Balneotherapy and Persian Medicine: a narrative comparative review of concepts, mechanisms, and therapeutic applications
- Authors: Jaladat A.M.1, Heydarirad G.2, Tavakoli A.1, Marchenkova L.A.3, Pasalar M.1,4
-
Affiliations:
- Shiraz University of Medical Sciences
- Shahid Beheshti University of Medical Sciences
- National Medical Research Center for Rehabilitation and Balneology
- Qatar University
- Issue: Vol 25, No 4 (2026)
- Pages: 114-122
- Section: Articles
- Published: 25.08.2026
- URL: https://journals.eco-vector.com/2078-1962/article/view/713688
- DOI: https://doi.org/10.38025/2078-1962-2026-25-4-114-122
- ID: 713688
Cite item
Full Text
Abstract
INTRODUCTION. Balneotherapy — defined as the therapeutic use of mineral-rich water, thermal baths, mud, and gases — has been practiced across cultures for centuries. Persian Medicine (PM), a holistic traditional medical system dating back more than a millennium, also incorporates extensive water-based therapies, medicinal clays, and thermal practices.
AIM. To compare balneotherapy with related therapeutic modalities described in classical PM texts, highlighting historical foundations, mechanisms of action, clinical applications, and potential opportunities for integrative research.
MAIN CONTENT OF THE REVIEW. A narrative review was conducted using scholarly databases (PubMed, Scopus, and Google Scholar) and classical PM sources, including works of Avicenna (Ibn Sina), Rhazes (Al-Razi), and Jorjani. Modern clinical evidence on balneotherapy was compared with PM concepts and historical applications. Significant conceptual and practical parallels exist between balneotherapy and PM. Both utilize hot and cold bathing, mineral waters, vapors, and medicinal muds for musculoskeletal disorders, dermatologic conditions, gastrointestinal dysfunctions, and mental well-being. Mechanistic overlaps include hydrostatic pressure, thermoregulation, mineral absorption, detoxification, and modulation of humoral balance (PM theory). PM contributes additional insights related to temperament (Mizaj), organ-specific bath prescriptions, and detailed therapeutic protocols.
CONCLUSION. Balneotherapy and PM share rich therapeutic traditions with considerable conceptual convergence. Bridging these systems through integrative research could expand therapeutic options and support culturally-informed healthcare models. Further comparative clinical and mechanistic studies are recommended.
Full Text
INTRODUCTION
Balneotherapy refers to the therapeutic use of natural mineral waters, thermal baths, mud applications, and gases for health promotion and disease treatment. Widely used in Europe, Japan, and the Middle East, balneotherapy has gained renewed scientific interest due to its benefits in musculoskeletal disorders, chronic inflammation, and stress-related conditions [1, 2].
Persian Medicine (PM) — also known as Iranian Traditional Medicine — represents a holistic medical system rooted in works such as The Canon of Medicine by Avicenna and Al-Hawi by Rhazes. PM emphasizes equilibrium of the four humors, temperament (Mizaj), lifestyle principles (Setteh-ye-Zaruriyyah), and diverse therapeutic strategies including water-based interventions, hammam protocols, medicinal mud, and mineral treatments [3–5].
Given the long-standing use of hydrothermal techniques in both systems, a comparative analysis is valuable for understanding shared mechanisms, historical continuity, and potential avenues for integrative clinical practice.
AIM
To compare balneotherapy with related therapeutic modalities described in classical PM texts, highlighting historical foundations, mechanisms of action, clinical applications, and potential opportunities for integrative research.
MAIN CONTENT OF THE REVIEW
This narrative review employed a qualitative, integrative approach to synthesize and compare perspectives on balneotherapy in modern medicine and PM. Contemporary biomedical literature was identified through structured searches of PubMed, Scopus, Web of Science, and Google Scholar, using combinations of keywords such as balneotherapy, spa therapy, mineral water therapy, mud therapy, and related clinical indications. Peer-reviewed articles, narrative reviews, clinical trials, and mechanistic studies published in English were considered. Reference lists of key articles were also hand-searched to identify additional relevant publications. Given the narrative nature of the review, no formal restrictions on study design were applied, and study selection was guided by relevance to therapeutic concepts, mechanisms, and clinical applications of balneotherapy.
Classical PM sources constituted a parallel and equally weighted body of evidence. Primary texts included Avicenna’s Canon of Medicine, Rhazes’ Al-Hawi, and Jorjani’s Zakhirehye Kharazmshahi, along with other authoritative manuscripts addressing baths (hàmmām), mineral waters, clays, and water-based therapies. These sources were examined in their original Persian or Arabic forms when available, supplemented by reputable translations. In addition, secondary literature — such as scholarly commentaries, historical analyses, and modern interpretative studies of PM — was reviewed in above-mentioned databases to contextualize traditional concepts and terminology and to facilitate comparison with contemporary biomedical frameworks.
