An Overview of Mechanisms and Clinical Applications of Wet cupping therapy (Ḥijāma-bil-Sharṭ): A Comprehensive Review

Authors

Abstract

Background: Wet cupping therapy (WCT), also known as Ḥijāma-bil-Sharṭ, is a traditional therapeutic modality widely practiced in complementary and alternative medicine. In recent years, increasing scientific interest has focused on elucidating its physiological mechanisms and evaluating its clinical efficacy across various health conditions. Objective: To provide a comprehensive review of the historical evolution, underlying mechanisms, and therapeutic applications of wet cupping therapy, integrating traditional concepts with contemporary biomedical evidence. Methods: A structured literature review was conducted using databases including PubMed, ScienceDirect, and Google Scholar. Relevant English-language publications, including original research articles, clinical trials, review papers, and classical medical texts, were identified using keywords such as “wet cupping,” “Ḥijāma-bil-Sharṭ,” and “mechanisms of action.” Studies addressing mechanisms, clinical outcomes, safety, and traditional perspectives were included, while duplicates and low-quality studies were excluded. Results: WCT appears to exert therapeutic effects through multiple mechanisms, including haemodynamic modulation, nitric oxide-mediated vasodilation, neurophysiological pain regulation via Diffuse Noxious Inhibitory Controls and Pain Gate Theory, and potential immunomodulatory and biochemical alterations. Evidence supports its effectiveness in pain management, particularly in musculoskeletal conditions such as low back pain and arthritis. Additional benefits have been reported in neurological disorders, sleep quality, cardiovascular health, and fertility, although evidence remains limited.  Conclusion: Wet cupping therapy demonstrates promising therapeutic potential as a complementary intervention. However, current evidence is limited by methodological heterogeneity and lack of standardization. Further high-quality randomized controlled trials and mechanistic studies are required to establish its efficacy, safety, and integration into evidence-based clinical practice.

Keywords: “Wet cupping”, “Ḥijāma-bil-Sharṭ”, “Cupping therapy”, and “Mechanisms of action”

Keywords:

Wet cupping, Ḥijāma-bil-Sharṭ, Cupping therapy, Mechanisms of action

DOI

https://doi.org/10.22270/jddt.v16i8.7931

Author Biographies

Sadaf Nawaz, PG Scholar, Department of Ilaj Bit Tadbīr, AKTC, AMU, Aligarh, India,

PG Scholar, Department of Ilaj Bit Tadbīr, AKTC, AMU, Aligarh, India, 

Mohd Anwar, Professor, Department of Ilaj Bit Tadbīr, AKTC, AMU, Aligarh, India,

Professor, Department of Ilaj Bit Tadbīr, AKTC, AMU, Aligarh, India, 

 

Fatima Khan , Assistant Professor, Department of Ilaj Bit Tadbīr, A&U Tibbia College, Karol Bagh, New Delhi, India.

Assistant Professor, Department of Ilaj Bit Tadbīr, A&U Tibbia College, Karol Bagh, New Delhi, India.

References

1. Khatoon H, Khatoon R, Ansari T, Abbasi H, Khan SA, Rashid M. A Comprehensive Review of Cupping Therapy, Hijama Through the Ages. VW Appl Sci. 2023;5(2):177-84.

2. Welden J. Huangdi Neijing: A Synopsis with Commentaries by Y. C. Kong (review). China Review International. 2011;18(4):510-2. https://doi.org/10.1353/cri.2011.0118

3. Lari A, Nayab M, Tausif M, Ah Lari J, Anzar Alam Scholar M, Anzar Alam M. Therapeutic potentials of hijama-bila-shart (dry cupping therapy): A review. ~ 21 ~ International Journal of Unani and Integrative Medicine. 2017;1(1):21-4. https://doi.org/10.33545/2616454X.2017.v1.i1a.6

4. Christopoulou-Aletra H, Papavramidou N. Cupping: An alternative surgical procedure used by hippocratic physicians. Vol. 14, Journal of Alternative and Complementary Medicine. 2008. p. 899-902. https://doi.org/10.1089/acm.2008.0238 PMid:18925866

5. Frcs JLT, Mibiol EA. Annals of the Royal College of Surgeons of England (1983) vol. 65 History of Medicine Bleeding and cupping Conservator of the Pathological Museum.

