Hydropath, KHTP®
Hydropathy Practitioner
Hydropathic Approach to Treatment
(Lato Sensu Ad Modum Kneipp)
Hydrotherapy (HT), Balneotherapy (BT), Phyto-Balneotherapy (PBT)


     Study Program Requirement

I - Introductory Anatomy, Physiology & Pathology, APP

Minimum requisites: Students applying to this Course need to have Anatomy, Physiology and Pathology Course, either as a Course which was taken specific for Anatomy, Physiology and Pathology or part of another course, in which AP&P is given.

Please be aware that the minimum amount of Anatomy, Physiology and Pathology classroom hours should be no less than 150 hours.
Anatomy, Physiology and Pathology can be taken with Volksmed School or with any other school.

II -  Colon Hydropathy, GCH®
III - Hydropath, Hydropathy Practitioner, KHTP®
Specific study of the Kneipp Method of Cure and its relationships with the Health Sate of the body. Duration of Course: 600 Hours of Course Work Study of scientific academic research. 60 Hours of Classroom Lectures, 160 hours of Clinical Training.

Hydropathy Practitioner Course

Clinical Practice Training in Hydropathy, 160 hours of Clinical Practice Training in the Kneipp Hydropathy Method. The 160 hours of clinical training are spread over 20 days.

     Course Description

The Kneipp Hydropathy Course / module, consists on a 12 month study academic course / module gaining the clinical skills for professional Registration.

Who is this course for

Students who wish to study The Kneipp Method of Hydropathy ®

COURSE: Hydropath Practitioner
Lato Sensu Course

Course Syllabus
 (Non exhaustive List)

Part I

A - History of Medicine

1. History of Hydropathy
2. History of Homeopathy
3. History of Eclectic Medicine
4. History of Osteopathy
5. History of Chiropractor
6. History of Orthopaedics
7. History of Allopathy

B - Clinical Nutrition

C - Materia Medica

D - The Kneipp Health Teaching

1. Order of life
2. Hydrotherapy (water treatment)
3. Movement
4. Nutrition
5. Medicinal Herbs
I. Water therapy: effects and objectives
II. Helps treat a Kneipp cure
III. Weekly schedule for a Kneipp cure
IV. Kneipp products and medicinal herbs in the household

Part II


A - Cold Kneipp Treatments - Grundregeln

1. The Skin and its Functions
2. Treading Water
3. Taulaufen
4. To run barefoot
5. Snow Walking
6. Luftbad
7. Sunbathing
8. Drybrushing
9. Sauna
10. The cold washes - effects, conditions, implementation
11. The cold upper body wash
12. The cold stomach wash
13. The cold lower body wash
14. The cold whole ablution
15. The cold wash the sick in bed
16. The cold wash series

Part III


A - The Hot & Cold Baths - Effects

1. General Rules for the hot and cold bath
2. The Cold Arm Bath
3. The Warm Arm Bath
4. The Temperature rising arm bath
5. The Change-Arm bath
6. The Cold Footbath
7. The Warm Footbath
8. The Temperature rising Footbath
9. The Alternating footbath
10. The Warm Sitzbath
11. The Change Sitzbad
12. The Cold half-bath: a "merry Kneipp Bath"
13. The Warm three-quarter bath (Bath, Kneipp herbal Bath)
14. The Rising three-quarter Bath (Bath)
15. The Brush Bath
16. The Bath products

Part IV


A - Vapours

1. The Head & Facial steam
2. The Nose & Throat steam
3. The Herbal Supplements


Part V


A - The Fountains

1. The Kneipp Showers
2. The Cast: what it is, how it affects
3. Stimulus Intensity
4. Implementation
5. Pour life and reaction
6. Cast Rules
7. The Cold Face casting
8. The Warm Face casting
9. The Cold Eyes cast
10. The cold Armguss
11. The change-Armguss
12. The cold chest cast
13. Changing Breast Cast
14. The cold upper cast
15. The cold knee cast
16. The cold leg cast
17. The change-leg cast
18. The change-knee cast
19. The cold solid casting
20. The cold cast
21. The hot showers
22. The hot neck Cast
23. The hot Lumbalguss

Part VI


A - The Kneipp Winding

1. The Kneipp winding
2. The cold Kneipp winding
3. Effects and modes of action
4. The heat-removing cold compresses
5. The heat astonished cold compresses
6. The Perspiration cold compresses
7. Basic Rules when equipped
8. Winding Technology
9. The Cold and wet socks
10. The Cold Wadenwickel
11. Cold Neck wrap
12. The cold Chest wrapped
13. The cold Lumbar wrap
14. The cold Short winding

Part VII


A - Dressings & Compresses

1. The Cold Pad
2. Cool Pad with Arnika
3. The Cold Quark Edition
4. The Cold Lehmauflage
5. The Carbon Edition
6. The Onion Edition
7. The Hot Pad
8. The Small hot pad
9. The Hot Lehmauflage
10. The Dampfkompresse
11. The Hot Potato sack
12. The Heublumensack
13. The Hay Flowers
14. Pad Accessories and Kräuterabkochung
15. The Hot Roll
16. Kneipp Treatments for Children
17. Kneipp High Value Medicinal Plants Pharmacy
18. The Right Heilkräutlein
19. Other Applications of the High Value Medicinal Plants
20. The Full List of Kneipp Treatments, with their Clinical Indications & Contraindications


A - Clinical Practice

1. The different Therapeutic Methods
2. Scope of practice
3. When to refer
4. Indications
5. Contraindications
6. Anamnesis

Course Fee without AP&P and GCH: £3,300. (If you have already taken a AP&P and the GCH® course).

Course Fee without AP&P:
£6,600. (If you have already taken a AP&P course (level 3 or above) elsewhere you don't need to retake the AP&P course again).

Course Fees:
 £7,100. This is the total cost, including the 2 required courses Anatomy Physiology & Pathology Course, and Colonic Hydropathy Course. All the Academic Classroom Lectures, Clinical Practice and Course Manuals. If the student has already the AP&P & GCH® this amount will be deducted from the course total, and there is no need to retake the same.

Change of Mind & Refunds: Our courses are given to the best standards and are second to none.
But each person is different and we understand that things may change.

Our Guarantee to our students
If for any given reason you changed your mind after paying for any course but before taking a class then we will refund your payment “no questions asked”.
If you attended one or more classes and then had a change of mind we will refund you per each day you haven't participated, “again no questions asked”.

Hydropathy, DH Course
Clinical Training

Total Hours: Hydropathy, KHTP® Course

Location: Bahia, Brazil.
Course Fees:  £7,100
Price includes: Accommodation & Food.

1. Scientific Study Hours:         600 Hours
2. Classroom Lecture Hours:
    60 Hours in 80 Lessons (à 45 min.)
3. Clinical Training Hours:          160 hours (during 20 days) of Clinical Training in Hydropathy (Kneipp Method®)

Students who attend all class lectures but do not pass the final exam, and or do not wish to retake the exam will be issued an Award Certificate.

Students who complete and successfully pass their exams in all courses are awarded a Diploma: Kneipp Hydrotherapy® (Ad Modum Kneipp).

Professional Insurance: Students can apply for Professional Insurance if they wish to.

Prof. German M. Schleinkofer, Head Instructor of Hydrotherapy with Rui Alexandre Gabirro at the Kneipp School in Bad Worishofen, Germany

      Course objectives

Clinical Skills & Knowledge
1. Clinical Practice
2. Treatment Principle & Therapeutic Techniques
3. Indications & Contraindication

      Prerequisites and co-requisites

Minimum requisites: Students applying to this Course need to have Anatomy, Physiology and Pathology Course, either as a Course which was taken specific for Anatomy, Physiology and Pathology or part of another course, in which AP&P is given.

Please be aware that the minimum amount of Anatomy, Physiology and Pathology classroom hours should be no less than 150 hours.
Anatomy, Physiology and Pathology can be taken with Volksmed School or with any other school.

A letter of intent stating the reason why they wish to take the course.
Interview: Personal Interview to assess their expectations from the course matter, content and discipline. To establish if the candidate as a good understanding of what the course is about. Candidates will be notified if the course is what they expect in writing after 30 calendar days after the interview.

Course requirements

What students will have to do in the course: assignments, exams, projects, performances, attendance, participation.

Clinical Health Research

In Germany the Kneipp Method of Cure was applied for many years in Hospitals in the everyday health care (Study 2015 Charité Universitätsmedizin Berlin). And this with great success!

The Kneipp Method is Quick and effective, help provide relief, provide the patient with a feel-good experience, both during the day and at night.

The term Kneipp not simply means cold showers, but exciting knowledge from the single Holistic European Natural Healing Method.

