Wet cupping and heart rate variability

WET CUPPING (HACAMAT) THERAPY AND HEART RATE VARIABILITY PROF. DR. ŞENOL DANE TURGUT ÖZAL UNIVERSITY MEDICAL FACULTY

• Cupping is a traditional complementary treatment.

• Used in public medicine and also by clinicians in many countries.

• Creates a vacuum over certain points on the skin.

• Two methods of cupping: dry and wet (hacamat).

• A glass cup is applied on the skin over an acupuncture point, painful area, or reflex zone.

• Dry cupping has an only vacuum application.

• Wet cupping involves dry cupping and medicinal bleeding applications.

• Cupping therapy, in both wet and dry forms, is still used today in many cultures. • Cupping is thought to remove noxious materials from skin microcirculation and interstitial compartment.

• Dry and wet cupping drains excess fluids and toxins, loosen adhesions, bring blood flow to skin and muscles, and stimulate the peripheral nervous system.

• Reduces pain and high blood pressure, modulates neurohormones and the immune system.

• Used to improve subcutaneous blood flow and to stimulate the autonomic nervous system.

• A symptomatic treatment for a wide range of conditions seen in clinical practice, such as pain, hypertension, and stroke rehabilitation.

• The stimulation of pain fibers in wet cupping therapy causes release of b-endorphin and adrenocortical hormone into the circulation. These hormones might help block inflammation in arthritis.

• Cupping has some beneficial effects on the immune system by releasing of b-endorphin and activation of the opioid system.

• Ngai and Jones investigated heart rate variability (HRV) changes in response to transcutaneous electrical nervous stimulation over an acupoint, similar to wet cupping. HRV increased after transcutaneous electrical nervous stimulation.

A recent animal study Chinese Journal of Physiology 55(4): 253-258, 2012

• The effects of wet cupping on cardiac arrhythmias and infarct size after myocardial ischemic reperfusion injury in male rats.

• Reperfusion injury caused an infarct size of 50%, whereas dry cupping and single and repeated wet cupping reduced infarct size to 28%, 35%, and 22%, respectively.

• The rate of ischemia-induced arrhythmias was corrected by wet cupping.

• There are complex interactions between the sympathetic and parasympathetic nervous system inputs to the heart.

• The concept of ‘‘sympathovagal balance’’ reflects the autonomic state resulting from the sympathetic and parasympathetic influences.

• Heart rate variability (HRV) parameters are indexes of sympathovagal balance or imbalance.

• HRV is defined as fluctuations in cardiac rhythm affected by internal and external factors of the body.

• These fluctuations can be determined by ECG method (HRV).

• HRV analyzes the interaction between sympathetic and parasympathetic nervous systems and provides information about the autonomic nervous system abnormalities.

• Imbalances of the autonomic nervous system can be assessed by HRV. • Sudden death, coronary artery disease, heart failure, and cardiovascular risk factors (smoking, diabetes, hyperlipidemia, and hypertension) are the best-known clinical circumstances that can affect or be affected by the autonomic nervous system.

• An increase in HRV parameters shows good cardiac health, but a decrease poor cardiac health.

• In light of these reports, it can be speculated that cupping therapy can result in increased HRV parameters in humans.

• The current study investigated HRV parameters before and after wet cupping therapy in a healthy population.

Participants • Forty healthy people (26 women and 14 men; mean age 30.32 years). • Exclusion criteria were health problems, such as psychiatric, respiratory, metabolic, cardiac, or autonomic nervous system diseases, that might change the heart rate.

Wet Cupping Method • Five points: posterior neck, bilateral perispinal areas of the neck, and thoracic spine.

• Cups were placed on these points, and negative pressure was applied by a cupping pump on the middle level.

• The cups were removed after 2 to 3 minutes. The skin within the cupping sites was punctured to a 2-mm depth.

• Then, pumping with vacuum was applied three times and 3 to 5mL of blood was drained.

Recording HRV • Recording HRV was applied 1 hour before and 1 hour after cupping therapy.

• Participants rested for 10 minutes without recording ECG in order to stabilize autonomic parameters.

• ECG was performed by using PowerLab 26T (AD Instruments, Bella Vista, Australia).

• The digital signals were then transferred to a laptop computer and analyzed by using LabChart software.

Results • In the present study, all HRV parameters, except heart rate, increased after cupping therapy compared with before cupping therapy.

• These results indicate for the first time in humans that cupping might be cardioprotective.

• These results were consistent with those of a recent animal study performed in rats by Shekarforoush et al.

• Therefore, cupping may be used for myocardial infarction and cardiac arrhythmias.

• Reduced HRV has been shown to be a predictor of mortality after myocardial infarction. • Some other clinical conditions may also be associated with the lower HRV, including congestive heart failure, diabetic neuropathy, depression, sudden infant death syndrome risk, and poor survival in premature babies.

• Generally, cupping-induced negative pressure can dilate local blood vessels to improve microcirculation, promote capillary endothelial cell repair, and accelerate granulation and angiogenesis in the regional tissues, normalizing the patients’ functional state at last.

• In addition, cupping therapy removes different stresses and exhaustion from the human body that cause the sympathovagal imbalances.

• In addition, it can be suggested that cupping therapy restores homeostasis disturbances by stimulating acupuncture points.

• As a consequence, wet cupping therapy is a noninvasive harmless therapeutic application that can be confidently used to restore sympathovagal imbalances in cardiac rhythm. • Therefore, it may be useful for preventing cardiac arrhythmias and as a complement to medical treatment.

