{"id":10613,"date":"2026-03-09T09:00:25","date_gmt":"2026-03-09T08:00:25","guid":{"rendered":"https:\/\/termechianciano.it\/?page_id=10613"},"modified":"2026-05-04T13:04:11","modified_gmt":"2026-05-04T11:04:11","slug":"waters-science-page","status":"publish","type":"page","link":"https:\/\/termechianciano.it\/en\/waters-science-page\/","title":{"rendered":"The Waters - scientific page"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"10613\" class=\"elementor elementor-10613\" data-elementor-post-type=\"page\">\n\t\t\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-4734e79 e-flex e-con-boxed e-con e-parent\" data-id=\"4734e79\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6946c81 elementor-widget__width-inherit jet-breadcrumbs-align-left elementor-widget elementor-widget-global elementor-global-9582 elementor-widget-jet-breadcrumbs\" data-id=\"6946c81\" data-element_type=\"widget\" data-widget_type=\"jet-breadcrumbs.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-jet-breadcrumbs jet-blocks\">\n\t\t<div class=\"jet-breadcrumbs\">\n\t\t<div class=\"jet-breadcrumbs__content\">\n\t\t<div class=\"jet-breadcrumbs__wrap\"><div class=\"jet-breadcrumbs__item\"><a href=\"https:\/\/termechianciano.it\/en\/\" class=\"jet-breadcrumbs__item-link is-home\" rel=\"home\" title=\"Terme Chianciano\">Terme Chianciano<\/a><\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-b96c1ff e-flex e-con-boxed e-con e-parent\" data-id=\"b96c1ff\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-71759d8 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"71759d8\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">The waters of Chianciano: scientific evidence<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-7844fdb e-flex e-con-boxed e-con e-parent\" data-id=\"7844fdb\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-695b8e2 e-con-full e-flex e-con e-child\" data-id=\"695b8e2\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-15c0a41 elementor-toc--minimized-on-tablet elementor-widget elementor-widget-table-of-contents\" data-id=\"15c0a41\" data-element_type=\"widget\" data-settings=\"{&quot;headings_by_tags&quot;:[&quot;h2&quot;,&quot;h3&quot;,&quot;h4&quot;],&quot;container&quot;:&quot;.get-points&quot;,&quot;exclude_headings_by_selector&quot;:[],&quot;marker_view&quot;:&quot;bullets&quot;,&quot;icon&quot;:{&quot;value&quot;:&quot;&quot;,&quot;library&quot;:&quot;&quot;},&quot;no_headings_message&quot;:&quot;Non sono state trovate intestazioni in questa pagina.&quot;,&quot;minimize_box&quot;:&quot;yes&quot;,&quot;minimized_on&quot;:&quot;tablet&quot;,&quot;hierarchical_view&quot;:&quot;yes&quot;,&quot;min_height&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;min_height_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;min_height_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"table-of-contents.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-toc__header\">\n\t\t\t\t\t\t<h4 class=\"elementor-toc__header-title\">\n\t\t\t\tTable of Contents\t\t\t<\/h4>\n\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--expand\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__15c0a41\" aria-expanded=\"true\" aria-label=\"Open table of contents\"><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-down\" viewbox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M207.029 381.476L12.686 187.132c-9.373-9.373-9.373-24.569 0-33.941l22.667-22.667c9.357-9.357 24.522-9.375 33.901-.04L224 284.505l154.745-154.021c9.379-9.335 24.544-9.317 33.901.04l22.667 22.667c9.373 9.373 9.373 24.569 0 33.941L240.971 381.476c-9.373 9.372-24.569 9.372-33.942 0z\"><\/path><\/svg><\/div>\n\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--collapse\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__15c0a41\" aria-expanded=\"true\" aria-label=\"Close table of contents\"><svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-up\" viewbox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M240.971 130.524l194.343 194.343c9.373 9.373 9.373 24.569 0 33.941l-22.667 22.667c-9.357 9.357-24.522 9.375-33.901.04L224 227.495 69.255 381.516c-9.379 9.335-24.544 9.317-33.901-.04l-22.667-22.667c-9.373-9.373-9.373-24.569 0-33.941L207.03 130.525c9.372-9.373 24.568-9.373 33.941-.001z\"><\/path><\/svg><\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div id=\"elementor-toc__15c0a41\" class=\"elementor-toc__body\">\n\t\t\t<div class=\"elementor-toc__spinner-container\">\n\t\t\t\t<svg class=\"elementor-toc__spinner eicon-animation-spin e-font-icon-svg e-eicon-loading\" aria-hidden=\"true\" viewbox=\"0 0 1000 1000\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M500 975V858C696 858 858 696 858 500S696 142 500 142 142 304 142 500H25C25 237 238 25 500 25S975 237 975 500 763 975 500 975Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<article data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-07c847a e-con-full get-points e-flex e-con e-child\" data-id=\"07c847a\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ccd0bcf elementor-widget elementor-widget-image\" data-id=\"ccd0bcf\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img alt=\"\" fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/giovane-donna-in-posa-sommersa-sott-acqua-in-un-vestito-fluido-1024x683-1.webp\" class=\"attachment-large size-large wp-image-9985\" srcset=\"https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/giovane-donna-in-posa-sommersa-sott-acqua-in-un-vestito-fluido-1024x683-1.webp 1024w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/giovane-donna-in-posa-sommersa-sott-acqua-in-un-vestito-fluido-1024x683-1-300x200.webp 300w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/giovane-donna-in-posa-sommersa-sott-acqua-in-un-vestito-fluido-1024x683-1-768x512.webp 768w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/giovane-donna-in-posa-sommersa-sott-acqua-in-un-vestito-fluido-1024x683-1-18x12.webp 18w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2c229fa elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"2c229fa\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Composition, therapeutic properties and scientific evidence<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6db71d7 elementor-widget elementor-widget-text-editor\" data-id=\"6db71d7\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The Chianciano waters belong to the sulphate-bicarbonate-calcic class, with sulphate concentrations among the highest documented in the Tuscan thermal panorama (up to ~1800 mg\/L in Acqua Santa). The thermal compendium includes four distinct springs - Acqua Santa, Acqua Fucoli, Acqua Silene and Acqua Santissima - belonging to the same geochemical facies but differentiated by temperature, degree of mineralisation and gaseous content, with specific and complementary therapeutic indications.