WR800 Wellness and Rehabilitation Principles
Assignment 1: Essay Contemporary Approaches to Wellness and Rehabilitation
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Al Hijamah in Saudi Arabia
Cupping Therapy is an ancient medical treatment that relies upon creating a local suction to mobilise blood flow in order to promote healing (British Cupping Society, 2008).
Cupping Therapy, Hijamah in Arabic, is one of the oldest traditional alternative medicine (Udin, Haq & Sheikh, 2016) that has been used as a method of treatment for a variety of conditions or diseases by different cultures and societies in many parts of the world, notably in Asia and in the Middle East for over centuries (Al-Bedah et al.
, 2019). The ancient traditional Cupping Therapy has been passed on by its practitioners from generation to generation as it is believed to help cure different kinds of ilnesses. (Qureshi et al., 2017 p. 172). Determining the origin of cupping depends on the diverse geographical, cultural and religious influences from the different countries that are practicing it. However, traditional medicine such as Cupping Therapy is widely used in Saudi Arabia and other Arab and Islamic countries as it is a part of their culture and religion.
Cupping therapy has many types but dry and wet cupping are the two main types (Al-Bedah et al., 2019). Hijamah literally means sucking in Arabic language and it also refers to wet cupping in which blood is sucked out from small lacerations on the skin by negative pressure wherein the vacuum cups are on it. (Udin, Haq & Sheikh, 2016).
In this modern time, Cupping Therapy has grown and gained its popularity as far as the western countries as medical researchers and practitioners gained interest in making further studies on the mechanisms and effects of its use. This essay would further discuss the brief history, mechanisms of action, methods, indications and contraindications of Hijamah or Cupping Therapy done in Saudi Arabia
The Kingdom of Saudi Arabia is the largest country in the Middle East with a total land mass of 2.0 million square kilometers (Khaliq, 2012) and has a population of 33.70 million (World Bank Group, 2019). Saudi Arabia is the center of Islam as the two holy cities that are birthplaces of Islam are located (Devji, 2018). Unlike other wealthy countries that have high cost of healthcare services, the government of Saudi Arabia is providing full and free health care services to all of its citizens and expatriates working in the government as per the Saudi Constitution (Almalki, Fitzgerald, Clark, 2011).
According to Walston et al. (2008), the Saudi healthcare infrastructure began in the early 1950s based on a mixed private, public and other governmental sector model. The Saudi Ministry of Health provides primary, secondary an tertiary level of health care services (Almalki, Fitzgerald, Clark, 2011). They also said that the Saudi Ministry of Health focused on development of primary health care to be more accessible to all, especially to those residing in the rural areas. The health care system structure is based on a referral system whereas the primary health care facilities will be on the first line in providing health care services, both preventive and curative, and then they will refer the cases to secondary level of care which are the local hospitals and cases that require higher and advanced medical treatment will be referred to tertiary centers such as the central or specalized hospitals (Almalki, Fitzgerald, Clark, 2011).
However, eventhough healthcare services are provided free of charge, majority of Saudis still resort to their traditional alternative medicine to treat their ailments or illnesses because of its ready access unlike in the primary health care centers that has long waiting times for the health care services to be delivered (Walston, Al-Harbi, Al-Omar, 2008). Another reason why the public still favors the traditional alternative medicine is that it is a mandatory practice in their religion and that it has become their way of life (Al-Yousef, Wajid, Sales, 2018).
One of the most popular traditional alternative medicine in Saudi Arabia is the Hijamah, also know as the cupping therapy. Khalil et al. (2018, p214) stated that Cupping Therapy or Hijamah is a leading traditional practice after spiritual healings and herbal medicine in Saudi Arabia. It is also called as the prophetic medicine because according to Prophet Mohammad, Hijamah is the best of medicines and that Cupping is the most helpful procedure for human beings to cure themselves which is written in the Hadeeth (spoken words of Prophet Mohammad) (Bashir, 2019).
Hijamah or cupping therapy has been said to be used by ancient civilizations and one of the most possible area of origin of it is in Egypt, where it is the earliest origin of culture (Chen, Guo, Chen, Shang, 2016 p.2). The earliest reference recorded was in 1500 B.C. (3500 years ago) in one of the oldest medical textbook in Egypt called the Ebers Papyrus (El Sayed, Mahmoud, Nabo, 2013). According to Qureshi et.al (2017) Cupping Therapy is said to believe that the ancient Egyptians recorded the use of cupping therapy earliest than any other civilizations as it was symbolized in hieroglyphics in ancient Egyptian temples. They also said that the ancient Egyptians introduced the use of cupping therapy to the Greeks and eventually to other European countries and the Americas as well.
In ancient Greece, cupping therapy was highly advocated by many medical scholars. One of them is Hippocrates, the Father of Modern Medicine, in early 400 B.C. where he advised practitioners to use cups with a small diameter, conical shape and lightweight must be used for diseases with deep locations and that bigger cups should be used for diseases with shallow locations (Chen, Guo, Chen, Shang, 2016). Qureshi et. Al (2017) wrote that Galen, a prominent Greek physician, surgeon and philosopher in the Roman Empire also advocated the use of cupping therapy and is also a known practitioner in 200 A.D. They also included a Greek historian named Herodotus, who wrote that the Egyptian physicians used both wet and dry cupping for various diseases, including inflammatory diseases in 400 B.C.
