Cupping Therapy Encyclopedia: New Edition 1986200485, 9781986200486

This book describes the history, methods, and techniques of cupping therapy and provides practical guidelines for cuppin

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Cupping Therapy Encyclopedia A New Edition

Tamer Shaban

Tamer Shaban

Copyright © 2018 Tamer Shaban All rights reserved. ISBN-13: 978-1986200486 ISBN-10: 1986200485

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DEDICATION To my parents, To my wife, To My Children, To my professors With love.

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Tamer Shaban

Disclaimer Although the author and publisher have made every effort to ensure that the information in this book was correct at press time, the author and publisher do not assume and hereby disclaim any liability to any party for any loss, damage, or disruption caused by errors or omissions, whether such errors or omissions result from negligence, accident, or any other cause.. All information in this publication is for educational and information purposes only. Please consult your own physician for diagnosis or treatment of any health-related problems. The publisher and author are not responsible for any specific health or allergy needs that may require medical supervision and are not liable for any damages or negative consequences from any treatment, action, application or preparation, to any person reading or following the information in this book. The Information on This publication does not dispense medical or professional advice, nor do they prescribe any treatment or strategy that should be tested without the advice of a professional. This book is not intended as a substitute for the medical advice of physicians. The reader should regularly consult a physician in matters relating to his/her health and particularly with respect to any symptoms that may require diagnosis or medical attention.

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Cupping Therapy Encyclopedia - New Edition

Table of Contents

DEDICATION ...................................................................................... 3 Disclaimer.............................................................................................. 4 Chapter 1 ............................................................................................. 10 Traditional and Complementary medicine ......................................... 10 What is complementary medicine?...................................................... 11 Cupping Therapy ................................................................................. 14 History of Cupping .............................................................................. 14 Cupping Therapy in Egypt .................................................................. 15 Cupping Therapy in China .................................................................. 15 Greek History of Cupping ................................................................... 17 Cupping Therapy in Arabic and Islamic culture.................................. 18 Cupping Therapy in the West .............................................................. 20 Chronological Cupping Methods......................................................... 21 The Peak of Cupping Therapy: ............................................................ 25 Chapter 2 ............................................................................................. 28 Cupping therapy types and equipment ................................................ 28 Classification of cupping therapy types............................................... 29 New classification of cupping therapy types ...................................... 30 Technical types .................................................................................... 32 Dry Cupping: ....................................................................................... 32 Flash Cupping:..................................................................................... 34 Wet Cupping........................................................................................ 35 Massage Cupping ............................................................................... 37 The power of suction-related types: .................................................... 40 Light Cupping ..................................................................................... 41 Medium Cupping ................................................................................. 41

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Strong Cupping .................................................................................... 42 Pulsatile Cupping Therapy .................................................................. 44 Fire Cupping Therapy.......................................................................... 45 Manual vacuum Cupping Therapy ..................................................... 47 Electrical vacuum Cupping Therapy ................................................... 48 Added therapy related types ................................................................ 49 Needle Cupping .................................................................................. 49 Hot Cupping ....................................................................................... 50 Herbal Cupping .................................................................................. 52 Magnetic Cupping Therapy ................................................................ 52 Laser Cupping Therapy ....................................................................... 53 Electric stimulation Cupping Therapy ................................................. 54 Aquatic cupping................................................................................... 56 Water Cupping..................................................................................... 57 Condition and area treated related types.............................................. 58 Pedi cupping ....................................................................................... 58 Abdominal Cupping: .......................................................................... 59 Facial Cupping .................................................................................... 59 Female cupping .................................................................................. 60 Male cupping ....................................................................................... 61 Sports Cupping .................................................................................... 62 Types of Cups ...................................................................................... 63 Cupping equipment ............................................................................. 68 Cupping Therapy sets .......................................................................... 69 Chapter 3 ............................................................................................. 72 Effects and mechanisms of action of Cupping Therapy ...................... 72 Cupping Therapy effects ..................................................................... 73 The suggested equations of the cupping effects .................................. 76 Mechanisms of action .......................................................................... 77

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Cupping Therapy Encyclopedia - New Edition

Reflex zones theory ............................................................................. 79 Meridians system theory...................................................................... 86 Chapter 4 ............................................................................................. 88 Cupping Therapy in practice ............................................................... 88 Cupping Indications............................................................................. 89 Classification of Cupping Therapy indications ................................... 90 Cupping contraindications ................................................................... 90 Cupping Therapy for home use ........................................................... 91 Chapter 5 ............................................................................................. 94 Professional Cupping Therapy practice ............................................... 94 Performing Cupping Therapy .............................................................. 98 Cupping therapist - Patient relationship .............................................. 99 Cupping Therapy patient positions .................................................... 101 Cupping Therapy techniques ............................................................. 102 Clean Cupping Therapy technique .................................................... 102 Sterile Cupping Therapy technique .................................................. 104 Cupping Therapy methods................................................................. 105 Wet cupping....................................................................................... 108 Massage cupping ............................................................................... 113 Dry Cupping Therapy ........................................................................ 114 Needle cupping .................................................................................. 114 Water cupping ................................................................................... 115 Protocols of Cupping Therapy Treatments ........................................ 116 Chapter 6 ........................................................................................... 118 Safety of Cupping Therapy................................................................ 118 Cupping Therapy Adverse Events ..................................................... 119 Cupping Skin reactions (marks) ........................................................ 122 Dermatitis bullae ............................................................................... 125 Skin Infection .................................................................................... 126

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Panniculitis ........................................................................................ 127 Koebner Phenomenon........................................................................ 128 Cupping skin edema .......................................................................... 129 Post cupping scars ............................................................................. 129 Skin Ulcers ........................................................................................ 131 Lymphedema .................................................................................... 132 Vasovagal attack ................................................................................ 132 Anemia .............................................................................................. 135 Hepatitis............................................................................................. 136 Acquired hemophilia A .................................................................... 137 Cupping Safety .................................................................................. 138 Infection Control Measures ............................................................... 139 Refer and follow-up ........................................................................... 144 Chapter 7 ........................................................................................... 148 Cupping Therapy points .................................................................... 148 Front Points ....................................................................................... 152 Back Points ....................................................................................... 154 Head Areas and points ....................................................................... 156 Cupping Therapy points for some diseases ....................................... 157 Cupping Therapy for health promotion ............................................. 157 Cupping for pain related conditions .................................................. 159 Cervical pain ...................................................................................... 159 Frozen Shoulder................................................................................. 161 Knee pain ........................................................................................... 163 Acute Lumbar Sprain......................................................................... 165 Sciatica and low back pain ................................................................ 166 Headache ........................................................................................... 169 Cupping for Systemic diseases .......................................................... 173 Autoimmune diseases ....................................................................... 173

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Cupping Therapy Encyclopedia - New Edition

Rheumatoid Arthritis ......................................................................... 173 Gout ................................................................................................... 175 Urticaria ............................................................................................. 178 Respiratory diseases .......................................................................... 182 Bronchitis .......................................................................................... 182 Bronchial Asthma .............................................................................. 186 Digestive diseases .............................................................................. 190 Irritable bowel syndrome & spastic colon ......................................... 190 Chronic gastritis................................................................................. 193 Chronic diseases ................................................................................ 195 Hypertension...................................................................................... 195 Obesity and Weight Reduction .......................................................... 200 Diabetes Mellitus ............................................................................... 203 Neurological diseases ........................................................................ 207 Facial paralysis .................................................................................. 207 Carpal Tunnel syndrome ................................................................... 209 Women Health conditions ................................................................. 210 Amenorrhea ....................................................................................... 214 Female infertility ............................................................................... 217 Pediatric diseases ............................................................................... 221 Enuresis ............................................................................................. 221 Men's health conditions ..................................................................... 224 Male infertility ................................................................................... 224

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Tamer Shaban

CHAPTER 1

TRADITIONAL AND COMPLEMENTARY MEDICINE

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Cupping Therapy Encyclopedia - New Edition

WHAT IS COMPLEMENTARY MEDICINE?

Complementary medicine (CM) is a group of healing methods, practices or treatments outside the mainstream healthcare system. Complementary medicine may be used together alongside Western medicine and includes therapies such as acupuncture, cupping, aromatherapy, massage, and much more. Alternative medicine is the use of traditional healing practices instead of conventional medicine. However, most non-mainstream health practices are used together with conventional medicine.

What is integrative medicine? Integrative medicine has variety of definitions, but describes the use of complementary and conventional medicine practices in a coordinated way.

What is traditional medicine? Traditional medicine is defined by the World Health Organization (WHO). " Traditional medicine is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance

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of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness." In Africa, up to 80% of the population uses traditional medicine for primary health care, while 30-50% in China use traditional medicine, 70% in Canada, 50% in Europe and North America, and 90% in Germany, as shown in figure (1). The World Health Organization supports the use of traditional and complementary medicine and published the "WHO Traditional Medicine Strategy 2014–2023" and "WHO Traditional Medicine Strategy 2002–2005". The sixty-second World Health Assembly, held in Geneva from 18 to 22 May 2009, encouraged

participating

countries

to

consider

traditional

and

complementary medicine as an important part of the healthcare system.

Why do people use traditional and complementary therapies? People use complementary medicine for a variety for reasons. In some countries, traditional medicine is one of the main sources available for providing primary healthcare services, especially in rural areas. Traditional medicine is a part of some countries' cultures, so people turn to these healing methods due to their beliefs and historical use. And sometimes, people use traditional medicine as a complementary method of healing, especially in developed countries, for many reasons.

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Cupping Therapy Encyclopedia - New Edition

DATA EXTRACTED FROM WHO (WORLD HEALTH ORGANIZATION) WEBSITE – TRADITIONAL MEDICINE

Many insurance companies offer professional liability coverage for complementary and alternative medicine practitioners and therapists. According to the National Health Interview Survey, adults in the United States spent about $33.9 billion on alternative therapies in 2007. Most expenses ($22 billion) covered self-care products, materials, classes and homeopathic medicine, and $11.9 billion was spent on practitioner visits. There are 38.1 million adults who made an estimated 354.2 million visits to practitioners, most of these visits to body-based and manipulative

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complementary and alternative medicine practitioners.

CUPPING THERAPY

Definition: Cupping Therapy is an old treatment method in which cups are applied to certain points or areas on the skin, either by heat or suction, to get health benefits.

HISTORY OF CUPPING

Cupping Therapy is one of the oldest healing techniques. It has been practiced effectively for thousands of years and was the base of healing practices for many of those years. Cupping Therapy has been practiced by most of the world, east and west. No one knows exactly where the root of Cupping Therapy practice was.

The Ancient Chinese and

Ancient Egyptians were the first to record their practice of it and as a matter of fact, most ancient medical textbooks that mention Cupping Therapy were written by ancient Egyptians.

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Cupping Therapy Encyclopedia - New Edition

CUPPING THERAPY IN EGYPT

Cupping Therapy was practiced in Egypt for thousands of years. The ancient medical book known as the Ebers papyrus was written in 1550 B.C.E, but is believed to have been rewritten from earlier texts, so the information it contains may be even older. The Ebers Papyrus contains about 110 pages, which when unrolled would be more than 20 meters long. The Ebers Papyrus mentions Cupping Therapy. Ancient Egyptians used wet cupping to remove foreign matter from the body.

They

prescribed Cupping Therapy for most diseases, and passed the practice on to the Greeks.

CUPPING THERAPY IN CHINA

Chinese medicine is one of the oldest medical systems in the world. TCM, or traditional Chinese medicine, uses many healing therapies and practices including acupuncture, herbal medicine, massage and Cupping Therapy. Cupping Therapy is a cornerstone in Chinese medicine. It was used successfully for thousands of years for the treatment of many illnesses.

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The oldest discovered book to mention cupping in China was written by Ge Hong (281-341 AD). Several centuries later, the classic book Su Sen Liang Fang recorded successful treatment of chronic cough and snake bites by Cupping Therapy. In the 1950s, the efficacy of Cupping Therapy was confirmed by medical research done in cooperation between China and Soviet Union. Cupping Therapy is used to stimulate acupuncture points and remove Qi stagnation in the meridians and organs. The points are selected on meridians according to diagnosis of the practitioner and various Chinese medical theories of treatment. Andrew Nugent-Head reports "The use of ashi points (pain points) as the most practical approach to clinical acupuncture".

 We can note that : stimulation of pain points by cupping, acupuncture or massage is one of the principals of Chinese Medicine.

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Cupping Therapy Encyclopedia - New Edition

GREEK HISTORY OF CUPPING

Hippocrates (460 BC –370 BC) was one of the greatest figures in the history of medicine and is called the father of western medicine. The Hippocratic Oath was the first medical ethical expression. Modified versions of the Hippocratic Oath are still a requirement to practice medicine in many countries. Hippocrates recommended using Cupping Therapy for a variety of diseases. Hippocratic physicians used Cupping Therapy for treatment of two conditions in women: uterine prolapse, treated by applying cups on the hip, and postponing menstruation by applying cups to the breasts. Galen (Galenus) (129 AD – 210 AD) was one of the most famous Greek physicians and medical researchers. Galen contributed to the fields of anatomy, physiology, pathology, pharmacology and neurology. Galen was a user of Cupping Therapy and he condemned Erasistratus, an Alexandrian physician, for not using cupping. Then the art of Cupping Therapy was passed through the Alexandrians and Byzantines to Arab Muslims and Asians.

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CUPPING THERAPY IN ARABIC AND ISLAMIC CULTURE

Prophet Mohammed (peace be upon him) treated by cupping (hijama in Arabic) and encouraged his fellows to use cupping (hijama) for the treatment of diseases. He said, ―Cupping (hijama) is the best of your remedies.‖ The points of Prophetic Sunnah: The prophet Mohammed (peace be upon him) used Cupping Therapy as treatment by applying cups on certain points called "Sunnah points". They are about nine points in total.

Prophetic Sunnah points are: Kahil point: This is a point between the shoulders around the 7th cervical vertebra . Akhdaain points: These are two points related to the right and left posterior external jugular veins. Yafookh point: This is located on the top of the head in the middle. Kumohdwuah point: This is located at the base of the skull above the nape cavity.

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Cupping Therapy Encyclopedia - New Edition

Werk points: These are two points located on the left and right of the hips. Top of Foot Points: Two points are located on the tops of the feet. From these teachings, we can note that:  Cupping Therapy on pain points was an Islamic and prophetic medical principal. Between 1 to 3 points are used in each session.

Prophetic Medicine (Al-Tibb al-Nabawi): This is one of the most famous Islamic books and was written by Ibn Qayyim al Jawziyya. It mentions Cupping Therapy as a medical practice. Muhammad Ibn Zakaryia Al-Razi (865 – 925) was one of the best physicians and scientists in history; he was the first to differentiate smallpox from measles, and was described as the father of pediatrics. He benefited from Cupping Therapy in his treatment of many diseases. Ibn sīnā (Avicenna) (980– 1037) was one of the most famous physicians in history, and author of the well-known Book of Healing and The Canon of Medicine. The Canon of Medicine was used as a textbook in the

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university of Montpellier as late as 1650. The Canon of Medicine stated that cupping was known to be effective on more than 30 different diseases.

CUPPING THERAPY IN THE WEST

From the Egyptians, Ancient Chinese and Greeks, cupping spread to the entire world. Cupping Therapy became a popular therapy among European and American doctors, practiced successfully for a wide range of diseases during the eighteenth century and after. Much historically published research reported the efficacy or benefits of Cupping Therapy during the nineteenth century. Charles Kennedy, a famous surgeon, wrote

in

1826:

“The art of cupping has been so well-known, and the benefits arising from it so long experienced, that it is quite unnecessary to bring forward testimonials in favor of what has received not only the approbation of modern times, but also the sanction of the remotest antiquity.” Sir Arthur Keith (1866 –1955) was a Scottish anatomist and a fellow of the Royal College of Surgeons of England and the president of the Royal Anthropological Institute. He was famous because he discovered

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Cupping Therapy Encyclopedia - New Edition

the sino-atrial node in 1907. Sir Arthur Keith wrote how he witnessed cupping performed with excellent success.

CHRONOLOGICAL CUPPING METHODS

Horn Therapy and Mouth Suction: Horn therapy was one of the oldest techniques of Cupping Therapy. Horn therapy involved using a hollow animal horn with an opening on its tip and a piece of wax or a wad of dried grass to close this opening after applying suction. The ancient therapist created the suction by sucking air out with the mouth from the opening on the horn tip. When the preferred suction was achieved, the therapist put in the dried grass or wax with his tongue to close this opening.

Bamboo Cupping and Fire Suction: Bamboo Cupping Therapy was developed later. It involved using bamboo for making cups. One end of the cup

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Tamer Shaban

should be closed by a natural grass. Fire is used to apply suction inside the cup by putting a small piece of paper on the bottom of the bamboo cup and burning it. Skin burns are a risk of this method.

Metal Cups: Cups made from metal, especially bronze, were used for thousands of years. Ancient Egyptians, Romans, and Greeks used these cups. Many ancient bronze cups were discovered which dated back to 300 BCE and beyond. Various medical history and science museums presented ancient bronze cups.

Glass Cups: Glass cups were used for thousands of years. Ancient Romans used glass cups, which dated back to 251-400 AD. Glass cups were developed over centuries. Therapists could apply suction by fire when an ordinary glass cup was used or by suction pump when certain glass cups with a valve on top were used. Glass cups had some advantages, such as their transparency and the ability to sterilize them.

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Cupping Therapy Encyclopedia - New Edition

Manual Suction: Manual suction pump was developed between 1930 and 1940 by putting a valve at the top of the cup and making suction by a manual pump that could make suction of air possible without fire. In 1940, many medical product companies began to make and sell these cupping sets.

Development of historical scarification device: A scarificator was developed to be used in phlebotomy or bloodletting. The instrument had many retracing blades which were fired by moving a certain trigger. A scarificator was used to produce a number of wounds as a part of bloodletting therapy. The depth and shape of blades were expected to produce deep large wounds. This method is no longer used. Auto-lancing device is a recent modern scarificator. Auto-lancing device may produce one or three punctures according to the number of needles inside the device. These single use needles are commonly used as apart of blood sugar measurement devices. The nedles produce small punctures. You can control the depth of the puncture by a ring control on

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Tamer Shaban

the device.

