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EFFECTS OF HIJAMAT (CUPPING) IN BALANCING THE BODY HUMOURS. – A REVIEW M.S.M. SHIFFA* MD Scholar, Department of Moalijat, F/O Medicine, Jamia Hamdard, New Delhi.

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Outline • • • • • • • • •

Humoural Theory Unani - Tibb therapy Hijamat (Cupping) Results of some clinical trials Immuo modulatory function of the cupping Some important sites of Cupping and its benefits Al Hadith Conclusion References 2

Humoural Theory Unani Medicine is based on Hippocratic theory of four humours i.e. Khoon (blood), Bulgham (phlegm), Safra (bile) and Sauda (black bile).  Every physical existence is the combination of above four groups of elements. • The humours are the primary fluids which are manufactured by the liver from the food and drink we consume. Every level of organization in the body – sub-cellular organelles, cells, tissues and organs – is infused with, and interconnected by, the humours1. 

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Humoural Theory Cont… • A proper balance of humours within a person’s body ensures efficient metabolism, prevents the build-up of toxins, and maintains optimum health1. • One of the most important functions of the humours is to maintain the ideal qualitative states associated with the temperament of an individual. • Humoral imbalance is often the root cause in the origin and development of a particular illness 4.

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UNANI -TIBB THERAPY Treatment of chronic ailments is carried out by way of four approaches5. All of them aimed at correcting qualitative imbalances associated with the humours and temperament of an individual.

(1) Ilaj bil Ghiza (Dietotherapy) according to the patient’s temperament and the nature of the ailment (2) Ilaj bil Dawa (Pharmacotherapy) – that is, treatment with one or more of a range of herbal products;

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UNANI -TIBB THERAPY CONT… (3) Ilaj bil Yad (Surgical intervention). (4) Ilaj bil thadbeer (Regimental therapy), which includes a number of therapeutic interventions, such as Cupping, purging, diuresis, meditation, massage and fasting. • Cupping – both dry and wet – is a major part of regimental therapy6.

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HIJAMAT (CUPPING) • Al-hijamah (also hijama) is derived from the Arabic word hajm which means "sucking.“ This practice was highly encouraged by the Prophet muhammad (peace be upon him)2. • Cupping or Hijamat is a method used for local evacuation or diversion of morbid humours in which a horn (singhi) is attached to the surface of the skin of the diseased part through negative pressure created by vacuum3.

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HIJAMAT (CUPPING) CONT… • According to Avicenna ‘Cupping depurates the neighboring skin or organ more effectively and it withdraws thin blood rather than thick blood, thus it helps to balance the humours1,4. • Thus cupping removes bad or morbid matters from the body and helps to neutralize the humours (Akhlath) and also helps to regain the health7,9-10.

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HIJAMAT (CUPPING) CONT… • Cupping causes the tissues beneath the cup to be drawn up and swell, and an increase in blood flow to the affected area. This enhanced blood flow under the cup draws impurities and toxins away from the nearby tissues and organs to the skin, from where they are expelled9,10.

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HIJAMAT (CUPPING) CONT… • Cupping diverts toxins and impurities (swellings) from important organs such as the liver or kidney to the less important organ, the skin1. therefore it purifies the akhlath especially Dam (Blood). • It could be used to divert madda from the direction of its flow– checking the menstruation - cupping under the breast1 or cupping on the medial epicondyle of the femur. – Heamoptysis - cupping on the area in between the shoulders9,10.

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HIJAMAT (CUPPING) CONT… • Cupping is a safe, non-invasive and inexpensive technique. It is used to alleviate the pain and discomfort arising from disorders of the lungs, heart and other internal organs, and muscle spasms, t pains, and numerous other conditions due to derangements of akhlaths1. It removes morbid matter (madda-e-marz), or correct the derangement of temperament (soo-e-mizaj) by regulating humours1.

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Results of some clinical trials  Hijamat bil Shurt in combination with Unani formulation for Waja ul Mufasil is better than when compared with formulation alone8.  Two RCTs suggested significant pain reduction for cupping in low back pain compared with usual care (P < 0.01) and analgesia (P < 0.001). Another two RCTs also showed positive effects of cupping in cancer pain (P < 0.05) and trigeminal neuralgia (P < 0.01) compared with anticancer drugs and analgesics, respectively. Two RCTs reported favorable effects of cupping on pain in brachialgia compared with usual care (P = 0.03) or heat pad (P < 0.001)11. 12

Results of some clinical trials cont…

 Traditional wet-cupping care delivered in a primary care setting was safe and acceptable to patients with nonspecific low back pain. Wet-cupping care was significantly more effective in reducing bodily pain than usual care at 3-month follow-up12.  Wet -cupping leads to clinical relevant benefits for primary care patients with headache13.

