center's research themes is the consolidation of this hands-on knowledge jointly by doctors, pharmacologists, nurses, horticulturalists, and educators to create a systematic therapy method. We have also already launched research on a program to improve both physical and mental functions through combining horticultural therapy with oriental medicine to generate synergistic effects. The above research projects commenced in the summer of 2004, and the results of the Center's first phase of research were published in August 2005 (Noda, 2005). We plan in future to complement and combine the above research with aromatherapy, acupuncture, forest bathing, Western medicine, and so forth.

(2) LOHAS urban design

Right from the start, we aimed to design the Center campus and influence the development of its surroundings in a way that reflects the ideals and mission of the Center. To ensure that the Kashiwanoha campus is a fitting symbol of a new era of emotional fulfillment and care for the environment, we decided to (1) make full use of Chiba University's collective capabilities, (2) consider the role of the campus in relation to the surrounding community, and (3) place top priority on health and environment, while (4) also considering income generation.

We also decided to employ LOHAS (Lifestyles of Health and Sustainability) concepts in designing the surroundings of the Kashiwanoha Campus Station. LOHAS consumers seek (1) eco-friendly lifestyles, (2) the creation of a sustainable economy, (3) healthy lives with a priority on prevention of illness rather than drug-based healthcare, and (4) to put priority on self-expression.

We are planning to line the road of about 1 km by 2008, leading from the station, through the campus, and on to Kashiwanoha Park with double-flowered cherry trees, and proposals have been submitted for facilities in the vicinity of the station such as a Yakuzen (cooking with traditional Chinese herbal remedies) health food restaurant and shop, herbal medicine pharmacy, community farm, acupuncture clinic, organic greengrocer, and nursing home and other care facilities that incorporate horticultural therapy.

(3) Closed-system herbal medicine production

With the graying of the populations of developed countries, the rapid economic growth of Asian countries (particularly China), and growing interest in healthy living worldwide, the demand for herbal remedies is rising. However, owing to the overharvesting of wild-growing medicinal plants, stocks have declined significantly. The need to protect the natural environment and boost the production of ingredients for herbal remedies is expected to drive the development of cultivation systems. The development of cultivation technologies for boosting the growth and increasing the active ingredient content of medicinal plants, and the cultivation and patenting of genetically superior variants in terms of growth rates, active ingredient content, and tolerance to disease are going to be crucial to the development of the herbal remedy health industry.

In view of the above circumstances, the cultivation of medicinal plants in specially designed facilities located in key consumer nations is likely to become a major trend. As one such possibility, the Center is looking into the cultivation of medicinal plants based on a closed system. The features of such systems are: (1) enclosure in insulated walls that shut out light; (2) use of artificial light only; (3) minimum ventilation; and (4) minimum import and export of materials into and out of the system (Kozai et al.; http://phdsamj.ac.affrc.go.jp/topic/5_2.html).

Closed-system cultivation offers the following advantages: (1) cultivation is unaffected by external climatic conditions; (2) resource-efficient and eco-friendly, requiring less water, fertilizer, and CO2 enrichment; (3) ability to shut out pests makes pesticides unnecessary; (4) equipment and operating costs are cheaper per production unit than greenhouses; (5) labor- and space-efficient, requiring only 1/10th the space of greenhouses; (6) maintenance of an ideal environment enables fast growth and production of higher concentrations of active ingredients; (7) high-quality produce owing to exclusion of insects, germs, pesticide residues, dust, and other impurities; and (8) vegetative propagation from cuttings of the best stock enables the cultivation of genetically uniform, high-quality crops. These merits have been demonstrated so far by research involving closed-system cultivation of St. John'swort (Hypericum perforatum L.) (Mosaleeyanon et al., 2005), Chinese licorice (Glycyrrhiza uralensis) and other medicinal plants.

7. Community engagement activities

(1) Public lectures on environment and health(http://www.h.chiba-u.jp/center/event/event.htm)

To forge closer relationships with the local community, the Center has, since its Seeds Hall lecture room was completed in February 2004, held regular "Environment and Health" lectures mainly on weekends (organized by fulltime Center faculty members Katsuji Noda and Satoru Tsukagoshi,). Most lectures were given by fulltime Center faculty members, but depending on subject, joint faculty members or outside experts have also been invited to give lectures. By autumn 2005, 26 lectures had been held.

(2) Environment and Health Business Forums

We held 8 "Environment and Health Business Forums" from May to December 2004 mainly for the purpose of exchanging information and views with representatives of private enterprise and local government. The first 3 forums were devoted to explanation of aims and to self-introductions by participants. The ensuing 5 forums each featured the presentation of a specific theme, followed by open discussion. The themes discussed were: (1) Current status and outlook for healthcare based on oriental medicine: the practice of medical treatment in tune with nature; (2) Closed-system plant cultivation; (3) Kashiwanoha Campus and urban design; (4) Horticultural therapy: overview and initiatives; (5) Development of simplified methods for measuring trace quantities of chemical substances. Each forum drew a participation of 70ー150.

(3) Senryoku-kai volunteer group

Senryoku-kai (literally "One Thousand Greens Association") volunteers donate their time to a wide range of activities, including organization of the almost monthly Environment and Health public lectures, cultivation of plants for the horticultural therapy garden, and help in harvesting crops. Volunteers also participate as subjects in the Center's horticultural therapy research experiments. Almost all Senryoku-kai members are very active types who love getting their hands dirty tending crops, and they derive real pleasure from participating in activities of the Center. We feel that Senryoku-kai could become an ideal model for community engagement and volunteer activities to support public research and educational institutions.

