International Journal of Current Advanced Research

ISSN: O: 2319­6475, ISSN: P: 2319­6505,

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Available Online at www.journalijcar.org
Volume 7; Issue 4(M); April 2018;; Page No. 12226­12232
DOI: http://dx.doi.org/10.24327/ijcar.2018
//dx.doi.org/10.24327/ijcar.2018.12232.2142
Review Article
RESURGENCE OF HIJAMAH (CUPPING) THERAPY: A REVIEW
Shaista Anwar Mansoori.,
Mansoori Azhar jabeen*., Shazia Jilani and Roohi Azam
Department of Moalejat, School of Unani Medical Education
Education and Research, Jamia Hamdard
AR T IC L E I NF O AB ST RA CT
Article History: Al Hijamah (cupping therapy) is an important modality and is used widely in one form or
th another and is considered to be an important non pharmacological therapy in traditional
Received 12 January, 2018
systems of Medicine. Cupping is an ancient method which was practically used amo among the
Received in revised form 4th
Chinese, Babylonians, Egyptians and Greeks. In Greece, history of cupping dates back to
February, 2018 Accepted 26th March, 2018
Hippocrate s(460­377
377 B.C) and is a treatment module in Unani system of Medicine. It is a
Published online 28th April, 2018
formal modality of treatment in China and in some European countries. European societies
already have a shift in attitude to include complementary medicine within the conventional
Key words: health care system. Many any studies have been carried out about its efficacy in pain
Hijamah, cupping therapy, history, resurgence, management and various other diseases. The aim of this article iis to discuss the therapy in
mechanism of cupping, detail and its possible mechanism of action.

Copyright©2018 Azhar jabeen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

INTRODUCTION Many published research papers confirmed the efficacy of

cupping therapy during the nineteenth century.[11] Ancient
Al-Hijamah (Cupping) is derived from an Arabic word “Hajm”
“ Chinese and ancient Egyptians were tthe first to practice
which means “sucking or vacuum”[1] [2]. Originally Hijamah cupping therapy. But in fact, the ancient medical texts that
was known as ‘cupping’ because of the use of cups as mentioned cupping therapy were written by ancient Egyptians.
therapeutic tool. According to the classical Unani literature it
is a Unani regimenal mode of treatment which is carried outo by Earliest records of Cupping therapy: The ancient medical
application of a cup­shaped
shaped glass or plastic vessel on the body book Ebers papyrus, written in 1550 B.C.E. Prescribed
surface, creating vacuum by heat or by special suction cupping
upping therapy for many diseases and passed this art to the
apparatus [3]. There are two types of hijama: Hijama bil shart Greeks. Hippocrates (460 BC –370 BC) one of the greatest
(Cupping with scarification) and Hijama bila shart (Cupping figures in the history of medicine, called the father of western
without scarification). First one is used for diversion and the medicine is also a famous cupping therapy user and
later for the evacuation of morbid matter.[4][5][6][7][8][9] At recommended it for variety ety of diseases. Samuel Bayfield
first it was applied using cattle horn and consequently was also (1839) wrote, “Hippocrates was a minute observer, and has left
called ‘horn therapy’. To create a negative pressure inside the us some striking remarks on the shape and application of the
horn, thehe cupping practitioner used his mouth to physically cups. He recommends that they should be small in diameter,
suck the air out from a hole on top of the horn, thus creating a conical in shape, and light in their wei weight, even when the
negative suction inside the horn. With the introduction of disease for which they are applied is deeply seated”. Galen, the
bamboo, earthenware and later on the glass cups, fire was great physician and surgeon was one of cupping therapy users
ignited to expel the air. [10] and he condemned Erasistratus, an Alexandrian physician, for
not using cupping. Then the art of cupping therapy was passed
History of cupping therapy through the Alexandrians and Byzantines to Arab Muslims and
Cupping therapy has been used in China and some African Asians. The canon of medicine, book by Avicenna, stated that
countries for several thousand years. It spread to the world cupping was known to be effective on more than 30 different
from Egyptians and Greeks. It became a very popular therapy diseases [11]. Also the location of the cups application of
among European and American doctors and was practiced cupping
ping therapy according to the lunar date and condition of
successfully for a wide range of diseases during the eighteenth the patient. He stated, “the second and third hours after getting
century and after. up are the best hours for cupping. ‘Some authorities advise
against applying cupping­glasses
glasses at the beginning of the lunar
months because
cause the humours are then not yet on the move or in
*Corresponding author: Azhar jabeen a state of agitation; also against applying them at the end of the
Department of Moalejat, School of Unani Medical lunar month, because at that period (of the cycle) the humours
Education and Research, Jamia Hamdard are less plentiful. The proper time (according to them) is the
 International Journal of Current Advanced Research Vol 7, Issue 4(M), pp 12226-12232, April 2018

