CHP Contraindications & Precautions 3 — Questions and Answers
Question 1: Hijama should NEVER be applied directly over which of the following?
- Areas with visible muscle tension and knots
- Active skin infections, open wounds, or ulcerated tissue (Correct answer)
- Areas with normal subcutaneous fat distribution
- Areas with dense hair follicles
Correct answer: Active skin infections, open wounds, or ulcerated tissue
Applying cups over broken or infected skin introduces pathogens into the bloodstream and worsens local infection.
Question 2: A patient presents with active psoriasis plaques across the mid-back. The practitioner should:
- Cup directly over plaques to improve blood flow to affected areas
- Avoid cupping over plaques and treat only adjacent healthy skin if appropriate (Correct answer)
- Use smaller cups with less suction directly on plaques
- Apply petroleum jelly over plaques as a barrier before cupping
Correct answer: Avoid cupping over plaques and treat only adjacent healthy skin if appropriate
Cupping over psoriatic plaques risks koebnerization — triggering new plaques — and may break already fragile skin.
Question 3: Why are varicose veins on the lower limbs a local contraindication to hijama at those sites?
- Cup suction cannot be maintained over varicose vessels
- Direct cupping could rupture fragile vein walls, causing hemorrhage or deep vein thrombosis (Correct answer)
- Varicose veins cause cup marks to become permanent
- Suction increases systemic venous pressure throughout the body
Correct answer: Direct cupping could rupture fragile vein walls, causing hemorrhage or deep vein thrombosis
Varicose veins have weakened, tortuous walls that can rupture under suction, and stagnant blood increases thrombosis risk.
Question 4: A patient has a burn injury on the right shoulder that is 2 weeks old with incomplete healing. The practitioner should:
- Apply gentle dry cupping to stimulate healing circulation
- Avoid the burned area entirely until skin is fully healed and cleared by a physician (Correct answer)
- Wait 48 hours after injury before applying cups
- Use wet cupping to drain the burned tissue
Correct answer: Avoid the burned area entirely until skin is fully healed and cleared by a physician
Incompletely healed burns lack intact skin integrity; cupping risks infection, scarring, and graft damage if applicable.
Question 5: Which skin condition over the intended cupping site requires absolute avoidance of hijama at that location?
- Mild xerosis (dry skin) without fissuring
- Active eczema with weeping, broken skin (Correct answer)
- A fully healed surgical scar more than 12 months old
- Silver stretch marks on the abdomen
Correct answer: Active eczema with weeping, broken skin
Weeping eczema involves broken skin barriers, and cupping would introduce pathogens and significantly worsen the condition.
Question 6: Lymphedema in a limb is a local contraindication to hijama on that limb because:
- Swollen tissue prevents cup adhesion
- Cupping could worsen fluid accumulation and damage already compromised lymphatic vessels (Correct answer)
- Lymphedema causes excessive bleeding after incisions
- The suction would be intolerable due to nerve compression
Correct answer: Cupping could worsen fluid accumulation and damage already compromised lymphatic vessels
Disrupting lymph vessels in an already compromised limb risks worsening edema, fibrosis, and increasing infection susceptibility.
Question 7: A patient with vitiligo patches on the back requests hijama over those depigmented areas. The practitioner should:
- Avoid the vitiligo patches, as mechanical trauma may trigger or worsen the Koebner response (Correct answer)
- Target vitiligo patches specifically to stimulate melanocyte repopulation
- Proceed normally since vitiligo is a cosmetic condition only
- Apply maximum suction over vitiligo areas to improve blood flow
Correct answer: Avoid the vitiligo patches, as mechanical trauma may trigger or worsen the Koebner response
Vitiligo can exhibit the Koebner phenomenon, where skin trauma at affected sites triggers or spreads depigmentation.
CHP Contraindications & Precautions 3
Hijama should NEVER be applied directly over which of the following?