The course fee is deliberately kept affordable in order to enable as many health care professionals in this training.

Long-standing, scientifically verified clinical knowledge, according to practice, the courses are based.

Dr Manfred Fischer, Prof. Sissi Eichhorn-Schleinkofer, Instructor, Prof. German M. Schleinkofer, Head Instructor of Hydropathy with Rui Alexandre Gabirro at the Kneipp School in Bad Worishofen, Germany

Hydrotherapy in Orthopedics

“Hydrotherapy is an effective therapeutic measure capable of producing beneficial results more striking than the average medication now in vogue.

Just as the pharmacological action of a drug is determined prior to its use, so should the specific value of hydrotherapy procedures be known and applied.

l am not advocating that hydrotherapy should be used as the sole remedial agent.

Diet, medication, colonic irrigations, endocrine therapy, vaccines, foreign proteins, electrotherapy, massage, passive and active motion, mechanotherapy, and occupational therapy may also be employed when indicated.”

- Dr Lowell Thomas in “Hydrotherapy in Orthopedics” University of Nebraska College of Medicine, 1936.


Hydropathy Therapeutics

"They improve the tone, function and appearance of the skin, stimulate the appetite, improve the functions of the stomach, bowels and kidneys, equalize the circulation of the blood and lymph, favourably influence nutrition, increase the elimination of carbon-dioxide and the intake of oxygen by the lungs and influence the patient to sleep naturally and comfortably." - Dr Rebekah Wright, MD in "Bulletin of Iowa State Institutions", Vol.20, 1918.

Scientific Evidence-Based Effects of Hydrotherapy on Various Systems of the Body

Am J Med Sci. 2014 May; 6(5): 199–209.

A Mooventhan and L Nivethitha Ujire, India
Department of Research and Development, S-VYASA University, Bangalore, Karnataka, India


The use of water for various treatments (hydrotherapy) is probably as old as mankind. Hydrotherapy is one of the basic methods of treatment widely used in the system of natural medicine, which is also called as water therapy, aquatic therapy, pool therapy, and balneotherapy. Use of water in various forms and in various temperatures can produce different effects on different system of the body. Many studies/reviews reported the effects of hydrotherapy only on very few systems and there is lack of studies/reviews in reporting the evidence-based effects of hydrotherapy on various systems. We performed PubMed and PubMed central search to review relevant articles in English literature based on “effects of hydrotherapy/balneotherapy” on various systems of the body. Based on the available literature this review suggests that the hydrotherapy has a scientific evidence-based effect on various systems of the body.

Keywords: Evidence-based effects, Hydrotherapy, Various systems


Hydrotherapy is the external or internal use of water in any of its forms (water, ice, steam) for health promotion or treatment of various diseases with various temperatures, pressure, duration, and site. It is one of the naturopathic treatment modality used widely in ancient cultures including India, Egypt, China, etc.[1] Though many countries used water to produce different physiological/therapeutic effects on different part of the system for maintaining health, preventing, and treating the diseases, the scientific evidence-based effects are not well documented. There are many studies/reviews that reported either physiological or therapeutic or combination of both the effects of hydrotherapy on particular system but did not report in all the major systems of the body, which made us to do this review with the aim and objective to report scientific evidenced-based effects of hydrotherapy on various systems of the body. In order to provide a general overview, we performed PubMed and PubMed central search to review relevant articles in English literature based on “effects of hydrotherapy/balneotherapy” on various systems of the body. Articles published from 1986 to 2012 were included in this review.

Hydrotheraphy in general

Superficial cold application may cause physiologic reactions such as decrease in local metabolic function, local edema, nerve conduction velocity (NCV), muscle spasm, and increase in local anesthetic effects.[2]

One hour head-out water immersions (WI) in various temperatures (32°C, 20°C, and 14°C) produced various effects. Immersion at 32°C did not change metabolic rate (MR) and rectal temperature (Tre), but it lowered the heart rate (HR) by 15%, systolic blood pressure (SBP) and diastolic blood pressure (DBP) by 11% and 12%, respectively, compared, with controls at ambient air temperature. Along with HR and blood pressure (BP), the plasma renin activity, plasma cortisol, and aldosterone concentrations were also lowered by 46%, 34%, and 17%, respectively, while diuresis was increased by 107%.[3]

Immersion at 20°C produced similar decrease in plasma renin activity, HR, SBP, and DBP, in spite of lowered Tre and increased MR by 93%. Plasma cortisol concentrations tended to decrease, while plasma aldosterone concentration was unchanged. Diuresis was increased by 89%. No significant differences in changes in plasma renin activity, aldosterone concentration, and diuresis compared with subjects immersed in 32°C.[3]

Immersion at 14°C lowered Tre and increased MR by 350%, HR, SBP, and DBP by 5%, 7%, and 8%, respectively. Plasma noradrenaline and dopamine concentrations were increased by 530% and by 250%, respectively, while diuresis increased by 163%, which was more than at 32°C. Plasma aldosterone concentrations increased by 23%. Plasma renin activity was reduced. Cortisol concentrations tended to decrease. Plasma adrenaline concentrations remained unchanged. Changes in plasma renin activity were not related to changes in aldosterone concentrations.[3]

WI in different temperatures did not increase blood concentrations of cortisol. There was no correlation between changes in Tre and changes in hormone production. The physiological changes induced by WI are mediated by humoral control mechanisms, while responses induced by cold are mainly due to increased activity of the sympathetic nervous system (SNS).[3]

Regular winter swimming significantly decreased tension, fatigue, memory, and mood negative state points with the duration of swimming period; significantly increased vigor-activity scores; relieved pain who suffered from rheumatism, fibromyalgia, or asthma; and improved general well-being in swimmers.[4]

Cardiovascular system

Cold exposure (CE) to small surface area produced compensatory vasodilatation in deeper vascular system resulting increased blood flow to the tissues underlying the site of exposure. This vascular reaction occurs mainly to maintain constant deep tissue temperature.[2]

In patient with chronic heart failure (CHF), thermal vasodilatation following warm-water bathing and low-temperature sauna bathing (LTSB) at 60°C for 15 min improves cardiac function;[5] repeated sauna-therapy (ST) increased left ventricular ejection fraction; increased 6-min walk distance in association with improvement in flow-mediated dilation and increase in number of circulating CD34 (+) cells; reduced plasma levels of norepinephrine and brain natriuretic peptide. These indicates that ST improves exercise tolerance in association with improvement in endothelial function.[6] LTSB improves peripheral circulation in cerebral palsy (CP).[5]

After ST reduced level of total and low density lipoprotein (LDL)-cholesterol concentration, while increased level of high density lipoprotein (HDL)-cholesterol was observed. These changes are good prognoses for the prevention of ischemic heart disease.[7] ST increases endothelial nitric oxide synthase (eNOS) activity and improves cardiac function in heart failure and improve peripheral blood flow in ischemic limbs. In myocardial infarction (MI)-induced Wistar rats ST increases myocardial eNOS, vascular endothelial growth factor mRNA levels. It attenuates cardiac remodeling after MI through improving coronary vascularity in the noninfarcted myocardium and thus ST might serve as a novel noninvasive therapy for patients with MI.[8]

Acute MI was thought to result from thrombosis or plaque rupture because of coronary artery spasm. The vasospasm might be induced by stimulation of the alpha-adrenergic receptors during alternating heat exposure during sauna bath followed by rapid cooling during cold water bath. This effect showed the dangers of rapid cooling after sauna bathing in patients with coronary risk factors.[9] Regular ST (either radiant heat or far-infrared units) appears to be safe and produce multiple health benefits but use of ST in early pregnancy is a potential concern because evidence suggesting that hyperthermia might be teratogenic.[10]

Cold water immersion (CWI) induces significant physiological and biochemical changes in the body such as increase in HR, BP, metabolism, and peripheral catecholamine concentration; and decrease in cerebral blood flow.[11]

Reduction in HR, and increases in systolic and diastolic biventricular functions, were observed during acute warm-WI.[12] In contrast, increase in HR and a decrease in SBP and DBP were observed in 30 min of head-out WI (38.41 ± 0.04°C).[13]

Hyperthermic immersion (HI) produced shortening of activated partial thromboplastin time. During HI plasminogen activator inhibitor (PAI) activity was decreased; thrombocyte count was increased; increases in tissue-type plasminogen activator concentration and leukocytes count were attributed to hemoconcentration. Immediately after HI, fibrinogen concentration decreased but increased during recovery. During thermo-neutral immersion prothrombin time, PAI activity and granulocyte count ecreased. Warm water bathing leads to hemoconcentration and minimal activation of coagulation; decrease in PAI-1 activity. During warm water bathing, marked risk for thrombotic or bleeding complications in healthy males could not be ascertained.[14] During contrast baths, longer duration in the second heating phase was required to produce sufficient fluctuation in blood flow.[15]