6. Bhikha R, Saville J. Cupping: time to re-evaluate its position. Ibn Sina Institute of Tibb. 2015; p. 1-8.

7. Jurjani I ibn H. Zakhira Khawarzam Shahi. New Delhi: Idara Kitab-us-Shifa; 2010. 650 p.

8. Baghdadi I.H. Kitabul Mukhtarat fit Tibb (Urdu translation). Vol. 1. CCRUM; 2005. 277 p.

9. Qureshi NA, Ali GI, Abushanab TS, El-Olemy AT, Alqaed MS, El-Subai IS, et al. History of cupping ( Hijama ): a narrative review of literature. J Integr Med. 2017 May;15(3):172-81. https://doi.org/10.1016/S2095-4964(17)60339-X PMid:28494847

10. Al-Bedah A, Aboushanab TS, Alqaed M, Qureshi N, Suhaibani I, Ibrahim G, et al. Classification of Cupping Therapy: A Tool for Modernization and Standardization. Journal of Complementary and Alternative Medical Research. 2016 Jan 10;1(1):1-10. https://doi.org/10.9734/JOCAMR/2016/27222

11. El Sayed SM, Abou-Taleb A, Mahmoud HS, Baghdadi H, Maria RA, Ahmed NS, et al. Percutaneous excretion of iron and ferritin (through Al-hijamah) as a novel treatment for iron overload in beta-thalassemia major, hemochromatosis and sideroblastic anemia. Med Hypotheses. 2014;83(2):238-46. https://doi.org/10.1016/j.mehy.2014.04.001 PMid:24857772

12. Rozenfeld E, Kalichman L. New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. J Bodyw Mov Ther. 2016 Jan;20(1):173-8. https://doi.org/10.1016/j.jbmt.2015.11.009 PMid:26891653

13. Tham LM, Lee HP, Lu C. Cupping: From a biomechanical perspective. J Biomech. 2006;39(12):2183-93. https://doi.org/10.1016/j.jbiomech.2005.06.027 PMid:16126216

14. Roustit M, Cracowski J-L. Assessment of endothelial and neurovascular function in human skin microcirculation. Trends Pharmacol Sci. 2013 Jul;34(7):373-84. https://doi.org/10.1016/j.tips.2013.05.007 PMid:23791036

15. Al-Bedah AMN, Elsubai IS, Qureshi NA, Aboushanab TS, Ali GIM, El-Olemy AT, et al. The medical perspective of cupping therapy: Effects and mechanisms of action. Vol. 9, Journal of Traditional and Complementary Medicine. National Taiwan University; 2019. p. 90-7. https://doi.org/10.1016/j.jtcme.2018.03.003 PMid:30963043 PMCid:PMC6435947

16. Tagil SM, Celik HT, Ciftci S, Kazanci FH, Arslan M, Erdamar N, et al. Wet-cupping removes oxidants and decreases oxidative stress. Complement Ther Med. 2014 Dec 1;22(6):1032-6. https://doi.org/10.1016/j.ctim.2014.10.008 PMid:25453524

17. Khalil A, AlQaoud K, Shaqqour H. Investigation of Selected Immunocytogenetic Effects of Wet Cupping in Healthy Men. Spatula DD - Peer Reviewed Journal on Complementary Medicine and Drug Discovery. 2013;3(2):51. https://doi.org/10.5455/spatula.20130712050838

18. Akbari A, Mohammad Ali Shariat Zadeh S, Ramezani M, Mahdi Shariat Zadeh S. Nationalpark-Forschung in Der Schweiz The Effect of Hijama (Cupping) on Oxidative Stress Indexes & various Blood Factors in Patients Suffering from Diabetes Type II. Vol. 102. 2013.

