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Al Hijamah (Cupping Therapy): A Brief Introduction with Modern Perspective

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 Research & Reviews: A Journal of Pharmacognosy
Volume 1, Issue 1
www.stmjournals.com

Al Hijamah (Cupping Therapy): A Brief Introduction

with Modern Perspective
Sheikh Haneef Mohammad1*, Azhar Jabeen2, Fasihuzzaman2, Siddiqui2
1
A & U Tibbia College, Karol Bagh, New Delhi, India
2
Jamia Hamdard, Hamdard Nagar, New Delhi, India

Abstract
Alhijamah (cupping therapy) refers to a Unani regimental mode of treatment.
Alhijamah is an ancient method which was practically used among the Chinese,
Babylonians, Egyptians, Greeks, Romans, Arabs and Indians. The earliest recorded
evidence of Alhijamah was discovered in Egyptian medical document Ebers Papyrus
dating back to 1550 BC. In Chinese medicine too, Alhijamah is used for the treatment
of various diseases. The treatment by vacuum cups has been mentioned in the book of
Al-Ambratoor Al-Seeni about 4000 years ago. In Greece, history of cupping dates back
to Hippocrates (460–377 BC). This therapy entered Europe through Spain when the
Muslim physicians and their scientific literature were the primary sources of medical
sciences. This mode of treatment was unavailable for a long period of time. With the
advancement in the field of science and technology, this mode of treatment was also
proved to be beneficial scientifically in a large number of diseased conditions. With its
re-evaluation after scientific validation, nowadays it is used in various countries. In
India, several clinical trials have been performed under the supervision of various
Unani institutions all over country.

Keywords: Al Hijamah (cupping therapy), Unani

*Author for Correspondence E-mail: shm8272@gmail.com

INTRODUCTION Humeral imbalance is often root cause in the

Unani medicine, also called Unani Tibb,
Arabian medicine, Graeco-Arabian medicine,
or Islamic medicine, a traditional alternative
system of healing and health maintenance is
observed in South Asia. The origins of Unani
medicine are found in the doctrines of the
ancient Greek physicians Hippocrates and
Galen. As a field, it was later developed and
refined through systematic experiment by the
Arabs, most prominently by Muslim scholar-
physician Avicenna [1].
Unani medicine is based on Hippocratic
doctrine of four humors (Akhlat) theory, which
are Dam (blood), Balgham (phlegm), Safra
(yellow bile) and Sauda (black bile). The body
has the power of self-control to maintain an
optimum balance of these humors, which is
called as Quwwat-e-Mudabbirah-e-Badan
(Medicatrix Naturae). One of the most
important functions of Akhlat is to maintain
the ideal qualitative states associated with
Mizaj (temperament) of an individual.
origin and development of a particular illness.
In Unani system of medicine, treatment of
ailments is carried out in the following three
ways:
1) Ilaj bit Tadbeer (regimental therapy)
2) Ilaj bid Dawa (pharmacotherapy)
3) Ilaj bil Yad (surgery) [2–5].
Literal Meaning
The word Hijamah comes from the root
Al-hajm. Its various meanings have been
mentioned in different Arabic lexicons and
dictionaries. Out of all these meanings, most
relevant that has been correlated by various
writers is that Al-hajm means “to suck.” Ibn
Manzur writes in Lisan-ul-Arab:
“And the basic meaning of the Al-hajm is to
suck.”
Hajjam (cupper) or Massas (sucker) is one
who performs the operation termed Hajm or
one who scarifies and draws blood with the
Mihjamah. On the other hand, Mihjam or

