WHAT IS CUPPING (HIJAMA) THERAPY?
• Cupping therapy (hijama) is a scientific treatment.
• Cupping therapy (hijama) is based on the principles of energy. Production, flow and regulation.
• Energy mechanics is best explained in energy medicine.
• Energy medicine, systems and icons are explained in constitutional medicine.
• Constitutional medicine is based on the concept and scientific fact that 96% of human body is made up of 4 major elements
2 Types of Hijama / Bloodletting
There are a number of different methods and types of bloodletting and while the therapist should know in detail which method is best, based on the patient’s health, the presenting ailment and general constitution, as well as geographic, seasonal and climatic factors, the patient should also be aware of these differences.
Hijama in the condition of strength The simplest method of Hijama is that used for general health promotion and the Nabi (SAW) used the most common method. In this type of Hijama there is no serious complaint by the patient that would warrant a special type of Hijama or the use of “special” Hijama points other than the standard points on the back, neck or head. This is traditionally termed as Hijama-bi-Sihhat (Hijama in the condition of health), many also refer to it as “sunnah cupping”. Both terms are not correct however as the Rasool of Allah (SAW) had cupping done both in health and as a treatment for particular pains and ailments, and it is also rare to find someone nowadays with absolutely no illness.
I prefer the term Hijama in strength, referring to performing Hijama for someone who is of general good health and strength. Such a patient may however complain of general symptoms such as a feeling of sluggishness, tiredness etc, they may also have a regular habit of doing Hijama and are aware of the benefits it has for them personally, or they are trying this method of health preservation for the first time under recommendation from their friends or acquaintances. Their general health is good, and very importantly their pulse is strong indicating a healthy amount of blood and also a good amount of heat in the blood. They may also be suffering from a constitutional blood or heat excess as is common in hot climates. If the pulse is weak or deep then this type of Hijama is not indicated as it means that there is deficient blood or the heat of the body is internal and not in the exterior parts of the body. In this type of Hijama care is taken to observe the rules of Hijama with regard to the condition of the patient, as well as the season, climate, day of the lunar month and time of the day in which Hijama is performed as this greatly influences the nature of blood that will be removed.
Not observing these and performing this type of general Hijama outside of its recommended times will not result in any benefit for the patient and will very often result in long term harm for the patients health. This may not be apparent immediately after the procedure, but will be noticed in the months and even years to come afterward.
When applying Hijama in the condition of strength the areas being cupped are standard, these are mentioned in the Ahadeeth: Hadhrat Abu Kabsha (Radhiallaahu Anhu) narrates that Rasulullaah (Sallallaahu Alayhi Wasallam) used to undergo cupping on the head and between his shoulders and he used to say, ‘Whosoever removes this blood, it will not harm him that he does not take any other medical treatment.’ (Mishkat p. 389)
From examining the various Ahadeeth and by consensus of those experienced practitioners of Hijama the areas used in this general form of Hijama are.
For a man: The area between the shoulder blades, most commonly in line with the inferior end of the scapula which is in line with the 7th thoracic vertebra.
Sometimes other points lateral to the spinal column between the spinouts processes of the 6th to 9th thoracic vertebrae are used. This particular area is the best for performing general Hijama as it is the area where toxins and impurities in the blood accumulate and stagnate especially around the 17th. 19th and 21st of the month.
In Traditional Chinese Medicine this point is regarded as the meeting point of the blood and is used for all blood disorders whether due to deficiency or excess.
2. The occipital area of the neck in the recesses formed between the upper portion of the sternocleidomastoid and the trapezius muscles. This is in the region of a commonly used acupuncture point called Feng Chi, which means “wind pool”. It is believed that many pathogens enter the body at this area and that is why it is recommended to cover this area when it is cold or windy. Treating this area is helpful in resolving a number of common ailments of the head and neck, including headache, vertigo, pain/stiffness of neck, blurry vision, red/painful eyes, tinnitus, nasal obstruction, common cold, and rhinorrhea (runny nose, nasal discharge associated with allergies or hay fever or common cold). It’s also very useful for insomnia, and tends to have a relaxing and balancing effect upon the nervous system.
