Getting rid of bad blood

From headache to heart disease, the ancient practice of hijama, or cupping therapy, has its roots in the region, where practitioners claim it has been healing people for centuries.

Cupping, which involves plastic cups on the skin, has changed considerably since the days when the main suction instrument was a hollowed-out bull's horn.

One of the oldest medical treatments, the practice of hijama, which involves suctions that draw out stagnant or congested blood from a wound deliberately cut in the body, has its origins in the Middle East. The Ebers Papyrus, one of the oldest medical books in history written in 1550 BCE - stated that the healing method cleansed the circulatory system by removing contaminated blood via a vacuum that sucked the fluid through tiny incisions on the skin.

The practice has persisted to the present day with many in the region still using it to treat ailments from headaches and eye problems to gout and heart disease."We know that when we do cupping therapy, making these suctions on the skin and clearing out the stagnated blood, it can decrease problems like chest diseases and blood pressure because we remove the bad blood," explained Dr Mohamed Tamimi, a physiotherapist who treats patients using hijama at the Al Rahma Medical Center.

In the same way that a tree log can impede a river's flow, the idea is that "bad" or dark clotted blood is to blame for circulation problems."When there is an area of water that becomes stagnant, when there is not running water, what happens?" Dr Tamimi said. "This water, after time, will bring diseases and flies, so it's the same with blood. We can say a section is more liable to be diseased and infected."

The theory behind hijama is that, unless the capillaries are able to carry oxygen and nutrient-rich blood to the body's cells, tissues and organs may weaken or operate inefficiently.As the body is unable to naturally rid itself of the toxic stasis blocking blood vessels, a 30-minute hijama session can help rejuvenate patients and alleviate pain associated with 80 per cent of common diseases, Dr Tamimi said.

"Kidney problems, heart problems, stroke, gout - these can be treated with this procedure," he said, adding that he would prescribe the treatment for anyone feeling fatigued, restless, stressed or sluggish."It is in my view that it feels like 20 or 30 times more effective than a massage," he said.The procedure has changed over the centuries, with modern medicine and concerns about hygiene and infection.

Traditionally, the main instrument used to create a vacuum was a hollowed-out bull's horn. The hijama specialist would locate meridians on the patient's body - such as the back of the neck to treat headaches, or the inside shoulder for chest pains - and then place the bell of the horn on the site.With a sharp knife, the healer would slice very fine, superficial cuts into the targeted area and then re-cover the marked skin with the horn, while sucking the horn's mouthpiece to extract dead blood cells from the wound. A clot of dark blood would begin accumulating in the cup.

Modern medicine has all but eliminated the old ways of wet cupping, and today's hijama specialists in the UAE are licensed professionals.Plastic, individually wrapped cups with varying diameters have replaced bull's horns. Mr Tamimi demonstrated how a pump attaches to a nozzle at the dome of the cup, then seals in the air to create the negative energy needed to extract blood from slits in the skin.

"I choose which meridians to put this suction on. From experience, I can see if there is low circulation or high circulation in this area," he said, sticking one of the pressurised cups to his palm. The colour of the flesh seized in the vacuum indicates the health of the blood beneath, he explained.After locating the appropriate spot, he would cut "very small, fine incisions with a surgical razor." All of the blades are also individually wrapped. Like the hijama cups, they are immediately disposed of after every session.

From about seven cups, only about 300-400 ml of blood in all is extracted. The bad blood collected in the jars is easy to remove as it clots easier. "It looks like a dark, thick jelly because the blood is more liable to clot," Dr Tamimi said. As for whether the patient would feel any pain from the superficial cuts or the bleeding, he said some regarded the sensation of having their meridians stimulated as "amazing." Others only reported slight discomfort.

"The incisions themselves are very light," he added, laying out a Kleenex to demonstrate. "If I take this tissue and I made incisions, I would not penetrate it. I make maybe 15 cuts - just enough of an opening to allow blood to drain when I apply the suction."Red marks typically vanish within days while the shallow lacerations may take up to three weeks to heal completely.There is also an optimal time for hijama based on the lunar calendar, Dr Tamimi said.

Just as the moon affects the ocean's tide, the same principles can apply to the human body."When the full moon is out, in the 15th day of a month, we believe that the moon will have this affect to draw a good amount of blood," he said. The connection between circulation and the lunar cycle has a well-documented history in both Eastern and Western medical traditions. Certain feast days of saints were thought to be optimal times for bloodletting in Medieval Europe.

The Talmud also makes recommendations for particular times of the year where bloodletting is more effective. The direct link between circulatory function and general health fell out of favour in Western medicine in the 19th century.

But with so much emphasis in medical history on the circulatory system, the particular practice of cupping is a difficult to credit to one particular culture, as the Chinese have for centuries applied suctions to stimulate the body's meridians. This method is known as "dry cupping" because it does not involve drawing blood. Instead, a lit match is dropped into a small tumbler. The heated air of the jar, when pressed against the skin, creates a negative pressure that pulls the skin upwards and also extends the capillaries beneath.Cupping improves the circulation of blood and lymph and also regulates and improves the functioning of the autonomic nervous system, its practitioners contend.

Dr Tamimi said the three hijama specialists at the Al Rahma centre treat non-Muslims, as well as toddlers and elderly people. He advised healthy people to have at least an annual session, but cautioned that pregnant women as well as people with anaemia and haemophilia should avoid the treatment. He also said that more research needs to focus on the medical benefits of hijama, noting that Egyptian scholars have written about the procedure's ability to decrease cholesterol levels and blood pressure.

"I advise all countries to look to this traditional way because it can save money, it can save lives and save operations," he said. "To me, hijama is really a treasure but it needs more research."