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Al Hijamah: A Modern Perspective
__________________________________________________________________________________________
Mihjamah (plural Mahajim) is the scarifying
instrument of the Hajjam or the Qarurah
(glass vessel or the like) of the Hajjam. Or the
thing with which the Hajjam operates or the
utensil in which the blood produced by the
operation of Hijamah is collected by sucking.
And Mishrat is the instrument, which is used
for scarification or prickling the skin (blade,
lancet or scalpel) [6–16].
Definition
As such, there is no definition of Hijamah in
Unani classical literature. Keeping in view all
its aspects, Hijamah can be defined as,
“Hijamah is a Unani regimenal mode of
treatment which is carried out by application
of a cup-shaped glass or plastic vessel on the
body surface, creating vacuum by heat or by
special suction apparatus, in order to evacuate
the morbid materials, to divert the material
from the diseased part, to return a displaced
organ to its natural position or to encourage
the blood flow to the site of Hijamah.”
Contrary to this well-accepted concept, Ibn
Abbas Majusi in his treatise, Kamilus Sena,
described Hijamah under Ilaj bil Yad
(surgery). Besides Hijamah is discussed in the
classical surgical books, as surgical procedure,
like Kitab-ul-Umdah fil-Jarahat written by Ibn
al Quf Masihi and Kitab-ul-Tasreef written by
Abul Qasim Zehravi, in which we can also
find surgical tools used for Hijamah [17–19].
Synonyms
Hijamah (Arabic) [20]
Singhi or Pachna Lagana (Hindi) [21]
Cupping (English)
Bekam (Malay) [22]
Kyuka Ku (Japanese) [22]
AlFaasik (German) [22]
Jiofa or the horn technique; Shuiguanfa or
liquid cupping; Shanhuofa or flash-fire
cupping; Dijiufa (alcohol-fire cupping) and
Baguanfa (Chinese) [21–23].
HISTORICAL BACKGROUND
Whatever information is available in the
record of history in the form of monuments,
paintings and pictures shows that the Hijamah
is an ancient method which was practically
used among the Chinese, Babylonians,
Egyptians and Greeks. The pottery cups, horn
cups and bamboo cups were used commonly
for the purpose [24]. The earliest recorded
RRJoPC (2014) 1-6 © STM Journals 2014. All Rights Reserved
Mohammad et al.
evidence of Hijamah was discovered in Egypt
in a document Ebers Papyrus dating back to
1550 BC. Some notes and paintings have been
found on the tomb of the King Tut-Anakh-
Amun, showing the pictures of the cups used
for bloodletting, in the temple of Kum-Ambu,
which was considered to be the biggest
hospital of that period [13, 25].
In Chinese medicine too, Hijamah is used for
treatment of various diseases. According to Dr.
Ghassan Jafer, the treatment by the air cups in
the internal diseases has been mentioned in the
book of Al-Ambratoor Al-Seeni about
4000 years ago [24]. But another writer
Subhooti Dharmananda, discussing about the
Chinese cupping therapy writes regarding its
history in China, “The earliest use of cupping
that is recorded, is from the famous Taoist,
alchemist and herbalist, Ge Hong (281–
341 AD), who described this method in his
book A handbook of Prescriptions for
Emergencies, in which cups were actually
animal horns used for draining pustules” [23].
In Greece, history of Hijamah dates back to
Hippocrates (460–377 BC), the Father of
Medicine, who wrote a book Cupping and
Venesection. He recommended it for the
treatment of angina, menstrual and other
disorders. Hippocrates also described its types
as dry and wet cupping [26, 27]. In India,
mostly horn cups were used for this purpose
[24].
The ancient Arabs were aware of Hijamah and
its utility [24]. Cupping therapy before the
advent of holy Prophet Muhammad (PBUH)
was considered only a mode of medical
treatment, but after his (PBUH) advent, it
became Sunnah also. More than sixty Ahadiths
(traditions) regarding Hijamah are attributed to
the Prophet (PBUH). According to these
Ahadiths, the Prophet (PBUH) not only
confirmed its effectiveness, but also advised
people to cure themselves through it [28].
This therapy entered Europe through Spain
when Muslim physicians and their scientific
literature were the primary sources of medical
sciences [24].
PRESENT SCENARIO
At present, Hijamah is used widely in one
form or another. According to some reports, it
is popular even in those countries where it is
not allowed. So many studies have been
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 Research & Reviews: A Journal of Pharmacognosy
Volume 1, Issue 1
__________________________________________________________________________________________
carried out about its utility and mechanism of
action, certain examples of which are given
below:
1) Ehsan Ahmad et al., in a clinical study
entitled “Hijamat bish Shurut (wet
Cupping) in combination with Unani
formulation for Waja ul Mafasil
(arthritis),” found that Hijamat bish Sharat
is better when compared with Unani
formulation alone [28].
2) Kaleem Ullah et al., in a study entitled
“An investigation into the effect of
cupping therapy as a treatment for anterior
