Anatomical Sites for Practicing Wet Cupping Therapy (Al-Hijamah): In Light of Modern Medicine and Prophetic Medicine

Wet cupping therapy (WCT) is increasingly practiced worldwide, especially in hospitals of China and Germany. Al-hijamah is WCT of prophetic medicine. Al-hijamah was recently reported to be more effective than Chinese WCT. Al-hijamah filters and clears blood and interstitial fluids from causative pathological substances (CPS) including disease-causing substances (DCS) and disease-related substances (DRS) according to the evidence-based Taibah theory. This occurs via a percutaneous pressure-dependent and size-dependent filtration of capillary blood of skin circulation. This explains why Al-hijamah treats diseases with different pathogeneses e.g. headache and rheumatoid arthritis. Hijamatology is a novel term describing the science of education, qualification, practice and research related to Al-hijamah. Al-hijamah was described by Prophet Mohammad (Muhammad) peace be upon him as one of the best remedies: “The best among what you use in therapy is Al-Hijamah and Al-Qust Al-Bahri (white roots of saussurealappa)”. No published research studies are there to guide researchers, physicians and practitioners to the best anatomical sites for practicing Al-hijamah for treating different diseases as this science is still in its beginning and may benefit from future research. Based on our background in prophetic medicine, anatomy, medicine and our practice, we review here prophetic medicine, its remedies, cupping therapy of prophetic medicine (Al-hijamah), indications and anatomical sites that may be suitable for practicing Al-hijamah. Suitable anatomical sites for practicing Al-hijamah differ from disease to disease. In prophetic medicine, Al-hijamah was practiced at skin overlying and near sites of pathology e.g. skin overlying skull vertex, dorsal surface of the foot, thigh region and at general sites e.g. kahel region (mainly skin overlying 7th cervical vertebra) and akhdayin (both sides of the neck posterior and inferior to ears and close to jugular veins. We report here a novel technique (Salah’s technique) for practicing Al-hijamah safely at some special anatomical sites. In conclusion, Al-hijamah is better to be practiced at sites of pathology (for local clearance), at back region and back of neck (for general blood clearance). Alternative & Integrative Medicine A l t e rn at ive & Int ative Mdici n e


Introduction
Cupping therapy is a simple, effective, economic and time-saving treatment. Different types of cupping therapy e.g. dry cupping therapy (DCT) and wet cupping therapy (WCT) are reported in traditional Chinese medicine (TCM) and are still practiced till now in China and in many parts of the world [1][2][3]. Contribution of TCM for herbal medicine and natural therapies deserves appraisal. TCM includes natural, simple and effective remedies e.g. cupping therapy. TCM improved the practice of cupping therapy to include many different subtypes e.g. weak/light cupping, medium cupping, strong cupping, moving cupping, needle cupping, moxa/hot needle cupping, empty/ flash cupping, full/bleeding cupping, herbal cupping and water cupping [1][2][3]. Cupping therapy is practiced officially in Chinese hospitals and gains attraction of researchers worldwide for its effective results in treating incurable chronic pain conditions [1][2][3][4]. In this review article, we will review cupping therapy of prophetic medicine (Al-hijamah), remedies in prophetic medicine, indications and anatomical sites for practicing prophetic Al-hijamah for treating different diseases.
In the Arab environment at prophetic era (more than 1400 years ago), there were no universities, medical conferences or medical schools. There was no contact with other physicians and there was no internet or telecommunications. Medical principles and practice changed wholly since that age and the new modern medicine replaced almost all the old medical knowledge [9][10][11][12]. Medicine taught and practiced during the era of Islamic civilization was a unity of the natural sciences and humanities under the umbrella of Islamic medical ethics [8,13].
Later on, the golden age of the Arab civilization encouraged establishing universities and medical schools [8,33]. The term "Prophetic Medicine" was the name of the book written by the well-known moslim scholar Ibn Qayem Al-Jawzeyah who described (in Arabic) remedies of prophetic medicine for treating different diseases [6]. Another Arabic scholar, Al-Zahaby also wrote a book entitled (Prophetic Medicine) and described how the remedies mentioned in hadeeths and teachings of Prophet Mohammad peace be upon him relieved and cured patients with different diseases [7].
Generally, remedies in prophetic medicine are simple, safe, cheap, available, effective, valid and up-to-date. Al-hijamah (WCT of prophetic medicine) is among the best remedies according to the hadeeth (The best among what you use in therapy is Al-hijamah) [5,14]. Al-hijamah was referred to in a previous report as cupping, puncturing and cupping method (CPC) method of wet cupping therapy (CPC-WCT), which includes three major steps: cupping (suction of skin to create a skin uplifting), puncturing (scarification of skin uplifting) and cupping (suction of skin to excrete collected fluids mixed with some blood cells due to trauma of skin scarification) [1][2]. Al-hijamah may simply be referred to as suction, scarification and suction (SSS method or triple S) method. Taibah theory was recently suggested to explain medical and scientific bases of Al-hijamah [1][2] and explained possible therapeutic roles of Al-hijamah in treating diseases of different etiologies and pathogeneses in light of Taibah theory e.g. headache, fibromyalgia, carpal tunnel syndrome, hypertension, rheumatoid arthritis and pain conditions [1].
The prophet (peace be upon him) asked his nation to seek for medical treatment as every disease has a treatment: "for every disease, there is a treatment" [34].
Therapeutic aspects of Al-hijamah (CPC-WCT) aims at enhancing venous drainage at the skin related to diseased organ or tissue, which may lead indirectly to enhancement of arterial circulation at that diseased organ or tissue causing improved perfusion and improvement of body's response to pathology. According to Taibah theory, Al-hijamah aims also at causing a percutaneous non-specific pressure-dependent and size-dependent filtration then excretion of causative pathological substances (CPS) and accumulated metabolites in interstitial fluids and blood (in cutaneous blood capillaries) related to skin overlying diseased organ or tissue, which leads subsequently to clearance of causative factors of the disease pathogenesis. CPS include both disease-causing substances (DCS) and disease-related substances (DRS) arising during disease pathogenesis. Filtration of CPS occurs through pores and fenestrae of the fenestrated endothelium of skin capillaries [1].
Moreover, during Al-hijamah, a portion of the fluid component of blood (blood plasma) containing CPS, old hemolyzed blood cells, inflammatory interstitial exudate and any other soluble substances can be removed sparing the cellular components of blood i.e. preventive function of the triple S technique. This decreases the amount of CPS and helps therapeutic effect of current pharmacological therapies [1].

