The Benefits of Removing Dirty Blood with Traditional Cupping Treatment

In daily life, Muslims are ordered to behave by the teachings in the Al-Quran and the sunnah of the Prophet Muhammad, including regarding health. In the world of health, it is known that alternative medicine in the style of Rasulullah SAW is known as At-Thibb Al-Nabawi; one example is cupping therapy. The purpose of preparing this paper is to master the meaning of cupping, the procedures for carrying out cupping, and knowing the urgency and virtues of cupping. The research method used is a literature study. Cupping is the oldest traditional medicine method in the world, believed to have existed since 3000 BC. It aims to remove blood contaminated with toxins resulting from metabolism through the skin's surface by using a tube or glass placed on the skin's surface as a place to collect the dirty blood. There are five types of cupping: dry cupping, wet cupping, sliding cupping, fire cupping, and synergy cupping. Cupping features include pain relief, increasing blood circulation, lowering blood pressure, overcoming cardiovascular disease, lowering cholesterol, treating diabetes mellitus, and many more.


Background
Basically, many Islamic teachings are based on the Sunnah of Rasullulah SAW, who is a leader and a good role model for Muslims in carrying out various aspects of activities. Sunnah itself is defined as words, deeds, decrees, or good qualities before becoming the Prophet Muhammad and after being appointed as the Apostle of Allah. Sunnah is the second legal basis for Muslims because it functions as an explanation of the Al-Qur'an, so it has an important role in Islamic law which originates from the Al-Qur'an. In everyday life, Muslims are required to act in accordance with the teachings in the Qur'an and the sunnah of the Prophet Muhammad, including regarding health. In terms of the world of health, there is an alternative treatment ala Rasulullah SAW which is based on the Al-Qur'an and Hadith or known as At-Thibb Al-Nabawi. Alternative medicine is treatment that uses tools, materials and methods other than medical treatment. One of the Prophet's alternative treatments is cupping therapy. Cupping therapy is a method of vacuuming the skin to release accumulated toxins and oxidants in the body. In the human body, the skin is the largest organ, therefore many toxins collect in the skin. So, cupping can clean dirty blood in the human body. Scientifically, cupping can be used for prevention and rehabilitative efforts. Cupping can reduce the risk of cardiovascular disease and treat various diseases such as hypertension, migraine, carpal tunnel syndrome, stroke rehabilitation, and effectively affect the autonomic system. Cupping is the best treatment solution for every Muslim because Rasulullah SAW once said: "It is good that the treatment you are doing is Al-Hijamah" (HR. Ahmad). The medicine prescribed by the Prophet Muhammad SAW must be believed, is certain and comes from Divine revelation. Therefore, cupping is not just an alternative treatment, but has become a shortcut for Muslims and its surroundings, as well as being used as the main treatment guide that must be practiced.

Materials and Methods
In this study we used the research method of reviewing journals with keywords At-Thibb Al-Nabawi, Cupping, Traditional Medicine.

