若い女性の方。眩暈と頭痛で受診。前医の見立ては “頸性” で経過をみていたが改善しない。確かに後継部に圧痛があって、立ち仕事が多いので筋は通っている。早く正職員として働きたい。自立しないといけないから、と。ご両親は？と問うと、LDと言われていたのだけれど、学校を出て、これでも社会人ですから一人で大丈夫。とのことだった。そうか、ちょっと気を使いすぎて疲れたのかもしれないから、漢方薬を試してみる？そして、1ヶ月後に再来。全く改善なし。時間経過を確認する：1年以上持続。朝は最悪で起き上がるのが大変、午前10時過ぎになるとようやく落ち着く。職場でも家でも同じ。起立試験では血圧の低下なし、脈拍上昇３０。採血は特に異常がない。POTS。ようやく辿り着いたところは、しかし、これからの舵取りの難しい未来だ。僕は何を学んだのだろう。いったい何が起きているのだろう。もうすぐ７０歳にもなる私の反省の弁は次回に、続く。そろそろCMSの大きな構想を、少しずつ明らかにする時が来たようだ。・・なんて、偉そうな。
CMS位置：理解／身体×時間×文脈
A young woman presented with dizziness and headache. Her previous physician had considered the condition “cervical” in origin and had followed her over time, but there was no improvement. There was tenderness in the posterior neck, and given her frequent standing work, the reasoning seemed consistent.
“I want to become a full-time employee as soon as possible. I need to be independent,” she said. When I asked about her parents, she replied, “I was told I had LD, but I finished school, and I am a working adult, so I can manage on my own.”
Perhaps she had been trying too hard and was exhausted, I thought, and suggested trying Kampo medicine. One month later, she returned—no improvement at all.
Re-examining the timeline: the symptoms had persisted for over a year. Mornings were the worst, making it difficult for her to get out of bed. Around 10 a.m., she would finally settle. The same pattern appeared both at work and at home.
On standing test, there was no drop in blood pressure, but her heart rate increased by 30 beats per minute. Blood tests were unremarkable.
POTS.
We finally arrived there. Yet what lies ahead is a difficult course to navigate.
What did I learn?
What was truly happening?
As a clinician approaching 70, my reflections will continue next time.
It feels as though the broader vision of CMS is beginning, little by little, to reveal itself… though that may sound somewhat grandiose.
CMS Position: Understanding / Body × Time × Context
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