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Journal of Drug Delivery and Therapeutics
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Open Access Full Text Article Review Article
Exploring Hijama (Cupping Therapy) for Sciatica Relief: An Integrative Review of Unani Practices
Saif Ali Siddiqui 1*, Mohammad Shoaib 2, Asia Sultana 3
Lecturer, D/O Ilaj-Bit-Tadbeer, Markaz Unani Medical College, Kozhikode, Kerala, India 1
Assistant Professor, D/O Ilaj-Bit-Tadbeer, A.M.U, Aligarh, Uttar Pradesh, India 2
Professor, D/O Ilaj-Bit-Tadbeer, A.M.U, Aligarh, Uttar Pradesh, India 3
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Article Info: ___________________________________________ Article History: Received 19 April 2024 Reviewed 02 June 2024 Accepted 22 June 2024 Published 15 July 2024 ___________________________________________ Cite this article as: Siddiqui SA, Shoaib M, Sultana A, Exploring Hijama (Cupping Therapy) for Sciatica Relief: An Integrative Review of Unani Practices, Journal of Drug Delivery and Therapeutics. 2024; 14(7):116-119 DOI: http://dx.doi.org/10.22270/jddt.v14i7.6655 ___________________________________________ *Address for Correspondence: Saif Ali Siddiqui, Lecturer, D/O Ilaj-Bit-Tadbeer, Markaz Unani Medical College, Kozhikode, Kerala, India |
Abstract ___________________________________________________________________________________________________________________ Background: Since ancient times, Unani physicians have controlled certain illnesses by altering the metabolic process using a variety of therapeutic approaches. Some treatment tenets have been promoted by Ibne-sina (Avicenna). Regimenal therapy is a fundamental approach to treatment that aims to eradicate sick matter, control excessive production, control its spread, and resolve it by specialised approaches, ultimately restoring humoral equilibrium. Hijama (Cupping) is one such operation. The Arabic word "Hijamat" (from the phrase “Hajm”) means "volume", but it is also used to refer to sucking. Additionally, it might indicate "to minimise", "to return to basic size", or "to reduce the volume". One of the most prevalent symptoms of Irq-al-nasa (Sciatica) is lower limb neuralgic pain. This illness has the potential to become persistent and chronic, with significant socioeconomic consequences. Its overall incidence is estimated to be between 13% and 40%. Objective: Mainstream therapists primarily treat Sciatica with medication, surgery, or occasionally both. There should be an efficient substitute for evidence-based medicine because of its negative impacts, high cost, and disease-centric approach to treatment. Extensive research has been conducted to investigate the potential benefits of this traditional treatment plan for the management of Sciatica. Keywords: Cupping, Irq-al-nasa, Sciatica, Hijama, Unani medicine |
Introduction
The amalgamation and ideas of various experiences and expertise have given rise to the Unani medical system. Buqrat, also known as Hippocrates, initially proposed it in Greece around the fourth and fifth centuries B.C. Its tenets hold that maintaining health, illness, and all of its manifestations are natural processes; hence, maintaining health requires ensuring that all physiological processes are operating normally. Illness results from any disruption of the regular humoral balance, be it an excess, decrease, or obstruction. Since ancient times, Unani physicians have controlled certain illnesses by altering the metabolic process using a variety of therapeutic approaches. The treatment guiding principles, according to Ibne-Sina 1 (Avicenna), are: Ilaj bit tadbeer wa Taghzia (Diet and Regimental Therapy); Drug therapy (Ilaj bil Dawa); Surgery (Ilaj bil Yad). Regimenal therapy is a fundamental approach to treatment that aims to eradicate sick matter, control excessive production, stop its spread, and resolve it by specialised approaches, ultimately restoring humoral equilibrium. Hijama (Cupping) is one such regimen.
