Category: Types of Hijamah / Bloodletting
Section: Introduction
167
In the Sunnah Hijama was praised by the Prophet (Allah’s peace be upon him) and it may be regarded as a safe, non-invasive and economical way of curing and preventing many diseases. Though Chinese use of this method was limited to certain medical complications like lungs infection, colds, to treat internal organs’ disorders, joint pain, etc. the scope of hijama in terms of benefit is much greater in the Sunnah.The word ‘hijama’ means ‘drawing out’ in Arabic. It is now being recognized as an alternative medicine or alternative way of treating different diseases and bodily disorders. Some sections of the modern medical community also endorse the various benefits of hijama and even encourage its practice for certain diseases.In this non-surgical procedure, toxic or ‘bad’ blood is drawn out from the body. Certain ‘hijama points’ on the body are addressed to do so. On such selected points, blood is encouraged to accumulate and then sucked out by using a little vacuum system. The blood is made to accumulate on the surface of the skin where minute incisions are introduced on the skin; the blood comes out from the incisions and is collected in a cup from where it is removed.Many scholars have mentioned that Hijamah is one of the effective means in curing magic affliction by extracting the substance of magic from the place in which it rests.Ibn Al-Qayim (R) said that Abu Obeid (R) mentioned in his book (Gharib Al-Hadith) that Abulrahman related that Allah’s Messenger (ﷺ) used Hijamah when he was affected with magic. Abu Obeid (R) also added that those with little knowledge can not see the relation between Hijamah and magic or this ailment and cure. He thus stated that if Hippocrates or Ibn Sina were to find a text saying so, they would have readily accepted it. The prophet, whose knowledge can not be doubted, advised the use of Hijamah. He knew that the magic material in his body settles in his head, affecting one of this powers whereby he would imagine doing things which did not actually do; this is a typical behavior of a magician in reality. The material used in the magic resulted in a change in his mood, altering its natural disposition.Ibn Al-Qayim (R) also added regarding the treatment of magic that using Hijamah in the place afflicted with magic is the best cure if used in the ascribed manner (Zaad Al-Maad-4/125-126). Al-Qayim (R) also maintained that Hijamah was used by the prophet (ﷺ) a means of treatment even before it was revealed to him that he was under the effect of magic (Al-Tib Al-Nabawi -p.118).The act of performing Hijama (cupping) is a Sunnah of the Prophet Muhammad (ﷺ) and it is extensively reported in a wide collection of authentic ahadith. Its practice is strongly recommended and emphasized in a number of narrations. The practice of Hijama forms an integral part of Islamic Prophetic Medicine.Hijama was a common practice of the Prophet Muhammad (ﷺ) and his companions for the treatment of a range of ailments as well as a form of body maintenance and health promotion.
Section: Benefits of Hijama (Cupping)
168
Hijama has been in use in many countries to treat certain diseases or bodily disorders. While the Chinese seem to have played a leading role in using this technique to treat certain diseases, Arabs and others have also adopted it since it was recognized as beneficial by the Prophet (Allah’s peace be upon him). The Europeans were also doing cupping to treat many diseases. The difference between the Arabs or Muslims and others in doing hijama was not hidden since while believers were more interested to do hijama as the Sunnah of the Prophet (peace and blessings of Allah be upon him) (without questioning anything), others were doing it purely for medical benefit.The first and top-level benefit of hijama for a believer is the reward he or she will get, both heavenly and worldly, for following a stressed Sunnah of the Prophet (peace and blessings of Allah be upon him). Not only the believers but also anyone can openly observe or experience the benefits that are bestowed on the followers of the commands of Allah Most High and His Prophet (peace and blessings of Allah be upon him). On the other hand, when we look at this technique from a worldly perspective, we can find hijama has many benefits.It is noted that hijama promotes the flow of energy in the blood. It removes toxins and other waste material from the blood. It helps hasten recovery time for people recovering from certain diseases. Hijama is known to prevent many diseases and, therefore, can be considered one of the best preventive measures against many diseases. Moreover, in many cultures, hijama is thought to help those who are under some magic spell or who are under the influence of some evil beings.Hijama has no side effects as long as performed properly. It is also worth noting that many diseases and disorders are associated with failure of blood to circulate properly in the body. Furthermore, we get sick or our body organs fail to perform healthily when our blood keep circulating loaded with toxins and other impurities. Unless the toxic waste is removed from the body or from the blood, not only we do not recover quickly from disease but also we become victims to other diseases. Hijama is an excellent way to remove the toxic waste from the blood stream, and the results will obviously be a healthy and properly functioning body. We should never forget that this highly useful and recommended Sunnah of the Prophet SAW helps us in controlling many diseases such as infections, hypertension, circulatory diseases, pains, infertility, cancer, etc.