8. Closing comment

The research, education, and community engagement activities being carried out at Chiba University Center for Environment, Health, and Field Studies are not by any measure cutting edge endeavors. In fact, they could almost be seen as areas left behind in the rush, but we feel that we are tackling issues of vital importance to modern society, and we put priority on the steady but sure resolution of problems rather than on speed and efficiency. It is our fervent wish that the efforts of the Center will spread throughout the world and contribute to welfare in the 21st century, a century that we position as an era of emphasis on environment and emotional fulfillment.

Foreword

From my 3rd to 6th year as a medical student, I belonged to a society in the med school dedicated to providing healthcare services to communities lacking a fulltime doctor. Over the summer vacation, we would enlist the services of doctors in the university hospital to carry out health checkups, while in the winter break, teams of doctors plus med students would go around calling in on every household in a community to check on any health problems. I helped provide such services in my 3rd year in the villages of Okura and Sakegawa near Shinjo in Yamagata Prefecture, and in my 4th, 5th, and 6th years in the town of Kawanishi, which is now part of the city of Tokamachi in Niigata Prefecture, a region noted for high snowfall. This was 1968ー1971, a time when Japan's economy was red hot, and almost all young folk in farming households apart from the eldest son headed for the cities, and even most of those who remained would leave to do seasonal work elsewhere. It was a time when Japan was industrializing rapidly, and farming held little appeal as a future. Owing to excessive government protection, the agricultural sector failed to modernize at the pace it should have done as a genuine food production industry, and the country's food self-sufficiency rate accordingly dropped to 40% in terms of energy. In this session, I would like to consider agromedicine from the perspective of medicine, looking back on my experiences of that time. And speaking in my present capacity as a specialist in community medicine, I would also like to propose the establishment of dietary science as a discipline in Japan.

1. Farming population

In 1975, 11% of Japan's population worked in the agriculture sector, but since then the country's industrial structure has changed dramatically, causing the farming population to drop to 4% (3.82 million people). Migration to the cities is said to have diminished in recent years, but those remaining in rural communities still tend to be elderly, the percentage of people of 65 years and over in such communities in 2000 standing at 28.6%, compared with a national average of 17%. A full 52.9% of those who give farming as their main occupation are 65 and over. Considering that the equivalent for the UK and France is 7.8% and 3.9% respectively, Japan's farming population is conspicuously elderly. In my student days, why people would choose to leave country villages for the cities with their foul air and water, and what the future held for Japanese agriculture were subjects we discussed endlessly, but we could not help but be pessimistic about the outlook for both agriculture and rural communities. Our perception at the time was that young people probably headed to the cities in search of a modern and prosperous lifestyle, but now when I think about it, it could also be seen as an aspect of reproduction, since it would be only natural for young people seeking marriage partners to migrate to the cities where they would have much greater choice. Young people are also attracted to industries with good growth prospects, and those industries also flourish as a result of the intake of young people.

With the enactment of the New Basic Law on Food, Agriculture, and Rural Areas in 1999, Japan changed direction from protection of farmers to policies for promoting sustainable agriculture from the perspective of the public at large. The new law positioned agriculture as a food production industry and implemented policies aimed at improving the lives of food producers through developing the industry itself. In 1999, the farming population stood at 3.24 million households, of which about 480,000 were fulltime farmers, but with the change in policy, by 2010, farming households are expected to drop to 2.3ー2.7 million, with fulltime farmers practicing efficient farm management that generates a steady income numbering 330,000ー370,000, and agricultural co-ops and other incorporated food production bodies numbering 30,000-40,000.

2. The importance of dietary education

It goes without saying that the vitality of a society depends on the vitality of the people that make up that society, and it is physical and mental health that underpins the vitality of individuals.

To maintain physical and mental wellbeing over their lifetimes, people need to follow appropriate dietary, exercise, and sleeping habits. Dietary habits in particular tend to be heavily influenced by the kind of dietary regimen that people are exposed to as children. Good dietary habits in the formative years are also essential to the healthy development of both body and mind. In short, the practice of good dietary habits as children leads to a more physically and mentally healthy adult population and serves as a foundation for enhancing the vitality of society as a whole. In recent years, changes in the social environment as it affects dietary habits have resulted in unbalanced nutritional intake, increasing obesity, unhealthily skinny physiques and other worrying outcomes, and poor dietary habits are also thought to be closely linked to lifestyle-related diseases. As such, the promotion of correct dietary habits could be regarded as a matter of national concern. In the light of such circumstances, the government passed a Basic Law on Nutritional Education on June 17, 2005. While "skills education" is a particularly important component of the education of medical specialists, dietary education needs to be positioned as a 4th fundamental component of education in general, joining the 3 pillars of intellectual, moral, and physical education. Dietary education should be focused on the nurturing of people capable of practicing healthy dietary habits through furnishing them with practical knowledge about nutrition and diet and the ability to make appropriate choices regarding the food they eat. In addition to diet and nutrition, this education should also cover such subjects as food safety and cultural aspects of food and diet.

Appropriate nutritional intake plays an important role in the prevention and treatment of lifestyle-related diseases, and agriculture accordingly also has a major role to play in the everyday life of the general public. Snack foods and instant foods with their high fat and salt content are feared to be promoting unbalanced nutritional intake. Moreover, food is important not only for its nutritional value, but also as a cultural component that enriches everyday life. While the development of health foods, non-perishable foods, and therapeutic diets is important, it is also just as important to develop the means to evaluate the safety and efficacy of such foods and diets. Efficacy in particular is not yet being adequately assessed. Dietary education itself also needs to be scientifically evaluated for its educational content. Traditional food science too needs to be rethought and reorganized as dietary scienceーa discipline that covers all aspects of food and diet, rather than just foodstuffs.