middle of the month (when the humours are in state of practitioner. More than 200 years ago, a book was compiled
agitation) and during time when the moonlight is increasing entitled Ben Cao Gang Mu She Yi by Zhao Xue Ming, in
(when the humours are on the increase). During that period the which he describes in detail the history and origin of different
brain is increasing in size within the skull, and the river water kinds of cupping and cup shapes, functions and applications.
is rising in tidal rivers” [12]. Ibn Zakariyā Rāzī, (865 – 925) In the 1950s the clinical efficacy of cupping was confirmed by
one of the best scientist and physician in history had benefited further research in China and acupuncturists from the former
from cupping therapy in his treatment of many diseases [11]. Soviet Union, and was established as an official therapy
History of cupping therapy in Islam: Prophet Mohammed practice in hospitals all over China [10].
(peace be upon him) the prophet of Islam, encouraged the use History of cupping in West: Medicinal bleeding has been
of cupping (hijama). The Prophet (PBUH) stated that, “the best practiced since 15th century in Finland. They used wet cupping
medicine with which you treat yourselves is Hijamah; or it is as complementary and alternative medicine by using cow
one of the best of your medicines. [Sinin ibn Maja, vol 2, Al­ horns. During the middle­ages bloodletting became so
hijamah. 351]. Ibn Abbas (may Allah be pleased with him) common that Barbers started practicing and they would display
reported that the Prophet (PBUH) said “Healing is to be found “bloodletting pole” outside their shops. Cupping became
in three things: Drinking honey, the knife of the cupper, and widespread in US. The traditional principles of cupping were
cauterization of fire”. [Al­Bukhari, 10/136]. It was reported being ignored as it was being carried out incorrectly by barbers
from Ibn Abbas (may Allah be pleased with him) that the and non­medico people, resulted in large number of adverse
Prophet (PBUH) said: “the best time to be treated with events and deaths. The traditional principles of hijama were
Hijamah are the seventeenth, nineteenth or twenty­first of the ignored and it was incorrectly carried out by barbers and the
month.” [Al­Tirmidhi, 2054] Later on this hadeeth has been people who had no medical knowledge which resulted in many
proved scientifically. Gravitational forces exerted by the sun adverse events and deaths. By 1800s the therapy was sharply
and moon cause the oceans to sretch creating low and high criticised and discredited by modern medicine and the newly
tide. As seventy percent of body’s composition is water, the established model of medicine gained dominance. However in
tide’s range influences the humours of body. In the first and 1900s and early 20th century bloodletting managed to survive.
third quarter of moon, the sun and moon are separated by 90° Many published research papers confirmed the efficacy of
when viewed from the earth, at this time the solar tidal force cupping therapy during the nineteenth century [16]. Sir Arthur
partially cancels the moon’s tidal force. So the tide’s range is Keith (5 February 1866 – 7 January 1955): was a Scottish
minimum at this time. During first quarter the humours are anatomist and a fellow of the royal college of surgeons of
deep seated and they are in static static state during last quarter England and the president of the royal anthropological
of month. Hence during both these periods chances of losing institute. He was famous because he discovered the sino atrial
good humours are more. Therefore doing hijamah on 17th, 19th node in 1907. Sir Arthur Keith wrote how he witnessed
and 21st of lunar month prevents the loss of good humours. cupping performed with excellent success [11]. The founder of
[18] Royal Free and Royal Marsden Hospitals in London, surgeon
William Marsden (1796­1867), also employed cuppers in his
Al­tibb al­nabawî was one of the famous Islamic books which
Royal Free Hospital in Gray’s Inn Road, London, during the
was written by Ibn Qayyim al jawziyya and mentioned
1830s. He decided to open a hospital and freely treat the poor
cupping therapy as a medical practice. Another book, Islamic
and enlisted surgeons and doctors who contributed their time
Medical Wisdom – The Tibb al­A’imma, Imam Ali ibn Abu
free of charge, with the exception of a paid apothecary and a
Talib also describes the benefits of cupping, sites of cupping
