INTRODUCTION

The term used for this therapy originates from the Arabic language, it’s hijamah. This therapy is a method of cleaning the blood and wind by sucking. remove residual toxins in the body through the skin surface by sucking (1). Al-hajamah according to language is the same as “suction”. This is in accordance with the procedure for this therapy, sucking blood from the intervention area. So hijâmah according to language is an something about sucking blood and removing it from the surface of the skin, and then collected in a mihjamah glass, which causes concentration and pulling of blood in there, then incision is made on the skin with a scalpel to remove the blood. Hijamah is different from cutting the veins.

BENEFITS OF CUPPING

There are benefits of cupping, including in the case of high blood pressure, the blood pressure can to normal range, in the case of low blood pressure, the blood pressure rises to normal, white blood cells (leukocytes) increased in 60% of cases and was still normal range, blood sugar levels down in people with diabetes in 92.5% of cases, uric acid in the blood decreased in 83.68% of cases, blood that came out from the cupping, it was found that the erythrocytes were in odd shape, did not function normally, and interfered with the performance of other cells. Currently, cupping has been modified so the technical implementation follows scientific rules using practical and effective tools.

TYPES OF CUPPING

Cupping has several types on the method and practice. The types of cupping are :

1. Dry Cupping

Dry cupping is cupping that done without scratches or cuts on the body. Dry cupping is also known as wind cupping, which is cupping that is done by sucking the skin and massaging the surrounding area without removing dirty blood. Dry cupping is good for people who afraid from needle and blood.

Dry cupping is usually placing the glass in a certain place, followed by sucking the air in the glass with careful calculations. However, the cupper does not make an incision at this point. Cupping is commonly used for people who suffer from diabetes. Because if an incision is made, it is feared that the wound will be difficult to healing.

2. Wet Cupping

Wet cupping is dry cupping with additional treatment, that’s blood is removed by incision on certain area being cupped. The process is the surface of the skin is suction before , then cut or incision using a lancer (a sharp needle) or scalpel, then the surrounding area is sucked back to remove blood containing toxins from the body. Each suction is left for three to five minutes and then the dirt is removed by placing it in a special container or trash can.

CUPPING MECHANISM

Cupping is divided into two types, that’s wet cupping and dry cupping. Dry cupping includes slide cupping, fire cupping, and pull cupping. The difference between wet cupping and dry cupping is the presence or absence of blood. The sliding cupping technique is done by cupping a certain body part, then launching the cup to another body part. Pull cupping is done by cupping for a few seconds then the cupping is pulled and affixed back to the skin. In the process of cupping, there is a local dam, where the stimulation of the meridian points, causes hypoxia and inflammation, so that it can improve microcirculation and cell function quickly. Fifteen days after cupping, there is an increase in the elasticity of spectrums that can stimulate the work of the immune system: natural killer cells, so that the body's immune system increases both as a prevention and against disease.

INDICATIONS AND CONTRAINDICATIONS CUPPING

Cupping can be used for diseases that are local or systemic. Cupping can be used to reduce pain such as headaches, carpal tunnel syndrome and some other local disease. Meanwhile, for systemic diseases, cupping is using in cases of hypertension and diabetes mellitus. Cupping cannot be done directly over veins and arteries, nerves, on inflamed skin, body orifices (ear, nose), eyes, lymph nodes, open wounds, broken bones, burns and thrombosis. deep vein. The diseases that are contraindications for cupping can be grouped into absolute and relative contraindications. Absolute contraindication occur when there is insufficient information about cupping.

SIDE EFFECTS

The side effects caused by cupping are not severe, only cause discomfort due to cupped and incision on the skin. However, these scars will disappear within 2-3 days so cupping is safe to do. Meanwhile, undesirable events that can occur due to cupping include scar tissue, burns, headaches, itching, dizziness, fatigue, muscle tension, anaemia, nausea, bullae formation, hematoma, onset of pain at the site of cupping, abscesses, skin infections, insomnia, hyperpigmentation, vasovagal reflex. In the practice of cupping, it is very rare.