WET CUPPING AND OXIDATIVE STRESS • The most conditions in which wet cupping therapy is commonly employed were pain related conditions including chronic muscle pain, fibromyalgia, herpes zoster pain and neuralgias such as headache and siatica. Also, cupping therapy is used in many other abnormalities such as cough or asthma, acne, common cold, urticaria, facial paralysis, soft tissue injury, arthritis, neurodermatitis

• Free oxygen radicals formed during physiological and pathophysiological metabolism are balanced by a similar rate of their consumption by antioxidants. Although their excess production may cause oxidative damage on biological molecules, cell membranes and tissues, their generation is inevitable for some metabolic processes.

• Oxidative damage has been implicated in the pathogenesis of a large number of diseases, including autoimmune diseases of endocrine glands, cancer, inflammatory diseases,cardiovascular disease, (atherosclerosis, hypertension, ischemia/reperfusion injury), diabetes mellitus, neurodegenerative diseases (Alzheimer’s disease and Parkinson’s disease), rheumatoid arthritis, and ageing.

• We wondered If wet cupping therapy affects oxidative balance or not.

• The aim of this study was to investigate the dynamics of oxidative stress and antioxidant status markers in both venous blood and wet cupping blood of healthy volunteers by measuring the levels of malondialdehyde (MDA), nitrite, and the activities of superoxide dismutase (SOD) and myeloperoxidase (MPO).

• We measured all these parameters in wet cupping and venous blood samples of healthy people.

• Wet cupping therapy is implemented to 31 healthy volunteers. Venous blood samples were collected after overnight fasting and just before wet cupping employment and placed into no-additives-containing tubes. Wet cupping blood samples were taken from the cups after bleeding and vacuum applications and placed into the test tubes.

Wet cupping • All cupping procedures were applied by physicians certificated by British Cupping Society and Natural Health Institute. For the cupping therapy, sterile disposable cups of 5 cm in diameter were used. Five points of the posterior neck, bilateral perispinal areas of the neck and thoracic spine were selected for treatment. These points are classic wet cupping points chosen in all cupping therapies. Cups were placed these points and applied the negative pressure by cupping pump in middle level. Two-three minutes were waited and cups removed. Then, the skin was punctured to a 2-mm. The pumping with vacuum was applied three times and 3 to 5 cc of blood was drained per cupping site.

Results • Wet cupping blood had higher activity of MPO, higher levels of MDA, and NOx compared to the venous blood. In addition, wet cupping blood had lower activity of SOD. • We found positive correlations between NOx levels of venous blood and NOx levels of wet cupping blood (r=0.64, p=0.001).

• Table (word document)

• The action mechanism of wet cupping therapy is not fully known despite its common use.

• Wet cupping therapy may have many different mechanisms.

• We hypothesize that one of the action mechanism of wet cupping might be through oxidative balance.

• The cardinal findings of this study include that: (i) compared with the venous blood, wet cupping blood had higher activity of MPO (ii) lower activity of SOD (iii) higher levels of MDA (iv) and higher levels of NOx

• NO is one of the most abundant free radicals in the body. Both cytoprotective and cytotoxic effects of NO have been reported. Interaction of O2 and NO leads to the production of more reactive oxidant[22]. We observed that in wet cupping blood the level of nitrite was significantly higher than the venous one.

• The organism can defend itself against the effects of oxidative stress by increasing SOD activity as a protection mechanism. Our results indicate that the activity of SOD was lower in wet cupping serum. It should be further investigated why SOD activity decreased while oxidant parameters were increasing.

• LP was monitored by measuring of MDA, which results from free radical damage to membrane components of the cells. LP modifies the functional characteristics of the cellular membranes, changing their permeability and causing inactivation of membrane-bound receptors and enzymes. MDA can also deactivate membrane transporters, by forming intramolecular and intermolecular crosslinks[23].

In the present study, we found that the MDA level was higher significantly in wet cupping blood than venous blood.

• Niasari et al. tested wet cupping therapy on serum lipid concentrations. They concluded that wet cupping may be an effective method of reducing LDL cholesterol in men and consequently may have a preventive effect against atherosclerosis[24]. These results support the present study and drainage or excretion hypothesis of excess fluids and toxins from the body by wet cupping[5].

• The results of this study showed that venous blood and wet cupping blood have not the same characteristics. Wet cupping blood had obviously higher oxidants compared to venous samples.

The therapeutic effects of wet cupping in various conditions might be due to the excretion of these oxidants from the body. We hope that the relationships between wet cupping and other harmful substances in the body will be investigated in the future and this preliminary study would be guiding for these studies.

• This study was accepted for publication in “Current Therapies in Medicine” journal 1 week ago.

WET CUPPING AND HEAVY METALS

• Wet Cupping is a kind of simple, effective, repeatable and economic treatment modality.

• Negative pressure applied to skin surface using cups creates skin upliftings.

• This causes increased capillary filtration with local collection of filtered fluids as well as interstitial fluids.

• The scarifying skin surface at skin upliftings opens the skin barrier, applying sucking cups creates a pressure gradient and a traction force across the skin leading to excretion of collected interstitial fluids.

• Heavy metals have been recognized as toxins for centuries. • They are common in our environment, individuals are occasionally exposed due to lack of sufficient knowledge of the household products they are using. This includes products such as many insecticides contain arsenic and many paint products contain lead (Pb).

• Since humans frequently encounter toxic metals and WCT is proposed to rid body from toxins we wondered If WCT has an effect on the levels of heavy metals in the body. We investigated the levels of aluminum (Al), mercury (Hg), silver (Ag), and Pb in both venous and wet cupping blood.

Results • In our analysis, we found that the levels of all selected heavy metals were significantly higher in wet cupping blood than venous blood.