Al-Hijamah (Prophetic Wet Cupping Therapy) is a Novel Adjuvant Treatment for Viral Hepatitis That Excretes Viral Particles and Excess Ferritin Percutaneously, Synergizes Pharmacotherapy, Enhances Antiviral Immunity and Helps Better HCC Prevention and Treatment: A Novel Evidence-Based Combination with Prophetic Medicine Remedies

Background

Hepatitis B and C viruses are oncogenic viruses due to incorporation of their nucleic acids into the hepatocytes’ genome. Hepatitis B virus is a DNA virus that directly incorporates into the hepatocytes’ genome. Hepatitis C virus is an RNA virus where DNA can be produced from RNA by activity of reverse transcriptase enzyme. Newly produced viral DNA genome can integrate into genome of infected hepatocytes and become oncogenic. Malignant transformation through viral hepatitis infection may occur mainly through the activation of cancer genes (proto-oncogenes) and suppression of tumor suppressor genes.^1,2 Viral hepatitis is a common potentially fatal health problem due to its long-term sequelae, especially in developing countries. Hepatitis B and C may progress to chronic hepatitis and liver cirrhosis. Hepatocellular carcinoma is a possible complication of liver cirrhosis and may complicate the chronic viral infection itself.³

Unfortunately, several challenges are facing sofosbuvir (Sovaldi) treatment to viral C hepatitis including viral resistance, difficulty to treat all the genotypes, and inability to provide treatment access in low-resource countries and in special populations.⁴ Over the past few decades, the hepatitis C virus (HCV) epidemic has spread to many nations. According to estimates, 34,000 persons in the United States alone died in 2017 as a result of serious hepatitis C consequences such as cirrhosis and liver cancer. Drug injection is responsible for 43% of the hepatitis C virus disease burden globally and 79% of the disease burden in high-income nations. The World Health Organization (WHO) created a worldwide health strategy to eradicate hepatitis C virus infection as a public health issue by 2030 as a result of the development of extremely effective direct-acting antiviral therapies for the disease in recent years.⁵

Diagnosis of Viral Hepatitis Infection

Raised liver enzymes may support the diagnosis of hepatitis. Detection of HCV antibodies (HCV Ab) or HBV surface antigen (HBs Ag) using enzyme-linked immuno-sorbent assay (ELISA) is diagnostic. Polymerase chain reaction (PCR) is better than ELISA as a diagnostic tool as it diagnoses the presence of nucleic acids of hepatitis viruses (DNA in hepatitis B and RNA in hepatitis C). Diagnosis and monitoring the increase in the number of hepatitis viral copies in patients’ sera can be done using PCR and is helpful to monitor and predict the future and outcome of the treatment. HBs Ag is a sign of active disease and is detected during the incubation period while HBV envelop antigen (HBe Ag) appears during the incubation period and is detected in the acute stage of the disease and in some chronic carriers.^2,6

Current Management of Viral Hepatitis Still Faces a Lot of Obstacles

Current treatment for HBV infection includes alpha interferon together with lamivudine and adefovir (both are nucleoside analogues that inhibit HBV replication through inhibiting HBV-DNA polymerase). Unfortunately, they are not quite effective. Current treatment for HCV infection includes Sovaldi (the golden standard), alpha interferon and ribavirin. Treatment for viral hepatitis is so expensive, time-consuming and with serious side effects.^7–11 Unfortunately, several challenges are facing Sovaldi treatment to viral C hepatitis including viral resistance, difficulty to treat all genotypes, and inability to provide treatment access in low-resource countries and in special populations.⁴ This may necessitate introducing new adjuvant treatments as Al-hijamah and other prophetic medicine remedies that can work by different mechanisms to treat viral hepatitis as will be discussed here.