WI up-to shoulder levels at different temperatures (25°C, 34°C, and 40°C) showed no significant effect on cardiac output in 25°C compared with 34°C, but in 40°C a considerable increase in cardiac output was observed.[16]

Carbon dioxide (CO2) enriched WI reduced free radical plasma levels, raised antioxidants levels, and induce peripheral vasodilatation suggests improvement in microcirculation.[17,18] Decrease in tympanic temperature; increase in cutaneous blood flow at immersed site was significantly greater in CO2-WI compared with fresh WI.[18] The three main effects of CO2 enriched WI are decline in core temperature, increase in cutaneous blood flow, and elevation of score on thermal sensation, which were analyzed.[19]

Respiratory system

WI up-to shoulder levels at different temperatures (25°C, 34°C, and 40°C) showed increased MR, oxygen (O2) consumption (VO2) only at 25°C. Two main factors affecting O2 transport during immersion are temperature and hydrostatic pressure. O2 transport was improved above neutral temperature, because of increase in cardiac output resulting from the combined actions of hydrostatic counter pressure and body heating. Below neutral temperature, O2 transport is altered. At any of the temperatures tested, the pulmonary tissue volume and arterial blood gases were not significantly affected.[16]

Significant decrease in vital capacity (VC) with bath temperature was observed (i.e., VC at 40°C >34°C >25°C). Significant increase in tidal volume (VT) in cold or hot water compared with thermo neutral water (i.e., VT 40°C >34°C< 25°C). Alterations in respiratory muscles functioning might produce variations of the pulmonary volumes as a function of water temperature.[20]

CWI was associated with increase in respiratory minute volume and decrease in end tidal CO2 partial pressure.[11] Repeated cold water stimulations reduced frequency of infections; increased peak expiratory flow, lymphocyte counts, and expression of gamma-interferon; modulated interleukin expression; and improved quality of life (QOL) in patients with chronic obstructive pulmonary disease.[21]

In children suffering from recurrent and asthmatic bronchitis in remission, a single total air bath, or douche and local (cooling of the feet with water) exposure to mild cold did not raise noticeable disorders of the respiratory function. Local cold procedures improve bronchial patency but heat exposure resulted in its worsening.[22]

Inhaling hot air while in a sauna produced no significant impact on overall symptom severity of common cold.[23] A male track and field athlete, a case of breathing difficulties at rest and during exercise, was exacerbated in the supine position and during WI.[24]

Nervous system

Three cold modalities such as ice massage, ice pack, and CWI applied to right calf region for 15min reduced skin temperature (Tsk) (mean 18.2°C); reduced amplitude and increased latency and duration of compound action potential. It also reduced sensory NCV by 20.4, 16.7, and 22.6 m/s and motor NCV by 2.5, 2.1, and 8.3 m/s, respectively. Even though all three modalities effectively reduced Tsk and sensory conduction at a physiological level, CWI is the most indicated, effective modality for inducing therapeutic effects associated with the reduction of motor nerve conduction.[25]

Temperature and pressure of water in aquatic or hydrotherapy can block nociceptors by acting on thermal receptors and mechanoreceptors and exert positive effect on spinal segmental mechanisms, which is useful for painful condition.[26] Forty sessions of Ai Chi aquatic exercise (AE) program improves pain, spasms, disability, fatigue, depression, and autonomy in patient with multiple sclerosis.[27]

In a study on physiotherapy on land or water in patient with Parkinson's disease (PD), functional reach test was improved in both therapies, but Berg Balance Scale (BBS) and Unified Parkinson's Disease Rating Scale (UPDRS) were improved only in aquatic therapy group. It indicates improvement in postural stability in PD was significantly larger after aquatic therapy.[28]

Sauna bath on paraplegic (P) group and tetraplegic (T) group, HR increased significantly during sauna but decreased significantly during postsauna phase in P group. DBP significantly reduced in T group during postsauna phase but no significant changes in SBP in both the groups.[29]

In a study on CP, LTSB produced increase in HR and cardiac output; decrease in BP and total peripheral resistance; significant improvement in skin blood flow, blood flow velocity, pulsatile index, and resistive index; decrease in numbness and chronic myalgia of the extremities with no adverse effects.[5]

Ten minutes of immersions in whirlpools produced increases in pulse and finger temperature with increased feelings of well-being and decreased state anxiety.[30] CO2-WI activates parasympathetic nerve activity in humans.[18]

Adapted cold shower might have antipsychotic effect similar to that of electroconvulsive therapy because it could work as mild electroshock applied to sensory cortex. Additionally, cold shower is example of stress-induced analgesia and would also be expected to “crowd out” or suppress psychosis-related neurotransmission within mesolimbic system.[31]

CE can activate components of reticular activating system such as locus ceruleus and raphe nuclei, which can result in activation of behavior and increased capacity of central nervous system (CNS) to recruit motoneurons.[32] CE activates SNS; increase blood level of beta-endorphin and noradrenaline; and increase synaptic release of noradrenaline in brain. Antidepressive effect of cold shower attributed to presence of high density of cold receptors in skin expected to send an overwhelming amount of electrical impulses from peripheral nerve endings to the brain. It has significant analgesic effect and it does not cause dependence or noticeable side effects.[33] Most narcotics administered rectally can cause intoxication. There is a significant co-morbidity of schizophrenia with intestinal illnesses and thus colon cleansing can significantly improve mental state.[31]

Musculo skeletal system

Walking in water at umbilical level increases the activity of erector spinae and activates rectus femoris to levels near to or higher than walking on dry ground.[34] CWI <15°C is one of the most popular intervention used after exercise,[11,35] which significantly lowered ratings of fatigue and potentially improved ratings of physical recovery immediately after immersion with reduction in delayed onset muscle soreness at 24, 48, 72, and 96 h follow-ups after exercise compared with passive interventions involving rest or no intervention.[35]

Rate of decrease in plasma lactate concentration over 30 min recovery period after intense anaerobic exercise was significantly higher in contrast-WI [hot (36°C) and cold (12°C)] compared with passive recovery on bed for both genders.[36]

Leg immersion in warm water (44 ± 1°C) for 45 min before stretch-shortening exercise reduced most of the indirect markers of exercise-induced muscle damage, including muscle soreness, creatine kinase activity in the blood, maximal voluntary contraction force, and jump height. Decreasing muscle damage did not improve voluntary performance, therefore clinical application of muscle prewarming may be limited.[37]

Contrast water therapy (CWT) [alternating 1-min hot (38°C) and 1-min cold (15°C)] for 6/12/18 min lowered subjective measures of thermal sensation and muscle soreness compared with control (seated rest) but no consistent differences were observed in whole body fatigue. It indicates CWT for 6 min assisted acute recovery from high-intensity running and CWT duration did not have dose-response effect on running performance recovery.[38] Contrast baths have been suggested for reducing pain; hand volume; and stiffness in affected extremities but it had no significant effect on pre- and/or postoperative hand volume in carpal tunnel syndrome.[39]

Cold water or cold/thermoneutral water did not induce modifications of inflammatory and hematological markers. The performances of athletes were not negatively influenced by CWI or CWT. Reduced perception of fatigue after training session was the principal effect of CWI[45] because CE increases opioid tone and high MR, which could diminish fatigue by reducing muscle pain and accelerating recovery of fatigued muscle, respectively,[32] which can improve training and competitions in young soccer players.[40]

A systematic review on management of fibromyalgia syndrome (FMS) through hydrotherapy described as “there is strong evidence for the use of hydrotherapy in the management of FMS” and it showed positive outcomes for pain; tender point count; and health-status.[41] Combination of ST (once daily for 3 days/week) and underwater exercise (once daily for 2 days/week) for 12 weeks significantly reduced pain and symptoms (both short- and long-term); and improved QOL in patients with FMS.[42] Pool-based exercise using deep water running three times/week for 8 weeks is safe and effective intervention for FMS because it showed significant improvement in general health and QOL compared with control; and significant improvement in fibromyalgia impact questionnaire score, incorporating pain; fatigue; physical function; stiffness; and psychological variables.[43]

Hydrotherapy may have some short-term benefit to passive range of movement in rehabilitation after rotator cuff repair.[44] Spa water (37°C) and tap water heated to 37°C for the duration of 20 min/day for 5 days/week for the period of 2 weeks with home-based exercise program improved the clinical symptoms and QOL in patient with osteoarthritis of knee (OAK). However, pain and tenderness statistically improved in spa water.[45] It may be due to that spa waters are not only naturally warm, but their mineral content is also significant. Spa water has mechanical, thermal, and chemical effects.

