Death Associated with Wet Cupping Therapy (Hijama)

Wet cupping therapy (hijama), a traditional medicine practice, holds religious and cultural significance, particularly in Middle Eastern and Islamic societies. However, this practice can lead to serious complications, particularly when performed under inappropriate conditions or by unqualified individuals. This paper presents a case in which sudden cardiac death occurred following a hijama performed by an unlicensed practitioner on a patient diagnosed with ischemic stroke and a bladder tumor.

A 40-year-old male patient had hijama applied to different parts of his body on consecutive days. In the case review, it was determined that this may have contributed to hemodynamic instability and potentially precipitated sudden cardiac arrest due to cumulative blood loss and stress. Autopsy findings revealed myocardial fibrosis associated with previous myocardial infarction, and no other acute toxicological or pathological findings were present. While a direct causal link cannot be definitively proven, the close temporal association, forensic assessment, and lack of alternative causes suggest a plausible connection between the hijama procedure and the fatal outcome.

The authors concluded that this case underscores the importance of performing invasive traditional medicine practices under appropriate conditions and by authorized healthcare professionals. Raising awareness among the public and healthcare workers about such practices and ensuring the effective enforcement of legal regulations is critical to preventing potential complications.

Wet cupping involves scarring the skin at multiple sites and subsequently placing a vacuum cups on the areas. This would suck blood from the microcirculation of the skin into the cups. The total volume of blood is usually small relative to the ~5L a human body contains. It seems thus unlikely that it can contribute to hemodynamic instability in healthy individuals. However, the above patient was far from healthy. Thus, the procedure might indeed have contributed to his death.

This effect is likely to be an extremely rare event. Yet, it is worth remembering that wet cupping has other adverse effects that are much more frequent:

• It is painful.
• It can lead to nasty infections.
• It can leave unsightly scars.

Even more important is, I think, the fact that wet cupping has no or very few benefits. This means its risk/benefit balance fails to be positive. And, in turn, this means, that we should discourage people from using it.