Hepatocellular Carcinoma Exhibits the Warburg Effect

Hepatocellular carcinoma (HCC) is the third most common cancer in the world and a primary liver cancer with over 90% are primary HCC. HCC’s occurrence and progression are tightly correlated with the Warburg effect (permanent production of lactate from glucose even in the presence of oxygen). Warburg effect is tumors’ unique glucose oxidation to give the pro-oxidant lactate (but not the antioxidant pyruvate) even in the presence of oxygen.⁸

Warburg Effect and Cancer Cells’ Products in HCC

Like most solid tumors, HCC cells exhibit the Warburg effect (Figure 1). HCC cells follow the same cancer biology criteria as other tumors, eg, increased glucose uptake, increased glycolysis (glucose oxidation), restricted mitochondrial oxidative phosphorylation, increased pentose phosphate pathway, and enhanced glutamine breakdown. High serum lactate in cancer patients (Warburg effect) mediates chemoresistance, radioresistance, angiogenesis, metastasis and invasion.^12,13

Figure 1 HCC cells exhibit the Warburg effect.

Prophetic medicine is the body of knowledge about medicine that has been derived from the teachings, customs (sunnah), ahadith (sayings), actions, and agreements of Prophet Muhammad, peace be upon him. All prophetic medicine remedies are natural antioxidants. Both therapeutic and preventive aspects are present in prophetic medicine. All therapies from prophetic medicine are natural antioxidants, including Al-hijamah (prophetic medicine’s wet cupping therapy), which works by clearing the body of harmful pathological chemicals by excreting excess oxidants. The medical literature is currently fertile ground for innovative studies on the subject of prophetic medical cures.^14,15 Prophet Muhammad peace be upon him said: “If there is a benenvolence (benefit) in any of your medicines, benefit will be in shrtat mihjam (Al-hijamah), honey drink, and a stinge of fire compatible with disease and I do not like to cauterize”. Hadith no. 5683 in Sahih Al-bukhari book.

Examples of prophetic medicine remedies include Al-hijamah (wet cupping therapy of prophetic medicine that clears blood using the fenestrated skin capillaries) (Figure 2A), Ajwa dates of Aliah (from Al-Madinah, Saudi Arabia), nigella sativa, costus (saussurea lappa), oral honey, sana (senna, cassia angustifolia), sanut (fennel, foeniculum vugulare), and other natural treatments. All are abundant in dozens of all-natural antioxidant compounds that prevent the oxidative stress-related cellular and tissue damage that individuals with viral hepatitis frequently experience.¹⁵

Figure 2 There is a structural similarity between the fenestrated capillaries in the skin dermis (superficial subepidermal capillary plexus) and the renal glomerular capillaries. Notes: (A) The skin may act as a super-kidney during Al-hijamah for proper excretion of the disease-causing substances. (B) Scientific bases of Taibah theory for explaining how Al-hijamah (wet cupping therapy of prophetic medicine) works in treating different diseases. Data from these studies.16,17.

Expert Opinion: Al-Hijamah (Combined to Other Prophetic Medicine Remedies) as a Promising Adjuvant Treatment to Current Hepatitis Treatments

Based on the author’s longstanding experience as a hijamatologist physician (certified by the Saudi National Center for Complementary and Alternative Medicine), and over 10 years of teaching Al-hijamah and prophetic medicine to medical students at Taibah University (in Al-Madinah, Saudi Arabia), the author reports that: Al-hijamah is a promising adjuvant treatment for viral hepatitis (B and C and other viral illnesses) for percutaneous excretion of hepatitis viral particles, excess ferritin (Box 1), inflammatory mediators, free radicals, and antigen-antibody complexes and potentiating the antiviral immunity (Box 2). Al-hijamah is also a promising preventive and therapeutic adjuvant treatment to HCC via clearing the blood and tissues from HCC’s products as lactate (Warburg effect), exosomes, MMPs, VEGF, oxidants, inflammatory mediators and others.

Box 1 Importance of Decreasing Serum Ferritin in Patients Having Viral Hepatitis. Serum Ferritin Was Significantly Decreased via Direct Excretion Using Al-Hijamah

Box 2 Suggested Therapeutic Benefits of Al-Hijamah to Viral Hepatitis Patients

Details of this expert opinion include:

1. Hepatitis patients have excess serum viral particles, ferritin, inflammatory mediators, oxidants, free radicals and antigen-antibody complexes that cannot be excreted in urine through the kidneys. Al-hijamah is a reported general clearance treatment for serum, interstitial fluids and tissues,^16,36–40 so that Al-hijamah is highly recommended for treating hepatitis patients (Figures 2B and 3).
2. Hepatitis patients maximally and significantly benefit from Al-hijamah (wet cupping therapy of prophetic medicine) as did thalassemia patients in clearing the serum and the body from disease-causing substances as reported in our previous publications.^{16,18,31,33,36–40}
3. Based on biochemical, pharmacological, histological and Al-hijamah backgrounds, Al-hijamah can excrete the hepatitis viral particles, excess ferritin, inflammatory mediators, free radicals, and antigen-antibody complexes via the percutaneous route (Figure 3).
4. High serum ferritin is a major problem in both hepatitis patients and thalassemia patients. High serum ferritin in viral hepatitis correlates with chronicity and viremia. In thalassemic patients, Al-hijamah effectively cleared thalassemic children of causative pathological substances (CPS) that included excess ferritin.¹⁸ So, Al-hijamah will do the same (blood clearance of serum ferritin) in hepatitis patients.
5. Al-hijamah excretes and clears thalassemic patients of free radicals¹⁸ and serum lipids.^{16,18,31,33,36–40}
6. Al-hijamah significantly increased the antioxidant power (deficient in hepatitis patients).^18,36 So, Al-hijamah will do the same (blood clearance of serum from excess lipids) in hepatitis patients.
7. Al-hijamah potentiated the natural antiviral immunity in thalassemic children, eg, increasing CD4 count, CD8 count and CD4/CD8 ratio. So, Al-hijamah will do the same (increasing the antiviral immunity) in hepatitis patients. All these reported benefits are quite beneficial and helpful to hepatitis patients.
8. In thalassemic children, Al-hijamah proved to be tissue-protective via inducing a significant decrease in serum oxidants (as malondialdehyde), iron overload,¹⁸ liver enzymes and excess serum lipids.³⁶ So, Al-hijamah will do the same tissue-protective effects in hepatitis patients.
9. Al-hijamah alleviates some drugs-induced side effects, eg, Ribavirin reduces absolute lymphocytes counts in Hepatitis C virus infection³⁵ while Al-hijamah induces lymphocytosis.³¹ So, Al-hijamah will be hepato-protective in hepatitis patients.
10. Other viral diseases like AIDS can benefit from the same treatment advantages. Al-hijamah is absolutely necessary for the excretion and removal of CPS that promote cancer, such as lactate (the Warburg effect),⁴¹ growth factors, metalloproteinases, and others, even after cancer (as HCC) has developed.¹³ Immune potentiation brought on by al-hijamah is very beneficial to cancer patients as HCC.^13,31
11. To maximize the therapeutic effects, combine al-hijamah with other natural antioxidant remedies of Prophetic medicine, such as nigella sativa, costus, natural honey, Zamzam water, and others.^15,16,36

    Figure 3 Pathogenesis of hepatitis viral infection. Notes: Causative pathological substances of viral hepatitis (viral particles, viral antigens, viral antigen-antibody complexes, inflammatory cytokines, free radicals and others) are present in the blood of hepatitis patients and may leak into the interstitial fluids (interstitial fluids are formed through filtration of blood plasma). They cannot be excreted in urine and become retained favoring a chronic viral hepatitis status. Al-hijamah is capable of excreting all the causative pathological substances.

Current evidences supporting this expert opinion:

• High serum ferritin in viral hepatitis reflects disease chronicity, increased necroinflammation, hepatotoxicity, progression to cirrhosis, unresponsiveness to treatments and viremia (Box 1). Excretion of serum ferritin through Al-hijamah was confirmed in thalassemia patients^18,31,36 and will benefit hepatitis patients so much via reversing excess ferritin effects.
• Current evidence includes the published reports that Al-hijamah generally clears the human body of disease-causing substances as serum oxidants (malondialdehyde) and potentiates the immunity.^{16,18,31,33,36–40}
• The reported results that Al-hijamah causes immunological potentiation, excretion of CPS, and clearance of blood and interstitial spaces^18,31,36 through the fenestrated skin capillaries^{16,33,37,38,40} confirmed its therapeutic benefits to hepatitis patients.
• The evidence-based Taibah mechanism (Taibah theory, Figure 2) strongly supports this expert opinion that Al-hijamah excretes all the diseases-causing substances^{16,18,31,33,36–40} related to viral hepatitis that may include viral particles.
• Al-hijamah has three major steps applied to the skin: suction, scarifications (shartat mihjam in Arabic) and suction, ie, triple S technique. Al-hijamah benefits from the skin histological structure to excrete CPS through the fenestrated skin capillaries in a pressure-dependent and size-dependent manner (a kidney-like manner), which agrees with the evidence-based Taibah theory (Taibah mechanism).^{16,18,31,33,36–40}
• CPS differs from disease to disease according to disease etiology and pathogenesis, so CPS of viral hepatitis include high serum viral particles, viral antigens, viral nucleic acids, inflammatory mediators and high serum ferritin.
• Our previous publications confirmed the success of Al-hijamah to significantly increase the antioxidant power (based on decreasing serum ferritin and free radicals)¹⁸ and potentiating the natural antiviral immunity, eg, increasing CD4 count, CD8 count and CD4/CD8 ratio.³⁶ Such immunological benefits significantly increase CD4/CD8 ratio in thalassemic patients via increasing total antioxidant capacity/malondialdehyde (TAC/MDA) ratio that takes place via excreting the excess serum oxidants via the percutaneous route.³¹ This confirms the therapeutic benefits that can be gained by Al-hijamah treatment to patients having viral hepatitis.

Suggested Mechanisms of Al-Hijamah as a Percutaneous Excretory Procedure That May Clear Serum and Interstitial Fluids of Hepatitis Patients from Disease-Causing Substances

Causative pathological substances (CPS) in viral hepatitis (both HBV and HCV infections) include the virus particle itself (B or C especially during stage of viremia), viral antigens (eg, HBs Ag and HBe Ag), viral nucleic acid (DNA in hepatitis B and RNA in hepatitis C), inflammatory cytokines, free radicals and the resultant antigen-antibody complexes (in hepatitis B) (Figure 3).^7–11 Taibah mechanism for medical bases of Al-hijamah strongly suggests Al-hijamah for treating viral hepatitis. Taibah mechanism states that: “Using a physiological excretory mechanism (pressure-dependent filtration and excretion) through the fenestrated capillaries of the skin dermis (acting as a filter) that resemble the fenestrated capillaries of the renal glomeruli, Al-hijamah (wet cupping therapy of prophetic medicine) acts as a super kidney that can excrete all the CPS collectively and simultaneously outside the human body. This clears the tissues, serum and intercellular fluids from CPS and enhances the immunity (Figure 2A)”.^16,39,40

Taibah Mechanism (Theory) Supports This Expert Opinion (Percutaneous Excretion of Viral Particles and Clearance of Blood and Tissues Using Al-Hijamah)

Based on Taibah theory, CPS for hepatitis patients include the high serum viral particles, viral nucleic acids, free radicals (reactive oxygen species), inflammatory mediators, ferritin and immune complexes. CPS for HCC patients include the high serum tumor cells’ products as massive lactate production (Warburg effect),⁴¹ metalloproteinase (MMP) enzymes (facilitating invasion and metastasis), vascular endothelial growth factor (facilitating angiogenesis), exosomes, free radicals (reactive oxygen species and reactive nitrogen species), and others. Among the MMP family, only MMP1, MMP3, MMP8, MMP9, MMP11, MMP12, MMP14, MMP15, MMP20, MMP21, and MMP24 significantly increased in HCCs compared with adjacent tissues. Crucially, survival and univariate analyses indicated that only MMPs 1, 9, 12, and 14 predict poor overall survival.¹⁴

