TThe Science Behind Hijama Cupping Therapy Explained.
Welcome to the realm of holistic healing! In this article, we delve into the science behind Hijama Cupping Therapy, shedding light on its mechanisms of action and scientific evidence supporting its efficacy. As advocates for natural and effective wellness solutions, Unilog Care Devices LLP proudly promotes and provides top-quality cupping therapy products to enhance your holistic health journey.

Section 1: Understanding Hijama Cupping Therapy
Hijama, an ancient practice with roots in traditional medicine, involves creating suction on the skin to stimulate blood flow and promote healing. At Unilog Care Devices, we recognize the rich history and therapeutic potential of cupping therapy, offering a range of meticulously designed cupping products to support practitioners and enthusiasts alike. or manual suction. Then the cup is applied to the skin and left for a period of three to 5 min. The second step is about scarification or puncturing. Superficial incisions are made on the skin using Surgical Scalpel Blade No. 15 to 21, or puncturing with a needle, autolancing device or a plum-blossom needle.15 The third step is about suction and bloodletting. The cup is placed back on the skin using the similar procedure described above for three to 5 min. The fourth step includes the removal of the cup, followed by the fifth step which includes dressing the area after cleaning and disinfecting with FDA approved skin disinfectant. Furthermore, suitable sizes of adhesive strips are then applied to the scarified area, which remain there for 48 h.16 It is wise to know that the suction and scarification are the two main techniques of wet cupping therapy. Each technique of cupping might be responsible for certain changes at the level of body cells, tissues or organs. Specific interventions could enhance or suppress body hormones, or it might stimulate or modulate immunity, or it may get rid of harmful substances from the body, and eventually it might ease the pain.

Section 2: Mechanisms of Action

Scientifically, cupping therapy triggers a cascade of physiological responses that contribute to its healing effects. By promoting blood circulation, reducing inflammation, and releasing muscle tension, cupping therapy serves as a versatile modality for addressing various health concerns. Unilog Care Devices ensures practitioners access premium cupping cups designed to optimize these mechanisms for superior therapeutic outcomes. three main possible hypotheses and theories might explain mechanisms of pain reduction. These include “Pain-Gate Theory” (PGT), “Diffuse Noxious Inhibitory Controls (DNICs)”and “Reflex Zone Theory” (RZT).

Pain Gate theory (PGT) to prove cupping therapy as to relieve pain
This theory comprehensively explains how the pain is transmitted from the point of its inception to the brain, and how it is processed in the brain which sends back the efferent, protective signal to the stimulated or injured area. It is reported that local damage of the skin and capillary vessels acts as a nociceptive stimulus.21 This is explanation based on a neuronal hypothesis whereby cupping influences chronic pain by altering the signal processing at the level of the nociceptors both of the spinal cord and brain.61 In support of this clinical effect of cupping, a systematic review of randomized controlled trials (RCTs) reported that cupping could be a promising therapy for pain treatment.62 The “Pain Gate Theory” is one of the most influential theories of pain reduction.63 Melzack and Wall (1965)proposed that both thin and large (touch, pressure, vibration) nerve fibers carry the pain signal from the site of injury to two destinations in the dorsal horn of the spinal cord however, transmission cells carry the pain signal to the brain while the inhibitory interneurons impede transmission cell activity. The activity in both thin and large diameter fibers excites transmission cells. Thin fiber activity impedes the inhibitory cells (tending to allow the transmission cell) and large diameter fiber activity excites the inhibitory cells (tending to inhibit transmission cell activity). So, the more large fiber (touch, pressure, vibration) activity, the less pain is felt.64 It is expected that the activation of nociceptors by cupping and other reflex therapies can stimulate “A” and “C” fibers with involvement of the spino-thalamo-cortical pain pathway. It is noted that the peripheral nociceptor is sensitized by metabolic factors like lactate, adenosine triphosphate, and cytokines.65 When a stimulus is applied to the skin, it produces an increase in the number of active receptor-fiber units as information about the stimulus is transmitted to the brain. Since many larger fibers are inactive in the absence of stimulus change, stimulation tends to produce a disproportionate relative increase in large fiber over small fiber activity. Thus, if a gentle pressure stimulus is applied suddenly to the skin, the afferent volley contains large-fiber impulses which not only fire the “T” cells but also partially close the presynaptic gate. And if the stimulus intensity is increased, more receptor-fiber units are recruited and the firing frequency of active units is increased.66,67 The resultant positive and negative effects of the large fiber and small-fiber inputs tend to counteract each other, and therefore the output of the “T” cells rises slowly. If stimulation is prolonged, the large fibers begin to adapt, producing a relative increase in small-fiber activity. As a result, the gate is opened further, and the output of the “T” cells rises more steeply. If the large-fiber steady background activity is artificially raised at this time by vibration or scratching (a maneuver that overcomes the tendency of the large fibers to adapt), the output of the cells decreases.68 Cupping therapy may alleviate pain by means of antinociceptive effects and by counter irritation. However, at present, it is unclear to what extent cupping induces such mechanisms.69 But it is believed that cupping stimulate pain receptors which lead to increase the frequency of impulses, therefore ultimately leading to closure of the pain gates and hence pain reduction. So, validation of such theory by a scientific clinical studies is highly needed.