However, another country that is in controversy of the origin of cupping therapy is China. Chen, Guo, Chen and Shang (2016) wrote that the earliest recorded reference as to the use of cupping therapy in China is in Wushier Biangfang (Formulas for Fifty-Two Diseases), an ancient book written on silk, which was written in pre-Qin Dynasty 2400 years ago. They also noted that cupping therapy was even included into the formal medical education system and became an independent medical discipline and given the equal status with acupuncture-moxibustion, massage and other traditional therapies in the Tang Dynasty. From then on, the use of cupping therapy in China has been evolving and Chinese practitioners continuously contribute in the development of cupping therapy through research through every dynasty (Qureshi, Gazzafi, Abushanab, El-Olemy, Alqaed, El-Subai, Al-Bedah, 2017)
In the middle east, the Assyrians, the first Arab population, were reported to be the first Arab practitioners of cupping therapy as early as 3500 B.C. (5500 years ago) (El Sayed, Mahmoud, Nabo, 2013). The Islamic countries especially in Saudi Arabia patronize the use of Hijamah Therapy as it is one of the Prophetic Medicine according to their religious beliefs. Qureshi et. al stated that Prophetic Medicine is a term given to the knowledge gained from the teachings, advice and sayings (hadeeths) of the Prophet Mohammad which are related to health and the treatment of diseases. They also reported that according to the prophet, healing is found in three things: the use of honey, cupping, and cautery and that cupping is believed to be an effective medical practice.
Aboushanab and AlSanad (2018 p.84) stated that a typical cupping therapy set should include six or more different sized cups and a method of suction. The types of cups used in cupping therapy are plastic, glass, rubber, bamboo, ceramic, metal and silicone cupping sets in variable sizes ranging from 25-75mm in diameter (Mehta, Dhapte, 2015). The type of cups used varies in the location or part where it will be applied on. There are also cupping therapy sets that are related to the method of suction such as the manual, automatic and self-suction cupping sets (Aboushanab, AlSanad, 2018). Another instrument used in performing the wet cupping therapy is a Surgical Scalpel blade No. 15 to 21, or a puncturing needle, auto-lancing device or a plum blossom needle (Al-Bedah et. al, 2019) used to make superficial incision or scarification also known as Shartat Mihjam in Arabic. It is also important to use an approved skin disinfectant to sterilize the skin before and after performing the cupping therapy. In addition, adhesive strips are also applied on the scarified area to prevent contamination and infection that should be left for atleast 48 hours. Honey are also applied on the opening of the cups to fix the position of the cup and to enhance the rate of healing of the skin scarifications (Mehta & Dhapte, 2015).
Al-Bedah et. al (2016) reported that there are six main categories in classification of cupping: the technical types (dry, flash, wet and massage), the power of suction (light, medium, strong and pulsatile), the method of suction (fire, manual vacuum and electrical vacuum), the materials inside the cups (herbal, water, laser, Moxa, needle, electrical stimulation, and magnetic), the area to be treated (pedi, abdominal, facial, female and male) and last is the other types (sports, cosmetics and aquatic). But the two most common types of cupping is the dry and the wet cupping (traditional wet cupping and the Hijamah) (Al-Yousef, Wajid & Sales, 2018).
The focus of this essay is on wet cupping. However, since dry cupping is also a part of one of the two methods of wet cupping therapy, the writer will just briefly discuss the difference between the dry cupping and the wet cupping.
According to Mehta and Dhapte (2015), the most commonly used method in the traditional Chinese medicine is the dry cupping and the suction is generated by the use of flame. Dry cupping is the application of negative pressure on the skin by use of the suction inside the cup thereby pulling the skin into the cup without any scarifications (Al-Bedah et. al, 2019). Meanwhile, wet cupping therapy of Prophetic Medicine or Hijamah is by far the most common practice used in Saudi Arabia and other Islamic countries because of it religious influence (Khalil, Al-Eidi, Al-Qaed, & AlSanad, 2018). The difference of wet cupping from dry cupping is that there are skin lacerations or scarifications.
There are two techniques of wet cupping, the Puncture-Cupping (PC) technique or also known as the Scarification-Suction (double S) technique and the Cupping-Puncturing-Cupping (CPC) technique or also known as the Suction-Scarification-Suction (triple S) technique (Mehta & Dhapte, 2015). These two techniques are currently used in training schools in Saudi Arabia but apparently, the CPC or the triple S technique is the one the most commonly used by the traditional practitioners because it is the technique used by Prophet Mohammad (Al-Eidi, Mohamed, Abutalib, AlBedah, Khalil, 2019). The PC technique is also called the Asian wet cupping however on the other hand, the CPC technique is the traditional Hijamah.
El Sayed, Mahmoud & Nabo, (2013) reported that there are six steps of Hijamah, and they are: skin demarcation, sterilization, suction, scarification, suction and sterilization. The first step of the Arabic methodology of Hijamah is the skin demarcation. It is where the practitioner marks the skin where the cups are going to placed. The placement of the cups significantly varies from the kind of illness or disease the patient needs healing (Hasan, 2018). The next step is sterilization of the skin where the cups will be placed using a skin antiseptic disinfectant. It is followed by the cupping proper or the C in CPC. It is wherein the cups are applied for suctioning for about 3-5 minutes (Al-Bedah et. al, 2019) and then the cups are removed for Puncturing (P) or the scarification. In Hijamah, scarifications are multiple, longitudinal approximately 1-2 mm in long, parallel rows and equally distributed (El-Shansory et. al, 2019). Reattaching the cups again is next and will again be left for 5 minutes. And lastly, cleaning and disinfecting the cupping points and an adhesive dressing will be applied.
The same steps are applied in the PC method it is just that the initial cupping done before the scarification is not omitted. And that in Asian wet cupping, auto-lancet needles are used for scarifications and it is more like punctures than lacerations in the traditional Hijamah.