In ankylosing spondilitis (AS) patients, balneotherapy statistically improved pain; physical activity; tiredness and sleep score; Bath Ankylosing Spondilitis Disease Activity Index (BASDAI); Nottingham Health Profile (NHP); patient's global evaluation and physician's global evaluation at 3 weeks, but only on modified Shober test and patient's global evaluation parameters at 24 weeks. It indicates the effect of balneotherapy in improving disease activity and functional parameters in AS patients.[46] Infrared sauna, a form of total-body hyperthermia was well tolerated; no adverse effects; and no exacerbation of disease were reported in patients with rheumatoid arthritis (RA) and AS in whom pain, stiffness, and fatigue showed clinical improvements during the 4 weeks treatment period but these did not reach statistical significance.[47]

Aqua-jogging without caloric restrictions in obese persons for 6 weeks was associated with reductions in waist circumference and body fat; improvement of aerobic fitness and QOL.[48]

AE may be an excellent alternative to land exercise for individuals who lack confidence, have high risk of falling, or have joint pain.[49] Water buoyancy reduces the weight that joints, bones, and muscles have to bear.[50] Warmth and pressure of water also reduce swelling and reduces load on painful joints, remotes muscle relaxation.[51] AE has significant effects on pain relief and related outcome measurements for locomotor diseases. Patients may become more active and improve their QOL as a result of AE.[52] Water-based and land-based exercises reduced pain and improved function in patients with OAK and that water-based exercise was superior to land-based exercise for relieving pain before and after walking.[53]

Hydrotherapy is highly valued by RA patients who were treated with hydrotherapy (30-min session/week) reported feeling much better/very much better than those treated with land exercises (similar exercises on land) immediately on completion of the treatment program (6 weeks). But this benefit was not reflected on 10 m walk times, functional scores, QOL measures, and pain scores by differences between groups.[51] Hot compress (HC) with surrounding electro-acupuncture needling was significantly effective on rear thigh muscles strain and it was superior to conventional needling method and cupping in improving symptoms and physical signs as well as recovery of walking function of athletes.[54]

Gastrointestinal system

Drinking water significantly elevates the resting energy expenditure (REE) in adults but in overweight children transient decrease in REE was observed immediately after drinking 10 ml/kg cold water (4°C). Then a subsequent rise in REE was observed, which was significant after 24 min and the maximal mean REE values were seen after 57 min, which was 25% higher than baseline. The recommended daily amount of water consumption in children could result in energy expenditure equivalent to additional weight loss of about 1.2 kg/year suggesting that water drinking could assist overweight children in weight loss or maintenance.[55] Exposure to cold increases MR, for example, head-out immersion in cold water of 20°C almost doubles MR, while at 14°C it is more than quadrupled.[3]

When very-HC applied to lumbar region of healthy female for 10-min blood flow to the back increased to 156% with increased blood flow to upper arm. Immediately after HC, bowel sounds increased 1.7 times compared with before application, which suggest that a very HC can be useful to promote flatus or defecation.[56] Low mineral water intake normalizes the intestinal permeability of patients with atopic dermatitis.[57]

Warm water is effective for colonic spasm in which significantly less discomfort was reported compared with control group and this may be useful as an alternative for glucagon (expensive) and hyoscyamine (has side effects) because it has no side effects and costs practically nothing.[58]

In patients with acute anal pain due to hemorrhoids or anal fissures, neither cold water (<15°C) nor hot water (>30°C) sitz bath (SB) did control pain statistically.[59] Similarly, after sphincterotomy for anal fissure, SB produced no significant difference in pain but significant relief in anal burning and better satisfaction score with no adverse effects were observed compared with control group.[60] Healing and pain relief was not significant in SB but it improved patient satisfaction in acute anal fissures.[61]

Though there was no strong evidence to support the use of SB for pain relief and to accelerate fissure or wound healing among adult patients with anorectal disorders (ARDs), patients were satisfied with using SB and no severe complications were reported.[62] In contrast, warm-water SB (40°C, 45°C, and 50°C for 10 min each time) in ARD, pain relief was more evident and lasted longer at higher bath temperatures.

Pain relief after SB might attribute to internal anal-sphincter relaxation, which might be due to thermosphincteric reflex, resulting in diminution of the rectal neck pressure. The higher the bath temperature, the greater the drop in rectal neck pressure and internal sphincter electromyographic activity, and longer the time needed to return to pretest levels.[63]

In posthemorrhoidectomy care, water spray method could provide a safe and reliable alternative to SB as a more convenient and satisfactory form of treatment.[64]

Spa treatment with mineral water Nizhneivkinskaya (sulfate calcium) induced clinical remission of the disease, normalization of the echoscopic picture of stomach and gallbladder, their motor function, tesiocrystalloscopic characteristics of saliva suggest its effectiveness in rehabilitation of patients with gastric and gallbladder motor-evacuatory dysfunction.[65] Intake of sulfate-chloride-sodium mineral water activates regulation of carbohydrate metabolism by insulin and cortisol due to the formation of adaptive reactions. It promoted trophic effects of insulin and gastrin in animals with significant reduction in peptic ulcer size and enhanced resistance to stressful factors.[66]

Immersion in Dead Sea water produced significant reduction in blood glucose in type-2 diabetes mellitus (DM) and no significant differences in insulin, cortisol, and c-peptide levels were observed between DM patients and healthy volunteers following immersion.[67]

Genito urinary system

Mean labor pain scores were significantly higher in control group than immersion bath (IB) group suggest that use of IB as an alternative form of pain relief during labor.[68] WI in primipara at any stage of labor, from 2 cm external opening of the uterine cervix, significantly decreased parturition duration compared with traditional delivery. It raised both the amplitude and frequency of uterine contractions proportional to uterine cervix gaping with no disturbances in contraction activity of the uterus. A 3-cm gaping of uterine cervix is the optimal timing for WI in the primipara because earlier WI at 2-cm uterine cervix gaping also accelerated the labor but required repetitions of WI or use of oxytocin for correcting weakened uterine contraction.[69]

In contrast, IB did not influence the length of labor and uterine contractions frequency. However, contractions length was statistically shorter in IB and it can be an alternative for woman's comfort during labor, since it provides relief to her without interfering on labor progression or jeopardizing the baby.[70]

WI during first stage of labor reduces the use of epidural/spinal/paracervical analgesia/anesthesia compared with controls and there is no evidence of increased adverse effects to fetus/neonate or woman from laboring in water or water birth.[71] Neonatal swimming can accelerate babies growth in early stage.[72] In a microbiological study, comparing neonatal bacterial colonization after water birth to conventional bed deliveries with or without relaxation bath showed no significant difference between three groups in neonatal outcome, infant's and maternal infection rate.[73]

Cold-SB but not warm-SB, significantly reduced edema during postepisiotomy period[74] and perineal pain, which was greatest immediately after the bath.[75] Bakera, a steam bath prepared with various plants (commonly the essential oil plants) is traditionally used in Minahasa (Indonesia) mainly for recuperation after childbirth. It is based onthermotherapy with aromatherapy which attribute for its therapeutic effects. Thermotherapy soothes symptoms such as heaviness in limbs, edema, muscular strain, loss of appetite, and constipation. Essential oils of the plants used have antiseptic, antiphlogistic, and immunostimulant effect. Hence it can be an effective and safe method for recuperation after child birth.[76] In postnatal mothers, alternate (hot and cold) compress and cold cabbage leaves were equally effective in reducing breast engorgement, but in relieving breast engorgement pain, alternate compresses were more effective than cold cabbage leaves.[77]

Warm-SB (40-45°C) for 10 min, for at least 5 days immediately after the removal of Foley urethral catheter in patient undergone transurethral resection of prostate, significantly reduced urethral stricture compared with no SB group who had 1.13-fold increased risk of re-hospitalization within 1 month after surgery due to postoperative complications compared with warm-SB group.[78] Thirty healthy volunteers and 21 patients with urinary retention after hemorrhoidectomy underwent SB at 40°C, 45°C, and 50°C where the number of spontaneous micturitions increased with higher-temperature baths and it seems to be initiated by reflex (thermo-sphincter reflex) internal urethral sphincter relaxation. The urethral pressure both in normal and retention subjects showed significant reduction, which increased with higher temperature; and vesical pressure or EMG activity of the external urethral sphincter did not show significant differences.[79]


Subsequent CE induced increase of leukocytes, granulocytes, circulating levels of interleukin (IL)-6, and natural killer (NK) cells and its activity. Leukocytes, granulocyte, and monocyte responses were augmented by pretreatment with exercise in water (18°C) and thus acute-CE has immune-stimulating effects.[80]

Daily brief cold stress can increase both numbers and activity of peripheral cytotoxic T-lymphocytes and NK cells, the major effectors of adaptive and innate tumor immunity, respectively. It (for 8 days) improved survival of intracellular parasite Toxoplasma gondii infected mice, with consistent enhancement in cell-mediated immunity. The sustained/longer-term effects of cold stress repeated daily over the period of 5 days to 6 weeks increased plasma levels of tumor necrosis factor-α, IL-2, IL-6. A hypothesis describes, daily brief cold-water stress over many months could enhance antitumor immunity and improve nonlymphoid cancer survival rate.

