The purpose of this study was to review randomized controlled trials of the effects of treatment in spas, thereby clarifying therapeutic effects of these treatments on individual diseases, and its healthpromoting effects.
A review of the PubMed database for articles that fulfilled the following eligible criteria identified the studies that were chosen for this review. Key words were “randomized controlled trial” and “spa” or “balneotherapy”. Articles were published after 1990, and written in English. No criteria were set up concerning the number of subjects, the observation period, or the kind of disease studied. The quality of individual articles was evaluated on a 13-point modified PEDro scale that was constructed by adding three terms, representing the number of subjects, the observation period, and quellencharakter to the 10-point PEDro scale.
A total of 18 articles were chosen. Since two of them were essentially identical in content, these two articles were counted as one. As a result, a total of 17 articles were reviewed. Seven studies were conducted in France, 3 in Germany, 3 in Israel, 2 in the Netherlands, and 1 each in Italy and in Japan. Diseases studied in these articles were mostly disorders of the locomotorium, with pain as a main symptom; rheumatism in 6 articles, osteoarthritis in 4, lumbago in 3, and Parkinson's disease, varicosis, psoriasis, and health-promotion in one each. The mean score on the 13-point modified PEDro scale was 7.5 (SD, 2.3), with a minimum score of 2 points and a maximum score of 12 points.
The method of intervention in the spa varied widely from study to study. In addition to balneotherapy, exercise therapy, mud pack treatment, and douche massage were employed in numerous studies. Besides the intensity of pain and the amount of anodynes consumed by patients, emotional effects, QOL, physical working capacity, and even decreases in medical expenses were monitored as indicators for evaluation of the effect of the treatments in some studies. Improvements in the indicators were always more marked in balneotherapy intervention groups than in control groups, irrespective of the diseases studied. The improvements persisted for relatively long periods. In particular, a review of the high quality articles that reported effects of balneotherapy on patients with rheumatism, osteoarthritis, or lumbago showed that effects of intervention provided only once could be expected to persist for six months. With regard to the effect of quellencharakter on diseases, no definitive conclusion was obtained. On the basis of these results, we devised a “3-layer model of evidence to be accumulated in balneotherapy”

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The effects of bathing with inorganic salts and carbon dioxide (ISCD) on body temperature, systemic circulation, food ingestion and absorption have been studied in healthy volunteers. The peripheral blood flow in the forearm was found to increase in and after immersion of the forearm into a 25l bathing receptacle containing ISCD, as compared with plain water. The peripheral blood flow tended to increase in a dose-dependent manner with ISCD bathing. The skin core temperature, the skin surface temperature and the peripheral blood flow were significantly higher after ISCD bathing than after plain water bathing. The influences of ISCD bathing on food ingestion and absorption were also studied in healthy volunteers. Blood glucose and insulin levels after food ingestion tended to be suppressed by ISCD bathing as compared with plain water bathing. There was no difference between ISCD and plain water bathing in total protein, total cholesterol, triglyceride, HDL cholesterol, and uric acid levels in the blood. These results suggest that ISCD bathing may contribute to the promotion of human health.

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We evaluated the effects of SCP bathing on the body by compared with those of a-EG, one of major component of SCP, bathing and the control bathing with tap water alone. Healthy adults were used as the subjects. The effects of bathing on blood pressure and pulse rate were not significantly different among the three bathings, indicating that effects of SCP and α-EG bathing on the lung and heart were similar to those of an ordinary bathing. The surface skin temperature at the forehead decreased more slowly in the subjects after taking a SCP bathing than the other two, suggesting that SCP has temperature holding effects. Also, the results of deep body temperature suggested that α-EG might be related to the heat absorbing effects of SCP bathing, which were significantly marked than those of the other two bathings. The present results regarding the changes in blood flow and deep body temperature during bathing suggest that SCP might produce an environment that allows more rapid heat transfer from bath water to the body and less releasing it from the body. Therefore, we concluded that some component other than α-ethylglucoside would be involved in the heat transfer and moisturizing during SCP bathing. Measurement of skin water content indicated that a region directly contacting with hot water was moisturized in a short time, but this condition quickly returned to the pre-bath condition. Whereas, for regions not contacting with bath water, the skin was much more moisturized by taking SCP bath than the other two bathings. Therefore, it was concluded that SCP is effective for enhancement of skin moisturizing.

