Efficacy of Hijamat (wet cupping therapy) in Iranian patients with nonalcoholic fatty liver disease: a controlled clinical trial

Background/aim: Nonalcoholic fatty liver disease (NAFLD) is known to be the most prevalent chronic liver disease all over the world. The incidence of this disease has dramatically increased during the last decade. Studies have shown a strong relationship between the level of ferritin and the severity of NAFLD. The objective of the present study was to assess the effect of adding Hijamat, as an iron reducing procedure, to standard lifestyle modification on the improvement of insulin resistance and liver enzymes in patients with NAFLD. Materials and methods: One hundred and twenty NAFLD patients participated in a randomized, controlled, single-blind trial design of study. The control group received counselling for nutrition and physical activity for a period of 6 months. The treatment group received the above items plus Hijamat for 3 times during 1 month. Ultrasound images of liver, HOMA-IR, and laboratory data including ALT, AST were assessed pre- and postintervention. Results: At the end of the study, a significant decrease was demonstrated in the serum level of HOMA-IR (–1.30 ± 0.88 vs –.02 ± 0.47, P < 0.001) and serum levels of ALT (–6.50 ± 4.92 vs –2.38 ± 3.92, P < 0.001) and AST (–2.78 ± 4.29 vs –1.30 ± 2.33, P = 0.021) in the Hijamat group were compared to the control group. Ultrasound images of the liver improved in 23.3% of the patients in the Hijamat group, while the rate of improvement in the control group was 10% (P = 0.050). Hijamat therapy was safe and tolerable in this trial. Conclusions: Hijamat resulted in a relative improvement in fatty liver severity and improved HOMA-IR and liver enzymes more than lifestyle modification alone in patients with NAFLD.