Comparison Biochemistries of Obtained Blood Products between The Hijama and Phlebotomy techniques of Traditional Islamic Remedy; Healthy Young Adults at Fasting State

Background: The Hijama is the name of the traditional Islamic healing technique. It utilized over 1400 (Hejira A.H.) years. The method consists of cupping and scarification of the specific skin area of the body. It applied as a remedy for bloody and liverish disease. The both Hijama and phlebotomy techniques are ancient methods of removing blood from the body to attain remedy. The aim of the study was to compare biochemistries of blood products between the Hijama and the phlebotomy techniques among healthy young adults at fasting state. Material and methods: Thirty one healthy young adult consecutively enrolled according to the self-reported health questionnaire. The Hijama method practiced via instruction of Islam. Blood products of Hijama and phlebotomy removed and measured matching to design protocol. Results: The significant differences observed between triglyceride, cholesterol, uric acid, and urea concentrations in serum of Hijama with phlebotomy techniques (P<0.05). Conclusion: Meaningfully differences detected between the content of blood product in Hijama and phlebotomy techniques. It may be due to the effects of the Hijama practice. Further investigations are required in order to clear underlying mechanism of the Hijama in the future years.


Introduction
The objective of bloodletting (therapeutic bleeding) is a removing amount of blood volume from an open vein or artery(vascular access [1]) of the patients [2]. Bloodletting is the heritage of prehistoric methods of remedy and its history dates back more than two millennia [3]. The human seems to be a family with remedial properties of bloodletting in the ancient world [4]. Blood is a universal truth and bloodletting has been accepted as a concept of healing among different cultures such as; Chinese, Hindu, Arabs, and Greek medicine, [5]. It is believed that bloodletting effects on all ailments in human such as; cure number of illness,symptoms [6] and having roles in the prevention of diseases [7,8]. Let us imagine that bloodletting has been progressively modified through various applying methods and improving instruments among different cultures along the time such as; venesection (Fasd ‫,)=دصف‬ wet cupping [9], leech therapy [10] and phlebotomy techniques [11]. The Hijama is the name of the practice in Traditional Islamic Healing Technique (TIHT). The name of Al-Hijama ‫)هماجحلا(‬ is an Arabic and originated from the Hajm root ‫.)مجح(‬ It means sucking [12]. The literature review indicated that Hijama is exchanged with wet cupping [13], -blood-letting cupping [14] and subset of the prophetic medicine (treatment based on the instruction of faith Mohammad PBUH) [15]. Hijama differs from wet cupping. Cupping therapy is the oldest method, and wet-cupping is one of the classes of cupping in Chinese Traditional Medicine. The previous method was recorded as a treatment tool in 200 years ago [16]. The Hijama technique included two components; cupping and scarification. It is applied to the limited sites of the body surface areas and performed at specific days of the lunar cycle and lunar months [17].

Results
Thirty-one healthy subjects enrolled randomly. The Mean± standard deviation (SD) age recorded 24.93±2.74 years. The age ranged from 20-30 years. The sex included male, 84% (26) and female, 16% (5), respectively. Table 1 shows results of blood biochemistries between Hijama and phlebotomy techniques. Significant differences observed between serum values of triglyceride, cholesterol, urea, and uric acid concentrations in the blood produced of Hijama with phlebotomy techniques (p<0.05).

Discussion
Noticeable differences found between triglyceride, cholesterol, urea, and uric acid in serum of Hijama with phlebotomy techniques. Our results are an agreement with the fact that the blood as a material of the study was similar between both techniques. It seems that current concept may be due to the The Hijama is popular among Iranian public and well-known as the Hijamat. It has been performed most commonly in the spring season and annually. They have believed that it is Sunna (means what Prophet Mohammad's peace be upon him liked to do). Aside, it is effective in general health.
It is a method of healing and constructed in orders of Islam. Hijama confirmed evidence of the commentaries on the Quran. It recorded under the first sign from chapter 17 th ; children of Israel. It has been recommended by Islam as one of the gifts of God" Hadith: Lo, Mohammad (PBUH), to practice Hijama and order to perform your nation [21][22][23]. The Prophet Mohammed (PBUH) himself was cupping the Hijama and then Muslims do well to follow him. Nowaday, Hijama was applied as therapy, adjuvant treatment [24], and enhanced natural immunity [25]. The Avicenna is the father of modern medicine (980 -1037), brought into effective action Hijama as an Interventional therapy [26]. The aim of the study was to compare biochemistries of blood products between the Hijama and the phlebotomy techniques among healthy young adults at fasting state.

