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Università degli Studi di Milano
Centro di Ricerche in Bioclimatologia Medica
Biotecnologie – Medicine Naturali
Centro di Ricerche in Talassoterapia
Direttore: Prof. Umberto Solimene
QUO VADIS,THERMAE?
An old science,for a modern medicine
- UMBERTO SOLIMENE -
www.naturmed.unimi.it
www.talasso.unimi.it
Brasilia – 14, 15 Maggio 2008
WORLD HEALTH ORGANIZATION
Collaborating Centre
For Traditional Medicine

Italian Miniature XV century

THE HISTORY OF THE MEDICINE
•2000 2000 B.C. Here, Here,
eat this root. root
•1000 1000 A.D. This root is heathen. heathen
Here, Here,
say this prayer. prayer
•1850 1850 A.D. That prayer is superstition.
superstition
Here, Here,
drink this potion. potion
1940 A.D. That potion is snake oil.
Here, Here,
swallow this pill. pill
•1985 1985 A.D. That pill is ineffective. ineffective
Here, Here,
take this antibiotic. antibiotic
2000 A.D. That antibiotic doesn’t doesn t work anymore. anymore
Here, Here,
eat this root.
root

THE SPA: AN ANCIENT RESOURCE FOR A MODERN
APPROACH TO HEALTH
SPAS in Italy
Italy has a great many spas, a characteristic it ownes to its
geological conformation. Endowed with more than its fair
share of volcanoes and traversed by a network of
underground waters that are the source of hot and cold
mineral water springs, Italy can be described as a “truly
thermal” country.
Spas have ancient origins and have always been closely
linked to the culture, traditions and customs of Italy: from
the baths and balnea of the ancient Romans that were the
centres of social and recreational life, to the early 20th
century spas for an elite few, and today’s accepted concept of
the spa ,no longer limited to preventive cures and
rehabilitation therapies, as a centre of all-round wellbeing.

Caratteristiche Modelli di riferimento Distanza atteggiamento stagionalità ricettività problemi tendenze tasso di sviluppo
prevalenza clientela Salsomaggiore T. prossimità motivazione allungata alberghiera assenza di mercato arroccamento sulla t -2,5% 2,5%
Anni Ottanta assistita dal SSN scarsa presenza Montecatini T. medio
raggio
terapeutica raramente di (aprile aprile - ottobre) ottobre
nessuna azione di
marketing
concezione sanitaria
del benessere be essere Chianciano T. prevenzione
mancata penetrazione
calo clientela del benessere
diminuzione delle ricerche
diminuzione dell'assistenza forte calo della
Anni clientela Novanta Beauty farm Saturnia Ischia prossimità medio
raggio
motivazione terapeutica motivazione preventiva
allungata alberghiera (aprile aprile - ottobre) ottobre
erosione della
verso una concezione domanda
di turismo della
salute che non
passaggio
al mercato
riesce ad imporsi
"regionalizzazione
regionalizzazione" della
t -6-7% 7%
distinzione tra Salsomaggiore T. proprietà delle terme più
curandi e curisti Montecatini T.
pubbliche più significative
Chianciano T.
passaggio ad una Centri
prossimità motivazione allungata alberghiera integrazione tra terme logica del t. +3%
concezione di terza
talassoterapici
generazione francesi
medio
preventiva (aprile aprile - ottobre) ottobre
nuove forme e benessere parco ambientale
della salute
Anni non solo cura e
Ischia raggio
motivazione di promozione della (agriturismo agriturismo - "privatizzazione
privatizzazione" della
villaggio
gestione delle aziende riposizionamento
Duemila prevenzione ma anche promozione
del el proprio stato
I Parchi o le aree ambientali e della
salute lungo
raggio
salute
termale
etc.)
pubbliche delle "città città termali" termali
unicità di comportamento tra
di salute
le Regioni
MEDICINA TERMALE INTEGRATA
Il sistema termale europeo

IL SETTORE
Le Terme in Italia (dati ( dati 2007)
Aziende termali ⇒ 350
Addetti diretti ⇒ 15 mila
Addetti compresi l’indotto indotto ⇒ 70 mila
Fatturato termale
Di cui a carico del Ssn
⇒
⇒
350 milioni euro
100 milioni euro
Fatturato Indotto ⇒ Circa 4 miliardi
Curandi a carico del Ssn ⇒ 1,3 milioni
Curandi totali ⇒ Circa 2 milioni
Presenze termali ⇒ 30 milioni