Hijama and Its Classification
The Arabic word "Hijama" is derived from the word "Hajm," which is meant to refer to volume but is more commonly used to describe sucking. It can also imply to reduce, to a minimum, or to a fundamental size or volume. The ancient technique known as Hijāmat was particularly utilised by the Chinese, Babylonians, Egyptians, Greeks, and others. Commonly utilised for the purpose were ceramic cups, bamboo cups, and animal horns that had been hollowed out. 2 The significance of this regimen can be determined by considering the wise words of Hazrat Mohammed, the holy prophet of Islam: Hijama is the best remedy you have.3Although there are essentially two main forms of hijama, but according to procedure there are actually three forms as: 4
Hijama Bil Shart (Wet Cupping)
It is actually a bloodletting technique called Tadbeer Istefragh, where the sickness is caused by Damvi Madda (Sanguinous matter), which has to be removed. Consequently, the human body has designated multiple locations for the application of the hijama.
Hijama Bila Shart (Dry Cupping)
It is a method of applying cups, horns, clay pots, etc. across the human body's muscular surface to produce a vacuum. There are two ways to perform this procedure:
Hijama Bila Naar (Cupping without fire)
This procedure can be performed by the several methods:
Hijamat Bin Naar / Mehjama Nariya (Fire Cupping)
This procedure also can be done by different techniques.
General Principles of Hijama:
Ibne Sina has discussed about Hijāma beside its description in detail and has pointed out certain important principles which are as follows:
Procedure of Hijama (Cupping):
The patient is placed in a comfortable position (either sitting or lying down) and the area that has to be cupped is made visible. In order to secure the cups firmly on the body, shaving is necessary if the area is hairy. If they don't fully adhere to the skin, air may seep into the cups and the adhesive force will be compromised. After that, warm water is applied to the area with a sponge to promote blood flow. Subsequently, the cone-shaped piece of paper is burned using a candle or lamp. After wards the burning paper is inserted into the cup and opening of the cup is placed on the skin of the particular area. Consequently, a significant amount of air within the cup will be burned by the burning paper, creating a negative pressure that will solidify the cup's adhesion over the affected area.
In the end, there will be more traffic in the neighbourhood, which will make the space extremely crowded. The superficial vaso-dilatation that occurs as a result of the tugging effect on the skin and the elevated warmth inside the cup contributes to an enhanced vascular circulation. Because of this, blood cups are so abundant that they tend to tug on the skin for a period, which partially stops the collected blood from interacting with the circulation. After fifteen to twenty minutes cup is removed from the body. The cup is removed by holding its belly between the thumb and forefinger of one hand and simultaneously depressing the skin of adjacent area by the other hand. This is the method of Hijāmat-e-NariyaBila- Shart, when its purpose is to increase the blood flow or to divert the humours towards the site of Hijāma.
In case of Hijāmat-e-Nariya bil- Shart, the region is treated with medical antiseptics following the aforementioned processes. The cup is then swiftly placed back on the site to begin sucking blood after a few small cuts are made on the swollen patch of skin with the edge of a sharp, sterile blade.
Cups are fixed till the sucking process is finished. After that, the blood-filled cup is removed as previously described, the region is thoroughly washed with an antiseptic, and sterile dressing is applied.
Although Hijāma-e-Ghair-Nariya is also completed in the same way, the cups are fixed and removed using a different technique. Cups have evolved into extremely customised and sophisticated objects with the introduction of new methods and instruments. These altered cups come with a hand-operated pump and a valve on top. The cup is fixed to the skin by keeping its edges over it and using a suction pump to draw out air from the cup to generate a vacuum. Likewise, to extract the cup, just use your thumb and forefinger to draw up the valve. By pulling the valve, air will be allowed into the cup, and it will separate on its own. 7
Glass cups, Vacuum pump, Medical antiseptics, Lamp or Candle, Small paper, Sterilized gloves, Sterilized medical scalpel,Cotton roll, Sterilized gauze, Micro pore tape, Razor to remove the hair of the site if needed.8
According to Unani physician Rāzi's book Al-Hāwi, enema is more beneficial for treating Irq-al-nasa (Sciatica) than purgation; nevertheless, if thick humours accumulate in the hip joint, Hijāmat becomes necessary and offers significant advantages over alternative treatments. According to Rāzi, when the disease initially affects the site of pain, hip surgery will be performed using the Hijama-bil-Shart and Hijāma-Bila-Shart techniques. He goes on to say, Hijāma, becomes very useful for this condition if the humours in the affected joint become thick due to improper treatment".10
Regarding the treatment of sciatica, Unani book “Kaamil-us-Sana” states that Hijāma-e-Nariya is crucial since it draws material from the joints towards the skin. This is especially true when the disease becomes chronic and drug treatment is ineffective.11 Ibne Sina notes under the treatment of Irq-al-nasa that Hijāma (cupping) with or without scarification over the hip will be beneficial if the pharmacological treatment is insufficient to address the issue.
