Efficacy of Hijamat (wet cupping therapy) in Iranian patients with nonalcoholic fatty liver disease: a controlled clinical trial
Efficacy of Hijamat (wet cupping therapy) in Iranian patients with nonalcoholic fatty liver disease: a controlled clinical trial
Background/aim: Nonalcoholic fatty liver disease (NAFLD) is known to be the most prevalent chronic liver disease all over the world.The incidence of this disease has dramatically increased during the last decade. Studies have shown a strong relationship between thelevel of ferritin and the severity of NAFLD. The objective of the present study was to assess the effect of adding Hijamat, as an ironreducing procedure, to standard lifestyle modification on the improvement of insulin resistance and liver enzymes in patients withNAFLD.Materials and methods: One hundred and twenty NAFLD patients participated in a randomized, controlled, single-blind trial design ofstudy. The control group received counselling for nutrition and physical activity for a period of 6 months. The treatment group receivedthe above items plus Hijamat for 3 times during 1 month. Ultrasound images of liver, HOMA-IR, and laboratory data including ALT,AST were assessed pre- and postintervention.Results: At the end of the study, a significant decrease was demonstrated in the serum level of HOMA-IR (–1.30 ± 0.88 vs –.02 ± 0.47,P < 0.001) and serum levels of ALT (–6.50 ± 4.92 vs –2.38 ± 3.92, P < 0.001) and AST (–2.78 ± 4.29 vs –1.30 ± 2.33, P = 0.021) in theHijamat group were compared to the control group. Ultrasound images of the liver improved in 23.3% of the patients in the Hijamatgroup, while the rate of improvement in the control group was 10% (P = 0.050). Hijamat therapy was safe and tolerable in this trial.Conclusions: Hijamat resulted in a relative improvement in fatty liver severity and improved HOMA-IR and liver enzymes more thanlifestyle modification alone in patients with NAFLD.
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- 1. Benedict M, Zhang X. Non-alcoholic fatty liver disease: an
expanded review. World Journal of Hepatology 2017; 9 (16):
715-732. doi: 10.4254/wjh.v9.i16.715
- 2. Bellentani S. The epidemiology of non‐alcoholic fatty liver
disease. Liver International 2017; 37: 81-84. doi: 10.1111/
liv.13299
- 3. Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y et
al. Changes in the prevalence of the most common causes of
chronic liver diseases in the United States from 1988 to 2008.
Clinical Gastroenterology and Hepatology 2011; 9 (6):524-530.
doi: 10.1016/j.cgh.2011.03.020
- 4. van Welzen BJ, Mudrikova T, El Idrissi A, Hoepelman AI,
Arends JE. A Review of non-alcoholic fatty liver disease in
HIV-infected patients: the next big thing? Infectious Diseases
and Therapy 2019; 8 (1):33-50. doi: 10.1007/s40121-018-0229-
7
- 5. Esser N, Legrand-Poels S, Piette J, Paquot N, Scheen A. NLRP3
inflammasome and visceral adipose tissue. Revue Médicale de
Liège 2014, 69: 57-61.
- 6. Sara Al-Rawi, Michael D Fetters. Traditional arabic & islamic
medicine: a conceptual model for clinicians and researchers.
Global Journal of Health Science 2012; 4 (3): 164-169. doi:
10.5539/gjhs.v4n3p164
- 7. El Sayed S, Mahmoud H, Nabo M. Methods of wet cupping
therapy (Al-Hijamah): in light of modern medicine and
prophetic medicine. Alternative & Integrative Medicine 2013:
1-16.
- 8. Valenti L, Moscatiello S, Vanni E, Fracanzani A, Bugianesi
E et al. Venesection for non-alcoholic fatty liver disease
unresponsive to lifestyle counselling—a propensity scoreadjusted
observational study. Monthly Journal of the
Association of Physicians 2011; 104 (2): 141-149. doi: 10.1093/
qjmed/hcq170
- 9. Khodadoostan M, Zamanidoost M, Shavakhi A, Sanei H,
Shahbazi M et al. Effects of phlebotomy on liver enzymes and
histology of patients with nonalcoholic fatty liver disease.
