Mechanism of Hijāma bi’l Shart (wet cupping) explained in view of piezo channels in Waja’al-Rukbah (knee osteoarthritis): an open labelled, randomised, controlled clinical trial

Arsheed Iqbal; Mohammad Sheeraz Mushtaque Ahmed; Afroza Jan; Shugufta Hamid; Arjumand Shah; Huma; Nasir Nazir Wani; Arif Habib

doi:10.18203/2394-6040.ijcmph20254435

Authors

Arsheed Iqbal Regional Research Institute of Unani Medicine, Srinagar, Jammu and Kashmir, India
Mohammad Sheeraz Mushtaque Ahmed Department of Moalajat, Regional Research Institute of Unani Medicine, Srinagar, Jammu and Kashmir, India
Afroza Jan Department of Physiology, Government Unani Medical College, Ganderbal, Jammu and Kashmir, India
Shugufta Hamid Department of Moalajat, Regional Research Institute of Unani Medicine, Srinagar, Jammu and Kashmir, India
Arjumand Shah Regional Research Institute of Unani Medicine, Srinagar, Jammu and Kashmir, India
Huma Regional Research Institute of Unani Medicine, Srinagar, Jammu and Kashmir, India
Nasir Nazir Wani Department of ilmul Advia, Regional Research Institute of Unani Medicine, Srinagar, Jammu and Kashmir, India
Arif Habib Regional Research Institute of Unani Medicine, Srinagar, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20254435

Keywords:

Hijāma bi’l Shart, Knee osteoarthritis, Piezo channels, Waja’al-Rukbah, Wet cupping

Abstract

Background: Osteoarthritis (OA), described as Waja‘al-Mafāṣil in Unani medicine, results from an imbalance between degeneration and regeneration of articular cartilage and bone, where natural repair mechanisms become inadequate. It is a major public health issue and a leading cause of disability in developing countries. Wet cupping, an important Unani therapeutic modality, is explored here for its scientific basis through piezo-channels-mechanosensitive ion channels that convert mechanical pressure stimuli, a key component of wet cupping, into electrochemical signals that may influence joint pathology.

Methods: A non-inferiority RCT was conducted on 60 OA patients aged 40-70 years, randomized 1:1 into test (wet cupping) and control (Aceclofenac 100 mg twice daily) groups. The test group received five cupping sessions on days 0, 15, 30, 45 and 60, and both interventions lasted 8 weeks. Outcomes were assessed using WOMAC, 100-mm VAS, and active range of motion, along with subjective symptoms. Safety was evaluated through hemogram, LFT, KFT, and urine tests at baseline and week 8.

Results: Pre-protocol analysis included 60 patients (30 test, 30 control) who completed the study. Both groups showed significant improvement in objective parameters (VAS, WOMAC, AOR) and subjective measures. However, intergroup comparison revealed no statistically significant difference between the test and control groups.

Conclusions: Wet cupping’s mechanotransduction effects explain intergroup differences, suggesting it can serve as an effective alternative treatment for knee osteoarthritis.

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References

Fusco M, Skaper SD, Coaccioli S, Varrassi G, Paladini A. Degenerative joint diseases and neuroinflammation. Pain Pract. 2017;17(4):522-532. DOI: https://doi.org/10.1111/papr.12551

Dai WL, Zhou AG, Zhang H, Zhang J. Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. Arthroscopy. 2017;33(3):659-670. DOI: https://doi.org/10.1016/j.arthro.2016.09.024

Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646-56.

Guilak F. Biomechanical factors in osteoarthritis. Best Pract Res Clin Rheumatol. 2011;25(6):815-23.