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In the town which commenced health promotion facilities using hot spring in May, 2000, how the utilization frequency influences afterwards health status and active life expectancy, was investigated by the follow-up study.
The research subjects were all inhabitants aged 40 or more years living in J town with about 10, 000 inhabitants in Toyama Prefecture, Japan. The cooperation request of the survey was carried out to women's association, when the survey was performed in December, 2000.
With regard to the entry survey, the answers of 5, 812 (95.0%)of the 6, 117 registered inhabitants were collected. They were served to the follow-up survey on (1) death, (2) bone fracture, (3) cerebral apoplexy, (4) senile dementia, (5) welfare facilities entrance, (6) long term admission beyond 6 months, (7) bed bound, (8) diabetes mellitus from April, 2001 to March, 2004. The sex-age matched control was randomly selected from the inhabitants participated in the entry survey for case-control study.
As the result, the occurrence rates of (1) death and (2) bone fracture were significantly lower in the group with twice or more utilization of the hot spring per year compared with the group utilizing once or less per year, and (3) cerebral apoplexy showed the slightly significant relationship, even after adjusting with exercise habit and WHO-QOL of confounding factors. The other events were not significantly associated with frequency of hot spring utilization.
It has been indicated that health promotion facilities using hot spring could contribute to active life expectancy via health and welfare promotion.

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One of the methods of external treatment is herbal bathing. We studied the usefulness of herbal bathing by investigating the physiological and biochemical changes that occurred during whole-body herbal bathing.
Eleven healthy adult males (36±9 years old) were subjected to two types of bathing, herbal bathing and plain water bathing, at an interval of four or more days at random sequence after giving written informed consents. Physiological and biochemical changes were monitored 10min before bathing, 10min during herbal bathing in the sitting position, and up to 60min after bathing.
The results showed that the skin temperature of the face (forehead) and hands decreased at a slower rate, fluctuations of the blood pressure were smaller, and the peripheral vascular resistance decreased more faster in herbal bathing than in plain water bathing. These results suggest that herbal bathing is more effective in maintaining peripheral skin temperature, stimulates peripheral circulations, and suppresses excessive fluctuations of blood pressure better than in plain water bathing. Analysis of the autonomic nervous activity by ECG R-R variability showed that the parasympathetic tone was more predominant in the herbal bathing than in plain water bathing, supporting the result showing a larger relaxing effect in herbal bathing. Although there was no significant difference between herbal bathing and plain water bathing in terms of changes in the total blood volume of the Musculus Trapezius, the increase in the total blood volume of the forehead was greater in herbal bathing than in plain water bathing. These results suggested that the herbal bathing might be able to increase the blood volume of the frontal lobe.
These differences of the physiological changes between herbal bathing and plain water bathing indicated that the herbal bathing may stimulate the circulation in the frontal lobe as well as the skeletal muscles. These results supported the health-promoting effects of herbal bathing.

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We previously reported the possibility that acupuncture stimulation to the Guangming (GB37) increased retinal blood-flow volume. In this study, we examined whether this reaction was peculiar to GB37 by measuring the blood-flow velocity and pulsatility index (PI) of the central retinal artery (CRA) with Color Doppler imaging. The points to be stimulated were the Waiqiu (GB36), GB37, the Yangfu (GB38) or the non-meridian point on the outside of the crus. Acupuncture stimulus was applied to one point on the right side with a needle for 15min. Seven measurements were made at intervals of 7.5min during a 45-minute period while the subject (control group n=35, stimulus group n=89) was in the sitting position. Patterns of the change in blood-flow velocity and PI with time differed significantly between the five groups. An increase in retinal blood-flow volume occurred in the GB37 group only suggesting there was a peculiarity related to the meridian point. The reaction patterns of the right and left eyes were not significantly different. Blood pressure and heart rate exhibited no significant differences either. These results suggest the relevance of choosing GB37 for improving or maintaining the retinal blood-flow volume.

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