paid cupper [10]. Cupping therapy was also recommended in
along with the do’s and donts’.[10][13]
1923 edition of the book The Principles and Practice of
Records of cupping in china: Bo Shu, an ancient book written Medicine. As there was emergence of new medical knowledge,
on silk, was discovered in an ancient tomb of the Han Dynasty antibiotics and anti­pyretics along with scientific research
in 1973. Some therapeutic cupping methods were also based validation and negation of medical practices, cupping
introduced in a book by Zouhou Fang in about 28 ad. In 755 therapy completely waned in modern medicine in the western
AD, cases of treatment of tuberculosis were also recorded in world within a few decades [16][17]. But, it still ramined a
Weitaimiyao. Susen Liang Fang, another ancient classic, part of Chinese medical therapy and the Muslim world
recorded effective cure for chronic cough and the successful including the countries with larger muslim populations like
treatment of poisonous snake bites using cupping therapy Malaysia and Indonsia. [16]
which was found three hundred years later [10][14]. A famous
There was a tremendous resurgence of cupping therapy in
surgeon, Wei Ke Zen Zong presented a detailed record of the
muslim communities living in different parts of world in past
cupping methods used in surgical practice about 500 years
20 to 30 years and courses were being offered to both medical
ago,[10][14]. Through several thousand years of accumulated
practitioners and other people. However in western countries
clinical experience, the clinical applications of cupping have
like US, Canada and Australia, the practice of Hijamah was
become increasingly wide. During the Jin dynasty, Ge Hong
not permitted by non­medical people. As the procedure
(281­341 ad), in his book A Handbook of Prescriptions for
involves scarifying of the skin and exposure to the blood there
Emergencies, first mentioned the use of animal horns as a
is high risk of spreading infections like HIV and Hepatitis. So
means of draining pustules [15]. Zhao Xueming of the Qing
the authorities legislate the use of cupping therapy to qualified
dynasty (1644–1911), in his Supplement to Outline of Herbal
and registered medical practitioners and acupuncturists. [16]
Pharmacopoeia, wrote a separate chapter on the subject under
the heading ‘Fire­Jar Qi’. The original natural horn cup has
been replaced by bamboo, ceramic or glass cups. Because
cupping is widely used in Chinese folklore culture, the
technique has been inherited by the modern Chinese clinical
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Resurgence of Hijamah (Cupping) Therapy: A Review
Different Cupping Equipments and Types of Cupping done in musculoskeletal disorders like neck paon, back pain
Therapy etc. Also this is is used in cosmetic procedures like facial
cupping and for cellulite reduction.
Glass Cups: These cups are made of glass mostly without
valve, having thick edges and they are easy to clean and Flash Cupping: In this type of cupping the cups are placed
sterilize. These cups are used for fire cupping as the vacuum is and removed frequently several times along the area being
created by using alcohol swab ignited with fire then the cup is treated.
placed. [19][20]
There are some other types of cupping but these are not
Pistol-Handle Valve Cups: These cups are made up of clear practically in so much use like Herbal cupping in which herbal
Perspex material having a valve attached to its top used with a tincture or decoction is used within the cup, water cupping, ice
pistol shaped manual suction pump. These are most commonly cupping where ice is placed in the cup and hot cupping or
used cupping sets for dry cupping and gliding or moving Moxa cupping in which dried mugwort leaves or Moxa which
cupping. [19][20] is a great warming herb is used. [20]
Disposable Cupping Sets: These are most commonly used Theories regarding mechanism of cupping therapy
cups especially for wet cupping as they can be disposed off
There are several theories which explain the mechanism of
immediately after use. The cups are made of clear plastic
cupping therapy.
material and are affordable in terms of disposal. [19][20
Taibah theory: This theory was proposed by El Sayed et al.
Silicon cup: These cups are self­suction cups and are more
that al­hijamah is an excretory procedure that clears the blood,
suitable for sensitive areas because of smooth edges and used
