Terapi Bekam (Cupping Therapy, Al Hijamah, Oxidant Drainage Therapy) dalam Kedokteran Tradisional China. Bagian I

Oleh : Huang Shixi

Terapi bekam merupakan terapi khusus dalam kedokteran tradisional China. Karena sifatnya yang mudah untuk dipelajari, diterapkan dan tidak ada efek sampingnya, maka terapi bekam telah dipergunakan secara luas di seluruh dunia. Pada tulisan ini akan dibahas tentang mater, metode dan penggunaan terapi bekam. selanjutnya akan diuraikan tentang penggunaan terapi bekam untuk perawatan sebelas penyakit yang sering terjadi, yaitu pilek, torticollis, sciatica, periarthritis pada bahu, hemiplegia, nyeri epigastrik, nyeri perut, lumbago, obesitas, dismenore, dan urtikaria.

Terapi bekam adalah suatu metode di mana pembuluh darah tepi ditarik ke permukaan kulit dengan cara dihisap, yang bertujuan untuk mencegah atau menyembuhkan penyakit. Pada zaman dahulu terapi bekam dikenal juga dengan sebutan "bekam tanduk' atau "terapi bambu". Dalam literatur pengobatan China terdapat banyak risalah tentang terapi bekam, dan telah terkenal dan dipakai secara luas. Terapi ini mudah dipelajari, cepat, efektif, dan aman. Secara historis, fokus awal dari terapi ini adalah untuk merawat hematoma dan pembengkakan yang disertai nanah, namun kemudian penggunaannya berkembang untuk merawat ratusn penyakit klinis, yang meliputi penyakit dalam, penyakit pembedahan, masalah-masalah kandungan, dan penyakit anak.

Dari sudut pandang biomedis, rangsangan mekanis karena tekanan negatif di dalam tabung bekam (kop) akan mengaktifkan metabolisme jaringan lokal, meningkatkan fagositosis, dan meningkatkan proses penyembuhan.

Berdasarkan teori pengobatan tradisional China, terapi bekam didasari oleh teori saluran (channel theory), di mana memilih titik yang tepat di sepanjang saluran yang tepat pula merupakan hal yang paling mendasar.

Penyakit dalam seringkali bermanifestasi pada permukaan tubuh sebagai rasa nyeri atau sensitivitas, khususnya pada Ashi point, yaitu titik yang terasa sakit bila dilakukan penekanan karena terjadi stagnasi dari qi, darah, lembab, lendir, makanan atau api. Semua keadaan stagnasi ini akan berubah bentuk, terutama menjadi kondisi kronis. Memilih titik yang tepat untuk perawatan dapat membangkitkan efek perawatan yang signifikan dan cepat. Di samping itu, karena petechie dan eksudasi pada kulit yang disebabkan oleh pembekaman memerlukan waktu beberapa hari agar hilang, maka adanya hal tersebut menjadi rangsangan yang terus-menerus pada kulit, yang akan menyeimbangkan ying dan wei, menyebabkan sirkulasi darah dan qi, serta membersihkan saluran.

Umumnya terapi bekam memiliki berbagai fungsi terapetik, seperti merangsang keringat dan menghilangkan pathogen eksogen, membersihkan saluran, mengurangi pembengkakan dan meredakan nyeri, menghangatkan saluran untuk membuang dingin, meningkatkan qi dan sirkulasi darah, mempercepat penyembuhan, dan mengatur suhu tubuh.

Tipe kop
Ada beberapa tipe kop yang bisa dipakai dalam terapi bekam, yaitu :
1. Kop tanduk. Alat bekam kunao ini menggunakan tanduk binatang. Alat ini praktis, ekonomis, dan menghasilkan penghisapan yang baik, namun tidak cocok untuk sterilisasi suhu tinggi.
2. Kop bambu. Bambu bersifat ekonomis, tipis, dan tidak mudah pecah. Namun demikian, bambu mudah retak, sehingga kebocoran udara sering terjadi.
3. Kop logam. Kop jenis ini terbuat dari tembaga, besi, atau aluminium. Kop mudah panas, sehingga jarang dipakai.
4. Kop gelas. Jenis ini mempunyai tepi mulut yang halus, dan sifat transparannya membuat pengamatan lebih mudah dilakukan. Jenis inilah yang paling banyak digunakan di klinik profesional.
5. Kop vakum. Kop jenis ini biasanya dibuat dari bahan plastik transparan dan tidak mudah pecah. Alat ini menggunakan tabung penghisap pada bagian atasnya, dan sering digunakan secara umum di rumah-rumah.