knee pain and its potential role in health,”
observed that there was statistically
significant difference between the level of
pain, wellbeing and range of motion for
patients with anterior knee pain pre- and
post-cupping (P < 0.05) [29].
3) Chirali et al., in a study entitled “Cupping
for patients with inflammatory complaints
–Clinical and biochemical outcomes,”
concluded that 95% patients reported an
improvement in their symptoms with
therapy and there was significant
improvement in the main and secondary
complaints [30].
4) Michalsen et al., in a study entitled
“Effects of traditional cupping therapy in
patients with carpal tunnel syndrome: A
randomized controlled trial,” observed that
cupping therapy was more beneficial than
heat, according to the primary outcome
measure, change in the total symptom
score after day 7 [31].
5) Niasari M. et al., in a clinical study
entitled “The effect of wet cupping on
serum lipid concentrations of clinically
healthy young men: A randomized
controlled trial,” concluded 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 seem to be
related to the reduction in LDL cholesterol
[32].
6) Huang ZF et al., in a clinical study entitled
“Observations on the efficacy of cupping
for treating 30 patients with cancer pain,”
compared the effects of dry cupping on
cancer pain with conventional drug
therapy and reported favorable effects for
RRJoPC (2014) 1-6 © STM Journals 2014. All Rights Reserved
cupping after 3-day intervention (RR, 67%
versus 43%, P < 0.05) [33].
7) Hong YF et al., in a study “The effect of
moving cupping therapy on non-specific
low back pain,” compared dry cupping
with non-steroidal 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,
11.4–34.2, P < 0.001) [34].
8) Zhang Z, in a study, “Observation on
therapeutic effects of blood-letting
puncture with cupping in acute trigeminal
neuralgia,” suggested that wet cupping
reduced pain compared with analgesics in
acute trigeminal neuralgia after the
intervention period (RR, 93% versus 47%,
P < 0.01) [35].
9) Farhadi K et al., in a clinical study
entitled, “The effectiveness of wet-
cupping for nonspecific low back pain in
Iran: A randomized controlled trial,”
concluded that 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 six points present pain
intensity; 95% CI, 1.7–2.6, P < 0.01) [36].
10) Ludtke R et al., in a clinical study,
“Brachialgia paraesthetica nocturna can be
relieved by “wet cupping” – Results of a
randomized pilot study,” observed that 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) [37].
11) Michalsen A et al., in a clinical study
entitled, “Effectiveness of cupping therapy
in brachialgia paraestetica nocturna:
Results of a randomized controlled trial,”
observed 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, 10.5–35.3,
P < 0.001 [38].
12) Xu L et al., in a clinical study entitled,
“Therapeutic effect of Aciclovir
combination with collateral-puncturing
and cupping in the treatment of 40 cases of
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Al Hijamah: A Modern Perspective
__________________________________________________________________________________________
herpes zoster,” observed that 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 [39].
13) Bhikha et al., in a study entitled, “Pilot
research project conducted at the
University of Western Cape therapeutic
cupping as adjunctive therapy in the
treatment of diabetes, hypertension and
osteoarthritis,” found that 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
patients and a welcome fall in blood
cholesterol levels and adjuvant cupping
therapy provides pain relief, significantly
improves ROM, and has a positive impact
on the reduction of crepitus [40].
14) Ahmed SM et al., observed that BLC
therapy combined with conventional
therapy may improve the clinical condition
of patients with RA. It has modulatory
effects on the innate and adaptive cellular
immune responses that could be used as
monitoring tools for disease activity and
prognosis [41].
CONCLUSIONS
It has been found that Hijamah is a good
analgesic and anti-inflammatory regimen in
comparison to other conventional therapies. It
is an effective method in reducing total
cholesterol, LDL cholesterol and the
LDL/HDL ratio. Hijamah lowers blood
glucose in type 2 DM and shows a marked
reduction in body mass and blood pressure in
hypertensive patients. As an adjuvant therapy,
Hijamah provides significant improvement in
cancer pain and has a marked effect in
improving the quality of life. It has
immunomodulatory effect that could be used
as monitoring tools for disease activity and
prognosis. Hijamah or cupping therapy is an
important non-pharmacological regimental
mode of treatment. It is an emerging
alternative way of treatment. Based upon the
above-cited data, it can be easily concluded
that Hijamah is beneficial in a large number of
disorders proven by modern scientific
parameters.
RRJoPC (2014) 1-6 © STM Journals 2014. All Rights Reserved
Mohammad et al.
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