Scientific Rules of Practicing Al-hijamah
Together with practicing Al-hijamah, medical consultation and treatment should be asked from specialized physicians where current pharmacological treatment should be given. In many disease conditions e.g. musculoskeletal pain conditions, Al-hijamah proved effective as a sole treatment. Al-hijamah was proved to be among the best treatment modalities to treat different diseases by itself or when combined with pharmacological treatments [1]. Al-hijamah should be regarded as strong, effective and curative treatment in itself and as a complementary and potentiating treatment to current medical and surgical treatment modalities. However, as Al-hijamah is a beneficial adjuvant preventive and therapeutic treatment during which blood and interstitial fluid are cleared, it has certain indications as any medical modality of treatment. This is the most important point to be considered.
Al-hijamah itself can be considered as a medical science (Hijamatology) to which scientific research should be directed to set up the standard way for gaining maximal therapeutic benefits from Al-hjamah. Hijamatology is a novel term describing the science related to education, knowledge, qualification, practice and research related to Al-hijamah. Hijamatologists are scientists and qualified practitioners working in Al-hijamah. Al-hijamah will synergize all medical treatment modalities as it will remove CPS (including DCS and DRS) that are targeted by medical treatment, which will facilitate better therapeutic outcomes and shorten the way towards cure. Being a non-pharmacological treatment, Al-hijamah is never antagonistic to any pharmacological treatment modalities as no chemical interaction will occur between Al-hijamah and therapeutics taken for different diseases, which will not disturb the therapeutic role exerted by different drugs. Whenever Al-hijamah is indicated or advised, it should be practiced by a qualified licensed practitioner (better to be a physician) in a well-equipped proper place (better in hospitals).
Al-hijamah (as an example of cupping therapy) is not working through opening or restoring energy sources (Qi) or opening energy channels as thought by some cupping practitioners because no published scientific evidence or report exists to support that. There is no anatomical or histological evidence to support that. This type of non-scientific thinking and interpretation for successful results of Al-hijamah or cupping therapy in treating certain diseases brought a big harm to the reputation of Al-hijamah [1]. Also, we disagree with some conceptions, which claim that female gives Yin (female Qi) and receives Yang (male Qi) while male gives Yang and receives Yin or the conception that both the Yin and Yang modalities of Qi are actively present in all males and females [35] as there is no published scientific evidence or report to support that.
It was explained that cupping therapy can remove the wind, cold, dampness and stagnant blood, especially when cupping therapy was combined with acupuncture [36]. We disagree with that also.
Modern understanding of cupping therapy (in light of modern medicine and prophetic medicine) concludes that cupping therapy does not work through establishing the balance between positive and negative or Yin and Yang, which is against scientific thinking and has no medical background. Instead, Taibah theory for scientific mechanisms of cupping therapy is recently published as a novel evidence-based mechanism for explaining scientific and medical bases of cupping therapy [1].
Taibah theory explains on scientific bases how cupping therapy works through clearing blood plasma and interstitial fluids from CPS. Negative pressure introduced through sucking cups creates skin uplifting inside which interstitial fluids, filtered fluids from blood capillaries, hemolyzed blood cells (but no intact blood cells) and CPSare collected just beneath skin barrier inside skin uplifting. Upon scarifying skin uplifting superficially and applying 2 nd suction step using cups, all collected fluids are excreted mixed with some blood cells that come out from traumatized capillaries. Further capillary blood clearance occurs with further removal of CPS from capillary blood. During the process of Al-hijamah, excretory skin functions are enhanced, congestion is removed, tissue adhesions are broken and homeostasis is restored [1].

Indications of Al-hijamah
Based on Taibah theory, indications for Al-hijamah include treating diseases that will benefit maximally or partially from clearing blood and interstitial spaces from CPS through excreting excess intravascular fluids, excess interstitial tissue fluids and excretion of other CPS while taking into account the other health-based benefits of Al-hijamah (Table 1). An example for increased extracellular and interstitial fluid volume is hypertension [37] that was reported to improve on WCT [38] as fluid overload was reported to play an important role in the pathogenesis and development of salt-dependent hypertension [39]. An example for toxic CPS in interstitial fluids is cellulitis. Cellulitis is a local form of suppurative inflammation of the skin and underlying tissues with an accompanying increase in inflammatory tissue fluids (exudate) together with increased CPS in the form of bacteria and bacterial toxins (CPS) [40][41][42]. Cellulitis was reported to improve on using WCT [1,43].
An example for increased inflammatory CPS is chronic osteoarthritis. Chronic osteoarthritis is a chronic inflammatory process initiated by proinflammatory cytokines e.g. interleukin-1 and tumor necrosis factor-1 alpha together with an acceleration of cartilage degradation process through increased levels of matrix metalloproteinases, stromelysins, gelatinase and plasminogen activators [44]. All those CPS are catalyzing the pathogenesis of osteoarthritis. Al-hijamah-induced clearance of those CPS from blood plasma and interstitial fluids may explain on scientific bases the improvement reported by chronic osteoarthritis patients upon treatment with Al-hijamah.

Anatomical Sites for Practicing Al-hijamah
As a repeated question asked to hijamatologists by many practitioners and patients: what are the most suitable skin sites for applying sucking cups during Al-hijamah therapy? Is there any scientific bases underlying specifying those sites? Do those sites differ from disease to disease? Do therapeutic outcomes change on using different sites?
In fact, little published research exists to answer such questions but the answers can be gained based on understanding Al-hijamah in light of modern medicine and prophetic medicine. Basically speaking, diseases that will benefit from Al-hijamah are diseases in which their pathogenesis may be characterized by excess tissue fluids (transudates or exudates), intravascular fluids or CPS. As a general guide when putting sucking cups during Al-hijamah, it is better to be as near anatomically as possible to the diseased tissue to facilitate excretion of CPS. Taking cellulitis as a proved example of excreting bacterial toxins and bacteria in cupped blood [43], WCT done over the inflamed cellulitis region dramatically relieved the inflammatory and toxic processes through excreting bacteria and bacterial toxins in cupped blood in addition to sucking edema fluid (inflammatory exudate). Based on Taibah theory [1], when the pathology or disease process occurs in a viscus or organ that is not near the skin surface e.g. headache and migraine [45], blood clearance can be done -as we learnt from prophetic medicineby applying sucking cups to head regions, kahel region and akhdayin regions as we will discuss later. Answering previously asked questions implies that specifying anatomical sites that differ from disease to disease is important according to anatomical sites of pathology and the required degree of clearance of blood and interstitial spaces. Scientific bases for selecting specific anatomical sites when treating pathological conditions using Al-hijamah (as we learn from prophetic medicine) depends on the primary site of pathology and its distribution and the degree of therapeutic benefits gained from blood and interstitial fluid clearance as we will explain below. The degree of blood clearance can be enhanced by increasing the number, size and pressure (to a certain extent) of cups. Optimization of Al-hijamah-induced therapeutic clearance will differ when changing the sites of cups application or the number of cups. This urged us to write this article to benefit practice and research in hijamatology.

