A RESEARCH PROJECT BY DR NADIA GANI

1. A STUDY TO DEMONSTRATE THE EFFICACY OF CUPPING AS A MONOTHERAPY IN THE TREATMENT OF CHRONIC HEADACHES A RESEARCH PROJECT BY DR NADIA GANI A REQUIREMENT FOR COMPLETION OF INTERNSHIP PROGRAM BCM (UNANI TIBB)

2. ABSTRACT • This study demonstrates the effectiveness of Wet cupping using B1, B5 and B10 as standard points in all patients and the use of local points according to associated conditions or symptoms. The frequency of cupping ranged from a single wet cupping session, fortnightly or monthly depending on patients’ needs and availability. The sample is made up of patients with varying temperaments and varying types of headaches all chronic in nature. Before patients come in for a session of wet cupping they are prepped for optimal results. They are to increase their water intake, not eat for 3 hours prior, take a hot shower before and where possible have a session after a full-moon. This will aid physis in restoring balance by concocting and eliminating excess humour responsible for causing the headaches. Patients experienced dramatic improvement in the frequency and severity of headaches as well as associated symptoms. A few patients suffered with a severe headache 1-2 days after the session, but felt the benefits thereafter. This could result from the readjustment made by Physis to restore harmony to the body.

3. INTRODUCTION • TIBB PHILOSOPHY: Four Headache types • Each with a characteristic ‘pattern’ • ACUTE: Qualitative imbalance • CHRONIC: Humoral imbalance • FOCUS OF STUDY: chronic headaches (Humoral imbalances)

4. SANGUINOUS HEADACHES • CAUSE: Excess blood in head region • POSSIBLE SIGNS/ SYMPTOMS ∙ blackouts ∙ dizziness ∙ papitations in temple region ∙ heaviness in eye region

5. PHLEGMATIC HEADACHES • CAUSE: Cold + Moist imbalance • CHARACTERISTIC PATTERN: ∙ frontal headache ∙ spreads to the rest of the head ∙ usually accompanied by sinus complaint ∙ worse with cold

6. BILIOUS HEADACHES • CAUSE: Bilious accumulation in the CNS • CHARACTERISTIC PATTERN: ∙ unilateral ∙ typical migraine ∙ worse with excessive Hot + Dry lifestyle factors

7. MELANCHOLIC HEADACHES • CAUSE: Cold + Dry imbalance in the body • SIGNS/ SYMPTOMS: ∙ dull feeling in occipital region ∙ pulling of neck muscles ∙ defective digestion

8. PATIENT PREPARATION • Increase water intake • No food to be eaten for 3 hours prior to session • Hot shower before session • Sessions done after full-moon, where possible • RATIONALE

9. PATIENT PROFILES

10. PATIENT ‘A’ • Female • Age 52 • Temperament: Phlegmatic Sanguinous • C/O: Bilious headaches for past 41 years ∙ aggravated by stress and dairy products • Current Rx: daily Adcodols ∙ relief is slight and temporary

11. TREATMENT: MONTHLY WET CUPPING SESSIONS • SESSION 1: B1, B5, B10 • SESSION 2: B1, B5, B10 • SESSION 3: as above, H2 • SESSION 4: as above, H2 • Severe headache the next day • Severe headache next day, then noticeable improvement • Decreased frequency & severity, less dependent on meds • A single HA (due to stress). Meds required once every few weeks!)

