Therapeutic potentials of hijama-bila-shart (dry cupping therapy): A review

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International Journal of Unani and Integrative Medicine 2017; 1(1): 21-24
E-ISSN: 2616-4558
P-ISSN: 2616-454X
IJUIM 2017; 1(1): 21-24
Received: 08-05-2017
Accepted: 10-06-2017
Abuzar lari
P.G Scholars Department of
Ilaj bit Tadbeer, NIUM
Bengaluru, Karnataka, India
Mohd Nayab
Lecturer Department of Ilaj
bit Tadbeer, NIUM Bengaluru,
Karnataka, India
Mohammad Tausif
P.G Scholars Department of
Ilaj bit Tadbeer, NIUM
Bengaluru, Karnataka, India
Javed Ah Lari
Prof. Department of Munafe-
ul-Aaza, Mansoora Tibbiya
College, Malegaon,
Maharashtra, India
Md. Anzar Alam
PhD Scholar, Dept. of
Moalajat, National Institute of
Unani Medicine, Bangalore,
Karnataka, India
Correspondence
Abuzar lari
P.G Scholars Department of
Ilaj bit Tadbeer, NIUM
Bengaluru, Karnataka, India
Therapeutic potentials of hijama-bila-shart (dry
cupping therapy): A review
Abuzar lari, Mohd Nayab, Mohammad Tausif, Javed Ah Lari and Md.
Anzar Alam
Abstract
Unani medicine is also called as Greco-Arabic medicine there are three modes of treatment in USM, in
which Ilaj-bit-tadbeer is one of the mode where treatment is done through several regimes in which
Hijama (cupping) therapy is most famous among them. Hijama (Cupping therapy) is one of the oldest
methods of treatment which was used by Unani physician since ancient time. It is used for diversion of
morbid matter from diseased part by creating negative pressure through vacuum pump, it is indicated in
various condition like arthritis, backache, migraine, hemorrhoids etc. the paper discusses the method
and therapeutic potentials of Hijama-bila-Shart.
Keywords: Unani Medicine, Hijama, Cupping, Regimenal therapy
Introduction
Unani medicine is also called as Greco-Arabic medicine or Islamic medicine. USM is based
on the wisdom and tradition of great Greek physician and father of medicine Buqrat (460-
377BC), Roman physician Jalinoos (129-200AD) medical system is also elaborate by Arab
and Persian physician such as Ibne-Sina, Al-Razi, Ibne-Nafis, Al-Zahrawi [1].
Treatment strategy in Unani system of medicine there are three methods of treatment:- Ilaj-
bit-Tadbeer (Regimenal therapy), Ilaj-bid-Dawa (Pharmacotherapy) and Ilaj-bil-Yad
(Surgery)
Ilaj-bit-Tadbeer is defined as therapeutic modification in Asbab-e-Sitta Zaruriyah.
Asbab-e-Sitta Zaruriyah are six essentials factors those play a customary role in life and
humans health and any alteration in these factors causes disease. These factors are: (1)
Hawa-e-Muheet (Atmospheric air) (2) Makul-wa-Mashroob (Food and beverage) (3)
Harkat-wa-sukoon-e-Badni (Physical activity and relaxation) (4) Harkat-wa-sukoon-e-
Nafsani (Mental activity and relaxation) (5) Naum-wa-Yaqzah (Sleep and awake fullness)
and (6) Ehtibas-wa-Istifrag (Retention and evacuation) [2, 3, 4].
Regimenal therapy is one of the most popular practicing method practiced by ancient Unani
physicians based on simple physical means to cure a disease, usually used along with
pharmacotherapy and dietotherapy. There are several regimens used such as Hammam, Dalk,
Takmeed, Cupping, Leeches, Fasd, Ishaal, Riyazat, Qai, Idrare-Baul.
Hijamat is an Arabic word derived from “Hajm” which stands for “Sucking”. Hijamat is a
method used for Imala-e-Mavad (diversion of morbid material) or Tanqiya-e-Mavad
(evacuation of morbid matter).In Ancient time, Hollowed out animals horns (Singhi) were
used for the procedure of Hijamat. Wide opening of horn is placed on the skin of the
required area and vacuum is created by sucking the air with mouth via narrow opening now
days, these animal horns are replaced by sophisticated plastic and glass cups in which
vacuum is created by vacuum pump [5].
Historical background
Whatever information is available in the record of history in the form of monuments and
pictures shows that Hijamat is an ancient method which was particularly used among the
Egyptians, Babylonions, Chinese, and Greeks etc. [6] According to Arabic writers, cupping
therapy is in use since 3500 BC where Assyrians were the first Arab population to use
primitive tools as animal horns; pottry cups bamboo cups for cupping therapy. Arabic
civilization termed cupping therapy, Al-Hijamah therapy (which means in Arabic: to restore
to the original size), where it was used in treating hypertension, polycythemia, headache,
migraine and drug intoxication [7].

