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.The practice has Greek and Persian origin and is mentioned by Hippocrates.

1. Cupping
The forgotten healing
art
ِ‫يم‬ ِ‫ح‬‫ه‬‫الر‬ ِ‫ن‬َ‫م‬ْ‫ح‬‫ه‬‫الر‬ ِ ‫ه‬‫اَّلل‬ ِ‫ْم‬‫س‬ِ‫ب‬

2. Cupping / Al-Hijama (‫)الحجــامة‬
Hijama, derived from the word Al-Hajm
translated as cupping, literally means to
suck. It is practiced by applying cups on
the body.

3. What is Cupping therapy ?
 Cupping is one of the oldest and most effective
methods of releasing toxins from the body’s tissues
and organs.
 A partial vacuum is created in cups placed on the
skin either by heat or suction. This draws up the
underlying tissues and blood.
 This enhanced blood flow under the cup draws
impurities and toxins away from the nearby tissues
and organs towards the surface for elimination.

4. History of cupping
 Cupping has been practiced since ancient times.
 The Ebers Papyrus (1550 BC) the oldest medical
textbooks in the world, describes the Egyptians' use of
hijamah (cupping) to ‘remove the foreign matter from
the body’ .
 Evidence in China of cupping dates back to 1000 BC.
 Hippocrates in 450 B.C describes cupping in his ‘Guide
to Clinical Treatment ’

5. Excavated Votive table
representing cupping and
bleeding instruments from
Temple of Asclepius at
Athens (320 B.C).
Painting depicting Galen's
(140 AD) in Rome using the
technique of cupping,
creating small vacuums in
heated cups to "draw the
poisons out."

6. Horn therapy – ancient cupping
treatment using cattle horns
(China 1400 A.D)
A Red Copper Cup Used in Fire Cupping
from Mongolia dated 250 B.C

7.  The Prophet Muhammed (‫)ﷺ‬ is reported to have been
a user and advocate of hijamah (cupping) therapy.
Anas ibn Maalik reported that the Messenger of Allah (‫)ﷺ‬
said, "Indeed the best of remedies you have is cupping
(hijama)…"
[Sahih al-Bukhari (5371)].

8. Types of Cupping
There are two main types of cupping:
 Dry cupping (Hijamah-Bila-shurt) – skin
immediately below the cup is sucked up
by a vacuum created inside the cup
 Wet cupping (Hijamah-Bil-shurt) – in
which the skin immediately below the cup
is cross cut superficially several times –
lightly lacerated – so that blood would
actually be drawn out by the vacuum
from the skin into the cup.

9. Both dry and wet cuppings are further classified into
two types:-
 (A) Cupping with fire - cupping in which any
inflammable thing is placed in the cup to produce
fire which creates negative pressure and thus helps
in attachment of the cups at the surface of the
included area
 (B) Cupping without fire - flame is not used to
create the negative pressure, i.e. vacuum is created
by any means other than flame (mostly by vacuum
pressure pumps).

10. Instruments used for cupping

11. The cupping technique
Dry Cupping
 The vacuum in the glass or hard plastic suction cup is usually
created in one of two different ways.
• either by holding a small flame inside the cups or
• by using vacuum pump
 The appropriate sized cups should be used.
 The skin and underlying tissue swells and becomes warm, and
gets sucked into the cup
 This produces blood congestion at the site and stimulates
circulation
 After a prescribed period of time the cup is gently removed
 No blood is removed from the body

13. Wet cupping
 Dry cupping is first performed
 Small cuts are made in the cupped area then the cup is replaced on the
skin and suctioned again
 The cup is then applied, and the air within will be evacuated with a
small hand-held pump.
 The skin will be drawn into the cup and blood is sucked out of the area
 This will draw 20 to 100 ml blood into the cup, depending on the skin
thickness of the application zone.
 After this, bleeding stops automatically, as haemostatic mechanisms
come into operation.
 The process lasts for around 15 to 20 minutes from application of the
cup.

15. Vacuum pressure applied:
Weak (light) Cupping:
 The amount of flesh drawn into the cup is
minimal and hardly raised.
 This method can be applied to almost
anywhere on the body and may cause a
slight reddening of the skin.
 Weak cupping is the most gentle method of
all cupping and is particularly suitable for
debilitated adults, elderly patients and
young children, especially those under 7
years of age

16. Medium cupping
 This is the most frequently used method on
patients.
 This method can safely be administered to
children over 7 years of age.
 With medium cupping, suction is firmer
pulling the skin well into the cup creating a
slight redness.
 Medium cupping can safely be applied
anywhere on the body.