CUPPING PROCEDURE

The procedure for doing cupping in general can be done in several stages, but before doing these stages it is better if cupping providing information about everything about cupping or the stages in carrying out cupping, so that the patient is not surprised by the stages conducted. After the patient has been conditioned, it is time to start the first stage, which is to find a point to do cupping. The cup is placed just above the point on the body that has been determined, then suction is carried out so that there is a void of air in most of the glasses.

The second stage is dry cupping, where the glass is left on the body for 3-5 minutes, after which it is removed. The benefit of this stage is to move various dirty elements in important parts of the body (such as joints) to less important parts (such as the skin surface). The third stage is to cut or stab. When making the first incision, it is better for the cupper to recognize the character of the patient's skin, the state of his blood vessels, and other related conditions. The length of the incision is approximately 4mm, there are about 15 incisions in one point. The tool used as a slasher is to use a sterilized medical razor or razor. The fourth stage is to do wet cupping which is done after incision or insertion. This stage is carried out for about 3-5 minutes until thick blood is seen, after which the glass is carefully removed so that it does not flow in the patient's body. Once these steps are completed the needle or scalpel used should be discarded and not reused for another patient. In addition, the glass or cup must be cleaned with water and soap as well as with other cleaners such as saffron, ditol, or alcohol. If there is blood in the glass, it must be thoroughly cleaned with chlorine. The glass can be used for one person on the same day.

EFFECTS OF CUPPING ON CARDIOVASCULAR

WHO (World Health Organization) has encouraged the application of traditional medicine since many patients are dissatisfied with modern medicine, especially those related to chronic diseases (2). Several alternative therapies have been suggested to control and treat hypertension. Cupping has been recommended by several doctors for cardiovascular disease (3). A meta-analyses study has reported that using cupping is beneficial for controlling and lowering blood pressure. Currently, cupping has potential benefits that are widely used for the rehabilitation of stroke patients (4).

EFFECTS OF CUPPING ON REPRODUCTION

Cupping is an alternative method that involves placing a cup on the skin using heat or suction for a few minutes. This will pull the tissue under the skin and form a blood pool so that a localized healing process occurs. The placement of cupping points is adjusted to certain acupuncture points that can affect some problematic parts or internal organs. Cupping also affects parts of the body up to 4 inches into the tissue so that it has the effect of removing toxins in the body, activating the lymphatic system and blood vessels, and is the best method of deep vein massage (5).

CUPPING THERAPY FOR MENSTRUAL PAIN

Production of inflammatory mediators, such as prostaglandins, can lead to increased uterine contractions resulting in pain, especially during menstruation. Cupping plays a role in reducing inflammatory mediators formed due to cell inflammation. This substance serves to send pain signals to the brain. Through the cupping process, this substance is released so that the pain felt by the patient can be reduced. In contrast to pharmacological treatment, cupping does not cause harmful side effects (6).

EFFECTS OF CUPPING ON STROKE AND DIABETES MELLITUS PATIENTS

Cupping is very beneficial for these patients although the benefits may not be felt in the short term. To cure diabetes mellitus (DM), a healthy pancreas with intact beta cells from the islets of Langerhans for endogenous insulin production is a curative treatment but this is still out of the question (7). Until this goal is achieved, DM is better treated with injection of exogenous recombinant human insulin (for type I diabetes) or oral hypoglycaemics (for type II diabetes). As for stroke patients, permanent neuronal death occurs either due to cerebral haemorrhage or infarction (8,9). Treatment for stroke patients is directed at maintaining the normal structure and function of the remaining healthy neurons and at preventing or relieving the neurological sequelae of stroke. Combining cupping with dietary control, hypoglycaemic and costal treatment for DM is expected to be useful in preventing progression to incurable sequelae and delaying or preventing the development of serious complications (10).

