Cupping

CUPPING   

 حجامة‎

Cupping therapy is an ancient form of Alternative medical procedure in which a therapist puts special cups on your skin for a few minutes to create suction. People get it for many purposes, including helping with pain, inflammation blood flow, relaxation and well-being, and as a type of deep-tissue massage

Cupping therapy might be trendy now, but it’s not new. It dates back to ancient Egyptian, Chinese, and Middle Eastern cultures. One of the oldest medical textbooks in the world, the Ebers Papyrus, describes how the ancient Egyptians used cupping therapy in 1,550 B.C.

Special note

Cupping [hijama] remained a constant in professional medical treatment throughout Europe. It was practiced by such famous physicians as Galen (131–200 AD), Paracelsus (1493–1541) and Ambroise Pare (1509–90). Cupping [hijama] was also practiced by other practitioners including barbers, surgeons and bath house attendants

According to traditional Chinese medicines (TCM), cupping is a method of creating a vacuum on the patient's skin to dispel stagnant blood and lymph thereby improving  to treat respiratory diseases such as the common cold, pneumonia and bronchitis. Cupping also is used on back, neck, shoulder and other musculoskeletal conditions

Hijama (Arabic: حجامة‎ lit. "sucking") is the  Arabic term for wet cupping, where blood is drawn by vacuum from a small skin incision for therapeutic purposes.^[1] Cupping is poorly supported by scientific evidence.^[2] Whether cupping has any effect at all, even on pain is supported at best by "tentative" evidence.^[3][4] Any reported benefits are likely due to the placebo effect.^[5]

The practice has Greek, Arab, Turkish and Persian origin and is mentioned by Hippocrates. It is reported that the Islamic prophet Muhammad said, "Indeed the best of remedies you have is hijama, and if there was something excellent to be used as a remedy then it is hijama

The cups may be made of:

• Glass
• Bamboo
• Earthenware
• Silicone

HISTORY

Over 3,000 years, the practice has been typically performed unsupervised, by individuals without any medical background

Iranian traditional medicine uses wet-cupping practices, with the belief that cupping with scarification may eliminate scar tissue, and cupping without scarification would cleanse the body through the organs. Individuals with a profound interest in the practice are typically very religious and seek "purification

There is reason to believe the practice dates from as early as 3000 BC. The Ebers papyrus written 1550  BC and one of the oldest medical textbooks in the Western world, describes the Egyptians' use of cupping,. In ancient Greece,   Hippocrates (c. 400 BC) used cupping for internal disease and structural problems. The method was highly recommended by Muhammad ^[18] and hence well-practiced by Muslim scientists who elaborated and developed the method further. Consecutively, this method in its multiple forms spread into medicine throughout Asian and European civilizations. In China, the earliest use of cupping that is recorded is from the famous Taoist alchemist and herbalist, Ge Hong (281–341 A.D.).^[24] Cupping was also mentioned in Maimonides' book on health and was used within the Eastern European Jewish community

There is a description of cupping in George Orwell's essay "How the Poor Die", where he was surprised to find it practiced in a Paris hospital

Society & culture

 Cupping is mentioned in the Islamic hadith (reported sayings of Muhammad peace be upon him):

Narrated Ibn 'Abbas: (The Prophet said), "Healing is in three things: A gulp of honey, cupping, and branding with fire (cauterizing). But I forbid my followers to use (cauterization) branding with fire  (The cauterization is forbidden if used on a healthy organ because it was at that time a common superstition to use it to prevent bad predestination )

Narrated Ibn 'Abbas: The Prophet was cupped on his head for an ailment he was suffering from while he was in a state of Ihram at a water place called Lahl Jamal. Ibn 'Abbas further said: Allah's Messenger was cupped on his head for unilateral headache while he was in a state of Ihram.

