Hijama’ as a treatment- is there any scientific basis?

‘Hijama’ as a treatment- is there any scientific basis?

What is Hijama? It is an ancient form of cupping treatment where blood is let out of the body. The blood that is let out is thought to be impure and full of “toxins”. Practitioners of Hijama claim that it is effective in curing a wide range of illnesses from low back pain to cough, and even helps in the treatment of cancer. There is another form of cupping called dry cupping in which blood is not let out. This is also claimed to be effective in a wide range of diseases.

The concept of “toxins” that can be eliminated from the body by treatment is an old one. Physicians, through the ages, had this concept. So did the general public.

Just 200 years ago, allopathic doctors in Europe went around with basins and knives. For almost all diseases, they would make a wound with their knives, cut open a vein, and let their patients bleed into the basin. They called this procedure bloodletting.

The justification was that diseases were caused by toxins in blood. Once bad blood was removed, the toxins went too, and so did the disease. The patient’s blood had been purified.

One cannot blame these practitioners. There were very few diseases which they could really cure. They had few drugs. Surgeries, except emergency amputations, could not be done safely. Bloodletting was all they knew and so they did this to all their patients.

Many of their patients died. A few died from the disease. Many others died from the treatment. One of the most famous victims of bloodletting was the first American president, George Washington. Washington was a big, strong man who had survived two great wars. He developed a fever and sore throat and called in the most famous doctors of the time to treat him. The doctors drained his blood four times in twenty-four hours. By the end of the fourth bloodletting Washington was dead.

Those days are long gone. Now there are no more allopathic practitioners. Today we have Modern Medicine. Modern Medicine integrates human biology, chemistry and technology to diagnose and treat diseases. It is a science, and hence keeps updating its knowledge. There are no holy books in Modern Medicine, no Bible. Not even a father.

Hippocrates is often called the ‘father of Modern Medicine’. He taught that all diseases were caused by disorders of the ‘humors’- blood, phlegm, black bile, yellow bile and so on. We are not taught this today. We know now that this is all nonsense. Modern doctors have today disowned their own ‘father’.

Modern medical science is thus a bastard- but a very smart bastard indeed. Like other smart bastards, if it is to have legitimacy in society, its practitioners must be ethical, and their conduct immaculate.

There are other legitimized systems of medicine in India, like Ayurveda, which require a proper degree and registration to practice. The scientific bases of these alternative systems are not as rigorous as in Modern Medicine. But they are all perfectly legitimate, as the practitioners are registered, and patients are free to choose their preferred system.

That is another story. Let us come back to our topic.

How is Hijama performed? It involves attaching a cup to the body with a vacuum seal. The mouth of a cup is placed on the skin at the chosen site. A tight seal is then created. Traditionally a vacuum was created with the use of fire. Modern practitioners use mechanical devices. The cup is removed after a while and several small wounds are made in the skin. The cup is then reapplied until the blood flow stops. The vacuum produces a suction effect which increases the blood flow. The blood which is let out is considered to be bad, full of toxins. In dry cupping, wounds are not made. The suction effect at specific points are thought to be sufficient to cure illnesses.

We know now that there is no bad blood or good blood. Toxins in the body are purified or cleared by the liver, lungs and kidneys. There is only blood, which may be oxygenated or de-oxygenated. De-oxygenated blood goes through the right heart to the lungs, where it fills up with oxygen, and from there to the left heart. The left heart pumps this oxygenated blood to all other parts of the body, where it supplies oxygen. All blood is good and an essential part of our body. You can say that blood is bad only so much as you can say that your brain is bad, or your bones are bad.

When a wound is made on a living body blood will pour out. This is neither bad blood nor filled with toxins. From superficial wounds, like those made in “Hijama’ therapy, what comes out is mainly capillary blood which is a mixture of oxygenated and deoxygenated blood.

The bottom line is that ‘de-toxification’ cannot be done with bleeding, as done by these practitioners today, or earlier by medieval allopathic practitioners.

There is no scientifically acceptable evidence that Hijama is effective in curing disease. There are a few studies, mostly from China, which show that dry cupping may be effective for chronic pain. These studies must be viewed with suspicion as Chinese studies are often favorable to all kinds of pseudoscience. Many studies from China, for example, show excellent results for acupuncture. Similar studies conducted elsewhere have not been able to reproduce these results. Well conducted studies about Hijama involving large numbers of people conducted over many years in multiple centers are lacking. Such studies are unlikely to be done as mainstream medicine has little interest in this ancient pseudoscience.

Michael Phelps is a walking advertisement for cupping therapy. He claims that dry cupping has helped him do well in his sporting career. We must understand that sportsmen are not the best persons to comment on scientific matters. In fact many great sportsmen are notoriously superstitious. The great Sachin Tendulkar would not allow any of his team mates to move from their chairs when his team was doing well because he thought that if they changed position the team would lose. Would we consider this to be evidence that such a belief was right?

It is also argued that there are “some studies” which show that serum ferritin is an inflammatory marker, and that letting out blood can physiologically alter clotting mechanism in such a way that strokes and heart attacks are prevented. Can it be true? Anything can be true. But the evidence here is not compelling. If this is indeed true surely the best thing would be to become a voluntary blood donor.

We often unconsciously tend to find support for our deeply held beliefs. Let us say that we believe in something, Hijaama for example. We search the internet and find an enormous volume of evidence for and against Hijaama. We now pick out those studies which support our belief, thus confirming what we always knew was true. In scientific terms this mistake is described as a “confirmation bias”.

But this is NOT how science is done. Over the course of many years, evidence must mount to such an extent that a substantial number of well informed scientific experts agree that it is reasonable to try this particular treatment in that specific disease. The treatment must be delivered safely by a qualified practitioner. Has this happened with “cupping therapy?”. The answer is no.

Can we prove that it has no benefit at all? No, we can’t. This kind of a negative statement, as a rule, cannot be proven. For example, can we prove that drinking a glass of water with a bit of garam masaala early in the morning has no beneficial effect at all? It simply cannot be done. If we do very large scale studies involving thousands of people, we may be able to say that there is not enough evidence for any gross benefit. That is all.

Does religion come into it? Or other beliefs? One cannot see how it does. Ayurveda, for example, developed over the centuries with a lot of Hindu influences. Sanskrit slokas are recited, sometimes even during treatment. Does this mean that criticizing a specific Ayurvedic therapy disgraces Hinduism? It is a preposterous idea. One can argue against evidence for the benefits of a particular treatment in Modern Medicine, say robotic surgery. Will this be ‘anti-science’? This is not an understandable stance.

Why should we think about unscientific medicine at all? Can’t we just ignore it? Certain therapies with minimal scientific benefit like massage and aroma therapy are practiced as ‘feel-good’ therapies. The potential for harm here is low. But if it prevents or delays timely and proper treatment, then they can be harmful.

Can Hijama do harm? Certainly. For one, loss of blood in wet cupping may be severe, particularly in people with bleeding disorders. Secondly, if instruments used for the procedure are not properly sterilized, as is done in a medical setting, infections like Hepatitis B or HIV may occur. If one is careful, harm may not occur, but it can. We do need legitimacy here

Do the benefits outweigh the risks? This is the crucial question. The answer is that if you really want to let out some blood, please donate it to a blood bank. You may be doing some good in that case- needy patients will benefit.