CUPPING IN THE FUTURE

Today cupping is increasingly widely known by the people of Indonesia. Based on the number of cupping clinics that we can find both in big cities to villages. All data on the development of cupping show that public demand for cupping therapy as an alternative treatment in Indonesia is increasing sharply. Traditional medicine in Indonesia in general, including cupping, it is regulated in Government Regulation in Indonesia No. 103 (2014) about Traditional Health Services. For cupping, the action without injury is only in dry cupping, while wet cupping is included in the action with injuries. At the time this Ministerial Regulation comes into force, traditional healers who have provided traditional health services are in need of a traditional healer and have a Traditional Medicine Permit based on the Decree of the Minister of Health Number concerning the implementation of traditional medicine, to be recognized as traditional medicine, they must have followed the recognition of past learning at least level 5 of the Indonesian national qualification framework or passed diploma 3.

CONCLUSION

Cupping is very beneficial for these patients although the benefits may not be felt in the short term. The side effects caused by cupping are not severe, only cause discomfort due to cupped and incision on the skin. Cupping plays a role in reducing inflammatory mediators formed due to cell inflammation. This substance serves to send pain signals to the brain. Cupping can be used for diseases that are local or systemic. Cupping can be used to reduce pain such as headaches, carpal tunnel syndrome and some other local disease.

CONSENT FOR PUBLICATION

The Authors agree to publication in Journal of Society Medicine.

FUNDING

None.

COMPETING INTERESTS

None.

AUTHORS’ CONTRIBUTIONS

All authors significantly contribute to the work reported, whether in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas. Contribute to drafting, revising, or critically reviewing the article. Approved the final version to be published, agreed on the journal to be submitted, and agreed to be accountable for all aspects of the work.

ACKNOWLEDGMENTS

We would like to thank Ibnu Sina Hospital Indonesia.

REFERENCE

1. Ullah K., Younis A., Wali M. An investigation into the effect of cupping therapy as a treatment for anterior knee pain and its potential role in health promotion. Internet J Alternative Med. 2006;4:1

2. Al-Bedah A.M., Aboushanab T.S., Alqaed M.S. Classification of Cupping Therapy: a tool for modernization and standardization. J. Compl. Alternative Med. Res. 2016;1(1):1-0

3. Kim Jong-In, Lee Myeong Soo, Lee Dong-Hyo, Boddy Kate, Ernst Edzard. Cupping for treating pain: a systematic review. Evidence-based Complementary and Alternative Medicine. 2011: 1-5.

4. Mehtaa P, Dhapte V. Cupping therapy: A prudent remedy for a plethora of medical ailments. J Tradit Complement Med. 2015 Jul; 5(3): 127–134.

5. El Sayed SM, Mahmoud HS, Nabo MM. Medical and scientific bases of wet cupping therapy (al- hijamah): In light of modern medicine and propheticmedicine. Alternative and Integrative Medicine. 2013 5(2): 1-16.

6. Jadhav DK. Cupping therapy : An ancient alternative medicine. J Phys Fitness, Med Treat Sport. 2018;3(1):1–4.

7. Aboushanab TS, AlSanad S. Cupping therapy: An overview from a modern medicine perspective. JAMS J Acupunct Meridian Stud . 2018 11(3):83–7.

8. AL-Shamma YMH, Abdil Razzaq A. Al-Hijamah Cupping Therapy. Kufa Med Journal. 2009;12: 49-56.

9. Atlas SA. The renin-angiotensin aldosterone system: pathophysiological role and pharmacologic inhibition. JMCP. 2007; 13(8):S9-20.

10. Shekarforoush S, Foadoddini M. Cardiac effects of cupping: myocardial infarction, arrhythmias, heart rate and mean arterial blood pressure in the rat heart. Chin J Physiol. 2012;55: 253-258.