Wet Cupping (al-hijama) for Mental Health: A Systematic Review

Social Disconnection in Late Life Mental Illness – Commentary From the National Institute of Mental Health

The traditional and Islamic medicine is based on bringing out the wasted and hazardous materials from the body. For this reason well known ancient physicians used to do phlebotomy, wet cupping, vomiting, administer laxatives, enema and various other methods. Fortunately, wet cupping is known as an effective method in prevention and treatment for numbers of diseases even by medical society nowadays and there are increasing numbers of physicians who use this method. The other method used, is phlebotomy that can be recommended on different regions of the body and each of them has a special therapeutic effect but has not become known as well as wet cupping. The routine phlebotomy is the transfusion in which only one of the body vessels is used and the aim is to donate blood but the traditional medical aspect of phlebotomy is something completely different, which is applied only for therapeutic reasons (established on special body vessels and taking out significant amount of blood that might be applied of the arms, legs, frontal region or even sublingual vessels etc.) This article presents the effects of phlebotomy and wet cupping in the treatment of some diseases. An opinion for treatment of 43 diseases described by an ancient philosopher and physician named Jorjani is also collected in this article. Jorjani used phlebotomy and wet cupping beside medical treatment to get better results. His comments on the effectiveness of wet cupping and its indications and timing are also mentioned in this article.

Cupping has a long history in Iran which is one of the most widely used methods in prevention and treatment of diseases in Persian medicine. However, it still has many opponents in the Iranian conventional medical community. So, this systematic review study was conducted to survey the scientific and authoritative articles related to wet and dry cupping that have been done in Iran and the diseases for which Iranian researchers have suggested cupping. In general, the effect of wet and dry cupping on various kinds of pain (e.g. headache, musculoskeletal pain, postpartum pain, etc.), as well as the effect of wet cupping on hematological and biochemical factors of blood were among the most common studies. Also, persistence of therapeutic effects of wet and dry cupping on various diseases was satisfactory. The results of this study showed that wet and dry cupping, even alone, are effective in the treatment of many diseases, and if the objections to the use of these two treatments are reduced, more extensive and high-quality researches in this regard will be done.

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Cupping therapy is a widely used complementary medicine for the treatment of migraine headaches globally. However, conflicting evidence exists on its effectiveness. To evaluate the safety and efficacy of cupping therapy in treating migraine headache disorder. Seven databases were systematically searched PubMed/MEDLINE, Clinicaltrials.gov, Cochrane CENTRAL, ScienceDirect, ProQuest, SinoMed, and the National Science and Technology Library. The primary endpoints are the treatment success and the pain intensity reduction. The secondary endpoints were adverse events (AEs) risk and improvement in quality of life (QoL), which was based on the Migraine Disability Scale (MIDAS). Subgroup analyses were performed based on the cupping techniques (wet and dry cupping) and adjunctive complementary treatments (i.e. acupuncture and/or collateral pricking). Eighteen trials out of 348 records were included, pooling 1,446 participants (n = 797 received cupping therapy). Treatment success was significantly higher among those with cupping therapy (risk ratio [RR] [95% CI] = 1.83 [1.52-2.21]); with significant improvement observed only with wet cupping (RR [95% CI] = 1.88 [1.53-2.30]). The adjunctive complementary therapy did not achieve a greater amplitude of treatment success compared to cupping therapy alone. Furthermore, cupping therapy showed significant pain reduction compared to baseline (standardized mean difference [SMD] [95% CI] = 0.55 [0.39-0.70]) and achieved fewer risks of AEs (RR [95% CI] = 1.88 [1.53-2.30]). However, cupping did not improve the overall QoL (MIDAS SMD [95% CI] = -0.79 [-3.55-1.98]). Cupping therapy was an effective complementary modality to treat migraine headaches. However, it did not demonstrate improvement in QoL (PROSPERO CRD42024514509).

