Evaluation of the Effectiveness of Wet Cupping Therapy in Fibromyalgia Patients: A Randomized Controlled Trial

INTRODUCTION

The aim of this study was to investigate the efficacy of wet cupping therapy (WCT) in patients diagnosed with fibromyalgia syndrome (FMS) as a complementary method in fibromyalgia treatment.

MATERIALS AND METHODS

A total of 120 participants between 18 and 65 years who were diagnosed with FMS were included in the study. They were randomized into two groups: 60 patients as the intervention and 60 patients as the control group. Each participant in the intervention group received 3 sessions of WCT once a month in addition to their ongoing treatment whereas the control group received only routine medical treatment. The evaluation was conducted in both groups based on the fibromyalgia impact questionnaire (FIQ), visual analog scale (VAS), and quality of life scale (QoL) parameters initially (at 0th week) and 1 week after the WCT sessions (at the 10th week). For the comparison of quantitative variables showing a normal distribution between the two groups, the Student's t test was used, while the Mann-Whitney U test was employed for variables not showing a normal distribution. The χ2 test and Continuity (Yates) Correction were used for the comparison of qualitative data. The significance level was set at p < 0.05.

RESULTS

The study included 107 female and 13 male participants, with a mean age of 45.79 ± 8.49 years. When comparing the pretreatment FIQ, VAS, and QoL scores with the scores obtained after three sessions of WCT, it was observed that in the WCT group, the FIQ and VAS values significantly decreased compared to the control group while the QoL significantly increased compared to the control group (p < 0.001 in all).

CONCLUSION

The findings obtained from this study indicate that WCT can be an effective treatment option for patients with FMS.

Einleitung

Mit dieser Studie soll die Wirksamkeit der blutigen Schröpftherapie (wet cupping therapy, WCT) bei Patienten mit diagnostiziertem Fibromyalgie-Syndrom (FMS) als komplementäre Methode in der Fibromyalgie-Behandlung untersucht werden.

Material und Methoden

Insgesamt wurden 120 Teilnehmer mit diagnostiziertem FMS zwischen 18 und 65 Jahren in die Studie aufgenommen. Diese wurden randomisiert zwei Gruppen zugeordnet: 60 Patienten wurden der Interventionsgruppe zugewiesen und 60 Patienten der Kontrollgruppe. Alle Teilnehmer der Interventionsgruppe erhielten einmal im Monat drei Sitzungen WCT zusätzlich zu ihrer laufenden Therapie, während die Kontrollgruppe lediglich die Standardbehandlung erhielt. Die Bewertung erfolgte in beiden Gruppen anhand des Fibromyalgia Impact Questionnaire (FIQ), der Visuellen Analogskala (VAS) und der Parameter der Quality of Life (QoL) Scale zu Beginn (in Woche 0) und eine Woche nach den WCT-Sitzungen (in Woche 10). Für den Vergleich von quantitativen Variablen, die eine Normalverteilung zwischen den beiden Gruppen aufwiesen, wurde der Student’s t-Test verwendet, während bei Variablen ohne Normalverteilung der Mann-Whitney-U-Test zur Anwendung kam. Qualitative Daten wurden mit dem Chi-Quadrat-Test und der Kontinuitätskorrektur (Yates) verglichen. Das Signifikanzniveau wurde auf p < 0,05 festgelegt.

Ergebnisse

In die Studie wurden 107 Frauen und 13 Männer mit einem Durchschnittsalter von 45,79 ± 8,49 Jahren aufgenommen. Beim Vergleich der FIQ-, VAS- und QoL-Werte vor der Behandlung mit den nach drei WCT-Sitzungen erhobenen Werten zeigte sich in der WCT-Gruppe ein signifikanter Rückgang der FIQ- und VAS-Werte im Vergleich zur Kontrollgruppe, wohingegen bei der QoL ein signifikanter Anstieg gegenüber der Kontrollgruppe zu beobachten war (p < 0,001 in allen Fällen).