Section: Importance of Hijama in the Divine Guidance
169
Instead of depending on our own opinions in favor of cupping, we must see the following ahadith that are enough to explain its importance.“Indeed in hijama (cupping) there is a cure”. – Saheeh Muslim.“Indeed, the best of remedies you have is hijama (cupping)”. – Saheeh Al Bukhari.“Hijama is the most helpful procedure for human beings to cure themselves”. – Saheeh Al Bukhari and Saheel Muslim.The importance of hijama in the divine guidance can further be stressed by the following words which were related to the Prophet SAW on the night of Israa (ascension to the heaven) by angles: “O Mohammed, encourage your ummah (people) to do hijama (cupping)”. – Saheeh, Sunan Tirmidhi.The Prophet Muhammad (Allah’s peace be upon him) is reported to have had hijama performed on his head for a headache [Bukhari], on his foot after a sprain [Ibn Majah], on his neck [Abu Dawud], on his hip for hip pain [Abu Dawud] and between his shoulders for detoxification [Ahmed].Abdullah ibn Abbas (RA) reported that the Prophet (Allah’s peace be upon him) said: “I did not pass by an angel from the angels on the night journey except that they all said to me: Upon you is cupping (hijama), O Muhammad.” [Saheeh, Sunan ibn Majah]“The best medicine with which you treat yourselves is cupping, or it is one of the best of your medicines.” Or “The treatment for you is cupping.” [Bukhari: 5371]“Cupping is the most helpful procedure for human beings to cure themselves.” [Bukhari and Muslim]Abu Hurairah (RA) reported that the Messenger (Allah’s peace be upon him) said, “If there was something excellent to be used as a remedy then it is cupping (hijama).” [Sunan Abu Dawud, Sunan Ibn Majah]
Section: Hijamah in the condition of strength
170. Introduction
The simplest method of Hijamah is that used for general health promotion and the Nabi (SAW) used the most common method. In this type of Hijamah there is no serious complaint by the patient that would warrant a special type of Hijamah or the use of "special" Hijamah points other than the standard points on the back, neck or head. This is traditionally termed as Hijamah-bi-Sihhat (Hijamah in the condition of health), many also refer to it as "sunnah cupping". Both terms are not correct however as the Rasul of Allaah (SAW) had cupping done both in health and as a treatment for particular pains and ailments, and it is also rare to find someone nowadays with absolutely no illness. I prefer the term Hijamah in strength, referring to performing Hijamah for someone who is of general good health and strength.Such a patient may however complain of general symptoms such as a feeling of sluggishness, tiredness etc, they may also have a regular habit of doing Hijamah and are aware of the benefits it has for them personally, or they are trying this method of health preservation for the first time under recommendation from their friends or acquaintances. Their general health is good, and very importantly their pulse is strong indicating a healthy amount of blood and also a good amount of heat in the blood. They may also be suffering from a constitutional blood or heat excess as is common in hot climates.If the pulse is weak or deep then this type of Hijamah is not indicated as it means that there is deficient blood or the heat of the body is internal and not in the exterior parts of the body. (The method of feeling and interpreting the pulse is detailed in the Hijamah Treatment Guide for Practitioners)In this type of Hijamah care is taken to observe the rules of Hijamah with regard to the condition of the patient, as well as the season, climate, day of the lunar month and time of the day in which Hijamah is performed as this greatly influences the nature of blood that will be removed. Not observing these and performing this type of general Hijamah outside of its recommended times will not result in any benefit for the patient and will very often result in long term harm for the patients health. This may not be apparent immediately after the procedure, but will be noticed in the months and even years to come afterward.When applying Hijamah in the condition of strength the areas being cupped are standard, these are mentioned in the Ahadeeth:Abu Kabsha (Radhiallaahu Anhu) narrates that Rasulullaah (Sallallaahu Alayhi Wasallam) used to undergo cupping on the head and between his shoulders and he used to say, 'Whosoever removes this blood, it will not harm him that he does not take any other medical treatment.' (Mishkāt p. 389)From examining the various Ahadeeth and by consensus of those experienced practitioners of Hijamah the areas used in this general form of Hijamah are;
171. For a man
1. The area between the shoulder blades, most commonly in line with the inferior end of the scapula which is in line with the 7th thoracic vertebra. Sometimes other points lateral to the spinal column between the spinouts processes of the 6th to 9th thoracic vertebrae are used. This particular area is the best for performing general Hijamah as it is the area where toxins and impurities in the blood accumulate and stagnate especially around the 17th. 19th and 21st of the month. In Traditional Chinese Medicine this point is regarded as the meeting point of the blood and is used for all blood disorders whether due to deficiency or excess.2. The occipital area of the neck in the recesses formed between the upper portion of the sternocleidomastoid and the trapezius muscles. This is in the region of a commonly used acupuncture point called Feng Chi, which means "wind pool". It is believed that many pathogens enter the body at this area and that is why it is recommended to cover this area when it is cold or windy. Treating this area is helpful in resolving a number of common ailments of the head and neck, including headache, vertigo, pain/stiffness of neck, blurry vision, red/painful eyes, tinnitus, nasal obstruction, common cold, and rhinorrhea (runny nose, nasal discharge associated with allergies or hay fever or common cold). It's also very useful for insomnia, and tends to have a relaxing and balancing effect upon the nervous system.3. On the head in the midline, the exact point is normally directly above the apex of the ear as in the diagram below: In Traditional medicine this point corresponds with the acupuncture point called Bai Hui, meaning a hundred convergences and is the meeting point of all the yang energy of the body. It is commonly used to treat all mental, emotional disorders, but also useful for headaches, epilepsy, neurological and endocrine disorders.4. On the anterior aspect of the foot in a depression distal to the junction of the 2nd and 3rd metatarsal bones. This area is traditionally used to treat swelling, headache, dizziness / vertigo, abdominal pain, bloating, constipation. It can also aid groundedness and focus and treat ADD/ADHD, mania, restlessness, palpitations and epilepsy.In women the same areas are used except for the Hijamah point on the head but the quantity of blood removed is less. Note that women are not in need of regular Hijamah as they do release blood through the menses, if they have experienced menopause then it is fine to do as long as they are still strong and not suffering from blood deficiency in which case one must observe the rules of performing Hijamah in illness.