19. Faraci FM. Role of nitric oxide in regulation of basilar artery tone in vivo. American Journal of Physiology-Heart and Circulatory Physiology. 1990 Oct 1;259(4):H1216-21. https://doi.org/10.1152/ajpheart.1990.259.4.H1216 PMid:2121050

20. Ma S-X. Enhanced Nitric Oxide Concentrations and Expression of Nitric Oxide Synthase in Acupuncture Points/Meridians. The Journal of Alternative and Complementary Medicine. 2003 Apr;9(2):207-15. https://doi.org/10.1089/10755530360623329 PMid:12804074

21. Ignarro LJ, Buga GM, Wood KS, Byrns RE, Chaudhuri G. Endothelium-derived relaxing factor produced and released from artery and vein is nitric oxide. Proceedings of the National Academy of Sciences. 1987 Dec;84(24):9265-9. https://doi.org/10.1073/pnas.84.24.9265 PMid:2827174 PMCid:PMC299734

22. Schäffer MR, Tantry U, Gross SS, Wasserkrug HL, Barbul A. Nitric Oxide Regulates Wound Healing. Journal of Surgical Research. 1996 Jun;63(1):237-40. https://doi.org/10.1006/jsre.1996.0254 PMid:8661204

23. Wang X, Zhang X, Elliott J, Liao F, Tao J, Jan YK. Effect of Pressures and Durations of Cupping Therapy on Skin Blood Flow Responses. Front Bioeng Biotechnol. 2020 Dec 8;8. https://doi.org/10.3389/fbioe.2020.608509 PMid:33425873 PMCid:PMC7793847

24. Ernst M, Lee MHM. Sympathetic effects of manual and electrical acupuncture of the Tsusanli knee point: Comparison with the Hoku hand point sympathetic effects. Exp Neurol. 1986 Oct;94(1):1-10. https://doi.org/10.1016/0014-4886(86)90266-9 PMid:3758275

25. van Wijk G, Veldhuijzen DS. Perspective on Diffuse Noxious Inhibitory Controls as a Model of Endogenous Pain Modulation in Clinical Pain Syndromes. Vol. 11, Journal of Pain. 2010. p. 408-19. https://doi.org/10.1016/j.jpain.2009.10.009 PMid:20075013

26. Melzack R, Wall PD. Pain Mechanisms: A New Theory. Science (1979). 1965 Nov 19;150(3699):971-9. https://doi.org/10.1126/science.150.3699.971 PMid:5320816 PMCid:PMC10694261

27. Schouenborg J, Dickenson A. The effects of a distant noxious stimulation on A and C fibre-evoked flexion reflexes and neuronal activity in the dorsal horn of the rat. Brain Res. 1985 Feb;328(1):23-32. https://doi.org/10.1016/0006-8993(85)91318-6 PMid:3971178

28. Bernaba M, Johnson KA, Kong JT, Mackey S. Conditioned pain modulation is minimally influenced by cognitive evaluation or imagery of the conditioning stimulus. J Pain Res. 2014 Nov 26;7:689-97. https://doi.org/10.2147/JPR.S65607 PMid:25473310 PMCid:PMC4251756

29. Marquardt Hanne. Reflexotherapy of the feet. Georg Thieme Verlag KG; 2017. 224 p.

30. Lett Ann. Reflex zone therapy for health professionals. Churchill Livingstone; 2000. 299 p.

31. Shaban Tamer. Cupping therapy encyclopedia. T. Shaban; 2014. 174 p.

32. Radak Z, Ishihara K, Tekus E, Varga C, Posa A, Balogh L, et al. Exercise, oxidants, and antioxidants change the shape of the bell-shaped hormesis curve. Redox Biol. 2017 Aug;12:285-90. https://doi.org/10.1016/j.redox.2017.02.015 PMid:28285189 PMCid:PMC5345970

33. Lowe DT. Cupping therapy: An analysis of the effects of suction on skin and the possible influence on human health. Complement Ther Clin Pract. 2017 Nov;29:162-8. https://doi.org/10.1016/j.ctcp.2017.09.008 PMid:29122256

34. Ahmed SM, Madbouly NH, Maklad SS, Abu-Shady EA. Immunomodulatory effects of blood letting cupping therapy in patients with rheumatoid arthritis. Egypt J Immunol. 2005;12(2):39-51. PMID: 17977209.