Menghasilkan kondisi vakum
Ada beberapa cara untuk menghasilkan kondisi vakum, dan yang paling sering dilakukan adalah dengan metode api dan metode penghisapan.

A. Metode api
Metode api menghasilkan kondisi vakum dengan memasukkan nyala api ke dalam kop, sehingga tekanan negatif melekatkan kop ke kulit. Teknik yang sering dipakai adalah :

1. Metode menarik api.
Metode menarik api dari kop ini merupakan metode yang paling sering dilakukan. Letakkan mulut kop menghadap ke bawah, kemudian jepit gulungan kapas beralkohol dengan sebuah penjepit atau pinset. Hati-hati jangan sampai ada alkohol yang menetes dari kop. Dengan cepat nyalakan kapas dengan korek api dan masukkan ke dalam kop. Kemudian keluarkan kapas menyala tadi dengan cepat dan segera letakkan kop pada permukaan kulit yang telah ditentukan. Keadaan vakum yang dihasilkan akan melekatkan kop pada kulit.

2. Metode melemparkan api.
Metode ini dilakukan dengan melemparkan gulungan kapas beralkohol atau potongan kertas yang dibakar ke dalam kop, kemudian dengan cepat kop diletakkan pada permukaan kulit yang ditentukan. Metode ini cocok untuk bekam yang dilakukan di bagian samping tubuh, di mana kemungkinan terbakarnya kulit dapat dihindari.

B. Metode penghisapan udara
Letakkan kop pada permukaan kulit yang sudah ditentukan dan hubungkan alat penghisap dengan ujung katup pada kop. Hisap udara dari dalam kop dengan memompa alat penghisap untuk menghasilkan kondisi vakum, sehingga kop melekat pada permukaan kulit.

Manipulasi yang biasanya dilakukan
a. Metode menarik api secara berulang.
Biasanya metode ini digunakan untuk merawat penyakit karena angin, yang menyebabkan kebas, nyeri pada permukaan tubuh, dan untuk penyakit yang letaknya berpindah-pindah.

Metode ini menggunakan teknik menarik api, meletakkan kop pada lokasi yang telah ditentukan, dan dengan segera dilepaskan. Hal tersebut dilakukan beberapa kali untuk membuang angin. Umumnya pengulangan dilakukan 15 - 30 kali hingga kulit bewarna merah.

b. Metode membiarkan kop.
Metode ini sering digunakan untuk penyakit yang disebabkan oleh dingin, di mana lokasi nyeri menetap, mudah ditentukan dan dalam, untuk masalah yang disebabkan oleh stagnasi qi dan darah, penyumbatan saluran serta disfungsi zangfu dalam jangka panjang.

Letakkan kop pada lokasi yang telah ditentukan selama 5 - 25 menit untuk menguatkan efek pembuangan faktor pathogen. Pada anak-anak, orang tua, dan pasien yang kondisinya lemah, maka kop biasanya hanya ditinggalkan selama 5 - 15 menit.

c. Metode menggerakkan kop.
Juga dikenal dengan "metode kop berjalan, metode mendorong kop, metode menarik kop, metode menggeser kop, atau metode meluncurkan kop." Metode ini banyak dipakai dan dapat digabungkan dengan metode b.

Umumnya dipakai pada permukaan tubuh yang luas. Pertama, balurkan minyak atau vaselin pada kulit dan sebarkan dengan menggunakan kop. Kedua, lekatkan kop pada kulit dengan salah satu netode menghasilkan vakum seperti yang telah dijelaskan, kemudiandorong dan tarik kop secara berulang. Pastikan permukaan mulut kop halus dan tidak ada yang pecah. Manfaat yang dihasilkan metode ini menggabungkan keuntungan yang diperoleh dari bekam dan pemijatan.

d. Metode kop dengan jarum akupunktur.
1. Penerapan secara berurutan. Dalam hal ini akupunktur digunakan sebelum atau sesudah terapi bekam. Metode ini khususnya cocok untuk pasien dengan penyakit yang serius dan sulit. Teknik jarum akupunktur biasanya dilakukan terlebih dahulu dan setelah selesai dilanjutkan dengan meletakkan kop di atas titik yang dirawat. Bekam juga bisa dilakukan sebelum akupunktur. Pada kasus seperti ini digunakan metode meninggalkan kop.

