Effect of Wet Cupping Therapy on Changes in

Cholesterol and Hemoglobin Levels in patients

given Cupping Therapy at Hamdalah Clinic
Makassar
Wahyuni Tahir, Rini Rachmawaty, Takdir Tahir
Nursing Science Program, Faculty of Medicine, University of Hasanuddin
Jl. Perintis Kemerdekaan Kampus Tamalanrea KM.10 Makassar Telp./Fax (0411) 581431
e-mail: wahyunnni@gmail.com, rini.rachmawaty80@gmail.com, ns.takdirpsikuh@gmail.com

ABSTRACT
High level of blood cholesterol is a risk factor the occurrence of atherosclerosis.
Atherosclerosis is a plaque that can clog arteries. Cupping therapy is a
complementary therapy that is based on Islamic believed to help reducing the
cholesterol levels. The secretion of number of blood due to wet cupping therapy
process result the important blood components in the body as well go wasted such as
hemoglobin. The purpose of this study was to determine the effect of cupping therapy
on changes in levels of cholesterol and hemoglobin in patients given wet cupping
therapy at Hamdalah Clinic Makassar. This study method used a pre-experiment
design: one group pre-post test design. Data obtained by using consecutive sampling
within 3 weeks. Data were collected by using a measurement of cholesterol and
hemoglobin levels on the 30 respondents who had met the inclusion criteria.
Cholesterol and hemoglobin measured 5 minutes before and 15 minutes after wet
cupping therapy was given. In this study showed that there was change in decreased
of cholesterol and hemoglobin levels before and after cupping therapy. The average
decreased in cholesterol as many as 29.36 mg / dl and hemoglobin 1.41 g / dl, with
the value of p<0.05. There was significant effect statistically and clinically on wet
cupping therapy to reduce cholesterol and hemoglobin levels in patients given wet
cupping therapy at Hamdalah Clinic Makassar.

Keywords: cholesterol, hemoglobin, cupping therapy

INTRODUCTION
Most people think that cholesterol
is a disease. But the fact, cholesterol is a
lipid component. Cholesterol is the main
constituent of the plasma membrane and
the plasma lipoprotein and is often found
as cholesteryl ester with the hydroxyl
group in the third position esterified with
a long chain fatty acid (Murray, Granner,
& Rodwell, 2003).
Cholesterol is a needed substance
in the body, especially in the formation of
cell walls as well as the formation of
steroid hormones. However, if the excess
cholesterol levels in the blood, it will be
buried in the walls of blood vessels and
lead to atherosclerosis which is a
narrowing or hardening of the arteries
which is a major cause of cardiovascular
disease (Anies, 2015).
High levels of blood cholesterol or
hypercholesterolemia is a risk factor for
atherosclerosis which is a plaque that
clogs arteries. Atherosclerosis most often
occurs in the arteries that flow through
heart, brain, kidneys and lower extremity
causing myocardial infarction, stroke due
to cerebral infarction and sudden cardiac
death (Robbin, Cotran, & Kumar, 2007).
According to the World Health
Organization (WHO), 80% of all
cardiovascular Diseases deaths (CVDs)
are due to heart attack and stroke. In
2013 the prevalence of coronary heart
disease in Indonesia is based on a
doctor's diagnosis is approximately
2.650.340 inhabitants. South Sulawesi is
in the eight position of the number of
patients with the most cardiovascular
disease in Indonesia (data and
information center Ministry of Health
Affairs, 2014), and heart disease is the
second case of death of people in the city
of Makassar in 2014 (Books pocket of
health department of Makassar, 2014).
The handling of high cholesterol
levels can be handled by using
pharmacological and non pharmacological
therapy. Pharmacological therapy is
commonly used to consume drugs known
as statins, fibrates, resins and others (Bull
& Morrel, 2007). While the non-
pharmacological treatment can be done
with medical nutrition therapy (high-fiber
diet), increased physical activity such as
brisk walking, small running, cycling 3-5
times per week for 30-60 minutes as well
as alternative therapies (cupping therapy)
(Fikri, 2011 ).