3. Towards the integration of medicine with agriculture

By promoting cooperation and interactions between urban and rural communities, we can cultivate trust and build personal ties between food consumers and producers. This would hopefully boost consumer awareness and encourage them to take a deeper interest in food and diet, while also providing them with the peace of mind that comes with being able put familiar faces to the vegetables and other produce they consume. Such consumers would also hopefully be far less inclined to waste food, thus leading to the more effective use of food resources. All of this may in turn hopefully inject new life into rural economies in a way that is also environment-friendly.

Occupied as they are in the promotion of health, medical professionals are ideally positioned to spread the word at every opportunity about the wisdom of following good dietary habits. It is the duty of medical science to scientifically judge the benefits of dietary education and develop the required educational methodology. Equipped as it is with the resources for teaching both agriculture and medicine, Kitasato University should put those resources to good use to promote the development of dietary science and education.

Scholarship has tended to branch into many different fields as it has advanced, and such specialization often makes it difficult for any single field to independently come up with solutions to real-world problems. It is for such reasons that we are seeing interdisciplinary cooperation and joint research by different fields, but because such collaboration requires considerable energy to bring about, it rarely works unless goals are first very clearly defined. To enhance the output from agromedicine, I feel it is necessary to cultivate links between agriculture and medicine by setting concrete goals such as those listed below. I also feel that it is necessary to establish an Agromedicine Center at Kitasato University under the authority of the president to promote educational and research activities.

(1) Research

1. Development of functional, non-perishable, and other types of foods, and scientific evaluation of their nutritional efficacy
2. Fact-finding surveys of dietary habits and identification of areas requiring improvement: evaluation of the health implications of eating alone, eating out, snacking, skipping breakfast, and so forth.
3. The relationship between dietary habits and mental health
4. Concrete recommendations for improving dietary habits: display of energy, salt, and nutrient content on menus
5. Prevention of lifestyle-related diseases through correct eating, development of treatments

(2) Education

1. Practical, hands-on education for students in dietary education: establishment of infrastructure, interactive education between Schools of Agriculture and Medicine.
2. Development of dietary education teaching methods: creation of materials and curricula, development of software
3. Application of agromedicine to student mental health: early intervention for students having adjustment problems
4. Volunteer activities for the local farming community: participation in agriculture in the Sagamihara area agriculture
5. Acquisition of agro-ecological concepts: growing out of the mass-production, mass-consumption model

Closing remarks

Conducting the above agromedicine research and educational activities will, in my mind, require the establishment of an Agromedicine Center (provisional name) staffed by a collection of specialists in food science, nutrition, agriculture, immunology, and other disciplines. Securing field sites for the hands-on education of students and surveys and analyses is another important requirement.

1. Negative aspects of the industrialization of agriculture

Following the 1992 Rio Earth Summit, Japan passed the Basic Environment Law in 1993, the Basic Law on Food, Agriculture and Rural Areas in 1999, the Basic Law for Establishing the Recycling-Based Society in 2000, the Basic Law for Forests and Forestry in 2001, the Law for the Promotion of Nature Restoration in 2002, the Law for Enhancing Motivation on Environmental Conservation and Promoting of Environmental Education in 2003, the Three Laws on Scenery and Greenery in 2004, and the Basic Law on Nutritional Education (a member bill) in June 2005. Diet is fundamental to health, and so it makes perfect sense to legislate for correct eating habits, but this list of laws testifies too to how the way we eat has been distorted by our runaway modern civilization.

By "runaway modern civilization", I mean the way that all of our economic behavior tends these days to be geared towards greater and greater efficiency.

In our eagerness to boost efficiency, productivity, and "the economy", we are even ready to sacrifice human life and health, and the health and sustainability of our environment. Insofar as it ignores the biodiversity and conservation of the ecosystem on which our own survival depends, this blinkered pursuit of economic efficiency at all costsーwhat I call the "pursuit of partial efficiency"ーis indeed a runaway philosophy that has grave implications for all of us.

This pursuit of partial efficiency could, put in very plain terms, be seen as the outcome of modern scientific method, and more specifically, an engineering approach. Imagine, for example, using closed-system machinery to create a production system geared to achieving the greatest efficiency as determined experimentally under certain fixed conditions. One such example would be the chemical industry, which has boosted its productivity and competitiveness through reducing effluent treatment costs by passing the buck onto the economy at large in the form of pollution and environmental degradation. Regrettably, modern agriculture is of course guilty of committing the same errors.

It is said that modern agriculture began with the willow cultivation experiments of Flemish scientist Jan Baptista van Helmont (1577ー1644), but it really took off with the research and development of chemical fertilizers, synthesized agrochemicals, and mechanization carried out from the 19th century onwards. Spurred by the cheap energy that the discovery of oil produced, agriculture industrialized at a spanking pace, eventually giving rise to the concerns that Rachel Carson articulated in Silent Spring.

In recent years, much is being said about the multifarious functions of agriculture, and particularly the role that agriculture and forestry can play in environmental protection, but as long as we continue to rely on the same partial efficiency approach to agricultural R&D, we will not be able to come up with any real solution to the environmental problems we face.

2. The multifunctionality of agriculture

Human survival is unthinkable without economic activities, and so economic pragmatism is essential, but the need to preserve the sustainability of the global ecosystem and human health (which also depends on the maintenance of a dynamic balance between all parts of the body) demands that we urgently adopt an "overall efficiency" approach.

Tokyo University of Agriculture's "Eco-Eco Agriculture" Academic Frontier Project (Matsuda; Fujiki et al.) to develop new agricultural methods that combine ecology with economy could be seen as a concrete initiative aimed at implementing such an overall efficiency approach.