Automatic Suction: Electrical Cupping Therapy involves a new method of suction developed recently. There are many electrical vacuum devices available, including an electrical pump, electrical suction apparatus and electrical suction machines that measure the pressure inside the cup. These devices are commonly used in beauty centers and hospitals.

Modern Cupping Therapy Today there are thousands of

centers

around

the

world offering dry, wet and

massage

treatments

and

cupping courses.

They are located in many countries, including the USA, Europe, South Africa, Middle East, Turkey and the United Kingdom. Many professional associations around the world support these modalities, and many insurance companies offer coverage for some integrative and complementary therapy treatments. The growing number of research papers about Cupping Therapy

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Cupping Therapy Encyclopedia - New Edition

that are being published is one important reason for the growing interest of the international medical community to know more about this therapy.

THE PEAK OF CUPPING THERAPY

Cupping caught peoples‘ attention and interest in 2016, when round marks from Cupping Therapy appeared on Michael Phelps during the Olympic games in Rio 2016. Michael Phelps, who was born in 1985, is the best Olympian athlete in history. He won twenty-eight medals, twenty-three of which were gold. Other athletes in the Rio 2016 Olympic games used Cupping Therapy and appeared with skin marks. So, according to Google Trends, the ―Cupping Therapy‖ search term spiked during Rio 2016, in the second week of August. Many TV channels around the world

presented

reports about Cupping Therapy, and

top

magazines,

journals

and

publications published articles and reports about cupping. People‘s interest in Cupping Therapy increased, and many athletes and celebrities tried Cupping Therapy. Neymar (the famous football player) tried Cupping Therapy, as reported by newspapers.

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Tamer Shaban

Michael Phelps and other athletes in the 2016 Olympic Games were not the first famous people to use cupping. Cupping Therapy marks appeared on the back of Gwyneth Paltrow in 2004. Cupping marks were visible on Jennifer Aniston‘s back in 2013. Many athletes and celebrities have used cupping as a healing method.

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Cupping Therapy Encyclopedia - New Edition

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Tamer Shaban

CHAPTER 2

CUPPING THERAPY TYPES AND EQUIPMENT

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Cupping Therapy Encyclopedia - New Edition

CLASSIFICATION OF CUPPING THERAPY TYPES

The history of the classification of Cupping Therapy types: A previous version of this classification of cupping was published in my previous book.

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Tamer Shaban

NEW CLASSIFICATION OF CUPPING THERAPY TYPES

Cupping Therapy types can be classified into five main categories. The first category is "Technical types," which includes: dry, massage, wet and flash Cupping Therapy. The second category "The power of suction related types" includes: light, medium and strong Cupping Therapy. The third category "Method of suction related types" includes: fire, selfsuction, manual, and electrical vacuum cupping. The fourth category "Added therapy related types" includes: laser, herbal, needle, water, moxa, aquatic cupping, electrical stimulation, ozone, and magnetic cupping. The fifth category "Condition and area treated related types" includes: cosmetic cupping, Pedi-cupping, abdominal, facial, male upping, female cupping, and sports cupping. Please see reference 3 at the end of the book.

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Cupping Therapy Encyclopedia - New Edition

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Tamer Shaban

TECHNICAL TYPES

Technical types included wet cupping, dry cupping, massage cupping and flash cupping.

DRY CUPPING

Alternative names: Static cupping = retained cupping = dry cupping Definition: Practitioners perform Cupping Therapy by applying cups over specific skin points then decreasing pressure inside the cups by fire, self-suction, manual or electrical vacuum pump. Duration: Usually, dry Cupping Therapy lasts no more than 15 minutes, depending on the power of suction. The duration may range between 5 and 15 minutes. The duration of dry cupping should be decreased with any increase in suction.

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Cupping Therapy Encyclopedia - New Edition

Course of the treatment: Course of the treatment ranges from 5 to 10 sessions, one session per day or every few days according to the patient‘s condition and response. Setting individualized treatment plan which can be modified throughout the treatment course is so important. Indications: Dry cupping can be used in the treatment of chronic pain conditions and to improve blood circulation. Athletes use dry cupping to decrease pain, help in the treatment of muscle fatigue, and improve performance. There is no strong scientific evidence for these claims, so we wait for more scientific research and high-quality clinical trials to support or deny these claims. Safety: It is recommended to: •

Disinfect the skin and cups before performing dry cupping with an approved and suitable anti-septic solution.



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Using light or moderate suction.

Tamer Shaban



Do not leave cups on for more than 15 minutes.



Remove cups immediately if you feel discomfort or severe pain.

Skin infection, dermatitis bulla, skin ulcers, hyper-pigmentation and pruritus are some of the recorded adverse effects related to dry cupping. There is also an increased risk of burns when using fire as a suction method.

FLASH CUPPING

Alternative names: Flash cupping and empty cupping. Definition: It is a type of cupping characterized by quick application/removal of cups. Flash cupping is performed several times in a quick succession along the area being treated to stimulate it. Duration:

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Cupping Therapy Encyclopedia - New Edition

The duration is less than 30 seconds from applying a cup to removing it. Course of the treatment: The course of the treatment is 2 to 3 times per week for 10 sessions and can be adjusted according to patient's condition. Indications: Flash cupping is a stimulatory technique, which is used to stimulate muscles, and nerves. Flash cupping can be used as a complementary treatment for asthma and facial palsy. Safety: Follow general safety guidelines for cupping therapy. Take care when doing flash cupping for children under 16 years and on sensitive skin areas like the face.

WET CUPPING

Alternative names: Wet cupping, full cupping, bloodletting

35

cupping

or

Tamer Shaban

bleeding cupping Definition: Wet cupping is one of the most frequently used methods. A surgical instrument is used to scrape the skin before applying cups. Duration: Practitioners perform wet Cupping Therapy by using two techniques: Two-step technique: Practitioners perform wet cupping by doing skin scarification or puncturing first then applying cups on to collect blood for 5 to 10 minutes. This method is used in China, Korea, and some other countries. Three-step technique: Practitioners perform wet cupping by applying cups first for about 5 minutes, then puncturing or doing skin scarification. Lastly, practitioners apply the cups again to collect the blood for about 5 minutes. This method is usually used in Arabic countries. Course of the treatment:

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Cupping Therapy Encyclopedia - New Edition

The ideal course of treatment is one per month for three successive months. It can be adjusted according to the patient's condition. Indications: Wet Cupping Therapy is used for a variety of illnesses. Wet cupping is effectively used for the treatment of pain-related conditions such as: low back pain, knee pain, neck pain, shoulder pain, headache, migraine and musculoskeletal conditions. It can also be used for the treatment of facial palsy, trigeminal neuralgia, and hypertension. Safety: Generally, Cupping is contraindicated directly on veins, arteries, nerves, skin inflammation, any skin lesion, body orifices, eyes, lymph nodes or varicose veins. Cupping is also contraindicated on open wounds, bone fractures, and on the site of deep vein thrombosis. We will discuss Cupping Therapy contraindications and safety in the next chapters.

MASSAGE CUPPING

Alternative names:

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Tamer Shaban

Massage cupping or moving cupping or dynamic cupping or gliding cupping Definition: Practitioners perform massage cupping by applying oil to the treated skin area then applying cups. Practitioners use silicon, rubber, plastic or glass cups to perform massage cupping. Silicon cups are the recommended cups for performing massage cupping. Various herbal oils can be used such as: olive oil, peppermint oil, sunflower oil, and lavender oil. Course of the treatment: The course of treatment is 1 to 2 times per week for up to 10 sessions according to the patient‘s condition. Indications: Massage cupping is a deep type of massage and used to cover a big area of muscles. It has a relaxing effect. It is usually used to treat musculoskeletal conditions, muscle spasms, pain-related conditions, and sometimes in stress management.

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Cupping Therapy Encyclopedia - New Edition

Safety: Cupping massage is relatively safe, but some adverse events have been reported. Skin inflammation, discoloration, and pain during manipulation were observed. Light manipulation is recommended to decrease or avoid pain during the session. Massage cupping should be performed by licensed practitioners.

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Tamer Shaban

Comparison between the four technical types of cupping.

THE POWER OF SUCTION-RELATED TYPES:

How to measure the pressure inside cups? Pressure inside the cup can be measured by Boyle's law according to (Tham et al., 2005) which can be stated as:

P1V1=P2V2 (P1= Pressure before suction, V1= Volume before suction, P2= Pressure after suction, V2= Volume after suction ) Tham et al. showed that when the cup volume was 80 ml, and the pump chamber was 41.5 ml with efficiency 60-65%. One suction = 141 mbar, Two suctions= 254 mbar.

This category includes light cupping, medium cupping, strong cupping, and pulsatile Cupping Therapy.

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Cupping Therapy Encyclopedia - New Edition

LIGHT CUPPING

Definition Practitioners use a weak suction to perform light

cupping.

Light

cupping

is

the

recommended suction power to use with children and elderly people. The pressure inside the cup was mild from 1 to 300 mbar if the applied cup was 80 ml in volume. Practitioners perform up to two full manual pump suctions. Indications: Light cupping is used to treat patients with sensitive skin, children, and the elderly. It can be used to treat or massage special sensitive areas of the body like the face. Light cupping is also recommended for patients who are suffering from diabetes mellitus.

MEDIUM CUPPING

Definition

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Tamer Shaban

Medium cupping is a medium strength, general purpose cupping. The pressure inside the cup was between 300 and less than 500 mbar if the applied cup was 80 ml in volume. Practitioners do three to four full manual pump suctions to perform medium cupping. Indications: Medium cupping is suitable when performing most of the cupping types. It is relatively safe for most adults. Safety: When the patient feels that he/she is not comfortable, decrease the suction pressure or remove the cups and reapply them while decreasing the suction power.

STRONG CUPPING

Definition Strong cupping is done by creating high subatmospheric pressure inside the cups. Suction is intense, and therefore it is not suitable for

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Cupping Therapy Encyclopedia - New Edition

children and elderly people. The negative pressure inside the cup is more than 500 mbar if the applied cup is 80 ml in volume. Practitioners perform five or more full manual pump suctions to perform strong cupping. Indications: Strong cupping is a painful type of cupping. It is not used frequently. Try to use light or medium cupping instead of it unless you have a clear indication for doing strong cupping. Safety: Strong cupping has an increased risk of adverse events such as dermatitis bullae formation, and skin inflammation.

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Tamer Shaban

PULSATILE CUPPING THERAPY

Definition Pulsatile cupping therapy is a special type of Cupping Therapy. The pressure inside the cup is not constant and variable. It was used as a research method to conduct a randomized clinical trial evaluating the efficacy of Cupping Therapy in the treatment of osteoarthritis. Indications: Pulsatile cupping is used mainly for knee osteoarthritis. It may be evaluated in other pain conditions in the future. Safety: It has a relatively good safety profile.

METHOD OF SUCTION-RELATED TYPES

Method of suction-related types includes: fire cupping, manual vacuum cupping, and electrical vacuum cupping.

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Cupping Therapy Encyclopedia - New Edition

FIRE CUPPING THERAPY

Definition Fire cupping is a type of cupping by creating negative pressure inside the cups by using fire. There is a higher incidence of skin burn in this cupping type. Methods: Fire-Twinkling Method •

You can use a cotton ball or a piece of paper.



Hold an alcohol-soaked cotton ball with a forceps and light it



Put it inside the cup and very quickly move it in circles.



Take it out quickly, and put the cup on the skin point to attach it.



It is the most used method.

Fire-Throwing Method

45



You can use a cotton ball or a piece of paper.



Light an alcohol-soaked cotton ball

Tamer Shaban



Put it quickly into the cup.



Leave it for a while, then put the cup on the selected skin point. The cup is rapidly placed firmly against the skin on the desired location.



High risk of skin burn

Cotton-Attaching Method •

This method is similar to the fire throwing method.



Attach a small cotton ball soaked with a few alcohol drops inside the cup.



Light it and quickly put the cup on the skin point.



High risk of skin burn.

Safety: Risk of burn is increased with this type of Cupping Therapy, especially when done by untrained or unqualified practitioners. There are recorded cases of burn due to fire cupping type.

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Cupping Therapy Encyclopedia - New Edition

MANUAL VACUUM CUPPING THERAPY

Definition Manual cupping is a type of cupping that occurs by creating negative pressure inside the cups by using a manual suction pump. Selfsuction cups using rotator on top of cup, or squeeze rubber top can be added to this type. Methods: Using manual suction pump: •

Put the upper end of the cup that contains the valve into the rubber tip of the pump.



Ensure that full suction is obtained.



Repeat this to obtain the preferred suction power; light, medium or strong.

Using squeeze rubber cups: •

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Put the cup on the preferred skin point.

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Squeeze the cup body with your hand.



Press the skin slightly using the rim of the cup.



Leave the cup in place.

Using cups with top rotator: •

Put the cup on the preferred skin point.



Rotate the top of the cup counter-clockwise until preferred suction achieved.

Safety: Do not over-suction with manual cupping methods. Try to make the patient comfortable. If the patient feels pain during suction, try to remove the cups and decrease the suction.

ELECTRICAL VACUUM CUPPING THERAPY

Definition Electrical vacuum cupping is a type of cupping that occurs by creating negative pressure inside the cups by using an electrical suction

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pump or apparatus. Methods: Using electrical suction apparatus: •

Adjust the preferred pressure and time if applicable.



Set the power button to "ON" mode.

Safety: Adjusting the power of the suction is very important to avoid strong suction.

ADDED THERAPY RELATED TYPES

It includes needle cupping, hot cupping, herbal cupping, magnetic cupping, laser cupping, electrical stimulation cupping, aquatic cupping, and water cupping.

NEEDLE CUPPING

Alternative names:

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Acupuncture cupping – needling cupping Definition: Needle cupping is done by first applying an acupuncture needle then the cup is applied over it. Indications: Acupuncture cupping is used to treat some pain conditions that benefit from both acupuncture and cupping suction stimulation. Safety: It is important to use a thin short needle and avoid dangerous body areas such as abdomen and chest. It is essential to protect the patient from serious adverse events like penetrating organ, or pneumothorax.

HOT CUPPING

Alternative names: Moxa cupping

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Definition: Dried herb, sometimes called Moxa is used to perform hot cupping. Method: Practitioners perform hot cupping by using a needle, which was warmed by burning Moxa, and then applying the cup over it. Practitioners use a special technique to protect the skin from burn by using a thin aluminum layer under the hot moxa. Indications: The patient can benefit from the moxibustion and Cupping Therapy at the same time. Moxa is used traditionally to treat a variety of diseases. It is used to treat some pain-related conditions, fatigue, dysmenorrhea, herpes zoster, asthma and other conditions. Safety Hyperpigmentation, allergies, burns, and infections are some of the reported adverse events related to Moxa. The practitioner should be trained in how to perform Moxa to do this type of Cupping Therapy.

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HERBAL CUPPING

Alternative names: Medicinal cupping Definition: Done by boiling bamboo cups in a suitable herbal tincture then applying them to the skin. Indications: This method is traditionally used to treat pain, asthma, and cough. Safety Risk of burn is associated with this type of cupping. It is recommended to let the cups sit for at least one minute before applying them.

MAGNETIC CUPPING THERAPY

Definition: Magnetic Cupping Therapy is done by using magnetic cupping sets

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that contain magnets inside the cups. Indications: Usually, this type of cupping is used to relieve pain in joints. It stimulates points by magnetic therapy in addition to Cupping Therapy. Safety: If magnetic cups are left for a long duration, a pressure ulcer may result. You should care for cupping duration and cupped area throughout the cupping session. Magnets are not safe for patients who use pacemakers, or insulin pumps. Magnets can interfere with the functioning of the medical devices.

LASER CUPPING THERAPY

Definition There is a new cupping device that contains acupuncture laser probe inside the cups. It stimulates acupuncture points by laser stimulation in addition to cupping. Indications:

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Laser cupping is used to treat pain-related conditions especially low back pain, and musculoskeletal back pain. The most commonly used type is the red type. Its wavelength is 635 nM. It is claimed to have stimulatory and tonifying effects. Safety: Do not use laser cupping around the eye. Follow the safety instructions of the laser cupping device.

ELECTRIC STIMULATION CUPPING THERAPY

Definition Electrical stimulation cupping is performed by using an electrical stimulator inside or around the cups. It is for stimulating points and muscles with electric (TENS) and vacuum stimulation. Plastic cups and rubber cups are commonly used in this cupping type. How to use: •

Apply a thin layer of oil or medical gel.

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Apply the cup by a suction method (squeeze rubber cups or use manual suction pump for plastic cups).



Attach the pin connector to the cup if not attached.



Use two cups for negative and positive current.



Connect the other sides of wires to the TENS unit or electrical stimulation unit, and adjust the intensity, duration, and frequency according to instructions manual and treatment needs.



After the treatment, turn off the unit, disconnect cups, remove the cups.



Clean and disinfect all materials.

Indications It is claimed to be used for pain-related conditions, and for musculoskeletal disorders. It also claimed to be used for enhancement of blood circulation. Safety: Always follow the instruction manual for the TENS unit. Do not do TENS cupping for patients who suffered from epilepsy, or over anterior part of the neck. It is also contraindicated in patients who used a

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pacemaker, or pregnant. Do not use it on the mouth, or on non-intact skin.

AQUATIC CUPPING

Definition: Aquatic cupping is doing cupping underwater. The patient can benefit from aquatic therapy and Cupping Therapy. Aquatic therapy is a therapeutic group of water-based modalities and exercises. Methods: Rubber cups are usually used for performing this type of cupping. Aquatic cupping is performed by applying cups on selected body points while floating and partially submerged by the water. Indications: It is claimed to be used for relaxation, rehabilitation, and health promotion. Safety:

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It should be used with collaboration between physiotherapist and cupping therapist.

WATER CUPPING

Definition: Water cupping is the least practiced method. It involves filling a third of the cup with warm water. While holding the cup close to the client with one hand, bring it close to the point to be cupped and insert burning cotton wool into the cup, then swiftly and simultaneously place the cup onto the skin. When performed properly, no water spillage occurs. Indications: It is traditionally used to treat some inflammatory conditions. Safety: Adjust the temperature of water to be warm to avoid the risk of burn. This type of cupping should be administered by highly qualified and experienced cupping therapists.

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CONDITION AND AREA TREATED RELATED TYPES

Condition and area treated related types included: pedi cupping, abdominal cupping, sports cupping, facial cupping, female cupping, male cupping, and sports cupping.