Result and Discussion
According to an Islamic point of view, the law regarding the permissibility and virtues of cupping is definitely clear and final. This has been explained from several Hadits which indicate the permissibility of cupping and mention the virtues of cupping. One of the hadith is HR. Bukhari number 5294 "There are three ways of treatment therapy, namely; cupping, drinking honey, and by applying hot iron, and I forbid my people to do treatment with hot iron. In fact, the Messenger of Allah, when he was mi'raj, did not pass by any angels, except to say: "Do it by you Hijamah" (HR. At Tirmidhi). The many hadiths that discuss cupping make people believe that the existence of cupping has theological content and is considered the sunnah of the Prophet Muhammad SAW. In the book written by Ibn al-Qayyim al-Jauziyyah entitled "Aṭ-Ṭhibb al-Nabawi" several hadiths of the Prophet related to medicine have been described, including cupping. Similar research has also been written in a book entitled "Cupping Methods of Treatment According to the Sunnah of the Prophet SAW" by Muhammad Musa al-Naṣr which mentions more than 40 hadiths regarding the virtues of cupping. Not only that, M. Halabi Hamdi highlighted the Prophet's instructions regarding traditional medicine, namely the cupping method (ḥijāmah). At this time, Hijamah medicine has been modernized and follows scientific principles by using more effective tools and without side effects. In Arabic, "Cupping" is called "Ḥijāmah". the word "Ḥijāmah" comes from an Arabic term which means "the discharge of dirty blood". "Ḥijāmah" is the process of removing pathological substances that cause disease or toxins from the body through the surface of the skin. Etymologically, the word "ḥijāmah" has two meanings. First: The word "ḥijāmah" comes from the word "hajama" which is a verb which means to suck up. The meaning is to suck up a certain amount of blood from a certain place which aims to treat one organ or a certain disease. Second: The word "ḥijāmah" comes from the word "ḥajjama" which means to return something to its original volume and prevent it from developing. That is, stopping the disease from progressing. Meanwhile, in the Arabic-Indonesian dictionary it is stated that cupping comes from the word ‫حجما‬ -‫يحجم‬ -‫حجم‬ which means burying the sick. While the noun is ‫الحجمة‬ which means cupping work, while the isim fa'il is ‫حاجم‬ which means cupping. Whereas in the isim form ‫المحجمة‬ (Al-Miḥjamah) means a device for cupping, in the form of a glass to collect blood that is removed from the skin or a glass to collect ḥijāmah blood. Cupping has several names, including: cupping, canthuk, candhuk, or incubate.
Cupping is an empirically based treatment technique that existed at the time of Rasulullah SAW, namely the process of removing blood containing toxins and poisons that are harmful to the body through the surface of the skin. This treatment today has been adapted to the times and follows scientific principles with tools that are more practical and effective. Cupping is a therapy that is carried out by means of suction or vacumization using a suction device on the skin (Umar, 2012). Cupping is a method of removing blood from metabolism or oxidant blood and is contaminated with toxins through the surface of the skin. Cupping is a minor surgical procedure in which negative pressure (suction pressure) is applied to the surface of the skin using a glass or cup. This pressure causes an increase in the capillary filtration rate and decreases the absorption rate in the venous capillaries. One of the practices of the Prophet Muhammad SAW (Sunnah of the Prophet) is al-hijamah or cupping. This is stated in the hadith: This means: "Surely the best treatment you use is cupping or the best medicine for you is cupping" (H.R. Al-Tirmidhi, (1199) (Osman et al., 2020). In the Hadith narrated by Abu Hurairah RA, the Messenger of Allah once said "If there is something that is very good to be used as medicine, then that is cupping (al-hijamah)" (Sunan Ibnu Majah, Sunan Abu Dawud) (Saqlain et al., 2017). In this al-hijamah procession it is recommended to do it in the middle of the month. This had to do with the dirty human blood at that time when it was at its peak. In the history of Bukhari RA which reads "Whoever has cupping on 17, 19, 21 (Hijri month), then that (cupping) is a cure for all diseases" (Sunan Abu Dawud, Hadith No: 3861), (Zahrin et al., 2021). On these dates there are still differences of opinion regarding the validity of the hadith above. Therefore al-hijamah does not have to be done on certain dates because during the hijamah period, the Prophet Muhammad once performed al-hijamah or cupping on his head because of a headache and did not postpone it on another day. The Prophet Muhammad SAW did the same thing when he was poisoned by mutton. At that time the Prophet Muhammad SAW immediately performed cupping (Mustika, 2017). From the explanation above, it can be concluded that cupping can be done at any time when needed and not fixated on certain days. Cupping is one of the oldest alternative medicine in the world. Al-hijamah or cupping is believed to have been known since 3000 BC. In the ancient medical text book Ebers Papyrus it is explained that cupping is already known as a treatment with the function of removing odd substances from the body. This shows that al-hijamah or cupping has existed in Egypt