A thematic comparative framework was applied to integrate findings from both knowledge systems. Extracted data were qualitatively analyzed across predefined domains, including conceptual foundations (e.g., humoral theory versus biomedical models), treatment modalities, proposed mechanisms of action, therapeutic indications, and the nature and strength of the evidence base. Rather than aiming for exhaustive coverage or quantitative synthesis, this narrative approach sought to highlight convergences, divergences, and complementary insights between modern medicine and PM. As such, the review does not follow systematic review or meta-analytic methodologies, and no formal quality appraisal or risk-of-bias assessment was performed.
Historical Context
Balneotherapy has a long and geographically diverse history, with well-documented roots in ancient Greek and Roman civilizations, where public bath complexes (thermae) and natural thermal springs were integral to health maintenance and disease management. These practices were later institutionalized and refined within Central European spa traditions, particularly in regions such as Germany, Hungary, and the Czech Republic, where mineral-rich waters were systematically used for musculoskeletal, dermatological, and rheumatic conditions. Parallel traditions evolved in East Asia, notably in Japanese onsen culture, which emphasized regular immersion in geothermal waters for physical restoration and mental well-being. In the Middle East, mineral springs — most prominently those of the Dead Sea — were historically and continue to be employed for their high mineral content and therapeutic effects, especially in chronic inflammatory and dermatological disorders. Across these cultures, balneotherapy was traditionally applied to enhance vitality, alleviate chronic pain, and support functional recovery and rehabilitation [1, 6, 7].
PM offers a comprehensive and highly structured framework for water-based therapies, with detailed descriptions of hàmmām (bathhouse) practices embedded within its theoretical and clinical corpus. Classical PM texts elaborate on the therapeutic use of hot and cold baths, vapor rooms, and sequential bathing protocols, tailored to individual temperament (mizāj), disease state, and seasonal considerations. In addition to bathing, PM sources describe the medicinal use of natural mineral springs, therapeutic muds and clays — such as Tīn and Gil-e-Àrmàni — and the internal consumption of mineral-rich waters (Mā’ àl-Mà’dàni) for specific indications [8, 9]. The hàmmām was conceptualized not merely as a hygienic facility but as a controlled therapeutic environment, incorporating preparatory measures, manual therapies such as massage (Dàlk), and adjunct dietary recommendations [3–5]. This integrative approach reflects a holistic understanding of water therapy in PM, linking external treatments with systemic regulation and preventive care (Table 1).
Table 1. Comparison of core terminology in balneotherapy and Persian medicine
Concept | Balneotherapy Term | Persian Medicine Term | Explanation |
Heat-based therapy | Thermal bath | Hàmmām-e-Gàrm | Use of warm to hot water for circulation and pain relief |
Cold therapy | Cold bath | Hàmmām-e-Sàrd | Cooling water for inflammation, fever, and hot Mizaj conditions |
Mud therapy | Pelotherapy | Gel/Tīn/Gel-e-Àrmànī | Application of medicinal mud or clay |
Water drinking therapy | Mineral water cure | Mā àl-Màdànī | Internal use of mineral-rich waters |
Steam therapy | Vapor/steam chamber | Bokhūr/Hàmmām-e-Bokhār | Steam exposure sometimes mixed with herbs |
Hydrotherapy exercises | Underwater movements | Dalk + Bath | PM links massage and exercise to bath use |
Personalization | Protocol-based | Temperament-based (Mizaj) | Treatments adjusted according to individual constitution |
Treatment Modalities
Balneotherapy encompasses a range of water-based interventions, including immersion in hot baths (typically 38–42 °C), cold water baths, and contrast or alternating baths, all of which are utilized clinically to harness thermal and hydrostatic effects for therapeutic aims such as pain reduction, improved circulation, and functional recovery. Immersion in thermally elevated water is one of the most widely applied modalities in balneotherapy and has been systematically studied for its effects on dermatological and musculoskeletal conditions, with evidence suggesting that thermal mineral water baths can improve symptoms in psoriasis and other chronic conditions, likely through combined physical and chemical effects of water temperature and composition [6]. Aquatic exercises performed underwater as part of balneotherapy protocols have also demonstrated benefits for pain and disability in musculoskeletal disorders including paralysis, with buoyancy — reducing joint loading and facilitating therapeutic movement [10]. Contrast or alternating hot–cold immersion (hot followed by cold) has been investigated in systematic reviews, although heterogeneity in methods and outcomes complicates firm conclusions regarding its physiological impact [11]. Additionally, formulations of mineral-specific baths, including those rich in sulfur, radon, or other mineral constituents, are frequently studied for differential effects on pain, mobility, and inflammatory markers in chronic conditions, although evidence varies by mineral type and condition [12].