172. Days for performing Hijamah in strength
Anas ibn Maalik (RA) reported that the Rasul (SAW) said, "Whoever wants to perform Hijamah then let him search for the 17th, 19th and 21 st..." [Saheeh Sunan ibn Maajah (3486)].These are the generally accepted dates for Hijamah, irrespective of what day of the week they fall on, though there are other Ahadeeth that seem to prohibit having it done on particular days of the week, these Hadeeth are categorized as Daeef however and as such the days mentioned in them are not strictly prohibited, they are mentioned here for completeness:Ibn Umar (RA) reported that the Rasul (SAW) said, "Hijamah on an empty stomach is best. In it is a cure and a blessing. It improves the intellect and the memory. So cup yourselves with the blessing of Allaah on Thursday. Keep away from Hijamah on Wednesday, Friday, Saturday and Sunday to be safe. Perform Hijama on Monday and Tuesday for it is the day that Allaah saved Ayoub from a trial. He was inflicted with the trial on Wednesday. You will not find leprosy except (by being cupped) on Wednesday or Wednesday night." (Sunan ibn Maajah (3487)]Ibn Umar (RA) reported that the Rasul (SAW) said, "Hijamah on an empty stomach is best. It increases the intellect and improves the memory. It improves the memory of the one memorising. So whoever is going to be cupped then let it be) on a Thursday in the name of Allaah. Keep away from being cupped on a Friday, Saturday and Sunday. Be cupped on a Monday or Tuesday. Do not be cupped on a Wednesday because it is the day that Ayoub was befallen with a trial. You will not find leprosy except (by being cupped) on Wednesday or Wednesday night." [Sunan ibn Maajah (3488)].In reconciling these it can be said that for Hijamah in strength, the dates are specified, they are the 17th, 19th or 21st of the lunar month and the best is when these dates coincide with a Monday, Tuesday or Thursday, though there is no prohibition for having this type of Hijamah done on any other day as long as it corresponds with the 17th, 19th and 21st.(There is difference of opinion regarding the prohibition on particular days of the week, since another way of reconciling is considering that the Nabi of Allaah (SAW) in the above two Ahadeeth was referring to that particular month in which the Hadeeth was narrated and referring directly to the days of that week and the week after. If Thursday was the 19th, then the previous Friday, Saturday and Sunday would be the 13th, 14th and 15th, and on these days of the Islaamic month it is mentioned that cupping should not be done, Monday and Tuesday would be the 16th and 17th which would be okay for cupping, since they are after the full moon. Wednesday being prohibited in this case would be the exact day of the year that corresponded with the illness of Nabi Ayyoob (AS), and Thursday being the ideal day to perform Hijamah.)It is important to note that this type of Hijamah (i, e Hijamah in strength / Sunnah Hijamah) should be performed only in the seasons of spring and summer. When the climate is hot. However, in places like Hejaz where it is hot throughout the year it can also be performed in the other seasons.Further detail is discussed in the chapters on the guidelines for performing Hijamah.
Section: Hijamah in illness
173
When a patient is complaining of a particular condition, i.e. they are not in good health, but suffering from a particular illness for which Hijamah is indicated then this is termed Hijama-bil-Mardh (Hijamah in illness).In illness the rules of Hijamah are different. For this reason Imam Ahmad ibn Hanbal would have Hijamah at any time of the month and hour of the day as a result of the need of performing Hijamah due to illness. When performing Hijamah for a specific illness it should be done at those points of the body indicated for the illness and the rules of the amount of blood being removed etc. should be adhered to for maximum benefit. These are discussed in the Hijamah treatment guide. This type of Hijamah is very specialized and involves two major aspects, the correct selection of points (or superficial veins) to bleed and removing the correct amount of blood in order to effect cure of the patient's illness. It is also highly recommended to use herbal preparations in association with the Hijamah to address deficiencies/excesses present and treat cold or heat that is present.
Section: Phlebotomy vs Hijamah
174
Phlebotomy is often confused with Hijamah yet the two are very different in their method and effect on the body. Phlebotomy is the bleeding of veins via the use of a hypodermic needle and results in releasing of blood from the inner parts of the body as opposed to the outer part which is achieved through traditional Hijamah. It will also be regarded as part of bloodletting, but not Hijamah, as there are significant differences in the use of these two types of bloodletting.To understand the difference it is important to remember that the land of Hijaaz (where the Ahadeeth of Hijamah are reported) is hot. Hot and cold temperatures have different effects on the blood flow and distribution in the body. In hot countries, and other countries in the hot season, the blood and heat of the body flows more within the outer part of the body, and the inner parts remain cool and relatively deficient of blood. For this reason perspiration increases in summer, and because of the inner organs etc. being cooler, foods take longer to digest, and many summer-heat type illnesses occur. In cold countries, and in winter, the blood and heat of a person's body goes to the inner portions. As a result the digestive system is strengthened, more sleep is experienced, and food is digested easily.For this reason rich foods digest easily in winter, and take more time in summer. This is also the reason honey; dates and other heat creating foods do not affect the people of Hijaaz. In Hijamah, the blood in the outer parts of the body is removed, and in Hijaaz the heat is more on the outer parts of the body, therefore, Hijamah is more beneficial in hot countries and hot climates. In phlebotomy blood is let from the hypodermic veins and reduces heat from the inner parts of the body, therefore it will not be beneficial in hot countries and climates and was hence not a practice of the Nabi (SAW).
Section: Guidelines for performing Hijamah
175
This guide is meant primarily for the patient who is interested in Hijamah for themselves and as a primer for the medical practitioner who wishes to know more about the mechanism and scientific basis of Hijamah, as well as its contraindications, precautions and indications.For this reason and so as not to encourage those without the proper training, I do not describe the actual procedures of Hijamah in detail, this is left to the Hijamah treatment guide for practitioners. The guidelines below however are important to implement whether you are a prospective patient or a practitioner of Hijamah and should be observed in order to gain the benefits of this treatment without exposing oneself or one's patients to unnecessary harm through it.Who should practice HijamahHijamah is regarded as an invasive medical procedure and more importantly is such a procedure where the skin is pierced and there is subsequent handling of body fluids. Any such procedure in medicine presents with a large number of risks when compared to procedures where the skin is not pierced and there is no handling of body fluids.In recent years there has been a proliferation of dangerous infections that are transmitted easily through blood and body fluids. These include HIV, Hepatitis B, Hepatitis C and Viral Hemorrhagic Fever. Since it is difficult to determine what infectious pathogens any given blood contains, and some blood-borne diseases are lethal, standard medical practice regards all blood (and any body fluid) as potentially infectious.There are many cases where Hijamah has resulted in infection with the HIV and