Turismo 2,8 milioni di arrivi italiani 5,3 Permanenza media
complessivo nelle stranieri 4,6 nelle
città termali 14,4 miloni di presenze complessivo 5,0 città termali
L.It Euro Euro L.It
Giro di affari 98 milioni 189 miliardi a carico enti assistenziali
complessivo 567 miliardi 293 milioni 91 milioni 176 miliardi a carico curandi
delle aziende termali 99 milioni 192 miliardi non da core business
Economia dell'indotto 3.800 miliardi 1.962 milioni
Occupati 14,5 mila 12,5 mila dipendenti fissi e stagionali
2 mila collaboratori

Spa treatments have to be
prescribed according to precise
clinical rules, at stage of the illness
when they can be effective; the
precise duration of treatments
cannot be fixed in advance as the
appropriate length of treatment
varies according to the individual
clinical profile.

Posizionamento Patologia curata Inc. % Posizionamento Patologia curata Inc. %
1 Naso e Gola 29,4 6 Altre 2,0
2 Artroreumatiche 29,0 7
3
Incidenza delle patologie curate dalle terme italiane
Apparato
digerente
Vascolari
periferiche
1,9
22,2 8 Dermatologiche 0,6
4 Broncopolmonari 9,0 9 Ginecologiche 0,5
5 Orecchio/tuba
Orecchio/tuba
5,3 10 Apparato urinario 0,1

Distribuzione per sesso delle diverse componenti della clientela
delle aziende termali italiane
Uomini omini Donne
ASL 44,3 55,7
INPS 50,2 49,8
INAIL 73,4 26,6
Convenzionati 44,7 55,3
Privati termali 39,8 60,2
Termali classici 44,4 55,6
Benessere termale
termale Med. Med.
Term. Term.
Int 15,8
15,8 84,2
Clientela complessiva 42,3 57,7

Incidenza delle componenti della clientela
delle Aziende Termali in Italia - 2006
20,5%
7,4%
72,1%
Convenzionati Privati termali Benessere termale

From the NAIADE survey in Italy (2000 – 2004)

HOW TO CHOOSE A SPA
• “The Waters”
• Food, Nourishment, Diet and Nutrition
• Movement, Exercise and Fitness
• Touch, Massage and Bodywork
• Mind/Body/Spirit
• Aesthetics, Skin Care, Natural Beauty Agents
• Physical Space, Climatology, Global Ecology
• Social/Cultural Arts and Values, Spa Culture
• Management, Marketing and Operations
• Time, Rhythm and Cycles

SPA THERAPIES
· RHEUMATIC DISEASE
· EAR, NOSE AND THROAT AILMENTS
· GASTROENTERIC DISORDERS
· DISORDESR OF THE RESPIRATORY TRACT
· DERMATOLOGICAL DISORDERS
· VASCULAR DISORDERS
· DISORDERS OF THE URINARY TRACT
· GYNAECOLOGICAL DISORDERS
· SPA REHABILITATION
· THE SOURSE OF WELL-BEING

TERMOTERAPIA TERMALE
⇒ Azione analgesica
⇒ Azione miorilassante
⇓
Per innalzamento soglia del dolore e
ridotta sensibilità allo stiramento dei
fusi neuromuscolari.

Principali indicazioni all’ all idrokinesiterapia termale
Neurologia
Traumatologia
• Paralisi periferiche
• Fratture
(poliomielite, neurite, poliradicoloneurite)
poliradicoloneurite • Strappi, distrazioni muscolari,
• Patologie del sistema nervoso centrale
distorsioni, lesioni tendinee
(paraplegie, emiplegie, tetraplegie
• Rieducazione del politraumatizzato
incomplete, postumi di traumi cranici)
• Polisclerosi (non in fase evolutiva)
Reumatologia
• Miopatie
• Patologie articolari degenerative
(artrosi)
Ortopedia
• Patologie articolari infiammatorie
• Paramorfismi e dismorfismi dell’et dell età (in fase non acuta)
evolutiva (scoliosi, cifosi, epifisiolisi) epifisiolisi • Lombalgie, cervicalgie, cervicalgie,
lombosciatalgie,
lombosciatalgie
• Postumi d’interventi d interventi chirurgici che
cervicobrachialgie (in fase sub acuta e
necessitano mobilizzazione in scarico
cronica)
• Periartriti, fibrositi
(in fase sub acuta e cronica)
• Rigidità Rigidit muscolari, ipotono-ipotrofie
ipotono ipotrofie
muscolari

SPA THERAPIES
A. Thermal Mud Therapy
This medically recognized therapy
involves using thermal mud. Which
has a viscous quality and may be
either naturally hot or heated. It is a
blend of solid inorganic and/or
organic components mixed with
mineral water.

