Figure 1.

Preparation for performing Al-hijamah (wet cupping therapy of prophetic medicine).

Notes: (A) The sterile disposable new set of cups includes 12 cups of variable sizes and a hand-held pump. Large-sized cups are put at the upper back and upper chest. Antiseptic solution, eg, povidone iodine; sterile disposable sharp scalpels (size no 11); sterile cotton; sterile new gloves and clean sterile atmosphere at hospitals are the prerequisites for performing Al-hijamah. (B) Sterilization using povidone iodine cleaning from inside outward to clean all the areas in the upper back for application of cups. (C) First suction step of Al-hijamah. Using sucking cups where the negative pressure is created through manual suction and skin upliftings are created inside sucking cups. Sucking cups are put at the upper back region (at skin over 7th cervical vertebra and skin directly below 7th cervical vertebra scapular regions). (D) Inside sucking cups, skin upliftings are created beneath which exist collected fluids (local interstitial fluids+filtered fluids from skin capillaries) that cannot be excreted due to the presence of intact keratinized outermost layer of epithelium (skin barrier). The collected excreted fluids contain both disease-related substances and disease-causing substances (causative pathological substances, eg, ferritin, from serum and tissue deposits in iron overload conditions and oxidative stress indicators, eg, malondialdehyde).