Spa therapy which has been performed for patients with respiratory disease, particularly for those with asthma and pulmonary emphysema for last 22 years, demonstrates that spa therapy is effective for asthma and pulmonary emphysema. The characteristics of patients with respiratory disease has been changing during last 22 years.
The frequency and number of elderly patients with asthma, and the number of those with pulmonary emphysema has been increasing in recent years. Elderly patients with asthma and COPD including pulmonary emphysema show the narrowing of airways by mucus, and hyperinflation of the lungs as results of aging. At present time any physicians have no medication improving hyperinflation of the lungs. In the present study, evaluation of hyperinflation of the lungs by a band display procedure on HRCT and the effects of spa therapy on the hyperinflation were discussed in patients with asthma and COPD. The results show that spa therapy is important for the treatment of elderly patients with asthma and COPD, because the therapy can improve hyperinflation of the lungs without adverse side effects.

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The purpose of this study was to clarify effects of foot bathing at 44°C for the patients with hemiplegia. The subjects of this study were six patients with hemiplegia (average 71.6 years old) and six healthy volunteers (average 74.3 years old). Blood pressure and heart rate were measured using an autonomic spygmomanometer, tympanic temperature using a thermistor, and sweat rate using the ventrilated capsule method during the control period of 10 minutes before foot bathing, for 20 minutes during foot bathing, and for 10 minutes after foot bathing. Subjects wore a plain clothes while taking a footbath and the ambient temperature was set to 20°C. During foot bathing, heart rate was significantly increased, but blood pressure and pressure-rate product did not changed. Tympanic temperature was no significant changed in both subjects during foot bathing. But a significant increase of sweat rate was observed in patients. In healthy volunteers, in contrast, skin blood flow on the bottom of the foot was significant increased. These findings suggest that regulation system of cardiovascular is slightly declined in the patient, and patient's thermoregulatory system was difficult in healthy humans.

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緒言
入浴やサウナ, あるいは高温環境が血液循環や循環器, 皮膚血流, 発汗に及ぼす影響については多くの報告があるが, 肝, 腎, 消化管など内臓機能への影響に関する研究は少ない。41℃, 10分間の温水浸が肝血流に及ぼす影響を明らかにするために, インドシアニングリーン (以下ICG) の血漿消失率の変化について検討した。
対象
健常成人23名 (男性, 年齢32.6±1.9歳; 平均±SEM) である。
方法
対象を30分間安静臥床させた後, ICG (0.5mg/kg) を静注し, 注入から正確に3分, 6分, 10分後に採血し, ICGの血中濃度と血漿消失率を求めた。1回目のICG試験から30分後に41℃, 10分間の温水浸を行い, 出浴後に再度ICG試験を行った。またその他の指標として, 舌下温, 血圧, 脈拍, 心拍出量を測定した。
結果
41℃, 10分間の温水浸により舌下温は平均約1℃有意に上昇した。収縮期血圧には有意な変化は見られず, 拡張期血圧は浴後有意な低下を示した。脈拍と心拍出量は浴後有意に増加した。ICG血漿消失率は浴前0.200±0.008から浴後0.164±0.008へ有意に減少した。ICG血漿消失率の前後比は年齢に応じて上昇を示した。(R=0.582, P<0.0001)
考察
41℃, 10分間の温水浸で, 温熱性血管拡張による末梢血管抵抗の減少と, 静水圧による静脈還流量の増加に伴う心拍出量の増加にもかかわらずICG血漿消失率が低下したことは, 門脈血流量の減少を反映すると考えられる。門脈血流が減少した理由として, 肝外門脈シャントの増加や腸管粘膜における血流うっ滞が考えられる。年齢が高くなるほど, 温水浸によるICG血漿消失率の変化が減少したことは, 温熱による血流再分配の変化が, 加齢により小さくなったということであり, 加齢に伴う温熱性血管拡張反応の低下を示唆している可能性がある。
結論
41℃10分間の温水浸で, 健常人の肝血流は減少する。またその反応は50歳以下の比較的若年層においても, 加齢に応じて小さくなる。