Hepatitis viruses, at least one documented HIV infection has occurred in Saudi Arabia and two documented cases reported in Iranian studies. (The majority of cases go undocumented as the patients may not be aware that they have been infected and/or practitioners neglect to report adverse effects for fear of prosecution)Other risks of Hijamah are also inherent in terms of dealing with the effects of excessive blood loss (which may occur due to hereditary disease or medication the patient is taking), incorrect piercing of the skin and subsequent damage to nerves or blood vessels, all of which can potentially be fatal for the patient. Improper handling and disposal of body fluids and sharps is also a common occurrence by those practicing Hijamah without proper training and presents a serious risk of spread of infection to other members of the community.For this reason it is the opinion of many Ulama that the Hajjaam must be an individual who has had biomedical training, either a medical doctor or a qualified and registered practitioner of complementary medicine, or at least an individual who has received specific training in Hijamah and has also received with it training in human anatomy, physiology, general pathology, clinical medicine, clinical diagnostics, differential diagnosis, pharmacological interactions and how to properly handle body fluids and prevent infections.Most countries have a register of individuals who are qualified to practice medicine, whether conventional or complementary, and amongst these there are those who have learnt and practice Hijamah. In some countries like the UK there are specific registers for practitioners of Hijamah and such individuals have received training in the safe application of the procedure. These should be the individuals who are first sought for having Hijamah done and if one is interested in practicing Hijamah then one should endeavor to learn it properly with its necessary biomedical prerequisites in order to gain such formal qualification and registration.Individuals who practice Hijamah without the necessary qualifications are opening themselves up to prosecution by the law in their country should anything go wrong whether it be their own carelessness or by chance. Medical malpractice litigation is becoming more and more common and an unregistered practitioner has no support in such a case from any health council or registration body.In the US the regulations regarding Hijamah only allow the following licensed professionals to practice;1. Physicians2. Physicians Assistants (PA) 3. Advanced Practitioner Registered Nurse (APRN)4. Licensed Acupincturist (LAC)5. Phlebotomists-Only allowed to draw blood in lab setting.6. Paramedics-Allowed to draw blood or do incisions in emergency situations only.Of course there are some countries where the law is not strict about such matters, but the practitioner will have to live with the consequences of their lack of knowledge and experience in medical matters should something go wrong while practicing Hijamah.Many believe that Hijamah is exclusively an Islaamic practice and therefore it should be legalised for any Muslim to practice it. This is erroneous since Hijamah is a medical practice that was already present before the coming of the Nabi (SAW) and was encouraged by the Nabi (SAW), it is not specific to any particular religion or culture but rather it is a treatment for the entire world. Unlike the use of honey and black seed, Hijamah is a medical procedure and because in Islaam we are taught to take precaution and not engage in anything that can cause harm to us both spiritually and physically, one should seek out an expert in Hijamah, who also has the necessary biomedical qualifications for the procedure.(A list of individuals who have been assessed as having the necessary education and suitable qualifications can be found here: www.hujjaam.com, if you are a practitioner you can also go to the site to apply for assessment of your credentials and submission to the list)
Section: General contraindications and precautions
176. Introduction
As is discussed above, Hijamah is not without its risks, and it is not for everybody to undertake. The Hajjaam must see that the patient is fit for Hijamah and must know how to adapt the procedure based on the constitution of the patient and their current state of health. This is also borne out by the hadith:Jabir bin Abdullaah (RA) relates that he heard Rasulullaah (SAW) saying: "If there is any good in your treatments it is in the blade of the Hajjaam, a drink of honey or branding by fire (cauterisation/ moxibustion), whichever suits the ailment, and I do not like to be cauterized" (Bukhari & Muslim)This hadith infers that one must know if Hijamah is the best treatment for the patient, or another treatment would be more suitable. It is interesting to note that in this same hadith the 3 main principles of treatment are referred to, viz, supplementing (with honey), draining heat (by Hijamah) and treating cold and stasis (with fire).In order to know if Hijamah will suit the patient the Hajjaam must first know the contraindications and precautions for practicing Hijamah. Contraindications being those conditions if present, in which Hijamah should not be done and precautions being those in which it is not prohibited, but caution should be observed, especially in terms of how much blood is removed.
177. Excessive perspiration
“Do not bleed the one who is sweating, do not sweat the one who is bleeding”The first rule of preventing adverse effects of Hijamah is not to perform the procedure for a person who is suffering from excessive perspiration. In traditional medicine this is understood as a weakness of the body in its ability to hold the pores closed, which therefore results in excessive and easy perspiration. (This should not be confused with night sweats which are a different phenomenon mostly due to heat forcing the pores open at night.)A person who suffers from easy and excessive sweating is already suffering from a loss of body fluids and bleeding such a person will only aggravate this condition. They will also tend to bleed more easily and may exhibit excessive and uncontrolled blood loss should Hijamah be performed. Excessive sweating, or hyperhidrosis, can be a warning sign of thyroid problems, diabetes or infection. It is also more common in people who are overweight or out of shape. Such an individual is not normally suffering from an "excess heat" type of condition where Hijamah is indicated.The second part of this precaution, viz. do not sweat the one who is one bleeding, means that medication which is used to cause sweating (diaphoretics) should not be used in a person who is bleeding (as it will increase blood loss unnecessarily).
178. Hemophilia
Hemophilia is a genetic disorder that impairs the body's ability to control blood clotting or coagulation, which is used to stop bleeding when a blood vessel is broken, or to heal the incision that is created by the Hajjaam. It is more common in males than females and is characterized by lower blood plasma clotting factor levels of the coagulation factors needed for a normal clotting process.Thus when a blood vessel is injured, a temporary scab does form, but the missing coagulation factors prevent fibrin formation, which is necessary to maintain the blood clot. A hemophiliac does not bleed more intensely than a person without it, but can bleed for a much longer time. In severe hemophiliacs even a minor incision from Hijamah can result in blood loss lasting days or weeks, or even never healing completely. For this reason it is not recommended to perform Hijamah on a hemophiliac, unless it is in association with their medical practitioner who understands the severity and nature of the patients hemophilia and regards Hijamah as safe for the patient.The Hajjaam should take a proper history of the patient in order to determine if the patient is a hemophiliac.