Advanced Biomedical Research 2017; 6: 12. doi: 10.4103/2277-
9175.200787
- 10. El Sayed SM, Abou-Taleb A, Mahmoud HS, Baghdadi H,
Maria RA et al. Percutaneous excretion of iron and ferritin
(through Al-hijamah) as a novel treatment for iron overload
in beta-thalassemia major, hemochromatosis and sideroblastic
anemia. Medical Hypotheses 2014; 83 (2): 238-246. doi:
10.1016/j.mehy.2014.04.001
- 11. Ahmadi A, Schwebel DC, Rezaei M. The efficacy of wetcupping
in the treatment of tension and migraine headache.
The American Journal of Chinese Medicine 2008; 36 (1): 37-
44.
- 12. Hertzog MA. Considerations in determining sample size for
pilot studies. Research in Nursing & Health 2008; 31 (2): 180-
191. doi: 10.1002/nur.20247
- 13. Mihmanli I, Kantarci F, Yilmaz MH, Gurses B, Selcuk D et al.
Effect of diffuse fatty infiltration of the liver on hepatic artery
resistance index. Journal of Clinical Ultrasound 2005; 33 (3): 95-
99.
- 14. Shah RA, Kowdley KV. Serum ferritin as a biomarker for
NAFLD: ready for prime time? Hepatology International 2019;
13 (2): 110-112. doi: 10.1007/s12072-019-09934-7
- 15. Valenti L, Dongiovanni P, Fargion S. Diagnostic and therapeutic
implications of the association between ferritin level and severity
of nonalcoholic fatty liver disease. World Journal of Gastroenterol
2012; 18 (29): 3782-3786.
- 16. El-Shanshory M, Hablas NM, Shebl Y, Fakhreldin AR, Attia M
et al. Al-hijamah (wet cupping therapy of prophetic medicine)
significantly and safely reduces iron overload and oxidative stress
in thalassemic children: a novel pilot study. Journal of Blood
Medicine 2018; 9: 241-251. doi: 10.2147/JBM.S170523
- 17. Masarone M, Rosato V, Dallio M, Gravina AG, Aglitti A et al.
Role of oxidative stress in pathophysiology of nonalcoholic fatty
liver disease. Oxidative Medicine and Cellular Longevity 2018;
2018: 9547613. doi: 10.1155/2018/9547613
- 18. Suhaily MH, Ismail A-S, Aziz A, Najib MY. Randomized
control trial study on the effect of wet cupping on lipid profile.
International Medical Journal Malaysia 2017; 16 (2): 11-17.
- 19. Fattahi N, Sharifi K, Moradi G, Iri R, Reshadat R et al. Prevalence
of non-alcoholic fatty liver disease in Kurdistan Province, Iran,
2013-2014: a population based study. Govaresh 2018; 23 (2): 109-
116.
- 20. Mahaling DU, Basavaraj MM, Bika AJ. Comparison of lipid profile
in different grades of non-alcoholic fatty liver disease diagnosed
on ultrasound. Asian Pacific Journal of Tropical Biomedicine
2013; 3 (11): 907-912. doi: 10.1016/S2221-1691(13)60177-X
- 21. Valenti L, Fracanzani AL, Dongiovanni P, Bugianesi E,
Marchesini G et al. Iron depletion by phlebotomy improves
insulin resistance in patients with nonalcoholic fatty liver disease
and hyperferritinemia: evidence from a case-control study. The
American Journal of Gastroenterology 2007; 102 (6): 1251-1258.
- 22. Al-Bedah AM, Shaban T, Suhaibani A, Gazzaffi I, Khalil M et
al. Safety of cupping therapy in studies conducted in twenty one
century: a review of literature. British Journal of Medicine and
Medical Research 2016; 15 (8): 1-12.
- 23. Nimrouzi M, Mahbodi A, Jaladat A-M, Sadeghfard A, Zarshenas
MM. Hijamat in traditional Persian medicine: risks and benefits.
Journal of Evidence-Based Complementary & Alternative
Medicine 2014; 19 (2): 128-136. doi: 10.1177/2156587214524578
- 24. Harrison SA, Day CP. Benefits of lifestyle modification in
NAFLD. Gut 2007; 56 (12): 1760-1769.
- 25. Nseir W, Hellou E, Assy N. Role of diet and lifestyle
changes in nonalcoholic fatty liver disease. World Journal of
Gastroenterology 2014; 20 (28): 9338-9344. doi: 10.3748/wjg.
v20.i28.9338