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HSP70は, 新たに合成されたポリペプチドの折れたたみ, タンパク質の輸送と品質管理, 不要になったタンパク質の分解など, タンパク質の一生にわたり面倒をみつづけているストレスタンパクの一種であり, 健康増進などに関連するものの一つとして注目されている。このタンパクは温熱刺激によって誘導されることが知られており, 今回, 炭酸温水浴と水道水浴を比較し興味ある結果が得られたので報告する。対象は6名の健常成人 (平均年齢22.5±3.7, 男:女=3:3) に41℃高濃度炭酸温水と41℃水道水温水に10分間の全身浴を行い, 温浴前と1日後のHSP70を比較した。24時間の測定の間は温浴などの対外刺激を禁止した。どちらが先になるかはランダムとし, 3名ずつに分かれた。また, 双方の温水浴は10日間間隔をあけて測定した。その結果, 深部体温計での前胸部体温の上昇は水道水温浴1.0℃, 炭酸温水2.3℃であった。HSP70の変化は水道水温水が3.31→4.35 (AU/mg protein: p=0.08), 炭酸温水が3.42→5.04 (p<0.05) であり, 水道水温水でも増加がみられるものの, 炭酸温水で有意にHSP70の増加が認められた。このことは, 炭酸温水の方がこの条件下では水道水温水より体温上昇がまさり, そのことがHSP70の誘導につながったと考えられた。

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In recent times, an ingestible capsule sensor for the measurement of core body temperature has become available. This equipment was used to measure the relationship between core body temperature and daily living activities such as eating, exercise and bathing etc.
The main findings were as followings:
1. With respect to daily living activities, the core body temperature during bathing showed higher values in comparison with eating and light-grade exercise etc.
2. For the same-grade of exercise (HRmax60%) either in an environmentally controlled room at either constant temperature (25°C) and humidity (50%) or in water (36°C; 50%humidity), the core body temperature showed almost identical changes for peak value and the rise and fall ever time.
3. Atypical work at midnight was associated with a continuous decrease in core body temperature.
4. Atypical sleep in the daytime was associated with a continuous decrease in core body temperature.
5. For daily living activities inducing an increase in core body temperature, the correlation coefficient between core body temperature and heart beats/min was 0.87 (p<0.01).

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Objective
Seventeen patients with FMS were treated with balneo-Morita therapy, which combines the balneotherapy with Morita therapy. After one year of treatment, patients with favorable outcome were compared with those with poor outcome.
Subjects and methods
The mean treatment period was 4.3 weeks. The outcome after one year of treatment was assessed. Patients who were able to return to work without a relapse of FMS were classified into the responsive group (13 cases, 74.6% in all), and those who showed a relapse or were not able to return to work were classified into the unresponsive group (4 cases, 23.5%). The cases of these two groups were compared in terms of biological (physical), psychological, social and existential status induvidually.
Results
There was no significant difference in sex or age distribution between the two groups. In terms of disease entity, FMS can be classified into psychosomatic type (hyperadaptation type) and neurotic type (possible presence of psychosocial-existential problems which are difficult to resolve such as great trauma, or the conditions ranging from neurosis to psychosis). Cases of neurotic type were prevailing in the unresponsive group. Patients were assessed to find out in which of the particular features of biological, psychological, social and existential aspects the notable problems proper to each patient lie.
The number of patients having psychological problems was higher in the unresponsive group, with a significant difference. In one case of the unresponsive group, the condition changed into ME/CFS (myalgic encephalopathy/chronic fatigue syndrome).
Discussion
In the treatment of these patients, the somatic approaches or physical therapy such as pharmacological therapy or simple balneotherapy, should be given more importance for cases of the psychosomatic type. However, psychological therapy should be added to this treatment for cases of neurotic type. The efficacy of the balneo-Morita therapy was compared between the groups as classified by the type of the disease. The therapy was effective in 91.6% of the cases of psychosomatic type, while the efficacy rate was 40.0% for cases of neurotic type. During the period of the balneo-Morita therapy, a tendency of dependency on therapists may appear in patients. Although involution may be allowed transiently for the purpose of introducing catharsis, autonomy should be enhanced eventually. Yuatari (balneo-phenomenon, or balneo-intoxication) is a phenomenon, that develops in psychosomatic confusion resulting from sudden release from tension after the start of balneotherapy. This phenomenon is regarded as catharsis, from which patients are encouraged to establish a new self. Through this therapeutic experience, the therapists lead the patients from involution to autonomy without being so instructed, finally to cause a change in the way of living. In cases of psychosomatic type, this conversion was relatively easily achieved, but in cases of neurotic type such conversion was difficult. It is considered that difficulty in such conversion is attributable to psychological factors of patients (strength of self, severity of trauma, presence or absence of meaning, autonomy).

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