Cupping Therapy

(Ilaj bil Hijama)

Mohamed Shiffa
Institute of Indigenous Medicine
University of Colombo
Sri Lanka
Treatment Modes
Ilaj Bil Tadabeer wal Taghzia
Ilaj Bil Dawa
Ilaj Bil Yad

Ilaj bil Tagzia is one of the modes involved in

Ilaj bil Tadabeer and is not appropriate to
describe it as a separate mode of treatment
What is Ilaj bil Tadbeer (Regiminal
Therapy)

These are the modes of therapy, commonly external

and non-medicinal (not always) applied through
modifications and moderation in the six essential
factors Asbab e Sitta Zarroriya which are necessary for
maintainance of health and eradication of disease.
Introduction
Unani Medicine is based on Hippocratic theory of
four humours i.e. Khoon (blood), Bulgham (phlegm),
Safra (bile) and Sauda (black bile).
A proper balance of humours within a persons
body ensures efficient metabolism, prevents the
build-up of toxins, and maintains optimum health.
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.
Treatment of ailments is carried out by the way
correcting qualitative and quantitative imbalances
associated with the humours and temperament of an
individual.
Cupping or Hijama is a method used to correct,
evacuate or divert morbid humours in Unani
medicine.
According to Avicenna Cupping depurates and
balances the humours. Thus cupping removes bad
or morbid matters from the body, neutralizes the
humours and helps to regain the health.
 Cupping therapy in Islam

And whatsoever the Messenger gives you, take

it. And whatsoever he forbids, abstain....
[Quran 59:7]
Prophet Mohammad (Sallallaahu layhi Wasallam ) said,
"Indeed the best of remedies you have is cupping, in
drinking honey, and in cauterizing with fire, but I forbid my
Ummah from cauterization" (Saheeh al-Bukhaaree -
5371).
Jaabir ibn Abdullah (Raliyallahu Anhu) reported that the
Messenger (Sallallaahu layhi Wasallam) was treated
with cupping on his hip for a pain in that area [Saheeh
Sunan Abi Dawud (3863)].
The Messenger (Sallallaahu layhi Wasallam) said
"Indeed in cupping (hijama) there is a cure." [Saheeh
Muslim (5706)].
Rasullullah (SAW) was once hurt on his leg, (probably
due to the clogging of the blood), hence he underwent
cupping on his leg [Mishkat p. 389].
Anas ibn Maalik (Raliyallahu Anhu) reported that the
Messenger (Sallallaahu layhi 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)].
Prophet (Sallallaahu layhi Wasallam) said that on the
night of Israa (his ascension to the heavens) he
(Sallallaahu layhi Wasallam) did not pass by an angel
except that it said to him, "Oh Muhammad, order
your Ummah with cupping (hijama)." [Saheeh Sunan
Tirmidhee (3479)].
 Cont
Observations on the efficacy of cupping for treating 30
patients with cancer pain
Huang ZF, Li HZ, Zhang ZJ, Tan ZQ, Chen C, Chen W

Results:
Compared the effects of dry cupping on cancer pain with
conventional drug therapy and reported favorable effects for
cupping after 3-day intervention (RR, 67% versus 43%, P <
0.05)

Shanghai J Acupunct Moxibustion ( 2006;) 25:: 145

 Ilaj bil Hijamat
(Cupping)
Hijmat refers to a Unani mode of treatment,
which is carried out by creating a partial
vacuum in the cupping glasses, placed on the
body surface, by mean of heat or suction, in
order to evacuate the morbid materials, to
divert the material from the diseased part, to
return a displaced organ to its normal position
or to encourage the blood flow to the site of
Hijmat.
 )Cupping(wet
Saying of the Prophet (PBUH)
It is narrated by Abdullah-bin-Abbas that
the Prophet (PBUH) said, There are three
things which have cure: honey, cupping
and cauterization, and I advise my
followers to refrain from cautery.
 Historical background
Hijmat was popular with its great efficacy but its
scientific relevance was absolutely obscure at that
time. It was Hippocrates who freed the art of medicine
from all superstitions and gave a scientific rationale to it
by framing the theory of Akhlat (Humors). Then Hijmat
got scientific justification in the light of humoral theory.
Hijmat eliminates the morbid materials to bring
the humoral equilibrium and thus, restores health.
The popularity of Hijmat showed an acclivity during the
period of Prophet Mohammad (PBUH). He (PBUH) not only
advised people to opt for Hijmat but also gave practical
examples by getting cupped himself many a times .
Ancient Egyptians
Cupping in Africa
Cupping in Europe
Cupping in Ancient
Greece
Hippocrates (400 BC)
Cupping in present times
 Types of Cupping
On the basis of blood letting and non letting,
Hijamat has been classified into two types
Hijamat-bil-Shurt
Hijamat-bila Shurt

On the basis of method of cupping, the above

types have been further divided into two
types.
Hijamat-e-Nariyah
Hijamat-e-Ghair Nariyah
 Some Common Indications
Arthritis of various major joints
Gout
Spondylitis
Sciatica
Lumbago (Backache)
Headache of various origin
Migraine
Dyspnoea
Palpitation
Cont..