B. Balneotherapy
Balneoherapy consists of the complete or partial immersion of
the patient in an individual bath or a “collective” pool
containing mineral water that has been brought to and
maintained at the recommended treatment temperature.
Balneotherapy in an individual bath consists of full or partial
immersion in a bath specially adapted for physiotherapy and
rehabilitation. Bathing in thermal pool is also suitable for
active and passive physiotherapy and kinesotherapy.
The key factors in balneotherapy are :the temperature of the
water; the prescribed duration of the bath; and the length of
the treatment cycle – on ave – rage one bath a day for 10-20
days. Finally, the bath should be taken on an empty stomach.

A. Reaz. Reaz.
dovute
prev. prev.
al calore
PRINCIPALI REAZIONI ALLA FANGO-BALNEOTERAPIA
FANGO BALNEOTERAPIA
B. reaz. reaz.
dovute
alle tre componenti
associate
1. Termoassorbimento 1.1 Aumento temper. temper.
interna interna
da 0,30 a 1°C e più più
2. Termodispersione
3. Sollecitazioni scambi metabolici
2.1 Stimolazione processi termoregolatori:
• per impulsi afferenti afferenti dai termoricettori
• per azioni azioni dirette della della temperatura temperatura del sangue sangue
2.2 Stimolazioni sanguigne e linfatiche: linfatiche:
• iperemia cutanea cutanea con con aumento aumento velocità velocità
di circolo (effetto termosifone)
2.3 Sudorazione
4. Riduzione Riduzione ipertono muscolo-tendineo
muscolo tendineo
• sollecitazione archi archi riflessi riflessi
• azioni sul S.R.E. e I.
• azioni sulla capacità adattativa
• azioni sul connettivo
2.4 Stimolazione metabolismo metabolismo idrico-salino:
idrico salino:
• richiamo di liquidi liquidi nel nel torrente torrente circolatorio circolatorio
(lavaggio tessutale)

EFFETTI CURATIVI DELLA FANGO-BALNEO FANGO BALNEO TERAPIA
1. Sulla nutrizione
Azione emodinamica
Aumento del flusso sanguigno e del numero
dei capillari funzionanti (capillarizzazione
( capillarizzazione)
Azione metabolica
Aggiustamento reaz. reaz.
chimiche intra ed
extracellulari: modificazioni delle attività
enzimatiche, del potenziale di membrana,
dell’equilibrio idrico salino, ecc.
Azione detossicante
Drenaggio sostanze cataboliche: cataboliche:
Lavaggio tessutale, ecc.

EFFETTI CURATIVI DELLA FANGO-BALNEO FANGO BALNEO TERAPIA
2. Sulla capacità
adattativa
Adeguamenti funzionali a diversi livelli:
Cellule, tessuti, organi, con migliorata reattivit
vasculo-tessutale vasculo tessutale alle noxe patogene
Azioni sulla cenestesi
Sensazione di benessere per migliore
adattamento alle variazioni del mezzo
interno ed esterno
Riequilibrio nervoso
Per azioni neuro-umorali,
neuro umorali, eutrofiche, eutrofiche,
ecc.:
migliore integrazione tra gli elementi
cerebrospinali e neuro-vegetativi
neuro vegetativi

EFFETTI CURATIVI DELLA FANGO-BALNEO FANGO BALNEO TERAPIA
5. Sulle alterazioni
del connettivo
6. Sul metabolismo
dell’osso
Azioni sul metabolismo connettivale
Miglioramento processi fibrositici
pericapsulari e legamentosi, legamentosi,
rigidità
muscolo-tendinee
muscolo tendinee, , processi di riassorbimento
degli essudati
Azioni generali e locali
Sul trofismo osseo

OSTEOPOROSIS
Spa therapies may involve:
- The assimilation of calcium in
mineral water without the
accompanying contribution of
calories that occurs when taken in
the form of food.
- External thermal cures
(balneotherapy, mud baths), which
can alleviate the symptoms of the
disease.