Scientific bases Beyond Selecting Anatomical Sites for Practicing Al-hijamah in Prophetic Medicine
In prophetic medicine, we review here that prophet Muhammad peace be upon him asked for Al-hijamah in kahel region (mainly skin over 7 th cervical vertebral spine and may expand to include surrounding skin area and interscapular region) [46], Akhdayin (skin overlying both sides of the neck behind the ears) [46], in between the 2 scapulae, on the head region (after shaving hair) [47], on the center of the head (skull   [48], on the yafokh region (In the middle of the upper part of the vault of the skull) [49], on the thigh region [50,51] and on the dorsal surface of the foot [52]. The indications for performing prophetic Al-hijamah were to treat more than one disease condition, which supports the fact that Al-hijamah can benefit in treating more than one disease with variable etiologies and pathogeneses through non-specific excretion of CPS of each disease [1][2]. As a general rule, shaving hair in the area to be cupped ensures a perfect sterile atmosphere with no liability of existence of hair (foreign body) at skin puncture sites, which is expected to facilitate easy rapid healing of skin scarifications done in the process of Al-hijamah.

Indications for Prophetic Al-hijamah
We review here that in prophetic medicine, Al-hijamah (as a prophetic teaching) was asked by the prophet peace be upon him for treating different disease conditions. Al-hijamah was done at head region for treating headache and migraine [53] and was done at dorsum of foot [52] and at thigh region [51] for treating traumatic pain (may be due to strain or sprain). Prophetic Al-hijamah was done at sites of pain. Therapeutic benefits beyond clearance of blood and interstitial spaces in treating headache may occur through excretion of noxious substances related to to pathogenesis of headache and migraine. Those noxious CPS may include high serum brain derived neurotrophic factor [54], high serum transforming growth factor β1, C-reactive protein [55], excess serum fluids, chemical mediators, Il-6, vasoactive substances, neuropeptides causing headache [38,56] e.g. substance P, vasoactive intestinal polypeptide and calcitonin gene-related peptide that are important mediators in the pathogenesis of migraine and other primary headaches [56]. Al-hijamah may decrease interstitial fluid pressure and may treat predisposing factors for headache e.g. hypertension [1,38] and acute trigeminal neuralgia [1,2,57]. Common traumatic injuries at thigh region include strain, contusion and avulsion, which are characterized by hematoma at the musculotendinous junction, perifascial blood or haematoma, intramuscular hemorrhagic dissection and muscle fiber disruption [58]. Al-hijamah done at site of trauma may be beneficial in draining painful exudate collected locally in interstitial spaces at the site of trauma. It is reported that musculoskeletal infection is a common finding during trauma in emergency department affecting various soft-tissue layers, bones, and joints. Infection may present as necrotizing or non-necrotizing fasciitis, superficial cellulitis, myositis, soft-tissue abscess, osteomyelitis or septic arthritis [59].
Hematoma due to limb trauma may occur in rare cases and may progress to chronic expanding hematomas that are tumor-like lesions with a vague history of trauma that usually lays dormant for many months before suddenly starting to expand in a mode very similar to that of a chronic subdural haematoma [60]. The importance of these swellings lies in its mimicry to soft tissue sarcomas, dystrophic calcification (associated with reactive inflammatory changes), calcific myonecrosis, chronic expanding hematoma and post-traumatic cyst of soft tissues, which may rarely complicate such traumatic hematoma [60][61][62].
Based on modern understanding of how Al-hijamah works (Taibah theory), Al-hijamah may drain CPS [1] at trauma site e.g. hematoma, pain mediators, wound exudate, pus and inflammatory substances. Drainage of a localized hematoma may benefit in preventing its secondary bacterial infection or future calcification. Al-hijamah benefits patients having trauma through endogenous opioid production causing pain relief [1][2].
Interestingly, it was reported that whenever Prophet Muhammad peace be upon him was consulted for treatment of headache, he advised using Al-hijamah and when he was consulted for treating pain in legs, he advised using decoration with henna [63].

Lessons Gained from Anatomical Sites of Al-hijamah in Prophetic Medicine
The first lesson is to practice Al-hijamah at sites of pathology e.g. to put sucking cups on head regions when treating headache and migraine and at limb regions over painful sites in case of trauma and so on.
Second lesson learnt from prophetic medicine is to practice Alhijamahas soon as possible to get the maximal therapeutic benefit and to do Al-hijamah even during travel before reaching target destination (i.e. the sooner the better) e.g. during fasting or pilgrimage travel. It is also gained from prophetic medicine to practice Al-hijamah at Kahel region ((mainly skin over 7 th cervical vertebral spine and may expand to include surrounding skin area and interscapular region) and at back sites of the neck. The most safe and suitable skin points are the back region as this region is a hidden area (from the cosmetic point of view), having a large flat surface area (easy to apply sucking cups), away from critical structures (nerves and vessels) and is more comfortable to the patient. Prophetic medicine was our reference in selecting back points e.g. the Kahel region seems to be the most suitable point for practicing Al-hijamah for therapeutic and preventive purposes and is regarded as a common place for clearing blood coming to the skin circulation in treating many disease conditions. Kahel region is a prominent anatomical landmark and its surface marking is easy to be detected on the midline of the back at the junction of the back of the neck with the back region. Other related positions can be defined as above kahel region, below kahel region, to the right of kahel region and to the left of it. Prophet Mohammad peace be upon him asked the physician to do Al-hijamah for him at many sites for treating different diseases in which anatomical sites for practicing Al-hijamah changed from disease to disease.
Third lesson is to practice WCT not DCT as steps of Al-hjamah include all steps and health benefits of both DCT and WCT altogether (Taibah theory) [1]. Mere DCT is not therapeutically curative as no excretion of CPS or blood clearance occur in DCT [1,2]. 7. Points at course of neck veins, superficial temporal arteries or any superficial veins. therapeutic benefits are gained through Al-hijamah via better clearance of blood and interstitial fluids from CPS [1].