Schlussfolgerung

Die Ergebnisse dieser Studie deuten darauf hin, dass die WCT eine wirksame therapeutische Option für Patienten mit FMS sein kann.

Efficacy of topical galbanum oil with dry cupping in hospitalized COVID-19 patients: A randomized open-label clinical trial

Objective

This study was designed to detect the therapeutic effects of galbanum oil plus dry cupping (a Persian medicine-based method) in hospitalized patients with coronavirus disease-2019 (COVID-19).

Materials and Methods

In this randomized controlled trial, 60 hospitalized COVID-19 patients with positive polymerase chain reaction test (PCR), pulmonary involvement and blood oxygen saturation (SpO2) ≤93 mmHg, were randomly assigned into two groups to take the standard therapeutic regimen alone or alongside cupping and topical galbanum oil (Ferula gommosa oleo-gum resin) for 3-5 days. The SpO2 level, the severity of signs and symptoms of patients and laboratory parameters were compared between the two groups.

Results

Fifty-eight patients were analyzed. The SpO2 level changed from 89.27±3.82 to 90.29±3.09 mmHg (p=0.038) in control group, while it increased from 88.74±3.45 to 94.23±2.1 mmHg (<0.001) in galbanum group with a significant difference between the groups (p<0.001). Fever, cough, dyspnea, and anorexia alleviated in the galbanum group more than the control (p=0.003, 0.001, 0.01, and 0.04, respectively). No adverse effects were reported due to galbanum oil and cupping therapy.

Conclusion

Dry cupping with galbanum oil alongside the routine therapeutic regimen could be more effective than the routine therapeutic regimen alone for improving SpO2 level and alleviating fever, cough, and dyspnea in COVID-19 patients.

"Islamic Medicine": A true discipline for the 21st century or quackery?

The purpose of this review is to consider the position of "Islamic Medicine" and whether it is a legitimate form of clinical care or quackery. The analysis is based on published work together with an identification of themes derived from testimonials on practitioners' websites, as well as a consideration of how such therapies are considered in medical search engines. "Islamic Medicine" covers Traditional or Yunani practice, Prophetic Medicine, Hijama and Ruqya. Their origins are discussed and, subsequently, current-day practice and its relationship to allopathic medicine. Reasons for antagonism to modern medicine are considered and the absence of a rational basis for many of the views expressed. In the case of Yunani medicine, its pre-Islamic origins are identified together with the impact of anti-colonialism and the potential role of clerics in wishing to distance medical care from Galenic concepts. In the case of Hijama, the absence of effective training and regulation and its promotion as a "lost sunna" are discussed alongside claims for miraculous cures. The movement of Ruqyah away from Qur'anic recitation in support of the sick towards a popularised approach to dealing with magic and possession is considered, together with consequential adverse publicity in the media. The consequences of a failure to adopt training practices for Yunani medicine, as recommended by the WHO, are identified. Accredited detailed courses monitored by external statutory regulatory agencies, based in institutions committed to providing the best healthcare, and supporting research would allow "Islamic Medicine" to become a significant role player in contemporary clinical practice and stop present-day quackery.

Effectiveness of Wet Cupping on Patients with Facial Acne Vulgaris: A 12-Week, Randomized, Single-Blind, Intervention-Sham-Controlled Trial

INTRODUCTION

Acne vulgaris is a widespread skin disorder. The aim of this study was to assess the effectiveness of wet cupping in the treatment of moderate to severe facial acne vulgaris.

METHODS

Between August 2018 and January 2020, eligible patients with moderate to severe facial acne were recruited in this single-blind, intervention-sham-controlled clinical trial in Iran. The intervention group received wet cupping twice and likewise the control group received sham cupping. Also, both groups received 500 mg azithromycin 3 times/week for 12 weeks. Acne grades were assessed 6 weeks and 12 weeks after beginning of the treatment by the dermatologist uninformed of group allocation and participant self-assessment. Quality of life was assessed with valid questionnaire before and after the treatment.