Hunter DJ, Schofield D, Callander E. The individual and socioeconomic impact of osteoarthritis. Nat Rev Rheumatol. 2014;10(7):437-41. DOI: https://doi.org/10.1038/nrrheum.2014.44

Sowers M. Epidemiology of risk factors for osteoarthritis: systemic factors. Curr Opin Rheumatol. 2001;13(5):447-51. DOI: https://doi.org/10.1097/00002281-200109000-00018

Visser AW, de Mutsert R, le Cessie S, den Heijer M, Rosendaal FR, Kloppenburg M; NEO Study Group. The relative contribution of mechanical stress and systemic processes in different types of osteoarthritis: the NEO study. Ann Rheum Dis. 2015;74(10):1842-7. DOI: https://doi.org/10.1136/annrheumdis-2013-205012

Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol. 1965;38(455):810-24. DOI: https://doi.org/10.1259/0007-1285-38-455-810

Hochberg MC, Altman RD, Brandt KD, Clark BM, Dieppe PA, Griffin MR, et al. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee. American College of Rheumatology. Arthritis Rheum. 1995;38(11):1541-6. DOI: https://doi.org/10.1002/art.1780381104

Ashraf R, Mohi-ud-din R, Unani aspect of arthritis (Waja-ul-Mafasil) & its management: A review. Int J Herbal Medi. 2018;6(3):12-9.

Sina AA. Al Qanoon Fit Tib. (Urdu translated by Kantoori GH). Vol. 3. New Delhi: Idara Kitab u Shifa; YNM, 2007: 600-1129.

Ahmad AI, Hassan AI Jurjani, Shahi ZK. Urdu translation by HK Hadi hassan khan, Idara Kitab us Shifa, New Delhi, Volume 6; 1878: 637-638

Khan MA, Akseer-i-Azam (Al-Akseer) (Urdu translation by Hakeem Mohd Kabiruddin), Idara Kitabus Shifa, New Delhi 2011: 836-837.

Nayab M. Clinical Study on Effects of Hijāmat (Cupping Therapy) in the Management of Waja-ul-Mafāsil (Doctoral dissertation, Rajiv Gandhi University of Health Sciences (India)).

Nayab M, Anwar M, Qamri MA. Clinical study on Waja‘ al-Mafāṣil& evaluation of efficiency of Hijama-bila-shart in the treatment. Ancient science of life. Indian J Traditional Knowledge. 2011;10(4):697-701.

Baig MG, Quamri MA, Imtiyaz S, Sheeraz M, Ahmed Z. Concept and management of Wajaul-mafasil (arthritis) in greco arabic medicine-an overview. Int J Curr Res Rev. 2014;6(20):41.

Ranade SS, Syeda R, Patapoutian A. Mechanically activated ion channels. Neuron. 2015;87(6):1162-79. DOI: https://doi.org/10.1016/j.neuron.2015.08.032

Bagriantsev SN, Gracheva EO, Gallagher PG. Piezo proteins: regulators of mechanosensation and other cellular processes. J Biolog Chem. 2014;289(46):31673-81. DOI: https://doi.org/10.1074/jbc.R114.612697

Patil P, Dixit UR, Shettar CM. Risk factors of osteoarthritis knee-a cross-sectional study. IOSR-JDMS. 2012;2(5):08-10. DOI: https://doi.org/10.9790/0853-0250810

Asokan GV, Hussain MS, Ali EJ, Awate RV, Khadem ZK, Al-Safwan ZA. Osteoarthritis among women in Bahrain: a public health audit. Oman Med J. 2011;26(6):426. DOI: https://doi.org/10.5001/omj.2011.10

Connelly AE, Tucker AJ, Kott LS, Wright AJ, Duncan AM. Modifiable lifestyle factors are associated with lower pain levels in adults with knee osteoarthritis. Pain Res Manag. 2015;20(5):241-8. DOI: https://doi.org/10.1155/2015/389084

Al-Rubaye Kadhim Qasim Ali. The clinical and Histological skin changes after the cupping therapy (Al-Hujamah) J. Turkish Acad. Dermatol. 2012;6:1261. DOI: https://doi.org/10.6003/jtad.1261a1

Anderson AS, Loeser RF. Why is osteoarthritis an age-related disease?. Best Pract Res Clin Rheumatol. 2010;24(1):15-26. DOI: https://doi.org/10.1016/j.berh.2009.08.006

Pasero G, Marson P. Hippocrates and rheumatology. Clin Exp Rheumatol. 2004;22(6):687-9.