Japan's agricultural policy ever since the Agricultural Basic Law of 1961 has been devoted in the main to improving the economic productivity of agriculture solely as an industry. I, however, have long advocated considering (1) farmland (space), (2) farmers (human capital), (3) farming households (basic units for handing down culture, training successors, and sustaining agriculture), and (4) farming villages (political, economic and social units; local communities for the communication of history and culture) as an aggregation of assets that could be referred to collectively as agriculture or farming, and which include not only production assets, but also social, cultural, and environmental assets. It is because I considered taking an overall view to agriculture as being important that I also ensured that the content of the 2nd Basic Plan for Food, Agriculture and Rural Areas was peppered with references to rural landscape.

As the only industries found in all parts of Japan, farming and forestry are highly important from the perspective of environmental protection. As such, we need to formulate policies for the establishment of practices that make optimum use of all of their multifaceted functions.

Incidentally, according to the calculations of the Science Council of Japan (2001), the value of agriculture's many-sided functions works out at about 8.3 trillion yen a year, and that of forests at 70.3 trillion yen. I personally feel that these estimates are too low, since the annual turnover of Toyota, a single company is 16 trillion yen, which is over double the yearly value of agriculture mentioned above.

The reason that the EU's Deral says "Agriculture is more important than money, since agriculture is culture" is much the same as my reasons for inventing my own definition of agriculture after the Japanese for farmer (hyakusho, "one hundred names") as "a way of life that requires and makes the most of many different capabilities and is still essential in this age of specialization and industrialization." I feel that greenery and agriculture are truly entities of immeasurable, limitless value.

3. The naturalness and wholeness of "man and environment"

Modern agriculture's embrace of specialization and industrialization has confused and degraded the Earth and mankind, which are fundamentally holistic in nature.

We need now, more than ever before, to get back to agriculture as it used to be practicedーas a sustainable and organic means of producing food in tune with the natural environmentーand also to rediscover ourselves, humanity, as a totality.

I use the expression "farming landscape" and hyakusho, the Japanese word for farmer, in the hope that we can indeed restore the multifariousness and integrity of both agriculture and humanity as parts of a larger whole.

In this sense too, I think it is of vital importance to look at food, agriculture, and the environment from a holistic viewpoint, or if you will, as a single "landscape".

This approach of mine is in fact very much akin to that of a landscape artist, grounded as it is in the combination of "land" with an overall, holistic view ("scape"). It is from this perspective that I argued in a book titled "The Age of Agriculture" (pub. Gakugei Shuppansha, 2003) that if the 20th century was an age in which farming villages became urbanized, the 21st century is an age in which we should promote the ruralization of cities. As a negative legacy of the 20th century, our huge and packed cities have given rise to an increasing array of urban problems and pathologiesーcrime, murder, mental illness, technostress, neurosis, loss of will to live and other symptoms of precocious senility. As an antidote to these pathologies, I am arguing, albeit relatively, for the urgent need for a switch to lifestyles at the opposite pole from our huge, man-made cities, to lifestyles imbued with at least an element of agriculture and which offer opportunities for experiencing nature, countryside, life in farming villages, and so forth.

We human beings are, moreover, "wholes" made up, in the Western phrase, of a harmonious combination of body, mind, and spirit, and I think that we instinctively resent the way the division of labor under the differentiation and specialization of modern society has made it difficult for us to maintain this unity of body, mind, and spirit. I feel that we are instinctively seeking to recover the "wholeness" of the hyakusho lifestyle, and that this is fueling the rising interest in cultivation, horticulture, and "the country life" as a kind of shortcut to the recovery of wholeness. We are, moreover, first and foremost living creatures, and no matter how far civilization advances, it would be inconceivable without the existence of the natural environment. As such, I am arguing in absolute terms for the following types of coexistence: (1) coexistence with other living creatures and nature; (2) environmental coexistence with resources and energy; and (3) regional coexistence between city and farming village, developed and developing countries, and so forth.

4. Agriculture as the link between food and environment

In the past, people leading such holistic farming lives cultivated healthy food, and maintained a more healthy symbiotic relationship with the environment. However, the advance of industrial civilization has in 100 years boosted the global economy 20-fold and energy consumption 25-fold, despite the fact that the global population has only quadrupled over the same period. The growth of industry has created societies of mass production, mass distribution, and mass consumption, together with horrendous waste, giving rise to serious environmental problems that put the survival of humanity itself at risk.

To escape from this threat, we need to rethink our pursuit of specialization and partial efficiency, and reinstate concepts and practices grounded in holistic principles. The word "holistic" is, by the way, derived from the Greek word "holos", as are such words as "whole", "heal", "health", and "holy".

In academia too, we have seen increasing specialization. There are currently over 50 different societies registered with the Science Council of Japan under the Association of Japanese Agricultural Scientific Societies. This number testifies to the trend towards ever greater specialization in academia and university education.

With the aim of stemming this tide even if only slightly, in November 2004 I and others founded the Society of Practical Integrated Agricultural Sciences (president: Eiji Yamagiwa, vice presidents: Isoya Shinji, Katsuyuki Minami). While we recognize the need for research in specialized areas, we founded the Society because we felt it important to launch a movement consciously directed at the integration of various specialized fields, and at the practical application of its findings for the betterment of society. I chose the name Food, Agriculture & Environment for our journal (#1 issued in April 2005, #2 in December 2005) out of a desire to drive home the point that agriculture is the only link between food and environment, and their only common means of support.

5. Agriculture-oriented lifestyles

Figure 1 is my vision for (1) rekindling contact with agriculture and reestablishing the link between food and environment in the lives of city dwellers suffering from the illusion that distancing themselves from the soil and greenery represents progress and (2) conserving and rehabilitating what from local to national level is a natural environment made up largely of secondary nature that requires human intervention.

