◆ 308・Music Therapy and Internal Medicine

Asian Med. J. 44(1): 30-35, 2001
Abstract:  Music therapy has an alternative and supplemental treatment effects in addition to usual treatment against the diseases.  It can be useful and applicable to many kinds of diseases in the area of internal medicine, including psychosomatic diseases and life style-related diseases. The popular accepeted indication and situation have been as follows: digestive ulcer,NUD (non-ulcer dyspepsia), chronic pancreatitis, hypertension, bronchial asthma, diabetes mellitus, simple obesity, Basedow's disease, chronic dialysis, blood donation, end-state malignant disease, sinile dementia, rehabilitation after cerebral vascular accident, endoscopic examination, intensive care unit (ICU), cardial care unit (CCU), stabilization of blood pressure, easy sleeping, reduction of pain. Music therapy can be applicated to diet therapy.  On waking up, breakfast, supper, and communicating situation with Karaoke, adequate choice of music is effective.  Furthermore, it can be applicated to exercise and physical therapy.  In the rehabilitation for aged people and after cerebral vascular accident (CVA), associated music application is good for the treatment efficacy and for the interrelationship between the patients and the therapists.  For healthy people and professional sportsmen, music can be also used for dance therapy such as Awa Dance, and for additional rhythmical BGM such as walkman
Key words: music therapy, life style-related disease, diet therapy, exercise therapy Introduction      Music therapy can be useful and applicable to many kinds diseases in the area of internal medicine, including psychosomatic diseases.   In this article, the interaction between music therapy and life style-related diseases will be argued, especially in the light of diet and exercise of those.      Only the presence of medical science cannot cure the patients with various diseases.  The art of practice of medicine which was born in the Hypocrates period, however, can care the body and soul of the patients using music effectively in the medical care system.  Current methods of music therapy include medicine, medical care, music, education, and welfare. Moreover, they have important relationship with cultural and artistic factors. Human beings and rhythm
     Human beings always have music and rhythm in ourselves.  Fetus is growing up listening to the heart beat and voice of his mother.  With a variety of voices from the family and surrounding sound and noise, the voice of a baby changes from crying, smiling to speaking.  The tune in the heartful voice from mothers is said to be in the alto region. 

When someone speaks to a baby in alto region, and hugs swinging a baby in about 1 second regularly, the baby is reported to feel easy and healed.     After childhood, we always maintain our health by leading our daily lives with almost regular rhythm and melody.  When this harmonious balance is lost, our body and soul become out of order.  Our body includes a lot of organs.  Each organ has its own rhythm, such as pulse, body temperature, metabolism, blood flow, and so on.  Moreover, our daily activity has its own rhythm such as sleeping and meal.  They have almost regular daily rhythm, and the melody which includes a variety of work and activity will add to the fundamental rhythm.  Each organ is thought to be each musical instrument, and the conductor is our heart.  The integration of each role of the musical instrument will be summarized, leading to the performance of playing music in the orchestra. Application and Treatment      Music therapy is widely applicated to a variety of cases in medical care.  The popular indication in the area of internal medicine will be as follows: digestive ulcer, NUD (non-ulcer dyspepsia), chronic pancreatitis,hypertension1), bronchial asthma, diabetes mellitus, simple obesity, Basedow's disease, chronic dialysis, blood donation, end-state malignant disease2), sinile dementia3), rehabilitation after cerebral vascular accident, endoscopic examination4), intensive care unit (ICU), cardial care unit(CCU), stabilization of blood pressure, easy sleeping5), reduction of pain.  Music therapy is classified into two categories; one is active one such as singing and playing the musical instruments, and another is passive one such as listening to the music.  The latter has several kinds of methods, including the bodysonic (the bed with speakers inside), the pillow with stereo music playing, and back ground music (BGM)       Music therapy has an alternative and supplemental treatment effects, in addition to usual treatment against the diseases.  When we investigate the efficacy of the therapy, we have to choose the objective method and way. Using music therapy, the rehabilitation could be easier performed, and feeling uneasy for dialysis and various treatment could be reduced.      Usually in the medical care, music therapy has been indicated to the rehabilitation after cerebral vascular accident in the hospitals and affiliated nursing homes in Japan.  Using music therapy, blood pressure in the patients with hypertension would be reduced and stabilized.  In the case with patients with orthostatic hypotension, blood pressure  would be stable or unchanged.  Furthermore, music therapy would have a better compliance to continuous treatment for the rehabilitation after acute myocardial infarction6). Life Style-related Disease      Formerly in Japan, the term "adult disease" had been used.  Dr.Shigeaki Hinohara, the President of Japan Biomusic Association, has been reporting the adequate term "life style-related disease" from 1978.  The Ministry of Health and Welfare recently  decided to use "life style-related disease"  instead of "adult disease" in the future.  Its important factor is the balance of diet and exercise, and the adequate physical and mentaresting. The key to the road to the health is almost regular acticity in our life style.  Continuous 24-hour cycle daily rhythm would lead to the "1/f fluctuation" which is reported to be necesssary for feeling comfortable.  It has some irregularity in the fundamentally regular life style rhythm. Diet and Music      Breakfast is more important than lunch or supper in the light of daily nutrition.  Recently, a lot of people in young generation have been apt to skip the breakfast, which is one of the social and health problems in Japan. Averagely speaking, Japanese people have meal in calory for the following percentage; breakfast 20%, lunch 30%, supper 50%.  The ideal proportion of food intake is reported; breakfast 40%, lunch 35%, supper 25%.  When man continue this style of meal habit, he can avoid the onset of life style-related disease such as simple obesity.  Music can be taken to daily life, and the examples of these are as follows which is useful for the explanation to the patients.      1) Early riser is recommended.  Late riser can use the alarm clock which releases buzzar or eletric noise, irritating our nerve.  When one can get up easily, he can use the  time switch system flowing out early morning music, such as the baloque music.  It's a good idea for him to awake up comfortable.
     2) After getting up, recommended activity is taking water such as milk, and doing exercise such as walking, if possible.  Some activity before breakfast gives you more appetite.  Many kinds of fruits have fructose in nutrition, which is quickly reversed into energy without the insulin secretion from the pancreas.  As to the timing of taking fruits, it is said that breakfast is gold, lunch is silver, supper is bronze.
     3)  Usually during breakfast, many people feel uneasy for urging time sign in TV.  When you use back ground music (BGM) in the morning, rhythmical music piece would be recommended for the prelude of coming new day.  In the holiday, you can enjoy the breakfast associated with fantastic BGM, sound of small stream in the field and singing of the birds.
     4) In the evening, it is a good idea to exercise for a while, sweat, take a bath and have a supper.  This order is recommended for the health. The reasons is that bathing after supper is not benificial for the distribution of blood flow in our body.  Late supper makes easier onset of life style-related disease such as hyperlipemia.  Then supper should be scheduled in earlier time.  When you choose BGM, easy listening music is better for healing the fatigue of soul and body, than stimulous music such as rock'n roll music.
     5) Karaoke born originally in Japan is one of the best music therapy that can be proud for all the world.  It is adequate for wiping out the various daily stress, and obtaining the vigorous feeling for the tomorrow. Aristotheles stated the principle of same quality.  Man wants to have a merry music when he is happy, and have a soothing and heartful music when he is sad.  In order to sweep the unsatisfied feeling, I always recommend the order of choosing music; at first soul music, secondary love music, and at last rhythmic and merry music with tempo.      These recommendation are some examples, and it is the main principle to make the client choose his favorite music. Exercise and Music      In the rehabilitation for aged people and after cerebral vascular accident (CVA), associated music application is good for the treatment efficacy and for the interrelationship between the patients and the therapists.  Generally speaking, 2-beat or 4-beat music is recommended for the introduction of therapy with music.  After the patients are accustomed to these beats, you can try 3-beat, that is, waltz rhythm music.      I already arranged and published the music book, "Japanese four season's songs" including 12 famous Japanese traditional songs and small CD of my own piano playing.  I hope this music book and CD would be useful for active and passive music therapy in many hospitals and nursing homes (Fig.