C. Antrotherapy
Antrotherapy means literally cave
therapy (antrum=cave). The caves, which
may be naturally occurring or artificially
created, are situated around very hot
mineral springs. There are two kinds of
cave: “humid” where the stream from
hot springs circulates in the cave, and
“dry” where only the heat is transmitted.
The latter is also know as a stufa or oven.

Rheumatic diseases for which SPA
therapies are indicated
· Primary and secondary arthrosis
· Extra-articular rheumatism: fibre
myalgia
· Dysmetabolic rheumatism: gout
and pseudogout

Ear, nose and throat ailments for which
SPA therapies are indicated:
- Chronic inflammation of the upper respiratory
tract, in particular rhinitis and rhinosinusitis
- Allergic rhinitis
- Nonspecific vaso-motorial rhinopathy
- Atrophic rhinopathy
- Chronic rhino-otitis
- Secretory otitis of the middle ear
- Tubal disorders
- Rhinogenic deafness
- Chronic forms of pharyngo-tonsilitis
- Chronic adenoiditis
- Chronic laryngitis

Disorders of the respiratory tract for
which SPA therapies are indicated:
- Acute and chronic tracheobronchitis
- Chronic simple bronchitis or
accompanied by obstruction
- Allergic pathologies of the laryngo-
tracheo-bronchial apparatus

SPA THERAPIES
The various inhalation methods allow mineral water or
its gases to be introduced to the ear, nose and throat as
required. The principal methods are:
A. Nebulizations
Mineral water transformed into a mist of variable
density is released into a room where the patients
remain for the duration of the treatment. Patients can
also be treated with individual nebulizers.
B. Inhalation
The mineral water is broken down into droplets of
varying size.

C. Aerosol
Special aerosol equipment delivers the mineral water
in microscopic droplets, the diameter of which is
between 3 and 10 microns.
D. Humages
This method uses mineral water gas.
E. Nasal irrigation and micronized nasal douches
Temperate thermal water is allowed to flow
continuously into the nasal cavities for a period of time
that varies according to the individual patient’s needs.

D. Nebulization
Mineral water transformed into a mist is
released into a room where the patients
remain for the duration of the treatment.
Patients can also be treated with individual
nebulizers.
E. Pulmonary ventilation
This method uses special equipment to
apply intermittent positive/negative
pressure.

D. Mineral Water Cure
This cure consists of drinking mineral
water at fixed intervals, the quality
temperature, duration and timing of which
is also strictly controlled.
E. Treatments combined with
crenotherapy
Spa therapies can successfully be combined
with the many methods of rehabilitation.

Mineral Water Cure
This cure consist of drinking a precise quality of one or more
mineral water, the timing, frequency and temperature of which
is prescribed by the spa’s doctor.
The volume of water and solutes is usually greater than that
needed by the body’s normal homeostatic mechanisms.
The following must be taken into consideration:
- The quality of mineral water or waters
- Time of year
- At what time the cure is started
- The temperature of the water
- The amount of water consumed with each drink
- How slowly it should be drunk and the interval between each
drink
- Other procedures to be observed during the cure
- The position to adopt during the cure

Gastroenteric disorders for which
SPA therapies are indicated:
- Gastric dyspepsia
- Bilious dyspepsia
- Bilious dyskinesia
- Chronic simple constipation

Water, mud and balneotherapy
This treatment consist of applying a mud
pack around the area of the liver; it is then
followed by bathing in mineral water
Rectal douche
In this treatment a rigid or semi-rigid
cannula is used to introduce mineral water
under pressure at regular intervals into
the rectal ampulla

Dermatological disorders for which
SPA therapies are indicated:
-Psoriasis
- Eczema and atopic dermatitis
- Recurrent seborrheic dermatitis
- Angiopathic dermatosis
- Pruriginous dermatosis
-Acne
- Burn treatments

SPA THERAPIES
Mineral water is used for external applications:
A. Balneotherapy
Balneotherapy consist of the complete or partial
immersion of the patient in a bath or a pool
containing mineral water, the recommended
temperature of which may vary as does the duration
of the bath.
B. Thermal mud therapy
This therapy involves using thermal mud, which has a
viscous quality and may be naturally hot or it may be
heated. It is a blend of solid inorganic and/or organic
components mixed with mineral water.