Possibility of hemorrhage
Fifth lesson is to use manual suction method (moderate degree of suction pressure) not alcohol or flame suctions (higher degrees of suction pressure) [64], which may exert very high suction pressure that may damage capillaries and disturb the process of filtration and cause bloodletting instead. Manual suction is more reproducible than both flame and alcohol suction methods [64].
Sixth lesson is also based on understanding anatomical sites mentioned in prophetic medicine where anatomical sites for practicing Al-hijamah can be categorized into local and general anatomical sites. Local anatomical sites (overlying site of pathology and/or complaint) may be better for clearing interstitial fluids, interstitial spaces, lymphatic fluids, exudates and edematous sites. They are also better for resolving local pathology by excreting local fluid collections and CPS. General sites for practicing Al-hijamah (e.g. kahel region, some back points and akhdayin regions) may be better for clearing blood from any CPS (general sites are rich in blood supply and have a large flat surface area for application of more cups) but may be less effective than local sites for local tissue clearance.

Al-hijamah at the Special Anatomical Areas
The majority of anatomical points to which sucking cups should be applied are safe with no technical problems during performing Alhijamah. Anatomically, special areas of the body are few anatomical sites where superficial critical structures e.g. arteries, nerves and veins pass subcutaneously and may be injured during skin scarification step of Al-hijamah (Table 2). Dangerous anatomical area of the face is a triangular area bordered by the upper lip (lateral angles of the mouth on both sides) and the upper part of the nose.
It is advisable to avoid practicing Al-hijamah at critical anatomical sites unless necessary. Necessity is decided when improvement is not likely to occur without practicing Al-hijamah at those sites. Fortunately, most anatomical sites for practicing Al-hijamah are safe with no important subcutaneous structures. This note is very important, especially for beginners to ensure safety of practice. Whenever it is strongly indicated to practice Al-hijamah at such anatomical sites, it is a must to avoid performing Al-hijamah at the dangerous area of the face as a routine. It should only be practiced in rare highly indicated exceptional cases to avoid injuring critical structures. Al-hijamah on the face should never be practiced as a routine to minimize possibility of skin scarring or transmission of infection to intracranial structures. It is a must to select the most experienced, most senior, highly skillful and most knowledgeable practitioner to perform Al-hijamah at these sites. The patient to whom facial Al-hijamah will be performed should give a written consent.
It is a must to know and revise the detailed anatomy of the dangerous area of the face every time before practicing Al-hijamah. It is a must to feel and locate the course of superficial arteries, veins and nerves and to do the most superficial skin scarifications away from their anatomical course. Application of Salah's technique for safe practice of Al-hijamah at special anatomical sites is advisable.

Salah's Technique for Safe Practice of Al-hijamah at Special Anatomical Sites
This is a novel technique (named after author's name) aiming at gaining maximal and safe therapeutic benefit of practicing Al-hijamah (skin scarification step) at skin overlying sites of pathology in special anatomical areas (Table 2) e.g. skin overlying carpal tunnel in carpal tunnel syndrome, skin overlying the thyroid gland in thyrotoxicosis and skin overlying nasal sinuses in antibiotic-resistant severe cases of chronic sinusitis. First ensure that local hair is shaved and the local area is sterilized many times. The technique is preceded by 1 st cupping (suction) step for few minutes and is followed by 2 nd cupping (suction) step.
When doing skin scarifications, touch not cut the skin using a new sterile scalpel under proper illumination in a strictly sterile medical environment (wearing sterile gloves). The technique simply implies pinching a small fold of skin carefully between thumb and index fingers of the left hand, while the right hand scarifies the skin fold with few small superficial scarifications (about 0.1 mm in depth just to open skin barrier that is horny cell layer of the epidermis) then another skin fold is pinched out and so on. Selected pinched skin folds must be taken from the cupped area. Care must be taken not to include any anatomical structure (nerve or a superficial vein) inside the pinched skin fold and this is easily done by pinching a small skin area from the skin surface. Scarifications must be so superficial not deep, sequential not simultaneous, few not many, vertical not transverse, longitudinal not pin-point, short (about 2 mm) not long and gently slow not rapidly done.
Importance of this technique is that it allows gaining maximal therapeutic benefit from practicing Al-hijamah at skin sites directly overlying pathology, which is expected to give better local clearance of interstitial fluids and improvement of pathology than practicing Alhijamah at distant anatomical sites. Moreover, 1 st and 2 nd suction steps may benefit so much in relieving compression upon vital structures e.g. may relieve compression upon median nerve in carpal tunnel syndrome.

Anatomical Sites for Treating Different Diseases using Al-hijamah (Tables 3 and 4)
From the practical point of view, it is an important science to locate the most suitable anatomical sites for applying sucking cups to treat different diseases using CPC-WCT (Al-hijamah). Unfortunately, no published research work or medical study is there to compare different anatomical sites to guide us to the most suitable anatomical points to treat different diseases using Al-hijamah. In fact, hijamatology is an important science to which more extensive research should be directed to enrich this science with modern medical benefits. Ahmed Hefny was the first scientist and practitioner hijamatologist to locate and write about the best anatomical sites for applying sucking cups when treating different diseases using Al-hijamah. Ahmed Hefny mentioned the anatomical sites for practicing Al-hijamah based on his knowledge in prophetic medicine, TCM and the satisfactory results he got on performing Al-hijamah at those sites for treating different diseases [65]. Anatomical points mentioned by Ahmed Hefny were in head and neck region (Table 3a) (Figure 1), [66][67][68][69] frontal aspect of chest, abdomen and pelvis (Table 3b Future research and publications will help a lot to establish and optimize the best anatomical sites for practicing Al-hijamah. El-Ghazzawy reported also anatomical sites for practicing Al-hijamah based on background in prophetic medicine and TCM practice [77]. Rafeek Tib Nabawi (RTN, companion of prophetic medicine) anatomical sites were recently reported by Hany Salah as novel anatomical sites (Table  3e) (Figures 1-4) added to the anatomical sites originally reported by Ahmed Hefny [65]. Until now, it is a matter of optimizing the results of Al-hijamah practice and experience at the well-known anatomical sites for applying sucking cups and this is liable to future modifications in light of future research [78].
The golden rules when selecting anatomical sites for practicing Al-hijamah is to put sucking cups on the skin overlying the diseased tissue e.g. putting sucking cups over inflamed skin in cellulitis. This will facilitate clearing interstitial fluids and blood capillaries from CPS in this anatomical area. Second choice is to place sucking cups at the nearest possible skin area to the site of pathology e.g. putting sucking