Diffuse Noxious Inhibitory Controls (DNICs) Theory
Another theory related to pain reduction as a mechanism of action of cupping therapy is Diffuse Noxious Inhibitory Controls. DNIC signifies inhibition of activity in convergent or wide dynamic range-type nociceptive spinal neurons triggered by a second, spatially remote, noxious stimulus. This phenomenon is thought to underlie the principle of counter-irritation to reduce pain. Herein “one pain masks another”, or pain inhibits pain. This paininhibitory system can be easily triggered in an experimental setting.70 Notably the term conditioned pain modulation (CPM) replaced the “noxious inhibitory controls” or 'DNIC-like' effects. However, experts recommended using ‘diffuse noxious inhibitory controls’ to describe the lower brainstem-mediated inhibitory mechanism directly observed in animal studies, and ‘CPM’ to portray the human behavioral correlate. Most of the work concerning this theory was done on the idiopathic pain syndromes such as irritable bowel syndrome, temporomandibular disorders, fibromyalgia, and tension type headache, which have shown good response to cupping therapy.71 Local damage of the skin and capillary vessels induced by cupping may cause a nociceptive stimulus that activates DNICs.66 This mechanism requires a strong conditioning stimulus for pain attenuation, which may be at least partly dependent on a distraction effect,72 and may possibly act by triggering a DNIC60 or by removing oxidants and decreasing oxidative stress.7 Cupping therapy may produce an analgesic effect via nerves that are sensitive to mechanical stimulation. This mechanism is similar to acupuncture in that it activates Av and C nerve fibers which are linked to the DNICs system, a pain modulation pathway which has been described as ‘pain inhibits pain’ phenomenon

Reflex Zone Theory
Cupping therapy of defined zones or areas of the shoulder triangle segmentally related to the median nerve to treat carpal tunnel syndrome has been practiced in European folk medicine and is supported by various studies.49 Only a suction stimulation is done on the disturbed point and thereafter the red blood cells from the vascular system are brought out to the surrounding tissue areas without injuring capillary vessels. This is known as dry diapedesis. These extravasations are digested or removed by the connective tissue. This happens when the disturbed area is better supplied with blood causing an activation of biological processes on the treated area, i.e., disturbed reflex zone.18 In conventional medicine, external manifestations of an internal disease process can often be detected at a site distal to the affected organ. It is suggested that the principle of a link between one part of the body and another can be understood in terms of interactions of nerve, muscle and chemical pathways.74 RZT depends on the premise that signs and symptoms of illness related to one dermatome may be reflected in changes in neighboring dermatomes.75 The reflex signs of disease can be recognized in the skin, which becomes pale, cold and clammy due to vasoconstriction and flushing due to vasodilatation. The subcutaneous tissue becomes shiny, edematous and dense. The muscles become less contractile. The joints show degenerative changes appearing in ligaments, capsule and cartilage, and reduction of synovial fluid leading to painful and restricted movement. The functioning of organs becomes impaired as a result of reduced circulating blood and tissue fluids. Such changes in the color and texture of the skin or sweating are present from the earliest stages of disease.56 Sato and associates (1997) described the response of visceral organs to somatic stimulation and showed robust evidence that the stimulation of somatic structures including the skin and peripheral joints can have substantial effects on cardiovascular, bladder, and gastrointestinal function in experimental animals. These reflexes are more complex and can be excitatory and inhibitory of visceral function acting through spinal pathways and supraspinal and cortical centers.76 In cupping therapy, when the diseased organ sends a signal to the skin through the autonomic nerves, the skin responds by becoming tender and painful with swelling. Skin receptors are activated when cups are applied to the skin. The entire process will result in the increment of the blood circulation and blood supply to the skin and the internal organs through the neural connections.77 It worth mentioning that, further clarification of the mechanisms of action of reflex therapies will support their clinical evidence and add to our understanding of the neurobiology of complementary medicine including cupping therapy as a model.