The possible mechanism of nonspecific stimulation of cellular immunity might attribute to transient activation of SNS, hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid axes. Though daily moderate cold hydrotherapy does not appear to have noticeable adverse effects on normal subjects, some studies showed that it can cause transient arrhythmias in patients with heart problems and can also inhibit humoral immunity. Sudden ice-cold WI can produce transient pulmonary edema and increase blood-brain barrier permeability, thereby increasing mortality of neurovirulent infections. Studies are required to warrant this hypothesis for immunotherapy development for some (nonlymphoid) cancers, including those caused by viral infections.[81]

Warm water (28°C) treatment could not only cure bacterial cold-water disease but also immunize against causative agent Flavobacterium psychrophilum.[82]

Head-out WI (38.41 ± 0.04°C) for 30 min decreased blood viscosity; red blood cells count; and mean hematocrit without significant changes in leukocytes and platelets count; mean corpuscular volume; plasma viscosity; erythrocyte filtration time and red cell deformability index.[13] Application of hyper-thermic water bath produced significant reduction of relative B-lymphocyte. Whole-body hyperthermic water bath reduced relative total T-lymphocyte counts; increased relative CD8+ lymphocyte; NK cell counts and its activity, which were probably dependent on increased somatotropic hormone production.[83]

Endocraine/hormonal system

During CE increase levels of circulating norepinephrine was observed[80] and exercising HPA system by repeated CE could potentially restore its normal function in chronic fatigue syndrome, or at least increase net HPA activity (without changing baseline activity).[84] It produces temporary increase in plasma levels of adrenocorticotropic hormone (ACTH), beta-endorphin, and cortisol.[32] The sustained/longer-term effects of cold stress repeated daily produced increase in ACTH, corticosterone, and decrease in α-1-antitrypsin and testosterone.[81] Cold stress reduces level of serotonin in most regions of brain (except brainstem).[32] Cold stress-induced analgesia might be mediated by increased production of opioid peptide beta-endorphin (an endogenous pain-killer).[85,86]

Exposure to sauna and ice-WI significantly elevated epinephrine levels in winter swimmer.[87] Steam bath produced increase in blood serum concentrations of gastric and aldosterone, with decrease in concentrations of cortisol in athlete-fighters.[88] Whole-body hyperthermic bath increased STH activity in 8 out of 10 volunteers.[83]

Eye, skin, and hair

Warm moist air device seems to be safe and produced improvement in tear stability and symptomatic relief in ocular fatigue in patients with meibomian gland dysfunction.[89] Sauna (80°C) produced stable epidermal barrier function; increase in stratum corneum hydration; faster recovery of both elevated water loss and skin pH; decrease in casual skin sebum content on skin surface of forehead; increase in ionic concentration in sweat and epidermal blood perfusion in volunteers. It suggests protective effect of ST on skin physiology.[90]

Clinical remission of atopic dermatitis has been reported after intake of low-salt water.[57] Application of heated mustard compress produced second-degree, partial-thickness burn followed by hyperpigmentation and hypertrophic scarring.[91] Persistent use of cold pillow compress could reduce hair follicles inhibition or damage caused by chemotherapeutic agents. So alopecia can be decreased or prevented.[92]

Temperature regulation

Very-HC applied to lumbar region of healthy female for 10 min increased back Tsk to 41.1-43.1°C under HC, followed by decreased rapidly but no changes observed in BT.[56] A case of 20% of 2nd degree burns and severe heat stroke followed by temperature rose up to 40.5°C and patient developed severe multiorgan failure and critical polyneuropathy was reported after exposure to extreme heat in sauna for unknown period of time.[93]

The most effective method of reducing body core temperature appears to be immersion in iced water, main predictor of outcome in exertional heatstroke is the duration and degree of hyperthermia where possible patients should be cooled using iced-WI, but if it is not possible, combination of other techniques may be used to facilitate rapid cooling[94] such as fan-therapy, CWI, iced-baths, and evaporative cooling.[95]

Wet-ice, dry-ice, and cryogen packs applied to skin overlying right triceps surae muscle for 15 min on 10 females decreased mean Tsk 12°C, 9.9°C, and 7.3°C, respectively. None of the modalities produced Tsk cooling below 17°C and no cooling was demonstrated 1 cm proximal or distal to any modalities after 15 min of application. Significant mean Tsk reduction in between pretreatment rest interval (time 0) and 15 min after removal of modality (time 30) was observed only in wet-ice. It suggests wet-ice was significantly more efficient in reducing Tsk than dry-ice and cryogen packs.[96]

After exercise at 65% maximal oxygen consumption at ambient temperature of 39°C until Tre increased to 40°C produced no difference in cooling rate between WI at 8°C, 14°C, and 20°C but cooling rate was significantly greater during 2°C, which was almost twice as much as other conditions. It suggests that 2°C WI is the most effective treatment for exercise-induced hyperthermia.[97] When hyperthermic individuals are immersed in 2°C water for approximately 9 min to Tre cooling limit of 38.6°C negated any risk associated with overcooling.[98]

Whole body immersion in moderately cold water is effective cooling maneuver for lowering BT and body heat content of approximately 545 kJ at the end of immersion in absence of severe physiological responses generally associated with sudden cold stress.[99] Significant less BT variability and an overall higher BT were observed in late preterm infants following tub bathing procedure.[100]


Based on available literature, this review suggests that hydrotherapy was widely used to improve immunity and for the management of pain, CHF, MI, chronic obstructive pulmonary diseases, asthma, PD, AS, RA, OAK, FMS, anorectal disorders, fatigue, anxiety, obesity, hypercholesterolemia, hyperthermia, labor, etc. It produces different effects on various systems of the body depending on the temperature of water and though these effects are scientifically evidence based.

Source of Support: Nil
Conflict of Interest: None declared.


1. Fleming SA, Gutknecht NC. Gutknecht. Naturopathy and the Primary Care Practice. Prim Care. 2010;37:119–36. [PMC free article] [PubMed]

2. Weston M, Taber C, Casagranda L, Cornwall M. Changes in local blood volume during cold gel pack application to traumatized ankles. J Orthop Sports Phys Ther. 1994;19:197–9. [PubMed]

3. Srámek P, Simecková M, Janský L, Savlíková J, Vybíral S. Human physiological responses to immersion into water of different temperatures. Eur J Appl Physiol. 2000;81:436–42. [PubMed]

4. Huttunen P, Kokko L, Ylijukuri V. Winter swimming improves general well-being. Int J Circumpolar Health. 2004;63:140–4. [PubMed]

5. Iiyama J, Matsushita K, Tanaka N, Kawahira K. Effects of single low-temperature sauna bathing in patients with severe motor and intellectual disabilities. Int J Biometeorol. 2008;52:431–7. [PubMed]

6. Ohori T, Nozawa T, Ihori H, Shida T, Sobajima M, Matsuki A, et al. Effect of repeated sauna treatment on exercise tolerance and endothelial function in patients with chronic heart failure. Am J Cardiol. 2012;109:100–4. [PubMed]

7. Pilch W, Szyguła Z, Klimek AT, Pałka T, Cisoń T, Pilch P, et al. Changes in the lipid profile of blood serum in women taking sauna baths of various duration. Int J Occup Med Environ Health. 2010;23:167–74. [PubMed]

8. Sobajima M, Nozawa T, Shida T, Ohori T, Suzuki T, Matsuki A, et al. Repeated sauna therapy attenuates ventricular remodeling after myocardial infarction in rats by increasing coronary vascularity of noninfarcted myocardium. Am J Physiol Heart Circ Physiol. 2011;301:H548–54. [PubMed]

9. Imai Y, Nobuoka S, Nagashima J, Awaya T, Aono J, Miyake F, et al. Acute myocardial infarction induced by alternating exposure to heat in a sauna and rapid cooling in cold water. Cardiology. 1998;90:299–301. [PubMed]

10. Crinnion WJ. Sauna as a valuable clinical tool for cardiovascular, autoimmune, toxicant- induced and other chronic health problems. Altern Med Rev. 2011;16:215–25. [PubMed]