3. On the head in the midline, the exact point is normally directly above the apex of the ear: In Traditional medicine this point corresponds with the acupuncture point called Bai Hui, meaning a hundred convergences and is the meeting point of all the yang energy of the body. It is commonly used to treat all mental, emotional disorders, but also useful for headaches, epilepsy, neurological and endocrine disorders.
4. On the anterior aspect of the foot in a depression distal to the junction of the 2nd and 3rd metatarsal bones. This area is traditionally used to treat swelling, headache, dizziness / vertigo, abdominal pain, bloating, constipation. It can also aid 5 groundedness and focus and treat ADD /ADHD, mania, restlessness, palpitations and epilepsy. In women the same areas are used except for the Hijama point on the head but the quantity of blood removed is less.
Note that women are not in need of regular Hijama as they do release blood through the menses, if they have experienced menopause then it is fine to do as long as they are still strong and not suffering from blood deficiency in which case one must observe the rules of performing Hijama in illness.
Days for performing Hijama in strength Anas ibn Maalik (RA) reported that the Rasul (SAW) said, “Whoever wants to perform Hijama then let him search for the 17th, 19th and 21st…” Saheeh Sunan ibn Maajah (3486). These are the generally accepted dates to- Hijama, irrespective of what day of the week they fall on, though there are other Ahadeeth that seem to prohibit having it done on particular days of the week, these Hadeeth are categorized as Daeef however and as such the days mentioned in them are not strictly prohibited, they are mentioned here for completeness: Ibn Umar (RA) reported that the Rasul (SAW) said, “Hijama on an empty stomach is best. In it is a cure and a blessing. It improves the intellect and the memory. So cup yourselves with the blessing of Allaah on Thursday.
Keep away from Hijama on Wednesday, Friday, Saturday and Sunday to be safe. Perform Hijama on Monday and Tuesday for it is the day that Allah saved Ayoub from a thai. He was inflicted with the trial on Wednesday. You will not find leprosy except (by being cupped) on Wednesday or Wednesday night.” [Sunan ibn Maajah (3487). Ibn Umar (RA) reported that the Rasul (SAW) said, “Hijama on an empty stomach is best. It increases the intellect and improves the memory. It improves the memory of the one memorising. So whoever is going to be cupped then (let it be) on a Thursday in the name of Allah. Keep away from being cupped on a Friday, Saturday and Sunday. Be cupped on a Monday or Tuesday. Do not be cupped on a Wednesday because it is the day that Ayyub was befallen with a trial. You will not find leprosy except (by being cupped) on Wednesday or Wednesday night.” [Sunan ibn Maajah 3488].
In reconciling these it can be said that for Hijama in strength, the dates are specified, they are the 17th, 19th or 21st of the lunar month and the best is when these dates coincide with a Monday, Tuesday or Thursday, though there is no prohibition for having this type of Hijama done on any other day as long as it corresponds with the 17th, 19th and 21st. (There is difference of opinion regarding the prohibition on particular days of the week, since another way of reconciling is considering that the Nabi of Allah (SAW) in the above two Ahadeeth was referring to that particular month in which the Hadeeth was narrated and referring directly to the days of that week and the week after. If Thursday was the 19th, then the previous Friday, Saturday and Sunday would be the 13th, 14th and 15th, and on these days of the Islamic month it is mentioned that cupping should not be done, Monday and Tuesday would be the 16th and 17th which would be okay for cupping, since they are after the full moon. Wednesday being prohibited in this case would be the exact day of the year that corresponded with the illness of Nabi Ayyub (AS), and Thursday being the ideal day to perform Hijama. It is important to note that this type of Hijama (i.e. Hijama in strength /Sunnah Hijama) should be performed only in the seasons of spring andsummer. When the climate is hot.