Also, analyses of traditional practices describe how PM historically prescribed hot baths for muscle tension and for conditions associated with “cold temperament”, and cold baths to mitigate inflammation, fever, and excess internal “heat”, reflecting humoral theories of balance. Reviews of traditional Persian bathing practices highlight the therapeutic role of baths with varying temperatures and emphasize preventive and restorative uses of hot and cold water immersion. In PM, sequential heating–cooling protocols — analogous to modern contrast bathing — were used to modulate physiological responses, and specific localized baths (e.g., foot baths) were recommended for indications like headaches, consistent with traditional regimens tailored to temperament and symptom profiles [3, 5].
Mineral and Mud Therapy
Balneotherapy often incorporates pelotherapy, the application of therapeutic muds or peloids that are rich in mineral elements such as sulfur, magnesium, calcium, and organic compounds; these components are thought to contribute to anti-inflammatory, analgesic, and detoxifying effects through a combination of thermal, mechanical, and chemical actions when applied to the body surface. Randomized controlled clinical investigations and systematic reviews have examined balneotherapy and mud-pack therapy in musculoskeletal conditions such as osteoarthritis, finding significant reductions in pain and improvements in function associated with therapeutic mud applications, although heterogeneity in study designs limits definitive conclusions about specific mineral contributions [13, 14].
In PM, a diverse array of medicinal earths and clays — historically termed tīn or gil — are described across classical texts and later commentaries, with numerous varieties such as Gil-e-Tàbākhī, gil-e-àrmani (Armenian clay), and tīn-e-ghàsàb associated with topical and systemic applications. An evidence-based review of traditional Persian materia medica identified at least twenty-three distinct clays reported in Persian manuscripts, each attributed with varied pharmacological properties, and these substances were historically used to treat pain, paralytic disorder, inflammation, skin diseases, and detoxification processes, suggesting continuity with contemporary interests in mineral-based therapeutic agents [8, 15].
Vapor and Steam Therapy
Both balneotherapy and related traditional steam-based practices incorporate the use of vapor rooms or steam baths for a range of health purposes, including respiratory and dermatological conditions, relaxation, and detoxification (Table 2). In modern clinical contexts, humid heat therapies such as sauna or steam exposure have been studied for associations with reduced risk of respiratory diseases, with one long-term cohort study showing that frequent sauna bathing was associated with a lower incidence of asthma, chronic obstructive pulmonary disease, and pneumonia over extended follow-up, suggesting potential respiratory benefits of controlled thermal steam exposure [16]. Evidence also exists supporting herbal steam baths in symptomatic relief for allergic rhinitis, although clinical outcomes vary and methodological quality differs across studies [17]. Additionally, balneotherapy including thermal baths and related vapor therapies are recognized in the dermatological literature for their capacity to improve skin hydration and inflammatory conditions through combined thermal and moisture effects [6].
Table 2. Shared therapeutic Indications
Disease Category | Balneotherapy Evidence | Persian Medicine Indications | Overlap |
Musculoskeletal pain | Strong clinical evidence (OA, LBP) | Hot baths, clays for joint disorders | High |
Dermatologic disorders | Psoriasis, eczema | Clays and mineral baths for skin purifying | High |
Gastrointestinal issues | Constipation, dyspepsia | Warm baths, mineral waters for digestion | Moderate |
Stress, anxiety | Neuroendocrine effects | Hàmmām for emotional balance | High |
Chronic inflammation | Sulfur/mineral mechanisms | Humoral balancing, detoxification | Moderate |
Respiratory issues | Steam inhalation | Herbal steam (Bokhūr) | High |
Note: LBP — Low back pain, OA — Osteoarthritis.
In PM and related traditional systems of medicine, steam baths and vapor therapies such as hàmmām or steam inhalation have historically been prescribed for respiratory ailments, skin disorders, help to lose weight, and general relaxation and detoxification, often with the incorporation of herbal infusions or diaphoretic agents to augment therapeutic properties. Contemporary analyses of PM underscore the historical emphasis on induced sweating and vapor exposure as a strategy for health maintenance and disease management — including respiratory and systemic conditions — through modulation of humoral balance and elimination of waste products [18]. These traditional practices parallel modern steam and sauna therapies in their application of heat and humidity to support physiological functions, although clinical evidence varies and requires further rigorous investigation to clarify mechanisms and efficacy in specific indications [16, 17].