11. Bleakley CM, Davison GW. What is the biochemical and physiological rationale for using cold-water immersion in sports recovery? A systematic review. Br J Sports Med. 2010;44:179–87. [PubMed]

12. Grüner Sveälv B, Cider A, Täng MS, Angwald E, Kardassis D, Andersson B. Benefit of warm water immersion on biventricular function in patients with chronic heart failure. Cardiovasc Ultrasound. 2009;7:33. [PMC free article] [PubMed]

13. Digiesi V, Cerchiai G, Mannini L, Masi F, Nassi F. Hemorheologic and blood cell changes in humans during partial immersion with a therapeutic method, in 38 o C water. Minerva Med. 1986;77:1407–11. [PubMed]

14. Boldt LH, Fraszl W, Röcker L, Schefold JC, Steinach M, Noack T, et al. Changes in the haemostatic system after thermoneutral and hyperthermic water immersion. Eur J Appl Physiol. 2008;102:547–54. [PubMed]

15. Shih CY, Lee WL, Lee CW, Huang CH, Wu YZ. Effect of time ratio of heat to cold on brachial artery blood velocity during contrast baths. Phys Ther. 2012;92:448–53. [PubMed]

16. Choukroun ML, Varene P. Adjustments in oxygen transport during head-out immersion in water at different temperatures. J Appl Physiol. 1990;68:1475–80. [PubMed]

17. Dogliotti G, Galliera E, Iorio E, De Bernardi Di Valserra M, Solimene U, Corsi MM. Effect of immersion in CO2-enriched water on free radical release and total antioxidant status in peripheral arterial occlusive disease. Int Angiol. 2011;30:12–7. [PubMed]

18. Sato M, Kanikowska D, Iwase S, Nishimura N, Shimizu Y, Belin de Chantemele E, et al. Effects of immersion in water containing high concentrations of CO2 (CO2-water) at thermoneutral on thermoregulation and heart rate variability in humans. Int J Biometeorol. 2009;53:25–30. [PubMed]

19. Pagourelias ED, Zorou PG, Tsaligopoulos M, Athyros VG, Karagiannis A, Efthimiadis GK. Carbon dioxide balneotherapy and cardiovascular disease. Int J Biometeorol. 2011;55:657–63. [PubMed]

20. Choukroun ML, Kays C, Varène P. Effects of water temperature on pulmonary volumes in immersed human subjects. Respir Physiol. 1989;75:255–65. [PubMed]

21. Goedsche K, Förster M, Kroegel C, Uhlemann C. Repeated cold water stimulations (hydrotherapy according to Kneipp) in patients with COPD. Forsch Komplementmed. 2007;14:158–66. [PubMed]

22. Iarosh AM, Kurch TK. The effect of cold exposure on the respiratory function in children suffering from inflammatory lung diseases. Vopr Kurortol Fizioter Lech Fiz Kult. 1995;1:9–11. [PubMed]

23. Pach D, Knöchel B, Lüdtke R, Wruck K, Willich SN, Witt CM. Visiting a sauna: Does inhaling hot dry air reduce common cold symptoms? A randomised controlled trial. Med J Aust. 2010;193:730–4. [PubMed]

24. Whyte GP, Harries M, Dickinson J, Polkey MI. Breathless in the bath. Br J Sports Med. 2006;40:554–5. [PMC free article] [PubMed]

25. Herrera E, Sandoval MC, Camargo DM, Salvini TF. Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Phys Ther. 2010;90:581–91. [PubMed]

26. Bender T, Karag¨ulle Z, B´alint GP, Gutenbrunner C, B´alint PV, Sukenik S. Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatol Int. 2005;25:220–4. [PubMed]

27. Castro-Sánchez AM, Matarán-Peñarrocha GA, Lara-Palomo I, Saavedra-Hernández M, Arroyo-Morales M, Moreno-Lorenzo C. Hydrotherapy for the treatment of pain in people with multiple sclerosis: A randomized controlled trial. Evid Based Complement Alternat Med 2012. 2012 473963. [PMC free article] [PubMed]

28. Vivas J, Arias P, Cudeiro J. Aquatic therapy versus conventional land-based therapy for Parkinson's disease: An open-label pilot study. Arch Phys Med Rehabil. 2011;92:1202–10. [PubMed]

29. Gerner HJ, Engel P, Gass GC, Gass EM, Hannich T, Feldmann G. The effects of sauna on tetraplegic and paraplegic subjects. Paraplegia. 1992;30:410–9. [PubMed]

30. Robiner WN. Psychological and physical reactions to whirlpool baths. J Behav Med. 1990;13:157–73. [PubMed]

31. Shevchuk NA. Hydrotherapy as a possible neuroleptic and sedative treatment. Med Hypotheses. 2008;70:230–8. [PubMed]

32. Shevchuk NA. Possible use of repeated cold stress for reducing fatigue in chronic fatigue syndrome: A hypothesis. Behav Brain Funct. 2007;3:55. [PMC free article] [PubMed]

33. Shevchuk NA. Adapted cold shower as a potential treatment for depression. Med Hypotheses. 2008;70:995–1001. [PubMed]

34. Chevutschi A, Lensel G, Vaast D, Thevenon A. An Electromyographic Study of Human Gait both in Water and on Dry Ground. J Physiol Anthropol. 2007;26:467–73. [PubMed]

35. Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW. Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database Syst Rev. 2012;2:CD008262. [PubMed]

36. Morton RH. Contrast water immersion hastens plasma lactate decrease after intense anaerobic exercise. J Sci Med Sport. 2007;10:467–70. [PubMed]

37. Skurvydas A, Kamandulis S, Stanislovaitis A, Streckis V, Mamkus G, Drazdauskas A. Leg immersion in warm water, stretch-shortening exercise, and exercise-induced muscle damage. J Athl Train. 2008;43:592–9. [PMC free article] [PubMed]

38. Versey NG, Halson SL, Dawson BT. Effect of contrast water therapy duration on recovery of running performance. Int J Sports Physiol Perform. 2012;7:130–40. [PubMed]

39. Janssen RG, Schwartz DA, Velleman PF. A randomized controlled study of contrast baths on patients with carpal tunnel syndrome. J Hand Ther. 2009;22:200–7. [PubMed]

40. De Nardi M, La Torre A, Barassi A, Ricci C, Banfi G. Effects of cold-water immersion and contrast-water therapy after training in young soccer players. J Sports Med Phys Fitness. 2011;51:609–15. [PubMed]

41. McVeigh JG, McGaughey H, Hall M, Kane P. The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: A systematic review. Rheumatol Int. 2008;29:119–30. [PubMed]

42. Matsumoto S, Shimodozono M, Etoh S, Miyata R, Kawahira K. Effects of thermal therapy combining sauna therapy and underwater exercise in patients with fibromyalgia. Complement Ther Clin Pract. 2011;17:162–6. [PubMed]

43. Cuesta-Vargas AI, Adams N. A pragmatic community-based intervention of multimodal physiotherapy plus deep water running (DWR) for fibromyalgia syndrome: A pilot study. Clin Rheumatol. 2011;30:1455–62. [PubMed]

44. Hay L, Wylie K. Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 4: Hydrotherapy following rotator cuff repair. Emerg Med J. 2011;28:634–5. [PubMed]

45. Yurtkuran M, Yurtkuran M, Alp A, Nasircilar A, Bingöl U, Altan L, et al. Balneotherapy and tap water therapy in the treatment of knee osteoarthritis. Rheumatol Int. 2006;27:19–27. [PubMed]

46. Altan L, Bingöl U, Aslan M, Yurtkuran M. The effect of balneotherapy on patients with ankylosing spondylitis. Scand J Rheumatol. 2006;35:283–9. [PubMed]

47. Oosterveld FG, Rasker JJ, Floors M, Landkroon R, van Rennes B, Zwijnenberg J, et al. Infrared sauna in patients with rheumatoid arthritis and ankylosing spondylitis. A pilot study showing good tolerance, short-term improvement of pain and stiffness, and a trend towards long-term beneficial effects. Clin Rheumatol. 2009;28:29–34. [PubMed]

48. Wouters EJ, Van Nunen AM, Geenen R, Kolotkin RL, Vingerhoets AJ. Effects of Aquajogging in Obese Adults: A Pilot Study. J Obes 2010. 2010 231074. [PMC free article] [PubMed]

49. Arnold CM, Busch AJ, Schachter CL, Harrison EL, Olszynski WP. A Randomized clinical trial of aquatic versus land exercise to improve balance, function, and quality of life in older women with osteoporosis. Physiother Can. 2008;60:296–306. [PMC free article] [PubMed]

50. Biscarini A, Cerulli G. Modeling of the knee joint load in rehabilitative knee extension exercises under water. J Biomech. 2006;17:1–11. [PubMed]

