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Licensed Unlicensed Requires Authentication Published online by De Gruyter July 16, 2021

Effect of Ḥijāma (wet cupping), Dalk (massage) & Bukhūr (medicated steam) in amelioration of Waja al-Zahr (non-specific low back pain) – an open prospective clinical trial

Noor Zaheer Ahmed ORCID logo, Noman Anwar, Shahida Begum, Athar Parvez, Radhakrishnan Ezhil and Nighat Anjum



Low back pain is the most widespread musculoskeletal ailment and a common cause of disability worldwide. Conventional medicine typically treats low back pain with a combination of physical therapy; activity modification and rest; pain-relieving and anti-inflammatory medications which are associated with huge socioeconomic implications and adverse drug reactions. In contrast Ḥijāma, Dalk and Bukhūr are ancient medical techniques recommended in the management of musculoskeletal disorders with little or no adverse effects. To evaluate the safety and effectiveness of Ḥijāma bi’l Shart (wet cupping), followed by Dalk (Massage) with Roghan Dafli and Bukhūr (medicated steam) with Tukhm Soya (Anethum graveolens Linn) in patients of Waja al-Zahr (Non-specific Low back pain).


Patients of either gender in the age group of 18–50 years with low back pain persisting for four weeks or more as chief complaint were recruited in the trial. The study was GCP compliant. The duration of the protocol therapy carried out was 14 days.


Ninty two patients of NSLBP were screened, of which 34 who fulfilled the inclusion criteria and were willing to participate in the study were recruited. Three participants were lost to follow-ups due to personal reasons and 31 patients completed the trial during the study period. Overall therapeutic response observed in this study was 97% while 3% of the patients did not respond to intervention.


The study findings imply that there is a credible evidence to ensure that the regimens intervened are safe and effective in ameliorating the symptoms of Waja al-Zahr.

Corresponding author: Noor Zaheer Ahmed, Deputy Director, Regional Research Institute of Unani Medicine, Chennai, India; and Central Council for Research in Unani Medicine, Ministry of AYUSH, Govt of India, New Delhi, India, E-mail:

Funding source: Central Council for Research in Unani Medicine, New Delhi, Ministry of AYUSH, Govt. of India


The authors gratefully acknowledge the Director General, CCRUM, New Delhi for approving the study under intra-mural research project and the guidance extended in the execution of the project. Acknowledgement is also due to Dr. N. Kulasekaran, Consultant Radiologist of the institute for his valuable radiology reports. The authors also acknowledge the officers, laboratory technicians, librarian and staff of RRIUM, Chennai for their whole hearted support at various stages of study.

  1. Research funding: The study has been fully funded by Central Council for Research in Unani Medicine, New Delhi, Ministry of AYUSH, Govt. of India as part of Intra-mural research project. The authors declare that no any role of funding agency was involved in the design, execution and outcome of the study.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state that there is no any conflict of interest in conducting this study.

  4. Honorarium: No honorarium involved.

  5. Informed consent: Informed consent has been obtained from all individuals included in this study.

  6. Ethical approval: The research related to human use complies with all the relevant national regulations, institutional policies and was performed in accordance with the tenets of the Helsinki Declaration, and has been approved by the author’s institutional ethics committee.


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Received: 2021-03-05
Accepted: 2021-06-30
Published Online: 2021-07-16

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