Clinical vignettes from the World Trade Center Worker and Volunteer Mental Health Monitoring and Treatment Program at the Mount Sinai Medical Center in New York City are presented. The hospital-based program pairs mental health screenings with federally funded occupational medical screenings to identify persons with mental health problems related to their rescue and recovery roles. The program also provides on-site mental health treatment. The cases illustrate the diverse mental health needs of the rescue and recovery workers, some of whom initially sought treatment years after September 11, 2001. The cases show that in addition to symptoms of posttraumatic stress disorder, workers experienced survivor guilt, distressing memories of childhood trauma, shame associated with intense feelings, substance abuse relapse, psychosis, and problems with family relationships.

Objective: Wet cupping is a traditional bloodletting method recommended for controlling of respiratory disease complications. This study aimed to compare the efficacy of wet cupping vs. venesection on arterial O2 saturation level of smokers.Methods: This is a randomized controlled clinical trial which started with simple sampling of smokers. After administering spirometery, participants (N = 110 male smokers) with positive pulmonary function test (PFT), who manifested Chronic Obstructive Pulmonary Disease (COPD), were randomly assigned to intervention and control groups. The two groups were assessed in terms of demographic data, rate of hemoglobin (Hb), hematocrit (Hct), and arterial O2 saturation. Then, the intervention participants underwent wet cupping whereas venesection was performed on the control participants. At four stages after the two treatments, pulse oximetery was performed. Data was analyzed using SPSS (Version 17).Results: Result shows that mean arterial O2 sat level increased at three stages, namely before, immediately after, and 6 and 12 hrs after these two treatments (p ≤ 0.001). This indicates that wet cupping and venesection alike were effective on O2 sat level in the two groups, but the increasing pattern was maintained 12 hrs afterward only in those participants who had received wet cupping (p ≤ 0.001). Moreover, the results of repeated measure ANOVA between the two groups at the four stages showed that there were significant differences between the means of O2 saturation level at the 6- and 12-hrs stages (F = 66.92, p ≤ 0.001).Conclusion: Wet cupping caused a continued O2 saturation in the intervention group even up to 12 hrs afterward. Participants expressed liveliness and improved respiration after wet cupping. Therefore, wet cupping is recommended for promoting the health of cigarette smokers.

Background: Migraines are extremely incapacitating headaches. Cupping therapy is a successful treatment that lessens the severity of headaches and migraines. The study aims to determine the level of scientific support for cupping therapy as a treatment for migraines. Methods: Published systematic reviews, meta-analyses, and Clinical Practice Guidelines (CPGs) about cupping therapy for migraines were examined. PubMed, Research Gate, Google Scholar, Science Direct, Trip, OVID, Cochrane Library, and CINAHIL were among the medical databases that were reviewed. Cupping therapy's safety and effectiveness in treating migraines, either by itself or in combination, were evaluated. Results: Three systematic reviews incorporated eighteen clinical trials and CPGs of Traditional Korean Medicine were reviewed. Sixteen wet cupping and two dry cupping studies were used. The study found significant treatment success with cupping therapy compared to controls. Cupping therapy significantly reduced pain intensity either alone or in combination with drugs. One to eight cupping points are used with different treatment regimens according to Traditional Chinese Medicine, Prophetic Medicine, Korean Medicine and Persian Medicine. Conclusion: Migraines can be effectively treated with wet cupping either alone or, more effectively, in conjunction with other medications. It emphasizes the need for improved quality and transparency in research and is a major step towards comprehending the evidence and recommendations for cupping therapy within the CPGs in migraine. It is required that cupping therapy be included in the recommendations for treating migraine headaches.