179. Anticoagulant drugs
If a patient is on medication, the Hajjaam must determine whether it is safe to continue with Hijamah and that the medication will not cause excessive and potentially uncontrollable bleeding or other adverse effects.Amongst these medications the most dangerous are anticoagulant medicines. Anticoagulants are medicines that prevent the blood from clotting as quickly or as effectively as normal. Some people call anticoagulants blood thinners. However, the blood is not actually made any thinner - it just does not clot so easily whilst you take an anticoagulant.Anticoagulants are commonly used to treat and prevent blood clots that may occur in your blood vessels. Blood clots can block an artery or a vein. A blocked artery stops blood and oxygen from getting to a part of your body (for example, to a part of the heart, brain or lungs). The tissue supplied by a blocked artery becomes damaged, or dies, and this results in serious problems such as a stroke or heart attack. A blood clot in a large vein, such as a deep vein thrombosis (a clot in the leg vein), can lead to serious problems such as a pulmonary embolism (a clot that travels from the leg vein to the lungs).Patients on anticoagulant medication may exhibit excessive blood loss after Hijamah which in some cases can be fatal. The most common anticoagulants include warfarin and heparin, however these may go by different brand names and for this reason a Hajjaam should be familiar with basic pharmacology and be able to recognize anticoagulant use in prospective Hijamah patients. If you are using anticoagulants you should consult with your doctor before having Hijamah done.If you are not sure whether you are using anticoagulant medication you can check your medication against this list of common names for anticoagulant medication, the list is not exhaustive and ideally your Hajjaam should have the knowledge and training to identify if you are using an anticoagulant or not:Warfarin - Coumadin, Jantoven, Marevan, Lawarin, Waran, WarfantDabigatran - PradaxaAcenocoumarol - G 23350, Nicoumalone, NicumalonPhenindione - Dindevan, Fenindion, Phenylin-Zdorovye, SoluthrombineRivaroxaban - XareltoNote: Aspirin also has an effect of preventing clots by preventing platelets sticking together. However, it is classed as an antiplatelet agent rather than an anticoagulant.
180. Anemia
Anemia is a common condition in which the blood lacks adequate healthy red blood cells. Red blood cells carry oxygen to the body's tissues. Iron deficiency anemia is due to insufficient iron. Without enough iron, the body cannot produce enough hemoglobin, a substance in red blood cells that enables them to carry oxygen. As a result, iron deficiency anemia may leave an individual tired and short of breath.A number of recent studies are showing a link between excessive and unnecessary bloodletting and iron deficiency anemia, some even as severe as resulting in cardiomyopathy which is only seen in chronic severe iron deficiency anaemia.For this reason care should be taken not to cause this type of anemia through Hijamah. This will most often occur when women who are menstruating normally receive Hijamah without a serious reason, or when Hijamah is practiced too often and/or too much blood is removed.For the healthy person not living in a very hot climate, to have Hijamah once a year in the hot season is sufficient, provided the person exhibits signs of a healthy constitution and does not already suffer from anemia. If so, then it should be administered in a "low dose" only once every few years so as to encourage haematopoiesis. (For a women who is menstruating general Hijamah is not needed except where the woman is suffering from an abundance of blood as sometimes happens in the arab regions.)
181. Pregnancy
During pregnancy there is a tremendous demand by the baby for nourishment which is provided by means of the mothers blood. For this reason the woman's appetite grows tremendously due to the increased production of blood in her body. This is the system that Allaah has created to provide for the child in the womb of the mother. The heat of the body is also concentrated internally during the pregnancy period which leaves the outer parts relatively cold and lacking in blood. The normal menstrual cycle also ceases, which in traditional medicine is seen as a sign that there is no need for the woman to lose blood in this period. As a result, if Hijamah is applied in such a stage then great harm is done to the body and to the developing baby, this can easily result in miscarriage.It is shocking to me when I hear that women who are pregnant are having Hijamah done, and on more than one occasion I have come to know that this has resulted in miscarriage. The irresponsible Hajjaam then hides behind the claim of "taqdeer" when in fact this is medical malpractice and they will be held responsible in the court of Allaah for not adhering to basic medical guidelines in respect of care during pregnancy.Pregnancy is a clear contraindication for Hijamah, it should not be done or even considered during pregnancy and should a Hajjaam either due to ignorance or pursuit of money cause a miscarriage then the Hajjaam is to blame and in my opinion should be charged with a crime by the legal system prevailing in that country.
182. Wound healing disorders
When performing Hijamah incisions are made in the skin to release blood. Normally these heal within a short period and leave minimal scarring (especially when a post Hijamah blood and healing herbal formula and/or low level laser therapy is applied afterward).In some conditions however, the body's ability to heal and repair the incision is impaired, and results in either a longer healing time, no healing at all or excessive scarring and keloid formation.Keloids are thickened scars due to excessive synthesis of collagen after an acute injury, which can include the incision, required for Hijamah. Hypertrophic scarring and keloids most frequently arise in young adults and are particularly prevalent in dark-skinned individuals. They are equally common in males and females. These scars may also itch and/or be painful to touch. They are firm or hard, skin-coloured to bright red, smooth, elevated nodules and may have claw-like extensions far beyond the original wound. They are particularly frequently seen on earlobes, shoulders, upper back and anterior chest. Hijamah should be avoided in individuals who have a history of easily developing keloids and hypertrophic scarring. (This is not a contraindication but rather a precaution as we have experienced less occurrence of keloids if the patient is exposed to low level laser therapy after the procedure)Healing of the incisions can also be impaired by other factors that slow down or prevent complete healing and include issues such as the lack of growth factors, the presence of edema, poor blood flow, infection, hypoxia, arterial or venous insufficiency and neuropathy.Other systemic causes of impaired wound healing include metabolic disease, diabetes mellitus, the patients nutritional state, a history of smoking or drug use, exposure to radiation, aging, immune disorders, and abnormal collagen syndromes. A thorough history will reveal if the patient may have wound healing problems.Diabetes deserves special mention as it is a common disorder and when present gives rise to a high risk of major complications in the Hijamah incision, including infection and cellulitis and can even lead to amputation when performed on the extremities. Vascular, neuropathic, immune function, and biochemical abnormalities in diabetes each contribute to delayed healing. Even careful wound care in a patient with excellent glucose control may fail and result in these adverse effects. Special care should therefore be taken in diabetic patients in order to determine whether Hijamah is appropriate for the patient and if so, it should be done only in those areas and in a way that will not risk poor wound healing, subsequent infection and other adverse effects.