PEDI CUPPING

Definition: Pedi Cupping is a combination of Reflexology, Massage Cupping, and Plantar Fascial Release on the leg and foot. Indications: It was claimed to be used for the treatment of leg diseases. It may be used for the treatment of inflammatory and pain-related conditions of the leg.

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ABDOMINAL CUPPING

Definition: When Cupping is used for the abdomen, it is called abdominal cupping. Indications: It is claimed to be used for the treatment of obesity and digestive problems.

FACIAL CUPPING

Definition: Facial cupping is a rejuvenation treatment of the face by cups. It is used mainly for beauty reasons. Small silicon cups are used. The practitioners use special massage cupping techniques. Indications: It is commonly used as a form of cosmetic therapy. It is used to beautify the face. It is used for enhancement of the facial scars. As a treatment, it may be used for the treatment of facial palsy and sinusitis.

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Safety: Take care of suction power. Try to do a very light suction power. Avoid strong manipulations.

FEMALE CUPPING

Definition: The use of special cup sizes and sets to stimulate and support female breasts for beauty reasons. Indications: It is used for enhancement of breasts. Safety: Always follow the instructions given by the manufacturer of the device. Do not use strong suction. If there is uncomfortable feeling during the cups‘ application, release some suction. It is reported that female cupping has some adverse events such as skin rashes, skin damage, and pain.

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MALE CUPPING

Definition: The use of special cup sizes and sets to stimulate and support erectile function. Indications It is claimed to be used for erectile dysfunction and enhancement of erection. Safety: Always follow instructions given by the manufacturer of the device.

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SPORTS CUPPING

Definition: Cupping is used in the treatment of sports and athletic injuries and rehabilitation. It is called sports cupping. One of the best examples of it is when treating hamstrings ailments by cupping. Indications: It is used for pain relief, strains, musculoskeletal conditions, and plantar fasciitis. Some practitioners and athletes use it for improvement of performance. Safety: It must be used by highly qualified practitioners and physiotherapists who are specialized in the field of sports medicine. If performed by unqualified therapists, serious muscle harms and other adverse events may result.

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TYPES OF CUPS

There are many types of cups used from animal horns used in the past to the most modern cups:

Plastic cups: These are made from clear plastic material with a valve attached to the top. Suction can be applied by manual

or

automatic

vacuum

apparatus. Advantage:

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Disposable (one-time use).



Easy to use.



Inexpensive.



Some companies offered sterile cups.

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Self-Suction Cups Cups with rubber bulb: These cups are made from plastic and there is a bulb of rubber attached to the top of the cup.

Cups with rotator (twist or screw top cup): A cup has a top rotator which can be used to apply suction.

Bamboo cups Cups are made from bamboo. Commonly used for performing herbal Cupping Therapy. There are some disadvantages of these cups:

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Difficult to clean



Inadequate sterilization



Sharp edges

Glass cups Cups were made from glass with or without valve. Advantage: •

Thick edges (more comfortable).



Easy to clean and sterilize.



Easy to use.



Clear (you can see what is happening inside the cup).

Disadvantage:

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Breakable.



Little increase in the risk of burn if fire suction is used.

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Rubber cups Cups are made from rubber material. Advantage: •

Strong suction.



Can be used on sensitive areas because of the smooth edges.

Disadvantage: Cups are not suitable for sterilization, so these cups are for one-time use or for personal (single) use only.

Magnetic Cups These

cups

contain

opposite

magnetic probes. These cups are used to treat painful joints. They come in many types and various sizes. These cups are for personal use. There is no scientific proof on the efficacy of this method.

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Curved cups: Curved cups are plastic cups that have curved edges to be suitable for joint treatment. Curved cups can easily be applied to joints or bony areas to treat musculoskeletal ailments.

Two valves cups (smart cups): Smart cups are made from plastic. They have bottleneck and two side safety silicone rubber valves.

Silicone cups: Silicone cups are also self-suction cups that were made from silicone. Silicone cups are used mainly for performing

massage

Cupping

Therapy. Small silicone cups were developed to perform facial cupping successfully.

Low frequency infrared rays stimulator cups These cups are electrode cups that transfer low-frequency electrical current and have built-in infrared rays heating probe to manage pain conditions.

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Ceramic cups Ceramic cups are an older type of cups that are made from ceramic.

CUPPING EQUIPMENT

The cupping clinic may contain these tools: 1. Massage chair and/or table. 2. Skin disinfectant solution (hospital grade or FDA approved). 3. Cupping set for every patient (manual pump and 6 cups). 4. Various types and sizes of cups according to clinic specialty and use (Facial cupping clinics use silicone cups as an example). 5. Clean, sterile gloves, plastic aprons, and respiratory masks (all personal protective equipment). 6. Surgical blades (size from 15-21) (for wet cupping). 7. Auto-lancing device with needles (gauge = 26) (for wet cupping). 8. Olive oil or lavender oil (for some cupping types such as massage cupping).

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9. Linens and sheets. 10. Equipment to measure vital signs [digital blood pressure measurement instrument (sphygmomanometer) – temperature measurement instrument (thermometer )]. 11. Wound dressings (to be used after wet cupping). 12. FDA approved surface disinfection solution. 13. Hand-washing equipment. 14. Other infection control management equipment (sharp boxes – color coded waste disposal containers – heavy duty gloves – biohazard blood spill kits).

CUPPING THERAPY SETS

Classification of Cupping Therapy sets is suggested for the first time in my previous book (Cupping Therapy encyclopedia) in 2013. We can classify Cupping Therapy sets to: Cupping sets related to the types of cups 1. Plastic cupping sets

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2. Glass cupping sets 3. Rubber cupping sets 4. Bamboo cupping set 5. Ceramic cupping sets 6. Silicone cupping sets Cupping sets related to the methods of suction: 1. Manual cupping sets 2. Automatic cupping sets 3. Self-suction cupping sets Cupping sets related to the uses 1. Facial Cupping Sets. 2. Female cupping set (for breast enlargement). 3. Male cupping sets. 4. Massage cupping sets.

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Classification of cupping therapy sets

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CHAPTER 3

EFFECTS AND MECHANISMS OF ACTION OF CUPPING THERAPY

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CUPPING THERAPY EFFECTS

The suggested effects of Cupping Therapy are: 1. Local physiological effects (due to stress on tissue): 1. Increase local blood circulation. 2. Increase blood perfusion and skin temperature. 3. Local Anaerobe metabolism in the cupping area. 4. Bruises (cupping marks) and activation of Heme-Oxygenase 1 System. 2. Mechanical effects: 1. Enhancing skin penetration. 2. Enhancing skin viability and elasticity. 3. Systemic physiological effects: 1. Effects on blood LDL, natural killer lymphocyte, sodium, and potassium.

2. Pain reduction.

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3. Elevation of blood oxygen. 4. Anti-inflammatory and anti-oxidant. 5. Stimulation and regulation of the immune system. 4. The physiological effects of skin scarifications or puncturing in wet cupping therapy: 1. Activation of the wound healing system. 2. Release of Nitric Oxide.

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Local physiological effects

Mechanical effects

Effects on blood LDL, natural killer lymphocyte, sodium and potassium

Increase local blood circulation

Increase blood perfusion and skin temperature Local Anaerobe metabolism in the cupping area. Activation of HemeOxygenase 1 System

Systemic physiological effects

The physiological effects of skin scarifications or puncturing

Enhancing skin penetration

Release of Nitric Oxide Pain reduction

Elevation of blood oxygen

Enhancing skin viability and elasticity

Antiinflammatory and antioxidant

Activation of the wound healing system

Stimulation and regulation of immune system

classification of cupping therapy effects -2018

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THE SUGGESTED EQUATIONS OF THE CUPPING EFFECTS

Skin color equation: (Xhao et al., 2009) suggested an equation to measure the skin color after performing cupping therapy, which is:

Cupping skin color = 2.025 + 0.902 x 100 x negative pressure by (-MPa) Pressure inside the cup equation: Boyle's law can measure the pressure inside the cup: P1 V1 = P2 V2 P1 V1= pressure*volume before pumping, P2 V2= pressure*volume after pumping

Skin suction height equation: Duh & Chiu (2015) suggested an equation to explore the relationship between the pumping pressure and skin suction height inside the cup: H=0.1|Pv|

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H= skin suction height per mm, Pv= vacuum pressure per mmHg. Factors affecting the color and tissue behavior after cupping therapy: 1. Pressure 2. Time 3. Cup size 4. Cup rim

MECHANISMS OF ACTION

There are many theories explain the mechanism of Cupping Therapy. The commonest theories are: 1. Pain gate theory 2. Reflex zone theory 3. Nitric oxide theory 4. Genetic Theory 5. Immunomodulation theory

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6. Increasing blood circulation theory 7. Endorphins and encephalin production theory 8. Meridian system theory

PAIN GATE THEORY

This theory was suggested by Ronald Melzack and Patrick Wall in 1965 in their article "Pain Mechanisms: A New Theory." This theory stated that there is a gate or channel to transfer pain signals from its actual area or organ to the brain. So, we can feel the pain. There are two types of nerve fibers: nociceptive (small) that transfer pain signals, and non-nociceptive (large) that did not transfer pain and interfere with small fibers. Large nerve fibers can be stimulated by (touch, vibration, and pressure) which leads to interferance with small fibers and blocks pain sensation. So, when we do Cupping Therapy, the large fibers are stimulated that interfere with the actual pain being transmitted by small fibers and the gate is thereby closed and this leads to the actual pain being killed.

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REFLEX ZONES THEORY

This theory was suggested by Henry Head and Charles Sherrington in the 1890s. This theory is the principal theory of reflexology practice. This theory suggested that the presence of nerve connections and pathways between internal organs and the skin. You can treat internal organs with treatment applied to the superficial (skin) reflex zone area, which has the same connection with the treated internal organ.

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This base was known and used by all civilizations to relieve pain. The body is divided into segments that begin with every vertebra. Spinal nerves carry motor, sensory, and autonomic signals between the spinal cord and the body. The spinal nerves are 31 left-right pairs and are corresponding to the segment of the vertebral column. On the 7th cervical vertebra at the end of the neck, an elevation named (hormone hump), as it is used by cupping therapists to treat conditions related to hormonal imbalance such as diabetes mellitus, pituitary gland diseases, and ovarian dysfunction. The following table describes the internal organs and related reflex zones:

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C=cervical vertebra, t= thoracic vertebra, l= lumbar vertebra, s= sacrum vertebra In brief, the diseased organ sends a signal to the skin through the autonomic nerves, the skin responds by becoming tender, painful or swelling.

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In opposite, skin also can send stimulus signals to the internal organs. It can explain why angina pectoris occurs in cold weather because a sudden cooling of the breast area can lead to a mortal heart attack. And on the other hand, skin can have a therapeutic effect on internal organs. The skin receptors are activated by applying cups to the skin. So this will increase the blood circulation and blood supply to the skin and to the internal organs through the nervous connections. Thus, cupping has double effects. It stimulates the skin‘s local circulation, and it stimulates the internal organ circulation, and in a few days increase connective tissue metabolism. This activates the body through the autonomic nervous regulation system to come to a healthy state again.

Nitric oxide theory Researchers Ferid Murad, Ignarro, and Furchgott discovered nitric oxide. They won the Nobel Prize for medicine in 1998. Nitric Oxide is a very important substance that is released in the body as a result of any trauma. People who suffer from diabetes mellitus, hypertension, or atherosclerosis showed impaired nitric oxide pathways.

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Functions of nitric oxide are: 1. Promote blood circulation. 2. Muscle relaxation. 3. Help in vessel hemostasis. 4. Anti-thrombotic: It protects the blood vessels from thrombosis. 5. Decrease of inflammation 6. Prevent stenosis of blood vessels as inhibit proliferation of the blood vessels walls. Abnormal nitric oxide pathways may be a risk factor for many diseases such as: obesity, hypertension, and heart failure. There are some researchers such as Ma SX and Tsuchiya M, et al., reported the relation between acupuncture and nitric oxide release. It is claimed that nitric oxide is released during and after Cupping Therapy.

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GENETIC THEORY

I suggested in my previous version of Cupping Therapy encyclopedia that genetic theory is a suggested mechanism of action as massage cupping is a form of Cupping Therapy. In a recent study in Canada by Mark Tarnopolsky et al., they found that massage therapy can help repair exercise-induced muscle damage by decreasing inflammation and renewing mitochondria. They reported that five genes were differentially expressed after massage therapy, which played a role in altering inflammation process. Dr. Tamer suggested that Cupping Therapy theoretically can induce the same effect. This theory is updated by collaboration between Dr. Tamer Shaban and Dr. Munir Ravalia in 2017, and they suggested the following:

Cupping Therapy and Hypoxia: Hypoxia is a deprivation of oxygen (O2). It is a stimulus for gene expression. Transcription factors, growth factors, and glycolytic enzymes are critical genes modulated by hypoxia (low oxygen). The effects of these genes are the development of new vasculature to increase oxygenation and stimulation of glycolysis state.

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In cupping therapy, suction produces mechanical pressure and sometimes pain on the treatment area and partially deprives the skin and connective tissues inside the cup from Oxygen (O2), leading to anaerobic metabolism, which can be observed from increasing lactate and the lactate/pyruvate ratio.

Wet Cupping Wounds and Healing Process: Wounds are a stimulus that leads to the initiation of the wound healing mechanism and gene expression. In wet cupping therapy, skin incisions are performed, leading to superficial wounds which produce physiological and mechanotransduction signals. These signals can activate or inhibit gene expression. This mechanism of action may underlie some of the local and systemic therapeutic effects of cupping therapy. Many studies have reported that acupuncture may also lead to modulation of gene expression.

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MERIDIANS SYSTEM THEORY

In Chinese Medicine practice: Qi is a vital energy of the body and Cupping Therapy can treat stagnation of this vital energy (Qi). In the Chinese language, meridian is Jing Luo. Jing means pathway and represents the vertical channels and Luo means network and represents the horizontal channels.

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Qi is divided into two equal and opposite forces, yin and yang. Yin represented female, passive, cold, water and darkness. Yang represented male, active, warm, fire and light. any upset of yin and yang balance, diseases will be the result. Acupuncture points are concentrating areas of Qi, which are found on the skin throughout meridian system. These points are used for diagnostic and therapeutic purposes. Stimulation of these points by pressure, acupuncture, cupping, heating and other methods can lead to healing effects. Body meridians are twelve principal meridians and eight extra meridians. Governing (Du) and conception (Ren) meridians are the most important extra meridians.

The twelve meridians There are six yin and six yang meridians. Lung, heart, pericardium, spleen, kidney, and liver are the yin meridians. The large intestine, small intestine, triple burner, stomach, bladder and gallbladder are the yang meridians.

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CHAPTER 4

CUPPING THERAPY IN PRACTICE

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Cupping Therapy is a traditional complementary therapy. You can use Cupping Therapy for home or personal use with precautions and by following certain safety instructions. Cupping therapists and professional healthcare workers use Cupping Therapy professionally to treat patients in their licensed clinics.

CUPPING INDICATIONS

Cupping therapy may be effective in pain-related conditions. Cupping therapy has been used to treat many conditions, and recently there has been an increasing amount of research to evaluate the effectiveness of cupping therapy in the treatment of various diseases like headaches, asthma, respiratory disorders, rheumatoid arthritis, acne, hypertension, non-specific low back pain and non-specific neck pain among others. There are published systematic reviews stating that there is potential for cupping to treat pain disorders and herpes zoster. There are two published randomized clinical trials that have found cupping is an effective treatment for non-specific low back pain. There are two randomized clinical trials that have concluded the effectiveness of cupping to treat nonspecific neck pain.

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CLASSIFICATION OF CUPPING THERAPY INDICATIONS Cupping Therapy indication can be classified into local indications and systemic indications.

Local Cupping Indications

Therapy Systemic Cupping Therapy Indications

Neck Pain

Diabetes Mellitus

Knee pain

Hypertension

Low back pain

Fatigue

Muscle spasms

Rheumatoid Arthritis

Shoulder pain

Asthma

Headache and Migraine

Fibromyalgia

CUPPING CONTRAINDICATIONS

Cupping Therapy is contraindicated on injured skin, eyes, and all body orifices such as: anus and mouth. Practitioners can perform cupping on intact skin and avoid the injured skin. It is also

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contraindicated during pregnancy and for cases of acute hepatitis, tuberculosis, and AIDS infection. Cupping is also contraindicated in patients using anticoagulants until they have normal prothrombin time test which will be expressed as a ratio called the international normalized ratio (INR).

I published a new classification of cupping t herapy adverse events in 2018 which classify cupping adverse events into preventable and non-preventable adverse events.

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CUPPING THERAPY FOR HOME USE

Cupping Therapy is simple and easy. People around the world have used it for thousands of years. Dry cupping is the most common type used at home. It is recommended to use one of these cupping sets: 1. Plastic cupping set with a manual suction pump. 2. Silicone cupping set 3. Rubber cupping set The Cupping Therapy types are arranged below by required experience: 1. Dry Cupping

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2. Flash cupping 3. Massage cupping Special types of Cupping Therapy used at home with specific sets: 1. Female cupping 2. Male cupping

Please note:  You can easily follow the instructions to do conduct dry, flash or massage Cupping Therapy.  It is recommended to join a short Cupping Therapy training (one-day course) to ensure your professional and safe use of Cupping Therapy at your home.  Cupping therapy may be used as a health protective method or a therapeutic method for some simple ailments and pains by applying a cup on a pain point or massaging this point if there is no contraindication for that.  Getting

a

professional

consultation

from

a

professional is very important before trying cupping.

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CHAPTER 5

PROFESSIONAL CUPPING THERAPY PRACTICE

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For patients

How to choose the right clinic or therapist? Simple tips when looking for a clinic or therapist: 1. Ask your doctor for suggestions and recommendations. 2. Get a consultation from your doctor about the complementary medicine and suitability for you and your condition. 3. Choose a licensed clinic and a licensed therapist. 4. Ask the healthcare authority in your area for recommendations or a list of licensed clinics. 5. Ask a professional organization for a suggestion. 6. Visit the clinic you intend to use to see if you feel comfortable there and if the clinic is clean and has a professional appearance. 7. Call the clinic to find out if therapy or the type of therapy you would like is provided by this clinic (not all clinics provide all types of cupping).

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8. Be sure to check the license, qualifications, and insurance of therapist.

