Hydrotherapy, Balneotherapy and Thalassotherapy

     In Greek Medicine, there evolved a healing tradition called the Water Cure.  The Water Cure is the common term for a collection of therapies which, in one way or another, make skillful and ingeneous use of the healing virtues of Water:
     Hydrotherapy:  techniques of therapeutic bathing and use of water
     Balneotherapy:  therapeutic bathing in medicinal and thermal springs
     Thalassotherapy:  the therapeutic use of ocean bathing and marine products
     Hydrotherapy, balneotherapy and the Water Cure are not dead relics of abtiquity; rather, they have lived on, and are still practiced today.  Hydrotherapy enjoyed a great resurgence in 18th and 19th century Austria and Germany, and was a key part of Father Sebastian Kneipp's system of natural therapeutics, which went on to become the basis for Naturopathy.  In many European countries that have hot springs or spa resorts, balneotherapy and spa treatments are a recognized subspecialty of medicine.
     To better understand and appreciate these Water Cure therapies, we must go back to their roots.  We must put them in the context of Greek Medicine, out of which they evolved. 


The Healing Miracle of Water

     Water has a number of distinctive properties that make it one of the most useful substances in healing.  Yet the very familiarity of this most common and abundant of substances often blinds the untrained eye to its distinctive healing virtues.
     In Greek Medicine, the  element Water has an Expulsive Virtue that washes wastes and impurities from the body.  Water, the Universal Solvent, dissolves and softens all plethoras, thickenings, hardenings and accretions if given enough time.  The cleansing
action of Water is enhanced by its surface tension, which further enables it to penetrate, grab onto, and draw out toxins and impurities.
     Water, being the most receptive element and the greatest receiver of energy, also has a number of distinctive thermodynamic properties.  Hot Water stores a tremendous amount of caloric energy, which it powerfully transfers to the bodies it comes in contact with.  Conversely, cold Water is a powerful coolant, refrigerant and absorber of excess heat, inflammation and fever.  Water's powerful influence on the heat distribution patterns of the body can profoundly affect circulation patterns as well.  And so, Water's impact on the Vital Faculty and its functions is powerful and direct.  Water's impact is all the more powerful when one considers the fact that it can also be delivered to the whole body simultaneously through total immersion. 


Water Temperature and Therapeutics

     Water, with its distinctive thermodynamic properties, has markedly different therapeutic effects at different temperatures.  Below is a brief summary of these effects:
     Hot water is initially stimulating, raising the body temperature slightly, but is then very relaxing and dispersing, especially to the muscles, joints and blood vessels.  It also opens the pores, induces sweating, and can penetrate the skin and muscles quite deeply.  Hot water can also ripen latent boils, abcesses or skin eruptions and bring them to the surface for release.  Prolonged immersion in extremely hot water is not recommended.  Hot water draws the body's circulation outwards, opening up the pores and capillaries. 
     Warm water, about body temperature or slightly cooler, is gently relaxing, and also stimulating to the appetite and digestion, stimulating the activity of the digestive organs if done about an hour before eating.  It's not recommended to bathe too soon after you eat.  Above all, warm water is harmonizing and balancing.  Warm water, particularly water that's almost lukewarm, is also called tepid.  Warm water is best for general bathing purposes. 
     Cool water is good for soothing heat and inflammation, and for cooling the body on hot summer days.  A sponge bath with cool water is good for bringing down fevers. 
     Cold water immersion, for short periods of time, can act as a bracing, stimulating tonic.  After bathing in the hot water pools, Romans would go for a quick dip in the frigidarium, or cold water bath, to brace their skin and close back up their pores.  Contrary to Hot water, which relaxes, disperses, and shunts blood circulation out to the body's exterior, cold water stimulates, consolidates and shunts blood circulation inwards towards the core and internal organs.  Cold water constricts the blood vessels, stimulates circulation, digestion and metabolism, and awakens the appetite, having an exhilarating effect.  Cold water compresses reduce swelling and inflammation.  Cold water immersion isn't recommended for cold, Phlegmatic individuals, for those who are weak and feeble, for the very young and the very old, or for those prone to chills.  Cold water immersion should only be for a maximum of about 3 to 4 minutes.  Get out immediately if a chill develops. 
     Alternating Hot / Cold water applications, usually in the form of partial baths or compresses, are a particularly powerful technique.  The hot water draws old, stagnant blood out of the internal organs or the bady's interior, and the cold water drives fresh blood back into the internal organs and the body's core.  With alternating hot / cold applications, the circulation is powerfully increased, and the affected area begins to throb and pulsate.  This is a sign of healing and regeneration.  Usually, an initial hot application of about 3 to 4 minutes is followed by a cold application of 1 to 2 minutes.  You may repeat this cycle two or three times or more, but always end on a short hot or warm application to remove or neutralize any remaining chills.