2. Penerapan secara bersamaan. Dalam hal ini jarum akupunktur ditusukkan terlebih dahulu, kemudian kop diletakkan di atas jarum. Kombinasi akupunktur dan bekam ini akan meningkatkan perangsangan pada titik akupunktur. Metode ini biasanya dipakai pada perawatan penyakit kronis.

e. Metode perdarahan.
Merupakan metode yang sering digunakan, di mana terapi bekam dikombinasikan dengan perdarahan untuk menghasilkan efek perawatan yang cepat dan bermanfaat. Metode ini berfungsi untuk meningkatkan peredaran darah dan menghilangkan darah statis, membersihkan panas, meredakan nyeri, membersihkan saluran, dan secara khusus cocok untuk penyakit dengan pola panas yang berlebih (ekses), misalnya koma, heat stroke, demam tinggi, sakit kepala, nyeri tenggorokan, lumbago, carbuncles, erisipelas, dan lain-lain.

Jarum bermata tiga atau jarum lancet sering digunakan untuk menghasilkan perdarahan. Tusuklah daerah yang telah ditentukan agar berdarah, dan kemudian bekamlah daerah tersebut, tinggalkan kop selama 5 - 15 menit. Kop tidak boleh ditinggal lebih lama, karena bisa menghisap dan membuang qi yang sehat.

(Nyambung ke : Terapi Bekam (Cupping Therapy, Al Hijamah, Oxidant Drainage Therapy) dalam Kedokteran Tradisional China. Bagian II)

CUPPING

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Cupping refers to an ancient Chinese practice in which a cup is applied to the skin and the pressure in the cup is reduced (by using change in heat or by suctioning out air), so that the skin and superficial muscle layer is drawn into and held in the cup. In some cases, the cup may be moved while the suction of skin is active, causing a regional pulling of the skin and muscle (the technique is called gliding cupping).
This treatment has some relation to certain massage techniques, such as the rapid skin pinching along the back that is an important aspect of tuina (12). In that practice, the skin is pinched, sometimes at specific points (e.g., bladder meridian points), until a redness is generated. Cupping is applied by acupuncturists to certain acupuncture points, as well as to regions of the body that are affected by pain (where the pain is deeper than the tissues to be pulled). When the cups are moved along the surface of the skin, the treatment is somewhat like guasha (literally, sand scraping), a folk remedy of southeast Asia which is often carried out by scraping the skin with a coin or other object with the intention of breaking up stagnation. Movement of the cups is a gentler technique than guasha, as a lubricant allows the cup to slide without causing as much of the subcutaneous bruising that is an objective of guasha. Still, a certain amount of bruising is expected both from fixed position cupping (especially at the site of the cup rim) and with movement of the cups.
Traditional cupping, with use of heated cups, also has some similarity to moxibustion therapy. Heating of the cups was the method used to obtain suction: the hot air in the cups has a low density and, as the cups cool with the opening sealed by the skin, the pressure within the cups declines, sucking the skin into it. In this case, the cups are hot and have a stimulating effect something like that of burning moxa wool.
In some cases, a small amount of blood letting (luoci; vein pricking) is done first, using a pricking needle, and then the cup is applied over the site. The pricking is usually done with a three-edged needle, applied to a vein, and it typically draws 3–4 drops of blood (sometimes the skin on either side is squeezed to aid release of blood). A standard thick-gauge acupuncture needle or plum blossom needle may be used instead. This technique is said to promote blood circulation, remove stasis, and alleviate swelling and pain. It is employed especially when there is a toxic heat syndrome and for a variety of acute ailments.
The following report is derived mainly from a survey of reported cupping techniques published in 1989 (1), supplemented by information from acupuncture text books (5–9).

EARLY HISTORY
The earliest use of cupping that is recorded is from the famous Taoist alchemist and herbalist, Ge Hong (281–341 A.D.). The method was described in his book A Handbook of Prescriptions for Emergencies, in which the cups were actually animal horns, used for draining pustules. As a result of using horns, cupping has been known as jiaofa, or the horn technique. In a Tang Dynasty book, Necessities of a Frontier Official, cupping was prescribed for the treatment of pulmonary tuberculosis (or a similar disorder). More recently, Zhao Xuemin, during the Qing Dynasty, wrote Supplement to Outline of Materia Medica, including an entire chapter on “fire jar qi” (huoquan qi). In it, he emphasized the value of this treatment, using cups made of bamboo or pottery, in alleviating headache of wind-cold type, bi syndrome of wind origin, dizziness, and abdominal pain. The cups could be placed over acupuncture needles for these treatments. One of the traditional indications for cupping is dispelling cold in the channels. This indication is partly the result of applying hot cups. For example, bamboo cups would be boiled in an herbal decoction just prior to applying to the skin (this is one type of shuiguanfa, or liquid cupping, so-called because a liquid is incorporated into the treatment). Both liquid cupping and cupping over an acupuncture needle are favored for treatment of arthralgia. Cupping also is thought to dispel cold by virtue of its ability to release external pathogenic factors, including invasion of wind, damp, and cold.