Therapeutic Applications
Balneotherapy has been consistently investigated in musculoskeletal disorders, with a substantial body of evidence supporting its role as a non-pharmacological intervention. Systematic reviews and randomized controlled trials indicate that balneotherapy with thermal mineral water can improve pain, functional ability, and quality of life in osteoarthritis, with benefits attributed to the combined physical and chemical-physical properties of mineral water immersion. For example, a 2023 systematic review of clinical trials across multiple joint sites reported consistent improvements in symptoms and functional outcomes following thermal mineral water balneotherapy, although methodological limitations of many studies were noted [19]. Meta-analyses of randomized trials also show that balneotherapy provides significant analgesic effects in chronic low back pain and other chronic pain syndromes compared with control treatments [20]. In rheumatoid arthritis, available trials suggest improvements in quality of life and clinical parameters with balneotherapy, although heterogeneity and limited study quality mean that evidence remains tentative [21, 22]. Similarly, balneotherapy has documented benefits in dermatologic conditions such as psoriasis and eczema through its thermal and immune-modulating effects, with reviews highlighting reductions in inflammation and symptomatic relief following immersion in mineral-rich waters [6].
Beyond musculoskeletal and skin diseases, mineral water therapies have also been applied to gastrointestinal disorders such as chronic constipation and dyspepsia, where the ingestion of specific mineral waters and regulated bathing protocols have been associated with improved bowel function and digestive symptoms in clinical and observational studies, though further controlled research is needed to refine indications and mechanisms [23–25].
Additionally, balneotherapy and thermal water immersion have been linked to psychophysiological benefits; heat exposure during thermal bathing can elicit reductions in stress hormone levels and improvements in mood and sleep quality, likely via neuroendocrine modulation and enhanced parasympathetic activity [26]. In PM, classical texts describe elaborate hammam and water-based regimens — including combinations of bathhouse immersion with therapeutic massage — to address musculoskeletal pain, skin purification, digestive balance through both bathing and ingestion of mineral-rich waters, and emotional purification linked to sleep and mood regulation, reflecting a holistic approach to health maintenance grounded in humoral theory [3, 5, 15].
Mechanisms of Action
Modern biomedical research suggests that the therapeutic effects of balneotherapy arise from the combined physical, thermal, and chemical properties of water immersion. Thermal exposure promotes peripheral vasodilation, enhancing blood circulation and facilitating muscle relaxation and analgesia, which are particularly beneficial in chronic pain and musculoskeletal disorders. The buoyancy of water reduces gravitational loading on joints and the spine, thereby decreasing mechanical stress and enabling safer and more effective movement during rehabilitation exercises. In mineral-rich waters, cutaneous absorption or surface interaction with minerals such as sulfur has been proposed to modulate inflammatory and oxidative pathways, contributing to symptom relief in inflammatory and dermatologic conditions. In parallel, immersion in warm water induces neuroendocrine responses, including modulation of the hypothalamic–pituitary–adrenal axis, reductions in stress hormone levels, and improvements in mood and sleep quality. Additionally, hydrostatic pressure exerted by water immersion enhances venous return and lymphatic drainage, supporting the reduction of peripheral edema and improving cardiovascular efficiency [19, 27–30]. Collectively, these mechanisms provide a plausible physiological basis for the broad therapeutic applications of balneotherapy observed in clinical practice (Table 3).
Table 3. Mechanistic comparison
Mechanism Type | Balneotherapy (Modern Science) | Persian Medicine Interpretation |
Thermal regulation | Vasodilation; pain reduction | “Tàftīh” (opening blocked pathways) |
Hydrostatic pressure | Reduced edema; better venous flow | Removal of waste (Tànqīyà) |
Mineral absorption | Sulfur anti-inflammatory effect | Mineral balancing of humors |
Buoyancy | Joint unloading, mobility enhancement | Strengthening vital force (Quwwàt) |
Neuroendocrine | Cortisol reduction, relaxation | Emotional equilibrium (Tahdīà) |
Detoxification | Sweating, improved circulation | “Istifrāgh” (evacuation of morbid matter) |
In PM, the therapeutic effects of bathing and water-based interventions are interpreted through a humoral and temperamental framework. Clinical responses are primarily attributed to the restoration of balance among the four humors — blood, phlegm, yellow bile, and black bile — whose disequilibrium is considered a central cause of disease [31]. Baths with defined thermal and moisture qualities are prescribed to correct the individual temperament (Mizaj), using hot or cold and moist or dry conditions to counteract pathological deviations. In addition, water therapies are believed to strengthen vital energy (Quwwàt), thereby enhancing the body’s innate capacity for self-regulation and healing [3]. Persian medical texts also emphasize the role of bathing in eliminating waste substances through processes such as Tànqiyà (purification) in opening obstructed pathways (Tàhlīl and Tàftīh), facilitating the proper flow of bodily substances [15, 32]. Although the conceptual language differs fundamentally from contemporary biomedical models, many of these traditional explanations parallel modern physiological interpretations, including enhanced circulation, metabolic clearance, neuroendocrine modulation, and improved tissue perfusion, underscoring points of convergence between PM theory and current scientific understanding [33–36] (Table 4).