Region number
Anatomical sites and surface marking [65,77] 1 At skin overlying the spinous process of 7 th cervical vertebra. It is the most prominent vertebral spine at the lower aspect of back of the neck. cups over head sites in treatment of headache and migraine. This may help to a certain extent in clearing interstitial fluids and blood capillaries from CPS [1]. Third choice is to locate sucking cups at the skin areas supplied by the same cutaneous innervation (same dermatome as the site of pathology) e.g. putting sucking cups over skin of left shoulder (same dermatomal nerve supply with heart) on treating myocardial ischemia. This may decrease the pain intensity in the diseased tissue or viscus by making use of the nervous pathways for referred pain (pain that arises in an organ and is felt in a distant place usually a skin area with the same dermatome).
The areas in the back as kahel region (regions #1 and 55) and between the 2 scapulae are common sites for treating most diseases. These areas are mentioned originally in prophetic medicine. The reason seems that those points are in the skin of the back and are easily accessible in the flat surface of the back and are at hidden sites, which will not constitute a cosmetic problem due to ecchymosis or possible scars (in case of cupping malpractice). Back points are easy for fixing sucking cups, scarifying the skin and applying as many sucking cups as desired. Back points are related to skin beneath which exists the posterior abdominal wall but no critical structures or superficial blood vessels leading to absence of risk of massive bleeding on scarifying Region number Anatomical site and surface marking [67,68] 4 and 5 In between the upper part of the medial borders of the 2 scapulae i.e. about 3 cm lateral to the spinous process of 3 rd thoracic vertebra. 6 Over the medial aspect of the right scapula (lateral to the lower border of spinous process of the 10th thoracic vertebra).

and 8
In the middle of the back on both sides of the vertebral column i.e. lateral to the lower border of the spinous process of the 12 th thoracic vertebra). 9 and 10 Below 7and 8 points (lateral to the lower border of the spinous process of the 2 nd lumbar vertebra).

11
In between 4 th and 5 th lumbar vertebrae (lower part of the back).

and 25
In the upper part of the lower half of the back (above and lateral to region #18).

26
Below and lateral to region #16

27
Below and lateral to region #17

28, 29, 30 and 31
Represented At the lower half of tendo-achilis (above region #130) skin. Back points can accommodate large-sized cups that add more clearing effect during Al-hijamah. Moreover, in the same time, back points are the most suitable anatomically for treating pain related to spine. This includes pain of the back of the neck, pain in the lumbar region (lumbago) and pain in the low back region. Applying sucking cups to the back regions will benefit in breaking adhesions, relieving congestion and correcting musculoskeletal pain. Back points can allow putting many suction cups, which allow clearing blood at multiple different anatomical points leading to better clearance of blood and interstitial fluids.
For all that, back regions are recommended for practicing Alhijamah for preventive purposes, therapeutic purposes and for practicing Al-hijamah as a routine practice (Tables 3 and 4). Back regions are also indicated as adjuvants for practicing Al-hijamah in treating so many diseases of different etiologies and pathogeneses in which more clearance of interstitial spaces and blood will help in treating or curing the underlying pathology. Patient should receive regular medical and or surgical treatments prior to or simultaneously with Al-hijamah therapy. Table 1 lists some disease conditions in which Al-hijamah may be beneficial (degree of benefit varies from improving symptomatology to cure), while table 3 mentions the most suitable anatomical sites when treating such diseases using Al-hijamah. Table 4a-4j lists anatomical sites for applying cups for Al-hijamah for preventive purposes. Table  4 also lists some diseases that may benefit from treatment using Alhijamah and the anatomical sites for cups application (Figures 5-12).
As a golden rule, Al-hijamah should be done at as many anatomical points as the patient can tolerate to ensure better local and systemic  RTN 1 In between the 2 scapulae (on the left of the midline of the back) RTN 2 In between the 2 scapulae (on the right of the midline of the back) RTN 3 Just above the patella of the knee joint (on both sides) RTN 4 Below and medial to RTN 6 (medial to middle part of the patella of the knee joint) (on both sides) RTN 5 Below and lateral to RTN 7(lateral to middle part of the patella of the knee joint) (on both sides) RTN 6 Below and medial to RTN 3 (medial to upper part of the patella of the knee joint) (on both sides) RTN 7 Below and lateral to RTN 3 (lateral to upper part of the patella of the knee joint) (on both sides) RTN 8 Below RTN 4 (medial to lower part of the patella of the knee joint) (on both sides) RTN 9 Below RTN 5 (lateral to lower part of the patella of the knee joint) (on both sides)

RTN 10
Midline of the back (above gluteal region by about 6 cm i.e. above region #11) RTN 11 To the right of RTN 10 (immediately above region #12) RTN 12 To the left of RTN 10 (immediately above region #13) RTN 13 Midline of the back just above RTN 10 RTN 14 To the right of RTN 13 RTN 15 To the left of RTN 13 (immediately above RTN12) RTN 16 Upper part of the head on the coronal suture (at the meeting of the frontal bone with occipital bone) RTN 17 Above RTN 18 and directly to the right of RTN 19 RTN 18 Above and to the right of the sacroiliac joint RTN 19 At the midline of the back (about 6 cm above the sacroiliac joint) RTN 20 Directly to the left of RTN 19 RTN 21 Below RTN 20 (above and to the left of the sacroiliac joint i.e. corresponding to RTN 18) RTN 22 At sternal notch RTN 23 Below and to the left of the thyroid cartilage. N.B. This is a special anatomical area that should be taken with extreme care using Salah's technique.

RTN 24
To the left of thyroid cartilage. N.B. This is a special anatomical area that should be taken with extreme care using Salah's technique.

RTN 25
To the right of thyroid cartilage. N.B. This is a special anatomical area that should be taken with extreme care using Salah's technique.