lymphatics and interstitial spaces from CPS (Causative
for cosmetic cupping like cellulite on thighs and facial
Pathological Substances) and noxious substances. It includes
cupping. [19][20]
non­ specific blood clearance, pain relief, pharmacological
Electronic Cupping Apparatus: The cup is attached to the potentiation, restoring homeostasis etc. Prophetic method of
machine through an umbilical suction cord. The operator can wet cupping (Al­hijamah) in light of Taibah theory can be
adjust and control the suction strength and duration defined as a minor surgical excretory procedure by creating
electronically. This type of device is now a days used in facial superficial skin scarifications to open skin barrier and creating
cupping and cellulite cupping etc. [19] a pressure gradient and a traction force across the skin and
underlying capillaries to drain interstitial fluids and to enhance
Screw-Top Cups: These are inexpensive cups with adjustable
blood clearance and waste excretion through skin. [21] Al­
screw­threaded handle on its top attached to a piston­like
hijamah is different from traditional wet cupping therapy
suction pump inside the cup. The amount of suction required
confirmed by Huang, a Chinese scientist as it combines both
can be achieved by rotating the handle anticlockwise and
types of cupping therapy in a single original Arabic technique.
clockwise. These are very less in use now a days. [19]
[ 22][23][24]. It has triple S method i.e. Suction, Scarification
Cups with Squeeze Rubber Tops/ self-suction cups: These then second suction.[22] Both Chinese DCT & WCT can be
cups have hollow rubber handle attached to the top. The regarded as partial forms of Al­hijamah.[24][25] El Sayed et
suction obtained by these type of cups is light to medium al. confirmed the presence of many therapeutic benefits in Al­
strength and is preferably used for children. [19][20] hijamah over Chinese wet cupping method.[23][24]
Bamboo Cups: These cups are made of bamboo commonly Pain gate theory states that there is a channel or gate that
used in China. The edges of bamboo cups are sharp compared transfer the pain to the brain, while doing cupping therapy the
to glass and plastic cups and another disadvantage of these channel transmits the pain from cupping area to the brain that
cups is that the therapist cannot see the pressure or blistering interferes with the transmission of actual pain in the same gate
inside the cups as they are not transparent. [19][20] or channel which ultimately kills the pain.
There are different types of cupping done different conditions Prostaglandin theory explains that wet cupping therapy
and disorders. relieves the pain by removing prostaglandins out of the body
which are inflammatory products produced at the site of tissue
Dry cupping is usually done in conditions like pain and to
injury and transmits pain signals to the brain.
improve circulation in particular area. The suction is kept
medium to prevent blistering, according to the requirement of Endorphins and encephalins are endogenous pleasure
suction. The cups are kept not more than 10­15 minutes and substances that are released in our body as a result of cupping
removed when hyperaemia is achieved or when it starts to which reduces pain and enhances the mood.
bruise.
Increasing blood circulation theory Cupping therapy increases
Wet cupping/ Bleeding cupping/ Al-hijamah: As the name blood circulation by applying negative pressure and evacuating
suggests, blood is let out after scarifying the skin superficially the morbid humours which contains inflammatory products
by surgical blade and creating suction. This type of cupping is and toxins by wet cupping and reduces inflammation and pain.
done to remove the morbidities of blood or removal of toxins
Nitric oxide theory: Nitric oxide is a substance which is
and pathogenic substances from the body. Wet cupping is done
released in the body as a result of injury. It is also released
under proper surgically aseptic condition.
during and after cupping therapy. It has vasodilatation, anti­
Moving cupping/ Massage cupping/ Gliding cupping: By this thrombotic effects, also causes muscle relaxation and reduces
type of cupping is a negative pressure massage done along inflammation.
some oil by creating partial pressure in the cups. Then cup is
Reflex zones therapy / Segment cupping therapy: There are
then slightly moved over the body surface. This is commonly
31 pairs of spinal nerves, corresponding to the segment of

