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Hijama therapy.

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] 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."[2]


Clotted blood after being drawn by wet cupping.

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[3] warns against overuse 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[citation needed] 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.[citation needed] Hijama is considered a form of energy medicine because it has been claimed to unclog the meridians in the body, and is viewed by some practitioners as a cure that can alleviate black magic and possession.[4] 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.

Al-hijamah versus traditional WCT[edit]

There are two different reported methods of WCT. First method is puncturing and cupping (PC, traditional WCT) method havingfive steps: skin demarcation, sterilization, puncturing, cupping and sterilization. Second method is cupping–puncturing–cupping (CPC, Al-hijamah) method having six steps: skin demarcation, sterilization, first cupping, puncturing, second cupping and sterilization. CPC method of WCT (Al-hijamah) was reported to be better than PC method of WCT as regard blood and interstitial fluid clearance from CPS (with a lower degree of fresh blood loss) as Al-hijamah is a two-step filtration (cupping, purification) process while traditional WCT is a one-step filtration process. CPC method is the cupping therapy practiced in Arabic countries, while PC method has a worldwide distribution.(http://dx.doi.org/10.1016/j.mehy.2014.04.0010306-9877/).

Scientific studies[edit]

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.[5]

A study by Ahmed and colleagues was carried out in order to evaluate the efficiency of cupping [hijama] therapy in management of rheumatoid arthritis. They concluded cupping [hijama] combined with conventional medical therapy has several advantages. It significantly reduces the laboratory markers of disease activity and it modulates the immune cellular conditions particularly of innate immune response NK cell % and adaptive cellular immune response SIL-20 (Ahmed, Madbouly, Maklad $ Abu-Shady, 2005)[6]

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.[7]

There is some evidence that wet-cupping is effective in the treatment of non-specific lower back pain.[8] Studies have also shown some evidence that it may be effective in the treatment of post-herpetic neuralgia.[9] For the treatment of cancer, there is no scientific evidence to suggest that HIJAMA confers any health benefits.[10]

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. [11] Research into wet/dry cupping is mostly negative or of poor quality and with high bias.[12] [13]

Cupping is poorly supported by scientific evidence.[14] 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.[15] A 2011 review found tentative evidence for pain but nothing else.[16]

Any reported benefits are likely due to the placebo effect.[17]


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.[18]


Cupping has few major side effects aside from the pain of skin cuts. One potentially serious risk is infection. Another possible minor side effect which may occur is light-headedness post therapy, similar to the sensation one feels when donating blood. Cupping [hijama] encourages blood flow to the cupped region (hyperemia), one may therefore feel warmer and hotter as a result of vasodilatation taking place and slight sweating may occur. Pregnant women or menstruating women, cancer (metastatic) patients and patients with bone fractures or muscle spasms are also believed to be contra-indicated. Some practitioners suggest that a low risk of blood clotting is possible and therefore walking and staying awake after a procedure is advisable.[19]

In Islamic hadith[edit]

Cupping is mentioned in the Islamic hadith (reported sayings of Muhammad):

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."[20](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 )

Hijama gun with vacuum cups

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.[21]

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 (may 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.[22]

See also[edit]


  1. ^ Traditional Medicine Among Gulf Arabs Part II - Blood Letting, Albinali, H. A. Hâyar, Heart Views, Volume 5, No.2, June–August 2004
  2. ^ Qayyim Al-Jauziyah (2003). Abdullah, Abdul Rahman (formerly Raymond J. Manderola), ed. Healing with the Medicine of the Prophet. ISBN 978-9960892917. 
  3. ^ Cupping, Hijama, Buhwang . . .
  4. ^ Observations of the popularity and religious significance of blood-cupping (al-ḥijāma) as an Islamic medicine, Ahmed El-Wakil, Contemporary Islamic Studies, Vol. 2011, 2
  5. ^ FACT, Focus on Alternative and Complementary Therapies, Abdullah AlBedah,Mohamed Khalil, Ahmed Elolemy, Ibrahim Elsubai, Asim Khalil, Hijama (cupping): a review of the evidence, Volume 16, Issue 1, pages 12–16, March 2011
  6. ^ FACT, Focus on Alternative and Complementary Therapies, Abdullah AlBedah,Mohamed Khalil, Ahmed Elolemy, Ibrahim Elsubai, Asim Khalil, Hijama (cupping): a review of the evidence, Volume 16, Issue 1, pages 12–16, March 2011
  7. ^ http://www.worldscientific.com/doi/abs/10.1142/S0192415X08005564
  8. ^ Farhadi, K; Schwebel, DC; Saeb, M; Choubsaz, M; Mohammadi, R; Ahmadi, A (Jan 2009). "The effectiveness of wet-cupping for non-specific lower back pain in Iran: a randomized controlled trial.". Complement Ther Med. 17 (1): 9–15. PMID 19114223. doi:10.1016/j.ctim.2008.05.003. 
  9. ^ Cao, H; Zhu, C; Liu, J (2010). "Wet cupping therapy for treatment of herpes zoster: a systematic review of randomized controlled trials". Altern Ther Health Med. 16: 48–54. PMC 3151529Freely accessible. PMID 21280462. 
  10. ^ http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/cupping
  11. ^ https://www.researchgate.net/publication/50867336_Is_Cupping_an_Effective_Treatment_An_Overview_of_Systematic_Reviews
  12. ^ https://sciencebasedmedicine.org/cupping-olympic-pseudoscience/
  13. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289625/
  14. ^ Chen, B; Li, MY; Liu, PD; Guo, Y; Chen, ZL (July 2015). "Alternative medicine: an update on cupping therapy.". QJM : Monthly Journal of the Association of Physicians. 108 (7): 523–5. PMID 25399022. doi:10.1093/qjmed/hcu227. 
  15. ^ Singh, Simon; Ernst, Edzard (2008). Trick or Treatment. Transworld Publishers. p. 368. ISBN 978-0-552-15762-9. 
  16. ^ Lee, MS; Kim, JI; Ernst, E (March 2011). "Is cupping an effective treatment? An overview of systematic reviews". Journal of Acupuncture and Meridian Studies. 4 (1): 1–4. PMID 21440874. doi:10.1016/s2005-2901(11)60001-0. 
  17. ^ "In the News: Cupping". NCCIH. 2016-08-09. Retrieved 2016-08-15. 
  18. ^ Chirali, 1999
  19. ^ FACT, Focus on Alternative and Complementary Therapies, Abdullah AlBedah,Mohamed Khalil, Ahmed Elolemy, Ibrahim Elsubai, Asim Khalil, Hijama (cupping): a review of the evidence, Volume 16, Issue 1, page 5, March 2011
  20. ^ Bukhari, Book 7, Volume 71, Hadith 584 (Medicine)
  21. ^ Bukhari, Book 7, Volume 71, Hadith 602 (Medicine)
  22. ^ Muslim, Book 10, Hadith 3830 (The Book of Transactions [Kitab Al-Buyu`])

Further reading[edit]