One image proposal is shown in Figure 1. HM exists as a higher-level concept, within which PC, FM, and WH can be found. WH + CAM = IM, and there are cases where traditional medicine is dominant and cases where WH is dominant [7]. Overall, HM is thought to encompass the whole, from ancient times to the future.

Figure 1: Scheme of Relationships among holistic medicine and related medical paradigms.

These six concepts have been discussed in terms of their inclusive relationships, common philosophies, and differences. The biopsychosocial model has been discussed from three perspectives: i) Engel, ii) WHO, and iii) NCCIH, and there are some differences in perception between Western countries and Japan [8]. The background to these differences is as follows. From an international perspective, discussions on the ideas and definitions of HM began in the 1970s [9]. George L. Engel criticized the limitations of the biomedical mode of WM and proposed the biopsychosocial (PBS) model [10]. This later added a fourth factor, spirituality. The key point is that illness does not simply mean biological abnormalities. He also stated that the patient's subjective experience and social context are essential factors in medical treatment. This philosophy influenced and became the philosophical foundation of PM, HM, PC, and IM.

The World Health Organization (WHO) defines health as "a state of complete physical, mental, and social well-being." [11]. It also adopts a holistic view of health that goes beyond the biomedical model. Primary Health Care (PHC) which was from the declaration of Alma-Ata and Astana, emphasizes people-centered care and social determinants of health (SDH) [12]. Consequently, PC medicine can be considered a form of clinical implementation of the HM/BPS model. The NCCIH has defined CAM and IM as follows: i) IM equals WM plus CAM with evidence, ii)?CAM means any system of care other than WM, iii) IM combines conventional medicine and complementary approaches in a coordinated way, and places emphasis on scientific evidence [13]. As a global trend, Engel's philosophy has been carried over into WHO comments, and PC/PM/IM are a consistent trend. HP represents a medical worldview, not a medical model.

Meanwhile, Japan, located in the Far East of Asia, has culturally embraced and integrated both Western and Eastern cultures, achieving a world-class level of culture, civility, science, and technology [14]. PM focuses on physical illnesses in which psychosocial factors contribute to the onset and progression of illness, and the Engel model has been implemented in medical education and clinical practice. Regarding the positioning of each field, PM is included in HM, PM is "scientifically verifiable BPS medicine," and PM and PC play the role of the actual carriers of HM. A distinctive feature of Japan is its understanding and general scope of expertise within the medical community. HM emphasizes medical ethics, anthropology, and spirituality, while PM has established academic societies and specialist systems. IM is centered around universities and research institutions and is EBM-oriented, while CAM includes traditional medicine (traditional Chinese medicine, acupuncture, and moxibustion). In the field of PC, topics such as family medicine and community-based comprehensive care are being discussed, and active clinical and research activities continue in each field [15].

HM has various topics of discussion internationally. Among them, Japan has showed distinctive and characteristic developments. As the Eastern cultural background, IM, PM, existential medicine, nursing, and other fields have come together, and multifaceted discussions have been accumulating [16]. In other words, there is a shift from medicine that cures illness to medicine that supports lifestyles associated with containing illness. These perspectives demonstrate the importance of incorporating patients' outlooks on life and values ??into medical care. Furthermore, they are important as a practical concept that supports patients' dignity and meaning. Almost same perspectives are found in the philosophy of Hinohara-ism by Dr. Shigeaki Hinohara [17].

Related to BPS model, recent dynamic system would be 4 domains of body-mind-society-spirit recognized for useful perspectives. Its model with 4 factors seems to be effective for rehabilitation, disease prevention and treatment, community medicine and palliative care. They will hopefully serve as crucial theoretical foundation for developing future healthcare policy and medical education. From BPS point of view, noteworthy reports have been found for their application in cancer care and chronic diseases [18]. These studies have showed that nutritional and complementary methods are not peripheral but essential to improving the treatment tolerance, outcomes, and quality of life. Holistic interventions such as psychosocial support, exercise, nutrition, mindfulness, and spiritual care, may contribute to improved QOL, increased treatment adherence, and symptom relief in oncology. However, they also point out the necessity of evaluating the safety of interventions and ensuring the quality of evidence. Furthermore, HM with primary care perspectives can improve the quality of the patient-physician relationship and prevent medical care from becoming fragmented [19]. In the light of conceptual perspectives, the systematic review was found [20]. The term "holism" does not simply mean comprehensiveness, but is a philosophical stance that understands human relationships.

There is an meaningful and interesting report in the holistic care. From literature review for 11 years, holistic care domains showed interconnection of assessments and interventions for key features of palliative care [21]. Another recurring theme is the recognition of an individual's inherent capacity for self-regulation and adaptation. HM emphasizes lifestyle modification, behavioral change, and psychosocial support as core treatment strategies. Interventions such as mindfulness-based practices, physical activity, nutritional counseling, and social engagement are positioned as evidence-based adjuncts that may improve overall outcomes, rather than as substitutes for standard care [22]. For the latest report, an integrated novel care model was proposed [23]. It is the Minimally Disruptive Medicine frameworks in order to combine patient care, capacity, self-efficacy, activation, and resilience, and to decrease care burden through digital health, redesigned team, and policy reform.

In summary, several perspectives concerning WPH, BPS model, SDH for holistic medicine have been described in this article. In our recent complex society, we always pay attention to psychological and social aspects when we manage various patients. It is expected that current article will become useful reference for psychosomatic medical care region.

Conflict of interest: The authors declare no conflict of interest.

Funding: There was no funding received for this paper.