The government already recognizes the importance of this kind of course of action, and in its 2nd Basic Plan for Food, Agriculture, and Rural Areas being implemented since 2005, articulates its intention to "promote cooperation and interaction between cities and rural areas, and the participation of diverse parties in such initiatives". This policy also stems from a realization that Japan's population engaged in farming, fishing and forestry, now numbering under 5% of the total population, is too small to shoulder responsibility for the conservation of the 67% of Japan's territory covered in forest and the 13% currently comprising agricultural land.

In view of such circumstances, I see a need to proactively pursue such policies as the establishment of a special official category of part-time farmers encompassing the whole population, or the promotion of "21st century nature-oriented lifestyles". The Basic Plan mentioned above presents a model composed of the following 4 lifestyle levels: (1) permanent migration to rural areas, new fulltime farmers; (2) semi-permanent residence (dual urban/rural lifestyle); (3) recreational agriculture (participatory and volunteer rural village stays, urban community farms, etc.); (4) urbanーrural interactions (e.g. agrotourism, sister city arrangements, etc.).

I feel that unless such proposals for new, agriculture-oriented lifestyles are implemented as national projects or popular movements, there is little chance of creating a physically and mentally healthier populace or society through the integration of food, agriculture and environment.

To achieve such ends, I want to stress again the need to base our efforts on a clear understanding of the seriousness of modern urban pathologies and the special characteristics, value, and efficacy of agriculture and rural areas.

6. Environmental awareness for environmental welfare

Many people are of course unable to pursue rural life owing to their occupations, but the kind of nature-oriented lifestyle proposed in Figure 1 is more a matter of attitudes, something that can be practiced by anyone anywhere.

Architectural critic Noboru Kawazoe once said that almost all Japanese have a shared liking for festivals and horticulture, and it is with the same sentiment that I and others in 2001 founded an NPO named Japanese Society for the Promotion of Horticultural Welfare dedicated to encouraging people to discover the joy that cultivating flowers and vegetables can bring. As of January 2006, the Society has about 1,500 members, and 1,220 novice horticultural welfare specialists. Each year 1,200 people enroll in courses, with about 800 of those taking the novice horticultural welfare specialist exam. These specialists are now making a major contribution to society in such fields as welfare, medicine, and town planning, and have already held 6 national conferences. Through cultivating flowers and vegetables, people can join others outdoors in tilling the earth and enjoying the experience of nurturing life to cultivate safe food and contribute to the preservation of agriculture and environment.

Many people these days wish to contribute in some way to the solution of environmental problems. I refer to such people as "environmental citizens" or "environmental students", and have put together a number of introductory guides for them.

I decided to get involved in such activities out of a feeling that "economic welfare"ーthe use of money to make people happy that has been the norm up to nowーhad reached its limits and that what was needed now was "environmental welfare" (the creation of happiness through joining other like-minded people in a pleasant environment in activities that benefit everyone).

I felt that educating students with such inclinations (environmental students) and creating a network of people with such practical capabilities (environmental citizens) was a worthwhile endeavor.

In Table 1 I have listed the various reforms and policies for contributing to society that I implemented during my term as president of Tokyo University of Agriculture. The new Departments of Biotherapy and Aqua Biosciences opened in April 2006 are recent outcomes of such initiatives. Horticultural and animal therapy are perhaps the ultimate examples of biotherapy, but I felt the need to create a broader foundationーbio-welfare, if you willーon which to base such therapies. In Figure 2, Eisuke Matsuo (2004) shows the relationships between these components which, just as Hajime Orimo (2003) does in Figure 3 to show the need for integrated medicine, demonstrates too the fact that solving any problems these days ultimately requires a staged approach and the complementary use of various technologies and disciplines.

I am also involved in a number of other NPOs and initiatives. These include, at the overlap between food and agriculture, the Good Foodstuffs Promotion Association, and at the overlap between environment and agriculture, Fingers of Green (footpaths, woodland and farmland conservation), the Rural Nature Rehabilitation Contest (sponsored by the Ministry of Agriculture, Forestry and Fisheries and the Ministry of the Environment), the Rural Area Scenery Supporters Club (sponsored by the Ministry of Agriculture, Forestry and Fisheries), and the Beautiful Land Creation Association. All of these are holistic grassroots initiatives aimed at rehabilitating the relationship between humanity, food, agriculture, and the environment.

I am very fond of the word "reap" for the way it hints that we should all take some kind of action. In the words of American clergyman G.D. Boardman:

Sow a thought, and you reap an act; sow an act, and you reap a habit; sow a habit, and you reap a character;sow a character, and you reap a destiny.

It is not just medicine and food that share a common foundation. Medicine, agriculture, food, environment, and health are all fundamentally connected through the living creature that is man. The Japanese expression umashi kuni ("beautiful land") refers not only to visual beauty, but also to "amenity" in the sense of historical and natural goodness (the root of the word amenity, in turn, is thought to be related to amare [love]). Beauty derives from the harmonious integration of all the parts into a single whole.

1. Foreword

In recent years, we are seeing a major paradigm shift in the concept of health, owing largely to the inadequacy of the traditional paradigm of health and illness as diametrically opposed elements in resolving the medical issues faced by modern society. To promote preventive medicine (primary prevention), we need a new paradigm that recognizes a state that is neither healthy nor ill, but somewhere in between (known as mibyo ("un-ill") in oriental medicine), a paradigm for promoting health such as Antonovsky's theory of salutogenesis (the creation of health). I feel that oriental medicine and horticultural therapy are special for the way they serve as approaches not only to the causes of illness, but also to the creation of health.