However, in places like Hejaz where it is hot throughout the year it can also be performed in the other Season. Further detail is discussed in the chapters of the guidelines for performing Hijama. Hijama in illness When a patient is complaining of a particular condition, i.e. they are not in good health, but suffering from a particular illness for which Hijama is indicated then this is termed Hijama-bil-Marz (Hijama in illness).
In illness the rules of Hijama are different. For this reason Imam Ahmad ibn Hanbal would have Hijama at any time of the month and hour of the day as a result of the need of performing Hijama due to illness. When performing Hijama for a specific illness it should be done at those points of the body indicated for the illness and the rules of the amount of blood being removed 7 etc. should be adhered to for maximum benefit. These are discussed in the Hijama treatment guide.
This type of Hijama is very specialized and involves two major aspects, the correct selection of points (or superficial yeins) to bleed and removing the correct amount of blood in order to effect cure of the patient’s illness. It is also highly recommended to use herbal preparations in association with the Hijama to address deficiencies/excesses present and treat cold or heat that is present.
Phlebotomy vs Hijama
Phlebotomy is often confused with Hijama yet the two are very different in their method and effect on the body.
Phlebotomy is the bleeding of veins via the use of a hypodermic needle and results in releasing of blood from the inner parts of the body as opposed to the outer part which is achieved through traditional Hijama. It will also be regarded as part of bloodletting, but not Hijama, as there are significant differences in the use of these two types of bloodletting.
To understand the difference it is important to remember that the land of Hijaaz (where the Ahadeeth of Hijama are reported) is hot. Hot and cold temperatures have different effects on the blood flow and distribution in the body. In hot countries, and other countries in the hot season, the blood and heat of the body flows more within the outer part of the body, and ”the inner parts remain cool and relatively deficient of blood. For this reason perspiration increases in summer and because of the inner organs etc. being cooler, foods take longer to digest, and many summer-heat type illnesses occur.
In cold countries, and in winter, the blood and heat of a person’s body goes to the inner portions. As a result the digestive system is strengthened, more sleep is experienced, and food is digested easily. For this reason rich foods digest easily in winter, and take more time in summer. This is also the reason honey; dates and other heat creating foods do not affect the people of Hijaaz.
In Hijama, the blood in the outer parts of the body is removed, and in Hijaaz the heat is more on the outer parts of the body, therefore, Hijama is more beneficial in hot countries and hot climates.
In phlebotomy blood is let from the hypodermic veins and reduces heat from the inner parts of the body, therefore it will not be beneficial in hot countries and climates and was hence not a practice of the Nabi (SAW). Drawing blood from the veins beneath the superficial skin layer is considered phlebotomy and does not have the same effect as traditional Hijama The effects of Hijama on the body The simplest explanation of Hijama’s effects is common in all cultures that perform Hijama, viz. the removal of “bad” blood or impurities from the blood.
This is a common theme whether it is from the Indians of North America to lay practitioners in western countries. Some may also use it for its ability to remove the effects of “sihr” or “black magic” as well as “nazr” or the “evil eye”. The latter concepts are beyond the scope of this book but suffice to say that these are valid effects of Hijama.
Common effects of Hijama
1. Removal of “bad” blood or impurities from theblood
2. Treatment of Sihr or Nazr: There are other effects that are explained in more detail in,a number of traditional medical systems as well as through modern scientific research.
Understanding these is important as it allows for the correct selection and application of Hijama techniques depending on the patient and the illness they are presenting with. Amongst the traditional medical paradigms, Unani-Tibb and Traditional Chinese Medicine are the most detailed in terms of understanding why and how Hijama works in maintaining health and treating illness. Unani-Tibb is practiced in the Graeco-Arab region as well as by Unani practitioners throughout the world.
Traditional Chinese Medicine is practiced in the Asian regions and also by practitioners throughout the world and these two have similar philosophies with regards to the effect of Hijama. Unani-tibb is a form of traditional medicine widely practiced by Muslims and is largely based on the teachings of the Greek physician Hippocrates, and Roman physician, Galen, which was developed into an elaborate medical System by Arab and Persian physicians, such as al-Razi, Ibn Sena, Al-Zahrawi, and Ibn Nafis.
