THE USE OF CUPPING THERAPY IN REDUCING CVD RISK FACTORS PROF. DR AB AZIZ AL-SAFI ISMAIL USM, KELANTAN, MALAYSIA (2nd International Conference on Quality Propathic Medicine, Jeddah 5-7 April 2016) 1

EVIDENCE-BASED MEDICINE

HONEY & CUPPING Narrated Ibn `Abbas: (The Prophet ﷺ) ) said, "Healing is in three things: A gulp of honey, cupping, and branding with fire (cauterizing)." But I forbid my followers to use (cauterization) branding with fire." (Sahih al-Bukhari)  

CUPPING "‏ مَا مَرَرْتُ لَيْلَةَ أُسْرِيَ بِي بِمَلإٍ مِنَ الْمَلاَئِكَةِ إِلاَّ كُلُّهُمْ يَقُولُ لِي عَلَيْكَ يَا مُحَمَّدُ بِالْحِجَامَةِ ‏" It was narrated from Ibn ‘Abbas that the Messenger of Allah (ﷺ ) said: “On the night on which I was taken on the Night Journey (Isra’), I did not pass by any group of angels but all of them said to me: ‘O Muhammad, you should use cupping.” (Sunan Ibn Majah)

CUPPING ‏ "‏ إِنْ كَانَ فِي شَىْءٍ مِمَّا تَدَاوَيْتُمْ بِهِ خَيْرٌ فَالْحِجَامَةُ ‏"‏ ‏.‏ Narrated Abu Hurairah: The Prophet (ﷺ) said: The best medical treatment you apply is cupping. (Sunan Abi Dawud, Sunan Ibn Majah)  "‏ مَنِ احْتَجَمَ لِسَبْعَ عَشْرَةَ وَتِسْعَ عَشْرَةَ وَإِحْدَى وَعِشْرِينَ كَانَ شِفَاءً مِنْ كُلِّ دَاءٍ ‏"‏ ‏ Narrated Abu Hurairah: The Prophet (ﷺ) said: If anyone has himself cupped on the 17th, 19th and 21st it will be a remedy for every disease. (Sunan Abi Dawud)

POINT OF UMMU MUGHITS Narrated `Abdullah bin Buhaina: Allah's Messenger (ﷺ) was cupped on the middle of his head at Lahl Jamal on his way to Mecca while he was in a state of Ihram. (Sahih al-Bukhari) Narrated Abu Hurairah: Abu Hind cupped the Prophet (ﷺ) in the middle of his head. The Prophet (ﷺ) said: Banu Bayadah, marry AbuHind (to your daughter), and ask him to marry (his daughter) to you. He said: The best thing by which you treat yourself is cupping. (Sunan Abi Dawud) aziz.alsafi@usm.my

POINT OF QOMAHDUWAH The Prophet ((ﷺsaid “Use cupping on the nape cavity for it is cure for seventy-two diseases” [Recorded by At-Tabarani] Abu Nu'aim, in his book Al-Tibb al-Nabawî aziz.alsafi@usm.my

BIOCHEMICAL AND HEMODYNAMIC PARAMETERS A randomized control trial was done among 47 healthy people in Iran to look for the effect of cupping on lipid concentration. Serum lipid was taken before cupping and once a week for 3 weeks. There were decrease in LDL cholesterol (p < 0.001) and in the LDL/HDL ratio (p < 0.001) was found in the treated group compared to the control (Niasari et al., 2007).

There was significant changes in A study in Pakistan among 25 healthy male subject, to compare the venous blood and the cupping blood. There was significant changes in Serum cholesterol, triglyceride, HDL, LDL Serum urea and serum creatinine Blood sugar (Bilal et al.,2011) A pilot study of cupping as adjunctive therapy in the treatment of diabetes, hypertension and osteoarthritis was done at University of Western showed that the blood glucose was significantly reduced after the cupping therapy (p<0.001) (Bhika, 2008).