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Results of some clinical trials cont…

• The treatment was safe and well tolerated. cupping therapy may be effective in relieving the pain and other symptoms related to CTS. The efficacy of cupping in the long-term management of CTS and related mechanisms remains to be clarified16. • Wet cupping may be an effective method of reducing LDL cholesterol in men and consequently may have a preventive effect against atherosclerosis17. 14

Immuo modulatory function of the cupping • Cupping has the advantage of immuno-modulatory function. Thus it helps the humours especially Dam to become balanced (Mothadil). • Clinical researches  Immunomodulatory effects of blood letting cupping therapy in patients with rheumatoid arthritis14. conclusion- BLC therapy combined with conventional therapy may improve the clinical condition of patients with RA. It has modulatory effects on the innate (NK %) and adaptive cellular (SIL-2R conc.) immune responses that could be used as monitoring tools for disease activity and prognosis. 15

Immuo modulatory function of the cupping cont… Cupping for patients with inflammatory complaints –clinical and biochemical outcomes15. Conclusion •

Cupping therapy significantly effects the levels of certain immune cells and inflammatory markers. • Cupping may exert local inflammatory response through local vascular damage (increased platelets and lymphocytes) which stimulate healing

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Some important sites of Cupping and its benefits cont… • Between shoulders- Heamoptysis, Zeeequn Nafz Damavi (Sanguinous Asthma)1. Thus it can be used for the diseases caused by Dam. • Cupping over the shank- it purifies the blood (Dam) and promotes the menstrual bleeding. • Over the anus- attracts madda from the entire body especially from the head, menstrual problems and piles1. • Nape of the neck- fetor, stomatitis, diphtheria, meningitis, headache and conjunctivitis6.

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SOME IMPORTANT SITES OF CUPPING AND ITS BENEFITS CONT… • Over the hip- Sciatica1 • Between the hips- piles, hydrocele, gout and diseases on the hip and thigh1. • Calf muscles- Renal colic, endometiritis and amenorrhea6. • Under the chin- cleanses head and jaws6. • Jaabir ibn Abdullah (Raliyallahu Anhu) reported that the Messenger (Sallallaahu Álayhi Wasallam) was treated with cupping on his hip for a pain in that area. [Saheeh Sunan Abi Dawud (3863)].

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SOME IMPORTANT SITES OF CUPPING AND ITS BENEFITS CONT… • Jaabir ibn Abdullah (Raliyallahu Anhu) reported that the Messenger (Sallallaahu Álayhi Wasallam) was treated with cupping on his hip for a pain in that area. [Saheeh Sunan Abi Dawud (3863)]. • Anas ibn Maalik (Raliyallahu Anhu) reported that the Messenger (Sallallaahu Álayhi Wasallam) was treated with cupping when he was in Ihram, on the top of his foot, for a pain in that area. [Saheeh Sunan Abi Dawud (1836)].

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AL HADITH • Prophet Mohammad (Sallallaahu Álayhi Wasallam ) said, "Indeed the best of remedies you have is cupping, in drinking honey, and in cauterizing with fire, but I forbid my Ummah (nation) from cauterization (branding with fire)" [Saheeh al-Bukhaaree (5371)].

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Conclusion • Hajamat helps to remove morbid material from the capillaries and also it balancing the humours (Akhlath). Thus by regulating/balancing and purifying the akhlath It relieves several ailments. • It has medicinal property and also spiritual property. Resent clinical researches proved some of its efficacy, still there should be under taken more researches in this field to reveal its all benefits that authentic texts mentioned. 21

References 1. 2. 3. 4. 5. 6. 7.

Ibn-e-Sina, Al-Qanoon-Fil-tib (English), Faculty of Islamic Studies, Jamia Hamdard, New Delhi, 1995. http://islamic-practices.suite101.com/article.cfm/alhijamah_cupping_ and_ bloodletting _in_islam Mohd Akbar Arzani, Meezan-ut-tib (Urdu) translated by Kabeeruddin M, (Dafratul Mashih, Marol, Delhi), 1940, 147-148. Bakhtiar L. (1999). The Canon of Medicine – Avicenna. USA. Great Books of the Islamic World, Inc. Bhikha R A H and Haq M A. Tibb (2000). Traditional Roots of Medicine in Modern Routes to Health. Mountain of Light. South Africa. Hamdani K.H. Usool-e-tib, Urdu Academy, Uttar Pradesh, 1980, 405. Ibn-ul-Kuf, Kitab-ul-Umda fil Jarahat,(Daeratul Moarif Usmaniya University, Hyderabad) 1935, 15-23. 22

References 8.

9. 10. 11.

12.

13.

Ehsan Ahmad, Clinical Study on Hijamat bil shurt (wet cupping) And Evaluation of its efficacy in the treatment of Waja ul Mafasil (Arthritis), Department of Moalijat, Faculty of Medicine (U), Jamia Hamdard, New Delhi, 2006. Ismail Jurjani , Zakheera-e- Kharzam-e-Shahi, Vol. I, (Urdu) translated by Khan HH, (Munshi Naval Kishore, Lucknow), 1903, 224-225. Ali Ibnu Abbas Majusi, Kamilus Sana, Lucknow, 1989. Kim JI, Lee MS, Lee DH, Boddy K, Ernst E. Division of Standard Research, Korea Institute of Oriental Medicine, Daejeon, 305-811, South Korea. [email protected] 23

References 14. Ahmed SM, Madbouly NH, Maklad SS, Abu-Shady EA. Department of Microbiology, Faculty of Medicine For Girls, Al-Azhar University, Cairo, Egypt. 15. Ilkay Chirali, Mark Bovey, Roz Gibbs, Cupping for patients with inflammatory complaints – clinical and biochemical outcomes, www.acupunctureresearch.org.uk/presentations/chirali2008.pdf 16. Michalsen A, Bock S, Lüdtke R, Rampp T, Baecker M, Bachmann J, Langhorst J, Musial F, Dobos GJ.Effects of traditional cupping therapy in patients with carpal tunnel syndrome: a randomized controlled trial. Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, . [email protected] Pub: J Altern Complement Med. 2007 Jan-Feb;13(1):79-82 24

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