<\/p><p>Scientific research published in peer-reviewed journals has documented measurable effects on hepatobiliary function, with evidence of reduction of fasting cholecystic volume, modulation of the bile acid pool and improvement of symptoms of functional biliary disorders. Preclinical studies have also shown a possible role in modulating the gut-liver axis, with reduction of inflammatory markers and fibrosis in experimental models of hepatic steatosis.<\/p><p>In parallel, mud-balneotherapy with Acqua Silene is the subject of randomised controlled clinical trials that have documented its efficacy in the treatment of osteoarthritis of the knee, with improvement in pain, joint function and modulation of inflammatory and cartilage biomarkers, with persistent benefits over time.<\/p><p>Together, these data configure the Chianciano waters as a hydromineral system characterised by a stable chemical-physical base and documented clinical evidence, with hepatobiliary, gastrointestinal and osteoarticular therapeutic applications, within the framework of integrated thermal medicine recognised by the National Health Service.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-aa8e7fe elementor-widget__width-inherit elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"aa8e7fe\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b37964e elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"b37964e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">A unique hydromineral system in terms of composition and depth\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c03ebda elementor-widget elementor-widget-text-editor\" data-id=\"c03ebda\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The Chianciano waters emerge from a deep hydrogeological system fed by aquifers hosted in the Triassic and Cretaceous limestones of the Apennine substratum. The high degree of fracturing and marked karstification of these formations allow the waters to rise through deep faults, resulting in prolonged contact with carbonate and evaporitic successions of the Upper Triassic.<\/p><p>The decades of underground permanence and the geochemical interaction with the rocks through which it passes give the water its characteristic sulphate-bicarbonate-calcic facies, with an anionic component dominated by sulphate (SO\u2084\u00b2-) and bicarbonate (HCO\u2083-), and a cationic component that is predominantly calcic (Ca\u00b2\u207a) and magnesic (Mg\u00b2\u207a). Sodium and potassium contents are relatively low, confirming the absence of significant contributions from clastic evaporitic formations.<\/p><p>Systematic analyses carried out by ARPAT, supplemented by internal monitoring from 2002-2011 and the most recent analytical determinations carried out in 2025 by the Department of Chemical Sciences of the University of Naples Federico II, document a remarkable compositional stability over time, with limited variations in individual ions but maintenance of the geochemical facies.<\/p><p>A particularly important fact concerns the sulphate concentration in Acqua Santa, which reaches values close to 1800 mg\/L. This level is among the highest in the panorama of Tuscan thermal waters for therapeutic use and is the main chemical substrate of the hepatobiliary indications documented in the literature. The SO\u2084\u00b2-\/HCO\u2083- ratio, greater than 2, highlights the clear predominance of the sulphate component over the bicarbonate component.<\/p><p>From a chemical-physical point of view, the four sources present:<\/p><ul><li>Temperatures between 15\u00b0C and 37.8\u00b0C<\/li><li>Fixed residue at 180\u00b0C between ~2500 and ~3450 mg\/L<\/li><li>pH weakly acid-subneutral (6.1-6.9)<\/li><li>High calcium and magnesium content<\/li><li>Variable presence of free CO\u2082, particularly significant in Sillene Water<\/li><\/ul><p>The combination of hydrogeological circuit depth, multi-year stability and high sulphate concentrations configures the Chianciano hydromineral system as unique in the regional context. It is the chemical-physical basis on which the biological mechanisms described in the following sections are based.<\/p><p>\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e0a17d7 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"e0a17d7\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">A unique hydromineral system in terms of composition and depth\n<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ee7132d elementor-widget elementor-widget-text-editor\" data-id=\"ee7132d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<table><thead><tr><th>Parameter<\/th><th>Holy Water 1<\/th><th>Holy Water 2<\/th><th>Holy Water 3<\/th><th>Holy Water 4<\/th><\/tr><\/thead><tbody><tr><td>Temperature (\u00b0C)<\/td><td>33,3<\/td><td>15-18<\/td><td>37,8<\/td><td>24,4<\/td><\/tr><tr><td>pH<\/td><td>6,1-6,5<\/td><td>6,8-6,9<\/td><td>6,4<\/td><td>6,3<\/td><\/tr><tr><td>Fixed residue at 180\u00b0C (mg\/L)<\/td><td>3235-3451<\/td><td>2540-2721<\/td><td>2867<\/td><td>3095<\/td><\/tr><tr><td>Conductivity at 25\u00b0C (\u03bcS\/cm)<\/td><td>3110-3520<\/td><td>2660-2810<\/td><td>2810<\/td><td>3010<\/td><\/tr><tr><td>Hardness (\u00b0F)<\/td><td>250<\/td><td>194<\/td><td>N.A.<\/td><td>N.A.<\/td><\/tr><tr><td>Free CO\u2082 (mg\/L)<\/td><td>657-866<\/td><td>62-137<\/td><td>Very high<\/td><td>N.A.<\/td><\/tr><\/tbody><\/table><p><strong>Sources:<\/strong> ARPAT 2014; Terme di Chianciano (2020-2011); SEA Municipality of Chianciano Terme 2017<\/p><p>\u00a0<\/p><table><thead><tr><th>Ion<\/th><th>Holy Water 1<\/th><th>Holy Water 2<\/th><th>Holy Water 3<\/th><th>Holy Water 4<\/th><\/tr><\/thead><tbody><tr><td>Sulphate (SO\u2084\u00b2-)<\/td><td>~1800<\/td><td>1250-1580<\/td><td>1642<\/td><td>1728<\/td><\/tr><tr><td>Bicarbonate (HCO\u2083-)<\/td><td>852<\/td><td>421-758<\/td><td>720<\/td><td>842<\/td><\/tr><tr><td>Calcium (Ca\u00b2\u207a)<\/td><td>780<\/td><td>614-656<\/td><td>642<\/td><td>708<\/td><\/tr><tr><td>Magnesium (Mg\u00b2\u207a)<\/td><td>169<\/td><td>69-89<\/td><td>166<\/td><td>173<\/td><\/tr><tr><td>Sodium (Na\u207a)<\/td><td>23,7<\/td><td>N.A.<\/td><td>20,3<\/td><td>26,2<\/td><\/tr><tr><td>Potassium (K\u207a)<\/td><td>6,06<\/td><td>N.A.<\/td><td>N.A.<\/td><td>N.A.<\/td><\/tr><tr><td>Chloride (Cl-)<\/td><td>21,2<\/td><td>22,7-24,0<\/td><td>16,7<\/td><td>22,5<\/td><\/tr><tr><td>Fluoride (F-)<\/td><td>2,5<\/td><td>1,4-1,9<\/td><td>2,8<\/td><td>3,1<\/td><\/tr><tr><td>Silica (SiO\u2082)<\/td><td>25,8<\/td><td>11,2-18,0<\/td><td>N.A.<\/td><td>N.A.<\/td><\/tr><tr><td>Strontium (Sr)<\/td><td>12,45<\/td><td>10,4-11,5<\/td><td>N.A.<\/td><td>N.A.<\/td><\/tr><\/tbody><\/table><p><strong>Sources:<\/strong>\u00a0University of Naples Federico II - Department of Chemical Sciences (sampling 19.11.2025).