What this article covers
What is hijama and how is it performed?
Hijama, or wet cupping, is one of the oldest medical practices in human history. It holds a significant place in Islamic tradition, referenced in hadith, and remains widely practiced across the Arab world, Turkey, South Asia and parts of Africa. The procedure uses cups placed on the skin to create suction that draws the skin and underlying tissue upward. In dry cupping, this is all that happens. In wet cupping (hijama), small superficial cuts or punctures are made in the skin before or after the cup is placed, allowing a small quantity of blood to be drawn out.
A 2018 overview published in Journal of Acupuncture and Meridian Studies, titled 'Cupping Therapy: An Overview from a Modern Medicine Perspective' by Aboushanab and AlSanad, described wet cupping as a traditional medical procedure now studied within complementary medicine research, and noted that its practice in the Arab world and Muslim communities is grounded in centuries of cultural and religious heritage alongside therapeutic intent.
Dry cupping is simpler and carries lower risk because it does not break the skin and carries no infection risk from blood contact. It is increasingly used in sports recovery and physiotherapy settings. Wet cupping is the more traditional form and the one that requires careful attention to safety standards because it involves a wound-creating procedure.
Types of cupping therapy
| Type | Method | Relative risk level |
|---|---|---|
| Dry cupping | Suction cup on intact skin, no incisions | Low |
| Wet cupping (hijama) | Small skin punctures plus suction to draw blood | Moderate to high without strict hygiene |
| Gliding cupping | Cup moved across oiled skin | Low, used for muscle relaxation |
What does the research say about cupping's benefits?
A 2024 systematic review and meta-analysis published in Complementary Therapies in Medicine, titled 'The effectiveness of cupping therapy on low back pain' by Zhang and colleagues, analysed 17 randomised controlled trials and found that cupping significantly reduced chronic low back pain compared with no treatment. The benefit was smaller when cupping was compared against other active treatments, and the authors rated the overall evidence quality as low to moderate, calling for larger and better-designed studies.
A 2020 systematic review and meta-analysis published in The Journal of Pain, titled 'Cupping for Patients With Chronic Pain' by Cramer, Klose, Teut and colleagues, pooled data from multiple trials and found evidence of benefit for chronic pain conditions including neck pain, shoulder pain and low back pain. The reviewers added an important caveat: many included studies were small and at risk of bias because blinding participants to whether they received real versus sham cupping is difficult, which makes interpreting the results harder.
A 2025 meta-analysis published in BMJ Open, titled 'Effects of cupping therapy on chronic musculoskeletal pain' by Jia and colleagues, found improvements in pain and physical function with cupping therapy for musculoskeletal conditions, but noted significant heterogeneity across studies and called for higher-quality research. The honest summary: cupping is not placebo in the simple sense. There is something here worth studying. But the evidence base is not yet strong enough to make confident recommendations about who specifically benefits, by how much, and for how long.
Cupping and blood pressure: a closer look
A 2019 systematic review and meta-analysis published in Clinical and Experimental Hypertension, titled 'Wet cupping for hypertension' by Lu, Du, Fish and colleagues, analysed trials of wet cupping in people with high blood pressure and found small reductions in both systolic and diastolic readings. The reviewers flagged that most included studies were short-term and small, and that the reductions observed were not large enough to substitute for antihypertensive medication.
A 2025 review published in Cardiology in Review, titled 'Cupping Therapy: From Traditional Therapy to Cardiac Remedy' by El Ghazawi, Ajami and colleagues, noted growing interest in cupping within cardiovascular research but concluded that the existing evidence remains insufficient to recommend it as a standalone treatment for hypertension or heart disease. Mechanisms proposed include effects on local circulation, autonomic nervous system activity and stress reduction.
The practical message for anyone managing high blood pressure: cupping may offer a small supplementary benefit and some people find the sessions relaxing, which itself can temporarily lower blood pressure readings. But it must not replace prescribed medication, and you should tell your doctor if you are practising it, particularly if your blood pressure readings change after you start.