Release of Nitric Oxide Theory
Nitric Oxide (NO) is a signaling gas molecule that mediates vasodilatation and regulates blood flow and volume.78 NO regulates blood pressure, contributes to the immune responses, controls neurotransmission and participates in cell differentiation and in many more physiological functions.79 Cupping therapy could cause release of NO from endothelial cells and, hence, induce certain beneficial biological changes. This mechanism is explained by “Release of Nitric Oxide and increased blood circulation theory”. An experimental trial reported increased expression of NO synthase (s), enzymes producing NO from L-arginine was higher around skin acupuncture points of rats.80 Notably, the active substance Endothelium-Derived Relaxing Factor (EDRF) recovered from perfusates during application of the stimulus has been identified pharmacologically and chemically as NO. EDRF is an unstable humoral substance released from artery and vein that mediates the action of endothelium-dependent vasodilators. Furthermore the actions of NO on vascular smooth muscle closely resemble those of EDRF.81 Studies suggested that nitric synthesis is critical to wound collagen accumulation and acquisition of mechanical strength.82 Cupping dilates topical capillaries and increases dermal blood flow, which has been proved by numerous studies.83,84 Blood vessels in the treated areas by cupping are dilated by release of vasodilators such as adenosine, noradrenaline, and histamine, which lead to increased blood circulation.85 Tagil et al. (2014) found higher activity of myeloperoxidase, lower activity of superoxide dismutase, higher levels of malondialdehyde and nitric oxide in cupping blood compared to the venous blood.7 It seems that nitric oxide derived from endothelial cells due to cupping therapy causes vasodilatation, a decrease in vascular resistance, lower blood pressure, inhibition of platelet aggregation and adhesion, inhibition of leukocyte adhesion and migration, and reduction of smooth muscle proliferation, and all these effects prevent development of atherosclerosis.

Activation of Immune System Theory
From the perspective of body immunity and defense, practitioners begin to understand the action of cupping therapy through regulating immunoglobulins and hemoglobin,86 and its various immunological effects. Cupping decreases serum IgE and IL-2 levels and increases serum C3 levels which are found to be abnormal in the immune system.87 Cupping is likely to affect the immune system via three pathways. First, cupping irritates the immune system by making an artificial local inflammation. Second, cupping activates the complementary system. Third, cupping increases the level of immune products such as interferon and tumor necrotizing factor. Cupping effect on the thymus increases the flow of lymph in the lymphatic system.16 Overall, activation of immune system by cupping might explain its various effects including therapeutic outcomes in patients with autoimmune diseases. This theory explains the effect of cupping for strengthening immunity which has been the subject of recent research around the world. For instance, Khalil and colleagues (2013) claimed that cupping seems to play a role in the activation of complement system as well as modulation of cellular part of immune system and it may have a protective role by increasing immunity, and thereby, protect the body from diseases.34 A clinical study by XIAO Wei et al. (2010) concluded that cupping significantly improves immunologic functions in patients with chronic obstructive pulmonary disease during stable stage.88 Sahbaa et al. (2005) claimed that cupping therapy significantly reduces the laboratory markers of rheumatoid arthritis activity and modulates the immune cellular conditions particularly of innate immune response Natural killer cells and adaptive cellular immune response the Soluble Interleukin 2 Receptor SIL-2R.89 Mohammad Reza et al. (2012) evaluated Interferon Gamma (IFNg) and Interleukin 4 (IL-4) concentrations in supernatant of vein and cupping blood cultures with or without the presence of phytohemagglutinin (PHA) mitogen. The results showed IFN-g and IL-4 concentrations in cupping blood samples were higher compared to venous blood samples without presentation of any mitogen. He concluded that the high level of lymphocytes in cupping blood samples plays an important role in discharge of IFN-g and IL-4. Furthermore, in the presence of PHA mitogen the levels of IFN-g and IL-4 in cupping blood samples were equally low as in venous blood samples. The study claimed that lymphocytes in cupping blood samples may not have their natural function, so they cannot properly respond to stimulation of mitogen. Moreover, two weeks after cupping the researcher did not see any difference in IFN-g and IL-4 concentrations in venous blood. It seems that the reduplication of cupping immune response will be affected and IFN-g and IL-4 concentrations will increase.90 A study by Ye LH, (1998) revealed that cupping produces a bidirectional effects on human immunoglobulins, corrects the irregular immunoglobulin level, yields insignificant effect on normal immunoglobulin, and the regulation result is related to the original function state.91 Zhang et al. (2001) reported that cupping can upregulate the oxyhemoglobin and deoxyhemoglobin. As the carrier of hemoglobin, the red blood cell is an important defensive system, working to recognize antigens, and eliminate immune complex, tumor cells, and effector cells, as well as bind germs and viruses, and regulate immune function.92 Moreover, Zhong, et al. (1999) discovered the absolute value of C3b receptor rosette and immune complex of red blood cell significantly increased after moving cupping, which indicated that moving cupping can improve the immune function of red blood cell.93 Chen and Li (2004) claimed that cupping suggillation is the manifestation of auto-hemolysis, which can produce histamine-like substances, and consequently strengthen the activity of tissues and organs as well as the immunity.94 The recent study by Yang Guo et al. (2017) proposed that the microenvironment is changed when stimulating the surface of the skin, and physical signals transform into biological signals, which also interact with each other in the body. These signaling cascades activate the neuroendocrine-immune system, which produces the therapeutic effect.95 More immunological studies are needed to measure and validate the early assumption.