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-23d1abf elementor-widget elementor-widget-image\" data-id=\"23d1abf\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img alt=\"\" decoding=\"async\" width=\"1024\" height=\"561\" src=\"https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-1024x561.webp\" class=\"attachment-large size-large wp-image-10096\" srcset=\"https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-1024x561.webp 1024w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-300x165.webp 300w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-768x421.webp 768w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-18x10.webp 18w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6.webp 1355w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dda6f6c elementor-widget__width-inherit elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"dda6f6c\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3f32a4a elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"3f32a4a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Four sources, one integrated therapy system\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7e70777 elementor-widget elementor-widget-text-editor\" data-id=\"7e70777\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The Chianciano waters emerge from a deep hydrogeological system fed by aquifers hosted in the Triassic and Cretaceous limestones of the Apennine substratum. The high degree of fracturing and marked karstification of these formations allow the waters to rise through deep faults, resulting in prolonged contact with carbonate and evaporitic successions of the Upper Triassic.<\/p><p>The decades of subterranean permanence and geochemical interaction with the rocks through which it passes give the water its characteristic sulphate-bicarbonate-calcic facies, with an anionic component dominated by the sulphate ion (SO\u2084\u00b2-) and bicarbonate (HCO\u2083-), and a cationic component that is predominantly calcic (Ca\u00b2\u207a) and magnesic (Mg\u00b2\u207a). Sodium and potassium contents are relatively low, confirming the absence of significant contributions from chlorinated evaporitic formations.<\/p><p>Systematic analyses carried out by ARPAT, supplemented by internal monitoring from 2002-2011 and the most recent analytical determinations carried out in 2025 by the Department of Chemical Sciences of the University of Naples Federico II, document a remarkable compositional stability over time, with limited variations in individual ions but constant maintenance of the geochemical facies.<\/p><p>A particularly important fact concerns the sulphate concentration in Acqua Santa, which reaches values close to 1800 mg\/L. This level is among the highest in the panorama of Tuscan thermal waters for therapeutic use and is the main chemical substrate of the hepatobiliary indications documented in the literature. The SO\u2084\u00b2-\/HCO\u2083- ratio, stably above 2, highlights the clear predominance of the sulphate component over the bicarbonate component.<\/p><p>From a chemical-physical point of view, the four sources present:<\/p><ul><li>Temperatures between 15\u00b0C and 37.8\u00b0C<\/li><li>Fixed residue at 180\u00b0C between ~2500 and ~3450 mg\/L<\/li><li>pH weakly acid-subneutral (6.1-6.9)<\/li><li>High calcium and magnesium content<\/li><li>Variable presence of free CO\u2082, particularly significant in Silene Water<\/li><\/ul><p>The combination of hydrogeological circuit depth, multi-year analytical stability and high sulphate concentrations configures the Chianciano hydromineral system as unique in the regional context, providing the chemical-physical basis on which the biological mechanisms described in the following sections are based.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3dbe458 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"3dbe458\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Add header text here<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bad246b elementor-widget elementor-widget-text-editor\" data-id=\"bad246b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Holy water. Principal indication: hepatobiliary function and hydropinotherapy<\/p><p>The Chianciano waters emerge from a deep hydrogeological system fed by aquifers hosted in the Triassic and Cretaceous limestones of the Apennine substratum. The high degree of fracturing and marked karstification of these formations allow the waters to rise through deep faults, resulting in prolonged contact with carbonate and evaporitic successions of the Upper Triassic.<\/p><p>The decades of subterranean permanence and geochemical interaction with the rocks through which it passes give the water its characteristic sulphate-bicarbonate-calcic facies, with an anionic component dominated by the sulphate ion (SO\u2084\u00b2-) and bicarbonate (HCO\u2083-), and a cationic component that is predominantly calcic (Ca\u00b2\u207a) and magnesic (Mg\u00b2\u207a). Sodium and potassium contents are relatively low, confirming the absence of significant contributions from chlorinated evaporitic formations.<\/p><p>Systematic analyses carried out by ARPAT, supplemented by internal monitoring from 2002-2011 and the most recent analytical determinations carried out in 2025 by the Department of Chemical Sciences of the University of Naples Federico II, document a remarkable compositional stability over time, with limited variations in individual ions but constant maintenance of the geochemical facies.<\/p><p>A particularly important fact concerns the sulphate concentration in Acqua Santa, which reaches values close to 1800 mg\/L. This level is among the highest in the panorama of Tuscan thermal waters for therapeutic use and is the main chemical substrate of the hepatobiliary indications documented in the literature. The SO\u2084\u00b2-\/HCO\u2083- ratio, stably above 2, highlights the clear predominance of the sulphate component over the bicarbonate component.<\/p><p>From a chemical-physical point of view, the four sources present:<\/p><ul><li>Temperatures between 15\u00b0C and 37.8\u00b0C<\/li><li>Fixed residue at 180\u00b0C between ~2500 and ~3450 mg\/L<\/li><li>pH weakly acid-subneutral (6.1-6.9)<\/li><li>High calcium and magnesium content<\/li><li>Variable presence of free CO\u2082, particularly significant in Sillene Water<\/li><\/ul><p>The combination of hydrogeological circuit depth, multi-year analytical stability and high sulphate concentrations configures the Chianciano hydromineral system as unique in the regional context, providing the chemical-physical basis on which the biological mechanisms described in the following sections are based.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e264ba4 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"e264ba4\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Sillene water. Main indication: mud-balneotherapy and balneotherapy\n\n<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-96d4549 elementor-widget elementor-widget-text-editor\" data-id=\"96d4549\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Sillene water is the highest-temperature spring (approx. 