since 1500 BC. Cupping has many other terms such as cupping, canthuk. At the time of the Prophet Muhammad SAW, cupping or al-hijamah was done with elephant ivory, buffalo horn, camel bone and cow horn. In Europeans, the media commonly used in cupping is leeches, whereas in ancient China, cupping was commonly called "Horn Therapy". In years 400 BC, the ancient Greek philosopher Hippocrates used the cupping method to treat internal ailments and disorders such as menstruation, angina and others. Dry and wet cupping is also explained in Hippocrates' book, in which Hippocrates prefers dry cupping because it is safer and the treatment is gentler (no need to injure the skin). These two methods then spread in medicine in European and Asian civilizations. The use of cupping media in ancient times utilized natural resources such as animal horns, shells, or bones with a hole in the middle (Figure 1). In the process of withdrawing air from the media, it was also done with the mouth in ancient times. In more modern times, cupping media or cups use glass, bamboo or cups. The process of expelling air also no longer uses the mouth, but can use fire or with a pump that draws air out. In Europe Galen (131-200 BC), Ambroise Pare (1509-1590) and Paracelsus (1493-1541) along with several other famous doctors had practiced cupping. At the Wellcome Institute Library London there is a picture of a soldier whose hand was cupped during the Franco-German war in 1820 ( Figure 2) and a picture of a patient who had wet cupping done on his back by a surgeon (Figure 3). The term cupping therapy became widely known in the western world. Even the Korean State uses cupping as treatment in hospitals officially. In general, cupping or al-hijamah is divided into two types, namely wet and dry cupping. What distinguishes between dry and wet cupping is that in wet cupping an incision is made on the skin while in the dry cupping process no incision is made. There are several types of cupping or alhijamah, namely wet cupping, dry cupping, sliding cupping, fire cupping, and synergy cupping (Al-Khaleeda, 2018).
Dry cupping is known as wind cupping because of its treatment by sucking the surface of the skin and the surrounding area is massaged without removing dirty blood (Sugung, 2017). The dry cupping method aims to reduce pain and flex muscles, especially on the back or back of the body (Fauzan, 2017). Wet cupping is cupping in which the action is to remove a certain amount of blood from a certain point by using a scratch on the skin after placing a cupping glass. Sliding cupping is usually done on the back. This cupping is done by placing a cupping glass which is then given olive oil on the back so that the surface of the back is smooth and the cupping cup can be moved from one place to another. Sliding cupping can increase joint ROM (Clarkson, 2019). Fire cupping is al-hijamah which uses fire to suck air into a vacuum glass (Al-Khaleeda, 2018). Synergy cupping is cupping with the application of three traditional medical sciences Traditional Chinese Medicine, Tibbun Nabawi, and Modern Medicine. All of this knowledge is combined and used in analyzing a disease which then concludes whether to continue with cupping therapy or not. Synergy cupping is used in carrying out sterile and hygienic cupping practices according to modern medical guidelines. There needs to be special treatment in the sterilization and disinfection of tools and materials due to cupping therapy including minor cupping actions (Ridho, 2016). Cupping can be broadly divided into two areas: dry cupping and wet cupping. The choice between dry cupping and wet cupping depends on the situation and condition of the patient. Patients suffering from diseases such as diabetes usually use dry cupping for fear of wound healing in diabetic patients. Dr. Wada A. Umar, in his book Cupping for 7 Chronic Diseases, describes cupping as a treatment in which an inverted tube or glass is applied to the surface of the skin to create local embankments through negative pressure. For localized blood clots in the skin tube before the object is cauterized and placed in the tube. It also aims to increase the circulation of energy and blood to the human body according to ailments by sucking the accumulated blood from the skin. Breathe air into the bottle, let it stick to the skin for 3-5 minutes, then peel it off so that a red circle appears on the surface of the skin. Dry cupping is done by placing a cup in a certain location on a person's body, depending on the disease, then continuing to suck air into the cup and letting it stick to the skin for 3-5 minutes before removing it so that a red circle appears on the surface of the skin. Wet cupping is done first followed by dry cupping. Also, the cupping parts are scratched or cut with a lancer (sharp needle) or scalpel (women). The next step in the same place is cupping again to remove the poisoned blood from the body. Each cupping treatment is left for 3-5 minutes, after which the dirt (blood) is removed into a special container or place. In his hadith, it is said that cupping is said to be good and useful in curing disease. The Prophet was not an agricultural expert or a medical expert. In other comments, he also said that cupping was used by non-believers, and advocated following rational scientific rules (Syafe'i et al., 2022). The virtue of cupping is stated in a hadith from Said bin Jubair, from In