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Chinese literature reports that the cupping therapy is a part
of the traditional Chinese medicine (TCM) dating back to at
least 2,000 years [8]. In Ancient Egyptians culture, the
application of cupping therapy was earlier than many old
civilizations. it was one of the oldest known medical
therapies in Egypt. The first report of using cupping therapy
in ancient Egypt dates back to 1550 B.C. where drawings on
the famous Egyptian papyrus (Ebers papyrus) and ancient
Egyptian temples showed that Egyptians were advanced in
treatment by using cupping therapy [9, 10]. In 400 B.C.,
Herodotus (a Greek historian) recorded that the ancient
Egyptian physicians who recommended the use of sucking
cups to the body have already used both wet cupping
therapy and dry cupping therapy and treated various
diseases by application of cupping therapy including
headache, loss of appetite, maldigestion, fainting, to drain
abcess, narcolepsy (repeated sleepy desires) and others [11].
Buqrat (460 BC) described the therapeutic prospective of
both dry and wet cupping in his treatise “Guide to Clinical
Treatment”. He also claimed it for the treatment of angina
and menstrual and other gynaecological disorders. He
apparently preferred dry cupping, as this was less intrusive,
gentler and fitted better with his famous principle: “First do
no harm” [12].
Jalinūs (130-201 AD) a renowned Unani physician also
recommended cupping for a major therapeutic option,
perhaps even more so. He prescribed the wet procedure for
balance of ailments [12]. Al-Zahrawi (936-1036 AD) a great
surgeon, described cupping and its uses in detail. He
explained the specific sites of cupping as well as gave
description of equipments diagrammatically which should
be used during procedure [13]. Ibne Sina (980-1037 AD) the
foremost and best known practitioner of cupping, generally
accepted as the “Prince of Physicians” His thoughts on the
procedure are presented in his famous book, namely the Al-
Qanoon-Fit-Tibb. He not only detailed the underlying
theory and the target disorders which would benefit, also
advised on patient selection and preparation, actual
technique and best time for the procedure. Other advice
related to where on the body the cups should be positioned
and for how long [12]. Ismail Jurjani (d. 1140 AD)
mentioned the age restriction for Hijamat and describes the
contraindications in children and elderly people [14]. Ibne
Hubal (1122-1213 AD) writes in his book “Kitab-ul-
Mukhtarat-Fit-Tibb” that Hijamat sucks out the blood from
those minor vessels which are scattered under the muscles
and skin, so it does not produce weakness like Fasd. Further
he described that cupping have the property to reduce the
congestion locally and also from adjoining structures [15]. In
recent years cupping is becoming very popular mode of
treatment and gaining fame globally. A number of studies
reported and revealing the efficacy and value of cupping
either alone or with combination of other therapies.
Definitions of Hijamat
Taber's dictionary reveals that the application of a glass
vessel to the skin, from which air can be exhausted by heat
or by a special suction apparatus, is known as cupping. [16] In
English language Hijamat, is termed as Cupping. Several
scholars of the Unani medicine have defined Hijamat
(cupping) in their own words such as:
 Razi states that Hijamat is a process by which blood
oozes out from the superficial small vessels located in
muscles through superficial incisons. Hijamat relieves
the diseases of Imtila of the body [17].
 Ibne Hubal Baghdadi has defined Hijamat as a process
which helps in Istifragh-e-dam from the small vessels
of the skin & muscles and reduces the Imtila
(congestion) from the part applied [18].
 Allama Kabeeruddin says that Hijamat of lower limbs,
especially at ankle joints is similar to the Fasd
(venesection) because normally blood and noxious
matter move in the downward direction and Hijamat
also attracts them, so when Hijamat-bish-Shart is
indicated at ankle joints, the oozing of the blood is
higher than in venesection [18].
Types of Hijamat
Various classification of Hijamat has been decribed in
Unani litreture are as under:
Hijamat therapy is broadly classified in two types but these
types sub divided further by its need and use of object: (1)
Hijamat-bila-Shart (Dry cupping) (2) Hijamat-bish-Shart
(Wet cupping) [18, 19, 20].
According to need Hijamat-bish-Shart is further classified
into two types, Hijamat-e-Iztirariyah (mandatory or
essential), Hijamat-e-Ikhtiyariah (optional or voluntary) [19, 20].
According to the methods of applications, Hijamat-bila-
Shart is also further divided into two types: Hijamat-e-
Nariya (Cupping with fire), Hijamat-e-Ghair Nariya
(Cupping without fire) [18, 19] Apart from these two types,
Abul-qasim-al-Zahravi has mentioned a third type of
Hijamat in his book, Kitab-ut-Tasreef. (3)Hijamat-e-Mai
(Hijamat with hot decoction of drugs) [21].
Therapeutic Mechanism of Hijamat (Cupping)
In Unani system of medicine Hijamat is practicing from
thousands of years but there is no specific mechanism has
been explained by any eminent Unani physicians. Recent
studies reveal the mechanism which can be understood as
follows. As per Unani system mechanism of action is
mainly based on two ways. Tanqiya-e-Mavad (Evacuation
of morbid matter), Imala-e-Mavad (Diversion of morbid
matter).
Tanqiya-e-Mavad (Evacuation of Morbid matter): In
Unani literature, for any pathology there is root of cause or
morbid matter which accumulates in particular site or organ.