MODERN CUPPING
During the 20th century, new glass cups were developed (see Figure 1). Common drinking glasses have been used for this purpose, but thick glass cupping devices have also been produced and are preferred. The introduction of glass cups helped greatly, since the pottery cups broke very easily and the bamboo cups would deteriorate with repeated heating. Glass cups were easier to make than the brass or iron cups that were sometimes used as sturdy substitutes for the others; further, one could see the skin within the cup and evaluate the degree of response.
The glass cups are depressurized by providing some fire in the cup to heat up the air within just prior to placement. For example, hold a cotton ball dipped in alcohol with a pincer, ignite it, hold it in the cup, then rapidly apply to the skin; this is called shanhuofa (flash-fire cupping; see Figure 2). Sometimes, a small amount alcohol is put in the cup and lit; this method is called dijiufa (alcohol-fire cupping).
At the end of the 20th century, another method of suction was developed in which a valve was constructed at the top of the jar and a small hand-operated pump is attached so that the practitioner could suction out air without relying on fire (thus avoiding some hazards and having greater control over the amount of suction). Both glass and plastic cups were developed, though the plastic ones are not very well suited to moving along the skin once in place, as the edges are not entirely smooth and the strength of the cups is limited. The modern name for cupping is baguanfa (suction cup therapy).
In order to allow easy movement of the glass cups along the skin, some oil is applied. Medicated massage oils (with extracts of herbs) are particularly useful for this purpose. Since the cups are applied at room temperature, the indication of removing cold from the channels is no longer as applicable, at least to stationary cups. There is some friction generated with moving cups, so that there is a small but significant amount of heat applied by that method, especially if a warming oil is used as lubricant.
Generally, the cup is left in place for about 10 minutes (typical range is 5–15 minutes). The skin becomes reddened due to the congestion of blood flow. The cup is removed by pressing the skin along side it to allow some outside air to leak into it, thus equalizing the pressure and releasing it. Some bruising along the site of the rim of the cup is expected.
Today, cupping is mainly recommended for the treatment of pain, gastro-intestinal disorders, lung diseases (especially chronic cough and asthma), and paralysis, though it can be used for other disorders as well. The areas of the body that are fleshy are preferred sites for cupping. Contraindications for cupping include: areas of skin that are inflamed; cases of high fever, convulsions or cramping, or easy bleeding (i.e., pathological level of low platelets); or the abdominal area or lower back during pregnancy. Movement of the cups is limited to fleshy areas: the movement should not cross bony ridges, such as the spine. Following are some of the recommended treatment sites for various disorders.

Respiratory Diseases
 For chronic bronchitis and asthma, one can apply cupping at the following points: dingchuan, dazhui (GV-14), shenzhu (GV-12), geshu (BL-17), xinshu (BL-15), jueyinshu (BL-14), feishu (BL-13), fengmen (BL-12), dashu (BL-11), tiantu (CV-22), shanzhong (CV-17), huagai (CV-20), and zhongfu (LU-1). [see: Acupuncture treatment of asthma for more information about several of these treatment sites].
 For pediatric bronchitis: blood letting followed by cupping at dazhui (GV-14).
 For pediatric acute bronchitis: feishu (BL-13), shenchang (KI-25), lingxu (KI-24).

Digestive Diseases
 For dysentery, early morning diarrhea, and acute and chronic gastritis, perform cupping in the following areas: around the navel; at the bladder meridian shu points; or these stomach meridian points: burong (ST-19), guanmen (ST-22), huaroumen (ST-24), tianshu (ST-25).
 Pediatric indigestion: dachangshu (BL-25).

Pain Syndromes
 Shoulder blade: jianwaishu (SI-14) and tianzhong (SI-11).
 Loins: shenshu (BL-23), qihaishu (BL-24), guanyuanshu (BL-26).
 Head: taiyang and yintang for refractory headaches and migraines; dazhui (GV-14) and baihui (GV-20) for parietal and occipital headaches; for trigeminal neuralgia: qihu (ST-13), fengchi (GB-20), sizhukong (TB-23), jiache (ST-6); for toothache: dashu (BL-11), with acupuncture, massage, and cupping at yifeng (TB-17), jiache (ST-6), xiaguan (ST-7), and hegu (LI-4).
 Soft tissue injury: treat local pressure pain points and area of swelling; use plum blossom needling followed by cupping; additionally or alternatively use points above or below the site of injury along the channels that pass through the injury.