Table 4. Treatment modalities compared
Type of Therapy | Balneotherapy Types | PM Equivalent | Notes |
Water immersion | Thermal, mineral, aerated baths | Hàmmām, cold/hot baths | Similar procedural structure |
Mud/clay | Peloids (mud packs, wraps) | Medicinal clays | PM clay taxonomy is more detailed |
Steam | Steam rooms | Herbal steam rooms | PM often combines steam + herbs |
Drinking water | Mineral water ingestion | Mā’ àl-Mà’dànī | Both use mineral-rich water internally |
Combined protocols | Baths + exercise | Bath + Dàlk (massage) | PM emphasizes integration |
Note: PM — Persian medicine.
This comparative narrative review demonstrates substantial conceptual and practical overlap between modern balneotherapy and the water-based therapeutics described in classical PM.
Concordance between PM prescriptions and modern mechanistic understanding
PM prescribers described temperature-specific baths (cold, moderate, hot) and tied them to temperament (mizaj) and clinical goals — e.g. cold baths for strengthening and tempering, hot baths for "opening pores", sweating, and removal of morbid matter—an approach that maps well onto modern explanations of thermally mediated vasodilation, increased cutaneous blood flow, sweating, and neuromuscular relaxation [15]. Detailed PM dosing (temperature ranges and duration recommendations) parallels modern hydrotherapy protocols and offers a historically derived rationale for individualized temperature/duration prescriptions.
Several PM mechanisms — "opening of apertures" (tàftīh), removal of morbid matter (tànqiyà/īstifrāgh), and mizaj correction — can be reinterpreted in modern physiological terms: improved microcirculation, enhanced lymphatic and venous return via hydrostatic pressure, thermally induced modulation of inflammatory pathways, and neuroendocrine (stress-modulating) effects triggered by passive heating and immersion. These correspondences support the hypothesis that ancient PM observations reflect genuine biologic effects that modern science can quantify and test.
PM specificity that adds value to contemporary balneology
The PM sources emphasize (a) architectural design of baths to produce graded thermal and humidity microenvironments (entrance → sàrbīneh → mīyan-dàr → gàrmkhāneh → khàzīneh/ābzàn) [5], (b) stepwise acclimatization to prevent abrupt thermal stress, and (c) combining baths with manual therapies (dàlk), oils, fumigation, and herbal decoctions [32]. This multi-component approach resembles multi-modality spa protocols but adds explicit rationales tied to constitution and organ-specific indications. Integrating PM’s stepwise architecture and acclimatization protocols could reduce adverse events and increase tolerability in modern hydrotherapy programs, especially for frail or multimorbid patients.
Varied water types: an underexplored mechanistic resource
PM texts and the modern PM reviews catalog multiple water chemistries (sulfurous, saline, ferrous, copper, alum) and assign indication-specific uses: e.g., sulfur water for dermatologic and mucosal benefits; ferrous water for stomach/spleen conditions; copper/iron waters for local mucosal affections; alum water for bleeding disorders [15]. Contemporary balneology has investigated some mineral effects (e.g., sulfur baths reducing airway neutrophilic elastase and inflammatory cytokines) [13], but PM’s systematic, indication-based taxonomy points to a targeted route for mechanistic and clinical trials investigating specific ion or trace-element effects on skin, mucosa, inflammation, and microbiome composition.
Clinical concordance and modern evidence
The PM reviews cite many conditions historically treated with baths — musculoskeletal pain, dermatologic diseases, sleep disorders, anxiety, respiratory conditions, digestive problems, and specific female disorders — which aligns with modern RCTs and systematic reviews showing benefit of balneotherapy for osteoarthritis, chronic low back pain, psoriasis, fibromyalgia, sleep quality, and COPD-related rehabilitation outcomes. The overlap suggests that PM practice and modern evidence converge on common therapeutic targets; PM provides hypotheses (e.g., which bath type for which constitution/condition) that could refine inclusion/exclusion and stratification criteria in contemporary trials.
Safety considerations and context-sensitive application
The PM reviews are explicit about adverse outcomes of inappropriate bathing (excessive duration, wrong temperature for an individual constitution, bathing at wrong post-prandial times) and non-medical hazards (Legionella in sit-bath systems, fungal contamination) [4]. These cautions mirror modern infection-control and cardiometabolic safety concerns and highlight the importance of standardized safety protocols (water quality monitoring, temperature control, screening for contraindications) when translating PM protocols into clinical research or practice.