RTN 26
Below RTN 25 RTN 27 Region of the upper part of left cheek (left side of the face) in front of left auricle (below region #111) N.B. This is a special anatomical area (exit of facial nerve) that should be taken with extreme care using Salah's technique.

RTN 28
Corresponding to RTN 27 on the right side i.e. Region of the upper part of right cheek (right side of the face) in front of right auricle. N.B. This is a special anatomical area (exit of facial nerve) that should be taken with extreme care using Salah's technique.

RTN 29
The whole medial and lateral aspects of the leg and the foot in addition to the dorsum of the foot (excluding back of leg and plantar aspect of foot) RTN 30 Medial part of the right costal region attached to the lower end of the sternum. RTN 31 Below and lateral to RTN 30 RTN 32 Lower lateral part of the right costal region attached to the lower end of the sternum (lateral and superior to RTN 31) RTN 33 Below RTN 31 RTN 34 Middle part of right costal region attached to the lower end of the sternum (on the anterior abdominal wall i.e. slightly below and lateral to RTN31 at a portion of the skin region overlying liver).

RTN 35
Slightly below and lateral to RTN 33 RTN 36 At the hairy axillary region (skin overlying the axilla and frontal aspect of posterior axillary fold). N.B. This is a special anatomical area below which brachial plexus is present. It should be taken with extreme care using Salah's technique.

RTN 37
At the umbilical region (umbilicus should be in the center of the cup during Al-Hijamah) RTN 38 About 6 cm below the middle part of the left clavicle RTN 39 Corresponding to RTN 38 on the right side i.e. about 6 cm below middle part of the right clavicle RTN 40 Upper lateral part of the left breast (about 5 cm above and lateral to the left areola) RTN 41 Medial to (to the right of) RTN 40 beside midline RTN 42 To the right of RTN 41 RTN 43 Corresponding to RTN 40 on the right side (to the right of RTN 42). RTN 44 Just medial to the tip of the shoulder (on both sides). RTN 45 Posterior aspect of shoulder tip (on both sides). RTN 46 Below RTN 44 (below and medial to RTN 47 on both sides) RTN 47 Below and lateral to RTN 44 on both sides RTN 48 Below and lateral to RTN 50 (anteromedial to the left anterior superior iliac spine) RTN 49 In the inguinal region (anteromedial to the right anterior superior iliac spine) RTN 50 In the inguinal region (superior and medial to RTN48) (above external genitalia in pubic region) RTN 51 Superior and medial to RTN 49 (above external genitalia in pubic region) RTN 52 At ventral aspect of wrist region (overlying carpal tunnel on both sides) N.B. This is a special anatomical area that should be taken with extreme care using Salah's technique.

RTN 53
At dorsal aspect of wrist region (overlying carpal tunnel on both sides). N.B. This is a special anatomical area that should be taken with extreme care using Salah's technique.

Kahel Region and Akhdayin Regions
Kahel region and akhdayin regions are the most important anatomical regions reported in prophetic medicine for practicing Al-hijamah. The exact anatomical definition for those sites is still controversial. Regarding kahel region, skin overlying seventh cervical vertebra is the anatomical point known by majority of practitioners (region # 1). However region #55 should be added to region #1 when referring to kahel region. Some practitioners may like to add the interscapular region to both #1 and #55 when defining kahel region for performing Al-hijamah. For us, kahel region is a general anatomical site for practicing Al-hijamah for both preventive and therapeutic purposes and will benefit from including regions #55 and interscapular regions i.e. complete kahel region includes #1, 55, surrounding area and interscapular region. As for Akhdayin regions, they are 2 corresponding points. Literally, the word akhdayin in Arabic means the 2 jugular veins that run anatomically on both sides of the neck. Practically, Akhdayin regions are also controversial. Akhdayin regions are regions #43 and 44 (nearest anatomical sites to jugular veins) although some people may refer to regions #2 and 3 (behind both ears and at a distance from jugular veins) as akhdayin. Literally, regions #43 and 44 are closer to the Arabic definition of akhdayin (i.e. more closer to jugular veins). We also confirm that regions #43 and 44 are the akhdayin regions while regions #2 and 3 are the para-akhdayin regions (near akhdayin regions). This may help closer position to venous outflow of the brain (jugular veins). Concentration of calcitonin gene-related peptide, vasoactive intestinal polypeptide and other chemical mediators of headache are usually increased in jugular venous blood during attacks of cluster headache and migraine [1]. Future research is recommended to investigate if therapeutic outcomes of Al-hijamah at regions #43 and 44 may be superior to regions #2 and 3 in improving headache or enhancing blood clearance of the above-mentioned headache-related CPS. However, as regions #43 and 44 are near anatomically to jugular veins, extreme care should be taken when doing Al-hijamah at those sites (special anatomical sites) where Salah's technique should be applied. Alhijamah at regions #43 and 44 is very important according to prophetic

Diseases that can be treated with Al-hijamah
Anatomical sites to which sucking cups (cups of Al-hijamah) can be applied

Fibromyalgia and fibrositis
Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: • 1-55 • 49-120 • RTN1-RTN2 Cups should be put at the painful sites (in the neck or back region). Cups should be put at the surrounding muscles.

Back pain
Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: Putting cup at sites of pain Simple arthralgia, arthritis and musculoskeletal pain (Figure 5b) Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: • Cups should be put at the painful sites (in the neck or shoulder).
• Cups should be put at the surrounding muscles (secondary source of pain)

Persistent non-specific low back pain
Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: • 1-55 • 20-21-40-41-42 • RTN44-RTN45-RTN46-RTN47 • Cups should be put at the painful sites (in the neck or shoulder). Cups should be put at the surrounding muscles (secondary source of pain)

Persistent non-specific low back pain
Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: 2-3-11-12-13 RTN17-RTN18-RTN19-RTN20-RTN21 Putting cups on painful points in the back and lower limbs Traumatic strain, sprain and post-fracture conditions Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced by putting sucking cups over pain areas and surrounding it. Al-hijamah should be combined with conventional treatment from a specialized physician. Regular pharmacological treatment should be given.
Al-hijamah may better be practiced at: • Patient may benefit from applying cups locally at sites of atherosclerotic lesions.
• Patient may benefit from drinking a spoon of vinegar (Apple's vinegar before breakfast and dinner) Hypotension (Figure 6d) Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: Some conditions of circulatory insufficiency Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: • Local areas of circulatory insufficiency

Ischemia of the leg (Vascular thrombosis)
Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: • Cups should be put at the site of vascular thrombosis.
• Site of thrombosis should be surrounded by cups. medicine. However, Al-hijamah at regions #43 and 44 should never be done by a beginner or an unqualified practitioner as it is near jugular veins. Salah's technique may be needed to ensure a safe practice. On the contrary, Al-hijamah at regions number 2 and 3 is more safe and away from jugular veins. Research is needed to confirm therapeutic benefits of Al-hijamah at those different anatomical sites.

