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Hijama, also known as wet cupping therapy, is an age-old medical tradition rooted in Eastern cultures. It has gained some traction in Europe as well, but its safety and effectiveness remain topics of concern in Western medical circles. In this article, we’ll delve into the practice of hijama and its potential health implications.
Understanding Hijama:
Cupping therapy can be approached in two distinct ways. The first is the conventional ‘dry’ method, which involves placing a cup on the body, creating a vacuum by removing the air, and pulling the skin into the cup. This method doesn’t harm the skin and typically lasts for several minutes before removal.
The second method is what we refer to as ‘wet’ cupping, which involves more invasive steps and the disruption of skin integrity.
Hijama falls under the ‘wet’ cupping category, specifically involving bloodletting. It’s carried out in two primary ways:
- In this approach, a small incision is made in the skin, and a cup is promptly applied over the incision site. This method is commonly practiced in China and Korea.
- Cups are initially placed on intact skin for 3-5 minutes. Afterward, they are removed, a controlled incision is made, and the cup is repositioned on the same spot for 5-10 minutes. Following the procedure, the incision sites are treated with antiseptics and bandaged. This three-step method is traditionally known as ‘Al-Hijama,’ an Arabic term meaning ‘reduction in size.’ Al-Hijama sessions are typically scheduled during the third quarter of the lunar month, specifically on the 17th, 19th, and 21st days.
It’s crucial to note that cups are always situated on areas of the body with substantial muscle mass, such as the back, buttocks, chest, and abdomen. Regions with dense hair or underdeveloped musculature are avoided in the process.
How does hijama therapy work, and can it benefit your health?
In regions where wet cupping is a common practice, such as China, Korea, Iran, Iraq, and Egypt, it is employed to treat a range of ailments. It is primarily used to alleviate musculoskeletal pain, and there are also reports of its use for conditions like skin diseases, such as herpes zoster, and disorders related to lipid metabolism.
Despite its long history and popularity in certain areas, wet cupping therapy remains relatively understudied. The exact mechanism behind the effects of bloodletting cups is not well-established. In traditional Chinese medicine, it is believed to restore the balance of vital energies, whereas in the Middle East, it’s more about removing ‘impure’ blood.
Some attempts have been made to explain the therapeutic effects of hijama using modern scientific language, citing improvements in blood microcirculation, muscle relaxation, non-specific tissue changes, and activation of the immune system. However, there is a lack of concrete evidence to support the benefits of the procedure.
According to the American National Center for Complementary and Alternative Medicine, which assesses the outcomes of clinical trials for alternative treatments and therapies, the effectiveness of wet cupping therapy is not substantiated. Clinical studies on hijama are limited in number and often of low quality.
For instance, a review in the “Journal of Alternative and Complementary Medicine” evaluated the results of 14 clinical studies on cupping therapy for various conditions like musculoskeletal pain, migraines, and chronic obstructive pulmonary disease. The conclusions suggest that hijama might offer pain relief, but further research is necessary to establish its efficacy, as existing studies lack robust evidence.
An analysis of studies regarding wet cupping’s effectiveness in treating herpes zoster revealed that the research was flawed, with a high risk of statistical errors in the results, rendering it impossible to confirm the method’s benefits.
Studies investigating the impact of hijama on the treatment of other diseases are either scarce or limited, making it challenging to advocate for its application.
Potential Health Risks Associated with Cupping Therapy (Hijama)
Short-term Effects. Cupping therapy is an invasive procedure that can result in visible skin marks, including:
- Small cuts with minor bleeding.
- Redness known as erythema.
- Circular swelling and bruising.
In the regions where the cups are applied, individuals might experience discomfort, tingling, and pain. They might also encounter headaches, increased sweating, and a sensation of warmth.
Typically, the cupping marks fade within a month. However, some individuals may develop scars and circular discoloration – round marks in the areas where the cups were applied.”
Severe Complications to Be Aware of. While clinical studies typically do not mention significant issues arising from cupping therapy, medical literature does recount cases of potentially severe complications. These complications include internal bleeding, dangerous anemia due to substantial blood loss, and serious inflammatory or infectious diseases.
There is also evidence suggesting that cupping may contribute to the transmission of hepatitis C and may be linked to the potential spread of hepatitis B and HIV.
One of the most harrowing complications occurred in 2021 when orthopedic surgeons in South Africa encountered a case where a 35-year-old man was admitted to the hospital with necrotizing fasciitis following wet cupping. The only way to save the patient’s life was a bilateral above-knee amputation, but the patient refused the operation and tragically passed away.
In 2023, another severe complication from wet cupping was documented in China. A 33-year-old woman, who underwent cupping therapy for a hip ligament strain, developed an extensive staphylococcal infection with an abscess in the iliopsoas muscle, leading to bloody vomiting and anemia. The patient was eventually saved but required a two-month course of antibiotics.
The disconnect between the seemingly safe results of clinical studies and these recorded severe complications can be attributed to the following factors:
Clinical studies are typically conducted under stringent conditions by qualified medical professionals. Volunteers involved in these studies undergo comprehensive health assessments, and those with significant health issues are not allowed to participate. As a result, the risk of serious side effects is minimized.
In practice, cupping is often performed by individuals without medical backgrounds, sometimes in unsanitary settings with non-sterile equipment. The regulation of cupping therapy as a medical procedure varies by region, which leads to disparities in safety standards.
Bloodletting and cup placement are classified as medical services requiring a license. This means that cupping involving bloodletting can only be carried out in licensed medical facilities. However, in reality, the procedure is offered in underground salons or even the homes of practitioners who have completed only short courses.
Individuals who should avoid undergoing cupping therapy:
Cupping should be avoided by individuals with certain conditions, including cancer, hemophilia, severe internal organ diseases, the use of anticoagulants, deep vein thrombosis, and heart conditions. Additionally, cups should not be applied over varicose veins, inflamed or infected skin, near blood vessels, nerves, or lymph nodes. Cupping is contraindicated for elderly individuals, children, and pregnant women.
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