12. PATIENT ‘B’ • Male • Age 22 • C/O: Bilious HA 1/7, epistaxis 1-2/7, acne, leg muscle cramps • Severe injuries & cerebral oedema 17 months prior- MVA • Current Rx: Perbex (acne)

13. TREATMENT: A SINGLE WET-CUPPING SESSION • FOR HA’S: B1, B5, B10 • LOWER EXTREMITIES & LIVER POINTS (for other complaints) • FOLLOW-UP: 1 MONTH LATER • NO HEADACHES OR NOSEBLEEDS FOR AN ENTIRE MONTH! • 1/ 2 EPISODES OF MUSCLE CRAMPS • ACNE CLEARING • NO NEW PIMPLES HAVE APPEARED SINCE THE CUPPING SESSION

14. PATIENT ‘C’ • Female • Age 46 • Temperament: Phlegmatic • C/O: Bilious HA’s worse on LHS ∙ Severe & extensive keloid formation on back & chest

15. TREATMENT:A SINGLE CUPPING SESSION • DRY CUPPING: F3, mid-forehead • WET CUPPING: N4 (LHS), B1, B2, B5, B10 • Follow-up 5 days later: no HA since cupping • No keloid formation on cupping scars • A month later: no migraine attack since cupping • Only slight, occasional pain more on RHS of head

16. PATIENT ‘D’ • Male • Age 47 • Temperament: Sanguinous Bilious • C/O: Bilious HA’s worse on RHS, twice daily for past few years ∙ burning in neck & shoulders for months • Current Rx: 6-8 Adcodols daily (sometimes more) • Chronic smoker

17. TREATMENT:A SINGLE WET-CUPPING SESSION • B1, B5, B10 • 5 DAYS LATER: no HA since cupping session • 1 MONTH LATER: HA’s are less frequent, less severe, less reliant on meds. Panado sufficient for pain relief!

18. PATIENT ‘E’ • Male • Age 34 • Temperament: Sanguinous Bilious • C/O: a combination of bilious & melancholic HA’s

19. TREATMENT:SINGLE WET-CUPPING SESSION • H2, B1, B5, B10 • FOLLOW UP 3 DAYS LATER: No HA since the cupping session

20. PATIENT ‘F’ • Female • Age 52 • C/O: Sanguinous- Phlegmatic HA’s ∙ high blood pressure

21. TREATMENT:FORTNIGHTLY WET-CUPPING SESSIONS • SESSION 1: B1, B5, B10 • SESSION 2: B1, B5, B10 • 3 DAYS LATER: Patient felt much better • HA’s much less than before • Another 2 weeks later HA’s had ceased completely & BP readings are within normal range

22. PATIENT ‘G’ • Female • Age 21 • Temperament: Melancholic Phlegmatic • C/O: A combination of phlegmatic & melancholic HA’s almost daily, lasting the entire day • Current Rx: Tripiline & Indoblock ∙ using for a few weeks without much relief

23. TREATMENT:FORTNIGHTLY CUPPING SESSIONS • SESSION 1: Wet-cupping B1, B2, B5, B10 • SESSION 2: Wet-cupping N4, N5, B1, B2, B5, B10. Dry-cupping on temple area • 5 days later slight improvement in HA & neck tension,head feels lighter • HA only lasts for +- 2 hrs, frequency is the same • 10 days later: head feels lighter, no neck tension, HA less frequent & last 30 min!

24. RESULTS • DRAMATIC IMPROVEMENT IN FREQUENCY & SEVERITY OF HEADACHES AS WELL AS ASSOCIATED SYMPTOMS & OTHER PROBLEMS • FEW EXPERIENCED A SEVERE HA 1-2 DAYS AFTER THE SESSION • COULD BE DUE TO THE BODY RE-ADJUSTING (PHYSIS’S ROLE IN RESTORING HARMONY TO THE BODY) • THIS WAS ONLY TEMPORARY & IN FEW PATIENTS

25. IDEALLY, ALL PATIENTS SHOULD HAVE BEEN TREATED AT LEAST 3 TIMES, BUT THIS WAS NOT ALWAYS POSSIBLE • OVERALL: EXCELLENT RESULTS WERE OBTAINED • ALL PATIENTS IMPROVED & WERE EXTREMELY HAPPY WITH THE RAPID & LASTING RESULTS

26. IN SUMMARY FROM THE STUDY CONDUCTED, WE CONCLUDE THAT CUPPING IS, INDEEED, EFFECTIVE AS A MONOTHERAPY IN THE TREATMENT OF CHRONIC HEADACHES