Gynecological Disorders
 Infertility and irregular menstruation: shenshu (BL-23) with movement of cup downward (treat with acupuncture first, then do cupping).
 Leukorrhea: yaoyan (extra point under the 3rd lumbar vertebra) and around baliao (BL-31 through BL-34).
 Uterine cramps: needle zusanli (ST-36) and guanyuan (CV-4) and do cupping at guanyuan (CV-4).

Miscellaneous
 Common cold: dazhui (GV-14).
 Insomnia: xinshu (BL-15), geshu (BL-17), shenshu (BL-23).
 Facial paralysis: needling and cupping dazhui (GV-14), along with needling local facial points.

RECENT RESEARCH
The following protocols were reported to provide good results in individual clinical research reports:
a. Head pain (2): headache, toothache, sore throat, redness and soreness of the eyes, treated with blood letting followed by cupping. Treatment is applied to dazhui (GV-14) and dingchuan.
b. Frozen shoulder (3): after acupuncture at jianyu (LI-15) and jianliao (TB-14) to get propagated qi reaction, use pricking of ashi points followed by cupping over the bleeding area for 10–15 minutes. Ten treatments is a course of therapy.
c. Acute trigeminal neuralgia treating with blood letting followed by cupping (4): treatment is applied to dazhui (GV-14) and feishu (BL-13).
d. Acne (10): treatment is to use bloodletting followed by cupping at feishu (BL-13) and geshu (BL-17) on one day, then xinshu (BL-15) and ganshu (BL-18) the next day, alternating treatments for a total of eight days.
e. Urticaria (11): perform cupping at shenque (CV-8) three times consecutively for ten minutes each time. This is done for three days, followed by one day rest, and another three days as needed.
f. Acute diseases (13): fever and headache due to infection, acute conjunctivitis, lumbar sprain; perform blood letting at dazhui (GV-14), and then cupping (which promotes further bleeding).

TREATMENT SUMMARY
Cupping therapies often follow the point selection pattern that is used for standard acupuncture therapy, with somewhat greater emphasis on the use of back points (due to the ease of performing this technique there). In particular, most practitioners rely on using back shu points (bladder meridian) and dazhui (GV-14). Cupping is frequently applied after treatment by acupuncture, blood letting, or plum blossom treatment.

REFERENCES
1. Cui Jin and Zhang Guangqi, A survey of thirty years’ clinical application of cupping, Journal of Traditional Chinese Medicine 1989; 9(3): 151–154.
2. Wu Jiashu, Observation of analgesic effect of acupuncturing dazhui point, Journal of Traditional Chinese Medicine 1989; 9(4): 240–242.
3. Ju Huadong, 30 cases of frozen shoulder treated by needling and cupping, International Journal of Clinical Acupuncture 1998; 9(3): 327–328.
4. Zhang Zhilong, Observation on therapeutic effects of blood-letting puncture with cupping in acute trigeminal neuralgia, Journal of Traditional Chinese Medicine 1997; 17(4): 272–274.
5. Cheng Xinnong, Chinese Acupuncture and Moxibustion, 1987 Foreign Languages Press, Beijing.
6. State Administration of Traditional Chinese Medicine and Pharmacy, Advanced Textbook on Traditional Chinese Medicine and Pharmacology, volume IV, 1997 New World Press, Beijing.
7. O’Conner J and Bensky D (translators), Acupuncture: A Comprehensive Text, 1981 Eastland Press, Seattle, WA.
8. Zhang Ruifu, Wu Xiufen, and Nissi Wang (compilers), Illustrated Dictionary of Chinese Acupuncture, 1986, Sheep’s Publications, Hong Kong.
9. Academy of Traditional Chinese Medicine, An Outline of Chinese Acupuncture, 1975 Foreign Languages Press, Beijing.
10. Chen Decheng, Jiang Nawei, and Cong Xin, 47 cases of acne treated by prick-bloodletting plus cupping, Journal of Traditional Chinese Medicine 1993; 13(3): 185–186.
11. Wang Huaiping, Treatment of urticaria with cupping, Journal of Traditional Chinese Medicine 1993; 13(2): 105.
12. Li Jiang, A miraculous spinal pinching therapy, Journal of Traditional Chinese Medicine 1996; 16(3): 228–229.
13. Yin Ying, Blood-letting at a single point for treatment of acute diseases, Journal of Traditional Chinese Medicine 1997; 17(3): 214–216.


Source : http://www.itmonline.org/arts/cupping

Further information at http://www.rumahtherapysyafakallah.blogspot.com