Cupping therapist Cupping therapist is a recognized profession by the international classification of health workers (published by The World Health Organization). It is based on The International Standard Classification of Occupation (ISCO, 2008 revision) under the code (3230).

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THE CUPPING THERAPY CLINIC

Every Cupping Therapy clinic shall be maintained in a clean and sanitary condition at all times. Cupping Therapy clinics should be well ventilated and lighted. Cupping clinics should have enough infection control supplies and tools such as: gloves, masks, gowns, waste management tools, and disinfectant solutions. Waste management includes a segregation and disposal plan and tools. Use of colored labeled waste containers for biohazards waste disposal according to national infection control guidelines is recommended. A regular room cleaning schedule and policy in the cupping clinic is very important. Proper management of spillage and blood contamination is very critical Sterilization devices are a must for clinics that will reuse Cupping Therapy tools.

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PERFORMING CUPPING THERAPY

Please note: 5. Hand washing is the first step.

6. Skin shall be cleaned with an appropriate antiseptic solution before performing cupping.

7. Any complication arising during cupping treatment shall be referred immediately to a hospital.

8. Always use disposable cups and instruments. 9. Discard all used instruments after the treatment safely.

10. Lancets shall be disposed of by placing them in a sealed, unbreakable container (sharp box). 11. Follow instructions of your licensing authority. 12. Keep complete and accurate medical records for all your patients.

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CUPPING THERAPIST - PATIENT RELATIONSHIP

The establishment of good rapport with a patient is important. The quality of the patient-therapist relationship is important to both parties. The better the relationship in terms of respect, trust, and knowledge, the better the quality of treatment session. A formal relationship is recommended at first, but some familiarity with a therapist is recommended to make it easier for the patient to talk about the disease and be comfortable during the cupping session. Do not tell your patients that cupping can treat a disease without scientific evidence.

A QUALITY MODEL FOR SELECTING PATIENTS

The patient is suitable for cupping if: 1. There are no contraindications to performing cupping. 2. The vital signs are normal. 3. There is a clear diagnosis of the patient's condition.

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4. The clear benefits of performing cupping in comparison with risks. 5. The patient signed the informed consent.

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CUPPING THERAPY PATIENT POSITIONS

Practitioners choose patients' positions according to: 1. The safety of patients (practitioners always avoid unsupported positions). 2. The comfort of the patient. 3. The area treated should be accessible. 4. The comfort of the practitioner. Patients' positions are: 1. Sitting Position: Practitioner can use a massage chair, a massage table or an ordinary table and chair. This position is not preferred for the new patients, especially who are doing cupping for the first time. 2. Supine Position or Lying on Back position. 3. Lying on one side (left or right) position.

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4. Prone position or Lying face down: Prone is the best position for patients who are experiencing a Cupping Therapy session for the first time.

CUPPING THERAPY TECHNIQUES CLEAN CUPPING THERAPY TECHNIQUE

This technique includes various steps to do Cupping Therapy, but it is not recommended because of the increased incidence of infection compared to sterilized cupping technique. Equipment: 1. Clean cups 2. Clean gloves 3. Clean gauze 4. Disinfectants like alcohol Steps;

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1. Disinfect cups and pump with disinfectant. 2. The practitioner wears the suitable personal protective equipment. 3. Disinfect the skin with a suitable disinfectant and leave it for an appropriate time according to manufacturer instructions. For example, you should leave alcohol for 30 seconds, and povidone for two minutes. 4. Place the disinfected cups on the patient. 5. Use sterile surgical blade if you will do scarification. 6. Use clean or sterile (gauze) to clean skin. 7. Dispose of cups and gauze in the medical waste container. 8. Disinfect the skin again as in step 3. 9. Use sterile dressing to cover the wound. 10. Dispose of all used materials and personal protective equipment in the medical waste container.

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STERILE CUPPING THERAPY TECHNIQUE

Equipment: 1. Sterile or high disinfected cups 2. Sterile gloves 3. Sterile gauze and dressing 4. Disinfectants like alcohol Steps; 1. Disinfect cups and pump with high disinfectant or use sterile cups. 2. The practitioner wears the suitable personal protective equipment and uses sterile gloves. 3. Disinfect the skin with a suitable disinfectant and leave it for an appropriate time according to manufacturer instructions. For example, you should leave alcohol for 30 seconds, and povidone for two minutes. 4. Place the sterile cups on the patient.

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5. Use sterile surgical blade if you will do scarification. 6. Use sterile (gauze) to clean skin. 7. Dispose of all used materials and cups. 8. Disinfect the skin again as in step 3. 9. Use sterile dressing to cover the wound. 10. Dispose of all used materials and personal protective equipment in the medical waste container.

CUPPING THERAPY METHODS

MYOFASCIAL DECOMPRESSION (USING CUPPING THERAPY)

Steps: 1. Choosing points according to anatomical site of the muscle

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2. Apply cups and leave for 3 minutes while the patient relaxes. 3. Then the patient must perform a series of active movements. 4. Then the practitioner passively moves the patient through passive range of motion. 5. Cupping massage or sliding cupping from distal to proximal.

MYOTHERAPY

Myotherapy is a method of assessment and treatment of musculoskeletal diseases. It includes various soft tissue manipulations and techniques such as trigger point therapy, cupping, dry-needling, passive and/ or muscle stretching, deep massage, and exercise prescription.

HOW TO PERFORM CUPPING THERAPY?

BEFORE CUPPING

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General steps: 1. Inform the patient about what you will do. 2. Have the patient read and sign the written consent. 3. Take the patient's medical history. 4. Check the patient's physical condition. 5. Select the points of treatment and establish the treatment plan. 6. Choose the most appropriate type of Cupping Therapy according to the age and condition. 7. Choose the most comfortable and suitable position for the patient. Lying positions are the more comfortable and safe. 8. Choose the suitable cup size for the area treated.

Other steps include the following:

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WET CUPPING

1. Wear your personal protective equipment. 2. Select the cupping points. 3. Disinfect the skin with a suitable antiseptic solution. 4. Place the cups and apply medium suction. 5. Leave the cups for 3 to 5 minutes. 6. Remove the cups. 7. Use the surgical blade or auto-lancing device to scrape or puncture the skin to make scratches 0.3 to 0.5 cm in length and 0.1 to 0.5 mm in depth. 8. Be careful and make very small scratches(6 -12 in number) from above downwards in a horizontal order in 3 or 4 rows. 9. Apply the cups again. 10. Blood may draw out inside the cup. 11. Leave the cups on for 3 to 5 minutes. 12. Remove the cups and carefully clean the skin.

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13. You can perform 3 to 5 points per session. 14. Always begin with pain points = get more positive results. 15. Don't let too much blood get out, only 50 cc. 16. After the session, permanently dispose of all used equipment. 17. Wash your hands before and after the treatment.

Clinical notes

Applying cups: Cups should be applied to select body areas either by pump or by fire. The cup is retained from 10 to 15 minutes when performing dry Cupping Therapy. Scarification is performed at the first stage, then cups are applied and retained for up to 10 minutes when performing two-stages wet cupping. In three-stages Cupping Therapy (Arabic wet cupping), cups are applied as a first step for 5 minutes. After cups are removed, scarification is done then the cups are applied again for an additional 5 minutes. Flash cupping and massage cupping treatment duration is according to the

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patient‘s condition, therapist‘s decision and area being treated. Up to half an hour of dynamic cupping is usually enough for the treated body part.

Two stages wet cupping

Three stages wet cupping

Duration

10 to 15 minutes

5 minutes before scarification and 5 minutes after scarification

Tools used

Seven stars needle and auto-lancing devices used more commonly than surgical blades

Surgical blades are used more commonly than auto-lancing devices or seven stars needle

Culture place practice

Number Steps

and More commonly used in More of East Asian cultures like used

China and Korea of Two (scarification applying cups)

in countries

commonly Arabic

– Three (Applying cups – scarification – applying cups again)

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SCARIFICATION - PUNCTURING

Skin scarification is an important part of wet Cupping Therapy. Surgical blades, auto-lancing devices and seven stars needle are the the most commonly used tools. The epithelium is the target layer of the skin for scarification. Epithelium does not contain blood vessels and is one millimeter in diameter. So, scarification should be less than one millimeter in diameter, usually from 0.1 to 0.9 millimeter in depth. The scarification should be very shallow to facilitate the healing process and to prevent possible adverse events related to cupping. The scarification should be longitudinal from above downward. The length of scarification is between 2 to 3 millimeters and the number of scarifications should be between 6 and 12 times according to some researchers.

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Auto lancing device Size of used tool

Surgical blades

Needle gauge number Size from 15 to 21 26

Number scarifications

of 6-12 times

6-12 times

Type scarification

of Puncturing

Longitudinal scarification or small superficial wounds

uses

For diabetics, elderly and young patients, and patients who are suffering from healing delay. It can be used for all

Used for wet cupping for all patients except patients who are suffering from healing delay such as diabetics.

Infection control

Must be sterilized Disposable before and after use

Skills needed

There are no special Skills, training, and skills needed to use the experience are needed device

The typical treatment program is 1 treatment per month for 3 months, it can be used more frequently (every 2 weeks) for difficult cases.

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MASSAGE CUPPING

1. Follow general steps. 2. Select your treatment area. 3. Put a few drops of olive or lavender oil on the skin. 4. Massage the skin with your hands first. 5. Apply a medium size cup with light suction. 6. Move the cup slowly across the area. 7. If the patient feels pain, remove the cup then apply the cup again and decrease suction power until a comfortable state is achieved. 8. Move the cup in a straight or circular direction according to the shape of muscles. 9. The treatment setting takes from 20 to 30 minutes.

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DRY CUPPING THERAPY

1. Follow general steps. 2. Put the cup and apply light to medium suction. 3. Retain the cup for 5 to 10 minutes according to the suction power. 4. Remove the cup. 5. Select points according to the patient‘s condition, and begin with pain points. 6. It is a powerful method that anyone can do after initial training. 7. You can reuse the cups for yourself after proper disinfection. 8. Dry cupping may be suitable for home use.

NEEDLE CUPPING

1. Do general steps. 2. Insert the needle in the selected point

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3. Put the cup above the needle 4. Apply suction 5. Retain the cup for 5 minutes 6. Remove the cup 7. Remove the needle 8. Disinfect the skin

WATER CUPPING

1. Do general steps. 2. Fill one-third of the cup with warm water. 3. Be careful and stand close to the point. 4. Apply the cup to the point. 5. If you do it quickly and truly, no water spillage will occur. 6. Leave the cup for 5 minutes.

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7. Carefully remove the cup by adding the cup in the true position by asking the patient to move to correct the position of the cup and put the water into the cup, not the skin.

PROTOCOLS OF CUPPING THERAPY TREATMENTS

Cupping Therapy research and studies have used various protocols. Number of Cupping Therapy sessions vary according to the type of Cupping Therapy used, patient health condition, and treated disease. Michelle Gellis, a licensed, Board Certified Acupuncturist (USA) said, ―The number of treatments is highly dependent on the type of condition I am treating. In the early stages (Tai yang) of a disease, a ‗cold‘ in western medicine, one or two treatments of cupping in two consecutive days can usually expel the pathogen. For pain-related issues such as back, hip, shoulder pain, I tell my patients it will typically take a minimum of six treatments. Sometimes relief is felt after the first treatment, but for the effects to last, patients should continue treatment beyond the initial relief. These treatments are usually once a week A full course of facial rejuvenation acupuncture and cupping treatments is from 12-20 treatments.

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This range depends on the health of the skin and the lifestyle of the patient. These treatments are spaced either once or twice a week.

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CHAPTER 6

SAFETY OF CUPPING THERAPY

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CUPPING THERAPY ADVERSE EVENTS

Definitions: World Health Organization definition of an adverse event: "An injury related to medical management, in contrast to complications of disease. Medical management includes all aspects of care, including diagnosis and treatment, failure to diagnose or treat, and the systems and equipment used to deliver care. Adverse events may be preventable or non-preventable.” National Cancer Institute – National Institute of Health definition: "An adverse event is any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medical treatment or procedure that may or may not be considered related to the medical treatment or procedure. An AE is a term that is a unique representation of a specific event used for medical documentation and scientific analyses."

Classification of adverse events in general: United States Food and Drug Administration (FDA) classified adverse

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events into: 1. Preventable AE 2. Non-Preventable AE Serious Adverse Event: When an adverse event lead to death, lifethreatening, hospitalization (initial or prolonged), disability, permanent damage, birth defect, or required prevention of permanent impairment was considered a serious adverse event.

Cupping Therapy adverse events: Kim et al. conducted a systematic review to observe adverse events related to Cupping Therapy in studies conducted in Korea. A total of 16 studies were included in this review. Most frequently reported adverse events were: Anemia, factitial panniculitis, and herpes viral infection. The study reported the infrequent adverse events related to cupping. Classification of Cupping Therapy adverse events and side effects: We can classify Cupping Therapy adverse events and side effects into two categories: preventable Cupping Therapy adverse events and nonpreventable Cupping Therapy adverse events.

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Preventable cupping adverse event

Non-preventable cupping adverse event

Scar formation

Koebner phenomenon

Burn

Headaches

Bullae formation

Dizziness

Abscess and skin infection

Tiredness

pruritus

Vasovagal attack

Anemias

Nausea

Panniculitis

Insomnia

Preventable Cupping Therapy adverse events: The adverse events and side effects that can be prevented by following safety and infection control advice and protocols. Burns, bullae formation, skin infection, and scars were examples of preventable Cupping Therapy adverse events.

Non-preventable Cupping Therapy adverse events: The unfavorable events which cannot be avoided or expected easily by practitioners. The examples were Koebner phenomenon, headache, insomnia, and vasovagal attack.

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CUPPING SKIN REACTIONS (MARKS)

Cupping skin marks was a result of every cupping session. Explanations of Cupping Therapy marks were provided from Traditional Chinese Medicine and modern medicine perspectives.

Traditional Chinese Medicine Perspective: Cupping Therapy reactions were explained by: 1. Dark purple & black colors indicated deficient blood supply and blood stasis. 2. Scattered purple points indicated diseases such as stagnancy of Qi and blood stasis. 3. Bright red color generally indicated diseases of deficiency of yin. 4. Dark red color indicates diseases of high blood fat and heat pathogen. 5. Cold and pale white color indicated diseases of cold deficiency and pathogenic damp. 6. Bright Pink color indicated healthy areas.

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Histological and modern medicine perspective Skin is the outer covering layer of the human body. Skin is composed of three layers: 1. Epidermis: There are no blood vessels in this layer. It is about 1 mm in thickness. 2. Dermis: it is the thickest skin layer. It is about 1.5 to 4 mm in thickness. 3. Hypodermis: It contains subcutaneous fat and connective tissue.

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Qasim and Al-Rubaye reported that the histological changes following Cupping Therapy were: mild edema and longitudinal fissure as a result of cutting in the epidermis. In the dermis, histological changes were dermal edema and bleeding in the upper and lower parts of the dermis. No cellular infiltration was noted.

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DERMATITIS BULLAE Definition: Bulla was an inflammatory skin lesion characterized by a sac or multiple skin sacs filled with fluid. Causes related to cupping: 1. Very strong pressure inside the cup. 2. Cups retained for long duration. 3. Repeated cupping sessions daily on same points for long periods. 4. Change of environmental pressure while performing Cupping Therapy (as in an airplane). Researches: 1.

Che-Wei Lin, Jimmy Tse-Jen Wang, Cheuk-Sing Choy, and Heng-Hsin Tung, Iatrogenic Bullae Following Cupping Therapy - the journal of alternative and complementary medicine -Volume 15, Number 10, 2009, pp. 1–2

2. Chian-Ze, Peng; Chorng-Kuang. How - Bullae Secondary to Prolonged Cupping – American Journal of the Medical Sciences: July 2013 Volume 346 - Issue 1 - p 65.

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SKIN INFECTION

Definition: Skin infection was a skin lesion characterized by red inflammatory base. Viral, fungal, and bacterial were the main types of skin infection. Causes related to cupping: 1. Infected cups and cupping tools. 2. Ignorance of wearing personal protective equipment by practitioners and changing them after each patient. 3. Re-use of Cupping Therapy tools. 4. Ignorance of disinfecting skin before any type of cupping with a suitable disinfectant. Researches: Ye-Jin Jung, Jae-Hong Kim, Hae-Jin Lee, Hana Bak, Seung Phil Hong, , Soo Young Jeon, Sung Ku Ahn, A Herpes Simplex Virus Infection Secondary to Acupuncture and Cupping - Ann Dermatol Vol. 23, No. 1, 2011

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PANNICULITIS

Definition: Panniculitis was a group of diseases characterized by inflammation of subcutaneous fatty layer. Hardening of the skin, nodules, and subcutaneous lamb formation were signs of this diseases. Panniculitis could be associated with fever, fatigue, joint pain or weight loss. Causes related to Cupping Therapy: 1. Performing wet cupping at home without prior training or knowledge. (Please, do not perform wet cupping at home at all). 2. Multiple and very frequent cupping sessions. Researches: Moon SH, Han HH, Rhie JW - Factitious panniculitis induced by Cupping Therapy, J Craniofac Surg. 2011 Nov;22(6):2412-4. doi: 10.1097/SCS.0b013e318231fed6.

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KOEBNER PHENOMENON

Definition: Koebner Phenomenon is a body response to trauma by forming skin plaques. Koebner Phenomenon is common among psoriasis patients. Precautions for psoriasis and other skin lesions patients: 1. Do only a small number of cups in the first session (you can even start with one cup for the first session). 2. Inform the patient about the possibility of developing Koebner Phenomenon before the beginning of cupping session. 3. Do not apply cups on any skin lesion. 4. Follow up is very important. Researches: Rui-xing Yu, Yun Hui, Cheng-rang Li - Köebner phenomenon induced by Cupping Therapy in a psoriasis patient - Dermatology Online Journal 19 (6): 17

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CUPPING SKIN EDEMA

Definition: Cupping skin edema is a swelling at the cupping site due to the accumulation of fluid under the skin. Causes: 1. Small cup rim. 2. Strong cupping suction. 3. Sensitive skin area. 4. Cups were retained for a long duration.

POST CUPPING SCARS

Definition: Post cupping scars are skin marks developed after wet Cupping Therapy as a result of scarifications. Scar formation is a part of the body‘s natural healing process. Types of the scars related to Cupping Therapy are keloid

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scars and hypertrophic scars. Causes related to Cupping Therapy: 1. Deep scarifications. 2. Wrong direction of scarifications. 3. Ignorance of disinfection and other infection control measures. 4. Ignorance of post wet Cupping Therapy wound care. 5. Ignorance of safety protocols for young, elder and chronically ill patients.