37.8\u00b0C) and is characterised by a high free CO\u2082 content. It is not used for hydropinotherapy.<\/p><p>Its therapeutic use concerns:<\/p><ul><li>Thermal mud maturation for liver and joint applications<\/li><li>Carbonated baths with hydromassage<\/li><li>Balneotherapy in the Theia Thermal Pools<\/li><\/ul><p>Randomised controlled clinical trials have documented:<\/p><ul><li>Significant reduction of pain in knee osteoarthritis<\/li><li>Improved joint function (WOMAC, VAS)<\/li><li>Modulation of inflammatory and cartilage biomarkers<\/li><li>Persistence of benefit up to 9 months<\/li><\/ul><p>Fango-balneotherapy with Sillene Water represents one of the best documented clinical applications of the thermal compendium.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4059866 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"4059866\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Holy Water. Principal indication: inhalation cures\n<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2d2a6e1 elementor-widget elementor-widget-text-editor\" data-id=\"2d2a6e1\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Acqua Santissima emerges at around 24\u00b0C, with an ionic composition similar to other springs but with specific characteristics that direct its use to inhalation therapies.<\/p><p>It is used for:<\/p><ul><li>Thermal aerosols<\/li><li>Hot-humid inhalations<\/li><li>Nasal showers<\/li><\/ul><p>Indications include chronic and relapsing diseases of the upper respiratory tract: rhinitis, sinusitis, pharyngitis, laryngitis and chronic bronchitis.<\/p><p>It is not part of the hepatobiliary protocol but represents an autonomous therapeutic segment within the spa system.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3f83cfa elementor-widget__width-inherit elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"3f83cfa\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2e0bda4 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"2e0bda4\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Mechanisms of action of sulphate-bicarbonate-calcic waters\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a6270f1 elementor-widget elementor-widget-text-editor\" data-id=\"a6270f1\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The therapeutic properties attributed to Chianciano waters are based on biological mechanisms consistent with hepatobiliary, intestinal and osteoarticular physiology. The combination of the high concentration of sulphate (SO\u2084\u00b2-), the presence of bicarbonate (HCO\u2083-), calcium (Ca\u00b2\u207a) and magnesium (Mg\u00b2\u207a) results in documented effects on biliary secretion, cholecystic motility, the intestinal-liver axis and inflammatory modulation.<\/p><p>The main mechanisms described in the literature fall into four functional axes.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2b64413 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"2b64413\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">1. Choleretic and cholagogue action\n<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dbb1b00 elementor-widget elementor-widget-text-editor\" data-id=\"dbb1b00\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The sulphate ion represents the main pharmacological mediator of hepatobiliary activity.<\/p><p>The intake of sulphate-bicarbonate-calcium waters stimulates the release of cholecystokinin (CCK) in the duodenum, resulting in:<br \/>- Gallbladder contraction<br \/>- Release of the sphincter of Oddi<br \/>- Increased bile flow in the duodenum<\/p><p>This cholagogue effect was measured ultrasound in the controlled clinical study published in the World Journal of Gastroenterology (Corradini et al., 2012), which documented a significant reduction in fasting cholecyst volume after 12 days of hydropinotherapy.<\/p><p>In parallel, the increased hepatocyte secretion of bile (choleresis) contributes to the reduction of biliary stagnation, a predisposing condition for the formation of biliary sand and cholelithiasis.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-61b62a6 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"61b62a6\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">2. Modulation of the bile acid pool and FXR receptor activation\n<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-10234f1 elementor-widget elementor-widget-text-editor\" data-id=\"10234f1\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The therapeutic properties attributed to Chianciano waters are based on biological mechanisms consistent with hepatobiliary, intestinal and osteoarticular physiology. The combination of the high concentration of sulphate (SO\u2084\u00b2-), the presence of bicarbonate (HCO\u2083-), calcium (Ca\u00b2\u207a) and magnesium (Mg\u00b2\u207a) results in documented effects on biliary secretion, cholecystic motility, the intestinal-liver axis and inflammatory modulation.<\/p><p>The main mechanisms described in the literature fall into four functional axes.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1d9492e elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"1d9492e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">3. Modulation of the gut-liver axis\n<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9a88857 elementor-widget elementor-widget-text-editor\" data-id=\"9a88857\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The pathophysiology of metabolic liver steatosis (MASLD) is closely linked to alterations in the intestinal barrier and translocation of lipopolysaccharides (LPS) into the portal circulation. In a mouse model of steatohepatitis (Carpino et al., 2022), Chianciano sulphate-bicarbonate-calcic water showed:<\/p><ul><li><span style=\"font-size: 16px;\">Significant reduction in hepatic localisation of LPS<\/span><\/li><li><span style=\"font-size: 16px;\">Reduction of TLR4\/NF-kB pathway activation<\/span><\/li><li><span style=\"font-size: 16px;\">Reduction of lobular inflammation<\/span><\/li><li><span style=\"font-size: 16px;\">Reduced activation of hepatic stellate cells<\/span><\/li><li><span style=\"font-size: 16px;\">Improved intestinal mucosal integrity (increased occludin expression)<\/span><\/li><\/ul><p>These data suggest a modulating effect on the gut-liver axis, with potential impact on progression from simple steatosis to fibrosis.