Abbas which contains the method used by the Prophet Muhammad SAW in terms of health, Rasulullah said: Meaning: "Healing lies in three things, namely the incision of the cupping tool, drinking honey, and 'kay' with fire, in fact I forbid my people from 'kay" (Shohibu al-Bukhori, Ath-Thibb, Juz 1, p. 5680) (Mustika, 2017). The Prophet about the primacy of cupping. said in his hadith that cupping has the goodness and the advantage of curing disease. The Prophet was not an agricultural expert or a medical expert. In another comment, he said he does cup too. Used by non-believers, he recommends following common sense and scientific rules (Syafe'i et al., 2022). Cupping is widely used to relieve pain from various medical conditions such as musculoskeletal pain (including sprains, traumatic and post-fracture strains), symptoms related to shingles, lower back, low back pain, herniated discs, bone pain., and neck pain are among them. Cervical spondylosis, shoulder pain, migraine, and other headaches, dysmenorrhea, joint pain, gouty arthritis, rheumatoid arthritis, chronic fatigue syndrome, fibromyalgia, knee osteoarthritis, carpal tunnel syndrome (CTS), plantar fasciitis, night arm pain, trigeminal neuralgia, fatigue recovery for athletes, cupping also has an antipyretic effect to treat high fever due to diseases of the upper respiratory tract (Hidayati et al., 2019). Comparing the effects of dry cupping with conventional pharmacotherapy on cancer pain and finding a beneficial effect of cupping after 3 days after surgery. Significant differences in pain relief were found when comparing dry cupping with nonsteroidal anti-inflammatory drugs for nonspecific low back pain. There was also pain relief after the wet cupping intervention phase compared to pain relief for acute trigeminal neuralgia on wet cupping testing. We have also tested wet cupping and usual pain relief treatments compared to usual care for nonspecific low back pain. One session of wet cupping combined with usual care resulted in a one-week significant reduction in pain compared to usual care in patients with nocturnal brachial pain. One session of wet cupping has a beneficial effect on pain relief compared to the patient's heat pad (Hidayati et al., 2019). Cupping can improve circulation or blood flow in the body, and reduce muscle tension and damage that causes pain, accompanied by an increase in microcirculation which results in the repair of capillary endothelial cells and accelerates tissue granulation and angiogenesis. This process contributes to the normalization of the functional state of the body and the gradual relaxation of the muscles. In complementary medicine, cupping functions to clean dirty blood and is one of the best massage treatments accompanied by listening to verses from the Qur'an which can help relax, soothe and relieve pain and discomfort during cupping, especially for people who practice this cupping. the first time (Rosyanti et al., 2020). Another benefit of cupping is that it destroys crystallization in the blood which removes congestion and dirty products from the body. The presence of wounds on the skin and capillaries after cupping can trigger nociceptive stimuli which cause the removal of dirty substances from the body through the nervous system. Cupping can stimulate the peripheral and autonomic nervous systems, and help remove impurities from the microcirculation and skin interstitial fluid, remove excess fluid, increase blood flow to muscles and skin, cupping significantly reduces FBS (fasting blood sugar), serum urea, and serum creatinine after 1,3 and 4 months compared to baseline. Serum uric acid and SBP (spontaneous bacterial peritonitis) showed a significant reduction at 1 and 4 months. (Rosyanti et al., 2020). Cupping can reduce blood pressure in hypertensive patients. Cupping can cleanse the body of toxins using small incisions or stabbing using a razor needle on the surface of the skin and then removing the blood using a cupping cup. Cupping can release substances such as serotonin, histamine, bradykinin, slow-reacting substance (SRS), and other substances that can help the process of dilating blood vessel capillaries resulting in improved microcirculation of blood vessels resulting in relaxation of stiff muscles as well as balancing blood pressure through nitrites, oxide which functions in regulating vasodilation, increasing the supply of nutrients and blood needed by cells and blood vessels, thereby making blood vessels more elastic and strong and reducing blood pressure (Asis, 2022). The mechanism of lowering high blood pressure in cupping therapy is removing blood and toxins or poisons such as free radicals and lipid peroxides, increasing the production of nitric oxide, removing excess fluid, reducing blood flow back to the heart, reducing peripheral resistance, and lowering blood pressure. nitric oxide went smoothly, increased production of nitric oxide occurred after the initiation of the second phase of cupping treatment. Increased nitric oxide causes vasodilation of blood vessels and lowers blood pressure (Larasati & Wicaksono, 2016). Cupping can also improve heart rhythm in cases of arrhythmias. Elimination of inflammatory mediators that impair microcirculation can relieve symptoms of angina pectoris. There are no other studies on the effects of cupping on heart rhythm, blood pressure, and other microcirculation disorders (Risniati et al., 2020).