2. Western medicine: elucidating the cause of illness

Modern Western medicine has in general been based on a reductionist, mechanical theory of the origin of disease. For example, the 2005 Nobel Prize for Medicine was awarded to Drs. Barry Marshall and Robin Warren for "their discovery [in 1982] of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease". The researchers were recognized for proving the very close link between H. pylori and stomach inflammation and ulceration of the stomach and duodenum, and elimination of H. pylori is now the most common way of treating recurrent peptic ulcers. This is a typical example of the way Western medicine has advanced through elucidating the mechanism behind the occurrence of diseases in terms of simple linear, deterministic relationships between etiology and pathology (cause and effect), and then inventing new treatments accordingly. It goes without saying that this etiological approach will continue to play an important role in medicine.

3. Oriental medicine: normalizing health creation (salutogenesis)

However, despite the fact that 80% of Japanese over the age of 40 are infected with H. pylori, only 3%ー5% ever suffer peptic ulcers, and most carriers enjoy a relationship of healthy coexistence with H. pylori. In other words, if the "salutogenic" mechanisms that the human body is equipped with to maintain health are working properly, they can prevent disease and cure it naturally when it does occur. Oriental medicine aims both to remove the factors causing disease and to simultaneously invigorate the natural healing powers we all possess, thereby normalizing salutogenesis. For example, a doctor of oriental medicine might diagnose peptic ulcers as evidence of a decline in natural healing powers and prescribe Ninjinto, a herbal remedy, or on the other hand, diagnose ulceration as evidence of a rise in factors causing disease, and prescribe Orengedokuto, a different herbal remedy.

4. The role of oriental medicine in modern healthcare

Many of the major healthcare issues faced by present-day society stem from a rapid increase in the elderly population, increasing stress, and a shift in the disease landscape towards lifestyle-related diseases. The 3 most common threats to salutogenesis too are age-related changes, stress, and lifestyle-related diseases. For example, the reason why we tend to suffer from an increasing number of afflictions as we grow older is that salutogenic mechanisms are impeded with aging. A 74-year-old man came to me complaining of increasing physical fatigue. He was suffering from diabetes and related complications and was accordingly receiving separate treatments from specialists in internal medicine, ophthalmology, orthopedics, and urology respectively for his diabetes, cataracts, osteoporosis-related back pain, and frequent urination caused by an enlarged prostate. I diagnosed him as suffering from what in oriental medicine we refer to as insufficient ki or "life force", and prescribed Hachimijiogan, a herbal remedy that had the effect of lightening his various symptoms, enabling a reduction in the amount of conventional medicines he was taking. Oriental medicine can play a major role in healthcare for the elderly for the way it boosts natural healing powers and improves quality of life (QOL).

5. Investigation of health status using health-related QOL indices

In general, a person whose salutogenic mechanisms are working properly will be healthy, while someone whose salutogenic mechanisms are impeded will experience a decline in health. However, there are no scientific indicators in existence for objectively rating level of health, and so I decided to use the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-36 v2 (Japanese language edition), a health-related QOL survey that is used widely throughout the world, as indicators to investigate how the clinical conditionーfrom the perspective of oriental medicineーof patients attending the Kashiwanoha Clinic influenced their level of health, and the effect of herbal treatments on health level. Results showed that if the oriental medicine-based clinical condition is not serious, both PCS and MCS show little decline, but if it is serious, both PCS and MSC decline significantly. Results also showed that even relatively short periods of 4ー8 weeks of herbal remedy treatment improved both PCS and MCS significantly. Oriental medicine (herbal treatments) not only improves health-related QOL that has declined owing to impediments to salutogenic mechanisms, but also represents a mibyo ("un-ill") concept-based solution to the increased risk of contracting disease.

6. The many different benefits of horticultural therapy

At the Chiba University Institute of Environment, Health, and Field Sciences, in addition to the core practice of oriental medicine whose characteristics I described earlier, we are also looking into various ways of putting our verdant surroundings to good use, particularly for horticultural therapy. Horticultural therapy involves the addition of various therapeutic processesーin short, processes for improving condition, restoring functions, and raising QOLーto the practice of horticulture by people (subjects of healthcare and welfare). Horticultural therapy brings many different benefits, including (1) emotional solace derived from cultivating plants and experiencing the workings of life and the rhythms of nature and the seasons; (2) benefits derived from the diverse pleasures of growing plants, harvesting, eating, creation, and decoration; (3) benefits derived from exercising the body and developing manual dexterity; and (4) benefits derived from sharing plant growth and conversing and empathizing with others. Horticultural therapy is thought to boost natural healing powers through different channels from oriental medicine (herbal remedies), and as such, combining them both can be expected to generate synergistic effects.

7. Horticultural therapy and sense of coherence

Horticultural therapy might work by bolstering the sense of coherence (SOC) that is said to play the most important role in salutogenesis, and this is perhaps an outstanding attribute that is absent from oriental medicine. According to Antonovsky, SOC is a feeling of confidence in one's ability not only to understand and deal with the stressful demands in one's life, but also to regard these demands as worthy challenges.

It seems likely that by participating in horticultural activities and observing how plants grow according to the laws of nature, and by cooperating with others to successfully carry out horticultural tasks and experiencing how plants respond to the care given to them, one can regain one's sense of coherence. If you actually observe people participating in horticultural therapy, you would need no convincing by others that horticultural work being carried out with obvious enjoyment, by people on their own or in groups, is clearly contributing to better health. (However, finding objective proof and scientifically elucidating the mechanisms involved is far from easy.)

8. Closing comments

At the Chiba University Institute of Environment, Health, and Field Sciences, we are seeking to contribute to the health of the Japanese populace first and foremost through the practice of oriental medicine and horticultural therapy, but also through yakuzen therapy (cooking with traditional Chinese herbal remedies), environmental health education, and other means that utilize the Center's horticultural and health resources. We have still only just started to combine oriental medicine with horticultural therapy, but I hope that this talk will have been of some use to future contemplation of the subject of agromedicine.