Khan AA, Jahangir U, Urooj S. Management of knee osteoarthritis with cupping therapy. J Advan Pharma Technol Res. 2013;4(4):217. DOI: https://doi.org/10.4103/2231-4040.121417

Kim JI, Lee MS, Lee DH, Boddy K, Ernst E. Cupping for treating pain: a systematic review. Evidence‐Based Complement Alternat Medi. 2011;2011(1):467014. DOI: https://doi.org/10.1093/ecam/nep035

Wang YT, Qi Y, Tang FY, Li FM, Li QH, Xu CP, et al. The effect of cupping therapy for low back pain: A meta-analysis based on existing randomized controlled trials. J Back Musculoskel Rehabilit. 2017;30(6):1187-95. DOI: https://doi.org/10.3233/BMR-169736

Kim JE, Cho JE, Do KS, Lim SY, Kim HJ, Yim JE. Effect of cupping therapy on range of motion, pain threshold, and muscle activity of the hamstring muscle compared to passive stretching. Kor Soci Phy Medi. 2017;12(3):23-32. DOI: https://doi.org/10.13066/kspm.2017.12.3.23

Wang N. Review of cellular mechanotransduction. J Phys D App Phys. 2017;50:233002. DOI: https://doi.org/10.1088/1361-6463/aa6e18

van Oers RF, Wang H, Bacabac RG. Osteocyte shape and mechanical loading. Curr Osteoporos Rep. 2015;13(2):61-6. DOI: https://doi.org/10.1007/s11914-015-0256-1

El Sayed SM, Mahmoud HS, Nabo MM. Methods of wet cupping therapy (Al-Hijamah): in light of modern medicine and prophetic medicine. Altern Integ Med. 2013;2(3):1-16. DOI: https://doi.org/10.4172/2327-5162.1000111

Yan Y, Wang L, Ge L, Pathak JL. Osteocyte-mediated translation of mechanical stimuli to cellular signaling and its role in bone and non-bone-related clinical complications. Curr Osteopor Rep. 2020;18(1):67-80. DOI: https://doi.org/10.1007/s11914-020-00564-9

Guilak F. Biomechanical factors in osteoarthritis. Best Pract Res Clin Rheumatol. 2011;25(6):815-23. DOI: https://doi.org/10.1016/j.berh.2011.11.013

Sun W, Chi S, Li Y, Ling S, Tan Y, Xu Y, et al. The mechanosensitive Piezo1 channel is required for bone formation. elife. 2019;8:e47454. DOI: https://doi.org/10.7554/eLife.47454

Li XF, Zhang Z, Li XD, Wang TB, Zhang HN. Mechanism of the Piezo1 protein-induced apoptosis of the chondrocytes through the MAPK/ERK1/2 signal pathway. Zhonghua yi xue za zhi. 2016;96(31):2472-7.

Bonewald LF. The amazing osteocyte. J Bone Min Res. 2011;26(2):229-38. DOI: https://doi.org/10.1002/jbmr.320

Zhang ZH, Jia XY, Fang JY, Chai H, Huang Q, She C, et al. Reduction of SOST gene promotes bone formation through the Wnt/β‐catenin signalling pathway and compensates particle‐induced osteolysis. J Cellu Mole Medi. 2020;24(7):4233-44. DOI: https://doi.org/10.1111/jcmm.15084

Hu L, Yin C, Zhao F, Ali A, Ma J, Qian A. Mesenchymal stem cells: cell fate decision to osteoblast or adipocyte and application in osteoporosis treatment. Int J Mole Sci. 2018;19(2):360. DOI: https://doi.org/10.3390/ijms19020360

Lee W, Leddy HA, Chen Y, Lee SH, Zelenski NA, McNulty AL, et al. Synergy between Piezo1 and Piezo2 channels confers high-strain mechanosensitivity to articular cartilage. Proceed Nat Acad Sci. 2014;111(47):E5114-22. DOI: https://doi.org/10.1073/pnas.1414298111