Types of Baths and Applications

     Hydrotherapy is a very versatile treatment modality, capble of producing a wide variety of therapeutic effects not only according to the temperatures of the waters used, but also how they are applied.  Although there are almost an endless variety of ways to apply hydrotherapy, the major ones are:
     Full Bath:  Total body immersion.  Can produce a wide variety of systemic effects and reactions, depending on the water temperature(s) used, either singly or in succession.
     Foot Bath:  Immersing the feet, up to the ankles, in a shallow tub of water.  Cold water is indicated for varicose veins, foot edema, headaches, low blood pressure, sweaty feet, sprained ankle.  Warm for sleeplessness, susceptibility to colds and flu.  Alternating hot / cold for improving circulation in the feet and legs.  Avoid cold foot baths if the kidneys are weak, or the bladder sensitive or irritable.
     Sitz Bath:  Immersing the hips, buttocks and pelvis by sitting down in a medium sized tub, with water up to the navel.  Excellent for treating all types of pelvic disorders.  Cold for inflamed anus, hemorrhoids.  Warm for urinary obstruction, irritable bladder, prostatitis.  Alternating hot / cold to greatly strengthen circulation, immunity, healing and regeneration in the pelvic organs.
     Sponge Bath:  Great for cooling down the body in fevers, or in hot weather if cool water is used. 
     Blanket Wrap:  The patient is wrapped in a cotton or linen sheet, thoroughly wet with cold water.  Around this is wrapped a dry sheet, and around this a thick wool blanket.  If desired, the patient can drink a cup of hot diaphoretic (sweat inducing) herbal tea like Elder flower tea before getting wrapped.  This is used to powerfully sweat out colds and the toxins that cause them. 
     Steam Bath:  This is a sauna with the addition of water or herbal teas to create steam.  Steam has many of the dispersing, opening, relaxing effects of hot water, but is more penetrating.  Steam also penetrates into the lungs and respiratory tract to release phlegm, and opens the pores of the skin to release copious quantities of sweat.  Steam baths and saunas are contraindicated in acute infections, inflammations and fevers. 
     Compresses:  This is the application of hot and / or cold water bottles.  This is an excellent way to apply heat and / or cold locally to an area.  Apply alternating hot and cold compresses over the liver area, for example, to bring detoxification, healing and regeneration to that organ.
     Fomentations:  Soaking the affected area with a wet, hot or cold hand towel.  Usually, hot fomentations are used, which are re-dipped into the hot water or herb tea to refresh their heat once they start to cool off, for a total treatment period of 20 to 30 minutes, at least twice a day.  The heat and moisture draw out the blood and circulation, increase phagocytosis and immune activity, and open the pores so that the medicinal constituents of the herbs may penetrate more deeply.  Great for arthritis, rheumatism, and various skin disorders like eczema, if the right herb teas are used.     

Precautions and Contraindications for Hydrotherapy

     Regular bathing in tepid to moderately warm water is safe for everyone; it's an essential part of daily hygiene.  As long as the necessary precautions against catching chills after the bath are taken by those who are so predisposed, such bathing is absolutely safe. 
     Warm or hot water bathing immediately or shortly after meals, before one's food has been adequately digested, is also inadvisable, especially for long periods.  Warm or hot water immersion draws blood away from the digestive organs at the body's core and towards the periphery, thus imparing proper digestion.  Warm or hot water bathing also opens the pores of the skin through sweating, increasing one's susceptibility to drafts and chills. 
     Although bathing in water of a moderate temperature is relatively safe and recommended for everyone, bathing in very hot or very cold water isn't advised for those with compromising health conditions.  Most obviously, these include heart disease, high or low blood pressure, pregnancy, and the very old or very young. 
     Saunas and long, hot immersions are contraindicated for the very old and very young, pregnant women, and those with diabetes, heart disease, multiple sclerosis and abnormally high or low blood pressure.  The common sense laws of temperament also dictate that saunas or long, hot immersions should not be undertaken by those suffering from excessive heat - acute fevers, infections, putrefactions or inflammation.
     Similarly, cold immersions are contraindicated for the very old or very young, as well as those who are very frail and delicate of constitution, or those whose immune systems have been compromised.  Cold baths or showers are also contraindicated for those whose systems are cold and weak, or those who are prone to catching chills.  Cold bathing is also not for those with high blood pressure or heart disease, or those suffering from Raynaud's Syndrome.  Cold foot baths are contraindicated for those with weak kidneys or urinary debility, an irritable bladder or rectum, sciatica and low back pain, pelvic inflammatory disease, or arthritis and rheumatism in the feet, toes or ankles. 
     The most risky and problematic applications of hydrotherapy for those with compromising health conditions are long baths and full immersions in very hot or very cold water.  Local applications and partial immersions are generally far less risky and problematic, and much better tolerated, except where explicitly contraindicated, as in the preceding paragraphs.


