The medical perspective of cupping therapy: Effects and mechanisms of action.

Cupping Therapy (CT) is an ancient method and currently used in the treatment of a broad range of medical conditions. Nonetheless the mechanism of action of (CT) is not fully understood. This review aimed to identify possible mechanisms of action of (CT) from modern medicine perspective and offer possible explanations of its effects. English literature in PubMed, Cochrane Library and Google Scholar was searched using key words. Only 223 articles identified, 149 records screened, and 74 articles excluded for irrelevancy. Only 75 full-text articles were assessed for eligibility, included studies in this review were 64. Six theories have been suggested to explain the effects produced by cupping therapy. Pain reduction and changes in biomechanical properties of the skin could be explained by "Pain-Gate Theory", "Diffuse Noxious Inhibitory Controls" and "Reflex zone theory". Muscle relaxation, changes in local tissue structures and increase in blood circulation might be explained by "Nitric Oxide theory". Immunological effects and hormonal adjustments might be attributed to "Activation of immune system theory". Releasing of toxins and removal of wastes and heavy metals might be explained by "Blood Detoxification Theory". These theories may overlap or work interchangeably to produce various therapeutic effects in specific ailments and diseases. Apparently, no single theory exists to explain the whole effects of cupping. Further researches are needed to support or refute the aforesaid theories, and also develop innovative conceptualizations of (CT) in future.

History of cupping (Hijama): a narrative review of literature.

Cupping (Hijama in Arabic) is an ancient, holistic method for the treatment of a variety of diseases. Though the exact origin of cupping therapy is a matter of controversy, its use has been documented in early Egyptian and Chinese medical practices. Diverse human civilizations have contributed to the historical development and continuation of cupping therapy. This narrative review describes the history of cupping, historical definitions, cupping instruments and uses of cupping therapy. Electronic searches of relevant databases (PubMed, Google Scholar and OvidSP) were conducted using keywords and Boolean operators. Manual searches and references of published articles and books were also conducted. A number of articles (N = 625) were retained for extensive review, and finally 83 articles were included in this paper. The historical descriptions of cupping therapy were found in ancient human civilizations of the Eastern and Western world. There were inconsistent data concerning the origin of cupping, definitions, instruments, procedures, definite advancements and research in Hijama over centuries. Cupping therapy fell out of favor in 17th and mid-18th centuries but recovered popularity in modern medicine. Currently, cupping therapy is used for health promotion, prophylaxis and treatment of a variety of diseases around the world. Cupping therapy with a good safety profile has a checkered history and is a well-recognized traditional method for managing medical conditions. Currently, the scope of cupping therapy is expanding, and a growing body of research is providing additional evidence-based data for the further advancement of cupping therapy in the treatment of a variety of diseases.

Medical students' knowledge, attitude, and practice of complementary and alternative medicine: a pre-and post-exposure survey in Majmaah University, Saudi Arabia.

BACKGROUND: Evidently, complementary and alternative medicine (CAM) is a recognized medical practice that efficiently uses multiple treatment therapies and techniques in the prevention and management of a variety of human disorders. Many medical schools have integrated CAM curriculum in medical education system worldwide. Research in knowledge, attitude, and practice (KAP) of diverse health professionals exposed to CAM courses is important from many perspectives including improvement in KAP and teaching skills of faculty, together with capacity building and curriculum development. OBJECTIVE AND SETTING: This pre- and post-design cross-sectional study aimed to assess CAM-KAP of two intakes of medical students in Majmaah University, Saudi Arabia. METHODS: The second-year medical students of the first (year 2012-2013) and second (year 2013-2014) intake (n=26 and 39, respectively) were selected for this study. A reliable, 16-item self-administered questionnaire was distributed among all the students for answering before and after the 48-hour CAM course. The data were analyzed using appropriate statistical test of significance. RESULTS: Medical students' knowledge and attitude toward CAM significantly improved across some subitems of CAM questionnaire with a positive trend in the rest of its items including their views on CAM practices. CONCLUSION: CAM course tends to have a positive impact on KAP of medical students. The preliminary results of this study call for further research with a larger sample in academic settings across the nation.

Status of complementary and alternative medicine in the curricula of health colleges in Saudi Arabia.

OBJECTIVES: To assess the status of complementary and alternative medicine (CAM) education in health colleges in Saudi Arabia. METHODS: A cross sectional descriptive study was conducted including all medical, dentistry, pharmacy, nursing, allied medical science, and health colleges in Saudi Arabia. A semi- structured questionnaire was designed to collect information covering CAM tracks, courses and contents in the college's curricula, available postgraduates programs, continuing medical education activities, number of colleges staff members specialized or interested in CAM. RESULTS: Out of 110 health colleges in Saudi Arabia, 90 (81.1%) participated in the survey. There is no CAM specialized track or postgraduate education in any health college. Eleven (12.2%) colleges are teaching CAM courses in their curricula. Fifteen (16.7%) colleges are teaching topics related to CAM in different study subjects. Five (5.6%) colleges conducted continuing medical education (CME) activities related to CAM. Among faculty members, there are only 16 CAM specialists working in 7 colleges and 84 interested staff members, working in 20 colleges. Colleges of pharmacy are more interested in CAM education compared to other colleges with 42.9% (6/14) of them have CAM courses in their curricula, (p=0.006). Also, they have more faculty CAM specialists (p=0.026) compared to other colleges. CONCLUSION: There is a low and diverse attention given to CAM in medical education in Saudi Arabia. There is a need for a national plan to review health colleges curricula to prepare health care providers for the integration of evidenced based CAM practices.

Knowledge and attitudes of primary health care physicians towards complementary and alternative medicine in the Riyadh region, Saudi Arabia.

BACKGROUND: The aim of this study was to assess the level of knowledge, attitudes, and utilization of complementary and alternative medicine (CAM) of primary health care (PHC) physicians in Riyadh, Saudi Arabia. MATERIAL AND METHODS: A crosssectional study including all physicians working at PHC centers in the Riyadh region, Saudi Arabia, was carried out from the beginning of April 2010 to the end of June 2010. Using a self-administered questionnaire, 1,113 physicians answered questions regarding their socio-demographic data, and knowledge, attitudes and utilization of CAM. RESULTS: About 8% of the participants had attended a continuous medical education or a training activity. Most of them were unfamiliar with reflexology, energy healing, aromatherapy, ozone therapy, homeopathy, or chiropractic care (77.4, 71.3, 71.2, 67.2, 65.7, and 63.9%, respectively). On the other hand, most physicians felt that they could understand and feel comfortable about counseling patients about Ruqyah (spiritual healing), honey and bee products, dietary supplements, massage therapy, relaxation, herbal medicine, and cupping (40.3, 38.3, 34.9, 34.4, 25.8, 22.8, and 21.4%, respectively). More than half (51.7%) of the physicians used CAM for themselves or their family, but only 14.2% referred their patients to CAM practitioners. 85.1% of studied physicians agreed that physicians should have knowledge about CAM therapies commonly used in the region. 82.5% agreed that health authorities should have a role in regulating CAM, and 75.7% agreed that the physicians' knowledge about CAM practices leads to better patient outcome. CONCLUSION: There is a positive attitude regarding the concept of CAM, but there is a reluctance to refer or to initiate discussion with patients regarding CAM practices, which may be attributed to a lack of knowledge.