RESULT

Totally, 103 patients completed the trial. The patients in the intervention group had better improvement and grade of acne compared to the control group at the end of the trial. Patients showed a shorter time to removing facial lesions in the intervention group in contrast with the control group (p < 0.001). Quality of life significantly increased in the intervention group compared with the control group (p = 0.004).

CONCLUSION

Wet cupping plus antibiotic therapy seems to be more effective than antibiotic therapy per se in patients with facial acne vulgaris.

Use of traditional medicine for primary headache disorders in Kuwait

BACKGROUND

Traditional Medicine (TM) is widely accepted to be used for the treatment headache disorders in Kuwait however, researches remain poorly documented. We aimed to study the frequency of TM use and its impact in the primary headache patients.

METHODS

This is a cross sectional self-reported efficacy study, which was conducted in Headache clinic in Kuwait throughout 6 months. Patients who were diagnosed with primary headache disorders of both genders aged from 18 to 65 years were included. Self-reported questionnaires were distributed to patients who used TM in the previous year. It included demographic, and characteristics of headache (headache frequency, duration, number of analgesic used in days per month and severity of headache). TM queried included blood cupping (Hijama), head banding, herbal medicine (sabkha), and diet modification. It assessed characters of headache before and 3 months after the final TM session. Independent sample t test, paired sample t test and Chi-square test were used to compare between different values. P < 0.05 is considered significant.

RESULTS

A total of 279 patients were included. The mean age is 40.32 ± 11.75 years; females represented 79.6% of the cohort. Most patients (n = 195; 69.9%) reported the use of TM before presentation to headache clinic, mainly Hijama (47.3%). Cultural / religious beliefs were the cause of seeking TM in 51.3% versus 10% used it due to ineffective medical treatment and 8.6% used it because of intolerance of medical treatment. Patients used TM were older at the onset of headache (24.24 ± 10.67 versus 20.38 ± 8.47; p < 0.003), and had longer headache disease duration (19.26 ± 13.13 versus 16.12 ± 11.39; p < 0.044). All patients with chronic headache (100%) and most of episodic migraine patients (90.4%) sought TM while only (31.5%) of Tension type headache sought TM; p < 0.047. Patients who sought TM had more frequent episodes of headache, longer duration of attacks and higher number of days of analgesic-usage respectively over last 3 months before presentation to our side (9.66 ± 7.39 versus 4.14 ± 2.72; p < 0.001), (41.23 ± 27.76 versus 32.19 ± 23.29; p <. 0009), (8.23 + 7.70 versus 3.18 ± 3.06; p < 0.001). At 3 months after the final TM session, there was no significant reduction of frequency of headache days per month (9.19 ± 7.33 versus 8.99 ± 7.59; p < 0.50), days of analgesic use per month (7.45 ± 7.43 versus 6.77 ± 6.93; p < 0.09) and duration of headache (41.23 ± 27.76 versus 41.59 ± 27.69; p < 0.78). However, there was a significant reduction of the severity of headache (p < 0.02). Few patients (17.9%) reported adverse events with TM. Most of TM cohorts were not satisfied after receiving this type of medicine.

CONCLUSION

TM was widely used in Kuwait for primary headache. Patients sought TM before seeking physician because they found them more congruent with their own cultural and religious beliefs. Health care professionals involved in the management of headache should be aware of this and monitor potential benefits or adverse events of TM. The usage of TM was not effective in reducing headache attacks and severity.