Balneotherapy:  Taking the Waters

     As early as the 5th century B.C.E., the historian and physician Herodotus observed that different natural mineral springs, in various parts of Greece, had different therapeutic properties.  He developed a rudimentary system for differentiating the therapeutic indications of various  types of mineral waters.  He also recommended that courses of spa therapy be undertaken, for 21 days on end, at certain times of the year. 
     Hippocrates, the Father of Medicine, was also the father of hydrotherapy and balneotherapy.  He was very much interested in the therapeutic properties of various waters, which he saw were either rain fed, as in lakes or marshes, or from subterranean aquifers, as in mineral springs that come bubbling out of the rocks.  He theorized that their differing curative properties came from their differing contents of various minerals, like iron, copper, silver, gold or sulfur. 
     Within the Hippocratic writings, probably authored by Hippocrates himself, is the remarkable classic Airs, Waters and Places.  Not only did it concern itself with the curative effects of various mineral waters, but also with the therapeutic properties of the airs and microclimates of various locales.  This kind of holistic thinking has permeated the field of balneotherapy in the European spa resorts to this day: the central attraction is the mineral waters and their curative properties, but also important is climatotherapy - the therapeutic properties of the locality and its microclimate.  Also woven into the therapeutic mix is the archetype of the Asclepion - the healing retreat or sanctuary located in a pristine, beautiful and awe-inspiring natural setting. 
     After Hippocrates, many Roman and Byzantine physicians like Herophilus, Erasistratus, Asclepiades, Orebasius and Paul of Aegina studied the curative properties of mineral springs.  They came to the conclusion that, although certain generalities could be drawn, it was impossible to determine exactly how a certain spa developed its curative properties.
     In the 19th century, detailed chemical analyses of the mineral contents of various hot springs waters began.  In many European countries today, Balneology, or the scientific study of therapeutic spa bathing, is a recognized subspecialty of medicine.
     In balneotherapy, there are three basic ways of taking the waters.  These are: externally, through immersion, either total or partial; into the lungs and respiratory tract, through the inhalation of aerosols; and internally, through drinking.  The various kinds of mineral waters have differing effects through each of these modes of administration.
     In immersion, the skin absorption of the minerals in the water can be considerable, especially in total body immersion, and at high temperatures.  The skin and the peripheral lymphatic and capillary circulation are the most directly affected.  With aerosol inhalation, lung and respiratory conditions are targeted.  And with the internal imbibing of the waters, the digestive organs and the Natural Faculty are most directly affected, and through them, every organ and tissue in the body.  In addition, several auxiliary materials and techniques are used.  These include various kinds of salts, peats, clays and muds, as well as all the techniques of hydrotherapy and massage, including various kinds of salt glows and friction rubs. 