The real risks: infection and bleeding
Wet cupping is an invasive procedure because it deliberately breaks the skin. Any procedure that breaks the skin carries infection risk when sterility is not maintained. Unsterilised or reused blades and lancets can transmit serious bloodborne infections from one person to another, including hepatitis B, hepatitis C and HIV. This is not a theoretical concern: documented cases of infection transmission following cupping with non-sterile instruments exist in the medical literature globally.
The risk is higher in settings where cupping is performed in private homes or unlicensed centres without health oversight. In parts of the Arab world, cupping is practiced by individuals with no medical training who may not understand sterility principles. An instrument used on one person and wiped rather than discarded and replaced with a sealed sterile unit is a genuine infection hazard. This does not make cupping itself dangerous when performed properly, but it means the practitioner's standards matter as much as the technique.
Signs of infection after wet cupping that need a doctor's assessment: increasing redness, warmth and pain at the cupping sites after 24 to 48 hours, discharge of pus, fever, or swelling of nearby lymph nodes. The circular bruise-like marks left by dry cupping or suction are expected and not a sign of infection: they fade over days to weeks.
How to find a safe practitioner
One standard is non-negotiable for any wet cupping session: the practitioner must use sealed, individually wrapped sterile blades or lancets opened in front of you for the first time and discarded in a sharps container after your session. They are never reused on another person. If you see a practitioner use a blade on you that was previously used on someone else, or wipe and reuse a blade, leave.
Beyond the blade standard, a safe practitioner wears disposable medical gloves throughout the procedure and works in a clean environment. Before starting, they should ask you about your health history, what medications you take, and whether you have any conditions that increase bleeding or wound-healing problems. If a practitioner asks nothing about your health before proceeding, that is a warning sign.
Where possible, choose a licensed complementary medicine clinic over informal home-based services. Some countries in the region, including Saudi Arabia, have formal licensing frameworks for hijama practitioners. A practitioner who has undergone formal training in their country's framework is more likely to follow safety standards consistently. Ask about their training and certification before you book.
What to check before a cupping session
- 1Ask whether sealed sterile single-use blades will be used (ask to see the packaging opened)
- 2Confirm the practitioner will wear disposable gloves throughout
- 3Tell them all medicines you take, especially blood thinners
- 4Tell them about any chronic conditions including diabetes, kidney or liver disease
- 5After the session, keep contact details and watch for any signs of infection
Recovery after a cupping session
After dry cupping, circular reddish or brownish marks typically remain on the skin for several days to two weeks. These are caused by blood being drawn into the superficial tissues by the suction, not by bruising from impact. They fade without treatment and are considered an expected result. Tender muscles in the area may feel better after the marks fade. The colour of the marks is sometimes interpreted by traditional practitioners as reflecting the person's health status, but there is no medical evidence behind this interpretation.
After wet cupping, clean the small wounds with an appropriate antiseptic and keep them covered with a clean dressing for at least 24 hours. Avoid hot water, swimming and exposure to dirt or dust on the cupping sites until the small cuts have begun to close. Rest on the day of the session and avoid strenuous physical effort. Eat and drink normally before and after, and stay hydrated. In the days following, inspect the treated areas each time you shower to catch any early signs of infection.
Do not have wet cupping when you are already very fatigued, unwell or currently anaemic. Even a small blood loss in those conditions can worsen symptoms. Do not combine wet cupping with taking blood-thinning medication on the same day, as the combination increases bleeding risk significantly. If you are unsure about timing around your medication, ask your prescribing doctor.
For people with diabetes, healing of even small cuts is slower and infection risk is higher than in people without the condition. If your diabetes is well controlled and managed, your doctor may consider wet cupping acceptable with appropriate wound care and monitoring. If your blood sugars are frequently elevated or you already have complications affecting skin sensation or circulation, wet cupping is not a safe option.
Cupping in perspective: a complementary practice
The 2016 systematic review by Al Bedah, Khalil, Posadzki and colleagues published in Journal of Alternative and Complementary Medicine reviewed wet cupping trials and found evidence supporting its use in several conditions while clearly stating that methodological quality was insufficient for definitive conclusions. That remains the state of the evidence in 2026: promising signals in specific areas, not yet a treatment with the evidence base of established medicine.