Bullous pemphigoid induced by Hijama therapy (cupping)

Bullous pemphigoid (BP) is described as a subepidermal blistering disorder, which is commonly reported among the elderly, particularly those older than 60 years of age. In this report, we present the case of a 41-year-old female patient with BP lesions that were initially detected at the site of Hijama therapy with a subsequent generalized spread. Punch biopsy from the lesions and perilesional direct immunofluorescence (DIF) demonstrated features of BP. The anti-BP180 level was 178 RU/mL, and the anti-BP230 level was negative. BP antigens at the site of Hijama caused an antibody response, which led to widespread blistering over the trunk due to epitope spreading. In a comprehensive review of the literature, a total of 22 BP patients with lesions due to physical trauma were studied, and clinical, immunological, and epidemiological information was gathered. This article is the first report on the occurrence of BP induced by Hijama therapy.

A brief illustration of the official national standards for the safe use of cupping therapy (Hijama) in Saudi Arabia

Cupping therapy (Hijama in Arabic) is a popular traditional treatment especially in Asia, the Middle East and Central Europe. Traditionally, cupping therapy has been one of the most used practices in Saudi Arabia. Standardization of the practice of cupping therapy is a very important step to eliminate or reduce any adverse events related to cupping. This article gives a brief illustration and highlights the important points of the first accredited Saudi Arabian standards for the safe use of cupping equipment and its applications.

The medical perspective of cupping therapy: Effects and mechanisms of action

Cupping Therapy (CT) is an ancient method and currently used in the treatment of a broad range of medical conditions. Nonetheless the mechanism of action of (CT) is not fully understood. This review aimed to identify possible mechanisms of action of (CT) from modern medicine perspective and offer possible explanations of its effects. English literature in PubMed, Cochrane Library and Google Scholar was searched using key words. Only 223 articles identified, 149 records screened, and 74 articles excluded for irrelevancy. Only 75 full-text articles were assessed for eligibility, included studies in this review were 64. Six theories have been suggested to explain the effects produced by cupping therapy. Pain reduction and changes in biomechanical properties of the skin could be explained by "Pain-Gate Theory", "Diffuse Noxious Inhibitory Controls" and "Reflex zone theory". Muscle relaxation, changes in local tissue structures and increase in blood circulation might be explained by "Nitric Oxide theory". Immunological effects and hormonal adjustments might be attributed to "Activation of immune system theory". Releasing of toxins and removal of wastes and heavy metals might be explained by "Blood Detoxification Theory". These theories may overlap or work interchangeably to produce various therapeutic effects in specific ailments and diseases. Apparently, no single theory exists to explain the whole effects of cupping. Further researches are needed to support or refute the aforesaid theories, and also develop innovative conceptualizations of (CT) in future.

Evaluation of Bloodletting Cupping Therapy in the Management of Hypertension

Background

Bloodletting cupping therapy (Hijama) is a traditional alternative medicine practiced in different cultures. Claims about the therapeutic efficacy of Hijama in hypertension are contradictory. The aim of this project was to determine if Hijama therapy is beneficial in the treatment of patients with hypertension.

Materials and Methods

In this retrospective study, 60 files for patients treated for hypertension, aged 40-60 years and whose systolic blood pressure (SBP) is at least 140mm Hg, were used. The data from 30 patient files were obtained from three licensed Hijama centers (study group), whereas data from the rest of 30 patient files were collected from a hospital (control group). The data from Hijama centers included age, date of Hijama therapy, and blood pressure measured before each Hijama session. Both diastolic blood pressure (DBP) and SBP data were obtained over 3-month period.

Results

The results showed a significant reduction in SBP (P value < 0.01) over three sessions of wet cupping (from 149.2 to 130.8mm Hg), but this was not significant for DBP over three sessions (P = 0.074). The study also found that the mean SBP in the study group was 9.6mm Hg less than that in the control group (130.8 vs. 140.4mm Hg, P = 0.019), whereas there was no significant difference in DBP between the study group and the control group (87.0 vs. 86.0mm Hg, P = 0.75).

Conclusions

Our study shows clear relationship between Hijama and the reduction and control of SBP in patients with hypertension. Therefore, Hijama can be used as an adjunct to conventional therapy, which may allow downtitration of given doses of antihypertensive drugs. The possible association of SBP reduction by Hijama and pain reduction needs an investigation.