The Mineral Waters That Are Taken

     Balneologists have three major vectors for analyzing and classifying the natural mineral waters that occur at various spa resorts:
     Thermal:  The thermal waters, as they come out of the earth, are naturally one of three temperatures:
     Hypothermal:  from cool to tepid, well below body temperature.
     Mesothermal:  warm, or around body temperature.
     Hyperthermal:  hot, or well above body temperature.
Of course, after the waters come out of the earth, the water in various pools can be artificially heated or cooled to any temperature, depending on the therapeutic effects desired.
     Osmotic:  The concentration of total mineral content in the water relative to the osmotic concentration of minerals within the human cell or bloodstream: hypotonic (lower), isotonic (equal), or hypertonic (higher).  This determines the proper dosage and administration of the waters for various therapeutic purposes, and how the minerals are absorbed and metabolized by the organism.
     Chemical:  Although each hot springs mineral water has its own distinctive signature, or chemical composition that determines the exact nature of its therapeutic effects, the various mineral waters can be broadly differentiated into certain basic types, according to their predominant minerals.  Each of these types has their own therapeutic actions and indications:
     Oligomineral:  Various actions and indications, depending on the mineral.  Oligominerals (trace minerals) include: Metaboric Acid, Lithium, Manganese, Cobalt, Nickel, Copper, Zinc, Molybdenum, Chromium, etc...
     Carbogaseous:  Naturally carbonated waters.  Stimulates the appetite and digestion when drunk, increases digestive secretions of the stomach, pancreas and intestines.  Also has a diuretic effect.  Indicated internally for chronic, hypoacidic gastritis, gastrointestinal dyspepsia, chronic enterocolitis, biliary stagnation, kidney and urinary tract conditions.  Externally, a vasodilator; increases peripheral circulation, lowers blood pressure; indicated for heart disease, polyneuritis, neuralgias.
     Alkaline:  Waters rich in alkaline minerals and ions: Bicarbonates, Calcium, Magnesium, Potassium.  Internally, fluidifies and stimulates bile secretion, increases glycogen storage in the liver, lowers blood cholesterol; alkalizes the urine and the blood and increases the alkaline reserves of the organism; increases the secretions of the pancreas and intestines.  Calcium and Magnesium decrease allergic sensitivities.  Indicated internally for chronic gastroduodenitis, ulcers, gastrointestinal dyspepsia, chronic enterocolitis, chronic cholecystitis, biliary stragnation, metabolic disorders - gout, uremia, diabetes; acidic urinary stones, allergic reactions - cutaneous, respiratory, digestive.  Aerosol inhalation fluidifies, helps to expectorate phlegm in chronic rhino-pharyngitis, chronic laryngitis, chronic tracheo-bronchitis.
     Sodic:  Mineral waters rich in Sodium.  Stimulates and purifies the lymph and lymphatic system, good for arthritic conditions.
     Saline / Chloro-Sodic:  Waters rich in Sodium Chloride, or common table salt.  Internally, excites the gastric mucosa, increases gastric secretions and intestinal peristalsis, activates digestive enzymes of the pancreas and intestines, dissolves inflammatory mucus and catarrhs, lowers and regulates blood sugar levels.  Indicated internally for chronic gastritis, colitis, enterocolitis, intestinal dyspepsia, diabetes.  In aerosol inhalations, its anti-catarrhal action is therapeutic for chronic rhino-pharyngitis, sinusitis, tracheo-bronchitis.  External immersion increases cutaneous circulation, quells inflammatory processes; indicated for inflammatory rheumatism, peripheral nervous system disorders, post-traumatic complications to the limbs, sequelae of phlebitis, chronic gynecological disorders, endocrine dysfunction and hypofunction, skin disorders.
     Sulfated:  Waters rich in the sulfate salts:  Glauber's salts (NaSO4), Epsom salts (MgSO4), or Gypsum (CaSO4).  Internally or externally, through total immersion, detoxifies the organism, aiding suppuration processes, or the ripening and excretion of pus; also reduces gastric secretions, increases intestinal peristalsis, increases production and secretion of bile, has a mild diuretic effect.
     Sulfurous:  Waters rich in elemental Sulfur or Hydrogen Sulfide, usually with a sulfurous odor.  Taken internally, sulfurous waters increase gastric and hepatobiliary secretions, stabilize blood sugar levels, and have an antiallergic effect; they're indicated for chronic atonic gastritis, enterocolitis, intestinal dyspepsia, poor bile flow and post-operative sequelae to the biliary passages, incipient diabetes, uremia and digestive allergies.  Aerosols are inhaled for chronic rhino-pharyngitis, sinusitis and chronic tracheo-bronchitis.  External immersion, prefferably in very hot baths, is indicated for articular rheumatism, pre-arthritic states, polyarthrosis, post-traumatic sequelae, peripheral nervous system disorders, peripheral circulatory disorders, and skin disorders.  Hot water immersion provokes nervous and metabolic reflexes that profoundly impact the whole organism. 
     Ferruginous:  Waters rich in iron and its salts and oxides.  Taken internally and externally, exerts a vitalizing, tonic effect in convalescence, and is therapeutic for various types of anemia.  Contraindicated in gastroduodenitis with a tendency to hemorrhage or glomerulonephritis with a tendency to hemorrhage.   