Research implications and recommended next steps
Building on PM principles and contemporary evidence, a streamlined research agenda can be proposed: first, mechanistic pilot studies should examine PM-predicted effects of specific mineral waters (e.g., sulfurous vs non-sulfurous) on biomarkers such as inflammatory mediators, skin microbiome composition, transdermal ion absorption, and autonomic/endocrine stress markers. Second, pragmatic randomized trials could compare standard balneotherapy with PM-personalized protocols stratified by temperament (mizaj) or physiological surrogates, assessing patient-reported outcomes (pain, function, sleep) alongside objective measures (gait, joint range, cytokines). Third, implementation research may evaluate whether PM-inspired sequential exposure protocols — including staged temperature/humidity acclimatization and combined bathing, massage (dàlk), and oil therapies — enhance tolerability, adherence, and safety. Finally, safety and standardization studies should address water microbiology, contamination risks, and dermatologic safety of herbal and oil additives, integrating traditional PM cautions with modern infection-control standards.
Limitations and critical perspective
Although PM texts and modern PM reviews provide detailed procedural and indication data, direct high-quality clinical trial evidence for many PM-specific combinations (e.g., particular clay + oil + bath temperature for a given mizaj) is lacking. Translational work must therefore proceed via phased research with careful attention to blinding limitations inherent to bathing interventions and to culturally sensitive outcome measures.
CONCLUSION
The PM literature offers systematically described, clinically nuanced hydrotherapeutic protocols that map well onto known biophysical and biochemical mechanisms of modern balneotherapy. PM’s emphasis on individualized prescriptions, bath architecture, and combined modalities (massage, oils, fumigation) provides a fertile and testable source of hypotheses for current balneological research. Prioritized mechanistic studies and pragmatic trials — designed with PM concepts in mind — could validate useful PM practices, improve personalization in hydrotherapy, and safely expand integrative care options.
ADDITIONAL INFORMATION
Author Contributions. All authors confirm their authorship according to the international ICMJE criteria (all authors contributed significantly to the conception, study design and preparation of the article, read and approved the final version before publication). Special contributions: Jaladat A.M. — conceptualization, methodology, investigation, writing — original draft, writing — review & editing; Heydarirad Gh. — investigation, data curation, formal analysis, writing — review & editing; Tavakoli A. — investigation, data curation, formal analysis, writing — review & editing; Marchenkova L.A. — methodology, validation, supervision, writing — review & editing; Pasalar M. — conceptualization, supervision, project administration, writing — original draft, writing — review & editing.
Funding. This study was not supported by any external funding sources.
Disclosure. Marchenkova L.A. — Chair of the Editorial Council of Bulletin of Rehabilitation Medicine Journal. The other authors state that there is no conflict of interest.
Data Access Statement. The data that support the findings of this study are available on reasonable request from the corresponding author.
About the authors
Amir M. Jaladat
Shiraz University of Medical Sciences
Email: mehdipasalar@yahoo.com
ORCID iD: 0000-0003-3158-1250
Professor, Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine
Iran, Islamic Republic of, ShirazGhazaleh Heydarirad
Shahid Beheshti University of Medical Sciences
Email: mehdipasalar@yahoo.com
ORCID iD: 0000-0003-4301-5918
Professor, Traditional Medicine and Materia Medica Research Center and Department of Traditional Medicine, School of Traditional Medicine
Iran, Islamic Republic of, TehranAli Tavakoli
Shiraz University of Medical Sciences
Email: mehdipasalar@yahoo.com
ORCID iD: 0000-0002-3632-9356
Professor, Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine
Iran, Islamic Republic of, ShirazLarisa A. Marchenkova
National Medical Research Center for Rehabilitation and Balneology
Email: mehdipasalar@yahoo.com
ORCID iD: 0000-0003-1886-124X
D.Sc. (Med.), Associate Professor, Head of the Office of Scientific Research, Chief Researcher, Unit of Somatic Rehabilitation, Reproductive Health and Active Longevity, Professor at the Department of Restorative Medicine, Physical Therapy and Medical Rehabilitation
Russian Federation, MoscowMehdi Pasalar
Shiraz University of Medical Sciences; Qatar University
Author for correspondence.