USM STUDY PROBING THE WET CUPPING THERAPY ON MEASURABLE BENEFICIAL HEALTH EFFECTS OBJECTIVE To study the effect of wet cupping therapy on anthropometrics, biochemical, hemodynamic parameters and microvascular endothelial function on healthy individual

Methodology

Study place USM Kubang Kerian, Kelantan, Malaysia Study period January 2011 – February 2014

FLOW CHART

31 subjects for each group Study subject For Phase 1 Cupping group among healthy individual Control group Sample size 31 subjects for each group

Criteria For Study Subject Inclusion criteria Age 30 to 55 years old Healthy Exclusion criteria On medication Pregnant women Chronic disease History of blood disorder (eg hemophilia) On anti-coagulant medication Being treated for cancer History of allergy to latex History of stroke Patient with hepatitis and HIV

Instrumentation Basic cupping therapy equipment : Hand suction pump Plastic cups Lancet pen Antiseptic tools

The Procedure The Wet Cupping Technique (Ahmadi et al., 2008) Wet cupping was performed using transparent plastic vacuum cups. Cupping was done at five different sites Both scapula Both lumbar region Vertex

The Prophet’s 10 cupping points

STEP 1 Procedure was done using aseptic technique. Area around the cupping site was cleaned using an antiseptic preparation (NICE, 2008). aziz.alsafi@usm.my

STEP 2 The cups were placed on the respective points using a hand suction pump The local suction created allowed the skin and superficial muscle layer to be lightly drawn into the cups. The cups were left for a period of 8-10 minutes. aziz.alsafi@usm.my

STEP 3 A lancet pen was used to prick the skin at different sites around the cupped area (Abdullah, 1995) aziz.alsafi@usm.my

STEP 4 A hand suction pump is used to create vacuum underneath the cup aziz.alsafi@usm.my

STEP 5 Once the blood from that area stopped collecting, the cups were removed and the blood safely discarded. The skin area was then cleaned. (Manz, 2009 and Chirali, 1999) aziz.alsafi@usm.my

Results

Variables Cupping group Control group Age 44.97 (6.44) 43.23 (7.39) Table 1 : Socio-demographic characteristics of study subject Variables Cupping group Control group Age 44.97 (6.44) 43.23 (7.39) Gender Female Male 24 (45.2) 17 (54.8) 21 (67.7) 10 (32.3)

Comparison of Biochemical Parameters Between Cupping, Control Group and Diabetic Group

TOTAL CHOLESTEROL Changes of Total cholesterol level in diabetic group Comparison of Total cholesterol level in both groups There were significant differences of total cholesterol level between cupping, control group and diabetic groups at month 3 and month 4

HDL- CHOLESTEROL Changes of serum HDL-C level in diabetic group Comparison of HDL-C level in both groups There were significant differences of serum HDL-C level between cupping and control group at month 3 and month 4

LDL- CHOLESTEROL Changes of serum LDL-C level in diabetic group Comparison of LDL-C level in both groups There were significant differences of serum LDL-C level between cupping and control group at month 3 and month 4

TRIGLYCERIDES Comparison of Triglycerides level in both groups Changes of serum triglycerides level in diabetic group There were significant differences of triglycerides level between cupping and control group at month 4 There was no significant differences of serum triglycerides level

FASTING BLOOD SUGAR Comparison of fasting blood sugar level in both groups Changes of fasting blood sugar in diabetic group There were significant differences of fasting blood sugar level between cupping, control group and diabetic group at month 4

SERUM UREA Changes of serum urea level in diabetic group Comparison of serum urea level in both groups There were significant differences of serum urea level between cupping, control group and diabetic group at month 4

SERUM CREATININE Changes of serum creatinine level in diabetic group Comparison of serum creatinine level in both groups There were significant differences of serum creatinine level between cupping, control group and diabetic group at month 4

SERUM URIC ACID Comparison of serum uric acid level in both groups Changes of serum uric acid level in diabetic group There was no significant difference of serum uric acid level between cupping and control group There were significant differences of serum uric acid level at: Baseline – month 1 Baseline – month 3 Baseline – month 4

CUPPING THERAPY IMPROVE ENDOTHELIAL FUNCTION Antigen Von Willebrand factor (VWF) Profile plot shows estimated marginal mean of von Willebrand factor antigen for cupping and control group.