Vascular disorders for which SPA therapies
are indicated:
- Primitive viscose veins
- Secondary varicose veins and
postthrombophlebitic syndrome
- Early venous insufficiency caused by
“venous pump” dysfunction
- Lymphoedemas (low grade)
- Angiophatic dermatosis (angiodermitis,
dry eczemas, hypodermitis, dystrophic
ulcers)

SPA THERAPIES
In this case the treatment consist of balneotherapy combined
with hydromassage and “vascular exercise”.
Balneotherapy consist of the complete or partial immersion of
the patient in a bath or a pool containing hot mineral water, in
keeping with the general principles of balneotherapy.
The vascular exercise
This involves walking up and down two pools al least 80 cm
deep. They have a special floor that is beneficial to the vascular
system, and there is a temperature difference of 5-10° C
between two pools. The exercise should last 20 minutes during
which time the patient also receives the beneficial effects of jets
of water and ozone situated at various heights along the length
of the pool.

Disorders of the urinary tract
for which SPA therapies are
indicated:
- Calculosis of the urinary tract
and recurrences
- Urinary tract infections

SPA THERAPIES
Mineral water cure
This cure consist of drinking mineral water at set times, the
quality, temperature, timetable and frequency also being
determined in advance. Other factors that have to be taken
into consideration are:
- The quality of mineral water
- The time of year
- The time when the cure is started
- The temperature of the water
- The quality of the single draught and the total quantity of
mineral water to be drunk in a day
- Haw long each drink lasts and the time lapse between each
drink
- Procedures to be adhered to during the cure.

Gynaecological disorders for which
SPA therapies are indicated:
- Chronic aspecific and dystrophic
vaginitis caused by persistent
leucorrhea
- Painful sclerosis of pelvic
connective tissue due to scarring or
involutional changes.

SPA THERAPIES
The therapy in this case is vaginal irrigation that may or
may not be combined with thermal bath.
Vaginal irrigation
Mineral water at 37°C is allowed to flow into vagina
through an irrigation per day for 12-15 days.
Balneotherapy
Balneotherapy consist of complete or partial immersion
of the patient in a bath or a pool containing mineral
water; the length of time spent in the bath and the
temperature of the water varying according to the
patient’s history.

SPA REHABILITATION
The following spa resources all have a role in the
rehabilitation of the locomotory, neurological,
respiratory and cardiovascular apparati:
- Mineral waters and all their applications
- Thermal mud
- Caves and stufe
- Other therapeutic treatments and/or courses
(corrective gymnastics, active and passive exercise,
courses of physical therapy) and the opportunity to
alternate or combine them
- Health and medical services
- Ecologically and climatically pleasant surroundings

SPA THERAPIES
· RHEUMATIC DISEASE
· EAR, NOSE AND THROAT AILMENTS
· GASTROENTERIC DISORDERS
· DISORDESR OF THE RESPIRATORY TRACT
· DERMATOLOGICAL DISORDERS
· VASCULAR DISORDERS
· DISORDERS OF THE URINARY TRACT
· GYNAECOLOGICAL DISORDERS
· SPA REHABILITATION
· THE SOURSE OF WELL-BEING

The source of well-being
Spa resources can be used in many different ways but
the approach, as in cosmetic medicine, has to be
scientific. Seasoned mud yields its cosmetic potential to
rehydrate the skin through the interaction of water and
other components in the mud with active substances in
the skin; it acts as a vehicle for pharmacologically
active molecules in the mud that have beneficial effects
on our health and well-being.
Staff are always guided in their choice of treatment by
the patient’s individual requirements and the potential
benefits of the treatments. They are often combined
with special diets and preventive gymnastic.

Safeguarding our health
The therapeutic efficacy of spa therapies and their case
of use are such that they can have a marked positive
impact on our health in terms of prevention as well as in
the realms of therapy and rehabilitation.
In the many areas of Italy where mineral springs occur,
spas exploit the waters, muds and caves to provide
totally natural cures for preventive, therapeutic and
rehabilitative purposes.
In order to meet the demands and expectations of
international tourism, Italian spas have shifted their
focus to health protection rather than curing disorders,
finding in thermal medicine an answer both to
prevention and the recovery of psychological and
physical wellbeing.