 It is narrated on the authority of Humaid that Anas b. Malik was asked about the earnings of the cupper. He said: Allah's Messenger ( peace be upon him) got himself cupped. His cupper was Abu Taiba and he (the Prophet) commanded to give him two sa's [a unit of measurement] of dates. He (the Holy Prophet) talked with the members of his family and they lightened the burden of Kharaj (tax) from him (i.e. they made remission in the charges of their own accord). He (Allah's Messenger) said: The best (treatment) which you take is cupping, or it is the best of your treatments

Types

 Cupping therapy types can be classified into four main categories,

  1. First category is the "technical types"

                             a) Dry

                             b) Wet

                             c) Massage

                             d) Flash

 2. Second category is "the power of suction related types"

                            a) Light

                            b) Medium  

                            c) Strong

 3. Third category is "the method of suction related types"

                             a) Fire

                             b) Manual suction

                             c) Electrical suction

4. The fourth category is "materials inside cups related types

                             a) Herbal

                             b) Water

                             c) Ozone

                             d) Moxa

                             e) Needle and magnetic

A fifth category and a sixth category were developed later. The fifth category is area treated related types that included: facial, abdominal, female, male and orthopedic cupping therapy. The sixth category is the other cupping types that included sports and aquatic cupping.

Dry cupping

The cupping procedure commonly involves creating a small area of low air pressure next to the skin. However, there are varieties in the tools used, the methods of creating the low pressure, and the procedures followed during the treatment

The cups can be of various shapes including balls or bells, and may range in size from 1 to 3 inches (25 to 76 mm) across the opening. Plastic and glass are the most common materials used today, replacing the horn, pottery, bronze and bamboo cups used in earlier times. The low air pressure required may be created by heating the cup or the air inside it with an open flame or a bath in hot scented oils, then placing it against the skin. As the air inside the cup cools, it contracts and draws the skin slightly inside. More recently, vacuum is created with a mechanical suction pump acting through a valve located at the top of the cup. Rubber cups are also available that squeeze the air out and adapt to uneven or bony surfaces.

In practice, cups are normally used only on softer tissue that can form a good seal with the edge of the cup. They may be used singly or with many to cover a larger area. They may be used by themselves or placed over an acupuncture needle. Skin may be lubricated, allowing the cup to move across the skin slowly.

Skin markings are common after the cups are removed, varying from simple red rings that disappear relatively quickly, to discoloration from bruising, especially if the cups are dragged while suctioned from one place to another, ostensibly to break down muscle fiber. Usually treatments are not very painful.

Fire cupping

 Fire cupping involves soaking a cotton ball in almost pure alcohol. The cotton is clamped by a pair of forceps and lit via match or lighter, and, in one motion, placed into the cup and quickly removed, while the cup is placed on the skin. Fire heats the inside of the cup and a small amount of suction is created by the air cooling down again and contracting. Massage oil may be applied to create a better seal as well as allow the cups to glide over muscle groups (e.g. Trapezius, erectors, latissimus dorsi, etc.) in an act called "moving cupping".

Wet cupping

Wet cupping is also known as Hijama or medicinal bleeding. The first documented uses are found in the teachings of the Islamic prophet, Muhammad(peace be upon him)  According to  Muhammad al-Bukhari, Muslim ibn al-Hajjaj Nishapuri and Ahmad ibn Hanbal, Muhammad(peace be upon him) approved of the hijama (cupping) treatment.

 A number of hadith support its recommendation and use by prophet Muhammad(Peace be upon him)As a result, the practice of cupping therapy has survived in Muslim countries. Today, wet cupping is a popular remedy practiced in many parts of the Muslim world

In Finland, wet cupping has been done at least since the 15th century, and it is done traditionally in saunas. The cupping cups were made of cattle horns with a valve mechanism in it to create an partial vacuum by sucking the air out. Cupping is still practiced in Finland as part of relaxing and/or health regimens.

Hijama can be performed almost anywhere on the body, often at the site of an ache or pain in order to ease or alleviate it. A more conservative approach warns against over use of cupping and suggests that six optimal points on the body are all that is required to "clean" the entire cardiovascular system. The location is first shaved, if necessary, to ensure a tight seal with the cup. The mouth of a cup (metal, glass and plastic cups are generally used, although traditionally horns were used) is placed on the skin at the site chosen for hijama. A tight seal is then created. The traditional method is to burn a small piece of paper or cotton inside the vessel, so that the mouth of the cup clings to the skin. Some practitioners now use a machine instead of the manual cups. Some practitioners still strictly adhere to the Prophetic method with the use of fire, both for sterility^] and the benefits or properties from the element of fire itself that may be present. An additional reason to use fire to create the vacuum in the cup is that there is no danger of pumping out too much blood (as might occur mechanically). Drawing out more blood is not necessarily better for the patient. The cup is left to cling to the skin for a few minutes, then it is lifted off and several very small incisions are made in the skin. The cup is then put back as it was before until the flow of blood subsides