Researches: Kadhim Qasim, Ali Al-Rubaye, The Clinical and Histological Skin Changes After the Cupping Therapy (Al -Hijamah) - J Turk Acad Dermatol 2012; 6 (1): 1261a1.

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SKIN ULCERS

Definition: A skin ulcer is an area of loss of tissue integration on the skin. Hospitalization and surgical interventions are sometimes needed to manage skin ulcers. Causes related to Cupping Therapy: 1. Ignorance of following safety precautions for elder, young, and allergic patients. 2. Failure of evaluating risks/benefits values according to a patient‘s condition. 3. Performing magnetic Cupping Therapy for long duration using magnetic probe inside the cup (pressure ulcers may occur). Researches: Kam Lun E. Hon,David Chi Kong Luk,Kin Fon Leong,and Alexander K. C. Leung - Cupping Therapy May be Harmful for Eczema: A PubMed SearchCase Reports in Pediatrics - Volume 2013, Article ID 605829, 3 pages

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LYMPHEDEMA

Definition: Lymphedema is a local swelling due to the accumulation of lymph fluids. Lymphedema is common among cancer patients who remove lymph nodes. Avoid performing cupping for these patients. Apply risks/benefits rule to take your decision for other patients who suffer from bad, obstructed or damaged lymphatic system. Research: Sara Al-Reefy , Maryam Parsa-Nezhad, Lymphedema Following Cupping Therapy "Hijama" Post Breast Cancer Surgery and Axillary Clearance - Bahrain Medical Bulletin, Vol. 36, No. 1, March 2014.

VASOVAGAL ATTACK

Definition: Vasovagal attack or reflex is an overreaction of the body to certain triggers such as seeing blood and stress situations.

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Sudden syncope or deterioration of consciousness may occur due to a decrease in blood pressure. A vasovagal attack is usually self-limited illness. The care of the patient and prevention of fall during the attack are the main rules of the practitioner. Causes related to Cupping Therapy: 1. Seeing the blood during wet cupping session. 2. The patient is overstressed or feeling afraid of receiving cupping session. 3. The patient has a history of multiple vasovagal attacks. 4. The patient is very tired or has been fasting for long hours. 5. Practitioner

performed

deep,

painful

scarification

or

manipulation. How to prevent: 1. Take a detailed full medical history. 2. Measure carefully vital signs for every patient. 3. Observe your patient during the session closely especially if there is a history of previous attacks.

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4. Choose supported positions before performing cupping to prevent falling. 5. Talk with your patient and let him/her know what you will do. 6. Discuss cupping therapy and explore and resolve patient's fears before starting the session. How to manage: 1. Starting first aid measures (checking respiration (airway), pulse, and circulation). 2. Remove the cups. 3. Put the patient in the recovery position. 4. Measure vital signs. 5. Follow up until complete recovery. 6. Refer if the patient condition is deteriorated or not improved.

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Researches: Romy Lauche, Holger Cramer, Claudia Hohmann, et al., ―The Effect of Traditional Cupping on Pain and Mechanical Thresholds in Patients with Chronic Nonspecific Neck Pain: A Randomised Controlled Pilot Study,‖ Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 429718, 10 pages, 2012.

ANEMIA

Definition: Anemia is a disease characterized by a decrease in hemoglobin or red blood cells. Repeated frequent wet cupping therapy sessions may lead to iron deficiency anemia. How to prevent: 1. The time gap between any two wet cupping sessions should be from two weeks to one month according to the patient‘s condition.

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2. The time gap between blood donation and wet cupping therapy session should be at least one month. 3. Examine patients carefully for anemia symptoms such as pallor, palpitation, or fatigue. 4. Refer the patient if you think he/she is anemic, then follow up.

Researches: 1. Remzi Adnan Akdoğan, Elif Akdoğan, An unusual cause of iron deficiency anemia in a healthy man: Hijamah - Turk J Hematol 2011; 28: 254-6 2. Seung-Jun Lee, Young-Sung Suh , Yeon-Ju Lee, Dong-Gil Cho, Min-Ji Lee, Dae-Hyun Kim - Iron Deficiency Anemia due to Long-time Bloodletting Using Cupping - Korean J Fam Med. 2011;32:56-59.

HEPATITIS

Cupping therapy (wet cupping) may be a cause for transfer of bloodborne diseases such as Hepatitis B and AIDS if infection control measures are ignored.

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Following strict infection control measures is an essential step in cupping therapy practice. It is a very important step to perform a safety cupping technique. Safety of patients, visitors, workers, and practitioners are ensured by following appropriate infection control measures. There is no scientific proof of association between Cupping Therapy and Hepatitis C virus transmission Researches: 1- A.A. Al-Waleedi, Y.S. Khader - Prevalence of hepatitis B and C infections and associated factors among blood donors in Aden city, Yemen -EMHJ • Vol. 18 No. 6 • 2012 2- Colin W Shepard, Lyn Finelli, Miriam J Alter-Global epidemiology of hepatitis C virus infection - Lancet Infect Dis 2005;5: 558–67.

ACQUIRED HEMOPHILIA A

Definitions: Acquired hemophilia is the development of factor VIII inhibitors in a non-hemophilic patient. It is a rare disease. The inhibitors can develop in

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association

with

autoimmune

disease,

allergic

drug

reactions,

malignancies, and pregnancy. Researches: Weng YM , Hsiao CT - Acquired hemophilia A associated with therapeutic cupping - The American Journal of Emergency Medicine [2008, 26(8)

CUPPING SAFETY

Cupping Therapy is considered a relatively safe practice. Few adverse effects have been reported due to the therapy itself. It is very important to ensure that the practitioners are properly trained and aware of the risks of the practice. Practitioners should know how to prevent and manage minor cupping therapy adverse events.

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INFECTION CONTROL MEASURES

Risk of infection transmission: There is one published research study linking Cupping Therapy to the transmission of hepatitis B disease, which is considered one of the bloodborne diseases. Another research study concluded that cupping and tattooing are not linked to the spread of blood-borne diseases. But actually, in wet cupping when the practitioner draws out blood, there is a risk of transmission of these diseases. And sometimes in dry cupping, prolonged or repeated application of cups to the skin may cause extravasation of blood and fluids and draw of them through the skin even if is not visible immediately. Herpes simplex infection after dry Cupping Therapy was reported.

INFECTION CONTROL PROTOCOLS HAND HYGIENE

World Health Organization (WHO) published a guideline for hand hygiene. The guideline recommends using water and soap if hands are

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visibly dirty, contaminated with blood or body fluids or after toilet and using alcohol-based antiseptic gel in other clinical situations. World Health Organization recommended five moments for hand hygiene which are: before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. United States Centers for Disease Control (CDC) also recommends hand washing after glove removal. See the next Table for steps of hand rubbing with alcohol-based gel and steps for hand washing with soap and water.

Hand washing: Duration: 40 - 60 seconds Materials: soap and water. Steps: 1. Wet hands with water. 2. Apply enough soap. 3. Rub hands palm to palm. 4. Right palm over left dorsum and vice versa.

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5. Palm to palm with fingers interlaced. 6. Backs of fingers to opposing palms. 7. Rubbing of left thumb clasped in right palm and vice versa. 8. Rotational rubbing, backward and forwards with clasped fingers of right hand in left palm and vice versa. 9. Rinse hands with water. 10. Dry hands thoroughly with a single use towel. 11. Use towel to turn off faucet.

Alcohol rub Duration: 20 - 30 seconds. Materials: Alcohol -based formulation.

Steps: 1. Apply a palmful of the product in a cupped hand, covering all surfaces. 2. Rub hands palm to palm.

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3. Right palm over left dorsum with interlaced fingers and vice versa. 4. Palm to palm with fingers interlaced. 5. Backs of fingers to opposing palms with fingers interlocked. 6. Rotational rubbing of left thumb clasped in right palm and vice versa. 7. Rotational rubbing, backward and forwards with clasped fingers of the right hand in left palm and vice versa. 8. Once dry, your hands are safe.

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PERSONAL PROTECTIVE EQUIPMENT (PPE) A risk of blood contamination with therapist‘s skin and clothes is high if wet cupping is performed and a direct contact with intact skin and wounds happens. WHO recommends using various types of personal protective equipment to protect healthcare professionals and patients. Surgical gloves, impermeable gowns, plastic aprons, and masks are the main PPEs used in this case. Using head caps, boot covers, and protective eyewear in cases of blood or body fluid splashes. So, our recommendation is to use surgical gloves, a gown and/or a plastic apron and a mask when doing wet cupping and clean examination gloves, a mask when doing dry cupping.

REFER AND FOLLOW-UP

The cupping practitioner (if not a physician or the complaint is outside his/her specialty) should refer the patient to a specialist if there is no diagnosis for the patient's complaint. If there is any warning sign or medical emergency. If vasovagal attack happens during the cupping session and the patient‘s condition does

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not improve or deteriorates after first aid measures. Therapists also should refer patients who are taking anti-coagulants to their specialist to get his permission for doing Cupping Therapy and to obtain his recommendation to stop or modify anti-coagulant drugs. Certain investigations could be done for those patient before Cupping Therapy to check their blood coagulation profile. Follow-up is very important component of patient care. Follow-up includes checking patient condition after Cupping Therapy and to ask about round spots (bruises), and wound condition in wet Cupping Therapy. Patients should have the clinic contact number to ask about any symptoms they may feel after cupping. The clinic should contact the patient after 48 hours to ask for wound dressing removal, and 24 hours before any scheduled cupping session.

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CUPPING THERAPY AND BLOOD DONATION

There are many differences between cupping therapy and blood donation. The following table compares cupping therapy and blood donation

Wet Cupping Therapy

Whole Blood donation

The purpose

Therapeutic and preventive

Donation

Amount

10-50 ml

450-500 ml

Age

There are no references. usually started after 12y

From 16y and above

State of subjects

Healthy and sick people

Healthy volunteers

Source of blood

Under-skin circulation (ex. capillaries, venules)

Venous circulation

Spacing

Every month or every two weeks

You can donate blood every 56 days

Relation

You should wait at least one month after blood donation to have wet cupping

You can donate blood 6 months after wet cupping in the UK

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WET CUPPING THERAPY AND LUNAR MONTH

Does the efficacy of wet cupping therapy change with the lunar face? There is no definite scientific answer to this question until now. Muslims prefer to perform wet Cupping Therapy in the second half of the lunar month, especially in 17th, 19th, and 21st of every lunar month. Recent research by Benli & Sunay reported more significant and better results of wet Cupping Therapy for the treatment of migraine when performed in the second half of the lunar month. Large-scale clinical trials are recommended to explore this relationship.

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CHAPTER 7

CUPPING THERAPY POINTS

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CUPPING THERAPY POINT SELECTION

Choosing the right cupping point is a critical part of performing effective Cupping Therapy session. There are certain rules and laws to choosing these points, but the most important are: 1. Cupping on pain points: The most important place to perform cupping is pain points. Cupping practitioners should palpate the pain area carefully to determine the most painful points. If there are no contraindications to performing cupping on these points, the therapist should choose these as first choice points. Some theories explain why these points are the most important points such as: pain gate theory, reflex zone theory, nitric oxide theory and meridian channels theory. 2. Cupping on anatomical sites: Studying anatomy is an essential part of the training of any Cupping Therapy practitioner. If the practitioner does not find suitable pain

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points, then the next step is to choose the points according to the anatomical site of the complaint or affected organ. 3. Cupping on acupuncture points or meridians: One of the most commonly used methods, especially by Chinese medicine and oriental medicine practitioners, involves cupping on certain acupuncture points. It also depends on Chinese healing theory that states the disease is due to the imbalance between the two main opposite energy Yin and Yang. The cupping practitioner should know the basic principles of Chinese medicine, the meridians, and how to locate acupuncture points to select points according to this method. Measurements:

Definitions and illustrations of terms: •

Midline: An imaginary line situated in the median of the body which divides the body into two symmetrical halves.

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(cun): ((cun)): is a Chinese measurement unit which depends on the patient's measurements. The therapist should measure one ((cun)) of the patients by measuring the width of the middle of the thumb or the distance between the interphalangeal joints of the middle finger.

Measurement 1 (cun)

The width of the middle of the thumb

1 (cun)

The distance between the interphalangeal joints of the middle finger

1.5 (cun)

Two forefingers

3 (cun)

Four fingers without the thumb



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FRONT POINTS

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153

key

Acupoint Mark

Anatomical mark

1

REN 21

At the center of the sternal manubrium on the Midline.

2

LU1

At the level of 1st intercostal space near the front of the shoulder.

3

REN 17

on the Midline of the front of the body at the level of the fourth intercostal space.

4

REN 15

On the Midline of the upper abdomen, one (cun) below the sternum.

5

REN 9

On the Midline of the abdomen, one (cun) above the umbilicus.

6

ST25

On the abdomen, 2 (cun) lateral to the umbilicus.

7

REN 7

On the Midline of the lower abdomen, one (cun) below the umbilicus.

8

SP14

On the lower abdomen, 4 (cun) lateral to the Midline.

9

ST 32

On the anterior aspect of the thigh

10

SP9

At the medial side of the knee, between the posterior border of the tibia and gastrocnemius muscle.

11

GB33

Lateral side in the area related to the head of the femur

12

SP10

2 (cun) above the patella at the medial side of the knee in a depression on the vastus medialis muscle.

13

ST35

At the lateral lower border of the patella.

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14

ST40

On the anterior border of the leg, 1.5 (cun) from the anterior border of the tibia.

15

ST44

On the dorsum of the foot, related to the second and third metatarsal toes.

BACK POINTS

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155

Area Key

Acupoint mark

Anatomical mark

1

DU 14

At the base of the neck and at the level of the 7th cervical vertebra.

2

GB21

At the middle of the shoulder

3

SI10

At the superior and lateral margin of the trapezius.

4

SJ10

On the lateral border of the arm, above the elbow.

5

BL16, BL17

1.5 (cun) (two fingers) lateral to the Midline in a depression related to the mid of the scapula.

6

DU 9

On the posterior Midline, related to the spinous process of the 7th thoracic vertebra.

7

BL25

1.5 (cun) lateral to the Midline at the level of the spinous process of 4th lumbar vertebra.

8

DU 5

On the Midline in the depression related to the spinous process of the 1st lumbar vertebra.

9

GB30

On the gluteal region in the area related to the sciatic nerve.

10

BL 50

Upper part of the posterior border of the thigh

11

UB 37

On the posterior border of the thigh

Tamer Shaban

12

BL55

Between heads of the gastrocnemius muscle

13

BL57

In the middle of the calf muscles

HEAD AREAS AND POINTS

Key

Acupoint mark

Anatomical mark

1

DU 20

The junction between the Midline and the line connecting the apexes of the ears on the head.

2

DU 16

It is just below the external occipital protuberance

3

GB 20

In the depression between the sternocleidomastoid and trapezius muscles.

key

Acupoint mark

Anatomical mark

1

Du 20

The center of the head.

2

Du 24

At the front of the head, half (cun) posterior to frontal hairline

3

ST8

Half (cun) from frontal hairline on both sides of the scalp, at the corner of forehead

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CUPPING THERAPY POINTS FOR SOME DISEASES

CUPPING THERAPY FOR HEALTH PROMOTION

You can use these points for protective purposes and for health promotion. Cupping points:

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1. Area located at the base of the neck at the level of the 7Th cervical vertebra. 2. Area located at the mid of the scapula on both sides – 1.5 (cun) lateral to the Midline. Research: Kaleem Ullah and Ahmed Younis - An investigation into the effect of Cupping Therapy as a treatment for Anterior Knee Pain and its potential role in Health Promotion. The Internet Journal of Alternative Medicine - 4(1). 2007.

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CUPPING FOR PAIN RELATED CONDITIONS CERVICAL PAIN

Cervical pain is pain in the neck region. The most common causes are: trauma, muscle sprains, cervical disc prolapse, cervical vertebra diseases, and other musculoskeletal diseases. Cupping Points Pain points areas are the most effective points. If there are no pain points, you may use these areas: 1. Area related to the base of the neck at the level of the 7Th cervical vertebra. 2. Area located at the middle part of the shoulder. 3. Area located at the mid of the scapula on both sides – 1.5 (cun) lateral to Midline.

The cup stimulates and involves more than one acupoint because

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of the cup size in relation to the needle. Clinical Case: A 46-year-old man was suffering from cervical pain and inability to rotate his neck easily due to cervical disc prolapse. After 3 wet cupping treatments, one session per month, the severity of pain was decreased, he was able to move his neck easily, and he returned to his normal life.

Research: WAN Xue-wen. Clinical Observation on Treatment of Cervical Spondylosis with Combined Acupuncture and Cupping Therapies DOI: 10.1007/s11726-0070345-5

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FROZEN SHOULDER

Causes: The causes of frozen shoulder are not fully understood. Frozen shoulder may be a complication of other diseases such as: diabetes, cardiac diseases, and thyroid diseases or prolonged shoulder immobilization after surgery or accidents.

Symptoms: 1. Shoulder pain and stiffness 2. Then shoulder is very hard to move 3. It occurs in women more than men 4. People between forty and sixty years are usually affected.

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Cupping Therapy Points:  Pain points.  Back points: 1. Area located at the base of the neck at the level of the 7Th cervical vertebra. 2. Area located at the mid of the shoulder on both sides.  Front points: 1. Area at the first intercostal space related to acupoint (LU1) 6 (cun) lateral to the Midline. Clinical Case: An Italian man 67 years old suffered from frozen shoulder for more than 5 years. He was unable to raise his arms to his head level. There is a difficulty in his shoulder movement. Massage cupping for his back and shoulder area followed by wet cupping therapy for one session was the treatment. Immediately after the session, he was able to raise his hands over his head, and move his shoulder.