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-54ca823 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"54ca823\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">4. Anti-inflammatory action and modulation of cartilage turnover\n\n<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-304d97c elementor-widget elementor-widget-text-editor\" data-id=\"304d97c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>In the osteoarticular context, fangobalneotherapy with Chianciano waters acts through multiple mechanisms:<\/p><ul><li><span style=\"font-size: 16px;\">Modulation of pro-inflammatory adipokines (reduction of adiponectin and resistin)<\/span><\/li><li><span style=\"font-size: 16px;\">Reduction of pain symptoms (VAS)<\/span><\/li><li><span style=\"font-size: 16px;\">Improvement of functional indices (WOMAC)<\/span><\/li><li><span style=\"font-size: 16px;\">Stimulation of cartilage turnover (increase in CTX-II)<\/span><\/li><\/ul><p>A 2021 meta-analysis of 21 randomised trials confirms the clinical efficacy of fangobalneotherapy in gonarthrosis, with persistent benefits for up to nine months. The totality of the data suggests a biologically active effect not limited to thermal stress, but attributable to immunomodulatory and metabolic mechanisms.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c225200 elementor-widget elementor-widget-image\" data-id=\"c225200\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img alt=\"\" decoding=\"async\" width=\"1024\" height=\"561\" src=\"https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-1024x561.webp\" class=\"attachment-large size-large wp-image-10096\" srcset=\"https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-1024x561.webp 1024w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-300x165.webp 300w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-768x421.webp 768w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-18x10.webp 18w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6.webp 1355w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-825f1d5 elementor-widget__width-inherit elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"825f1d5\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d98f795 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"d98f795\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Scientific evidence on hepatobiliary function\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7c21f2a elementor-widget elementor-widget-text-editor\" data-id=\"7c21f2a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The available literature on Chianciano waters includes controlled clinical studies, observational studies and experimental preclinical models. The body of evidence documents measurable effects on cholecystic dynamics, the bile acid pool and hepatic inflammatory markers.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c8c103e elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"c8c103e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Clinical trial - Fraioli et al., 2011  \n<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-389aa2b elementor-widget elementor-widget-text-editor\" data-id=\"389aa2b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Rheumatology International<\/p><p><strong>Study design<\/strong> <br \/>61 patients with osteoarthritis of the knee divided into:<\/p><ul><li>Treated group: 3 cycles of mud-balneotherapy with Acqua Silene over one year<\/li><li>Control group: conventional drug therapy only<\/li><\/ul><p><strong>Endpoints evaluated<\/strong><\/p><ul><li>Visual Analogue Scale (VAS) of pain<\/li><li>Lequesne's Algofunctional Index<\/li><\/ul><p><strong>Results<\/strong><\/p><ul><li>Significant reduction in pain in the treated group<\/li><li>Superior functional improvement over controls<\/li><li>No adverse events reported<\/li><\/ul><p><strong>Conclusion<\/strong> <br \/>Fango-balneotherapy with Acqua Silene improves pain symptoms and joint function, with a favourable safety profile.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-01b1d01 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"01b1d01\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Randomised controlled trial - Fioravanti et al., 2015<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0b6e593 elementor-widget elementor-widget-text-editor\" data-id=\"0b6e593\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>International Journal of Biometeorology<\/p><p><strong>Drawing<\/strong> <br \/>Prospective randomised, single-blind study with follow-up up to 12 months.<\/p><p>Population <br \/>Patients with symptomatic primary bilateral gonarthrosis (ACR criteria).<\/p><p><strong>Endpoint<\/strong><\/p><ul><li>Global pain (VAS)<\/li><li>WOMAC (pain, stiffness, function)<\/li><\/ul><p><strong>Results<\/strong><\/p><ul><li>Significant improvement of VAS and WOMAC in the treated group<\/li><li>Persistence of benefit up to 9 months<\/li><li>Progressive attenuation at 12 months<\/li><\/ul><p><strong>Clinical implication<\/strong> <br \/>The clinical benefit of fangobalneotherapy extends beyond the immediate effect of heat and suggests a rationale for repeated annual cycles.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-54f548a elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"54f548a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">\nBiomarkers and biological mechanisms\n<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-760433f elementor-widget elementor-widget-text-editor\" data-id=\"760433f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Subsequent studies have explored the underlying molecular mechanisms.<\/p><p><strong>Adipokines (Fioravanti et al., 2015)<\/strong><\/p><ul><li>Significant reduction in adiponectin (p &lt; 0.001)<\/li><li>Significant reduction in resistin (p &lt; 0.0001)<\/li><li>No change in visfatin<\/li><\/ul><p>These results suggest a modulation of the adipose-articular axis and a systemic anti-inflammatory effect.<\/p><p><strong>Cartilage turnover (Pascarelli et al., 2016)<\/strong><\/p><ul><li>Significant increase in serum CTX-II (p &lt; 0.001)<\/li><li>Interpreted as stimulation of cartilage remodelling in response to controlled thermal stress.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3ebf75a elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"3ebf75a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Meta-analysis - Mennuni et al., 2021\n<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-42ccedb elementor-widget elementor-widget-text-editor\" data-id=\"42ccedb\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><strong>Overall sample<\/strong> <br \/>21 randomised controlled trials <br \/>1,816 patients<\/p><p><strong>Results<\/strong><\/p><ul><li>Significant improvement in WOMAC scores<\/li><li>Significant reduction in pain (VAS)<\/li><li>Benefit maintained for up to 9 months<\/li><\/ul><p><strong>Conclusion<\/strong> <br \/>Fango-balneotherapy is a non-invasive, well-tolerated treatment option with evidence of clinical efficacy in the management of knee osteoarthritis.