Background: According to the international diabetes federation, 629 million adults will suffer from diabetes by 2045. Wet cupping therapy is a combination of bleeding and dry cupping and has been used in traditional medicine as a complementary therapy for diabetes. Limonene was shown to have both antioxidant and antidiabetic activity but its potential alongside other treatments has not been thoroughly explored. Objectives: Although wet-cupping therapy is widely used under different conditions, its potential in the treatment of diabetes is not well-examined. Methods: Male Wistar rats were then injected with alloxan and nicotinamide to induce diabetes. After cupping, the rats’ serum nitric oxide, creatinine, SGPT, SGOT, cholesterol, triglyceride, glucose, GPX, urea, and HDL levels were determined. The glutathione, catalase, glutathione peroxidase, malondialdehyde, and protein level of the serum, renal, and liver were then measured. Results: The results showed a significant differences in serum glucose levels among the diabetic rats receiving wet cupping and limonene, in serum glutathione levels in diabetic rats receiving limonene or limonene and wet cupping compared to the diabetic rats, in liver GSH levels in control rats receiving limonene and wet cupping, in the liver GPX activity in control rats receiving limonene, and in liver catalase activity in control rats receiving limonene and wet cupping compared to control group. There was no significant change in serum NO, protein, creatinine, SGPT, SGOT, cholesterol, triglyceride MDA, urea, catalase, HDL, renal GSH, MDA, catalase, liver protein, and MDA Level. Conclusions: The findings of the present study suggested that a combination of limonene and wet cupping therapy could be presented as an agent to lower elevated blood glucose levels in diabetic rats. Further clinical studies are required to confirm the findings.

Background: Much alternative therapy such as cupping therapy in the community as one of the cheap treatment efforts without side effects makes the challenge and the goal for nursing staff improve nursing services. The unfinished scientific verification of cupping therapy's alternative therapy makes nurses need to prove decreased blood pressure and cholesterol levels in the elderly. Objective: Scientific proof of cholesterol and blood pressure decrease after Cupping Therapy in an elderly group in Wedomartani Village, Sleman Yogyakarta Indonesia. Method: quantitative type with pseudo experimental research design. Pre-test and Post-test nonequivalent control group. The treatment group was given wet cupping therapy, while the control group was given dry cupping. Respondents were selected using a purposive sampling technique. Blood pressure measurement uses a digital tensimeter and cholesterol measurement using a digital blood cholesterol level measuring device. Results: The elderly blood cholesterol levels after the average therapy decreased 42.89 mg/dl, whereas blood cholesterol levels in the control group decreased an average of 20.95 mg/dl. The blood pressure of the elderly systole in the intervention group after the average therapy decreased 10.74 mmHg, whereas the control group's systole blood pressure decreased an average of 1.58 mmHg. Diastole blood pressure in the treatment group decreased 3,48 mmHg, in the diastole blood pressure control group increased 5,26 mmHg. Conclusions: Wet and dry cupping are both significantly associated with decreased blood cholesterol and blood pressure levels, but wet cupping lowers blood cholesterol levels by a mean difference of 21.95 mg/dl and mean systole blood pressure of 3.74 mmHg and pressure diastole blood difference of mean 9.1 mmHg. Keyword: Blood Pressure. Cupping Therapy, Cholesterol, Elderly

Background: Much alternative therapy such as cupping therapy in the community as one of the cheap treatment efforts without side effects makes the challenge and the goal for nursing staff improve nursing services. The unfinished scientific verification of cupping therapy's alternative therapy makes nurses need to prove decreased blood pressure and cholesterol levels in the elderly. Objective: Scientific proof of cholesterol and blood pressure decrease after Cupping Therapy in an elderly group in Wedomartani Village, Sleman Yogyakarta Indonesia. Method: quantitative type with pseudo experimental research design. Pre-test and Post-test nonequivalent control group. The treatment group was given wet cupping therapy, while the control group was given dry cupping. Respondents were selected using a purposive sampling technique. Blood pressure measurement uses a digital tensimeter and cholesterol measurement using a digital blood cholesterol level measuring device. Results: The elderly blood cholesterol levels after the average therapy decreased 42.89 mg/dl, whereas blood cholesterol levels in the control group decreased an average of 20.95 mg/dl. The blood pressure of the elderly systole in the intervention group after the average therapy decreased 10.74 mmHg, whereas the control group's systole blood pressure decreased an average of 1.58 mmHg. Diastole blood pressure in the treatment group decreased 3,48 mmHg, in the diastole blood pressure control group increased 5,26 mmHg. Conclusions: Wet and dry cupping are both significantly associated with decreased blood cholesterol and blood pressure levels, but wet cupping lowers blood cholesterol levels by a mean difference of 21.95 mg/dl and mean systole blood pressure of 3.74 mmHg and pressure diastole blood difference of mean 9.1 mmHg. Keyword: Blood Pressure. Cupping Therapy, Cholesterol, Elderly