Email: mehdipasalar@yahoo.com
ORCID iD: 0000-0003-2458-2626
Professor, Traditional, Complementary, and Integrative Medicine Research Network Groups (TCIM-RNG)
Iran, Islamic Republic of, Shiraz; Doha, QatarReferences
- Nasermoaddeli A., Kagamimori S. Balneotherapy in medicine: A review. Environmental Health and Preventive Medicine. 2005; 10(4): 171–179. https://doi.org/10.1007/bf02897707
- Gutenbrunner C., Bender T., Cantista P., Karagülle Z. A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology. International Journal of Biometeorology. 2010; 54(5): 495–507. https://doi.org/10.1007/s00484-010-0321-5
- Alipour H., Qaraaty M., Sepehrikia S., et al. A review of old baths and its benefit in maintaining health from the perspective of Persian medicine: Baths from the perspective of Persian medicine. Journal of Current Oncology and Medical Sciences. 2022; 2(3): 284–293.
- Hossain Hashemi Z., Kasiri M., Montazerghaem A., Zargaran A. Bath, Its Preventive and Therapeutic Approach in Iranian Medicine. Journal for the History of Science. 2019; 17(1): 135–155.
- Vakilinia S.R., Alizadeh Vaghasloo M., Asghari M. Abzan, a Simple and Effective Method for Prevention and Treatment of Diseases from the Perspective of Iranian Traditional Medicine. Qom University Medical Sciences Journal. 2019; 13(5): 53. https://doi.org/10.29252/qums.13.5.53
- Protano C., Vitali M., De Giorgi A., et al. Balneotherapy using thermal mineral water baths and dermatological diseases: a systematic review. International Journal of Biometeorology. 2024; 68(6): 1005–1013. https://doi.org/10.1007/s00484-024-02649-x
- Van Tubergen A., Van Der Linden S. A brief history of spa therapy. Annals of the Rheumatic Diseases. 2002; 61(3): 273–275. https://doi.org/10.1136/ard.61.3.273
- Hosseinkhani A., Montaseri H., Hosamo A., Zarshenas M.M. An Evidence-Based Review on Medicinal Value of Clays in Traditional Persian Medicine. Current Drug Discovery Technologies. 2017; 14(1): 2–7. https://doi.org/10.2174/1570163813666161007160036
- Khalilzadeh S., Shirbeigi L., Naghizadeh A., et al. Use of mineral waters in the treatment of psoriasis: Perspectives of Persian and conventional medicine. Dermatologic Therapy. 2019; 32(4): e12969. https://doi.org/10.1111/dth.12969
- Verhagen A.P., Cardoso J.R., Bierma-Zeinstra S.M. Aquatic exercise & balneotherapy in musculoskeletal conditions. Best Practice & Research Clinical Rheumatology. 2012; 26(3): 335–343. https://doi.org/10.1016/j.berh.2012.05.008
- Breger Stanton D.E., Lazaro R., Macdermid J.C. A systematic review of the effectiveness of contrast baths. Journal of Hand Therapy. 2009; 22(1): 57–69; quiz 70. https://doi.org/10.1016/j.jht.2008.08.001
- Rapolienė L., Razbadauskas A., Mockevičienė D., et al. Balneotherapy for musculoskeletal pain: does the mineral content matter? International Journal of Biometeorology. 2020; 64(6): 965–979. https://doi.org/10.1007/s00484-019-01800-3
- Fraioli A., Mennuni G., Fontana M., et al. Efficacy of Spa Therapy, Mud-Pack Therapy, Balneotherapy, and Mud-Bath Therapy in the Management of Knee Osteoarthritis. A Systematic Review. BioMed Research International. 2018; 2018: 1042576. https://doi.org/10.1155/2018/1042576
- Morer C., Roques C.F., Françon A., et al. The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials. International Journal of Biometeorology. 2017; 61(12): 2159–2173. https://doi.org/10.1007/s00484-017-1421-2
- Sina H.A. Al-Qanun fi al-Tibb [The Canon of Medicine]. Alaalami Library; 2005.
- Kunutsor S.K., Laukkanen T., Laukkanen J.A. Sauna bathing reduces the risk of respiratory diseases: a long-term prospective cohort study. European Journal of Epidemiology. 2017; 32(12): 1107–1111. https://doi.org/10.1007/s10654-017-0311-6
- Tungsukruthai P., Nootim P., Worakunphanich W., Tabtong N. Efficacy and safety of herbal steam bath in allergic rhinitis: a randomized controlled trial. Journal of Integrative Medicine. 2018; 16(1): 39–44. https://doi.org/10.1016/j.joim.2017.12.010
- Mahlouji M., Alizadeh Vaghasloo M., Dadmehr M., et al. Sweating as a Preventive Care and Treatment Strategy in Traditional Persian Medicine. Galen Medical Journal. 2020; 9: e2003. https://doi.org/10.31661/gmj.v9i0.2003
- Protano C., Fontana M., De Giorgi A., et al. Balneotherapy for osteoarthritis: a systematic review. Rheumatology International. 2023; 43(9): 1597–1610. https://doi.org/10.1007/s00296-023-05358-7
- Roques C.F., Queneau P. [SPA therapy for pain of patients with chronic low back pain, knee osteo-arthritis and fibromyalgia]. Bulletin de l’Academie Nationale de Medecine. 2016; 200(3): 575–586; discussion 586–587.