17. Strong cupping
 This is one of the most draining techniques.
 A strong vacuum need to be produced, giving
a strong pulling sensation of the skin inside
the cup.
 The skin will quickly turn red and shortly turn
purple inside the cup and possible erythema
in the skin surrounding the cup.
 The cupping time should be short i.e. 5-10
minutes during the first session which can
increase up to 20 minutes during later
applications.
 Strong cupping is often coupled with wet
cupping.

18. Comparison between Weak (light), Medium and Strong Cupping

19. Other types of cupping
 Needle cupping - Not often practiced in Tibb as it follows
acupuncture treatment. The cup is placed over the inserted
acupuncture needle
 Moxa (hot needle) cupping – Same as needle cupping
(hot needles are used)
 Empty (flash) cupping - Empty cupping is also called
flash cupping for its speed during application.
 This is actually medium to strong cupping applied rapidly
i.e. the cups remain in place for a very short period (<30
seconds).
 It is used to stimulate and move blood and energy in the
weak and frail. This can be repeated for between 5-10
minutes.

20.  Herbal cupping - The cups are boiled in the pan with water and
the prescribed herbs.
 The cups are then placed on the patient in the traditional way using
(Flame).
 The herbs are absorbed into the bamboo cups, which in turn transfer their
healing properties to the patient.
 Cups can be left on for 10-20 minutes.
 Water cupping - This is one of the least used and practiced
cupping methods.
 The technique involves filling a glass or bamboo cup one-third full with
warm water and employing the cupping process quickly

21. Herbal cupping technique
Water cupping
technique

22. Post Procedure
 An antiseptic cream should be applied to the incisions after
cupping is terminated.
 The use of hone is not only effective as an antiseptic but also
assists in the healing of the skin.
 Adequate nutritious liquids should be taken after cupping.
 Solid food intake should be avoided, if possible, for at least 3
hours.
 No shower or bathing should be carried out for 12 hours after
cupping.
 Sexual activity should be refrained from for at least one day.

23. Sites on Human body for
Cupping Therapy

25.  Abdominal and back cupping

26.  Limb and foot cupping

27. Precautions
 The practitioner must wear disposable latex gloves whilst
carrying out both types of cupping.
 Before cupping actually begins, the patient’s blood pressure
and pulse should be checked.
 The blades used for wet cupping incisions should be
disposable.
 The incisions in wet cupping should be superficial, involving
the epidermis only.
 The patient should be questioned on how he or she feels –
any unusual sensation or fever.
 Patients about to undergo cupping (especially the wet
version) should be advised to take a nutritional drink before
the cupping.

28. Contraindication
 Dry cupping is not recommended for children below the age of 3
years.
 Wet cupping should be avoided in children below the age of 6 years.
 Wet cupping should not be carried out in patients above 65 years of
age, although dry cupping can be used in the elderly.
 It is not advisable to apply cupping to the patient with skin ulcers,
oedema, or on an areas overlying large blood vessels or even varicose
veins
 patients with high fever or who suffer from convulsions should not be
cupped.
 Cupping should not be applied to the abdominal and sacral regions of
the pregnant women.
 Wet cupping should never be applied to the female breast, unless
absolutely necessary.
 Care should be taken with wet cupping of anaemic patients, or those
susceptible to spontaneous bleeding.

29. Physiology of cupping
 During cupping therapy, both blood and lymph circulatory
systems are simultaneously stimulated to work more
efficiently.
 This results in a more efficient collection and transportation
mechanism for toxic substances, depositing it into the
lymphatic system to be destroyed and allowing the
circulation of fresh lymph in order to nourish the tissues and
generate a booster for the immune system.
 Cupping opens the pores of the skin thus allowing for the
precipitation of toxin through the skin.

34. Circulatory system – an overview

37. Lymphatic system- an overview
 The lymphatic system is made up of lymphatic vessels and
lymph nodes that extend throughout the body.
 It helps maintain the balance of fluid in the body by draining
excess fluid from the tissues of the body and returning it to
the blood system.
 Closely related to the cardiovascular system, the lymphatic
system has several major functions, e.g. filtering our bacteria,
producing lymphocytes, generating antibodies, etc.