Blood detoxification Theory
This theory addresses the removal of toxic substances from the affected area where the cups are applied. According to the blood detoxification theory, there is a decrease in the level of uric acid, HDL, LDL and the molecular structure and function of hemoglobin (Hb) and other hematological adjustments. This theory explains how the body is relieved of toxins and harmful materials through the underlying mechanism of cupping therapy. From the view of physics, for clearing the toxins, the negative pressure suction produced by cupping benefits the extraction of the toxins generated by the purulent fluid, exudation, and germs, as well as the histolytic enzyme. Cupping also promotes the growth of granulation and the recovery of wounds.34 Several studies reported significant differences in many of the biochemical, hematological and immunological parameters between the venous blood and the cupping blood.96 In cupping, the flow of blood tends to breakup obstructions and creates an avenue for toxins to be drawn out of the body. Several cups may be placed on a patient's body at the same time.97 Cupping may play a role in excretion of old red blood cells.98 The levels of uric acid, urea, triglycerides and cholesterol were significantly high in the wet cupping blood.99 In cases of acute gouty arthritis, cupping on the affected area is reported to stop pain, dissolves the toxic damp and removes blood stasis and promote the blood circulation.100 Daniali et al. (2008) reported that the concentrations of uric acid, HDL, LDL, serum glutamic oxaloacetic transaminase and iron were high in the wet cupping blood. Furthermore, the levels of red blood cells, hemoglobin, hematocrit, viscosity, mean corpuscular hemoglobin in the wet cupping blood were significantly higher compared to venous blood.58 Moreover, cupping can affect molecular structure and function of human hemoglobin and reduces the side effects of diabetes on Hb molecule.101 A study by Mahdavi et al. (2012) revealed highly significant increase in serum uric acid level as compared to venous blood sample.90 The increase of blood flow may promote the release of toxins and wastes, improves the local nutrition state, and finally boosts the metabolism and supporting the healthy aspect and eliminating the pathogenic factors.34 According to SumeyyeGok et al. (2016) removing heavy metals such as aluminum, mercury, silver and lead which were significantly higher in cupping blood compared to venous blood of the same patients would support the detoxification mechanisms of action59 and therefor, cupping may treat diseases associated with heavy metal deposition in different parts of the body.

Section 3: Scientific Evidence
Numerous studies support the effectiveness of cupping therapy for conditions such as pain management, musculoskeletal issues, and even skin disorders. As promoters of evidence-based wellness, Unilog Care Devices LLP stands firm in its commitment to providing cupping therapy products rooted in scientific validation. Explore our range to integrate proven therapeutic techniques into your practice.