Foreword

Health and safety are probably the two aspects of foodstuffs that most interest people in the present age. Everyone hopes for perennial youth and long life, and looking back into the past, people have over time practiced all sorts of customs related to food that are almost akin to religious belief.

The annual cost of national health care in Japan currently stands at about 31 trillion yen, and if it continues to grow at the present rate, it is expected to climb to 50 trillion yen in the near future. Such a rise signals the inevitable collapse of the system itself, and all sorts of reforms including steeper charges for senior citizen healthcare and higher patient co-payment rates are being implemented. The main reason for the steep rise in healthcare is the increase in lifestyle-related diseases, such as cancer, cardiac disease, and strokes. This has given rise to a shift in the focus of healthcare from treatment to prevention and, as an aspect of this shift, expectations are rising for the role that food and diet can play in the disease prevention and health promotion.

Food function and functional foods

Food function and functional foods are concepts advocated in the (then) Ministry of

Education, Culture, Sports, Science, and Technology's "Systematic Analysis and a View of Food Function" research project (1984ー1986), which proposed that in addition to nutrition (primary function) and palatability (secondary function), food performed tertiary functions such as bodily defense and regulation of physical condition. Proposing as it did that the daily intake of food (ingredients) not only supplied vital nutrients and maintained health, but also played an active part in the prevention and treatment of disease.

The project represented a landmark that attracted the attention of research institutes and the food, agriculture, and fishing industries as well as consumers. The findings of the project were also introduced overseas in the journal Nature (1993), prompting the creation of infrastructures for the study of food function in the West, where functional food science was established as a distinct discipline, and vigorous efforts were launched to apply research findings to the development of functional foods. Food function and functional foods became terms with global currency, but the latter is bound by no legal definitions or restrictions and is regarded internationally more as an idiom used by food-related industries. As such, the treatment of functional foods in Japan and the West in terms of nutritional value and health maintenance functions is not necessarily of the same level.

Designated health foods and dietary/food supplements

Japan has a system for permitting vendors to make health claims with respect to foods or food ingredients that have been proven to perform physiological functions and judged from human intervention trials to be suitable for the purposes of preserving human health. There are now over 500 of these "designated health foods". The term "functional foods" is often used in Japan in a narrow sense to refer to these designated health foods, whereas in USA it is used in a broader sense to include food and beverages with reduced fat, carbohydrates, cholesterol, and so forth, with functional foods in the Japanese sense being referred to as "dietary supplements". Most of these do not take the form of foods as such, and are positioned somewhere between foods and drugs, containing vitamins, minerals, amino acids, herbs, plant extracts and so forth, and are targeted to semi-healthy conditions that are a mix of over- and under-nutrition. In Europe, the same products minus herbs and other ingredients are marketed as "food supplements".

Japan's health food (or so-called health food) market is currently worth about 1.2 trillion yen annually, with designated health foods accounting for about halfー600 billion yen. In USA, dietary supplements and functional foods worth $20 billion are sold annually, while in Europe, functional foods worth 10 billion euros ($12 billion) are sold annually.

Studies on the use of foods for primary prevention of lifestyle-related diseases

The following studies have been carried out on the use of foods to prevent lifestyle-related diseases:

(1) Prevention of cancer

• Reduction of the carcinogenic properties of carcinogens (polyphenols, carotenoids, dietary fiber, broccoli sulforaphane)
• Destruction of cancer cells through stimulating the immune system (polysaccharides, including seaweed fucoidan and mushroom or barley β-glucan)
• Induction of differentiation and apoptosis of cancer cells (flavonoids such as isoflavone, quercetin, phloretin, and proanthocyanidin)
• Induction of apoptosis (flavonoids)

(2) Prevention of atherosclerosis

• Prevention of hyperlipidemia (polyunsaturated fatty acids DHA and EPA, α-linoleic acid, barley β-glucan, seaweed alginic acid, fruit pectin, soy protein, soy saponin, green tea catechin, etc.)
• Prevention of oxidation of low-density lipoproteins (vitamins C and E, carotenoids, green tea catechin, red grape skin constituents anthocyanin and resveratrol, etc.)
• Prevention of homocysteinemia (vitamins B6 and B12, folic acid)

(3) Prevention of hypertension

• Prevention through inhibition of angiotensin converting enzyme (ACE) (casein tripeptide, sardine muscle dipeptide, soy tripeptide, etc.)
• Search for hypertension-preventing substances using spontaneously hypertensive rats (SHR) (GABA tea [green tea containing GABA (γ-aminobutyric acid)], germinated brown rice, fermented rice bran extract, chitosan, vitamin C, α-lipoic acid, etc.)

(4) Prevention of diabetes

• Suppression of acute hyperglycemia (dietary fiber, gymnemic acid, arbutin, phloretin, incretin inhibiting peptide, etc.)
• Suppression of glycation of proteins etc. (flavonoids, pyruvic acid, chelate compounds, etc.)

(5) Prevention of aging and dementia

• (polyunsaturated fatty acids DHA and EPA, folic acid, vitamins B6 and B12, α-lipoic acid, egg yolk lecithin, arachidonic acid, etc.)

(6) Prevention of allergies

• (lactic acid bacteria and bifidobacteria, citrus fruit and green tea flavonoids, β-glucan, oligosaccharides, etc.)
• Nutrigenomics and personalized foods
• Important aspects of food function research and the development of functional foods include
• building a database of functional food factors in relation to the maintenance and improvement of health, conducting molecular level genome-based analyses (nutrigenomics), anddeveloping personalized foods.