In many health services places,
some clients ask about complementary
therapies or the alternative to the health
care workers such as doctors and nurses
(Widyatuti, 2008). The reason that the
client using complementary therapies is
they wanted to be directly involved in
decision making in the treatment and
improved quality of life. Approximately
82% of patients reported adverse
reactions are perceived from conventional
medicine so as choose complementary
therapies (Snyder & Lindquist, 2002).
Cupping Therapy in Indonesia has
been widely known by the public, it can
be seen by the number of houses or
clinics that provide cupping therapy
services. Cupping is the best choice for
people to seek treatment because it is
cheap, safe, practical and follow the
Sunnah of the Prophet Muhammad
(Gustriansyah, Sunardi, & Suhandi,
2014). Cupping therapy is actually one of
non-invasive complementary therapy
which is a traditional therapy combined
with the modern medical treatment
(Widyatuti, 2008). As a complementary
therapy, cupping has existed since long
time, it is about 2000 years BCE and is
widely known in the community with all
its various versions such as cupping
therapy, cupping, blood-letting therapy,
al-hijamah, candhuk and so forth.
Cupping therapy is done by suction with
or without bleeding through a small
incision in the skin surface which aims to
detoxification or harmful toxic secretion
for health (Umar, 2013).
The mechanisms underlying the
effect of cupping therapy on cholesterol-
decreased according to Sayed, (2013) that
allows the excretion through the skin
artificially due to small and thin injury as
well as vacuumitation. This process called
analogous from renal excretion. The
potential components to be excreted i.e.
waste products of the body's metabolism,
free radicals, chemical and biological
substances are released into the
interstitial fluid and blood, including
hydrophilic or hydrophubic including
lipoprotein or cholesterol.
 Research conducted in Syria by
using cupping method on 300 diseases
was found that in patients with
hypertension were decreased to normal
levels, cardiac electrical wave signal into a
proportional and an increase in cases of
anemia, Hemoglobin levels to the normal
range. It was also reported that about
75% of cases that had excess levels of
creatinine in the blood was decreased. In
addition 83% of cases on
hypercholesteromia patients experienced
cholesterol decreased in the blood, as well
as 66% of cases there was an increase of
iron levels in the normal range in patients
with iron deficiency (Sharaf, 2012).
Results of research conducted by
Saad (2006) entitled aspects of molecules
on the relationship of cupping therapy on
immune function in patients with chronic
HCV infection revealed that the results
showed the effect of cupping can improve
platelet counts in cupping that done
repeatedly, the increase in the number of
lymphocytes, as well as increased levels of
hemoglobin in the blood.
Research conducted by Fikri,
(2011), entitled decrease in cholesterol
levels with cupping therapy was found
that there is a significant effect of cupping
therapy on cholesterol-decreased. The
highest cholesterol levels decreased as
many as 82 mg / dl and the lowest was
10 mg / dl in patients aged 45 years and
over with hypercholesterol.
Other studies conducted by
Widodo & Khoiriyah, (2014) that the
average initial total blood cholesterol
283.5 mg / dl decreased to 246 mg / dl in
the second stage and into 244.25 mg / dl
at the final stage. These levels tend to
decline based on the progress of the
intervention, which means that there are
significant differences in levels based on
the progress of treatment or indicated the
presence of wet cupping therapy to
decrease total blood cholesterol levels in
patients with hypercholesterolemia.
Research conducted by Yunus,
(2015) about the effectiveness of Cupping
Therapy on Cholesterol Levels decreased
in 36 people in Ash Shihhah Clinic
Makassar concluded that the average
cholesterol levels of respondents prior to
the cupping therapy 230.39 mg / dl. After
cupping therapy average cholesterol levels
of respondents as many as 205.97 mg /
dl.
Based on information obtained at
Hamdallah Clinic Makassar by
interviewing the head of the clinic found
that 73% - 75% of patient with
hypercholesteromia history after cupping
therapy, decreased the cholesterol levels
in the blood.
Based on the background above,
researchers are interested in conducting
research about "The Effect of Cupping
Therapy on Changes in cholesterol and
Hemoglobin levels in Patients Given
Cupping Therapy".
