Where cupping therapy sits within traditional and complementary medicine, the assessment before treatment and the principles of safe clinical practice.
Cupping therapy, or hijama (wet cupping therapy), is a treatment method with a very long history, used to relieve pain. The physician places cups on your back, abdomen, arms, legs or other parts of the body. The vacuum created inside the cup draws the skin upwards.
Hijama is also widely used in Chinese and Middle Eastern medicine. People have been practising cupping therapy for thousands of years.
In this article we look at what cupping therapy is, how it is performed and which areas it is applied to.
The cups used may be made of bamboo, ceramic, metal or silicone. Historical sources show that even animal horns were used. The safest approach is to proceed with a specialist physician with verifiable references.
The History of Hijama
Cupping therapy is one of the oldest methods of removing toxins from the tissues and organs of the body. The Arabic origin of the word "hijama" is hijāma, from the root hajm, meaning to suck.
In the fifth century BC, Herodotus recommended both wet and dry cupping for many complaints including indigestion, loss of appetite and headaches.
Historical sources show that Ibn Sina recommended hijama in the first and last week of the lunar month, and listed the areas of application as: the back of the neck, the forehead, between the shoulders, the side of the neck, the shoulder tops, the calves, the crown of the head, under the chin, the hips and the knees.
Hijama was also one of the indispensable treatment methods of the Ottoman period. The main equipment then was animal horns; today glass and vacuum mica cups are the most common.
Is Hijama the Same as Bloodletting?
Hijama, which can be summarised as drawing blood using vacuum cups, is completely different from taking blood from a vein. Increasing microcirculation in the treated area aims to remove toxins from the blood and tissues.
The Difference Between Dry and Wet Cupping
There are two types of cupping: dry and wet. Dry cupping is performed without drawing blood and is non-invasive. Wet cupping is invasive and involves drawing blood.
Wet cupping filters both hydrophilic and hydrophobic material through high-pressure filtration. The high pressure from aspiration increases blood volume and capillary filtration rate and causes filtered and interstitial fluid to leave the area. This leads to improved blood flow, removal of toxins, restored neuroendocrine balance, improved oxygen supply and better tissue perfusion.
Which Areas Is It Applied To?
The back, chest, abdomen and hips, where muscle tissue is abundant, are the most common areas for cup placement. Areas avoided are those with plenty of hair, little muscle tissue and insufficient surface area for placing the cups.
Systemic conditions in which cupping therapy has been seen to help include hypertension, rheumatoid arthritis, diabetes, psychiatric disorders, systemic infections and skin disorders.
What Needs Care?
Hijama must not be applied directly over nerves, arteries, veins, varicose veins, skin lesions, body openings, lymph nodes, the eyes or areas with skin inflammation.
Cupping therapy is not recommended for geriatric and paediatric patients or for women who are pregnant or menstruating. People with chronic conditions such as cardiovascular disease, those treated with anticoagulants and those with an acute infection should generally avoid cupping therapy.
Applying sterile St John's wort oil or castor oil to the marked areas immediately after showering helps prevent scarring and speeds healing.
Materials Used in Hijama
Cups can be made from various materials including bamboo, glass and clay. Because non-disposable cups require advanced sterilisation and disinfection before reuse, disposable cups are preferred. The size of the cup varies according to where it is used.
In wet cupping, a sharp surgical blade is used to create superficial, controlled incisions. A lancet needle or pen is more common in the two-stage traditional wet method.
Hijama Methods
Dry cupping is a one-step technique; traditional wet hijama is a two-stage technique. Researchers advise that cups should not remain on the skin for more than 5-10 minutes. Marks left by hijama disappear within 1-10 days.
Can Complications Occur?
Cupping therapy is generally safe and side effects are infrequent; those reported are mild to moderate. Preventable side effects include scar formation, burns, blister formation, abscess, skin infection, itching, anaemia and panniculitis.
Handwashing and the use of appropriate protective equipment (gloves, mask, protective goggles, gown) are extremely important in preventing the spread of infection.
On the Benefits of Hijama
The strongest evidence for the benefit of cupping therapy comes from studies on musculoskeletal pain and on migraine or tension-type headache.
One study found a 66% reduction in mean headache severity following wet cupping therapy; the number of monthly headache days in these patients also fell by 12.6.
Dry cupping is generally used for musculoskeletal pain and to relieve muscle tension. Applied to the lumbar or cervical regions in patients with chronic back pain, it provided benefit in both the behavioural variables of pain and physiological parameters.
In general, dry hijama has shown the greatest benefit in generalised pain conditions, while wet hijama has shown the greatest benefit in inflammation-related pain conditions such as herpes zoster (shingles).
A study conducted in Germany showed that traditional wet cupping was effective in treating carpal tunnel syndrome. Various sources also report that wet cupping is effective in thalassaemia and autoimmune diseases. Cupping therapy has also been reported to be effective against cough, shortness of breath and acne.
What to Do Before the Procedure
- Animal-based food should be stopped for the 2 days before and 24 hours after the procedure.
- Do not arrive hungry and thirsty; stopping food and drink at least 3 hours beforehand is sufficient.
- Sexual activity and sport should be avoided from 24 hours beforehand, and the body should be rested.
- Medicines that affect blood flow and clotting should not be taken for at least 12 hours beforehand.
What to Do Afterwards
Warm water with vinegar or a honey drink, which have vasodilatory properties, are traditionally recommended after hijama, though your physician will give the most appropriate advice. You can shower after 12 hours. Avoid sexual activity, heavy sport and strenuous physical work for 24 hours after the procedure. An increase in appetite after hijama is common; keeping to good hygiene is sufficient.
Is Hijama Performed on Babies and Children?
Although various sources say it can be applied to babies and children, we recommend getting the most accurate information from your physician.
Hijama and cupping in children are reported to increase appetite and make weight gain easier, strengthen the body's defences and reduce frequent illness, support height and weight development, and maintain enzyme and hormone balance. Accordingly, a child's skin and hair also become healthier. Hijama is also recommended for problems commonly seen today such as attention deficit, disinterest in lessons, restlessness and hyperactivity.
Is Hijama Very Painful?
Pain thresholds vary from person to person, but in skilled hands there is no pain or soreness; the process is simpler than having blood taken.
Mild curiosity and unease may arise before the procedure, particularly the first time. At our clinic, detailed information before the procedure is provided personally by Dr. Murat Irmak.
What Is the Age Range for Adults?
Regardless of gender, hijama is not recommended for people over 70, since the likelihood of chronic conditions such as heart disease increases with age. This aims to prevent the small possibility of vasovagal syncope (fainting).
In people with polycythaemia (excess blood), those who use tobacco products and those with chronic lung conditions such as COPD, hijama may be performed under physician supervision.
Which Days of the Month Are Preferred?
Individuals and institutions who observe Islamic practice tend to choose Mondays, Tuesdays and Thursdays. In urgent situations such as arm, leg and foot pain this preference no longer applies and there is no harm in performing the procedure immediately.
Which Season Is Most Suitable?
Unless the situation is urgent, people with religious sensitivities are advised to have hijama in spring and autumn. It is not suitable on very hot days as it may cause fainting. Traditional practice recommends it once every three months.