Hepatitis
Piles
Endometritis
Ammenorrhoea
Acute Conjuctivitis

There are selected sites for specific

indications
Contraindications

Hijamat should be avoided during the

beginning and the end of the lunar month
Hijamat should be avoided in children and in
elderly persons.
Hijamat should be avoided in extreme cold
or hot weather.
Hijamat should not be done on an area having
poor musculature
Cont.
Hijamat should not be done on an area having
major blood vessels.
Hijamat should be avoided on torn ligaments
of the joints.
Hijamat should be avoided on just above the
varicose vein, but may be done on either
sides of the vein.
Hijamat should be avoided soon after eating
and is indicated two hours after meals.
Hijamat should not be done in the pregnant
women on the lower abdomen and chest
particularly in the first trimester.
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

26
Some important sites of Cupping and
its benefits
Between shoulders- Heamoptysis, Zeeequn Nafz
Damavi (Sanguinous Asthma). 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
piles.
Nape of the neck- fetor, stomatitis, diphtheria,
meningitis, headache and conjunctivitis. 27
 SOME IMPORTANT SITES OF
CUPPING AND ITS BENEFITS
CONT
Over the hip- Sciatica
Between the hips- piles, hydrocele, gout and
diseases on the hip and thigh.
Calf muscles- Renal colic, endometiritis and
amenorrhea.
Under the chin- cleanses head and jaws.
Jaabir ibn Abdullah (Raliyallahu Anhu) reported
that the Messenger (Sallallaahu layhi Wasallam)
was treated with cupping on his hip for a pain in
that area. [Saheeh Sunan Abi Dawud (3863)].

28
 SOME IMPORTANT SITES OF
CUPPING AND ITS BENEFITS
Jaabir ibn AbdullahCONT
(Raliyallahu Anhu) reported
that the Messenger (Sallallaahu layhi 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 layhi 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)].

29
Results of some Clinical Trials
Clinical Study on Hijamat bil shurt (wet cupping) And
Evaluation of its efficacy in the treatment of Waja ul Mafasil
(Arthritis)

Conclusion: Hijamat bil Shurt in combination with Unani

formulation for Waja ul Mafasil is better than when
compared with formulation alone.

(Ehsan Ahmad, 2006)

30
Therapeutic cupping as adjunctive therapy in the
treatment of diabetes, hypertension and osteoarthritis

Dry cupping can lower blood glucose in type 2 DM

Marked improvement in the majority of patients in quality of
life parameters, with a marked reduction in BP and body
mass in several of the patients, and a welcome fall in
elevated total blood cholesterol levels
Adjuvant cupping therapy provides pain relief, significantly
improves ROM, and has a positive impact on the reduction
of crepitus

Prof Rashid A Bhikha et al, 2008

31
 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-up.
Wet -cupping leads to clinical relevant benefits for
primary care patients with headache.
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 clarified.
Wet cupping may be an effective method of reducing LDL
cholesterol in men and consequently may have a
preventive effect against atherosclerosis.

33
 Immuno-modulatory function of the cupping
Immuno-modulatory effects of blood letting cupping
therapy in patients with rheumatoid arthritis.
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.

34
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 stimulates healing.

35
 An investigation into the effect of Cupping
Therapy as a treatment for Anterior Knee Pain
and its potential role in Health

Results: There was statistically significance

difference between the level of pain, well being and
Range of Motion for patients with anterior knee pain
pre and post Cupping (P <0.05).

Kaleem Ullah MSc Ahmed Younis

Mohamed Wali
University of East Anglia Principal Lecturer St Georges
University of London
St Georges University of London
 cont
Cupping for Patients with inflammatory complaints
Clinical and Biochemical outcomes
Ilkay Chirali, Mark Bovey,Roz Gibbs
RESULTS:
95% patients reported an improvement in their
symptoms with therapy
Significant improvements were seen in the main and
secondary complaints and in the activity levels of the
patients
 Cont
Effects of Traditional Cupping Therapy in Patients With
Carpal Tunnel Syndrome: A Randomized Controlled Trial
Andreas Michalsen, Silke Bock, Rainer Ludtke, Thomas Rampp,
Marcus Baecker
Immanuel Hospital Berlin, Department of Internal and
Complementary Medicine, Berlin, Germany
Results:
Cupping therapy was more beneficial than heat, according to
the primary outcome measure, change in the total symptom
score after day 7

J Pain. 2009 Jun;10(6):555

 Cont
The Effect of Wet Cupping on Serum Lipid Concentrations
of Clinically Healthy Young Men: A Randomized Controlled
Trial
Majid Niasari, M.D., A.P.C.P., Farid Kosari, M.D., A.P.C.P., And Ali
Ahmadi, M.D., A.P.C.P.
RESULTS:
The results of the study have shown that wet cupping is an
effective method in reducing LDL cholesterol and the LDL/HDL
ratio. Wet cupping did not show a significant influence on total
cholesterol, triglyceride, and HDL cholesterol; therefore, any
changes in the LDL/HDL ratio seems to be related to the
reduction in LDL cholesterol