Al-hijamah for Cerebrovascular Stroke and Diabetic Patients
Practically, Al-hijamah is so beneficial for those patients although the benefit may not be felt in the short term. To cure diabetes mellitus (DM), a healthy pancreas with intact beta cells of islets of Langerhans for endogenous production of insulin is the curative treatment but this is still beyond possibility. Until this goal is achieved, DM is better treated by exogenous recombinant human insulin injection (for type I DM) or oral hypoglycemics (for type II DM) [79]. As for stroke patients, permanent neuron death occurs due to either cerebral hemorrhage or infraction. Treatment for stroke patients is directed towards preserving normal structure and function of remaining healthy neurons and to prevent or relieve neurological sequelae of stroke. Combining Alhijamah with diet control, hypoglycemic treatment and costus for DM is expected to benefit patients so much. Combining Al-hijamah with physiotherapy and regular treatment for stroke patients may prevent progression towards irreversible sequelae. Both DM and stroke patients can benefit too much -from Al-hijamah-in delaying or preventing the development of serious complications. Diabetic and stroke patients may not feel an immediate improvement after practicing Al-hijamah as no dramatic relief of clinical picture occurs. However, Al-hijamah effectively corrects predisposing factors for progression of disease complications as Al-hijamah will treat hyperlipidemia [80], hypertension [80] and myocardial ischemia [81]. Al-hijamah clears blood of diabetic patients through excreting DRS e.g. advanced glycation end products (AGEPs), which may worsen the prognosis of DM. Al-hijamah treats diabetic foot (Table 1), while local honey application to diabetic wounds improves healing of diabetic wounds and ulcers [82][83][84][85]. Both Al-hijamah and honey are remedies of prophetic medicine [2,5,14]. At sites of limb paralysis in stroke patients, Al-hijamah improves local circulation [1], which may benefit the therapeutic role of physiotherapy.

Anatomical Sites for Al-hijamah in Diabetic Foot and Misconceptions Related to it
Regarding diabetic foot, treatment using conventional adjustment of blood glucose level, care of diabetic wounds and regular intake of broad spectrum antibiotics is a must [86]. However, understanding pathogenesis of diabetic foot helps to improve therapeutic lines and hence therapeutic outcome. Certain steps in the pathogenesis of diabetic foot may facilitate the development of diabetic foot ulcers and infection: hyperglycemic interstitial fluid in diabetic foot (suitable for bacterial growth and multiplication), AGEPs, poor local circulation and neuropathy are critical for progression to ischemia and gangrene [87][88][89][90][91]. Al-hijamah may be the sole treatment to treat such pathogenesis criteria. Al-hijamah may drain CPS related to pathogenesis of diabetic foot through non-specific clearance of interstitial fluids and circulation from both DCS and DRS [1,2]. Al-hijamah may treat diabetic foot ulcers and infection, drain hyperglycemic interstitial fluid, excrete AGEPs, improve local capillary and blood circulation and enhance natural immunity. Practicing Al-hijamah for treating diabetic foot should be done after evaluation of the foot by an experienced vascular surgeon.Alhijamah can be done at anatomical sites in the back of the trunk, head and neck (kahel region and akhdayin regions) i.e. away from diabetic foot region to clear blood from accumulating metabolic diabetic CPS (including AGEPs) and enhance endogenous production of nitric oxide (vasodilator) [1]  Al-hijamah at diabetic foot itself or lower limb region as long as there is no gangrene or impending gangrene. If there's gangrene, excision gangrenous tissue is a must of. When there is impending gangrene or gangrene, Al-hijamah is advisable at both general anatomical sites (in the back region and back of neck) and at limb region (to drain local pathogenic interstitial fluid with CPS and enhance local endogenous production of nitric oxide to improve local blood circulation) through covering medial and lateral aspects of leg (below knee) and dorsal aspect of diabetic foot with cups and taking extreme care of skin scarifications (should be superficial to the depth of 0.1 mm) and taking care not to injure superficial veins (avoid their course).
However, skin scarifications (0.1 mm in depth and 1-2 mm in length) done during Al-hijamah may seem strange and not welcomed when discussing Al-hijamah for treating diabetic foot as a preventive  measure and as an adjuvant therapeutic line of treatment. Poor healing power in diabetic foot wounds may be the cause why some physicians may not recommend doing Al-hijamah for treating diabetic foot. On the contrary, Al-hijamah creates so superficial skin scratches that can never be described as wounds i.e. non-full thickness skin wounds. Skin scarifications during Al-hijamah and suction pressure will increase endogenous production of nitric oxide (vasodilator and antimicrobial) and enhance capillary vascular blood flow, lymphatic and capillary microcirculation. Skin scarifications for diabetic foot are so shallow, short, sterile, associated with production of nitric oxide (vasodilator, antimicrobial and promote wound healing), followed by suction of stagnant unhealthy hyperglycemic local interstitial fluids and is associated with other health benefits of Al-hijamah e.g. enhancing natural immunity [1]. Accidental wounds in diabetic foot differ in all previously-mentioned criteria.

