J Acupunct Meridian Stud 2018;11(5):269e272

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- Letter to the Editor -

A Quality Model to Select Patients in

Cupping Therapy Clinics: A New Tool for
Ensuring Safety in Clinical Practice

KEYWORDS Abstract
Cupping therapy; Cupping therapy is a popular treatment in various countries and regions, including Saudi
Hijama; Arabia. Cupping therapy is regulated in Saudi Arabia by the National Center for Comple-
Quality; mentary and Alternative Medicine, Ministry of Health. The authors recommend that this
Safety; quality model to select patients in cupping clinics - version 1 (QMSPCC-1)dbe used
Model routinely as part of clinical practice and quality management in cupping clinics. The aim
of the quality model is to ensure the safety of patients and to introduce and facilitate qual-
ity and auditing processes in cupping therapy clinics. Clinical evaluation of this tool is re-
commended. Continued development, reevaluation and reassessment of this tool are
important.

1. Introduction 2. Safety of cupping therapy

Cupping therapy is a traditional and complementary me-
dicinal practice and is one of the oldest healing techniques.
It is popular across various countries and regions, such as
China, India, Saudi Arabia, Malaysia, Central Europe, and
Africa [1].
There are numerous types of cupping therapy, such as
wet, dry, massage, flash, magnetic, and water cupping.
Cupping types can be classified according to five categories:
technique, power of suction, method of suction, added
therapy, and condition and area treated. Some studies have
reported the efficacy of cupping therapy in the treatment
of pain-related conditions [2].
Cupping therapy is regulated in Saudi Arabia by the Na-
tional Center for Complementary and Alternative Medicine,
Ministry of Health.
Cupping therapy is a relatively safe practice; however,
some adverse events related to cupping practice have been
reported [3]. These adverse events are classified as pre-
ventable and nonpreventable. Preventable adverse events
include scar formation, burns, bullae formation, abscesses,
skin infections, pruritus, anemia, and panniculitis. [2] Most
of these adverse events can be prevented by effective
training and following infection controls and good practice
guidelines [4]. Developing and using a quality model for
selecting patients is an important step toward the safe
practice of cupping therapy and the standardization of
treatment methods.
Cupping therapy is contraindicated for patients with
cancer, renal failure, hepatic failure, and bleeding disor-
ders. Furthermore, it is also contraindicated for direct use

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270
on varicose veins and for patients using a pacemaker or
anticoagulants. Precaution should be taken for patients
with skin grafts, skin infections, abscesses, diabetic neu-
ropathy, and extreme hunger or satiation and those using
herbs with anticoagulant effects [5].
3. The quality model for selecting patients
The authors recommend that the quality model to select
patients in cupping clinics - version 1 (QMSPCC-1)dbe
Figure 1 Selection process flow chart (QMSPCC-1).
Letter to the Editor
used routinely as a part of clinical practice and quality
management. We hypothesize that by using QMSPCC-1, the
selection process of patients suitable for cupping therapy
will be enhanced. Performing cupping therapy exclusively
on suitable patients will protect others from unnecessary
adverse events. Completing the checklist for each patient
will automate the process of patient evaluation, thus
avoiding missing any data or any evaluation steps.
A patient arriving at a cupping (Hijama) clinic should be
evaluated carefully by a cupping therapy practitioner.
Letter to the Editor
Figure 2 Checklist auditing tool (QMSPCC-1).
Medical history should be obtained. Vital signs should be
measured. All cupping contraindications are excluded, and
general physical examination is performed. If the patient
has any abnormality or contraindication, the cupping
therapy practitioner should refer the patient to a medical
specialist. If the patient is suitable for cupping, the cupping
therapy practitioner should let the patient read and sign
the informed consent. If the patient signs the informed
consent, the practitioner should prepare the patient for the
cupping session. If the patient refuses to sign the consent
for any reason, the cupping practitioner should terminate
the session. If the answer is “No” to any part of the
checklist tool, then the practitioner should reevaluate,
refer, or terminate the session. The flow chart of the pro-
cedure is shown in Fig. 1. The checklist tool is shown in
Fig. 2.
4. Clinical importance
The use of this tool will introduce quality assurance to
cupping clinics. It will facilitate supervision, auditing, and
coaching processes at cupping clinics. Furthermore, it will
have an impact on ensuring the safety of patients. Finally,
following the process and filling the tool items for each
patient will transform these good clinical processes into an
automated, error-free procedure.
271
5. Conclusion
The aim of the quality model to select patients in cupping
clinics - version 1 (QMSPCC-1)dis to ensure the safety of
patients and to introduce and facilitate quality and auditing
processes to cupping therapy clinics.
Clinical evaluation of this tool is recommended.
Continued development, revaluation, and reassessment of
this tool are important.
Declaration of interest
No.
References
[1] Michalsen A, Bock S, Lüdtke R, Rampp T, Baecker M,
Bachmann J, et al. Effects of traditional cupping therapy in
patients with carpal tunnel syndrome: a randomized controlled
trial. J Pain 2009 Jun 1;10(6):601e8.
[2] Aboushanab TS, AlSanad S. Cupping therapy: an overview from
a modern medicine perspective. J Acupunct Meridian Stud 2018
Feb 7;11(3):83e7.
[3] Kim TH, Kim KH, Choi JY, Lee MS. Adverse events related to
cupping therapy in studies conducted in Korea: a systematic
review. Eur J Integr Med 2014 Aug 1;6(4):434e40.
[4] Al-Bedah AM, Shaban T, Suhaibani A, Gazzaffi I, Khalil M,
Qureshi NA. safety of cupping therapy in studies conducted in
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twenty one century: a review of literature. BJMMR 2016;15(8):
1e12.
[5] Cupping therapy regulation rules for practitioners and facil-
ities. Saudi Arabia: National Center for Complementary and
Alternative Medicine, Ministry of Health; 2015. p. 14.
Tamer Aboushanab*
Master of Child Health and Nutrition, National Center for
Complementary and Alternative Medicine, Ministry of
Health, Saudi Arabia
Letter to the Editor
Saud AlSanad
National Center for Complementary and Alternative
Medicine, Ministry of Health, Saudi Arabia
College of Medicine, Al Imam Mohammad Ibn Saud Islamic
University (IMSIU), Al-Nada, Riyadh, Saudi Arabia
E-mail: s.alsanad@nccam.gov.sa
*Corresponding author. National Center for Complementary
and Alternative Medicine, Ministry of Health, Saudi Arabia.
E-mail: tamer.shaban@gmail.com
27 April 2018
Available online 8 June 2018