Al-hijamah and oral honey for treating thalassemia, conditions of iron overload, and hyperferremia: toward improving the therapeutic outcomes

Abstract

Iron overload causes iron deposition and accumulation in the liver, heart, skin, and other tissues resulting in serious tissue damages. Significant blood clearance from iron and ferritin using wet cupping therapy (WCT) has been reported. WCT is an excretory form of treatment that needs more research efforts. WCT is an available, safe, simple, economic, and time-saving outpatient modality of treatment that has no serious side effects. There are no serious limitations or precautions to discontinue WCT. Interestingly, WCT has solid scientific and medical bases (Taibah mechanism) that explain its effectiveness in treating many disease conditions differing in etiology and pathogenesis. WCT utilizes an excretory physiological principle (pressure-dependent excretion) that resembles excretion through renal glomerular filtration and abscess evacuation. WCT exhibits a percutaneous excretory function that clears blood (through fenestrated skin capillaries) and interstitial fluids from pathological substances without adding a metabolic or detoxification burden on the liver and the kidneys. Interestingly, WCT was reported to decrease serum ferritin (circulating iron stores) significantly by about 22.25% in healthy subjects (in one session) and to decrease serum iron significantly to the level of causing iron deficiency (in multiple sessions). WCT was reported to clear blood significantly of triglycerides, low-density lipoprotein (LDL) cholesterol, total cholesterol, uric acid, inflammatory mediators, and immunoglobulin antibodies (rheumatoid factor). Moreover, WCT was reported to enhance the natural immunity, potentiate pharmacological treatments, and to treat many different disease conditions. There are two distinct methods of WCT: traditional WCT and Al-hijamah (WCT of prophetic medicine). Both start and end with skin sterilization. In traditional WCT, there are two steps, skin scarification followed by suction using plastic cups (double S technique); Al-hijamah is a three-step procedure that includes skin suction using cups, scarification (shartat mihjam in Arabic), and second skin suction (triple S technique). Al-hijamah is a more comprehensive technique and does better than traditional WCT, as Al-hijamah includes two pressure-dependent filtration steps versus one step in traditional WCT. Whenever blood plasma is to be cleared of an excess pathological substance, Al-hijamah is indicated. We will discuss here some reported hematological and therapeutic benefits of Al-hijamah, its medical bases, methodologies, precautions, side effects, contraindications, quantitative evaluation, malpractice, combination with oral honey treatment, and to what extent it may be helpful when treating thalassemia and other conditions of iron overload and hyperferremia.

Keywords: Al-hijamah; cupping therapy; iron chelation therapy; oral honey; phlebotomy; prophetic medicine.

Figure 1

Skin histology is ideal for practicing wet cupping therapy. Notes: (A) Epidermis is avascular, while dermis contains subepidermal fenestrated capillary networks suitable for pressure-dependent and size-dependent capillary filtration. Papillary loops are projecting into the epidermis. Subpapillary plexus of capillaries is present in the upper dermis just beneath the epidermis. The larger cutaneous capillary plexus is present at the junction of the dermis and hypodermis. (B) Pores of fenestrated capillaries can filter small molecules, but cannot filter blood cells. Data from Saladin, Bouwstra et al, and Young and Heath.

Figure 2

First step of Al-hijamah (first suction step). Notes: (A) Cups are put mainly at the interscapular regions and upper aspect of the back of trunk (Kahel region over seventh cervical vertebra). (B) Skin upliftings are created and become prominent after removal of cups. (C) Hair follicles become more prominent within the skin upliftings.

Figure 3

Second step of Al-hijamah (skin scarification, shartat mihjam in Arabic). Notes: (A) Skin scarifications should be confined to skin upliftings, superficial (0.1–0.2 mm in depth), short (1–2 mm in length), multiple, and evenly distributed. (B) Cups should be applied immediately after scarifying skin upliftings. (C) Salah’s technique for safe practice of Al-hijamah at special anatomical sites: a simple technique aiming at avoiding possible injury of the underlying anatomical structures (eg, nerves or blood vessels during skin scarification step during Al-hijamah). A fold of the skin uplifting is pinched out between the thumb and index fingers of the left hand to make sure that it is away from the underlying anatomical structures, while the right hand makes superficial scarifications in the pinched out skin fold. Another skin fold is then taken, and so on until finishing the skin uplifting properly.

Figure 4

Third step of Al-hijamah (second suction step). Notes: (A) Clearance of blood during Al-hijamah. External pressure applied through sucking cups helps filtration of small molecules through fenestrated skin capillaries. Small molecules in iron overload include iron, ferritin, liberated hemoglobin, and debris of hemolyzed or fragmented blood cells. (B) Collected coagulated bloody fluids excreted through Al-hijamah. (C) Filtered fluids (plasma-like) coming out through shartat mihjam with repeated skin suctions. Abbreviation: RBC, red blood cell.