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-74d28d1 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"74d28d1\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">\nCost-effectiveness analysis - Ciani et al., 2017\n<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7e46728 elementor-widget elementor-widget-text-editor\" data-id=\"7e46728\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The addition of fangobalneotherapy to conventional therapy has proven to be cost-effective compared to drug therapy alone, with improved quality of life and rational health care sustainability.<\/p><p>Summary of osteoarticular evidence<\/p><p>Clinical evidence indicates that fangobalneotherapy with Sillene Water:<\/p><ul><li>Reduces joint pain<\/li><li>Improves function<\/li><li>Modulates inflammatory biomarkers<\/li><li>Stimulates cartilage turnover<\/li><li>Presents persistent benefits over time<\/li><li>It is well tolerated and sustainable from a health point of view<\/li><\/ul><p>The totality of the data places fangobalneotherapy among the best-documented complementary options in the non-surgical management of gonarthrosis.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4ab5735 elementor-widget elementor-widget-image\" data-id=\"4ab5735\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img alt=\"\" decoding=\"async\" width=\"1024\" height=\"561\" src=\"https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-1024x561.webp\" class=\"attachment-large size-large wp-image-10096\" srcset=\"https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-1024x561.webp 1024w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-300x165.webp 300w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-768x421.webp 768w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-18x10.webp 18w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6.webp 1355w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c317569 elementor-widget__width-inherit elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"c317569\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b7bc5ff elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"b7bc5ff\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Related evidence on waters of the same chemical class<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-314c990 elementor-widget elementor-widget-text-editor\" data-id=\"314c990\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Acque di Chianciano belongs to the class of sulphate-bicarbonate-calcic mineral waters, a category widely studied in spa medicine for its physiological effects on:<\/p><ul><li>biliary secretion and outflow<\/li><li>\u00a0digestive function and intestinal motility<\/li><li>modulation of inflammation<\/li><li>osteoarticular wellbeing (particularly in balneo-mud applications)<\/li><\/ul><p>It is important to point out that each spring has a unique mineral signature (total mineralisation, sulphate\/bicarbonate ratio, CO\u2082 content, emergence temperature, trace elements) and therefore results from studies of other waters are not transferable \u201cby identity\u201d. However, the literature on waters of the same hydrochemical family supports rationales and biological mechanisms consistent with those observed for Chianciano.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c90645a elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"c90645a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">1. Hepatobiliary and digestive environment: why sulphates matter<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f34946c elementor-widget elementor-widget-text-editor\" data-id=\"f34946c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>In spa literature, sulphate-rich waters are associated with:<\/p><ul><li>increased biliary secretion (choleresis)<\/li><li>improvement of cholecystic motility (cholagogue action)<\/li><li>support in the management of functional dyspepsia and uncomplicated biliary disorders<\/li><li>subjective benefit on bloating, slow digestion and regularity<\/li><\/ul><p>This picture is consistent with the clinical results available on Chianciano (cholecystic dynamics and bile acid pool) and with traditional hydropinic use.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8740007 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"8740007\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">2. Gut-liver axis: shared rationale in functional mineral waters<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f826140 elementor-widget elementor-widget-text-editor\" data-id=\"f826140\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Studies on mineral waters with similar profiles suggest that modulation of digestive function and bile may have effects on:<\/p><ul><li>composition of the microbiota<\/li><li>intestinal barrier and permeability<\/li><li>metabolic-inflammatory signals (particularly in the context of dysmetabolism)<\/li><\/ul><p>In Chianciano, this rationale finds specific support in preclinical evidence on the MASLD model, which indicates a potential action along the gut-liver axis.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-73e5451 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"73e5451\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">3. Osteoarticular area: balneo-mud as a \u201cfamily\u201d of evidence<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-460a551 elementor-widget elementor-widget-text-editor\" data-id=\"460a551\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<!--StartFragment --><p>For gonarthrosis and, more generally, for pain and stiffness in degenerative diseases, the international literature on balneotherapy and mud therapy (also on waters of different origin but with similar applications) shows good consistency:<\/p><ul><li>reduction of pain<\/li><li>improved joint function<\/li><li>persistence of benefit for several months<\/li><li>generally favourable tolerability profile<\/li><\/ul><p>The evidence on Chianciano (trials, biomarkers, meta-analysis and cost-effectiveness) fits into this body of findings, strengthening its clinical robustness.<\/p><!--EndFragment -->\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-98225e9 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"98225e9\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">4. In summary<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-20d73be elementor-widget elementor-widget-text-editor\" data-id=\"20d73be\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<ul><li>The \u201cclass\u201d evidence does not replace the specific evidence on Chianciano.