38.  Cupping therapy enhances blood circulation, treats congestion
and stops the inflammatory extravasations (escaping of some
body fluids e.g. blood) from the tissues.
 Wet Cupping Therapy may affect the autonomic nervous
system and help to reduce pain .
 Cupping therapy may induce deformation or injury to the skin
leading to stimulation of Aβ fibers in the painful region and
distal skin regions and stimulation of inhibitory receptive fields
of the multi-receptive dorsal horn neurons at the level of the
spinal cord. In addition, cupping therapy may simulate special
naturopathic setting leading to relaxation and comfort of the
patient

40. Wet cupping therapy

41.  Cupping therapy penetrates deep into the body; approximately
4” deep and promotes blood circulation and nourishment to all
the internal organs.
 It strengthens the immune system and increases the white
blood cell count. When the localised ‘bruising’ or congestion
occurs, the body assumes it is hurt.
 So the immune system sends out more white blood cells to
heal the area quickly. It engages the parasympathetic nervous
system, which increases relaxation and promotes pain relief.
 Cupping therapy stimulates the nervous system reflex to the
cerebral cortex and aids in faster recovery from sickness and
pain

43. Clinical Benefits of Cupping
 On a general, systemic level, cupping improves the circulation of
blood and lymph.
 Regulates and improves the functioning of the autonomic
nervous system.
 Relief of pain and increased suppleness of stiff tendons and
muscles.
 Cupping increases the flow of lymph, while removing congested
blood from the muscles.
 The blood flow to the joint is increased and there's an increased
secretion of synoivial fluid into the joint cavity.
 Cupping has a dramatic detoxifying effect on the skin and
circulatory system.

45. Digestive system: constipation, diarrhea, irritable bowel syndrome
(IBS)
Vital, Metabolic: low energy, fatigue, anemia, atrophy of the tissues,
cellulite, emaciation, weight gain - normalizes body weight.
Nervous system: headaches, depression, emotional problems -
balances the nervous system.
Gynecological: menstrual pain, suppressed or irregular menses
Musculoskeletal: Local application, as appropriate, for back pain,
arthritis, traumatic injuries, lumbago, sciatica.
Respiratory & Circulatory: asthma, bronchitis, common cold and flu,
high blood pressure.

46. Scientific Evidence of
benefits from cupping
“There is evidence that wet-cupping is effective in the treatment of
nonspecific low back pain”
Alireza Ahmadi, David C. Schwebel, and Mansour Rezaei. The Efficacy of Wet-
Cupping in the Treatment of Tension and Migraine Headache. The American
Journal of Chinese Medicine 2008 36:01, 37-44
“Clinical studies have shown that wet cupping have beneficial effect on
herpes zoster compared with western medication”
Huijuan Cao,Chenjun Zhu, Jianping Liu. Wet cupping therapy for treatment of
herpes zoster: a systematic review of randomized controlled trials. Alternate
Therapy for Health Medicine. 2010 Nov-Dec; 16(6): 48–54.

47. “Cupping therapy is a complex therapy having multidimensional roles and
benefits in various diseases including acne, herpes zoster, paralysis, and
pain management.”
Piyush Mehta , Vividha Dhapte. Cupping therapy: A prudent remedy for a
plethora of medical ailments. Journal of Traditional and Complementary
Medicine.2015, 5:3,127–134.
“hijama is not just a simple technique of taking blood, but it is as a curative
procedure”
Mohammad Reza Vaez Mahdavi, Tooba Ghazanfari, Marjan Aghajani,
Farideh Danyali, Mohsen Naseri. Evaluation of the Effects of Traditional
Cupping on the Biochemical, Hematological and Immunological
Human Venous Blood. A Compendium of Essays on Alternative Therapy.
InTech, Croatia (2012), pp. 67–88

48. A. Michalsen, S. Bock, R. Ludtke, et al. Effects of traditional
cupping therapy in patients with carpal tunnel syndrome: a
randomized controlled trial J Pain, 10 (2009), pp. 601–608
M. Teut, S. Kaiser, M. Ortiz, et al. Pulsatile dry cupping in
patients with osteoarthritis of the knee–a randomized
exploratory trial BMC Complement Altern Med, 12 (2012), pp. 1–
S. Ahmed, N. Madbouly, S. Maklad, E. Abu-Shady Immuno
modulatory effects of blood -letting cupping therapy in
with rheumatoid arthritis Egypt J Immunol, 12 (2005), pp. 39–51

49. I do not advise anyone to try Cupping
Therapy without the knowledge of
certain medical conditions or unless
under the supervision of a Doctor or
specialist in this field
….Thank you!!!!