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 International Journal of Current Advanced Research Vol 7, Issue 4(M), pp 12226-12232, April 2018

vertebral column. They carry motor, sensory and autonomic four cups on the knee over the period of one month. Dry
signals between spinal cord and the body. The body is divided cupping therapy was found to be effective and safe regimen in
into segments that begin with every vertebra. Cupping on C7 symptomatic management of knee OA [43]. Michaelson et al
vertebra an elevation named hormone hump, used to treat conducted a clinical trial in which cupping therapy was found
hormonal imbalance like pituitary gland disease, diabetes to be safe and well tolerated and cupping of segmentally
mellitus and ovarian dysfunction. Application of cups to the related shoulder zones appeared to alleviate the symptoms of
skin activates the body through autonomic nervous system to carpel tunnel syndrome [39]. Ludke et al investigated the
bring it back to the state of health. effectiveness of wet cupping in patients suffering from
brachialgia paresthesia nocturna an found cupping effective in
Meridians system theory: Meridians are the channels in the
a defined connective tissue area (over the muscle trapezius)
body. In chinese language meridian is Jing Luo, Jing means
and has short term effects for at least one week [40]. Cupping
pathway and represents vertical channels and Luo means
has also be seen beneficial in sciatic pain as evaluated by
network which represents horizontal channels. Ancient
Muhammad Bilal et al in a clinical study in which significant
Chinese believed that there was a network to distribute Qi
relief in pain was seen [42]
(vital energy) and other substances to all the parts of body. The
also believed that cupping therapy can treat stagnation of vital Different types of Cups used for Al Hijamah (cupping)
energy. Qi is divided into two equal and opposite foreces, Yin therapy
which represents female, passive, cold, water and darkness and
Yang which represents male, active, warm, fire and light. The
imbalance beteen these two forces results in disease or disturbs
the healthy state. There are twelve meridians which are named
to the corresponding organs, six of which are Yin meridians
(Lung, heart, pericardium, spleen, kidney and liver meridian)
and six are Yang meridians (Large intestine, small intestine,
triple burner, stomach, bladder and gall bladder meridian) [27]
Studies Done on Cupping Therapy
Cupping therapy has been proven effective in many diseases
and clinical conditions. There are number of clinical studies
and meta­analyses done on the efficacy of cupping therapy or
Hijamah. Various clinical studies carried out on cupping in
patients of neck pain and shoulder pain showed that the
cupping has potential therapeutic effect as it significantly
decreased the neck and shoulder pain and improved quality of
life in patients with chronic non­specific neck pain and
shoulder pain. [28,29]. [30]. Also many studies have been
carried out to evaluate the efficacy of cupping on low back
pain. Kim et al in a clinical trial, concluded that wet cupping
improved pain and the analgesic effect was maintained even
after 2 weeks of follow­up. [31]. Another clinical study by
Albedah et al also supported the use of wet cupping in
reducing persistent non­specific low back pain and improving
disability associated with low back pain [32]. Other clinical
studies carried out by Farhadi et al and Hanan S. Ali, found
wet cupping was significantly more effective in reducing pain
and disability [33][34]. Studies have also been done to see the
effects of cupping therapy in different types of arthritis like
osteoarthritis and rheumatoid arthritis. In a clinical trail K
Ullah et al evaluated the effects of wet cupping on anterior
knee pain and he found significant difference in level of pain,
range of motion and well­being pre and post cupping [35].
Sheikh Haneef Mohammad also evaluated the efficacy of Different Types of Cupping Therapy
Hijamah bish shart (wet cupping) in the treatment of knee
osteoarthritis and found improvement in pain, stiffness and
Range of motion [36]. Ehsan Ahmed et al evaluated wet­
cupping in combination with Unani formulation for Waja ul
mafasil (Arthritis) found it better when compared with oral
unani formulation alone [37]. Ahmed et al in a clinical study
evaluated blood­letting cupping in the management of
rheumatoid arthritis, blood­letting cupping along with
conventional therapy found to have immunomodulatory effects
[38]. Dar A K. carried out a clinical trial to evaluate the
efficacy and safety of hijamah in patients of knee osteoarthritis
in which seven dry cupping sessions were given by applying
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Resurgence of Hijamah (Cupping) Therapy: A Review
Apart from musculoskeletal pain cupping therapy has also the human bodies have become full of toxins and metabolic
been found effective in treating migraine and tension headache wastes, we are inhaling toxic air and having food with
and herpes zoster. Ahmedi et al in his study suggested the use abundant of chemical fertilizers and steroids, everyone needs
of wet cupping along with standard care beneficial for to get of these toxic substances which have accumulated in
migraine and tension headache [41]. Cao et al did a systemic body in the form of morbid humors. Cupping therapy or Al­
review of randomized controlled clinical trials in which he hijamah is the best treatment to get rid of these causative
concluded that wet cupping appears to be effective in pathogenic substances and also for rejuvenation and
treatment of herpes zoster [48] immunomodulation hijamah works best.
Cupping therapy has also been found beneficial in References
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How to cite this article:

Shaista Anwar Mansoori et al (2018) 'Resurgence of Hijamah (Cupping) Therapy: A Review', International Journal of
Current Advanced Research, 07(4), pp. 12226­12232. DOI: http://dx.doi.org/10.24327/ijcar.2018.12232.2142

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