Dear Editors, Cupping glass therapy is rarely discussed in modern medical literature. It was commonly used for producing negative pressure in the field of oriental (Chinese) medicine. Cupping dates back over 3000 years, and is still believed to relieve pain and is used by alternative medicine practitioners, although evidence from well-designed randomised trials is lacking. Two representative forms of cupping therapy are popular. One is dry cupping. Cups are placed on the candidate’s skin area to be treated and suction is applied using negative pressure. The other is wet cupping, which involves minimal incisions at the acupuncture points followed by placement of cups over the incisions, with small volume of bleeding. Keloids are a proliferative ailment of fibrous tissue secondary to trauma, infection, surgery and other various causes (1). Although cupping therapy is popular in an Asian population to relieve pain and other symptoms, no keloid cases have been reported in the literature. As trauma is one of the major causes, keloids can develop when wet cupping therapy is performed. We report a recent case of a patient who suffered from keloids on her scapular area caused by dry cupping therapy performed by an oriental medicine practitioner (Figure 1). The patient complained of intermittent itchiness and pain. She refused corticosteroid injection therapy because of the pain due to injection. Keloid in the scapular area can result in severe aesthetic problems, posing a significant burden on the patient (2,3). Apart from its extreme rarity, we report this case to remind the clinician that both wet and dry cupping therapy by regulated oriental practitioners can result in unexpected keloids. Therefore, we stress the importance of exercising caution during cupping therapy and providing sufficient preexplanation to the patient regarding the possibility of keloid formations. Figure 1 A keloid scar on the right scapular area of the patient.

Reports an error in "Attitudes about the VA health-care setting, mental illness, and mental health treatment and their relationship with VA mental health service use among female and male OEF/OIF veterans" by Annie B. Fox, Eric C. Meyer and Dawne Vogt (Psychological Services, 2015[Feb], Vol 12[1], 49-58). The institutional affiliation in the byline for Annie B. Fox and Dawne Vogt did not include the National Center for Posttraumatic Stress Disorder. The online version of this article has been corrected. (The following abstract of the original article appeared in record 2014-45062-001.) In the present study, the authors explored gender differences in attitudinal barriers to and facilitators of care for Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans and examined the relationship of those factors with VA mental health service use among female and male veterans with probable mental health conditions. Data were collected as part of a national cross-sectional survey of OEF/OIF veterans; the current sample was limited to participants with a probable diagnosis of posttraumatic stress disorder, depression, or alcohol abuse (N = 278). Although negligible gender differences were observed in attitudes about VA care and perceived fit in the VA setting, men reported slightly more negative beliefs about mental illness and mental health treatment than women. In addition, logistic regressions revealed different associations with VA mental health service use for women and men. For women only, positive perceptions of VA care were associated with increased likelihood of seeking mental health treatment. For men only, perceived similarity to other VA care users and negative beliefs about mental health treatment were associated with increased likelihood of service use, whereas negative beliefs about mental illness were associated with lower likelihood of service use. For both women and men, perceived entitlement to VA care was associated with increased likelihood of service use and negative beliefs about treatment-seeking were associated with a reduced likelihood of seeking mental health care in the past 6 months. Results support the need for tailored outreach to address unique barriers to mental health treatment for female and male OEF/OIF veterans.