As interstitial fluids are formed by filtration of capillary blood at the arterial ends of capillaries and then become absorbed again at the venous capillary ends,^16,40 the interstitial fluids may contain the same CPS present in the blood plasma in hepatitis patients as evidenced by the presence of infectious hepatitis viral particles in some body fluids, eg, semen and vaginal secretions^7–11 (Figure 4A–F). Puncturing the skin upliftings and applying the second suction step can excrete the collected fluids (Figure 5A–D) and hence decrease the viral hepatitis CPS significantly. The sucking pressure applied during cupping therapy was reported to be from −150 to – 420 mmHg. This suction pressure (filtration force through scarifications created in skin barrier) is transmitted to around the skin capillaries to be added to another less strong filtration force, ie, capillary hydrostatic pressure (−33 mmHg at arterial end of capillaries and −13 mmHg at venous end of capillaries) (Figure 6A–D). Both work as excretory forces against a relatively weaker absorption force, ie, capillary osmotic pressure (+20 mmHg).^16,40 This creates a pressure gradient and a traction force across the skin to drain out the collected and filtered fluids. Suction traction pressure also creates a pressure gradient around the capillaries and increases the filtration at the arterial end of capillaries at a net pressure of −163 to −433 mmHg and at the venous ends of capillaries at a net pressure of −143 to −413 mmHg (Figures 3–6). This results in clearance of blood from CPS and restoration of homeostasis (Figure 7).^16,40

Figure 4 First suction step during Al-hijamah. Notes: (A) Applying suction pressure (inside sucking cups) causes creation of skin upliftings that gradually increase in size inside the sucking cups. Skin upliftings inside sucking cups contain interstitial fluids, some filtered fluids and causative pathological substances. (B) Skin sterilization. (C) Applying sucking cups to the upper back region. (D) Applying sucking cups to the right hypochondrium (right subcostal region). (E) Formation of the skin upliftings where the skin enters inside the sucking cups causing widened peri-capillary spaces and increased filtration of the fenestrated dermal capillaries (beneath the skin barrier). (F) Cup margins leave a temporary sign immediately after removal of the cups and before scarification step.

Figure 5 Skin scarification step (shartat mihjam). Notes: (A) Scarifying the skin superficially helps opening the skin barrier and excretion of the collected fluids with causative pathological substances (in agreement with Taibah mechanism). (B) Ideal skin scarifications (reflect the hand skills of the hijamatologist) are superficial, longitudinal, vertical, productive, in parallel rows, to the inside of the cup margin, equally done and distributed and covers the whole cup position. (C) The bloody excretion increases when adding the sucking cups. (D) The bloody excretion is the sum of the excretion coming from all the skin scarifications.

Figure 6 Upon applying the sucking cups again (with opening skin barrier), collected fluids containing causative pathological substances get out completely. Notes: (A) Negative (suction) pressure is transmitted to around the skin capillaries to increase the capillary filtration at both capillary ends, which results in clearance of the capillary blood from causative pathological substances (in agreement with the evidence-based Taibah theory). (B) The bloody excretion becomes clotted. (C) The bloody excretion is usually small in amount and not profuse, ie, no major blood loss occurs. (D) The site of cups application and scarifications after finishing Al-hijamah.

Figure 7 Restoration of homeostasis (through excretion of the causative pathological substances). Notes: This decreases the virus load and allows the immune system to overcome hepatitis infection and potentiates the therapeutic effects of pharmacological treatments (in agreement with Taibah theory).

Prophetic Medicine Remedies as Promising Adjuvants for Treating Viral Hepatitis and HCC

Remedies of prophetic medicine are quite promising for treating viral hepatitis (Figure 8A–C). Among the most important antioxidants in nigella sativa are thymoquinone, carvacrol, and pinene. Moreover, nigella sativa decreases hepatitis viral load, improves response to oxidative stress and improves the clinical condition and glycemic control in hepatitis patients (Box 3).⁴² Natural honey is rich in polyphenols and flavonoids that are strong antioxidants and exert tissue-protective effects (Box 4). Santamarin, dehydrocostus lactone, and costunolide are the principal antioxidants present in costus (Box 5).¹⁵ The preventive and therapeutic benefits of such remedies to the liver include combating hepatitis viruses, reducing hepatitis inflammatory responses, exerting potent antioxidant effects, exerting potent antitoxic effects, exerting potent anti-fibrotic effects, exerting hepatic tissue repair, suppressing carcinogenesis, reverting hepatocellular carcinoma cells to normal or near normal phenotype, and boosting the natural immunity.¹⁵

Figure 8 Natural prophetic medicine remedies. Notes: (A) Medicinal plants. (B) Prophetic medicine drinks. Prophetic medicine foods.