<\/li><li>However, they serve to explain why, from a physiological and clinical point of view, the indications attributed to sulphate-bicarbonate-calcic waters are consistent and why Chianciano is historically placed in this therapeutic vein<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-290ee6c elementor-widget elementor-widget-image\" data-id=\"290ee6c\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img alt=\"\" decoding=\"async\" width=\"1024\" height=\"561\" src=\"https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-1024x561.webp\" class=\"attachment-large size-large wp-image-10096\" srcset=\"https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-1024x561.webp 1024w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-300x165.webp 300w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-768x421.webp 768w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6-18x10.webp 18w, https:\/\/termechianciano.it\/wp-content\/uploads\/2026\/02\/programma6.webp 1355w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-763ebd6 elementor-widget__width-inherit elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"763ebd6\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-33a5305 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"33a5305\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Indications for use and therapeutic appropriateness<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a98c0e9 elementor-widget elementor-widget-text-editor\" data-id=\"a98c0e9\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<!--StartFragment --><p>The use of the Chianciano waters is part of integrated thermal medicine. The modalities of use - hydropinotherapy, inhalation cures, mud-balneotherapy and balneotherapy - must be customised according to the patient's clinical picture and medical assessment.<\/p><p>The reported indications are derived from published clinical evidence, established hydrological tradition and National Health Service recognition for specific conditions.<\/p><!--EndFragment -->\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-31ce64d elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"31ce64d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Hydropinotherapy (Acqua Santa and, in association, Acqua Fucoli)<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9a0129e elementor-widget elementor-widget-text-editor\" data-id=\"9a0129e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><!--StartFragment --><strong>Main indications<\/strong><\/p><ul><li>Functional disorders of the biliary tract<\/li><li>Dyspepsia of hepatobiliary origin<\/li><li>Biliary dyskinesias<\/li><li>Post-cholecystectomy syndrome<\/li><li>Functional constipation associated with slow transit<\/li><\/ul><p><strong>General mode of recruitment (typical protocol)<\/strong><\/p><ul><li>400-500 mL per day<\/li><li>In the morning, on an empty stomach<\/li><li>At emergency temperature<\/li><li>Slow intake, in small sips<\/li><li>Cycle of 12 consecutive days<\/li><li>The duration and mode can be changed on the advice of the spa doctor.<\/li><\/ul><p><strong>Appropriateness<\/strong><br \/>Hydropinotherapy does not replace prescribed drug therapies for complex organic diseases (symptomatic cholelithiasis, acute hepatitis, advanced cirrhosis, cholangitis).<br \/>It is indicated as a complementary treatment in functional conditions or in uncomplicated phases.<\/p><p><!--EndFragment --><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ae26456 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"ae26456\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Mud and balneotherapy (Sillene Water)<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d5db020 elementor-widget__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"d5db020\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><strong>Main indications<\/strong><\/p><ul><li>Osteoarthritis of the knee<\/li><li>Osteoarthrosis of other sites<\/li><li>Chronic degenerative joint pain<\/li><li>Post-traumatic joint outcomes<\/li><\/ul><p><strong>Typical mode<\/strong><\/p><ul><li>Application of mud matured in thermal water<\/li><li>Pack duration: approx. 15-20 minutes<\/li><li>Followed by thermal bath<\/li><li>Cycle of 12 sessions<\/li><li>Annual or six-monthly repetition according to medical indication<\/li><\/ul><p><strong>Appropriateness<\/strong><br \/>Not indicated in cases of:<\/p><ul><li>Acute joint inflammatory states<\/li><li>Feverish phases<\/li><li>Unstable heart failure<\/li><li>Oncological pathologies in active phase without specialist evaluation<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-826aace elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"826aace\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Inhalation cures (Holy Water)<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6d40a3b elementor-widget__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"6d40a3b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><strong>Main indications<\/strong><\/p><ul><li>Chronic and relapsing rhinitis<\/li><li>Rhinosinusitis<\/li><li>Pharyngitis and chronic laryngitis<\/li><li>Chronic bronchitis<\/li><li>Selected paediatric respiratory diseases<\/li><\/ul><p><strong>Mode<\/strong><\/p><ul><li>Thermal aerosol<\/li><li>Hot-humid inhalations<\/li><li>Nasal showers<\/li><\/ul><p>Cycle duration: generally 12 sessions.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-247cef2 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"247cef2\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Safety and medical assessment<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3af0b9e elementor-widget__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"3af0b9e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Thermal cures are generally well tolerated. The available clinical studies on the Chianciano waters report no significant adverse events in the protocols analysed.<\/p><p>However, it is recommended:<\/p><ul><li>Preventive medical assessment<\/li><li>Communication of ongoing drug therapies<\/li><li>Special attention in patients with complex chronic diseases<\/li><\/ul><p>Treatments covered by the National Health Service require a doctor's prescription according to current regulations.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-46d7c5f elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"46d7c5f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Role in integrated medicine<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1440420 elementor-widget__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"1440420\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>The Chianciano Waters fit in as a complementary treatment, not a replacement, within:<\/p><ul><li>Pathways to hepatobiliary health<\/li><li>Multidisciplinary management of gonarthrosis<\/li><li>Strategies for functional prevention and metabolic well-being<\/li><\/ul><p>Clinical appropriateness is determined by the integration of medical assessment, available scientific evidence and individual patient characteristics<\/p><p><strong>Concluding Synthesis<\/strong><br \/>The Chianciano waters represent a hydromineral system with defined chemical-physical characteristics, documented compositional stability and studied clinical applications in the hepatobiliary, osteoarticular and respiratory fields.