METHODS
This study method used pre-
experiment design: one group pre-post
test design. Data were collected by using a
measurement of cholesterol and
hemoglobin levels on 30 respondents who
had met the inclusion criteria. Data were
obtained by using consecutive sampling
within 3 weeks was analyzed using a
statistical test. The instrument used in
this study was a questionnaire on
demographic data, cholesterol and
hemoglobin measurement tool (easy touch
GCHB)
Prior to the study, the researchers
gave informed content to the cupping
therapy patient. Researchers explain the
procedures to patients begin from
measurement procedures of cholesterol
and hemoglobin to the benefits that can
be obtained. Patients are willing to
become respondent then given the
informed content sheet to be signed on
the consent to be respondents.
Cholesterol and hemoglobin levels
measurements in this study performed
twice. The first measurements of
cholesterol and hemoglobin by these
researchers performed 5 minutes before
cupping therapy. Furthermore,
researchers measured levels of cholesterol
and hemoglobin 15 minutes after
respondents were given by experts
cupping therapy at hamdalah Clinic
Makassar.
 RESULTS Variable Mean (SD) Pre Mean (SD) Post Changes P
Characteristics of Respondents *Cholesterol 242.73 (± 37 622) 213.37 (± 24 604) 29.36
All respondents in this study were 0:00
female and had no smoking history as ** HB 12.46 (1.19123) 11.05 (0.99989) 1.41
many as 30 people (100%). Judging from * Wilcoxon test
the age characteristics obtained the ** Paired t-test
average mean of respondent is (37.17)
with standard deviation (9.063). Mean By using the Wilcoxon test found
average of respondent visitation in that of each group of data (pre and post) it
performing cupping therapy is (3.67) with appears that the mean average values
standard deviation (6177). Seen through before treatment was (242.73 mg / dl)
the respondent duration following with standard deviation (37.622) which is
cupping therapy the mean average is smaller than the value before treatment
(1.97) with standard deviation (8.65). i.e. (213.37 mg / dl) with standard
From the total respondents the mean deviation (24 604). Where the magnitude
average of cupping treatment amount is of the decreased in cholesterol levels pre
(14.93) with standard deviation (3542). and post cupping therapy is given as
Table 5.1 Distribution Kareteristik Respondents many as 29.36 mg / dl with the value of p
by Age, Visits to, and amount Lama
= 00:00 then (p <0.05). It is concluded
Following Cupping Cupping Clinic
Makassar hamdalah December- that there are significant effect
January 2017 (n = 30) statistically and clinically on wet cupping
Percentage Max therapy to decrease cholesterol levels.
Characteristic N Min
(%)
Gender In table 5.2 can be seen in the
Male 30 (100%) mean average of hemoglobin levels are
equal to (12:46 g / dl) with standard
History
Not Smoking 30 (100%)
deviation (1.19123). While hemoglobin
levels after cupping therapy, the mean
Mean (SD)
average is smaller than before the therapy
as many as (11:05 g / dl) with standard
age 37.17 (9063) 25 58
deviation (0.99989). Confidence Interval
Visitation 3.67 (6177) 1 24 minimum value is (1.04404) for the
Long follow 9:33 (15 593) 2 48 maximum value is (1.76263). The value of
Number of 14.93 (3542) 10 22 p = 0.000 with a significance level of 95%
cupping then (p<0.05). It is concluded that there
are effect significant statistically and
By using SPSS Statistics 20 clinically on wet cupping therapy to
researchers find the content in the data decrease the hemoglobin levels.
that cholesterol level before cupping
therapy were normally distributed, Table. 5.3 Correlation of the long followed
whereas in cholesterol levels after cupping Cupping, Number of Cupping
therapy is given the data were not with Cholesterol and
normally distributed. Because one of the Hemoglobin Levels after Wet
data was not normally distributed, the Cupping Therapy Given at
researchers decide to use the Wilcoxon Hamdalah Clinic Makassar,
test. While the data of hemoglobin levels December 2016 - January 2017
before and after cupping therapy were (n = 30)
normally distributed so that researchers
Cholesterol level Hemoglobin level
decide to use Paired t-test Variable
R p r P
Long followed cupping -0147 0439 -. 062 0745

Table 5.2 Cholesterol and Hemoglobin
Levels Before And After
Cupping Therapy Given at
hamdalah Clinic Makassar
(n = 30)
Number of cupping 0153 0418 -0386 0035
The table above shows the value of
p on long followed cupping as many as
(0.0439) with significant p > 0.05. This
study indicated that there was no effect
between the long followed respondents in
therapy with cholesterol levels after given
wet cupping therapy. The value of p on
hemoglobin as many as (0.745) with
significant p > 0.05. This study indicated
that there was no effect between the long
followed respondents in therapy with
hemoglobin levels after given wet cupping
therapy.