Muslim practitioners are referred to as a Hakim, literally meaning “wise”. Unani philosophy is based on the concept of the four humors: Phlegm (Balgham), Blood (Dam), Yellow bile (Safra”) and Black bile (Sauda1). It maintains that disease occurs through imbalance, or contamination, of the 4 humors, or alternatively as a result of the body being weak. It is Very much concerned with the temperament of the body and considers aspects such as heat, coolness, dryness, phlegm and moisture and how these cause and contribute to illness.
Bloodletting acts to, remove contamination in the blood, rebalance the humors and draws excessive heat out of the body. In the case of traditional Hijama (as opposed to phlebotomy) this heat will be drawn from the outer parts of the body, though there are indirect effects on the internal organs and systems. Contemporary Unani practitioners believe that Hijama acts to draw inflammation and pressure away from the deep organs (especially the heart, brain, lungs, liver and kidneys) towards the skin. This facilitates the healing process. They also explain that this process strengthens the immune system, encouraging the optimum functioning of the body by assisting the actions of Physis.
It diverts toxins and other harmful Impurities from these vital organs towards the “less-vital skin”, before expulsion. The blood that is diverted also then allows for a fresh ‘stream’ of blood to that area.
Effects of Hijama as per Unani-Tibb
3. Diverts and expels toxins and harmful impurities from the vital organs
4. Removes excess blood
5. Removes excess heat from the blood and surface of the body
6. Draws inflammation away from the deeper organs
7. Assists the body’s own healing abilities
10 Traditional Chinese Medicine (TCM) is similar to Unani-Tibb in its concept of “Humors”, though in the case of TCM it is the balance of 5 phases/elements viz. water, fire, wood, earth and metal and their correspondences in the body.
TCM however also adds the concept of proper movement and flow of blood and “qi” throughout the body. Qi is the vital energy of the body that is responsible for directing all the body’s functions. It moves within the blood and it also moves the blood itself. Qi is present in different forms, it includes but is not limited to the energy of the heart and lungs as they contract and expand, the force of the muscles in the body that open and close the various sphincters and also allow for bodily movement. It is also’ responsible for many phenomena of the body that would be attributed to the “soul” and even the “nafs” and is something that permeates the entire body but departs when a person dies, whereas the blood and form of the body remains.
In Traditional Chinese Medicine, it is believed that health is maintained when the blood and “qi” flow smoothly throughout the body. When there is stagnation or stasis this leads of disease which can be systemic, affecting the whole body, or local affecting a particular organ or part of the body.
Hijama is particularly effective at relieving this “stasis” and acts to restore proper flow especially of blood but also of qi in the body or local region. Stagnation or stasis is not the only pathology however that Hijama treats within TCM. In TCM there is a disease differentiation system called the 8 patterns.
In this system it is determined whether a disease is internal or external, hot or cold, excess or deficient and yin or yang. This matrix is then used to determine the core nature of an illness. When this system produces a pattern that is excess and heat related then Hijama is indicated. Excess heat patterns include Internal pathologies such as blood heat, blood toxins, liver heat, heat rising up in the body, stomach fire, large intestine fire, heart fire etc. and can be effectively addressed by hijama or bloodletting. “These patterns are characteristically defined by their being an “internal”, “excess”, “hot” pattern of disease. “External” excess heat patterns correspond with febrile infectious diseases and can also be effectively addressed by bloodletting. These include traditional Chinese medicine patterns such as invasion of wind-heat, toxic heat, spring warm etc.
Normally Hijama is not indicated when it is deficient heat pattern of any type of cold pattern except where there is significant stagnation. If it is used in these cases only a small amount of blood is removed so as not to worsen the “deficiency” or “cold” aspect of the disease.
In terms of the deeper principles of yin and yang, bleeding can also be used in cases of blood deficiency. For these cases a small amount of blood is removed which then has the effect of stimulating blood production.