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Research: Dorina Sohn, Hyunmin Yoon, Hyangmi Jung, Effects of Dry Cupping Therapy on Shoulder Pain and Fatigue in Nurses-Journal of Acupuncture and Meridian Studies 1 December 2011 (volume 4 issue 4 Page 269 DOI: 10.1016/j.jams.2011.10.009)

KNEE PAIN

We here take the anatomical position as our guide to do cupping around the knee and at the painful areas. Cupping Points:  Pain points

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 Front points (On affected side left or right): 1. Area located 2 (cun) above the patella at the medial side of the knee in a depression on the vastus medialis muscle. 2. Area located at the medial side of the knee, between the posterior border of the tibia and gastrocnemius muscle. 3. Area located at the lateral lower border of the patella. 4. Area located at the lateral side of the knee on the area related to the head of the femur. Clinical Case: A 35-year-old man was suffering from knee pain and arthritis. He was feeling severe pain when he walked. He had three wet cupping therapy treatments. He began to feel a decrease in pain after the first session. He was completely relieved after 4 sessions.

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Research: Michael Teut, Stefan Kaiser, Miriam Ortiz, Stephanie Roll, Sylvia Binting, Stefan N Willich and Benno Brinkhaus - Pulsatile dry cupping in patients with osteoarthritis of the knee – a randomized controlled exploratory trial - BMC Complementary and Alternative Medicine 2012, 12:184

ACUTE LUMBAR SPRAIN

Causes: 1. Excessive physical demands on the spine 2. Lifting heavy objects 3. Accidents 4. Heavy exercise Symptoms: 1. Sharp back pain 2. Pain during movement

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3. Difficulty in movement 4. There may be swelling or stiffness

SCIATICA AND LOW BACK PAIN

Sciatica is a symptom of a medical condition is not a condition itself, and it refers to pain, weakness, and leg numbness due to injury to or pressure on the sciatic nerve. Causes: 1. Pelvic injuries 2. Pelvic fractures 3. Tumors 4. Spinal disc herniation (pressing on sciatic nerve) 5. Some pain syndromes Symptoms: 1. Dull pain

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2. Pain that worsens at night or with coughing 3. Mild tingling or burning sensation 4. Sharp pain on one side of hip and numbness in other parts of the leg. The pain may also be felt at the back of the calf or on the sole of the foot.

Cupping Therapy points  Pain points.  Back Points: 1. Area located 1.5 (cun) lateral to the Midline at the level of the spinous process of the 4th lumbar vertebra. 2. Area located 1.5 (cun) lateral to the Midline at the level of the spinous process of the second lumbar vertebra. 3. Area located on the Midline in the depression related to the spinous process of the 1st lumbar vertebra. 4. Area located in the upper part of the gluteal region.

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5. Area located on the posterior border of the thigh. 6. Area located at the middle part of the calf muscles.

Clinical case: A 52-year-old man was suffering from sciatica and severe low back pain. After 4 massage cupping and wet cupping sessions, the pain was relieved. He was able to walk easily. Sharp pain on one side of hip and numbness in other parts of the leg. The pain may also be felt at the back of the calf or on the sole

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of the foot. Research: 1.

Jong-In Kim, Tae-Hun Kim, Myeong Soo Lee, Jung Won Kang, Kun Hyung Kim, Jun-Yong Choi, Kyung-Won Kang, Ae-Ran Kim, Mi-Suk Shin, So-Young Jung and Sun-mi Cho Evaluation of wet-cupping therapy for persistent non-specific low back pain: a randomised, waiting-list controlled, openlabel, parallel-group pilot trial - Trials 2011, 12:146 doi:10.1186/1745-6215-12-146

2.

[Hanan, S. Ali. and Eman, S. El-Said Cupping Therapy (AlHijama): It's Impact on Persistent Non-Specific Lower Back Pain and Client Disability. Life Sci J 2013;10(4s): 631-642] (ISSN:1097-8135).

HEADACHE

One of the diseases treated effectively with cupping therapy and acupuncture after medical consultation and diagnosis. Headache is defined as a pain in the area of the head or neck region. The pain varies in intensity, duration, and the area affected. The two types of headaches are: primary and secondary. A primary headache is the most common type of headache, and the most common example of this type is migraine. Migraine is a pain

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in half of the head and is characterized by a throbbing pain associated with nausea, vomiting, and visual disturbance. The secondary headache is caused by a problem or a disease in the head and neck. The most common causes are hemorrhage, thrombosis, inflammation, fever, and increased pressure in the head and neck region. Headaches are the most common problem of the nervous system. According to the World Health Organization, it affects two-thirds of men and 80% of women in developed countries. Migraine is the nineteenth most common cause of disability worldwide, and it reduces the social life of people who suffer from it by about 60% and may become a lifelong disability.

Cupping therapy points  Back Points: 1. Area located at the base of the neck. 2. Area located at the middle of the shoulder.

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3. Area located at the superior and lateral margin of the trapezius muscle. 4. Area located on the deltoid muscle. 5. Area at the center of the head. Some patients respond to cupping on DU 14 only, so try to begin the treatment with the most effective point and begin with a few points. Clinical cases: Case 1 A 30-year-old woman was suffering from a migraine. After one wet cupping session, the severity of pain and the frequency of the migraine was decreased significantly. Case 2 A 32-year-old man was suffering from a very severe headache. After 2 wet cupping sessions, his pain was relieved, and he was healthy and not suffering from a headache for years.

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Research: 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, Vol. 36, No. 1, 37–44.

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CUPPING FOR SYSTEMIC DISEASES

AUTOIMMUNE DISEASES RHEUMATOID ARTHRITIS Causes: The actual causes are unknown. Symptoms: 1. Morning stiffness 2. Joint pain usually on both sides 3. Joint may lose its range of motion and may become deformed 4. Other symptoms may include: dry eye and mouth, nodules under the skin, numbness in hands and feet, and sleep difficulties.

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Cupping therapy points: Back points: 1. Area located at the base of the neck. 2. Area located on the Midline at the level of the second thoracic vertebra. 3. Area located at the mid of the scapula on both sides – 1.5 (cun) lateral to Midline. 4. Area located at the level of the spinous process of the second lumbar vertebra. Front points: 1. Area located on the Midline of the front of the body at the level of the fourth intercostal space.

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Research: 1.

Khalil AM, Al-Qaoud KM, Shaqqour HM. Investigation of Selected Immunocytogenetic Effects of Wet Cupping in Healthy Men. Spatula DD. 2013; 3(2): 51-57. doi:10.5455/spatula.20130712050838

2.

Ahmed SM, Madbouly, NM, Maklad, SS, Abu-Shady EA. Immunomodulatory effects of bloodletting cupping therapy in patients with rheumatoid arthritis. Egypt J Immunol. 2005; 12:39-51.

GOUT

It is advised to continue drug therapy of gout like all conditions with cupping therapy treatment. Gout is a rheumatic disease, characterized by acute attacks of arthritis, usually in the great toe of the foot. It sometimes leads to deformity and chronic arthritis. Men are affected more than women. Ninety percent of gout sufferers are men over thirty years. There are more than two million gout sufferers in the United States of America. In 2002, World Health Organization published ―Acupuncture: Review and Analysis of Reports on Controlled

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Clinical Trials.‖ In this report, the World Health Organization mentioned using acupuncture and cupping for the treatment of gout. Symptoms of Gout: The inflammation is usually in one joint. 1. An increase in blood uric acid is usually present due to a metabolic disorder. 2. Acute gouty arthritis happens suddenly 3. The most affected joint is the joint of the great toe, but it may affect other joints such as the knee, feet, and ankles. 4. The affected joint is very painful, swollen, red and warm. 5. Fever is usually present. After the attack, the patient may be asymptomatic for years. Later, gout may become a chronic disease with a serious disability and deformity. Causes Excess alcohol, some infections, drugs, and surgical

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operations may increase blood uric acid and lead to acute gouty arthritis. Gout treatment Bed rest is helpful for an acute attack. Hot and cold compresses may be helpful for some patients. Avoiding excess alcohol consumption, restriction of high purine foods like meat, kidney, sardines and liver, and avoiding drugs which increase blood uric acid such as diuretics are recommended. Medical consultation during an acute attack is essential. Cupping therapy points:  Pain points.  Back Points: 1. Area located at the base of the neck. 2. Area located on the Midline at the level of the second thoracic vertebra. 3. Area located at the mid of the scapula on both sides– 1.5 (cun) lateral to Midline.

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 Front points: 1. Area located at the lateral lower border of the patella.

Research: Pan HL. (Observation of 39 cases of gout treated with plum-blossom needling plus cupping) Zhenjiu Linchuang Zazhi, 1997, 13(3):29(in Chinese).

URTICARIA

Urticaria is a common problem. About 20% of people suffer from urticaria at least once during their life. Urticaria is characterized

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by the appearance of itchy swollen skin lesions. Urticaria can be classified into allergic urticaria and non-allergic urticarial. Causes: Unknown causes for about 50% of cases. 2. Allergy to substances such as latex. 3. Infections. 4. Heat or cold. 5. Certain chemical exposure. 6. Emotional stress. Symptoms: Urticaria A raised and itchy rash and may involve small or Large skin areas. It may develop Angioedema or swelling of a deeper layer of skin.

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Cupping Therapy Points: Back Points: 1. Area located at the base of the neck at the level of the 7th cervical vertebra. 2. Area located at the Midline at the level of the 2nd thoracic vertebra. 3. Area located at the mid of the scapula on both sides– 1.5 (cun) lateral to Midline. 4. Area located at the Midline, at the level of the 7th thoracic vertebra. 5. Above the elbow joint on both sides.

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Research: Mohammad Sharif Sharifi, and Hamidollah Afrasiabian - Evaluation of Wet Cupping Treatment in Patients with Chronic Urticaria and Angioedema - The Open Conference Proceedings Journal, 2013, 3, 1-5

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RESPIRATORY DISEASES

BRONCHITIS

Is an inflammation of the bronchial tube which carries air to the lungs. Acute Bronchitis Causes: 1. Viruses (common cause). 2. Bacteria (uncommon cause). Symptoms: 1. Cough. 2. Shortness of breath. 3. Wheezing. 4. Chest tightness.

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5. Chronic Bronchitis. Chronic bronchitis Causes: 1. Cigarette smoking is the most common cause. 2. Long-term breathing of dust and other air pollution substances. Symptoms: 1. Wet Cough (inflamed bronchi produce a lot of mucus) 2. Shortness of breath 3. Chest tightness Cupping Therapy Points:  Back Points: 1. Area located at the mid of the scapula on both sides – 1.5 (cun) lateral to Midline.

 Front Points:

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1. Area located at the center of the sternal manubrium on the Midline. 2. Area located on the Midline at the level of the 4th intercostal space. 3. Area located at the level of 1st intercostal space near the front of the shoulder. Clinical case: A 54-year-old man was suffering from chronic bronchitis due to cigarette smoking. He was treated with wet cupping. There is an improvement in his symptoms. His chest tightness was decreased.

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Research: 1-Zhang CQ, Liang TJ, Zhang W. [Effects of drug cupping therapy on immune function in chronic asthmatic bronchitis patients during protracted period]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2006 Nov;26(11):984-7. 2-Zhao J. Combination of cupping therapy and antibiotic treatment of 220 pediatric cases with cough after acute upper respiratory infection [in Chinese]. Shanxi Journal of Traditional Chinese Medicine. 2010;26(8):34.

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BRONCHIAL ASTHMA

Causes: Bronchial asthma is an airway inflammation which is commonly initiated by some triggers. Many triggers affect sensitive people such as: cigarette smoking, dust, pollen, exercise and respiratory infections. Symptoms: 1. Cough 2. Chest tightness 3. Wheezing 4. Dangerous symptoms include: bluish color, loss of breath, decreased level of alertness, rapid pulse, sweating or increased anxiety ☒ Asthma

is

a

life-threatening

condition

during

exacerbation and acute attacks.

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Suggested criteria for performing cupping for asthmatic people: 1. A medical specialist examined and diagnosed the patient 2. A follow-up with healthcare professional was maintained 3. There is no acute exacerbation 4. The patient‘s condition is stable Cupping Therapy Points:  Front points (Flash Cupping Therapy): 1. Area located at the level of 1st intercostal space near the front of the shoulder. 2. Area located at the center of the sternal manubrium on the Midline. 3. Area located on the Midline of the front of the body at the level of the 4th intercostal space. 4. On the muscles of respiration.

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N.B.: The distribution of the points takes the normal anatomical position of the lungs.  Back Points: 1. Along para-spinal muscles on bladder meridians. Other recommended lines of treatment: 1. Hypoallergenic diet. 2. Stop cigarette smoking and avoid passive smoking. 3. Avoid inhalation of perfumes and dust. 4. Take a lot of hot drinks such as anise and ginger. Clinical cases: A 13-year-old boy was suffering from mild bronchial asthma. He received ten flash cupping therapy treatments – 2 sessions per week for five weeks. There was a significant increase in his pulmonary function tests. There was a decrease in his bronchial asthma symptoms and a decrease in his frequent needs for the risk medication.

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Research: 1.

Mohamed Elsayed Mohamed Abd al-Jawad, Saeed Adel Mohamed, Badawy Ahmed Elsayed, Abd Alfattah, Nevine M Mohamed - Evaluation of Wet Cupping Therapy (Hijama) as an Adjuvant Therapy in the Management of Bronchial Asthma - Indian Journal of Physiotherapy and Occupational Therapy – An International Journal Year : 2011, Volume : 5, Issue : 4

2.

Tamer Shaban, Magdy Karam El-Deen, Rehab Abd El kader, The Role of Cupping Therapy As a Complementary Therapy On The Pulmonary Functions And Quality Of Life Of Asthmatic Children. Medical Studies Department, Institute of Postgraduate Childhood Studies, Ain Shams UniversityEgypt- Master Thesis – 2011

DIGESTIVE DISEASES

IRRITABLE BOWEL SYNDROME & SPASTIC COLON

Irritable bowel syndrome (IBS) is an intestinal inflammatory disease. While, Inflammatory bowel diseases (IBD) refers to two major diseases Crohn's disease and Ulcerative Colitis.

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Irritable bowel syndrome is an adult disease, most frequently occurring between fifteen and twenty-five years old. Other management procedures: 1. Diet therapy. 2. Avoid stress. 3. Relaxation techniques. 4. Hypnotherapy treatment. Cupping therapy points:  Back Points: 1. Area located 1.5 cun lateral to the Midline at the level of the spinous process of 3rd lumbar vertebra. 2. Area located 1.5 cun lateral to the Midline at the level of the spinous process of 4th lumbar vertebra.  Front points:

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1. Four points around the umbilicus (Dry cupping).

. Research: MacPherson et al.: Acupuncture for irritable bowel syndrome: primary care based pragmatic randomised controlled trial. BMC Gastroenterology 2012 12:150.

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CHRONIC GASTRITIS

Chronic gastritis is a continuous inflammation of the stomach. Causes: 1. Infection by bacteria called Helicobacter pylori 2. Malfunction of the immune system 3. Stress Symptoms: 1. Pain in upper abdomen 2. Nausea and vomiting Cupping Therapy Points Back Points: 1. The two respiratory windows. 2. Area related to anatomical position of the stomach on the back.

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Front points: 1. Area located 1 (cun) below the costal margin on the Midline. 2. Area related to anatomical position of the stomach on the front. 3. Both sides of the umbilicus.

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Research: Shuang He, Junfan Luo, Jingfen Chen - Clinical study on chronic gastritis treated by acupuncture - Journal of Acupuncture and Tuina Science - June 2011, Volume 9, Issue 3, pp 179-181.

CHRONIC DISEASES

HYPERTENSION

Hypertension is a chronic elevation of arterial blood pressure. Normal blood pressure is 120/80 mmHg measured by special device (blood pressure monitor). Hypertension is diagnosed when your blood pressure is higher than normal during three separate measurements.

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Types: Essential hypertension: It is a common type of hypertension when there is no apparent cause of hypertension. Secondary hypertension: It was a secondary to a primary disease such as: kidney diseases, birth control pills, diet pills, diseases of the adrenal gland, and pregnancy are some causes. Risk factors: 1. Obesity 2. Cigarettes smoking 3. Drinking alcohol 4. Diabetic patients 5. Previous family history of hypertension 6. Stressful life condition

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7. Anxiety 8. These risk factors increase the chance of getting hypertension. Symptoms: No symptoms of essential hypertension in most of the cases so elderly people must measure their blood pressure regularly. Other symptoms: 1. Headache 2. Nausea 3. Vomiting 4. Blurred vision Cupping Therapy Points: Back Points: 1. At the base of the neck.

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2. At the area related to the second and third thoracic vertebrae. 3. At the level of the mid of the scapula on both sides 1.5 (cun) lateral to the midline. 4. At the lower back. Essential hypertension is the most common type of hypertension without known causes. Cupping therapy may help in decreasing blood pressure and increasing the quality of life. Blood pressure monitor is needed, and a full cupping therapy treatment course is recommended.

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Researches:

199

1.

Lee, Myeong Soo, Tae-Young Choi, Byung-Cheul Shin, Jong-In Kim, and Sang-Soo Nam. "Cupping for hypertension: a systematic review." Clinical and Experimental Hypertension 32, no. 7 (2010): 423-425.

2.

Aleyeidi, Nouran A., Khaled S. Aseri, Shadia M. Matbouli, Albaraa A. Sulaiamani, and Sumayyah A. Kobeisy. "Effects of wet-cupping on blood pressure in hypertensive patients: a randomized controlled trial." Journal of integrative medicine13, no. 6 (2015): 391-399.

Tamer Shaban

OBESITY AND WEIGHT REDUCTION

Obesity: According to the World Health Organization, in 2008, more than 200 million men and nearly 300 million women were obese. Eleven percent of adults worldwide aged 20 and over were obese. Obesity is to have or accumulate too much fat in the body which may lead to health problems. Obesity increases the risk of some cancers such as colon cancer, diabetes, heart diseases, stroke, and arthritis. Causes: There are many causes: 1. Excess food intake and lack of physical activity (The main cause) 2. Genetic factors 3. Some psychiatric disorders

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4. Increasing urbanization Cupping therapy points: Front points: 1. Area located 1 (cun) below the costal margin at Midline. 2. Area located just above the umbilicus. 3. Area located just below the umbilicus. 4. Area located at the left and right sides of the umbilicus. Back points 1. At the level of the mid of the scapula on both sides 1.5 (cun) lateral to the midline. Massage cupping: Massage cupping for fatty areas (Thighs, abdomen, buttocks, and back of arms) Exercises and diet therapy are recommended and very important.

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Research: Bu TW, Tian XL, Wang SJ, Liu W, Li XL, et al. Comparison and analysis of therapeutic effects of different therapies on simple obesity [in Chinese]. Chinese Acupuncture & Moxibustion. 2007;27:337–340.