In the table above also shows the
value of p on cholesterol as many as
(0.41b) with significant of p > 0.05. This
study indicated that there was no effect of
cupping frequency given to the
respondent with cholesterol levels after
given wet cupping therapy. And the value
of p on hemoglobin as many as (0.035)
with significant of p > 0.05. This study
indicated that there was effect of the
amount of cupping given to respondents
with hemoglobin level during therapy after
given wet cupping therapy.
DISCUSSION
1. Characteristics of Respondents
a. Gender
In this study, all respondents were
female as many as 30 respondents (100%)
with average cholesterol levels before
cupping therapy was 242.73 mg / dl.
Based on gender, males approximately 50
years old had 2-3 times greater risk than
women to suffer atherosclerosis. However,
during menopause women tend to have
equivalent cholesterol levels as male
(Anies, 2015).
Results of research conducted by
Ujiani, (2014) about the relationship
between age and gender with cholesterol
levels of obese people explained that there
was no significant correlation between
gender factor with cholesterol levels. But
women have a greater risk of increased
cholesterol levels. Before menopause,
women tend to have lower total
cholesterol levels than men of the same
age. Cholesterol levels in women and men,
naturally increases with age and
menopause are often associated with
increased cholesterol in women.
From the results of research
conducted by researchers on hemoglobin
level before given cupping therapy had
mean average (12:46 g / dl). It is known
that hemoglobin levels of women are lower
than men hemoglobin levels. The
difference is because women menstruate.
In addition there are hormonal differences
in men and women that affect hemoglobin
(Hidayat & Utomo, 2004)
b. Age
In this study, the average respondent
age ± 37 years with the cholesterol levels
result were 242.73 mg / dl.
Hypercholesterolemia usually occurs
when a person is 50 years old and above.
However, research conducted in 2004 in
Indonesia showed that about 9.3% of
hypercholesterolemia occurs at a young
age i.e. 25-34 years old (Anies, 2015).
Results of research conducted by
Ujiani, (2014) with the sample as many 57
and 63.3% are women using Spearmean
correlation test was p = 0.252. These
results explain that there was no
significant correlation between age and
cholesterol levels.
Based on the results of research
carried out in 30 respondents were on
average aged 37.17 years had an average
cholesterol levels before treatment
amounted to 242.17. Results of research
conducted by Rizkiawati, (2012) stated
that there is a relationship between age
and hemoglobin level. In the study
explained that increasing age and
decreased function of organs including
the lungs makes it easy to lead into the
respiratory system further into the lungs
and affect the levels of hemoglobin in the
blood.
c. smoking history
According Anies(2015) explained that
there were several factors that influence
blood cholesterol levels one of them is
smoking. The smokers tend to suffer
atherosclerosis and coronary heart
disease. Smoking habits may also
decrease levels of HDL cholesterol,
resulting in easier blood clot.
Smoking is an addictive substance
made from ingredients produced from
tobacco and can result in respiratory
distress. Besides harmful to the body,
smoking can also increase the production
of blood hemoglobin (Makawekes, Kalangi,
& paisak, 2016).
Research conducted by Makawekes,
Kalangi, & paisak (2016) by comparing
the blood hemoglobin levels in male
smokers and non-smokers. Showed that
hemoglobin level is higher in male
smokers compared with men who did not.
In the study explained that the
increased of hemoglobin in men smoking
occurs because the reflexes of
compensatory mechanisms of the body to
low levels of oxygen binds to hemoglobin
as a result shifted by carbon monoxide
has an affinity for stronger hemoglobin.