Material and Method
The study was a cross-sectional. In additional, history of common diseases evaluated through diagnosed by physicians and the subjects , awareness.
The excluded criteria consisted of cardiovascular diseases, renal disorders, diabetes mellitus or miscellaneous endocrinopathy, current infection in preceding two months ago, tuberculosis, dyslipidemia, and usage medications.
The one physician checked up participants and performed a physical examination, chest x-ray, complete blood count, fasting blood sugar, liver function test, kidney function test and profile of dyslipidemia. The eight participations refused the study. Generally, thirty-one subjects followed the criteria of the study.
The study carried out in specific days of the lunar month based upon the Islamic recommendation (Hadith  [30]. The Hijama is the name of unique traditional Islamic healing method. The healing concept depends on the removing bad or unclean blood( morbid substances ) from the body through some techniques [31]. It addressed for the firsttime since 10 Hejira years (A.H) by the Prophet of Islam. The Hijama was a known practice among Muslims. It applied as a remedy for the ancient ailments , suchlike liverish and blood diseases. It was practiced by the famous medical traditionalist physicians as Avicenna, Al-Jurjani, and Al-races in the past [32][33][34]. The antiqued therapeutic is known as the immemorial art and include enema, cupping, leech and counter-irritation [35]. Ayurvedic medicine is an ancient healing technique from Indian and founded on the control of the humoral system up to 2500 BC. It used bloodletting as a protocol of blood born disease via Leech-therapy [36]. The concept of human health has been defined according to the knowledge of ancient through control of humours (homer's medica). The humours are a complex concept and originated from the elements. The four essential elements of the life include Air, Water, Fire, and Earth. Each of them has four qualities Air= hot, wet, Water= cold, wet, Fire=hot, dry and Earth=cold, dry. They have organized four senses of humour and temperaments that linked to multiple organs. These consist of Blood; Sanguine with Heart, Phlegm; Phlegmatic with Brain, Yellow bile; choleric with liver and Black yellow; Melancholic with Spleen [37]. The humours imbalance or misplacement leads to the sickness [38]. One of the ways of developing a balance between different senses of humour is the elimination procedure [39]. The hot and wet upset presented clinically as blood humor disorders. Bloodletting eliminated superfluous humour from the body. It is accepted as one of the universal practice methods of remedy in the bloody illness [40].
Hijama consists of two components cupping and scarification, respectively. Cup instrument has dual functions in Hijama process. It used as a vacuum and collection device of removing blood. A cup made an animal horn with a hole in the pointed end in the past. It changed to a new design with a bell-shaped glass or bronze. Cupping process motivates hyperemia and congestion of superficial skin vessels. However, it may be stimulated a few skin reflexes on the Chinese meridian roots. The mechanism of Hijama has not been clearly understood as yet [41]. According to the recent Tibah theory, ultrastructure of the skin (capillary) permits the skin act as a filter for removing and cleaning the blood and interstitial fluid from the causative pathological substances(CPS) [42]. The another mechanism is recently suggested that the removing oxidant by Hijama and declining the level oxidative stress [43].
There is the difference between Hijama and wet-cupping.
Conforming to the database searching, wet-cupping technique is one of the types cupping technique 1 and was recorded in 200 years ago [44]. However, Hijama is older than it. The target sites of Hijama are special areas of the body surfaces. The most common site of Hijama located at the back and between scapula, back of the neck, the vertex of the head, lumbosacral region, and posterior aspect of the calf [45][46][47][48][49]. In addition, command of the performance Hijama and effectiveness in the number of illness are established in the specific lunar days and lunar months, perfectly exclusive. The earlier concept may support the healing effect of astrological events on the human body. A recent concept has not seen in wet-cupping alone. Aside, the practice guideline of Hijama has been originated by the Messenger. It founded with the Islamic texts [49][50][51][52][53]. The practice of Hijama has been advised for the protection of the health and therapy of the bloody humour disorders such as liverish and blood diseases [54,55].
There are association therapeutic points between Hijama with cupping and bloodletting. The Persian cupping therapy was used in the therapy of 1001 types illness [56]. Cupping therapy has various types as conditions; wet cupping, retained cupping, moving cupping, flash cupping, medicinal cupping, needle cupping and combined cupping 43. Cupping therapy mechanism has not been clearly understood. The suggested and known mechanism included that reducing inflammation, skin stiffness and peripheral, local substance P (44), decreased natural Killer cell [57].
All popular techniques of bloodletting used as management or treatment in different diseases. The cupping technique has been applied in the treatment of chronic pain [58] musculoskeletal pain, carpal tunnel syndrome, acne disease. The treatment of Hijama and wet cupping reported in a tension and migrant headache, low back pain, hypertension, thalassemia (Iron overload) and effective in the profile of dyslipidemia. A recent report indicated that the immunological, biochemistries and hematological blood products of the Hijama had significant differences with similar blood samples of the vein. It is an improvement with our resultants. Current concepts may be implicated about the effectiveness of Hijama. The different hypothesis may be advised that Hijama technique and anatomy of skin areas are both efficient on the outcome of the study. Pressure settings and scarification of the skin are both essential in the style. They can be influenced by the quality of blood biochemistries. We know that pressure effect is applied by a cup, should be had generalized and equally affected in the covered area under cupping space. Whereas, the outcome of the study indicated that there was a selection of the quality of blood products. However, cupping may be influenced by the lymphatic content and structure vessels , wall. induce hyperemia condition that conducts considerable of blood flow to the superficial. In addition, magnitude levels of pressure or applying time may be originated on the value of current distinctions of blood products. The designed study attempted to keep the effectiveness recent factors at limited value and prevented interchange variability through uniform applied pressure. In conclusion, there were suggestive differences between triglyceride, cholesterol, urea, and uric acid in serum of the Hijama with phlebotomy techniques. Planned studies should be required to determine the basic mechanism.