183. Who should have Hijamah done
In the hadith related by Jabir ibn Abdullaah (RA), the Nabi (SAW), said: توافق الداء meaning "whichever fits the ailment", in these 2 words the entire field of differential diagnosis and differential treatment was proven and emphasised. In this particular hadith the Nabi of Allaah (SAW) said this in respect of the 3 treatments of honey, hijamah and cauterisation. This indicates that albeit established that the contraindications are not present and the precautions are observed, Hijamah may not be the appropriate treatment for the patient.In order to determine if Hijamah fits the patient and their ailment the Hajjaam should possess some basic skills of differential diagnosis. This includes both western and traditional medicine diagnostic skills in order to determine two essential aspects, viz:1. The constitution or body type of the patient2. The pattern of the illnessBeing able to determine these two aspects will guide the Hajjaam as to whether Hijamah fits the ailment or not.
Section: Constitutions or body types
184. Introduction
Hippocrates said that: “It is more important to know what sort of person has a disease, than to know what sort of a disease a person has."This principle has all but completely departed from the practice of modern medicine but still remains an integral part of the practice of traditional medicine like Unani-Tibb and TCM. It is perhaps the most important criteria in both the identification of the nature of the disease as well as the selection of a treatment method. Understanding the type of person, their temperament as well as their lifestyle, social and environmental influences and history can make the difference between a successful resolution of the presenting illness and a litany of inaccurate diagnoses and ineffective treatments.Recognising the body types is not difficult to master. There are 4 primary constitutions or body types within the Unani philosophy and 5 within the Traditional Chinese Medicine philosophy. These can be combined into 5 main body types for the purposes of determining the suitability of Hijamah. They are as follows:
185. Fire constitution (Hot and Moist - Sanguinous)
They have a strong circulatory system and manifest with red facial hues. These individuals have a hotter temperament, their build is large with more muscle, the skin is warmer, their complexion is reddish in colour and glowing, and the veins are prominent. They usually have broad paravertebral muscles and well-proportioned shoulders, upper back and thighs. Their head is smaller and somewhat pointed, with a pointed chin, small hands and feet and usually curly hair, often these individuals may have an early receding hairline.They suffer from excessive thirst and are uncomfortable in the hot season. They tend to wear less clothing than others do and will sleep with the windows open. They may also be short in stature (dynamite in a small package) and have an "explosive" personality and tend to excessive laughter, they are persuasive, sociable, outgoing, talkative, all embracing, affectionate, expansive, generous, intuitive, warm and bright. Fire personalities are trusting, open minded, social, and fond of beauty. They are spontaneous and often funny.Potential disorders they may suffer from include insomnia, arrhythmias, paranoia, restlessness, palpitations, nervous exhaustion, anxiety, agitation.
186. Wood constitution - (Hot and Dry - Bilious)
They have softer skin, more fat, medium to muscular body with prominent veins. They are resourceful, outspoken, and may be short-tempered.Other words that describe them may include forceful, determined, bold, decisive, clear, tendency to overdo, over direct, over perform.They also have small and shapely hands and feet, broad shoulders and a straight flat back. By nature these individuals enjoy the spring and summer seasons and tend to dislike autumn and winter, as their constitution leaves them more vulnerable to pathogenic invasion and disease during these seasons. They have strong sinews and tendons and tend to manifest with green bluish facial hues.Wood constitutions tend to be kind, merciful, creative, and free in self-expression. They can also manifest stubbornness, dominance and may have issues with anger, excessive aggressiveness and are almost always overachievers. When sick they can be unassertive, unsure of themselves and their role in life. They may experience difficulties in expressing themselves, and have weak boundaries, and display timidity and self-doubt.Potential disorders include blood glucose issues, PMS, muscle pains, allergies and hayfever, depressive episodes, epilepsy, intolerance, impatience, vascular o rmigraine headaches, They may also suffer from diarrhea and frequent indigestion.
187. Metal constitution (Cold and Dry - Melancholic)
Their skin is dry and rough, they are more slender than the average, appear thin and bony and dont put on weight easily even though they may have a voracious appetite, they do not tolerate dry foods. They like moist things, hot water and thin oils are readily absorbed by their skin. The complexion is sometimes described as greyish, sooty or otherwise they appear white and pale but not shiny, they tend to be thoughtful, logical, analytical, and are perfectionists. Other words that describe them include self restraint, methodical, efficient, and disciplined, lives according to principle, sense of symmetry, logical mind, purity of ideals.Potential disorders include frequent Infections, chronic cough, COPD, sinus infections, dry skin, hair, skin disorders, stiff joints and muscles, shallow breathing, poor circulation.
188. Water constitution (Cold and Moist - Phlegmatic)
These individuals are often overweight and their skin feels cold to the touch. They have thin hair, a whitish shiny complexion, and laxity in the joints. In cold weather they become pale, leaden colored and have small veins. Their digestion is sluggish and often suffers from constipation. They tend to have a large round face, head and body, long upper back, large hips and may have uneven physical proportions.They tend to be calm, accommodating, patient and good listeners.Potential disorders include edema, urinary infections, impotence and infertility, low back weakness and pain, weak knees, deterioration of teeth, loss of libido.
189. Earth constitution
These individuals tend to have somewhat larger bodies and over proportioned head and abdomen, strong thighs, round face and wide jaw line. Their limbs are well proportioned and they often carry excess "flesh”.Balanced Earth personalities are predisposed to quiet peaceful lives unconcerned with wealth and fame. They are always at peace, calm and generous, forgiving and sincere. In life they are analytical, practical and logical with strong adaptability to changing circumstances.Earth constitutions can develop digestive and gastrointestinal tract illnesses as these organs can get injured with excessive worrying and over thinking.Qualities that describe an earth constitution include being practical, down-to-earth, intelligent, anticipating, meeting needs of the family, kind, supportive, pliant, reliable. They can sometimes however become too pushy and possessive.Potential disorders include weight difficulties, obsessions, worry, self-doubt, digestive disturbances, low energy, cold limbs, food allergies, weak muscles, and unrealistic expectations, meddling, overprotective.