CUPPING THERAPY IMPROVE ENDOTHELIAL FUNCTION Antigen Von Willebrand factor (VWF) Profile plot shows estimated marginal mean of von Willebrand factor for diabetic group.

VON WILLEBRAND FACTOR The vWF is a high molecular weight plasma protein, produced by endothelial cells and megakaryocytes which circulates in the blood plasma and its functions is to promote adhesion of platelets to collagen in hemostatic plug formation (Verma S et al., 2003). Patients with microvascular dysfunction shows high level of vWF expression (Hallenbeck J. M et al., 1981; Dash S et al., 1995) which also indicates severe damage to the microvasculature system in astrocytic glioma patients. (Hillen et al., 2007) vWF- glycoprotein is essential for normal hemostasis that is involved in the inflammatory process, and the regulation of angiogenesis (Starke et al., 2011).

VON WILLEBRAND FACTOR The von Willebrand factor (vWF) is principally released by endothelial cells and mediates the initiation and progression of thrombus formation via platelet aggregation at a site of vascular injury. (Spiel et al., 2008). Other studies have indicated that VWF is a mediator for platelet adhesion to the vessel wall and for platelet-platelet interactions under high shear-stress conditions (Rumbaut et al.,2010) Moreover, prolonged and/or repeated exposure to cardiovascular risk factors can ultimately exhaust the protective effect of endogenous anti-inflammatory systems within endothelial cells. As a consequence, the endothelium not only becomes dysfunctional, but the endothelial cells can also lose their integrity, resulting in senescence and detached into the circulation (Woywodt  et al., 2008)

SYSTOLIC BLOOD PRESSURE Profile plot shows estimated marginal mean of SBP for cupping and control group. Profile plot shows estimated marginal mean of SBP for diabetic group There were significant reduction of SBP between cupping, control group and diabetic group at month 4

DIASTOLIC BLOOD PRESSURE Profile plot shows estimated marginal mean of DBP for cupping and control group. Profile plot shows estimated marginal mean of DBP for diabetic group There were significant reduction of DBP between cupping, control group and diabetic group at month 4

Conclusions In both normal and diabetic group, there were significant improvements of: Serum lipid profile (total cholesterol, HDL-C, LDL-C and triglycerides) Fasting blood sugar Renal functions (serum urea, creatinine, uric acid) VWF, SBP & DBP

CUPPING THERAPY PREVENTIVE CURATIVE

APPRECIATION MOSTI UNIVERSITI SAINS MALAYSIA SCHOOL OF MEDICAL SCIENCES HEADS OF DEPARTMENTS ORGANISING COMMITTEE aziz.alsafi@usm.my

COURSE & BOOK

PUBLICATIONS THE EFFECT OF WET CUPPING THERAPY (BEKAM) ON FASTING BLOOD SUGAR IN HEALTHY INDIVIDUAL : A RANDOMIZED CONTROLLED TRIAL Suhaily Mohd Hairon, Ab Aziz al-Safi Ismail, Najib Majdi Yaacob, Nik Rosmawati Nik Hussain, Rehanah Mohd Zain, Mujahid Bakar, THE EFFECT OF WET CUPPING ON SERUM LIPID PROFILE IN HEALTHY INDIVIDUAL Suhaily Mohd Hairon, Abdul Aziz al-Safi Ismail, Nik Rosmawati Nik Hussain, Mohamed Saat Ismail, Rehanah Mohd Zain, Mujahid Bakar, Najib Majdi Yaacob THE EFFECT OF WET CUPPING THERAPY (BEKAM) ON RENAL FUNCTION TEST IN HEALTHY INDIVIDUAL Suhaily Mohd Hairon, Ab Aziz al-Safi Ismail, Najib Majdi Yaacob, Nik Rosmawati Nik Hussain, Rehanah Mohd Zain, Mujahid Bakar, RANDOMIZED CONTROL TRIAL STUDY ON THE EFFECT OF WET CUPPING ON SERUM LIPID PROFILE Suhaily Mohd Hairon, Ab Aziz Al-Safi Ismail, Nik Rosmawati Nik Hussain, Najib Majdi Yaacob, Mohamed Saat Ismail, Rehanah Mohd Zain, Mujahid Bakar

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