       1).     My home town, Tokushuma, has world-widely famous "Awa Dance Festival". It can be presented not only in summer  season, but also all the year around for the sight-seeing people.   According to the medical research in the light of sports medicine, Awa  Dance has enough effect on continuous aerobics activity for long time,  without strong loading or stress for heart and lung7).  A variety   of dance and associated activities are continuous aerobics exercise.   It can be also useful to music & exercise therapy in response to the  various condition of the client and patients.
     The aerobics training in the fitness club has been more popular, and younger and older people have been challenging the  aerobics.  It lasts about 30-75 minutes, and is effective for health  in the light of aerobics theory. When the pulse rate of the attendant becomes  more than 180 per minutes,  the attendant is advised to take a rest.    Then, this training has been safe one. I think, however,  there was   a small problem in the previous program.  It was a high impact exercise   for the knee and the ankle because of the jumping exercise of the program.    Several reports of tortion of the ankle and fracture of foot were seen,    and I was worried about the knee problem of aged and fatty people.   

     Recently, low impact program has been introduced.  It uses a box which has 10 - 24 cm in height, and it has a improved method that one foot is always on the floor, without strong impact to knee and ankle.  It is highly evaluated for its low impact to joints.  In every aerobics training at the fitness club,  music is indispensable for the program.  As to the cooling down phase of the program, application of beautiful music and darkend room make the attendants feel comfortable and accompolishment of the exercise.
     Professional sportsman can use music in the various training.  In the case of bicycle training, walking and running, the application of 'walkman' has a merit effect on the continuous monotonous training.  I am a speedskater and a representative athlete of Tokushima Prefecture for Japan National Sports Festival in winter.  During my training such as sliding board and image training on closed eyes, my own programmed music has been useful for improving the ability. Conclusion      In this article, I stated the importance of the daily rhythm of diet and exercise, and the advice for the usage of music therapy in the daily life.      In the future, I would like to investigate the efficacy of music therapy for diabetic patients, which can be treated only by the adequate diet and exercise habit.  I hope that music would be recognized for one of the effective tool for protecting the diseases, and that everyone would be healthy in body and soul by application of music therapy in daily life.
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Figure 1: Music Book of "Japanese four season's songs" associated with compact disk, edited by Shigeaki HINOHARA M.D., and arranged by Hiroshi BANDO. Published from Ongaku-no-Tomosha, Tokyo, Japan (Fax : +81-3-3235-4011) in January, 1998. * This article is a revised English version of a paper originally published in the Journal of the Japan Medical Association (Vol.122 No.7, pages 1173-1176

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