(1) Creation of a food factor database

Because functional food factors have been regarded as non-nutrient factors, they are not included in conventional food factor charts, and consequently there is a need for a database that enables estimation of intake in the same way as for nutrients. There have been plenty of studies carried out on the use of foods in disease prevention and health promotion, but most of these end up buried in journals and rarely reach the eyes of the general public. There is now an initiative underway to dig these studies out and gather them into a searchable database. Such functional foods need to be categorized according to evaluation criteria such as: (1) scientific evidence of benefits based on tests on humans; (2) scientific evidence of benefits based on animal experiments; (3) scientific evidence of benefits based on cultured cell experiments; (4) foods unable to be evaluated; and (5) no evaluation. Once such a database is created, it should be possible to estimate intake of functional food factors, and accordingly to formulate dietary guidelines and manage nutrient intake in a way designed to maintain health. It should also be possible for this information to be applied to design the molecular structure of functional food factors and to develop vegetables and fruits containing appropriate amounts of such factors.

(2) Nutrigenomics

It seems likely that functional food factors work to prevent illness and promote health by serving as a kind of living signal to either directly or indirectly influence genes (particularly at transcription level). Nutrigenomics is the name given to the study of the effects of functional food factors on gene expression and regulation. Human intervention trials provide the most reliable data, but ethical issues and the recruitment of willing subjects make such trials difficult to implement. There are, moreover, a great many genes related to metabolism on the conditions, such as obesity and inflammation, hence, it is not easy to elucidate how each and every gene works. Nutrigenomics, however, uses DNA micro-array technology (DNA chips) that enables the study of the effects of food factors on the expression of hundreds and even thousands of genes in a single experiment. This in turn enables us to learn about the metabolism of functional food factors and to draw conclusions regarding where and how the resulting metabolic products work their effects.

Carrot retinoids and salmon unsaturated fatty acids are known to combine with specific genes through peroxisome proliferator-activated receptors (PPARs) to suppress the synthesis of fatty acids and promote fatty acid oxidation. Results of DNA micro-array experiments on rats fed a diet containing ω6 and ω3 fatty acids showed that these fatty acids affected the expression of over 300 out of 12,000 genes (Berger et al., 2002). Experiments to screen the effects of about 1,000 different plant extracts on cultured human cells have also shown that turmeric curcumin, grape resveratrol, green tea catechin, black tea theaflavin, vitamin E, and other compounds contain factors that help to suppress the expression of the COX-2 gene that is associated with inflammation (Subbaramaiah etal., 2000).

These are all discoveries revealed for the first time by nutrigenomics, and they could not have been obtained without the use of DNA sequencing technology and genomic data. Nutrigenomics also holds out promise for the discovery of either positive or negative effects of combining food factors, which are heretofore unanticipated functions in single food factors.

(3) Personalized foods and nutrition guidance

Another area of application of gene technology is personalized foods and nutrition guidance. This application makes use of single nucleotide polymorphisms (SNPs) in the human genome. SNPs are DNA sequence variations that occur with a frequency of one in every several hundred nucleotide bases, with every individual possessing a different mix of SNPs. It has been demonstrated that many SNPs can have an influence on a person's receptivity to a certain drug, or predisposition to drug side-effects and so forth. Food factors have much weaker effects on physiology than medicines, making the elucidation of their effects difficult, but if individual differences in the disease prevention effect of foods or food factors with known functions can be elucidated, it should be possible to develop personalized foods and nutritional directions.

At Kagawa Nutrition University, nutrition clinic patients are tested for SNPs known to be involved in obesity and circulatory diseases and are investigated for any correlation between inherited traits and nutritional guidance or health indicators. Results showed that among the patients following nutrition clinic dietary guidance, there was no significant difference in body mass index (an indicator of degree of obesity: body weight2 / height) and total cholesterol between those possessing certain SNPs and those lacking them, proving that nutritional and exercise guidance is effective even for those possessing certain SNPs. It has also been shown through analysis of correlations between genetic constitution, diet, and health of various Asian peoples including Japanese that a far higher proportion of Japanese and Palauans than Caucasians possess SNPs of obesity-related genes such as leptin receptor and PPARγ2. This suggests that Japanese and Palauans have the kind of genetic make-up that enables them to weather a certain degree of nutritional deficiency better than Caucasians, and may, on the contrary, be more liable to put on weight if their nutritional intake is excessive.

Human health and functional foods

It is likely that further research will cast light on the influence of an increasing number of food factors on disease prevention and the maintenance and promotion of health, with the consequence that an increasing array of foods will be developed and put on the market. As long as the efficacy of functional foods is corroborated by solid scientific research and evidence, the suspicion surrounding present-day so-called health foods is likely to fade, and foods reflecting the new concepts will gain favor. In fact, as functional food science advances, health promotion and disease prevention functions (including lifestyle-related diseases) of an increasingly wide range of both new and traditional foods are likely to elucidated, and we may well witness the dawning of a new evidence-based age of convergence between food and healthcare.

But at the same time, the fact is that food is only food. I think we need to stop and ponder the meaning of the line in the preamble to the WHO's constitution that reads "Health is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity". It is important to remember that the enjoyment of health is a fundamental right of every human being and that we must consider the health also of the elderly, the sick, infants, and otherwise physically weak people. It goes without saying that any foods that may bring a lot of benefits to physical health, but are detrimental to mental health are not acceptable. No matter how effective a food is in promoting health and preventing disease, if it is unpalatable or otherwise lacks appeal as a food, it is not likely to be around for long. This is because food performs more than primary, secondary and tertiary functions, possessing as it does the power also to provide emotional fulfillment and solace, foster communication with others, sustain culture, bind local communities, and in fundamental ways enable us to be who and what we are.