So the body will improve and increase
hemotopoesis then increase the
production of hemoglobin, due to the low
partial pressure of oxygen (PO2) in the
body.
d. Visitation and history of cupping
therapy
Results showed that the mean
average of the respondent visitation in
performing cupping therapy as many as
3.67 with mean average of respondent
follow the cupping therapy as many as
1.97. In many health services places some
clients ask about complementary
therapies or alternative to health care
workers such as doctors and nurses
(Widyatuti, 2008). The reason the client
using complementary therapies is the
client wanted to be directly involved in
decision making in the treatment and
improved quality of life. (Snyder &
Lindquist, 2002).
There are several factors regarding
the respondents chose cupping for
treatment. Nurdiyana, et al (2010) stated
that there are three patient motivations in
following the cupping therapy. Patients
simply want to cure the illness
(motivation biogenetic), patient follow
cupping therapy because of the influence
of the environment (sosiogenetis
motivation) and the factor to follow
religious norms (motivation teogenesis).
e. Number of cupping
Results of research conducted by
researchers at hamdalah Clinic Makassar,
the average value of number of cupping
given to the respondents were 14 cup. The
number of each cup given to respondents
is various according to the complaint and
the patient's condition.
2. Changes in cholesterol levels pre and
post cupping therapy
Cholesterol is a chemical compound
that is naturally produced by the body
and the combination of lipid (fat) and
steroid. Approximately 80% of the body's
cholesterol is produced by liver, while the
rest comes from the food we eat. The liver
can regulate cholesterol levels in the blood
stream and can secrete cholesterol if it is
needed by the body. LDL cholesterol is
called bad cholesterol because increased
levels of LDL cholesterol are associated
with an increased risk of coronary heart
disease. Whereas HDL cholesterol is
called good cholesterol because HDL
cholesterol particle prevent
atherosclerosis by extracting cholesterol
from the artery walls and remove them
through the liver (Hall, & Edward, 2011).
According to traditional medicine,
presence a humid heat element in the
liver is a cause hypercholesterolemia. If
moist heat in the liver is excessive it will
cause damage to the liver, stomach and
spleen. Therefore, it is necessary to spend
a hot humid element of the liver, stomach
and spleen. In this case the cupping can
remove the element of moist heat through
a process of bloodletting. In addition
Cupping can also repair organs or blood
vessels damaged by stimulating the organ
with the treatment. Cupping is also
expected to restore full function of blood
vessels cholesterol plaques through
hemostatic theory (Umar, 2013).
The results using Wilcoxon statistical
tests obtained mean cholesterol levels
after therapy is smaller than before the
therapy. The value of P = the because of P
<0.05, it can be concluded that there are
differences in cholesterol levels before and
after cupping therapy given at hamdalah
clinic Makassar.
According to Sayed, (2013) that the
cupping therapy enabling small and thin
injury to the skin surface. Excretion
through the skin artificially due
vacuumitation in the area of injury or
incision is a spending waste products the
body's metabolism, free radicals,
chemistry substances, and biology are
released into the interstitial liquid and
blood including Hydropic and hydropubic
substance including lipoprotein or
cholesterol.
Research is also conducted by
Mustafa Dawood, and Al-Sabawy, (2012),
entitled wet cupping effect on serum lipid
profile in patients with hyperlipidemia.
This study aimed to evaluate the effect of
cupping therapy on serum lipids, the
concentration profile and its relationship
with some of the elements Cu, Zn, and
Mn.
The results of these studies have
demonstrated significant decreased in
total cholesterol, LDL-cholesterol and LDL
/ HDL ratio in the 1st and 2nd weeks.
Meanwhile, there is no significant change
in HDL cholesterol and triglycerides.
In a study carried out by Mahdavi,
Ghazanfari, Aghajni, Danyali, & Naseri
which aimed to see a decreased in serum
lipoproteins, especially LDL cholesterol on
atherosclerosis prevention by wet cupping
due to blood secretion process. The study
used two comparison groups. The first
group was given treatment procedure and
another group as a control group
treatment. The concentration of serum
lipids were collected from the brachial
vein taken during wet cupping for 3
weeks. It was found that the decreased in
LDL cholesterol was found in the
treatment group compared with the
control group. There are no significant
changes in serum triglyceride between
groups. Although no statistically
significant changes in total cholesterol
and HDL cholesterol, total cholesterol
decrease of 7% and 3% increase in HDL
may be important clinically.