Box 3 Nigella Sativa Benefits to Viral Hepatitis and HCC Patients

Box 4 Natural Honey Benefits to Viral Hepatitis and HCC Patients

Box 5 Costus Benefits to Viral Hepatitis and HCC Patients

Among the prophetic medicine remedies that were reported to enhance immunity (in addition to Al-hijamah)³¹ are natural honey (increased bone marrow cellularity and lymphocyte count) (Box 4),³⁷ nigella sativa (increased lymphocytes count, CD4 & CD8 lymphocyte count).³² Costus (saussurea lappa increased the number of macrophages or lymphocytes),⁸⁵ and camel milk (decreased hepatitis C virus load and converted IgG isotype profile to Th1 immunity).⁸⁶

Interestingly, Ajwa dates transformed the malignant phenotype of hepatocellular cancer cells into a phenotype that was very similar to that of normal hepatocytes.⁸⁷ This is completely in line with the prophetic hadith that suggested Ajwa date fruit as a remedy and cure for toxins (Box 6).⁸⁸ The highly recommended treatment mechanism is the antagonistic relationship between Ajwa antioxidants and toxins-induced oxidant production.

Box 6 Ajwa Benefits to Viral Hepatitis and HCC Patients

How to Quantitate the Therapeutic Benefits of Al-Hijamah to Patients Having Viral Hepatitis (B or C) or HCC?

As we cannot evaluate what we do not measure, quantitative assessment of the therapeutic benefits of Al-hijamah should be performed. That can be done using Al-hijamah indices that were previously reported.^18,93 The five indices for evaluating Al-hijamah and the hijamatologist (the therapist who performed Al-hijamah) are:

1. Excretion index
2. Clearance index (Purification index)
3. Pharmacological potentiation index
4. Immunological index
5. Clinical therapeutic index

Unfortunately, resistance characterization was reported to ledipasvir and velpatasvir in treating hepatitis C virus genotype 4.⁹⁴ Al-hijamah (a minor dermatological and surgical procedure) and other prophetic medicine remedies (nutritional treatments) are simple potentiating natural therapies that synergize the given treatments (and never antagonize them) to patients having viral hepatitis and HCC. The need for Al-hijamah and other prophetic medicine remedies maximizes upon facing drug resistance, treatment failure or co-infection with AIDS.

Practical Example 1: Pharmacotherapy Combined with Al-Hijamah and Other Prophetic Medicine Remedies for Treating Viral Hepatitis and AIDS (for Continuous Medical Education)

Mr XXX is a 48-years-old patient having chronic hepatitis C infection genotype 4. Unfortunately, he was reported to have resistance to ledipasvir and has co-infection with AIDS (unresponsive to highly active antiretroviral therapy, HAART). First blood samples (before ledipasvir administration) indicated that his hepatitis viral load was 3,600,000 copies/mL and his AIDS viral load was 2,000,000 copies/mL. Second blood samples (after ledipasvir administration) indicated that his hepatitis viral load was 3,200,000 copies/mL and his AIDS viral load was 1,500,000 copies/mL. His CD4 count was 198 cells/mm³ (normal range: 500–1500 cells/mm³). The physicians decided to keep on the current treatments without change and to add some prophetic medicine remedies as adjuvants. Al-hijamah (wet cupping therapy of prophetic medicine) was done for him by an expert hijamatologist (a physician therapist) who did superficial scarifications using 10 large sucking cups (8 cups at the upper back and 2 cups at the right hypochondrium, and subcostal region). Two weeks later, third blood samples (after ledipasvir + Al-hijamah) indicated that his hepatitis viral load became 1,200,000 copies/mL and his AIDS viral load became 500,000 copies/mL. His CD4 count was 396 cells/mm³ (normal range: 500–1500 cells/mm³). A nutritional cocktail containing grinded nigella sativa (2 grams/dose), grinded costus (0.5 gram/dose), grinded fennel (3 grams/dose), natural honey (15 mL/dose), Ajwa date fruit (7 dates/dose) and camel milk (200 mL/dose) was added three times/day to the nutritional regimen. Two weeks later, fourth blood samples (after ledipasvir + Al-hijamah + other prophetic medicine remedies) indicated that his hepatitis viral load was 5000 copies/mL and his AIDS viral load was 500 copies/mL. His CD4 count was 550 cells/mm³ (normal range: 500–1500 cells/mm³). The adjuvant treatment was recommended for another 4 months. Dosage was based on our previous reports.^34,95–97

How can Al-hijamah benefits be evaluated in the first 2 weeks?