The Journal of Alternative and Complementary, Volume 13, Number 1,

2007, pp. 7982 DOI: 10.1089/acm.2006.4226
 Cont
Cupping for Treating Pain: A Systematic Review
Jong-In Kim1, Myeong Soo Lee1,2, Dong-Hyo Lee1, Kate Boddy2 and
Edzard Ernst2

1
Division of Standard Research, Korea Institute of Oriental
Medicine, Daejeon, Korea and2 Complementary Medicine,
Peninsula Medical School, Universities of Exeter & Plymouth,
Exeter, UK
Results:
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
 Cont
The effect of moving cupping therapy on non-specific low
back pain
Hong YF, Wu JX, Wang B, Li H, He YC

Results:
compared dry cupping with nonsteroidal anti-inflammatory drugs
in nonspecific low back pain and suggested a significant
difference in pain relief on VAS after treatment duration (MD, 22.8
of 100 mm VAS; 95% CI, 11.434.2, P < 0.001)

Chin J Rehabil Med ( 2006) 21: 3403

 Cont
Observation on therapeutic effects of blood-letting
puncture with cupping in acute trigeminal neuralgia
Zhang Z

Results:
suggested that wet cupping reduced pain compared with
analgesics in acute trigeminal neuralgia after the
intervention period (RR, 93% versus 47%, P < 0.01)

J Tradit Chin Med ( 1997) 17: 2724.

 Cont
The effectiveness of wet-cupping for nonspecific low back pain
in Iran: A randomized controlled trial
Farhadi K, Schwebel D, Saeb M, Choubsaz M, Mohammadi R, Ahmadi A

Results:
Wet cupping plus usual care for pain reduction compared with usual care in
non-specific low back pain suggested significant differences in pain relief
(McGill Pain Questionnaire) at 3 months after three treatment sessions
(MD, 2.2 of 6 points present pain intensity; 95% CI, 1.72.6, P < 0.01)
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-up.

Complementary Therapies in Medicine ( 2009) 17: 915

 Cont
Brachialgia paraesthetica nocturna can be
relieved by "wet cupping" results of a
randomised pilot study
Ludtke R, Albrecht U, Stange R, Uehleke B

Results:
one session of wet cupping plus usual care
significantly reduced pain during a week
compared with usual care alone in patients with
BPN (MD, 1.6 of 10 points score, 95% CI, 0.13
3.07, P = 0.03)

Complement Ther Med ( 2006) 14: 247253.

 Cont
Effectiveness of cupping therapy in brachialgia paraestetica
nocturna: Results of a randomized controlled trial
Michalsen A, Bock S, Ludtke R, Musial F, Rampp T,
Langhorst J, Dobos GJ

Results:

showed favorable effects of one session of wet cupping on

pain reduction compared with a heat pad in patients with
BPN at 7 days after treatment (MD, 22.9, 100 mm VAS; 95%
CI, 10.535.3, P < 0.001

Forsch Komplementarmed ( 2007) 14: 19.

 Cont

Therapeutic effect of aciclovir combination with callateral-

puncturing and cupping in the treatment of 40 cases of
herpes zoster
Xu L, Yang XJ

Results:

wet cupping plus conventional drugs on pain reduction

compared with conventional drugs alone in patients with
herpes zoster failed to show favorable effects of wet cupping
after interventions (RR, 100% versus 88%, P = 0.065
Tianjin Pharmacy ( 2004;) 16:: 234
 Conclusion
In Unani Medicine, Cupping is regarded as a therapy which moves
matter from one part to another part of body or eliminates it from
the body. Therefore it removes the pathogenic factors and ease
local symptoms.
Prophet Mohammed (Sallallahu Alaihi Wasallam) has used cupping
therapy for himself and advocated to his family members and also
recommended other to follow so on.
Nowadays by various clinical trials it has been proved that cupping
therapy has beneficial effects on human beings
According to latest scientific interpretation, the mechanism of action
most likely involves a local increase in blood flow, activates the
blood flow and increases the elimination of metabolites.
Furthermore it activates the immune system.
References
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Jamia Hamdard, New Delhi, 1995.
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_cupping_and_ bloodletting_in_islam
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ml
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48
8. Ehsan Ahmad, Clinical Study on Hijamat bil shurt (wet cupping) And
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Sciences, Iran. ahmadiar1012@yahoo.com

49
14. Ahmed SM, Madbouly NH, Maklad SS, Abu-Shady EA. Department of
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J, Musial F, Dobos GJ.Effects of traditional cupping therapy in patients with
carpal tunnel syndrome: a randomized controlled trial. Immanuel Hospital
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a.michalsen@immanuel.de J Pain. 2009 Jun;10(6):555.
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Edition. Churchill Livingstone.

50
Thank you

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