DIABETES MELLITUS

Diabetes is a metabolic disorder. A diabetic patient has a high blood sugar due to the failure of the pancreas to produce the right amount of insulin that is used to move sugar from the blood into cells, or the cells do not respond in the right way to the produced insulin. Types There are many types, but the three main types are: 1. Type 1 diabetes is an autoimmune disease 2. Type 2 diabetes is the most common type

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3. Gestational diabetes is diagnosed during pregnancy Causes: Type 1 diabetes is caused by a lack of insulin due to the destruction of insulin-producing beta cells in the pancreas. Type 2 diabetes is caused by a combination of factors, including increased insulin resistance and lack or decrease of insulin production. The trigger factors include overweight and obesity, environmental factors, genetic factors, and stressful life condition. Symptoms: 1. Fatigue. 2. Frequent urination. 3. Increased thirst. 4. Increased hunger. 5. Weight loss. 6. Slow healing of wounds.

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Cupping Therapy Points:

 Back Points: 1. At the base of the neck. 2. Area related to the second and third thoracic vertebrae. 3. At the level of the mid of the scapula on both sides 1.5 (cun) lateral to the midline. 4. Anatomical site of the pancreas.  Front points: 1. On the midline of the front of the body at the level of the fourth intercostal space. 2. Anatomical position of the pancreas.

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Research: 1.

2.

Ramazani M, Shariatzade S, Malekirad A, Akbari A, Shariatzade M. Effect of cupping on blood factors and oxidative stress in diabetes type II. Arak University of Medical Sciences Journal. 2013; 15 (8) :54-60 Ashraf Hussein Hassan, Farag Mohammed Farag, Mohammed Elmahdy H.Sarhan, Mohammed Yakout Abdel Aziz, and Mohammed Ahmed Abo Elela. Evaluation of cupping therapy in some chronic diseases (Rheumatoid Arthritis, Type 2 DM and chronic HCV infection). Thesis Submitted in partial fulfillment for M.D Degree of Internal Medicine. 253. 2006.

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NEUROLOGICAL DISEASES FACIAL PARALYSIS

It is a one sided paralysis of the face. It may involve one muscle or multiple muscles of the face. Causes: 1. Facial nerve trauma, inflammation or injury. 2. Brain disease or injury involved the brain part which controls the facial muscles. 3. Some tumors. 4. Stroke. Symptoms: The main symptom is inability to move one or more muscles of the face on one side. Cupping Therapy points:

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Types of cupping: Massage cupping, Flash cupping or dry cupping Front points: 1. Points related to facial nerve and affected muscles.

Research: 1.

Huang LP, Cao RL, Bi YF, Han ZC, Yue BA, et al. Combination of flash cupping and acupuncture on treating of 115 cases with peripheral facial paralysis [in Chinese]. Shanxi Journal of Traditional Chinese Medicine. 2009;30:597–599.

2.

Li P. Clinical observation on treatment of 60 cases of acute peripheral facial paralysis with acupuncture and flash cupping therapy [in Chinese]. Journal of Shanxi College of Traditional Chinese Medicine. 2010;33(4):83–84

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CARPAL TUNNEL SYNDROME

Definition: Carpal tunnel syndrome CTS) is a neurological disease due to compression of the median nerve. The median nerve is located in the carpal tunnel of the wrist.

Symptoms: 2. Pain 3. Numbness 4. Tingling in fingers.

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Cupping Therapy points: 1. Area over the trapezius muscle. 2. Area over the trapezius muscle. Research: Mic h al se n, An d r e a s, Si l ke B o c k, Ra i ner Lü d t ke , T ho ma s Ra mp p , Marc u s B a ec ker , J ür ge n B ac h ma n n, J o st La n g ho r st, Fr a u ke Mu s ia l, a nd G u sta v J . D o b o s. " E f fe ct s o f trad it i o na l c up p i n g th erap y i n p a ti e nt s wi t h car p a l t u n n el s yn d ro me : a ra nd o mi zed co n tro l led tri al." T h e j o ur na l o f p ai n 1 0 , no . 6 ( 2 0 0 9 ): 6 0 1 -6 0 8 .

WOMEN HEALTH CONDITIONS DYSMENORRHEA

It is defined as a pain with menstruation or painful menstruation. It is classified into primary dysmenorrhea and secondary dysmenorrhea. Primary dysmenorrhea is a recurrent menstrual cramps not related to any other diseases. The secondary dysmenorrhea is a menstrual pain due to reproductive

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system disease. Causes: Primary dysmenorrhea may be due to uterine contractions. Secondary dysmenorrhea is due to reproductive system diseases such as endometriosis. Symptoms: 1. Abdominal pain 2. Abdominal heaviness or pressure 3. Pain in the back, hips and inner thighs

Cupping Therapy Points: Front Points 1. Area located 3 (cun) below the umbilicus. 2. On both sides, at the anatomical site of ovaries. Back Points

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1. Area located 1.5 cun lateral to the Midline at the level of the spinous process of 3rd lumbar vertebra. 2. Area located 1.5 cun lateral to the Midline at the level of the spinous process of 4th lumbar vertebra. 3. Area located on the Midline in the depression related to the spinous process of the 1st lumbar vertebra.

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Research:

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1.

Arshiya Sultana, Khaleeq ur Rahman, Muzn. Farzana, and Azad Lone - Efficacy of Hijamat Bila Shurt (Dry Cupping) on Intensity of Pain in Dysmenorrhoea-A Preliminary Study Anc Sci Life. 2010 Oct-Dec; 30(2): 47–50.

2.

Caroline A. Smith, Caroline A. Crowther, Oswald Petrucco, Justin Beilby, and Hannah Dent, ―Acupuncture to Treat Primary Dysmenorrhea in Women: A Randomized Controlled Trial,‖ Evidence-Based Complementary and Alternative Medicine, vol. 2011, Article ID 612464, 11 pages, 2011. doi:10.1093/ecam/nep239

Tamer Shaban

AMENORRHEA

Amenorrhea is a disease characterized by the absence of a monthly menstruation period. It is classified into primary or secondary amenorrhea. Primary amenorrhea is a disease of young girls who do not menstruate by the age of 16. Secondary amenorrhea is an absence of menstruation cycle in a woman after having normal menstruation cycles. Causes: 1. Primary Amenorrhea: 2. Disease of ovaries 3. Reproductive organs deformity or poor formation 4. Neurological or hormonal diseases Secondary amenorrhea 1. Pregnancy 2. Breastfeeding

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3. Menopause 4. Due to action of some birth control methods or cessation of birth control bills 5. Poor nutrition 6. Emotional stress and psychiatric diseases 7. Chronic diseases 8. Tumors Symptoms: No monthly menstrual flow Cupping Therapy Points Front Points 1. Area located 3 (cun) below the umbilicus. 2. On both sides, at the anatomical site of ovaries.

Back Points

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1. Area located 1.5 (cun) lateral to the Midline at the level of the spinous process of 1st lumbar vertebra. 2. Area located 1.5 (cun) lateral to the Midline at the level of the spinous process of 2nd lumbar vertebra. 3. Area located below the spinous process of the 4th lumbar vertebra at the Midline. 4. Area located 3(cun) lateral to the Midline at the level of the spinous process of 4th lumbar vertebra.

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Research:

RUQIYYA PARVEEN - Clinical efficacy of Hijamat Bil Shurt (Wet Cupping) in the management of Ehtebas Tams Sanwi (Secondary Amenorrhea) – 2012 Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore – Disseration - http://hdl.handle.net/123456789/7796

FEMALE INFERTILITY

It is the inability of the female to be pregnant after 2 years of marriage with regular intercourse and without using any contraceptive devices.

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The prevalence among couples is about 10% to 20%, so this method can help married infertile women to have normal ovulation and increased chance of getting pregnant. There were abundant clinical experiences and medical records for infertility in traditional medicine and cupping therapy. So we follow the world trend to do the research on traditional medicine since WHO launched the first global strategy on traditional and complementary/alternative medicine (TM/CAM) to assist countries in creating a stronger evidence base about the safety, efficacy and quality of the TM/CAM products and practices. Causes: The most common causes are hormonal disturbances or polycystic ovary and hypo-ovarianism. Cupping Therapy may regulate the hormonal system and stimulate ovulation. Cupping may stimulate ovulation and regulates hormones.

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Cupping Therapy Points: Back Points: 1. At the base of the neck. 2. Area related to the second and third thoracic vertebrae. 3. At the level of the mid of the scapula on both sides 1.5 (cun) lateral to the midline. 4. Area located 1.5 cun lateral to the Midline at the level of the spinous process of 4th lumbar vertebra. 5. Area located below the spinous process of the 4th lumbar vertebra at the Midline. Front points: 1. On anatomical sites of both ovaries (dry cupping therapy). ✓ The most important points are (ovarian sites) Other interventions include diet therapy if the female is obese. Clinical Case: A female 28 years old and married 5 years ago, was suffering from

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infertility, polycystic ovaries, anovulatory periods and obesity. Pregnancy occurred after the first cupping therapy session. She delivered a twin (two boys) and they were healthy and normal.

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Research: Rong Zhao, Acupuncture-moxibustion treatment for polycystic ovary infertility: A report of 20 cases - Journal of Acupuncture and Tuina Science - April 2012, Volume 10, Issue 2, pp 89-91.

PEDIATRIC DISEASES ENURESIS

Enuresis is known as bed-wetting. The disease is not diagnosed unless the child is 6 years or maybe 7. Nocturnal enuresis, or bed-wetting at night, is the most common type. Causes: The most common causes are: 1. A small bladder. 2. Urinary tract infections. 3. Stress or psychological disease.

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4. Diabetes. 5. Chronic constipation. 6. Hormonal imbalance. Symptoms: Repeated bed-wetting at least 2 times per week for longer than 3 months. Cupping Therapy Points: Back Points: 1. Alongside para-spinal muscles (bladder meridians).

Front points: (Dry Cupping) 1. On the Medline of the abdomen, 1 (cun) above the umbilicus. 2. On the Medline of the lower abdomen, 1 (cun) below the umbilicus.

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On the abdomen, 2 (cun) lateral to the umbilicus.

Research: Zhu Wei-ping - Clinical observation of 82 cases of enuresis treated by gingerpartitioned moxibustion plus cupping therapy - Journal of Acupuncture and Tuina Science - December 2003, Volume 1, Issue 6, pp 24-25

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MEN'S HEALTH CONDITIONS

MALE INFERTILITY

Male infertility is the inability to have children. The causes may include azoospermia (no sperms), varicocele, decreased number of sperms, decreased motility of sperms, and abnormal shape of sperms. Cupping Therapy Points: Back points: 1. Area located at the base of the neck and at the level of the 7th cervical vertebra. 2. Area located 1.5 cun lateral to the Midline at the level of the spinous process of 4th lumbar vertebra. 3. Area located at the Midline below the spinous process of 4th lumbar vertebra.

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Other interventions include: 1. Using multivitamins with zinc supplements 2. Using royal jelly 3. Asian ginseng (herbal supplement) 4. Dietary interventions 5. Avoid stress and fatigue Case study: A 34-year-old male was suffering from infertility, his seminal analysis was not normal. Sperm count was about three million with a decrease in motility. After cupping treatment and nutritional therapy, his sperm counts were twelve million. And his wife got pregnant after 2 months.

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Research: Rajput, K. U., & Ozturk, M. (2015). Male hypogonadism: exploring the role of heavy metal toxicity using mRNA analysis pre and post Cupping Therapy treatment. Integrative Medicine Research, 4(1), 28-29.

IMPOTENCE

It is a common male disease that has many causes such as: psychological causes, fatigue, somatic causes and uses of certain drugs.

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The definition of impotence is the inability to perform sexual intercourse due to the failure of erection maintenance. Cupping Therapy Points: Back Points: 1. Area located at the base of the neck and at the level of the 7th cervical vertebra. 2. Area located 1.5 cun lateral to the Midline at the level of the spinous process of 4th lumbar vertebra. 3. Area located at the Midline below the spinous process of 4th lumbar vertebra. Other interventions include: 1. Using multivitamins with zinc supplements 2. Using royal jelly 3. Asian ginseng (herbal supplement) 4. Dietary interventions 5. Avoid stress and fatigue

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PROSTATITIS

Prostatitis is an inflammation of the prostate that is very common in old age. Prostatitis may be acute or chronic inflammation. Symptoms of prostatitis are many such as: pain, discharge, and difficulty in passing urine.

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Cupping Therapy Points Back Points: 1. Area located 1.5 cun lateral to the Midline at the level of the spinous process of 4th lumbar vertebra. 2. Area located at the Midline below the spinous process of 4th lumbar vertebra.

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ILLUSTRATIONS

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References and further reading

1. A.A. Al-Waleedi, Y.S. Khader - Prevalence of hepatitis B and C infections and associated factors among blood donors in Aden city, Yemen -EMHJ • Vol. 18 No. 6 • 2012 2. Abdullah AlBedah, Tamer Shaban, Amen Suhaibani, Ibrahim Gazzaffi, Mohammed Khalil and Naseem Qureshi, Safety of Cupping Therapy in Studies Conducted in Twenty One Century: A Review of Literature, British Journal of Medicine and Medical Research, 2016, ISSN: 2231-0614,Vol.: 15, Issue.: 8 ,DOI: 10.9734/BJMMR/2016/26285 3. Aboushanab TS, AlSanad S. Cupping Therapy: An Overview From A Modern Medicine Perspective. Journal of acupuncture and meridian studies. 2018 Feb 7. 4. Ahmed SM, Madbouly, NM, Maklad, SS, Abu-Shady EA. Immunomodulatory effects of bloodletting cupping therapy in patients with rheumatoid arthritis. Egypt J Immunol. 2005; 12:39-51. 5. Aleyeidi, Nouran A., Khaled S. Aseri, Shadia M. Matbouli, Albaraa A. Sulaiamani, and Sumayyah A. Kobeisy. "Effects of wetcupping on blood pressure in hypertensive patients: a randomized controlled trial." Journal of integrative medicine13, no. 6 (2015): 391-399. 6. 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, Vol. 36, No. 1, 37–44 7. Arshiya Sultana, Khaleeq ur Rahman, Muzn. Farzana, and Azad Lone - Efficacy of Hijamat Bila Shurt (Dry Cupping) on Intensity of Pain in Dysmenorrhoea-A Preliminary Study - Anc Sci Life. 2010 Oct-Dec; 30(2): 47–50. 8. Ashraf Hussein Hassan, Farag Mohammed Farag, Mohammed Elmahdy H.Sarhan, Mohammed Yakout Abdel Aziz, and

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Mohammed Ahmed Abo Elela. Evaluation of cupping therapy in some chronic diseases (Rheumatoid Arthritis, Type 2 DM and chronic HCV infection). Thesis Submitted in partial fulfillment for M.D Degree of Internal Medicine. 253. 2006. 9. Bahram Jam, PT - Tissue Distraction Release with Movement (TDR-WM): A Novel Method of Soft-tissue Release - Advanced Physical Therapy Education Institute (APTEI), Thornhill, ON, Canada - May 27, 2016 10. Benli, A. R., & Sunay, D. (2017). Changing Efficacy of Wet Cupping Therapy in Migraine with Lunar Phase: A Self-Controlled Interventional Study. Medical Science Monitor, 23, 6162-6167. 11. Blunt SB, Lee HP - Can traditional "cupping" treatment cause a stroke? - Medical Hypotheses [2010, 74(5):945-949]. 12. Bu TW, Tian XL, Wang SJ, Liu W, Li XL, et al. Comparison and analysis of therapeutic effects of different therapies on simple obesity [in Chinese]. Chinese Acupuncture & Moxibustion. 2007;27:337–340 13. Caroline A. Smith, Caroline A. Crowther, Oswald Petrucco, Justin Beilby, and Hannah Dent, ―Acupuncture to Treat Primary Dysmenorrhea in Women: A Randomized Controlled Trial,‖ Evidence-Based Complementary and Alternative Medicine, vol. 2011, Article ID 612464, 11 pages, 2011. doi:10.1093/ecam/nep239 14. Che-Wei Lin, Jimmy Tse-Jen Wang, Cheuk-Sing Choy, and Heng-Hsin Tung, Iatrogenic Bullae Following Cupping Therapy THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE -Volume 15, Number 10, 2009, pp. 1–2 15. Chian-Ze MD Peng; Chorng-Kuang How - Bullae Secondary to Prolonged Cupping – American Journal of the Medical Sciences: July 2013 - Volume 346 - Issue 1 - p 65 -doi: 10.1097/MAJ.0b013e3182575ba1- Images in the Medical Sciences 16. Colin W Shepard, Lyn Finelli, Miriam J Alter-Global epidemiology of hepatitis C virus infection - Lancet Infect Dis 2005;5: 558–67 17. Deng H, Shen X. The Mechanism of Moxibustion: Ancient Theory and Modern Research. Evidence-based Complementary and

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Alternative Medicine : doi:10.1155/2013/379291.

eCAM.

2013;2013:379291.

