Hijama (Wet Cupping) in Islamic Practice: Tradition, Evidence and Infection Risks

What it is

Hijama (also spelled hijamah, al-hijamah or hacamat) is the name used for wet cupping. In wet cupping the skin is pierced and blood flows into a cup, whereas dry cupping does not pierce the skin. [1] Dutch public health authorities call wet cupping an invasive treatment, because the skin is cut or pricked. [2] This page gives general information only. It does not explain how to do the procedure and no one should attempt it at home.

Tradition and cultural context

Wet cupping is practiced in many cultures. In Islamic communities it has special meaning, because according to Islamic tradition the Prophet Muhammad himself underwent hijama. [2] A concept analysis of Prophetic medicine lists wet cupping among the core elements of that tradition. [3] See Prophetic medicine for the wider context.

Persian medicine gives a humoral explanation. When there is excess blood in the body, and the body's own nature cannot remove it, the physician may let blood out by phlebotomy, wet cupping, leeches or other methods. [4] This is a traditional framework, not established biology. See traditional Persian medicine. Chinese dry cupping has its own history, covered in cupping therapy.

What research shows

Hold hijama to the same standard as any treatment. Benefit for pain is the most-studied claim.

1. Does wet cupping help pain?

   Unclear

   A systematic review of 14 randomized trials found 9 favored wet cupping over comparison treatments in conditions including non-specific low back pain, hypertension and carpal tunnel syndrome, but the trials had variable risk of bias and methodological limits. [5]

   Promising but limited

2. Is the effect lasting?

   Unclear

   A meta-analysis of 11 cupping trials for low back pain found pain improved at 2 to 8 weeks, but no continuing improvement at one month or at 3 to 6 months. [6]

   Mixed

3. Overall view of cupping research

   Unclear

   NCCIH says most research on cupping is low quality and that cupping may reduce pain, but the evidence is not very strong. [1]

   Insufficient evidence for most uses

4. Detoxifying or "removing toxins"

   Unclear

   Proper evidence not found. We looked for trials measuring toxin removal and found none in the sources read.

   No good evidence of benefit

5. Other claims (migraine, blood pressure, metabolic syndrome)

   Unclear

   Some trials in the wet cupping review favored wet cupping and others showed no significant difference. [5]

   Mixed

Trials of cupping cannot be fully hidden from participants, so expectation and attention may affect results. See understanding evidence.

Risks, especially infection

• Bloodborne infection. NCCIH says cupping equipment can become contaminated with blood, and using the same equipment on more than one person without sterilization can spread bloodborne diseases such as hepatitis B and C. [1]
• What studies show about that risk. Dutch public health authorities (RIVM) report a chance that practitioners or clients can catch hepatitis B or C when wet cupping is done without hygiene, and say earlier studies found higher hepatitis C risk in countries where hepatitis C is common. [2] They also note that a 2012 investigation of one practice after a case of acute hepatitis B probably found no transmission through the cups. [2] A short letter in a US infection-control journal also discusses the risk of bloodborne infections from hijama. [7]
• Bacterial infection. A case report from China describes a 33-year-old, otherwise healthy woman who developed a widespread Staphylococcus aureus infection after wet cupping, with fever, liver and kidney injury and an abscess. [8] It is rare, but the authors recommend high hygiene standards. [8]
• Blood loss. NCCIH reports anemia after repeated wet cupping. [1]
• Skin. Persistent discoloration, scars, burns and infections can occur, and cupping may worsen eczema or psoriasis. Marks should be explained to health providers so they are not mistaken for abuse. [1]
• Body type. Persian-medicine authors note wet cupping may cause harm in extremely thin or obese patients. [4]

For more on cupping injuries, see moxibustion and cupping risks.

Who should check with a clinician first

People with eczema or psoriasis, which cupping may worsen, [1] and people with anemia, since anemia has followed repeated wet cupping, [1] should talk with a doctor first. For pregnancy, children, blood thinners and weak immune systems, proper evidence not found in the sources we read, so ask a clinician before booking. Seek care urgently for fever, spreading redness, pus, severe pain or feeling very unwell after cupping. In the US, call 911 for an emergency.

Training and regulation by country

Rules differ widely and change. We cite only what we read, from the dates shown.

• Saudi Arabia. In 2015 the Ministry of Health announced licensing of cupping practice. Applicants would complete a training course, pass a test, and show they are free of infectious diseases including HIV, hepatitis B and C and tuberculosis, with the stated aim of curbing random practice at homes and barber shops. [9] Read 2026-10-22; current rules may have changed.
• Netherlands. According to RIVM (2023), only professionals in the national BIG register, such as doctors, are authorized to puncture or cut the body under the Wet BIG, and the health inspectorate oversees alternative care. [2] The same report says hijama courses exist but give certificates, and the professional association was not active. [2]
• Elsewhere. We did not read the rules of other countries or US states, so check your local health authority. A certificate from a course does not by itself mean a license.

See how to check a traditional practitioner, how traditional practices are regulated by country, and reporting a problem.