Diseases that can be treated with Al-hijamah Anatomical sites to which sucking cups (cups of Al-hijamah) can be applied
Gastritis (Figure 8a) Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at:

Some Diseases in which Patients may apparently Benefit to a Small Extent with Al-hijamah
As a golden rule, Al-hijamah will benefit every patient as we will discuss below and there is no reported harm carried by proper practice of Al-hjjamah. The degree of health benefits after Al-hijamah ranges from cure to improvement according to disease condition when Alhijamah is used as a sole treatment. Combining current medical and surgical treatments with Al-hijamah expands its spectrum and effectiveness.
Taking into account the excretory benefit, immunological benefit, metabolic benefit and other therapeutic benefits of Al-hijamah [1], we may get the sense when and for how many times we should perform Alhijamah and to what extent we can expect the improvement.
However, in patients with the above-mentioned diseases, it is Diseases that can be treated with Al-hijamah Anatomical sites to which sucking cups (cups of Al-hijamah) can be applied Gout and gouty arthritis (Figure 10b) Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at anatomical points number: • 1-55 • RTN1-RTN2 • 9-10-11-12-13-28-29-30-31-121 • Put cups at points of pain in legs and feet and where urate crystals are deposited.
Thyroid dysfunction (Figure 10a) Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at:

Diseases that can be treated with Al-hijamah Anatomical sites to which sucking cups (cups of Al-hijamah) can be applied
Cellulitis Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: • 1-55 • 43-44-49-120 • RTN1-RTN2 • Directly put as many cups as you can at cellulitis region to include it all and also at points of poor microcirculation near cellulitis region Some viral infections e.g. herpes zoster Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: • RTN 29 is the most important for clearance of interstitial fluids, put as many cups as you can).

Diseases that can be treated with Al-hijamah Anatomical sites to which sucking cups (cups of Al-hijamah) can be applied
Conditions of impaired immunity (Figure 12a) Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: Glaucoma (Figure 12b) Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: Pain of dysmenorrhea Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: • 1-55 • RTN1-RTN2-RTN48, RTN49, RTN50, RTN51 • 11-12-13-125-126 N.B. Performing dry cupping therapy below both breasts may be useful Some ovulatory disorders (cause of female infertility, which may be due hyperestrogenemia Al-hijamah should be combined with conventional treatment from a specialized physician. Al-hijamah may better be practiced at: • 1-55 • RTN1-RTN2-RTN48, RTN49, RTN50, RTN51 • 2-3-11-12-13-32-36-39-125-126 better not to do Al-hijamah as a sole treatment. Instead, it is better to combine current medical and surgical treatments with Al-hijamah to expand its spectrum and effectiveness. For example, obesity due to endocrine causes may benefit from Al-hijamah through clearing blood from excess causative hormones (CPS), while immunological and pharmacological potentiation exerted by Al-hijamah will benefit cancer patients. Al-hijamah is beneficial for preventive purposes even in healthy subjects as Al-hijamah induces non-specific clearance of blood and interstitial fluids from CPS through clearing blood of patients with diabetic neuropathy form AGEPs, normalizing blood chemistry and decreasing the damage in nerve cells due to diabetic metabolic disturbances. In addition, there is a long list of therapeutic health benefits of sAl-hijamah as previously reported in the evidence-based Taibah theory [1] e.g. general benefit (may include improvement of general condition), detoxification benefit, immunological benefit (via enhancing natural immunity, increasing number of natural killer cells and enhancing immunostimulatory cytokines [92,93], neurological benefit (improving headache), hemodynamic benefit (improving local capillary circulation), angiogenic benefit, hemostatic benefit, hematological benefit (blood clearance of CPS and old hemolyzed blood cells), cosmetic benefit (breaking adhesions, resolving inflammation and swelling), pharmacological benefit (potentiating and facilitating therapeutic effects of drugs simultaneously administered with Alhijamah through removing disease CPS), analgesic benefit (through stimulating the release of endogenous opioids and excreting painrelated substances), excretory benefit (of CPS and noxious substances), metabolic benefit (improving cellular perfusion), nutritional benefit (decreasing LDL and cholesterol), psychological benefit (secondary to all benefits and due to improvement of affective component of pain) and treatment of disease predisposing factors [1]. However, extent of therapeutic benefit may be greatly enhanced upon combining Alhijamah with other components of the pentad of cure as we will discuss here.

Conclusion and Recommendations
Al-hijamah is an excretory procedure having both medical and scientific bases in clearing blood, lymphatics and interstitial spaces from CPS and noxious substances. Both modern medicine and prophetic medicine proved the beneficial value of Al-hijamah in treatment of different diseases with different pathogeneses. We really appreciate so much that the Chinese are pioneering in practicing cupping therapy officially in their hospitals in a pure medical atmosphere. We appreciate also that Al-hijamah is officially practiced in hospitals in United Arab Emirates. We recommend practicing Al-hijamah officially in all hospitals for treating human diseases for the great benefits of this promising line of treatment.
Miraculous remedies in prophetic medicine are a heritage (legacy) for the whole humanity. The prophet Muhammad peace be upon him is being described in the Holy Qur'an as a mercy for the whole humanity and a mercy for all people [109]. Researchers worldwide are invited to pay more attention to develop more research in investigating remedies and therapeutic treasures practiced in prophetic medicine to cure and relieve human suffering in many incurable diseases with dismal prognosis.
The majestic deep-rooted Egyptian Universities as Al-Azhar, Cairo, Alexandria Universities and the internationally ranked King Saud University, Taibah University, Islamic University in Al-Madinah and Om Al-Quraa University in Makkah in Saudi Arabia (homeland of prophethood and prophetic medicine) are invited to guide research and researchers to introduce remedies and treasures in prophetic medicine to scientific and medical humanity literature. The pioneering report of Sahbaa Ahmed (Al-Azhar University) in treating rheumatoid arthritis using Al-hijamah [93] is well cited and appreciated.
WHO is invited to shed more light upon health benefits of Alhijamah and to encourage its practice in hospitals in the western world. Ministries of health worldwide and in the Arab world are invited to allow and encourage the practice of Al-hijamah in hospitals officially in  a pure medical atmosphere (as it is done in China and Germany now) to close the way in face of unqualified malpractitioners. Ministries of health worldwide and in Islamic countries are invited to allow and encourage the practice of Al-hijamah officially in hospitals (as it is done in China and Germany now) to benefit patients, relieve pain and to decrease human suffering. Potential challenges against practicing Alhijamah in the past were lack of a scientific rational to explain how Alhijamah and cupping therapy may treat different diseases. However, that was solved through introducing Taibah mechanism (by Salah M. El Sayed) [1] that explained on scientific and medical bases how beneficial is Al-hijamah and its therapeutic and health benefits. Skillful practitioners of Al-hijamah can easily be qualified immediately after recognizing Al-hijamah as a formal modality of treatment in hospitals in the western world and worldwide. Hijamatology should be studied at medical schools at the undergraduate and postgraduate levels to enrich medical background of students and physicians regarding Al-hijamah. Until that goal is achieved, plastic surgeons are the best medical practitioners to practice Al-hijamah. Qualifying non-medical practitioners for Al-hijamah is strongly recommended to improve their scientific and practical levels.