51. Eversden L, Maggs F, Nightingale P, Jobanputra P. A pragmatic randomised controlled trial of hydrotherapy and land exercises on overall well being and quality of life in rheumatoid arthritis. BMC Musculoskelet Disord. 2007;8:23. [PMC free article] [PubMed]

52. Honda T, Kamioka H. Curative and health enhancement effects of aquatic exercise: Evidence based on interventional studies. Open Access J Sports Med. 2012;3:27–34. [PMC free article] [PubMed]

53. Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S, Jones A, et al. Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: A randomized clinical trial. Phys Ther. 2008;88:12–21. [PubMed]

54. Xu XS, Lin WP, Chen JY, Yu LC, Huang ZH. Efficacy observation on rear thigh muscles strain of athletes treated with surrounding needling of electroacupuncture and hot compress of Chinese medicine. Zhongguo Zhen Jiu. 2012;32:511–4. [PubMed]

55. Dubnov-Raz G, Constantini NW, Yariv H, Nice S, Shapira N. Influence of water drinking on resting energy expenditure in overweight children. Int J Obes (Lond) 2011;35:1295–300. [PubMed]

56. Hishinuma M, Hiramatsu N, Kasuga M, Ooyoshi M, Kaharu C, Misao H, et al. The effect on bowel sounds of very hot compresses applied to the lumbar region. Nihon Kango Kagakkaishi. 1997;17:32–9. [PubMed]

57. Dupuy P, Cassé M, André F, Dhivert-Donnadieu H, Pinton J, Hernandez-Pion C. Low-salt water reduces intestinal permeability in atopic patients. Dermatology. 1999;198:153–5. [PubMed]

58. Church JM. Warm water irrigation for dealing with spasm during colonoscopy: Simple, inexpensive, and effective. Gastrointest Endosc. 2002;56:672–4. [PubMed]

59. Maestre Y, Parés D, Salvans S, Ibáñez-Zafón I, Nve E, Pons MJ, et al. Cold or hot sitz baths in the emergency treatment of acute anal pain due to anorectal disease? Results of a randomised clinical trial. Cir Esp. 2010;88:97–102. [PubMed]

60. Gupta PJ. Effects of warm water sitz bath on symptoms in post-anal sphincterotomy in chronic anal fissure – a randomized and controlled study. World J Surg. 2007;31:1480–4. [PubMed]

61. Gupta P. Randomized, controlled study comparing sitz-bath and no-sitz-bath treatments in patients with acute anal fissures. ANZ J Surg. 2006;76:718–21. [PubMed]

62. Lang DS, Tho PC, Ang EN. Effectiveness of the Sitz bath in managing adult patients with anorectal disorders. Jpn J Nurs Sci. 2011;8:115–28. [PubMed]

63. Shafik A. Role of warm-water bath in ano-rectal conditions. The thermo-sphincteric reflex. J Clin Gastroenterol. 1993;16:304–8. [PubMed]

64. Hsu KF, Chia JS, Jao SW, Wu CC, Yang HY, Mai CM, et al. Comparison of clinical effects between warm water spray and sitz bath in post-hemorrhoidectomy period. J Gastrointest Surg. 2009;13:1274–8. [PubMed]

65. Guliaeva SF, Pomaskina TV, Guliaev PV, Martusevich AK, Aistov VI. Efficacy of sulfate calcium mineral water in disorders of motor evacuatory function of the stomach and gallbladder. Vopr Kurortol Fizioter Lech Fiz Kult. 2004;6:20–2. [PubMed]

66. Razumov AN, Surkov NV, Frolkov VK, Ziniakov NT. Therapeutic and preventive effects of sulfate-chloride-sodium mineral water in experimental peptic ulcer. Vopr Kurortol Fizioter Lech Fiz Kult. 2009;3:22–5. [PubMed]

67. Mizrahi E, Liberty I, Tsedek I, Harari M, Friger M, Sukenik S. The influence of single immersion in Dead Sea water on glucose, insulin, cortisol and C-peptide levels in type 2 diabetes mellitus patients. Harefuah. 2011;150:646–9. 689, 688. [PubMed]

68. Da Silva FM, de Oliveira SM, Nobre MR. A randomised controlled trial evaluating the effect of immersion bath on labour pain. Midwifery. 2009;25:286–94. [PubMed]

69. Malarewicz A, Wydrzynski G, Szymkiewicz J, Adamczyk-Gruszka O. The influence of water immersion on the course of first stage of parturition in primiparous women. Med Wieku Rozwoj. 2005;9:773–80. [PubMed]

70. Da Silva FM, de Oliveira SM. The effect of immersion baths on the length of childbirth labor. Rev Esc Enferm USP. 2006;40:57–63. [PubMed]

71. Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane Database Syst Rev. 2009;2:CD000111. [PMC free article] [PubMed]

72. Zhao S, Xie L, Hu H, Xia J, Zhang W, Ye N, et al. A study of neonatal swimming (water therapy) applied in clinical obstetrics. J Matern Fetal Neonatal Med. 2005;17:59–62. [PubMed]

73. Fehervary P, Lauinger-Lörsch E, Hof H, Melchert F, Bauer L, Zieger W. Water birth: Microbiological colonisation of the newborn, neonatal and maternal infection rate in comparison to conventional bed deliveries. Arch Gynecol Obstet. 2004;270:6–9. [PubMed]

74. LaFoy J, Geden EA. Post episiotomy pain: Warm versus cold sitz bath. J Obstet Gynecol Neonatal Nurs. 1989;18:399–403. [PubMed]

75. Ramler D, Roberts J. A comparison of cold and warm sitz baths for relief of postpartum perineal pain. J Obstet Gynecol Neonatal Nurs. 1986;15:471–4. [PubMed]

76. Zumsteg IS, Weckerle CS. Bakera, a herbal steam bath for postnatal care in Minahasa (Indonesia): Documentation of the plants used and assessment of the method. J Ethnopharmacol. 2007;111:641–50. [PubMed]

77. Arora S, Vatsa M, Dadhwal V. A Comparison of cabbage leaves vs. hot and cold compresses in the treatment of breast engorgement. Indian J Community Med. 2008;33:160–2. [PMC free article] [PubMed]

78. Park SU, Lee SH, Chung YG, Park KK, Mah SY, Hong SJ, et al. Warm sitz bath: Are there benefits after transurethral resection of the prostate? Korean J Urol. 2010;51:763–6. [PMC free article] [PubMed]

79. Shafik A. Role of warm water bath in inducing micturition in postoperative urinary retention after anorectal operations. Urol Int. 1993;50:213–7. [PubMed]

80. Brenner IK, Castellani JW, Gabaree C, Young AJ, Zamecnik J, Shephard RJ, et al. Immune changes in humans during cold exposure: Effects of prior heating and exercise. J Appl Physiol. 1999;87:699–710. [PubMed]

81. Shevchuk NA, Radoja S. Possible stimulation of anti-tumor immunity using repeated cold stress: A hypothesis. Infect Agent Cancer. 2007;2:20. [PMC free article] [PubMed]

82. Sugahara K, Eguchi M. The use of warmed water treatment to induce protective immunity against the bacterial cold-water disease pathogen Flavobacterium psychrophilum in ayu (Plecoglossus altivelis) Fish Shellfish Immunol. 2012;32:489–93. [PubMed]

83. Blazícková S, Rovenský J, Koska J, Vigas M. Effect of hyper thermic water bath on parameters on cellular immunity. Int J Clin Pharmacol Res. 2000;20:41–6. [PubMed]

84. Dorfman M, Arancibia S, Fiedler JL, Lara HE. Chronic intermittent cold stress activates ovarian sympathetic nerves and modifies ovarian follicular development in the rat. Biol Reprod. 2003;68:2038–43. [PubMed]

85. Gerra G, Volpi R, Delsignore R, Maninetti L, Caccavari R, Vourna S, et al. Sex-related responses of beta-endorphin, ACTH, GH and PRL to cold exposure in humans. Acta Endocrinol (Copenh) 1992;126:24–8. [PubMed]

86. Glickman-Weiss EL, Nelson AG, Hearon CM, Goss FL, Robertson RJ. Are beta-endorphins and thermoregulation during coldwater immersion related? Undersea Hyperb Med. 1993;20:205–13. [PubMed]

87. Kauppinen K, Pajari-Backas M, Volin P, Vakkuri O. Some endocrine responses to sauna, shower and ice water immersion. Arctic Med Res. 1989;48:131–9. [PubMed]

88. Panov SF, Pleshakov AA. Effect of steam bath on gastric secretion and some endocrine changes of athlete-fighters. Fiziol Cheloveka. 2011;37:92–9. [PubMed]

