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.”