Ismail Jurjani has expounded upon Hijāma in relation to Waja-ul-Warik (low backache) and Waja-ul-Aqab. He says if the patient has a sedentary lifestyle, it is best to keep him on a fast and prescribe activity after the general evacuation. Only morbid humours should be removed towards the surface of the diseased area if these Tadabeer (means) fail to alleviate the illness. Hijama-e- Nariya (cupping with fire) achieves this goal. Hijāma attempts made repeatedly, in which a large amount of blood is sucked, usually result in the situation being relieved by the removal of morbid materials from the joints. 12
Unani physiacian “Azam Khan” states, "Last but not least, Tadābeer (measures) that have Muhallil (anti-inflammatory) and Mulattif (demulcent) effects should be carried out in the management of sciatica in order to remove the deeply seated materials to the surface of the body." These Tadābeer recipes contain Hijama (Cupping), Muhammir (Rubifacient drugs) paste of garlic, onion, nargis, baladur, and fig; however, some laxative medications should also be used in addition to these recipes to prevent dry joints. 13 This indicates that the hijab has anti-inflammatory and calming properties in addition to causing diversion and evacuation. According to the aforementioned quotation, Hijāma can be helpful in treating Waja-ul-Warik (low backache), Waja-ul-Mafasil (Joints pain), and Irq-al-nasa (sciatica).
Various theories are put forth as to the benefits of the Hijamat Bila Shart; one theory suggests that with the increase in circulation over the area of procedure, the morbid matter is eliminated from the desired area. The site of cupping not only improves circulation but also provide nutrition.14
Cupping without bloodletting works on the principal of Imaale-mawaad i.e. diversion of morbid humours from one site to another. In case of Mehjama Nariya, due to combustion of air inside the cups, the air becomes warm, and helps in retracting the muscular surface, causing pulling of the area beneath the cups immediately after its application resulting in relief of pain.15 Blood cupping has a neuro-modulating input into central nervous system activating CNS multiple analgesia systems and stimulating pain modulation system to release neurotransmitters such as endogenous opioids.14 Another possible mechanism that may explain the analgesic effect of cupping therapy is that vigorous sensory stimulation can produce a sharp decrease in pain for varying periods of time due to blocking of messages from sensory nerves carrying pain impulses by faster moving impulses, this mechanisms is called gate control theory.16 Bloodletting cupping might exert effects on inflammation in that injury to the skin leads to release of β-endorphin and adrenocortical hormone into circulation. Both are helpful in blocking the inflammation in arthritis.17The physiological mechanism through which wet cupping might function remains unknown. It has been suggested that the effects of wet-cupping can be divided into several components, including neural, hematological, immune and psychological effects.
Hijama is essential for managing sciatica as long as the regimen is applied carefully and all relevant information is taken into account. In addition to the treatment methodology's essential importance, there exists an issue with the absence of consistent standard operating procedures. Because this therapy is inexpensive, easy to administer, and free of side effects, it appears imperative to standardise it and establish specific scientific criteria for assessing its effectiveness. Therefore, in order for a large segment of society to benefit from this regimen, scientific studies are being conducted to validate it in several Unani research institutions across India. It is necessary to assess this therapy for preventive use in order to prevent some of the upcoming sickness episodes or bouts.
Acknowledgement
I would like to extend my gratitude to all the authors for their kind guidance and cooperation, authors whose references quoted and the journal reviewers for pointing out certain discrepancies. There is no any conflict of interest.
References