89. Matsumoto Y, Dogru M, Goto E, Ishida R, Kojima T, Onguchi T, et al. Efficacy of a new warm moist air device on tear functions of patients with simple meibomian gland dysfunction. Cornea. 2006;25:644–50. [PubMed]

90. Kowatzki D, Macholdt C, Krull K, Schmidt D, Deufel T, Elsner P, et al. Effect of regular sauna on epidermal barrier function and stratum corneum water-holding capacity in vivo in humans: A controlled study. Dermatology. 2008;217:173–80. [PubMed]

91. Linder SA, Mele JA, 3rd, Harries T. Chronic hyperpigmentation from a heated mustard compress burn: A case report. J Burn Care Rehabil. 1996;17:351–2. [PubMed]

92. Li LC, Wang M, Ning XC. Study on preventing alopecia caused by chemotherapy with cold pillow compresses. Chin J Nurs. 1995;30:643–5. [PubMed]

93. Rünitz K, Jensen TH. Heat stroke and burns resulting from use of sauna. Ugeskr Laeger. 2009;171:305–6. [PubMed]

94. Smith JE. Cooling methods used in the treatment of exertional heat illness. Br J Sports Med. 2005;39:503–7. [PMC free article] [PubMed]

95. Harker J, Gibson P. Heat-stroke: A review of rapid cooling techniques. Intensive Crit Care Nurs. 1995;11:198–202. [PubMed]

96. Belitsky RB, Odam SJ, Hubley-Kozey C. Evaluation of the effectiveness of wet ice, dry ice, and cryogen packs in reducing skin temperature. Phys Ther. 1987;67:1080–4. [PubMed]

97. Proulx CI, Ducharme MB, Kenny GP. Effect of water temperature on cooling efficiency during hyperthermia in humans. J Appl Physiol. 2003;94:1317–23. [PubMed]

98. Gagnon D, Lemire BB, Casa DJ, Kenny GP. Cold-water immersion and the treatment of hyperthermia: Using 38.6°C as a safe rectal temperature cooling limit. J Athl Train. 2010;45:439–44. [PMC free article] [PubMed]

99. Marino F, Booth J. Whole body cooling by immersion in water at moderate temperatures. J Sci Med Sport. 1998;1:73–82. [PubMed]

100. Loring C, Gregory K, Gargan B, LeBlanc V, Lundgren D, Reilly J, et al. Tub bathing improves thermoregulation of the late preterm infant. J Obstet Gynecol Neonatal Nurs. 2012;41:171–9. [PubMed]


Father Sebastian Kneipp a Practitioner, responsible for the revival of modern Hydropathy

Concerning the naturopathy: “Naturopathy (is) too broad description thus becoming a dumping ground for anything alternative!” - Dr Jon Wardle on channel 10 News, Australia July 2016

Father Sebastian Kneipp was the revival of the Hydrotherapy movement since Vincent Preissnitz, he improved and developed Hydrotherapy to a more inclusive integration, of botanical medicines, Exercise, Nutrition, Mental Balance.

In 1891, Father Kneipp founded Kneipp Bund in Germany, and organization that promotes water healing.

Father Kneipp passed away on the 17 June 1897, the word Naturopathy was created in 1895 by John Scheel (USA), Benedict Lust around 1900, purchased the name Naturopathy from John Scheel. In America, Kneipp Societies w
ere founded, which, under the influence of Benedict Lust, changed their name to Naturopatic Society of America.

The Merriam-Webster Dictionary states that the first known use of the word "naturopathy" in print is from 1901.

“My water cure as tested through more than thirty years and described for the healing of diseases and the preservation of health”.

There is no reference to the word Naturopathy:
More than 100 times the word: Water
12 times the word: Water Cure
3 times the word: Hydropathic

“Dr Benedict Lust, the father of Naturopathy and a strong advocate for natural healing methods, requested in 1918 in the Universal Naturopathic Encyclopedia, that some Naturopath develop bloodless surgery technique, etc. He became very much interested in bloodless surgery and suggested that the writer do something about it.

In 1934 and 1935, Dr Lust was a frequent visitor to the Sanitarium where the writer was assistant director , and assisted in performing bloodless surgery operations, which proved very successful.” - by Dr Paul Wendel in Page 2 of the book “Bloodless surgery, Technique with treatment” 1945

Florence Nightingale & Hydropathy

Florence Nightingale (1820–1910)

Florence Nightingale was an English social reformer and statistician, and the founder of the Nursing Profession.

“Should not be here were it not for Malvern (Hydropathy Treatments). In August 1857, after my work at the Royal Sanitary Commission, and after 4 weeks of anxiety and exertion, I was told that my life was not worth 24 hours purchase - and I knew it too.

I owe 3 years of life to the water-cure at Malvern.

Don't disparage the wet sheet packing - I know it has saved many lives in fever. I am sure it saved mine.’ She explained that the term 'hydropathic treatment' misled people into believing that ailments could be cured solely by the use of water.” - Letter to Edwin Chadwick in 1860

In this letter, Florence Nightingale outlines her belief that patient health depends on the environmental conditions in which they recover from injuries and diseases. She recommends cleanliness and clean air – in addition to whatever directly medical treatment the patient is undergoing.

At the time she wrote this letter, Nightingale was already a national hero – the legendary ‘Lady With The Lamp’ of the Crimean War. While serving as a nurse in Crimea from 1854 to 1856, she noticed that more soldiers in her care were dying from infectious diseases than were dying from wounds. She thought this was due to overcrowding and malnutrition, but her proposed solutions – better ventilation and better sanitation – were effectively the foundation of modern nursing.

Transcription of the letter from Florence Nightingale to Edwin Chadwick who was a social reformer noted for his work on reforming sanitary conditions for the poor.

8 September 1860

Dear Mr Chadwick

"I make haste to answer your question as to my experience (as an old nurse) in the 'application of the water cure to incipient consumption,' especially as it regards so valuable a life.

In incipient tuberculosis, [where the object is to avoid local congestion, the water treatment (not as a charm, as Englishwomen take medicine, but as part of a treatment) I have seen to be most effectual, the rest of the treatment being open air during the greater part of the day] (riding or otherwise, according to the patient's strength), bedroom ventilation at night, diet, founded upon improved digestion, the result of the open-air exercise, sometimes gentle gymnastics, much cold water sponging and little wet-sheet packing.”

There are Five Essential Points in
Securing the Health
Florence Nightingale in “Notes on Nursing: What it Is, and What it is Not” 1860, page 24.

1. Pure air
2. Pure water
3. Efficient drainage
4. Cleanliness
5. Light

  Hydropathy is not Allopathy medicine

First Letter to the General Medical Council concerning Medicine & Disease:

Could you please let me know what is the official accepted definition by the General Medical Council of the following.

1. The official definition of Medicine
2. The official definition of Disease

Reply from the General Medical Council:

Definition of Medicine

Thank you for your email asking for a definition of the words "medicine" and also "disease".

The GMC register medical doctors in the UK that hold an acceptable Primary Medical Qualification in medicine and surgery. We require our doctors to hold a degree in "Allopathic medicine".

This term describes the format of "mainstream medicine which uses pharmacologically active agents or physical interventions to treat or supress symptoms or pathophysiologic processes of diseases or conditions".

This is the term used for the purpose of registration in the UK, but the definition of medicine has many relevant meanings dependent on the context.

Definition of Disease

For the word disease, I have used the common dictionary definition: "a disorder of structure or function in a human, animal, or plant, especially one that produces specific symptoms or that affects a specific location and is not simply a direct result of physical injury".

Second Letter to the General Medical Council concerning Hydrotherapy:

Could you please indicate what is the official position of the General Medical Council concerning:

1. Hydropathy or Hydrotherapy.

2. Is Hydropathy or Hydrotherapy part of Medicine?

Reply from the General Medical Council:

"Thank you for your email about hydrotherapy. I am afraid I cannot help you, as the matter you raise falls outside our jurisdiction.

It might help if I explain that the GMC is the statutory regulatory body for medical doctors in the UK.

Our responsibilities include setting standards for medical education, granting registration with a licence to practise to suitably qualified people, promoting good medical practice, and taking appropriate action where doubts arise about a doctor's fitness to practise.

In order to be registered with us, a doctor must hold a primary medical qualification in allopathic medicine."



Graduates from Volksmed School of Health and Pharmacology having obtained the School Private Title of “Dr”, “a doctor” or similar, should take care not to imply that they hold a general “medical” qualification in case they do not. The School doesn't gives any medical qualifications or titles, the School Students aren't medical doctors and aren't registered with the General Medical Council, and don't practice Allopathic Medicine.


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