In experimental analytic studies, total cholesterol levels before and after cupping therapy were due to cupping increasing skin viscoelasticity, thereby increasing arteriolar filtration and decreasing venous absorption. Cupping increases cholesterol excretion from the skin which helps lower total cholesterol levels (Helma et al., 2018). In patients suffering from diabetes mellitus, cupping can be useful as an alternative treatment. By being given cupping treatment it is hoped that can delay or prevent the occurrence of complications in DM patients. Wet cupping works by cleaning the patient's blood from disease related substances (DRS) which can worsen the prognosis of diabetes mellitus patients such as advanced glycation end products (AGEPs). Cupping treatment will provide significant benefits to patients with diabetes mellitus if used together with hypoglycemic or costus drugs and have a healthy diet (Risniati et al., 2020). Cupping can also be used to prevent or reduce the causes of ischemia and gangrene in the feet of patients with diabetes mellitus. In the feet of diabetic patients there is an accumulation of interstitial fluid which is hyperglycemic which makes the feet more susceptible to infection, worsens blood circulation, neuropathy occurs and ADEPs buildup. So, if left continuously will cause ischemia and gangrene. The location of cupping treatment can be done on the neck, the edge of the spine, or the head because cupping treatment is not always done in a place that hurts. Cupping treatment in diabetic foot patients is required to get supervision from a specialist. Cupping therapy affects reducing blood sugar levels in people with diabetes mellitus. Cupping shows differences in blood sugar levels before and after cupping (Risniati et al., 2020). In cupping, when an incision is made, blood sugar levels decrease, because the incision will stimulate the formation of nitric oxide, which plays a role in increasing blood flow to the pancreas and affecting the control of insulin levels. During cupping, the waste products of intestinal metabolism come out of the portal circulation of the liver. If the suction gets stronger, the liver's metabolic processes increase and blood sugar decreases. In addition to removing metabolic products, cupping can also remove various acidic substances from muscle and fatty tissue under the skin, allowing insulin to stick to its receptors, increasing insulin receptor sensitivity, and lowering blood sugar (Syafe'i et al., 2022).

Conclusion
From several opinions expressed by experts, it can be concluded that cupping therapy is a treatment technique to remove blood products of metabolism or blood that is contaminated with harmful toxins or poisons from the body through the surface of the skin. This cupping technique has been known since ancient times. At the time of the Prophet Muhammad, he used buffalo or cow horns, camel bones, and elephant ivory for cupping. There are several types of cupping or hijamah therapy, namely wet cupping, dry cupping, sliding cupping, fire cupping, and synergy cupping. The method of cupping treatment is done by inverting the cupping cup on the surface of the skin so that the negative pressure creates a local dam on the previously burned tube, and inserting it into the tube so that a blood clot forms. After that, the collected blood is sucked from the skin, which aims to increase energy and blood flow. There are several advantages of cupping, including pain relief, increasing blood circulation, lowering blood pressure, overcoming cardiovascular disease, lowering cholesterol, and also treating diabetes mellitus.