Table 2.
Al-hijamah versus phlebotomy for treating iron overload
| Phlebotomy | Al-hijamah | |
|---|---|---|
| Nature | Excretory therapeutic procedure | Excretory therapeutic procedure |
| Route of excretion | Venesection | Percutaneous excretion |
| Correcting causes of hemolysis | Less powerful | Powerful |
| Medical principles | Removal of a significant portion of whole blood in blood transfusion bags to decrease the concentration of an offending component | • Percutaneous nonspecific pressure-dependent and size-dependent filtration of blood through the fenestrated skin capillaries • Causes blood clearance from pathological substances |
| Indications | Therapeutic indications To treat polycythemia and iron overload conditions; eg, thalassemia |
Both preventive and therapeutic indications; eg, pain conditions, blood diseases, cardiovascular diseases, neuropsychiatric conditions and others1,28 |
| Side effects | • Excessive removal of blood may cause anemia • Phlebotomy may aggravate anemic state in thalassemia patients |
• Reversible circular bruises that disappear within few days • Skin vesicles and Taibah sign (sign of malpractice due to prolonged cup application) • Iron deficiency anemia due to excessive traditional WCT was reported4 |
| Repeating the procedure | Repeatable according to indication | Repeatable according to indication (every 2 weeks to 1 year) |
| Nature of excretion | Whole blood | Bloody fluid (containing a mixture of collected interstitial fluids, filtered capillary fluids, excreted pathological substances, and some blood cells)1–3,13 |
| Degree of loss of blood cells | Whole blood loss | More selective (loss of lesser amount of the red blood cell mass) |
| Steps | Bleeding in a blood collection bag to remove about 500 cc blood | Skin suction, scarification and second suction (triple S technique) |
| Place for receiving treatment | Hematology department in hospitals | Outpatient clinic or home |
| Treatment of associated disease conditions | No report | Reported to treat viral hepatitis, hypertension, hyperlipidemia, pain conditions, and others1,18,28 |
| Other therapeutic benefits | None | Improves local circulation, analgesia, hematological benefits, and others1,18,28 |
| Pharmacological potentiation effect | No report | Reported3 |
| Duration of the procedure | Few minutes | 0.5–1 hour |
| Clearance of skin iron | None | Yes |
| Other names | Fasd (in Arabic), bloodletting | Cupping bloodletting, WCT of prophetic medicine |
| Separation of noxious substances from blood | Not done There is only excretion of a significant portion of blood containing a portion of noxious substances |
Done There is excretion of noxious substances selectively in a pressure-dependent and size-dependent manner (similar to renal glomerular filtration) with loss of a minimal portion of red blood cells |
| Extent of improvement | Depends on the amount of letted blood (containing noxious substances) versus exaggerating the anemic state | Depends on the amount of excreted noxious substances with proper pressure-dependent filtration and capillary blood clearance (skill of practice). No exaggeration of the anemic condition |
Abbreviation: WCT, wet cupping therapy.