18. Dons' koi, B. V., Chernyshov, V. P., Osypchuk, D. V., & Baksheev, S. M. (2016). Repeated cupping manipulation temporary decreases natural killer lymphocyte frequency, activity and cytotoxicity. Journal of integrative medicine, 14(3), 197-202. 19. Dorina Sohn, Hyunmin Yoon, Hyangmi Jung, Effects of Dry Cupping Therapy on Shoulder Pain and Fatigue in Nurses-Journal of Acupuncture and Meridian Studies 1 December 2011 (volume 4 issue 4 Page 269 DOI: 10.1016/j.jams.2011.10.009) 20. Duh, F. C., & Chiu, Y. H. (2015). Vacuum cupping under various negative pressures: An experimental investigation. Vacuum, 2(7). 21. Emerich, M., Braeunig, M., Clement, H. W., Lüdtke, R., & Huber, R. (2014). Mode of action of cupping—local metabolism and pain thresholds in neck pain patients and healthy subjects. Complementary therapies in medicine, 22(1), 148-158. 22. Hanan, S. Ali. and Eman, S. El-Said Cupping Therapy (AlHijama): It's Impact on Persistent Non-Specific Lower Back Pain and Client Disability. Life Sci J 2013;10(4s): 631-642] (ISSN:10978135 23. Hanin Farhana Kamaruzaman, Rugayah Bakri, CUPPING THERAPY - HEALTH TECHNOLOGY ASSESSMENTSECTION - MEDICAL DEVELOPMENT DIVISION - MINISTRY OF HEALTH MALAYSIA - 010/2012 Available at the following website: http://www.moh.gov.my 24. Huang LP, Cao RL, Bi YF, Han ZC, Yue BA, et al. Combination of flash cupping and acupuncture on treating of 115 cases with peripheral facial paralysis [in Chinese]. Shanxi Journal of Traditional Chinese Medicine. 2009;30:597–599. 25. Ji Xu, Hongyong Deng, and Xueyong Shen, ―Safety of Moxibustion: A Systematic Review of Case Reports,‖ EvidenceBased Complementary and Alternative Medicine, vol. 2014, Article ID 783704, 10 pages, 2014. doi:10.1155/2014/783704

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26. Jong-In Kim, Tae-Hun Kim, Myeong Soo Lee, Jung Won Kang, Kun Hyung Kim, Jun-Yong Choi, Kyung-Won Kang, Ae-Ran Kim, Mi-Suk Shin, So-Young Jung and Sun-mi Cho - Evaluation of wet-cupping therapy for persistent non-specific low back pain: a randomised, waiting-list controlled, open-label, parallel-group pilot trial - Trials 2011, 12:146 doi:10.1186/1745-6215-12-146 27. Kadhim Qasim Ali Al-Rubaye - The Clinical and Histological Skin Changes After the Cupping Therapy (Al-Hijamah) -J Turk Acad Dermatol 2012; 6 (1): 1261a1. This article is available from: http://www.jtad.org/2012/1/jtad1261a1.pdf 28. Kaleem Ullah and Ahmed Younis - An investigation into the effect of Cupping Therapy as a treatment for Anterior Knee Pain and its potential role in Health Promotion. The Internet Journal of Alternative Medicine - 4(1). 2007 29. Kam Lun E. Hon,David Chi Kong Luk,Kin Fon Leong,and Alexander K. C. Leung - Cupping Therapy May be Harmful for Eczema: A PubMed Search- Case Reports in Pediatrics - Volume 2013, Article ID 605829, 3 pages http://dx.doi.org/10.1155/2013/605829 30. Khalil AM, Al-Qaoud KM, Shaqqour HM. Investigation of Selected Immunocytogenetic Effects of Wet Cupping in Healthy Men. Spatula DD. 2013; 3(2): 51-57. doi:10.5455/spatula.20130712050838 31. Kim, S. B., & Lee, Y. H. (2014). Numerical analysis of the change in skin color due to ecchymosis and petechiae generated by cupping: a pilot study. Journal of acupuncture and meridian studies, 7(6), 306-317. 32. Lee, Myeong Soo, Tae-Young Choi, Byung-Cheul Shin, Jong-In Kim, and Sang-Soo Nam. "Cupping for hypertension: a systematic review." Clinical and Experimental Hypertension 32, no. 7 (2010): 423-425. 33. Li P. Clinical observation on treatment of 60 cases of acute peripheral facial paralysis with acupuncture and flash cupping therapy [in Chinese]. Journal of Shanxi College of Traditional Chinese Medicine. 2010;33(4):83–84

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34. Li, T., Li, Y., Lin, Y., & Li, K. (2017). Significant and sustaining elevation of blood oxygen induced by Chinese cupping therapy as assessed by near-infrared spectroscopy. Biomedical optics express, 8(1), 223-229. 35. Lowe, D. T. (2017). Cupping therapy: An analysis of the effects of suction on skin and the possible influence on human health. Complementary therapies in clinical practice. 36. Ma SX. Enhanced nitric oxide concentrations and expression of nitric oxide synthase in acupuncture points/meridians. The Journal of Alternative & Complementary Medicine. 2003 Apr 1;9(2):207-15. 37. MacPherson et al.: Acupuncture for irritable bowel syndrome: primary care based pragmatic randomised controlled trial. BMC Gastroenterology 2012 12:150. 38. Markowski, A., Sanford, S., Pikowski, J., Fauvell, D., Cimino, D., & Caplan, S. (2014). A pilot study analyzing the effects of Chinese cupping as an adjunct treatment for patients with subacute low back pain on relieving pain, improving range of motion, and improving function. The Journal of Alternative and Complementary Medicine, 20(2), 113-117. 39. Michael Teut, Stefan Kaiser, Miriam Ortiz, Stephanie Roll, Sylvia Binting, Stefan N Willich and Benno Brinkhaus - Pulsatile dry cupping in patients with osteoarthritis of the knee – a randomized controlled exploratory trial - BMC Complementary and Alternative Medicine 2012, 12:184 doi:10.1186/1472-6882-12-184 40. Michalsen, Andreas, Silke Bock, Rainer Lüdtke, Thomas Rampp, Marcus Baecker, Jürgen Bachmann, Jost Langhorst, Frauke Musial, and Gustav J. Dobos. "Effects of traditional cupping therapy in patients with carpal tunnel syndrome: a randomized controlled trial." The journal of pain 10, no. 6 (2009): 601-608 41. Mohamed Elsayed Mohamed Abd al-Jawad, Saeed Adel Mohamed, Badawy Ahmed Elsayed, Abd Alfattah, Nevine M Mohamed - Evaluation of Wet Cupping Therapy (Hijama) as an Adjuvant Therapy in the Management of Bronchial Asthma - Indian Journal of Physiotherapy and Occupational Therapy – An International Journal Year : 2011, Volume : 5, Issue : 4

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42. Mohammad Sharif Sharifi, and Hamidollah Afrasiabian Evaluation of Wet Cupping Treatment in Patients with Chronic Urticaria and Angioedema - The Open Conference Proceedings Journal, 2013, 3, 1-5 43. Moon SH, Han HH, Rhie JW - Factitious panniculitis induced by Cupping Therapy, J Craniofac Surg. 2011 Nov;22(6):2412-4. doi: 10.1097/SCS.0b013e318231fed6. 44. Mourad, S. A., & Al-Jaouni, S. K. (2016). The Effect of Wet Cupping on Blood Haemoglobin Level. Alternative & Integrative Medicine, 1-6. 45. Mu-Lien Lin, Hung-Chien Wu, Ya-Hui Hsieh, et al., ―Evaluation of the Effect of Laser Acupuncture and Cupping with Ryodoraku and Visual Analog Scale on Low Back Pain,‖ EvidenceBased Complementary and Alternative Medicine, vol. 2012, Article ID 521612, 7 pages, 2012. doi:10.1155/2012/521612 46. Nugent-Head A. Ashi points in clinical practice. J Chin Med. 2013 Feb;101:5-12. 47. Pan HL. (Observation of 39 cases of gout treated with plumblossom needling plus cupping) Zhenjiu Linchuang Zazhi, 1997, 13(3):29(in Chinese). 48. Rajput, K. U., & Ozturk, M. (2015). Male hypogonadism: exploring the role of heavy metal toxicity using mRNA analysis pre and post Cupping Therapy treatment. Integrative Medicine Research, 4(1), 28-29. 49. Ramazani M, Shariatzade S, Malekirad A, Akbari A, Shariatzade M. Effect of cupping on blood factors and oxidative stress in diabetes type II. Arak University of Medical Sciences Journal. 2013; 15 (8) :54-60 50. Refaat, B., El-Shemi, A. G., Ebid, A. A., Ashshi, A., & BaSalamah, M. A. (2014). Islamic Wet Cupping and Risk Factors of Cardiovascular Diseases: Effects on Blood Pressure, Metabolic Profile and Serum Electrolytes in Healthy Young Adult Men. Altern Integ Med, 3(1), 151.

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51. Remzi Adnan Akdoğan, Elif Akdoğan, An unusual cause of iron deficiency anemia in a healthy man: Hijamah - Turk J Hematol 2011; 28: 254-6 52. Romy Lauche, Holger Cramer, Claudia Hohmann, et al., ―The Effect of Traditional Cupping on Pain and Mechanical Thresholds in Patients with Chronic Nonspecific Neck Pain: A Randomised Controlled Pilot Study,‖ Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 429718, 10 pages, 2012. doi:10.1155/2012/429718 53. Rong Zhao, Acupuncture-moxibustion treatment for polycystic ovary infertility: A report of 20 cases - Journal of Acupuncture and Tuina Science - April 2012, Volume 10, Issue 2, pp 89-91. 54. Roostayi, M. M., Norouzali, T., Manshadi, F. D., Abbasi, M., & Baghban, A. A. (2016). The Effects of Cupping Therapy on Skin‘s Biomechanical Properties in Wistar Rats. Chinese Medicine, 7(01), 25. 55. Rui-xing Yu, Yun Hui, Cheng-rang Li - Köebner phenomenon induced by Cupping Therapy in a psoriasis patient Dermatology Online Journal 19 (6): 17 56. RUQIYYA PARVEEN - Clinical efficacy of Hijamat Bil Shurt (Wet Cupping) in the management of Ehtebas Tams Sanwi (Secondary Amenorrhea) – 2012 - Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore – Disseration http://hdl.handle.net/123456789/7796 57. Saha, F. J., Schumann, S., Cramer, H., Hohmann, C., Choi, K. E., Rolke, R., ... & Lauche, R. (2017). The effects of cupping massage in patients with chronic neck pain-a randomised controlled trial. Complementary Medicine Research, 24(1), 26-32. 58. Sara Al-Reefy , Maryam Parsa-Nezhad, Lymphedema Following Cupping Therapy "Hijama" Post Breast Cancer Surgery and Axillary Clearance - Bahrain Medical Bulletin, Vol. 36, No. 1, March 2014 59. Seung-Jun Lee, Young-Sung Suh , Yeon-Ju Lee, Dong-Gil Cho, Min-Ji Lee, Dae-Hyun Kim - Iron Deficiency Anemia due to

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Long-time Bloodletting Using Cupping - Korean J Fam Med. 2011;32:56-59 60. Shuang He, Junfan Luo, Jingfen Chen - Clinical study on chronic gastritis treated by acupuncture - Journal of Acupuncture and Tuina Science - June 2011, Volume 9, Issue 3, pp 179-181. 61. Szu-Ying Wu, Chun-En Kuo, Yu-Chiang Hung and WenLong Hu (2016). Managing Pain with Laser Acupuncture, Pain Management, Prof. Milica Prostran (Ed.), InTech, DOI: 10.5772/62863. Available from: https://www.intechopen.com/books/pain-management/managingpain-with-laser-acupuncture 62. Tae-Hun Kim, Kun Hyung Kim , Jun-Yong Choi , Myeong Soo Lee, Adverse events related to cupping therapy in studies conducted in Korea: A systematic review - European Journal of Integrative Medicine - doi:10.1016/j.eujim.2013.06.006 63. Tagil, S. M., Celik, H. T., Ciftci, S., Kazanci, F. H., Arslan, M., Erdamar, N., ... & Dane, S. (2014). Wet-cupping removes oxidants and decreases oxidative stress. Complementary therapies in medicine, 22(6), 1032-1036. 64. Tamer Shaban, Magdy Karam El-Deen, Rehab Abd El kader, The Role of Cupping Therapy As a Complementary Therapy On The Pulmonary Functions And Quality Of Life Of Asthmatic Children. Medical Studies Department, Institute of Postgraduate Childhood Studies, Ain Shams University- Egypt- Master Thesis – 2011 65. Tamer, S. Aboushanab, and Ravalia Munir. "Genetic Theory–A Suggested Cupping Therapy Mechanism of Action." (2017). 66. Tham, L. M., Lee, H. P., & Lu, C. (2006). Cupping: from a biomechanical perspective. Journal of biomechanics, 39(12), 21832193. 67. Tsuchiya M, Sato EF, Inoue M, Asada A. Acupuncture enhances generation of nitric oxide and increases local circulation. Anesthesia & Analgesia. 2007 Feb 1;104(2):301-7.

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68. WAN Xue-wen. Clinical Observation on Treatment of Cervical Spondylosis with Combined Acupuncture and Cupping Therapies DOI: 10.1007/s11726-007-0345-5 69. Weng YM , Hsiao CT - Acquired hemophilia A associated with therapeutic cupping - The American Journal of Emergency Medicine [2008, 26(8) 70. WHO Draft Guidelines for Ad verse Event Reporting and Learning Systems - 2005 71. Xie, W. J., Zhang, Y. P., Xu, J., Sun, X. B., & Yang, F. F. (2017). The Effect and Mechanism of Transdermal Penetration Enhancement of Fu‘s Cupping Therapy: New Physical Penetration Technology for Transdermal Administration with Traditional Chinese Medicine (TCM) Characteristics. Molecules, 22(4), 525. 72. Xu, Q. Y., Yang, J. S., Zhu, B., Yang, L., Wang, Y. Y., & Gao, X. Y. (2012). The effects of scraping therapy on local temperature and blood perfusion volume in healthy subjects. Evidence-Based Complementary and Alternative Medicine, 2012. 73. Ye-Jin Jung, Jae-Hong Kim, Hae-Jin Lee, Hana Bak, Seung Phil Hong, , Soo Young Jeon, Sung Ku Ahn, A Herpes Simplex Virus Infection Secondary to Acupuncture and Cupping - Ann Dermatol Vol. 23, No. 1, 2011- DOI: 10.5021/ad.2011.23.1.67 74. Yoo, S. S., & Tausk, F. (2004). Cupping: east meets west. International journal of dermatology, 43(9), 664-665. 75. Zach lacross, Treatment outcomes of myofascial decompression on hamstring pathology - Oklahoma State University – 2014 76. Zhang CQ, Liang TJ, Zhang W. [Effects of drug cupping therapy on immune function in chronic asthmatic bronchitis patients during protracted period]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2006 Nov;26(11):984-7. 77. Zhao J. Combination of cupping therapy and antibiotic treatment of 220 pediatric cases with cough after acute upper respiratory infection [in Chinese]. Shanxi Journal of Traditional Chinese Medicine. 2010;26(8):34.

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78. Zhao, X. X., Tong, B. Y., Wang, X. X., & Sun, G. L. (2009). Effect of time and pressure factors on the cupping mark color. Zhongguo zhen jiu= Chinese acupuncture & moxibustion, 29(5), 385-388. 79. Zhu Wei-ping - Clinical observation of 82 cases of enuresis treated by ginger-partitioned moxibustion plus cupping therapy Journal of Acupuncture and Tuina Science - December 2003, Volume 1, Issue 6, pp 24-25

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ABOUT THE AUTHOR

Dr. Tamer Shaban

Qualifications •

Bachelor of medicine and surgery (M.B.B.Ch) (Cairo university) 2000.



Master Degree of Childhood studies - Child Health and Nutrition (Master Thesis about the Role of cupping therapy as a complementary therapy on pulmonary functions and quality of life of asthmatic children) (2011).

Publications list (some of published articles): 1. Aboushanab T, and Saud M. AlSanad. Cupping Therapy: An Overview From A Modern Medicine Perspective. Journal of Acupuncture and Meridian Studies, 2018-02 | journal-article, DOI: 10.1016/j.jams.2018.02.001 . Part of ISSN: 2005-2901 2. Aboushanab T, and Saud M. AlSanad. A Quality Model to Select Patients in Cupping Therapy Clinics: A New Tool for Ensuring Safety in Clinical Practice. Journal of acupuncture and meridian studies. 2018 Jun 8. 3. T. Aboushanab, Saud AlSanad. Simulation in Cupping Training: An Innovation Method, Journal of Acupuncture and Meridian Studies, 2017-12 .DOI: 10.1016/j.jams.2017.10.003.

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4. Tamer S. Aboushanab,. The Role of cupping therapy as a complementary therapy on pulmonary functions and quality of life of asthmatic children. Ain Shams University- Childhood Medical Studies, Master Thesis, 2010. http://www.eulc.edu.eg/eulc_v5/Libraries/Thesis/BrowseThesis Pages.aspx?fn=PublicDrawThesis&BibID=11775056 5. Aboushanab T, Khalil M, El-Olemy A, Alsanad S. Cupping Therapy Simulation Course; A Pilot Study Assessing Self Reporting of Confidence, Expectations/Satisfaction and Performance. Advanced Journal of Social Science. 2017 Nov 30;1(1):53-9. 6. Aboushanab T, AlSanad S. Cupping Therapy and Animal Research: The Progress. Journal of Acupuncture and Meridian Studies. 2018 Apr 28. 7. Tamer Aboushanab, Mohammed Khalil, Ahmed El-Olemy, Saud AlSanad .Development of a new tool for self-assessment of confidence, expectations/satisfaction and performance for cupping therapy simulation training modules. Advances in Simulation 2018, 3(Suppl 1):A9. 8. Tamer Aboushanab, , Saud AlSanad . The current status of using simulation based learning in integrative and complementary medicine training programs. Advances in Simulation 2018, 3(Suppl 1):A10. 9. Aboushanab T, AlSanad S. A Brief Illustration of The Official National Standards for the Safe Use of Cupping Therapy (Hijama) in Saudi Arabia. Journal of Integrative Medicine. (2018). 10. Aboushanab T, AlSanad S. An Ethnomedical Perspective of Arabic Traditional Cauterization; Al-Kaiy. Advanced Journal of Social Science. (2018) 11. Qureshi NA, Shaban T, Gazzaffi I, Alqaed MS, Elsubai IS, Olemy AT, Al-Bedah AM. History of cupping (Hijama): a narrative review of literature. 2017-05 | Journal of Integrative Medicine, DOI: 10.1016/s2095-4964(17)60339-x PMID: 28494847 12. Al-Bedah AM, Khalil MK, Posadzki P, Sohaibani I, Aboushanab TS, AlQaed M, Ali GI. Evaluation of Wet Cupping Therapy: Systematic Review of Randomized Clinical Trials. The Journal of Alternative and Complementary Medicine. 2016-10 | journalarticle, DOI: 10.1089/acm.2016.0193

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13. Abdullah M.N. Al-Bedah, Ibrahim S. Elsubai, Naseem Akhtar Qureshi, Tamer Shaban Abushanab, Ahmed Tawfik El-Olemy, Asim A.H. Khalil, Mohamed K.M. Khalil, Meshari Saleh Alqaed. The medical perspective of cupping therapy: Effects and mechanisms of action. Journal of Traditional and Complementary Medicine . 30 April 2018.

Previous books •

Cupping therapy encyclopedia (1st Edition) – 2013



Professional guide to cupping therapy.

Contact: [email protected]

Thank You

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