According to the principle of Tanqiya-e-Mavad, by applying
Hijamat-bish-Shart evacuation of morbid matter is done
directly from affected site. It helps to draw out and eliminate
the imbalanced qualities i.e. heat, cold, moistness, dryness.
Hijamat-bish-Shart opens the pores of the skin which allows
the Akhlate-Fasida to be evacuated from the body [18]. It
also provides better circulation to the area. Affected site get
nourished with fresh new blood [22]. It improves the
eliminative function and the evacuation of wastes from the
organism. In Unani medicine proper and timely evacuation
of wastes from the body is an important aspect of hygiene.
The main objective of treatment is to remove the cause of
disharmony from the body, restore the circulation and
balancing in homeostasis [23].
Imala-e-Mavad (Diversion of morbid matter): Hijamat-
bila-Shart (Dry Cupping) works on the principle of Imala-e-
Mavad. In this method, there is diversion of morbid matter
from one site to other [22]. By this diversion, Hijamat-bila-
Shart helps the Tabiyat mudabera badan to act on this

International Journal of Unani and Integrative Medicine
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matter and resolves it [24]. Because accumulation of any
morbid matter produces congestion, stagnation and blockage
which results in pain. By Hijamat-bila-Shart (Dry cupping)
there is breaking of congestion, resolving of blockage and
there is restoring free flow of blood circulation and relieving
the painful muscle tension [25]. It also helps to withdraw
inflammation and pressure away from the deep organs
(especially the heart, brain, lungs, liver and kidneys)
towards the skin or to exterior surface of the body. This
facilitates the healing process and provides strengths to the
immune system, so encouraging the optimum functioning of
the body. In other words, it assists the actions of Physis. In
doing so, it diverts toxins and other harmful impurities from
these vital organs towards the less-vital skin, before
expulsion. The blood which is diverted allows a fresh
stream of blood to that area [23].
Equipments of Hijamat-bila-Shart: Glass/ acrylic cups
with Vacuum pump, Antiseptic lotions, Sterilized gloves,
Cotton and medical gauze, micropore tape, Razor [26].
Therapeutic Purpose of Hijamat-bila-Shart: (1) Diversion
of matter (Madda): To divert the morbid matter from one
placed to another; Hijmat-bila-Shart is applied at the site
where material is to be diverted. e.g. in menorrhagia
Hijamat is done under breast, and in epistaxis Hijamat is
applied on abdominal muscles (2) For displacement of
organ: In case of inguinal hernia Hijamat is done on the
abdominal muscles of affected area. To return the
displacement part of intestine
3) For Drawing out disease body. e.g. in condition of
internal piles (4) In regeneration of warmth and movement
in a paralyzed muscles (5) Non-healing wound: Apply cups
on wounded site to draw out the pus and morbid matter (6)
To divert the secretions outside or towards periphery. e.g. in
leucorrhoea the Hijamat is done on pubic region (7) In colic
pain and sciatica on site of pain (8) For absorption and
dissolution of Riyah and induction of warmth in any organ,
e.g. in case of Burudat-e-Riyah fire cupping is done on
stomach area and (9) To relive pain.
To make inflammatory conditions more accessible to
medication [15, 27, 4, 24].
Therapeutic Sites and indication sites of Hijamat-bila-Shart [21]
S. NO
Site
Indications
1
Tahat-us-Sadyain (Below the bust line)
Menorrhagia, metrorrhagia and epistaxis
2
Na’ f (umbilical region)
Abdominal colic, tenesmus, dysmennorheoa
3
Lower abdomen
Inguinal hernia
4
Loin
Renal stone and obstruction
5
Right hypochondric region
Liver disorders, epistaxis from right nostrils
6
Left hypochondric region
Spleen disorders, epistaxis from left nostril
7
Warkain (buttocks)
Sciatica and dislocation of hip
8
In between Warkain
Piles, hydrocele, disorder of hip and thigh
9
Miq’ad (Anus)
Intestinal disorder, piles, diversion of matter from head, menstrual
disturbances, disorder of anus
10
Medial and dorsal aspect of thigh
Sciatica
11
Uzun (ears)
Fistula
Contraindication of Hijamat: Renowned Unani physician,
Jalinūs (Galen) quoted that Hijamat should not be perform
during early pre inflammatory stages because when
Hijamatis done at this stage, it will not extract or divert the
morbid matter completely leaving behind some residue that
may creates the foundation for chronic disease.[14] Children
below 2 years and elders above 60 years, Pregnant and
lactating women, During menstrual cycle, Patients having
history of cardiac complications, Patients of contagious
disease, Patients on anticoagulant medicine, Immune-
compromised patients[24], Should be avoided in obese
patients[28], In severe accumulation of raw matter, Just after
sexual intercourse and some heavy exercise, Hijamat should
not be performed after Hammam except in cases of patients
having viscid blood [18]. It should be avoided after excessive
work due to Kasrat-e-Tahleel., Hijamat should be avoided
in the beginning and the end of lunar month [29]. In late
stages of abcess [30].
Acknowledgement
We authors acknowledged to the librarian staffs of NIUM.
Conflict of Interest: Nil
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