190. Constitutions suited to Hijamah
Of these only the Fire, Wood and to a lesser extent Earth constitutions are suited to regular Hijamah. These constitutions display an excess of either (liver/ heart) heat and blood in the case of the fire type, (liver) heat and stagnation in the case of the wood type, or stagnation and (stomach) heat in the case of the Earth type. They therefore benefit tremendously from Hijamah done as a general health preservation modality.For the other constitutions, Hijamah is not generally indicated and if done must be done keeping in mind the principles of Hijamah done in illness. Too much blood must also not be removed as these individuals are already either deficient in blood (metal type) or deficient in heat (water type). There are times however when Hijamah applied in specific areas and for specific illnesses can be beneficial.
Section: 8 patterns of illness
191. Introduction
In TCM, one method of understanding the basic nature of an illness is to assess the ailment in terms of the "8 patterns". These are in fact 4 sets of opposing concepts viz.Hot / Cold Internal / External Excess / DeficiencyYin / YangWhen determining if an illness is suited to treatment by Hijamah we are mostly concerned with 2 of these sets, viz. hot/cold and excess/deficiency. There are a number of ways to determine and differentiate how the ailment relates to these concepts such as through asking about the presenting symptoms, as well as looking at the tongue and feeling the pulse.Pulse and tongue diagnosis are specialist fields that require practical training and therefore full detail is not provided on these aspects of diagnosis. Briefly, for Hijamah to be suitable for the ailment, the pulse should be rapid, floating or surging, not slow, deep or weak, it also should not be floating and hollow in the center.Asking about the symptoms in order to determine the nature of the illness is a method that is accessible to most and can provide enough information in the majority of cases to come to a diagnosis vis. a vie the pattern of illness.When determining heat we differentiate between excess heat or deficient heat.Excess heat has the following characteristics: Main Signs: Fever (sometimes), thirst, red face, red eyes, constipation. Urine is scanty and dark.Pulse: Rapid and FullTongue: Red with a yellow coatingThe following are some general signs of an Excess Heat pattern though the exact symptoms depend on the organ(s) affected.1. Raised, red skin eruption that feels hot e.g. acute urticaria 2. Any burning painful sensation e.g. urine or stomach pain 3. Loss of blood with large quantities of bright red blood indicates Heat in the Blood4. Extreme mental restlessness/manic behavior (Heat in the Heart) 5. Thick, yellow, sticky, malodorous secretions/ excretionsExcess Heat patterns are caused by excess of energy and blood in the body and individuals presenting with this type of pattern will respond very well to Hijamah.
192. Deficient heat has the following characteristics
Main Signs: Afternoon fever or feeling of heat in afternoon, dry mouth, dry throat at night, night sweats, fever in 5 hearts, dry stools, scanty-dark urine, mental restlessness and fidgeting, vague anxiety. (More specific signs depend on Organ involved)Pulse: Floating-Empty and Rapid or Thin and Rapid Tongue: Red, in severe cases peeled. No Coating.Other signs that may be present:Deficiency heat affecting the Lung - Malar flush, dry cough.Deficiency heat affecting the Liver - Headaches, dry eyes, irritability.Deficiency heat affecting the Heart - palpitations, insomnia and feelings of restlessness.Deficiency heat can be caused by many factors, stress being a major one. Excessive sexual indulgence, overwork, smoking, alcohol and drug abuse, all deplete the fluids and give rise to this type of heat as well. Long-standing emotional distress can also cause this pattern.Such patients are suited to Hijamah but only with small quantities of blood removed. If the patient is suffering from excessive sweating then Hijamah is contraindicated.
193. Circulation issues
Irrespective of the constitution, circulation problems are well treated by Hijamah provided that the area affected is treated directly. In order to determine if the circulation is affected in a particular area of the body, the practitioner will have to take a thorough history and examine the area. Though full detail is beyond the scope of this book and must be learned through a course in clinical diagnostic skills in addition to other subjects, there are some signs that indicate poor circulation, viz:1. The are feels cold to the touch when compared to other areas.2. There are prominent spider veins which appear purplish in nature.3. The patient experiences pain of a sharp and stabbing nature in the area.4. There are purple spots on the tongue corresponding with the affected body area.In these cases Hijamah may be beneficial though some special techniques must be employed such as bleeding of the spider veins etc. (This is detailed in the Hijamah Treatment Guide for Practitioners)
194. Geographical considerations
Modern medicine has not fully understood the effect of the climate on the health of individuals, yet traditional and complementary medical systems place tremendous emphasis on the climate, season and prevailing weather in the geographical area that a person resides in. Hakims are famous for recommending some patients move to another town or city that had a more favorable climate as the only method of treatment for the patients ailment. Similarly, the climate and weather must be taken into account when determining the suitability of Hijamah as is also borne out by this hadith:Anas ibn Maalik (RA) reported that the Rasul (SAW) said, "When the weather becomes extremely hot, seek aid in Hijamah. Do not allow your blood to rage (boil) such that it kills you." [Reported by Hakim in his 'Mustadrak' and he authenticated it and Imam ad-Dhahabi agreed (4/212)].From this we learn that Hijamah is suited to the hot climate, and this is corroborated by other Ahadeeth as well. If the patient lives in a region where the climate is normally hot, then Hijamah is probably suited to the patient. If the patient lives in a region where it is always cold, then care should be taken even if the patient displays the correct constitution for Hijamah. Every patient's condition will be different and it is up to the skilled and experienced Hajjaam to determine the weight of the climate, season and prevailing weather on the suitability of Hijamah. One may find that the season is correct, the dates are correct, the patient is suited to Hijamah but the particular weather on that day is cold and rainy. I would normally avoid doing Hijamah on such a day and postpone it to another day if it were a general Hijamah.In the commentary on the books of Ahadeeth, Ulama have also written the following which must be considered:“The saying of Sayyidina Rasulullaah SallAllaahu Alayhi Wasallam that cupping is the best medicine is very true. By this he was addressing the youth of the Haramayn, and also the inhabitants of the countries where the climate is hot, because their blood becomes thin, it remains more on the surface of the body and the climate of the country brings it even more closer to the surface.”