Niasari, et al., (2007) suggested that
the concentration of HDL, LDL, TG and
cholesterol in wet cupping is significantly
higher than the venous blood. This means
that the cupping may play an important
role in decreasing risk factors for
atherosclerosis with advanced extrusion
lipid.
Although cupping therapy has been
used for thousands years as a traditional
therapy for various diseases, the
mechanisms that underlie the workings of
cupping therapy remain unknown. Many
questions arise from time to time about
the proper role of cupping in treating
disease to explain the benefits of cupping
therapy.
3. Changes in hemoglobin levels pre and
post cupping therapy
Erythrocytes or RBCs have a cupping therapy at hamdalah Clinic
biconcave disk-like structure without a
core diameter of approximately 0.007 mm
and contains 300 million molecules of
hemoglobin (Parker, 2007). The
hemoglobin protein is a major component
of red blood cells. Hemoglobin composed
of molecules containing iron (heme) and
was bound by globulin protein (Kowalak,
Weish, and Brenna, 2011).
Anemia or hemoglobin below 13g% in
men and 12g% in women are the signs
and symptoms of certain diseases.
Anemia can be caused due to reduced
production, increased destruction or loss
of red blood cells (Oehadian, 2012).
If there is quickly bleeding, the body
will replace the fluid plasma within 1 to 3
days, but the concentration of red blood
cells become low. The concentration of red
blood cells will be back within 3 to 6
weeks if no bleeding occurs next. In
chronic intestinal blood loss cannot
absorb enough iron to form hemoglobin
as soon as blood loss. Red blood cells are
formed also have a smaller structure and
the hemoglobin contained in them very
little (Guyton & Hall, 2011).
Cupping is a treatment by sucking
the blood and removing it from the skin
surface which is then accommodated into
the glass that causes concentration and
secretion of blood, then made an incision
surface of the skin with a scalpel to
bleeding (Aldjoefri, 2015).
The secretion of number of blood due
to wet cupping therapy process result the
important blood components in the body
as well go wasted such as hemoglobin. So
that the person given cupping therapy,
the hemoglobin level in these patients is
lessened.
Conclusion
From the research, it can be
concluded that:
1. There is difference in the decrease of
cholesterol levels before and after given
wet cupping therapy which is
decreased in average as many as 29.36
mg / dl.
2. There is difference in the decrease of
hemoglobin levels before and after wet
cupping therapy which is decreased in
average as many as 1.41 g / dl
3. There was a significant effect
statistically and clinically wet cupping
therapy to decrease cholesterol and
hemoglobin levels in patients given wet
Makassar.
ADVICE
1. In patients given wet cupping therapy
should not be in a state of
menstruation. Because of blood loss
during wet cupping process can
increase the amount of blood loss due
to wet cupping process so that
patients can suffer anemia.
2. Wet cupping therapy should not be
performed in patients with
hemoglobin levels below normal.
3. Before the patient is given the wet
cupping therapy should do
hemoglobin test.
4. Further research must be done by
calculating the amount of secretion
blood when the patient is given wet
 cupping therapy. melaksanakan dan
5. Further studies should be done to menerapkan hasil penelitian.
examine the male respondents and Jakarta Timur: CV Trans info
used for control group as comparison media.
group.
6. Recommendations for further Djojodibroto, d. (2001). Seluk-beluk
research to take samples with a pemeriksaan kesehatan (general
larger number and use better of medical chek up ) : bagaimana
measuring instruments. menyikapi hasilnya. Jakarta:
7. For future studies should also Pustaka populer obor.
examine the input and output of
nutrients in patients given cupping Evelyn, p. (2009). Anatomi dan fisiologi
therapy to see changes in hemoglobin untuk paramedis. Jakarta:
and cholesterol levels. Gramedia pustaka utama.
8. Scientific mechanisms underlying the
Fikri, Z. (2011). Penurunan kadar
workings of cupping therapy is still
kolesterol dengan terapi bekam.
unknown with certainty, it should be
204-206.
done further research on the
mechanism of how the cupping Gustriansyah, r., Sunardi, h., & Suhandi,
therapy works n. (2014). Pembangunan m-bekam
berbasis sistem pakar.
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