THE WHO REPORT ABOUT STATE OF HEALTH
IN THE WORLD (2006)
10 main factors of risk about health in the world
- Deficiency in weight and malnutrition
- Not protected sexual relations
- Hypertension
- Tobacco
-Alcohol
- Not drinking water and bad sanitary meausures
- Hypercholesteremia
- Smoke and indoor pollution
- Deficiency in iron
-Obesity

TARGET 11 – HEALTH21
By the year 2015, people across society should
have adopted healthier patterns of living.
In particular:
⇒ 11.1 healthier behaviour in such fields as
nutrition, phisical activity and sexuality
should be substantially increased.
⇒ 11.2 there should be a substantial increase in
the availability, affordability and
accessibility of safe and healthy food

I WANT TO SHARE MY VISION
I want to share my vision of where I expect complementary and
alternative medicine to be in the years to come. As a result of rigorous
scientific investigations, several therapeutic and preventive modalities
currently deemed elements of CAM will prove effective. Therefore, in
future years, these interventions will be integrated into conventional
medical education and practice, and the term “complementary and
alternative medicine” will be superseded by the concept of “integrative
medicine”. The field of integrative medicine will be seen as providing novel
insights and tools for human health, and not as a source of tension that
insinuates itself between and among practitioners of the healing arts and
their patients.
Stephen E. Straus, M.D.
Director National Centre for Complementary & Alternative Medicine
National Health Institutes

DEFINITION OF TRM/CAM
Definition of Complementary/Alternative Medicine
(CAM)
“Complementary /Alternative / Non-conventional
Medicine” are used inter-changeably with Traditional
Medicine in some countries. It refers to a broad set of
health care practices that are not part of the country’s
own tradition and are not integrated into the dominant
health care system.
WHO General Guidelines for Methodologies on
Research and Evaluation of Traditional Medicine

DEFINITION OF TRM/CAM
Definition of Traditional Medicine (TRM)
Traditional Medicine has a long history. Traditional Medicine
is the sum total of knowledge, skills and practices based on the
theories, beliefs and experiences indigenous to different
cultures, whether explicable or not, used in the maintenance of
health, as well as in the prevention, diagnosis, improvement or
treatment of physical and mental illnesses. The terms
complementary / alternative /non-conventional medicine are
used inter-changeably with Traditional Medicine in some
Countries.
WHO General Guidelines for Methodologies on
Research and Evaluation of Traditional Medicine

FEMTEC Nongovernmental Organization acknowledged by WHO
THE 61 –st GENERAL ASSEMBLY AND
INTERNATIONAL SCIENTIFIC CONGRESS
OF THE WORLD FEDERATION OF HYDROTHERAPY
AND CLIMATOTHERAPY
(FEMTEC)
EAST & WEST MEET
“WATER & CLIMATE FOR HEALT IN THE MODERN SOCIETY”
25th - 29th November 2008
Ocean Spring Hotel
Zhuhai, CHINA

FEMTEC - AEMB - AICEB
THERMAE CAMPUS®
&
THERMAE QUALITY
International Superior School of Training and Updating on Science of
“Thermae”, Medical Ecology and Life Styles)
“VIRTUAL” CENTRE OF TRAINING AND
THEORETICAL AND PRACTICAL ADVICE
1) SCIENCE OF “THERMAE” (from Thermal Centres
to SPA):
• Integration between scientific medicine and traditional medical
learning
•Non medical/thermal operators and wellness
• Medical and administrative management and marketing
• Communication of Sanitary - Tourism Arts
• Plant engineering and architectural techniques

2) MEDICAL ECOLOGY
• Geology, environment-climate, health
3) LIFE STYLES
• Nutrition
• Relation mind/body
• Physical activity
• Hydrology and traditional complementary
techniques
• Healthy Ageing

-WHO
EXPERT TEACHERS OF:
- Harvard Medical School
- State University of Milan
- Cegos Italia
- France, Germany, Russia, Switzerland,
Hungary
Courses are accredited by Regions
and Ministry of Health

Thank you
and
welcome
to Milan!