Hijama is considered a form of energy medicine because it has been claimed to "unclog" purported meridians in the body, and is viewed by some practitioners as a cure for black magic and possession 

According to hadith, adhering to certain rules such as hijama being done on odd numbered days, during the last half of the lunar calendar, during the warmer months of the year, and never on Wednesdays and Saturdays, will make the therapy more effective^]

Evidence

In March 2011 three systematic reviews were analyzed for the effectiveness of wet and dry cupping in which two out of three showed some evidence for effectiveness of cupping for pain. Favorable effects were shown when wet cupping was combined with adjuvant conventional treatments. One of the three reviews showed little effectiveness for cupping for stroke rehabilitation. However few randomized control trials have been done to examine the effectiveness of cupping and many studies published are of low quality or have many limitations. Using a pre-post research design, 70 patients with chronic tension or migraine headache were treated with wet-cupping. Three primary outcome measures were considered at the baseline and 3 months following treatment: headache severity, days of headache per month, and use of medication. Results suggest that, compared to the baseline, mean headache severity decreased by 66% following wet-cupping treatment. Treated patients also experienced the equivalent of 12.6 fewer days of headache per month. It was concluded that wet-cupping leads to clinical relevant benefits for primary care patients with headache. Possible mechanisms of wet-cupping efficacy, as well as directions for future research are discussed

There is some evidence that wet-cupping is effective in the treatment of non-specific lower back pain  Studies have also shown some evidence that it may be effective in the treatment of post-herpetic neuralgia

 For the treatment of cancer, there is no scientific evidence to suggest that HIJAMA confers any health benefits

 

One report, published in 2015 in the Journal of Traditional and complementary medicine notes that it could help with acne, herpes zoster and pain management

That’s similar to the findings from a 2012 report, published in PLoS One. Australian and Chinese researchers reviewed 135 studies on cupping. They concluded that cupping therapy may be effective when people also get other treatments, like medication for various diseases and conditions, such as:

-Herpes zoster

-Acne

-Facial paralysis

-Cervical spondylosis

-The British Cupping Society says that cupping therapy is used to treat:

-Blood disorders such as anemia and hemophilia

-Rheumatic diseases such as arthritis and fibromyalgia

-Fertility and gynecological disorders

-Skin problems such as eczema and acne

-High blood pressure

-Migraines

-Anxiety and depression

-Bronchial congestion caused by allergies and asthma

Side Effects

Cupping is fairly safe, as long as you go to a trained health professional. But you could have these side effects in the area where the cups touch your skin

 Cupping is poorly supported by scientific evidence  In their 2008 book Trick or Treatment, Simon Singh and Edzard Ernst write that no evidence exists of any beneficial effects of cupping for any medical condition

 A 2011 review found tentative evidence for pain but nothing else

Any reported benefits are likely due to the placebo effect

                                                                                                   - Mild discomfort

                                                                                                   - Burn

                                                                                                   - Bruises

                                                                                                   - Skin infection

Safety

Cupping is generally safe when applied by trained professionals on people who are otherwise healthy It is not recommended for people with health problems due to side effects cupping is not recommended as a replacement for typical treatment  cupping may result in bruising, burns, pain, and/or skin infection

Research suggests that cupping is harmful, especially in people who are thin or obese: According to Jack Raso (1997), cupping results in capillary expansion, excessive fluid accumulation in tissues, and the rupture of blood vessels

Fire cupping can sometimes result in minor to severe burns, and may lead to hospitalization and may even require skin grafting to repair the injury. Also, other burns, due to carelessness with the flammable substances being used, such as spills and over application, can also occur

Cupping has not been studied in large, controlled clinical trials. Part of the reason for that is because it would be difficult to have a control group. Placebo effects can be strong, especially in regards to psychological effect of very large visible marks

Dr. SYED ABDUL RASHEED
BUMS (INDORE)