Answers: Using Al-hijamah indices, therapeutic benefits of Al-hijamah can be quantitated.^18,93

1* Excretion index for hepatitis C particles = (initial concentration of viral particles in serum before Al-hijamah) – (their concentration after Al-hijamah).

= 3,200,200–1,200,000 = 2,000,000 copies/mL, ie, about 2 million copies/mL were excreted in the bloody excretion during Al-hijamah.

- Excretion index for HIV particles = 1,500,000–500,000 = 1,000,000 copies/mL, ie, about 1 million HIV copies/mL were excreted in the bloody excretion during Al-hijamah.

2* Plasma purification index (from hepatitis C viral content) = 100 × ([initial concentration of viral particles in serum before Al-hijamah – concentration of the same viral particles in serum after Al-hijamah]/their initial concentration before Al-hijamah).

= 100 × (3,200,000–1,200,000)/3,200,000 = 62.5%, ie, a single session of Al-hijamah cleared blood plasma from 62.5% of the hepatitis C viral content.

- Plasma purification index (from HIV viral content) = 100 × ([initial concentration of viral particles in serum before Al-hijamah – concentration of the same viral particles in serum after Al-hijamah]/their initial concentration before Al-hijamah).

= 100 × (1,500,000–500,000)/1,500,000 = 66.7%, ie, a single session of Al-hijamah cleared blood plasma from 66.7% of the HIV viral content.

3* Pharmacological potentiation index for treating viral hepatitis = 100 × (therapeutic effects of Al-hijamah + conventional pharmacological treatments)/(therapeutic effects of conventional pharmacological treatments only).

= 100 × (viral load decrease due to ledipasvir + Al-hijamah)/(viral load decrease due to ledipasvir only).

= 100 × (2,000,000)/400,000 = 500%, ie, Al-hijamah potentiated ledipasvir effects about 5 times.

Pharmacological potentiation index for treating AIDS particles = 100 × (viral load decrease due to HAART + Al-hijamah)/(viral load decrease due to HAART only).

= 100 × (1,000,000)/500,000 = 200%, ie, Al-hijamah potentiated HAART effects 2 times.

4* Immunological index: [100 × (Immunological response after Al-hijamah)/(Immunological response before Al-hijamah)]

= 100 * 396/198 = 200%, ie, Al-hijamah increased cell-mediated immunity by twice the original value.

5* Clinical therapeutic index: is the percentage improvement of a tested clinical parameter after Al-hijamah (as a combined treatment here) measured at different time points.

Practical Example 2: Pharmacotherapy Combined with Al-Hijamah and Other Prophetic Medicine Remedies for Treating HCC (for Continuous Medical Education)

Mr YYYY was receiving Sorafenib for treating HCC but he cannot tolerate the side effects. His serum lactate level (Warburg effect, cancer cell’s products) was 4 mmol/L (normal range: <2 mmol/L).⁹⁸ α-fetoprotein level was initially 400 (normal range: 5 −10 ng/mL).⁹⁹ Al-hijamah was done for him by an expert hijamatologist (a physician therapist) who did superficial scarifications using 10 large sucking cups (8 cups at the upper back and 2 cups at the right hypochondrium, subcostal region). Two weeks later, his serum lactate level became 1.5 mmol/L (normal range: <2 mmol/L) and α-fetoprotein level became 150 (normal range: 5 −10 ng/mL). A nutritional cocktail containing grinded nigella sativa (2 grams/dose), grinded costus (0.5 gram/dose), grinded fennel (3 grams/dose), natural honey (15 mL/dose), Ajwa date fruit (7 dates/dose) and camel milk (200 mL/dose) was added three times/day to the nutritional regimen. Two weeks later, his serum lactate level became 1 mmol/L (normal range: <2 mmol/L) and α-fetoprotein level became 75 (normal range: 5 −10 ng/mL). The adjuvant treatment was recommended for another 4 months.