Thalassotherapy:  Healing from the Sea

     Thalassotherapy is a word coined from Thalasso, the Greek word for sea; and therapy, or treatment.  The Greeks, from the most ancient of times, have always been a seafaring people; and so, they have always placed great faith in the healing powers of the sea, and the marine environment. 
     Plato said, "The sea cures all ailments of man."  Euripides said, "The sea washes away all men's illnesses."  Plato, Hippocrates and Aristotle recommended hot seawater baths.  Cato the Elder served his slaves a mixture of wine and seawater to restore their energy. 
     Everyone can experience the health benefits of a trip to the seaside and a swim in the ocean.  The marine air is filled with healing, refreshing negative ions.  Modern science tells us that all life evolved out of the oceans, so the desire to take a healing, refreshing dip in the ocean can be seen as the desire to return to our Source.
     At the beginning of the 20th century, the French biologist Rene Quinton did the first full chemical analysis of seawater.  What he found was that it contained all the 104-odd minerals and trace elements present in human serum, or plasma.  So close is the similarity between seawater and human plasma that subsequent experiments have shown that human white blood cells can live and function for up to five weeks in seawater.  This has led many balneologists to conclude that seawater is the most complete of all mineral waters.
     The writings and discoveries of Rene Quinton formed the foundation  for the modern science of Thalassotherapy.  From his findings, French physicians started formulating treatment plans and therapeutic protocols in Thalassotherapy and started constructing seaside balneotherapy resorts where seawater was pumped in to large thermal treatment pools.
     Some of the health problems treated by Thalassotherapy include eczema and psoriasis, joint problems, arthritis, poor circulation, immobility and post-operative conditions, which are treated with seawater baths and sea algae packs.  Thalassotherapy is also very beneficial against the ravages of stress, fatigue and aging, and also other minor or banal health complaints we all suffer from, like depression, overweight and joint and back pain, which can slowly sap our vitality and immunity.
     The French government's healthcare program is so impressed by the results of Thalassotherapy that they will partially reimburse patients for a treatment regimen if prescribed by a doctor.  The French health ministry has statistics proving that those who undergo Thalassotherapy treatment become healthier, and therefore consume less in terms of healthcare services over the 6 months following their treatment. 
     The secret to seawater's effectiveness lies in its trace minerals, which act as catalysts to activate the cellular enzymes.  Without these vital trace minerals, cellular activity gets sluggish, which adversely impacts all major bodily functions.  The nutrients from food ingested by a de-mineralized body can't be properly absorbed, digested and metabolized.  The devitalized, hypofunctioning cells also can't properly expel metabolic wastes and toxins.  Cellular sluggishness and stagnancy can produce a whole plethora of symptoms, including fatigue, insomnia, edema, a slow metabolism, compromised circulation, and poor immunity, all of which lead to more serious health problems and diseases.  All of these conditions are remedied by the healing effects of seawater and Thalassotherapy.
     Some of the standard procedures in Thalassotherapy's treatment arsenal include algae poultices, algae hand and foot baths, hot seawater baths, underwater massage and jet showers.  Supplemental treatment modalities offered at Thalassotherapy spas include cryotherapy, aromatherapy, lymphatic drainage, electrotherapy, osteopathy and reflexology. 
     Another common auxiliary treatment modality of Thalassotherapy are applications of various marine muds.  These muds, which can also occur at the bottom of fresh water ponds and lakes, are also called peloids, or sapropelic muds.  They are a complex cocktail or mixture of naturally occurring clays and minerals mixed with anaerobically decayed organic matter. 
     These sapropelic marine muds are therapeutic for various conditions, including inflammatory and degenerative rheumatism, chronic gynecological disorders and infertility, and functional hormonal disorders.  Marine mud applications aren't recommended for the very old, or the very frail of health.  Each balneotherapy or thalassotherapy resort will have its own naturally occurring sapropelic mud, each with its own distinct therapeutic actions and applications. 


Resources, Internet and Otherwise

     The best book I've found on balneotherapy is:  Healing Springs: The Ultimate Guide to Taking the Waters, by Nathaniel Altman.  It is published by Inner Traditions.
     The following web pages provided a lot of the information I used to write this article:
     A book in Romanian that I used for technical information on balneotherapy is:
Ghidul Statiunilor Balneoclimatice din Romania by Dr. Laviniu Munteanu, Dr. Constantin Stoicescu, and Ludovic Grigore  -  Published by Editura Sport-Turism, Bucuresti 1978