35. Zhang Q, Wang X, Yan G, Lei J, Zhou Y, Wu L, et al. Anti- Versus Pro-Inflammatory Metabololipidome Upon Cupping Treatment. Cellular Physiology and Biochemistry. 2018;45(4):1377-89. https://doi.org/10.1159/000487563 PMid:29462800

36. Moayedi M, Davis KD. Theories of pain: from specificity to gate control. J Neurophysiol [Internet]. 2013;109:5-12. Available from: www.jn.org https://doi.org/10.1152/jn.00457.2012 PMid:23034364

37. Yoo SS, Tausk F. Morphology Cupping: East meets West. Vol. 43, International Journal of Dermatology. 2004. https://doi.org/10.1111/j.1365-4632.2004.02224.x PMid:15357746

38. Musial F, Michalsen A, Dobos G. Functional chronic pain syndromes and naturopathic treatments: Neurobiological foundations. Vol. 15, Forschende Komplementarmedizin. 2008. p. 97-103. https://doi.org/10.1159/000121321 PMid:18496023

39. Staud R. Peripheral pain mechanisms in chronic widespread pain. Best Pract Res Clin Rheumatol. 2011 Apr;25(2):155-64. https://doi.org/10.1016/j.berh.2010.01.010 PMid:22094192 PMCid:PMC3220877

40. Tiran D, Chummun H. The physiological basis of reflexology and its use as a potential diagnostic tool. Complement Ther Clin Pract. 2005 Feb;11(1):58-64. https://doi.org/10.1016/j.ctnm.2004.07.007 PMid:15984227

41. Wall PD. Cord Cells Responding to Touch, Damage, And Temperature Of Skin. J Neurophysiol. 1960 Mar 1;23(2):197-210. https://doi.org/10.1152/jn.1960.23.2.197 PMid:13842564

42. Melzack R, Wall PD. On the nature of cutaneous sensory mechanisms. Brain. 1962 Jun;85:331-56. doi: 10.1093/brain/85.2.331. PMID: 14472486. https://doi.org/10.1093/brain/85.2.331 PMid:14472486

43. Dey-Hazra E, Hertel B, Kirsch T, Woywodt A, Lovric S, Haller H, et al. Detection of circulating microparticles by flow cytometry: Influence of centrifugation, filtration of buffer, and freezing. Vasc Health Risk Manag. 2010;6(1):1125-33. https://doi.org/10.2147/VHRM.S13236 PMid:21191433 PMCid:PMC3004516

44. Guo J, Shi G, Guo X, Zhang L, Xu W, Wang Y, et al. Transcriptome analysis reveals that distinct metabolic pathways operate in salt-tolerant and salt-sensitive upland cotton varieties subjected to salinity stress. Plant Science. 2015 Sep;238:33-45. https://doi.org/10.1016/j.plantsci.2015.05.013 PMid:26259172

45. Diamant M, Tushuizen ME, Sturk A, Nieuwland R. Cellular microparticles: new players in the field of vascular disease? Eur J Clin Invest. 2004 Jun 16;34(6):392-401. https://doi.org/10.1111/j.1365-2362.2004.01355.x PMid:15200490

46. George FD. Microparticles in vascular diseases. Thromb Res. 2008 Jan;122:S55-9. https://doi.org/10.1016/S0049-3848(08)70020-3 PMid:18691501

47. Nurden A. Platelets, inflammation and tissue regeneration. Thromb Haemost. 2011 Dec 6;105(S 06):S13-33. https://doi.org/10.1160/THS10-11-0720 PMid:21479340

48. Kent MW, Kelher MR, West FB, C. Silliman C. The pro‐inflammatory potential of microparticles in red blood cell units. Transfusion Medicine. 2014 Jun 2;24(3):176-81. https://doi.org/10.1111/tme.12123 PMid:24786047 PMCid:PMC4451951

49. Cognasse F, Hamzeh-Cognasse H, Laradi S, Chou ML, Seghatchian J, Burnouf T, et al. The role of microparticles in inflammation and transfusion: A concise review. Vol. 53, Transfusion and Apheresis Science. Elsevier Ltd; 2015. p. 159-67. https://doi.org/10.1016/j.transci.2015.10.013 PMid:26584596

50. Farhadi K, Schwebel DC, Saeb M, Choubsaz M, Mohammadi R, Ahmadi A. The effectiveness of wet-cupping for nonspecific low back pain in Iran: A randomized controlled trial. Complement Ther Med. 2009 Jan 1;17(1):9-15. https://doi.org/10.1016/j.ctim.2008.05.003 PMid:19114223

51. Sobhy Elsaid Hussein E. Cupping Therapy (Al-Hijama): It’s Impact on Persistent Non-Specific Lower Back Pain and Client Disability [Internet]. Available from: http://www.lifesciencesite.com