How can Al-hijamah benefits be evaluated in the first 2 weeks?

Answers: Using Al-hijamah indices, therapeutic benefits of Al-hijamah can be quantitated.

1* Excretion index for serum lactate = (initial concentration of lactate in serum before Al-hijamah) – (concentration after Al-hijamah).

= 4–1.5 = 2.5 mmol/L, ie, about 2.5 mmol/L of lactate were excreted in the bloody excretion during Al-hijamah.

- Excretion index for α-fetoprotein = 400–150 = 250 ng/mL, ie, about 250 ng/mL of α-fetoprotein were excreted in the bloody excretion during Al-hijamah.

2* Plasma purification index (for serum lactate) = 100 × ([initial concentration of lactate of serum before Al-hijamah – concentration of lactate in serum after Al-hijamah]/their initial concentration before Al-hijamah).

= 100 × (4–1.5)/4 = 62.5%, ie, a single session of Al-hijamah cleared blood plasma from 62.5% of lactate content.

- Plasma purification index (from α-fetoprotein) = 100 × ([initial concentration of α-fetoprotein in serum before Al-hijamah – concentration of α-fetoprotein in serum after Al-hijamah]/their initial concentration before Al-hijamah).

= 100 × (400–150)/400 = 62.5%, ie, a single session of Al-hijamah cleared blood plasma from 62.5% of its α-fetoprotein content.

Anti-Inflammatory and Immunological Benefits of Al-Hijamah Were Confirmed by Chinese Cupping Therapy

Al-hijamah is totally different from phlebotomy therapy (Table 1). Al-hijamah is better when it is needed to clear the blood and tissues from disease-causing substances. Zhang et al reported that in asthmatic patients, Chinese cupping therapy (equals only one step of Al-hijamah) caused a significant increase of immune stimulating cytokines and a significant decrease in immune inhibition. Cupping therapy caused elevated levels of CD4+ (T-helper cells), CD4+/CD8+ (elevated T-helper to T-cytotoxic ratio), IL-2, IFN-gamma, C3, C4, IgA, IgG and IgM. There was a significant corresponding decrease in immune inhibitory cytokines, eg, IgE, IL-4, IL-10 and CD8 cells.¹⁰⁰ The authors concluded that the improvements were better in the treated group than that in the control group.¹⁰⁰

Table 1 Comparison Between Al-Hijamah (Wet Cupping Therapy) and Phlebotomy (Venesection)

Factors Affecting the Effectiveness of Al-Hijamah in Treating Viral Hepatitis

1. The hand skills of the hijamatologist (therapist).
2. The superficial nature of skin scarifications: to preserve the subepidermal capillaries networks (acting as blood filters during Al-hijamah).
3. The duration of applying the sucking cups (optimal is 4–5 minutes).
4. The size of the sucking cups (largest are the best).
5. The number of sucking cups (the more cups the better).
6. Number of sessions of Al-hijamah (the more sessions the better).
7. Time interval between sessions (the fewer the better): optimal is 3–4 weeks.
8. The amount of the bloody excretion of Al-hijamah (cupped bloody excretion): the more the better.
9. Combination with other prophetic medicine remedies: the more the better.
10. Combination with given drugs: better to combine.

Conclusion

Al-hijamah is a strongly recommended adjuvant to current pharmacological treatments to viral hepatitis. Al-hijamah (wet cupping therapy of prophetic medicine) may be a promising treatment for increasing the immunity of the human body, decreasing free radicals and their damaging effects and clearing the blood from the pathological substances causing and related to pathogenesis of viral hepatitis. Other viral diseases like AIDS can benefit from the same treatment advantages. Al-hijamah is absolutely necessary for the excretion and removal of CPS that promote cancer, such as lactate (the Warburg effect), growth factors, metalloproteinases, and others. Even if HCC has developed, patients with HCC benefit from the immune potentiation brought on by Al-hijamah. The therapeutic effects of al-hijamah will be maximized by combining it with other natural antioxidant remedies of prophetic medicine, such as nigella sativa, costus, natural honey, Zamzam water, and others. Al-hijamah is a strongly suggested supplement to the pharmacological treatments now available for viral hepatitis and HCC, along with other cures from prophetic medicine.