<\/p><p>Available scientific evidence includes:<\/p><ul><li>randomised clinical trials<\/li><li>preclinical studies on a liver metabolic model<\/li><li>Meta-analysis on balneotherapy<\/li><li>cost-effectiveness evaluations<\/li><li>safety and tolerability data<\/li><\/ul><p>Therapeutic applications must be framed in the context of integrated medicine, with preventive medical assessment and clinical appropriateness.<\/p><p>Chianciano's spa tradition is now part of a contemporary paradigm that integrates:<\/p><ul><li>digestive and biliary physiology<\/li><li>intestine-liver axis<\/li><li>inflammatory modulation<\/li><li>neuroendocrine mechanisms<\/li><li>osteoarticular rehabilitation<\/li><\/ul><p>Thermal cures do not replace drug therapy when indicated, but can be a complementary support with a physiological rationale and documented basis<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2068800 elementor-widget__width-inherit elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"2068800\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-50bea52 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"50bea52\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Bibliography<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7055272 elementor-widget__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"7055272\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><strong>GEOCHEMISTRY AND HYDROGEOLOGY<\/strong><br \/>ARPAT. <em>Main thermal emergencies in Tuscany. Hydrogeology and water chemistry.<\/em> Florence: ARPAT; March 2014.<br \/>Municipality of Chianciano Terme. <em>Strategic Environmental Assessment - Environmental Report, Operational Plan.<\/em> Approval February 2017.<br \/>Terme di Chianciano spa. <em>Thermal water comparison - In-house analytical data (2002-2011 sampling).<\/em><\/p><p><strong>HEPATOBILIARY FUNCTION<\/strong><br \/>Corradini SG, Ferri F, Mordenti M, et al. <em>Beneficial effect of sulphate-bicarbonate-calcium water on gallstone risk and weight control.<\/em> World J Gastroenterol. 2012;18(9):930-937. PMID: 22408352.<br \/>Carpino G, Overi D, Onori P, et al. <em>Effect of Calcium-Sulphate-Bicarbonate Water in a Murine Model of Non-Alcoholic Fatty Liver Disease: A Histopathology Study.<\/em> Int J Mol Sci. 2022;23(17):10065. PMID: 36077461.<br \/>Mennuni G, Petraccia L, Fontana M, et al. <em>The therapeutic activity of sulphate-bicarbonate-calcium-magnesiac mineral water in the functional disorders of the biliary tract.<\/em> Clin Ter. 2014;165:e346-e352. PMID: 25366951.<br \/>Fraioli A, Mennuni G, Petraccia L, et al. <em>Sulphate-bicarbonate mineral waters in the treatment of biliary and digestive tract diseases.<\/em> Clin Ter. 2010;161:163-168. PMID: 20499033.<\/p><p><strong>OSTEOARTICULAR PATHOLOGIES<\/strong><br \/>Fraioli A, Serio A, Mennuni G, et al. <em>A study on the efficacy of treatment with mud packs and baths with Sillene mineral water (Chianciano Spa Italy) in patients suffering from knee osteoarthritis.<\/em> Rheumatol Int. 2011;31(10):1333-1340. PMID: 20390281.<br \/>Fioravanti A, Bacaro G, Giannitti C, et al. <em>One-year follow-up of mud-bath therapy in patients with bilateral knee osteoarthritis: a randomised, single-blind controlled trial.<\/em> Int J Biometeorol. 2015a;59(9):1333\u20131343. PMID: 25516113.<br \/>Fioravanti A, Giannitti C, Chelsechsi S, et al. <em>Circulating levels of adiponectin, resistin, and visfatin after mud-bath therapy in patients with bilateral knee osteoarthritis.<\/em> Int J Biometeorol. 2015b;59(11):1691\u20131700. PMID: 25750093.<br \/>Pascarelli NA, Chelsechsi S, Bacaro G, et al. <em>Effect of Mud-Bath Therapy on Serum Biomarkers in Patients with Knee Osteoarthritis: Results from a Randomized Controlled Trial.<\/em> Isr Med Assoc J. 2016;18(3-4):232-237. PMID: 27228651.<br \/>Fraioli A, Mennuni G, Fontana M, et al. <em>Efficacy of Spa Therapy, Mud-Pack Therapy, Balneotherapy, and Mud-Bath Therapy in the Management of Knee Osteoarthritis. A Systematic Review.<\/em> Biomed Res Int. 2018;10:45276. PMID: 30046586.<br \/>Mennuni G, Fontana M, Perricone C, Nocchi S, Rosso R, Ceccarelli F, Fraioli A. <em>A meta-analysis of the effectiveness of mud-bath therapy on knee osteoarthritis.<\/em> Clin Ter. 2021;172(4):372-387. doi: 10.7417\/CT.2021.2343<br \/>Fioravanti A, Cantini F, Guidelli GM, Galeazzi M. <em>Mechanisms of action of spa therapies in rheumatic diseases: what scientific evidence is there?<\/em> Rheumatol Int. 2011;31(1):1-8. PMID: 21120502.<br \/>Tenti S, Chelsechsi S, Galeazzi M, Fioravanti A. <em>Spa therapy: can it be a valid option for treating knee osteoarthritis?<\/em> Int J Biometeorol. 2015;59(8):1133\u20131144. PMID: 25335982.<br \/>Chelsechsi S, Tenti S, Secciafico I, G\u00e1lvez I, Fioravanti A, Ortega E. <em>Balneotherapy year in review 2021: focus on the mechanisms of action of balneotherapy in rheumatic diseases.<\/em> Environ Sci Pollut Res Int. 2022 Feb;29(6):8054-8073. doi: 10.1007\/s11356-021-17780-0. Epub 2021 Nov 29. PMID: 34845635.<\/p><p><!--StartFragment --><\/p><p>\u00a0<\/p><p><strong>RELATED EVIDENCE<\/strong><br \/>Gravina AG, Romeo M, Pellegrino R, et al. <em>Just Drink a Glass of Water? Effects of Bicarbonate-Sulphate-Calcium-Magnesium Water on the Gut-Liver Axis.<\/em> Front Pharmacol. 2022;13:869446. PMID: 35837275.<\/p><p>Gravina AG, Pellegrino R, Romeo M, et al. <em>The use of bicarbonate-sulphate-calcium-magnesium and sodium-low drinkable water improves functional gastrointestinal symptoms in patients with non-alcoholic fatty liver disease.<\/em> Clin Nutr ESPEN. 2023;57:281-287. PMID: 37739669.<\/p><p>Arab JP, Karpen SJ, Dawson PA, et al. <em>Bile acids and nonalcoholic fatty liver disease: Molecular insights and therapeutic perspectives.<\/em> Hepatology. 2017;65(1):350-362.<\/p><p><strong>GUIDELINES AND GENERAL REFERENCES<\/strong><br \/>Rinella ME, Neuschwander-Tetri BA, et al. <em>AASLD Practice Guidance on the Clinical Assessment and Management of Nonalcoholic Fatty Liver Disease.<\/em> Hepatology. 2023;77(5):1797\u20131835.<\/p><p>Maraver F, Armijo F, Fern\u00e1ndez-Tor\u00e1n MA, et al. <em>Peloids as thermotherapeutic agents.<\/em> Int J Environ Res Public Health. 2021;18(4):1866.<\/p><h3><!--EndFragment --><\/h3>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/article>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Demo Home Chianciano Waters: scientific evidence Table of Contents Composition, therapeutic properties and scientific evidence Chianciano Waters: scientific evidence 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