Section: The condition of the person having Hijamah
195. Introduction
If Hijamah has been deemed suitable the patient must ensure to prepare themselves and be in the appropriate condition for the procedure. This is evident from a number of Ahadeeth such as the following:Ibn Umar (RA) reported that the Rasul (SAW) said, "Hijamah on an empty stomach is best. In it is a cure and a blessing..." [Saheeh Sunan ibn Maajah (3487)]Ibn Umar (RA) reported that the Rasul (SAW) said, "Hijamah on an empty stomach* is best. In it is a cure and a blessing. It improves the intellect and the memory..." [Saheeh Sunan ibn Maajah (3487)].This is the most important condition, i.e. the patient should have an empty stomach.The reason for this, especially in the case of Hijamah in strength, is because during the night, the toxins and impurities in the blood accumulate in the regions where Hijamah is done and remain there until a person eats. When a meal is taken blood is redirected to the digestive organs to enable the process of digestion and absorption. The toxins and impurities are therefore recirculated throughout the body instead of being concentrated in the Hijamah areas and also there is less blood in the superficial or outer parts of the body. If Hijamah is done in this condition it can lead to illness and this is also mentioned in some other Ahadeeth which say that Hijamah on a full stomach is disease and on an empty stomach is cure.When Hijamah is done on a person who has just eaten it often results in vertigo or syncope (fainting).The second condition is that the person should have enough strength for the procedure. This is also proven for the hadith:The Nabi, upon whom be peace, was cupped while he was fasting. However, if doing this weakens the fasting person, it is disliked. Thabit al-Bunani asked Anas: "Did you dislike cupping for a fasting person during the time of the Nabi?" He answered: "No swe did not), unless it made someone weak." This is related by al-Bukhari and others.There are some general conditions which are also recommended:1. The patient should ideally have taken a bath before the procedure, this assists in bringing the blood to the surface and helps it to flow better during the procedure.2. The are where Hijamah is to be done should be shaved, (often this will be done by the Hajjaam) 3. The patient should give some sadaqah (charity) beforehand. It is recommended in the Ahadeeth to treat the sick with charity, it prevents calamities and in the case of the Hijamah procedure helps with the procedure being easy and successful.
196. When should Hijamah be performed?
Hijamah can be performed either in general cases (Hijamah in strength) when the patient is healthy or to treat a particular illness (Hijamah in illness). The times stipulated for these are different.
197. Hijamah in strength
For general health in those who are suited to cupping, it should be done once a year. During the Spring or Summer time when it is hot is the best season in which to perform Hijamah. The reasons have been described in previous chapters.
198. Hijamah and the lunar cycle
In health it is generally recommended to perform Hijamah only on the 17th, 19th or 21st of the lunar month. These are the dates recommended in the Ahadeeth but there is no harm in doing it any time in the latter part of the lunar month from the 17th to the 27th, provided that the climate is suitable for it as detailed above.The reason for this has to do with the effect of the moon on the blood. Just as the moon has an effect on the sea and produces high tides, in the same manner when the moon is full it brings forth impurities from the blood to the surface of the body and has other effects as well.it is interesting to note that the term "lunatic" is derived from lunar and indicates the effect of the moon and such behaviour. In fact, lunacy is more likely at the time of the full moon since this is when there is a lot of liver energy which can give rise to easy anger, flared tempers etc.Many who suffer from conditions such as epilepsy, migraine headaches, high blood pressure etc note that their symptoms are worse during a full moon that at other times of the month. Studies show that more assaults occur around the full moon. More crimes, self and unintentional poisonings and animal bites occur during the full moon cycle as well. The moon also has an impact on fertility, menstruation, and birth rate. Melatonin levels which are influenced by the phase of the moon correlate with the menstrual cycle. Admittance to hospitals and emergency units because of various causes also correlate with the moon phases. In addition, other events associated with human behavior, such as traffic accidents, crimes, and suicides, are more common during the full moon phase as well.Studies indicate that melatonin and endogenous steroid levels are affected by the phase of the moon and may be the means by which the physiological changes occur in response to the moon phase. The release of these neurohormones may be triggered by the electromagnetic radiation and/or the gravitational pull of the moon.In a more recent study conducted in 2013 at the Psychiatric Hospital of the University of Basel, Switzerland, researchers found that around the time of full moon, sleep was affected with subjects experiencing decreased electroencephalogram (EEG) activity, taking longer to fall off to sleep, and also reporting decreased sleep quality. This also correlated with lower melatonin levels.It is however not recommended to have Hijamah during the full moon phase itself, as it is understood that the blood will flow in excessive and unnecessary amounts, but afterwards (from the 17th onward) it is a means of removing the impurities and 'heat' from the body.
199. Time of day
It is recommended to perform general Hijamah in the early morning before 10 a.m. while the impurities in the blood are still settled in the areas bled for Hijamah and have not had time to circulate and diffuse in the general circulation. Once the patient starts to get involved in his/her daily activities there is a significant redistribution of blood which is allocated to areas of the body that are in greater need depending on the activity being performed. The patient also may eat something which will cause blood to move to the internal digestive organs.By the afternoon, the blood starts to recede internally and this is why "blood deficiency" headaches tend to occur at this time. Office workers are especially prone to this and should not be treated with Hijamah after returning from work as this aggravates their blood deficiency issue.If the patient has had an afternoon nap and is fresh in the evening then Hijamah may be performed provided the climate is hot and the patient has not eaten.
200. Hijamah in illness
Hijamah in illness can be performed at any time of the month, but it is preferred during the daytime and when the climate is warm or hot. If this is not possible care should be taken that the room where Hijamah is being performed is warm and there is no draught entering, (whether it be through an incompletely sealed door or window etc.).The patient should also take extra precaution not to expose themselves to cold after the procedure and neither should they drink or eat cold or raw foods as these will divert heat to the interior of the body. For Hijamah during illness the amount of blood removed must correspond with the level of the pulse and the Hajjaam must have special training in order to apply the procedure effectively to treat the presenting illness. It is better that the treatment is also combined with herbal medication and dietary therapy in such cases.