Cupping is a practice with deep cultural, religious and traditional meaning across the Arab world and much of the Muslim community globally. This article aims neither to dismiss that significance nor to overstate what the science shows. Many people who practice hijama report genuine benefits in how they feel, and the role of a trusted traditional practice in wellbeing is real even when the mechanisms are incompletely understood.
The boundaries that matter from a safety standpoint are these: hijama is a complement to, not a replacement for, evidence-based medical treatment. Anyone with a serious condition, whether cancer, kidney failure, heart failure or uncontrolled diabetes, needs their medical treatment managed by a doctor. Cupping may offer additional comfort alongside that care, but it cannot substitute for it. And any practitioner who tells you otherwise is not serving your health interests.
In Sihtak you can log your cupping sessions and track any changes in your symptoms, pain levels or wellbeing over time. This helps you form a realistic picture of whether it is helping you specifically, and gives you something concrete to share with your doctor when discussing your complementary health practices.
Frequently asked questions
Is hijama scientifically supported?
There is preliminary scientific evidence that cupping reduces chronic pain, particularly back and neck pain, better than no treatment. The evidence quality is generally low to moderate, and larger higher-quality trials are still needed. It is not without any evidence, but it is not at the same level of established evidence as most conventional treatments.
Is cupping safe for everyone?
No. People on anticoagulant medication, those with anaemia, uncontrolled diabetes, bleeding disorders, active skin conditions at the treatment site, or who are pregnant should avoid wet cupping. Anyone with a chronic medical condition should consult their doctor before starting.
Can cupping treat high blood pressure?
Some studies show small temporary reductions in blood pressure readings with wet cupping. These reductions are not large enough to replace antihypertensive medication. Do not stop or adjust your blood pressure medication because of cupping. If you want to try it as a complement, tell your doctor first.
What are warning signs after a cupping session?
Increasing redness, warmth, pain and swelling at cupping sites after 24 hours, discharge of pus, fever, or swollen lymph nodes nearby, all warrant a doctor visit. The expected circular marks from suction that fade over one to two weeks are not a sign of infection.
Can cupping and medication be combined?
In most cases yes, but not always. The most important rule is never to stop a prescribed medicine in favour of cupping. Tell your doctor you are practising it, especially if you are on blood thinners or medicines that affect clotting. Some combinations of medication make wet cupping genuinely hazardous.
How often can cupping be done?
There is no medically established frequency. Traditional practice is commonly once or twice per month. More important than frequency is that each session is performed with full sterility standards and that the body has adequate time to heal between sessions. Daily cupping is not recommended.
Does cupping really remove bad blood?
The traditional description of cupping as removing harmful or stagnant blood is part of the historical and cultural framework of the practice. From a modern physiology standpoint, the blood that exits during wet cupping is ordinary blood from superficial capillaries. The mechanisms by which cupping may have therapeutic effects, such as local circulation changes, nerve stimulation and placebo response, are still being studied.
Sources
- Al Bedah AM, Khalil MK, Posadzki P et al: Evaluation of Wet Cupping Therapy: Systematic Review of Randomized Clinical Trials, Journal of alternative and complementary medicine, 2016
- Zhang Z, Pasapula M, Wang Z et al: The effectiveness of cupping therapy on low back pain: A systematic review and meta-analysis of randomized control trials, Complementary therapies in medicine, 2024
- Cramer H, Klose P, Teut M et al: Cupping for Patients With Chronic Pain: A Systematic Review and Meta-Analysis, The journal of pain, 2020
- Lu S, Du S, Fish A et al: Wet cupping for hypertension: a systematic review and meta-analysis, Clinical and experimental hypertension, 2019
- Aboushanab TS, AlSanad S: Cupping Therapy: An Overview from a Modern Medicine Perspective, Journal of acupuncture and meridian studies, 2018
- Jia Y, Dong X, Chai Y et al: Effects of cupping therapy on chronic musculoskeletal pain and collateral problems: a systematic review and meta-analysis, BMJ open, 2025
This content is for health education only and is not a substitute for medical advice. If you have symptoms that worry you, see your doctor.