- Santos I., Cantista P., Vasconcelos C. Balneotherapy in rheumatoid arthritis-a systematic review. International Journal of Biometeorology. 2016; 60(8): 1287–1301. https://doi.org/10.1007/s00484-015-1108-5
- Fernandez-Gonzalez M., Fernandez-Lao C., Martin-Martin L., et al. Therapeutic Benefits of Balneotherapy on Quality of Life of Patients with Rheumatoid Arthritis: A Systematic Review. International Journal of Environmental Research and Public Health. 2021; 18(24): 13216. https://doi.org/10.3390/ijerph182413216
- Bothe G., Coh A., Auinger A. Efficacy and safety of a natural mineral water rich in magnesium and sulphate for bowel function: a double-blind, randomized, placebo-controlled study. European Journal of Nutrition. 2017; 56(2): 491–499. https://doi.org/10.1007/s00394-015-1094-8
- Dupont C., Constant F., Imbert A., et al. Time to treatment response of a magnesium- and sulphate-rich natural mineral water in functional constipation. Nutrition. 2019; 65: 167–172. https://doi.org/10.1016/j.nut.2019.02.018
- Anti M., Lippi M.E., Santarelli L., et al. Effects of mineral-water supplementation on gastric emptying of solids in patients with functional dyspepsia assessed with the 13C-octanoic-acid breath test. Hepato-Gastroenterology. 2004; 51(60): 1856–1859.
- García-López H., García-Giménez M.T., Obrero-Gaitán E., et al. Effectiveness of balneotherapy in reducing pain, disability, and depression in patients with Fibromyalgia syndrome: a systematic review with meta-analysis. International Journal of Biometeorology. 2024; 68(10): 1935–1951. https://doi.org/10.1007/s00484-024-02732-3
- Tefner I.K., Kovács C., Gaál R., et al. The effect of balneotherapy on chronic shoulder pain. A randomized, controlled, single-blind follow-up trial. A pilot study. Clinical Rheumatology. 2015; 34(6): 1097–1108. https://doi.org/10.1007/s10067-013-2456-3
- Antonelli M., Donelli D., Fioravanti A. Effects of balneotherapy and spa therapy on quality of life of patients with knee osteoarthritis: a systematic review and meta-analysis. Rheumatology International. 2018; 38(10): 1807–1824. https://doi.org/10.1007/s00296-018-4081-6
- Montvydaitė-Kreivaitienė O., Kubilius R., Burbulytė A., et al. Comparative efficacy of mineral water and mud therapy vs standard rehabilitative interventions: a systematic review of osteoarthritis studies from 2000. International Journal of Biometeorology. 2025; 69(6): 1181–1206. https://doi.org/10.1007/s00484-025-02889-5
- Cozzi F., Ciprian L., Carrara M., et al. Balneotherapy in chronic inflammatory rheumatic diseases—a narrative review. International Journal of Biometeorology. 2018; 62(12): 2065–2071. https://doi.org/10.1007/s00484-018-1618-z
- Tafazoli V., Tavakoli A., Mosaffa-Jahromi M., et al. Approach of Persian medicine to health and disease. Note. Advances in Integrative Medicine. 2022; 9(1): 3–8. https://doi.org/10.1016/j.aimed.2021.07.007
- Razi M.Z. Al-Havi Fi Al-Tibb (Arabic). Dar Al Kotob Al-islmiyah; 2000.
- Srámek P., Simecková M., Janský L., et al. Human physiological responses to immersion into water of different temperatures. European Journal of Applied Physiology. 2000; 81(5): 436–442. https://doi.org/10.1007/s004210050065
- Ojima S., Ohishi M. Effects of hot spring bathing on cardiac and vascular function. Hypertension Research. 2023; 46(7): 1705–1706. https://doi.org/10.1038/s41440-023-01290-2
- Gálvez I., Torres-Piles S., Ortega-Rincón E. Balneotherapy, Immune System, and Stress Response: A Hormetic Strategy? International Journal of Molecular Sciences. 2018; 19(6): 1687. https://doi.org/10.3390/ijms19061687
- Carter H.H., Spence A.L., Pugh C.J., et al. Cardiovascular responses to water immersion in humans: impact on cerebral perfusion. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 2014; 306(9): R636–R640. https://doi.org/10.1152/ajpregu.00516.2013
Supplementary files