52. Lee MS, Kim JI, Lee DH, Boddy K, Ernst E. Cupping for treating pain: A systematic review. Vol. 2011, Evidence-based Complementary and Alternative Medicine. 2011. https://doi.org/10.1093/ecam/nep035 PMid:19423657 PMCid:PMC3136528

53. Ersoy S, Benli AR. Continue or stop applying wet cupping therapy (al-hijamah) in migraine headache:A randomized controlled trial. Complement Ther Clin Pract. 2020 Feb 1;38. https://doi.org/10.1016/j.ctcp.2019.101065 PMid:31668556

54. Zarei M, Tabatabaee A, Javadi SA, Mohammadpour A, Akbarbidaki A. The effects of wet-cupping on intensity of headache in migraine sufferers [Internet]. Vol. 1, Jundishapur Journal of Chronic Disease Care Quarterly Journal of Ahvaz Nursing and Midwifery School. Available from: https://www.researchgate.net/publication/260790873

55. El-Shanshory M, Hablas NM, Shebl Y, Fakhreldin AR, Attia M, Almaramhy HH, et al. Al-hijamah (Wet cupping therapy of prophetic medicine) significantly and safely reduces iron overload and oxidative stress in thalassemic children: A novel pilot study. J Blood Med. 2018;9:241-51. https://doi.org/10.2147/JBM.S170523 PMid:30588142 PMCid:PMC6300367

56. Kim M, Han C. The effectiveness and safety of cupping therapy for stroke survivors: A systematic review and meta-analysis of randomized controlled trials. Journal of Korean Medicine. 2021 Dec 1;42(4):75-101. https://doi.org/10.13048/jkm.21039

57. Shao TY, Wang JX, Shou ST, Fidimanantsoa OL. Wet cupping with rehabilitation training for upper-limb poststroke spasticity: A systematic review and meta-analysis of randomized controlled trials. Heliyon. 2023 Oct 1;9(10). https://doi.org/10.1016/j.heliyon.2023.e20623 PMid:37829814 PMCid:PMC10565697

58. Nalbant G, Yuksel S, Dane S. Wet Cupping (Hijamah) Increases Sleep Quality [Internet]. 2015. Available from: https://www.researchgate.net/publication/282720087

59. Raf J, Mustafa LA, Dawood RM, Al-Sabaawy OM. Effect of Wet Cupping on Serum Lipids Profile Levels of Hyperlipidemic Patients and Correlation with some Metal Ions Vol. 23. 2012 https://doi.org/10.33899/rjs.2012.60009

60. Abduljabbar H, Gazzaz A, Mourad S, Oraif A. Hijama (wet cupping) for female infertility treatment: a pilot study. Int J Reprod Contracept Obstet Gynecol. 2016;3799-801. https://doi.org/10.18203/2320-1770.ijrcog20163842

61. Dane S, Welcome M. A case study: Effects of wet cupping therapy in a male with primary infertility. Journal of Complementary Medicine Research. 2019;10(4):155. https://doi.org/10.5455/jcmr.20190807074320

Published

2026-08-16
Statistics
Abstract Display: 62
PDF Downloads: 57
PDF Downloads: 11

How to Cite

1.
Nawaz S, Anwar M, Khan F. An Overview of Mechanisms and Clinical Applications of Wet cupping therapy (Ḥijāma-bil-Sharṭ): A Comprehensive Review. J. Drug Delivery Ther. [Internet]. 2026 Aug. 16 [cited 2026 Aug. 30];16(8):223-9. Available from: https://www.jddtonline.info/index.php/jddt/article/view/7931

Issue

Vol. 16 No. 8 (2026): Volume 16, Issue 8, August 2026

Section

Review

Copyright (c) 2026 Sadaf Nawaz, Mohd Anwar, Fatima Khan

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Authors who publish with this journal agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).

How to Cite

1.
Nawaz S, Anwar M, Khan F. An Overview of Mechanisms and Clinical Applications of Wet cupping therapy (Ḥijāma-bil-Sharṭ): A Comprehensive Review. J. Drug Delivery Ther. [Internet]. 2026 Aug. 16 [cited 2026 Aug. 30];16(8):223-9. Available from: https://www.jddtonline.info/index.php/jddt/article/view/7931
Crossref
Scopus
Google Scholar
Europe PMC