An Overview of Mechanisms and Clinical Applications of Wet cupping therapy (Ḥijāma-bil-Sharṭ): A Comprehensive Review

Background: Wet cupping therapy (WCT), also known as Ḥijāma-bil-Sharṭ, is a traditional therapeutic modality widely practiced in complementary and alternative medicine. In recent years, increasing scientific interest has focused on elucidating its physiological mechanisms and evaluating its clinical efficacy across various health conditions. Objective: To provide a comprehensive review of the historical evolution, underlying mechanisms, and therapeutic applications of wet cupping therapy, integrating traditional concepts with contemporary biomedical evidence. Methods: A structured literature review was conducted using databases including PubMed, ScienceDirect, and Google Scholar. Relevant English-language publications, including original research articles, clinical trials, review papers, and classical medical texts, were identified using keywords such as “wet cupping,” “Ḥijāma-bil-Sharṭ,” and “mechanisms of action.” Studies addressing mechanisms, clinical outcomes, safety, and traditional perspectives were included, while duplicates and low-quality studies were excluded. Results: WCT appears to exert therapeutic effects through multiple mechanisms, including haemodynamic modulation, nitric oxide-mediated vasodilation, neurophysiological pain regulation via Diffuse Noxious Inhibitory Controls and Pain Gate Theory, and potential immunomodulatory and biochemical alterations. Evidence supports its effectiveness in pain management, particularly in musculoskeletal conditions such as low back pain and arthritis. Additional benefits have been reported in neurological disorders, sleep quality, cardiovascular health, and fertility, although evidence remains limited. Conclusion: Wet cupping therapy demonstrates promising therapeutic potential as a complementary intervention. However, current evidence is limited by methodological heterogeneity and lack of standardization. Further high-quality randomized controlled trials and mechanistic studies are required to establish its efficacy, safety, and integration into evidence-based clinical practice.