Efficacy of topical galbanum oil with dry cupping in hospitalized COVID-19 patients: A randomized open-label clinical trial

Document Type : Original Research Article

Authors

1 Department of Traditional Persian Medicine, School of Medicine, Shahed University, Tehran, Iran

2 Infectious Diseases Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Traditional Medicine, Institute for Studies in Medical History, Persian and Complementary Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran

4 Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran

5 Department of Biostatistics, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran

Abstract

Objective: This study was designed to detect the therapeutic effects of galbanum oil plus dry cupping (a Persian medicine-based method) in hospitalized patients with coronavirus disease-2019 (COVID-19).
Materials and Methods: In this randomized controlled trial, 60 hospitalized COVID-19 patients with positive polymerase chain reaction test (PCR), pulmonary involvement and blood oxygen saturation (SpO2) ≤93 mmHg, were randomly assigned into two groups to take the standard therapeutic regimen alone or alongside cupping and topical galbanum oil (Ferula gommosa oleo-gum resin) for 3-5 days. The SpO2 level, the severity of signs and symptoms of patients and laboratory parameters were compared between the two groups.
Results: Fifty-eight patients were analyzed. The SpO2 level changed from 89.27±3.82 to 90.29±3.09 mmHg (p=0.038) in control group, while it increased from 88.74±3.45 to 94.23±2.1 mmHg (<0.001) in galbanum group with a significant difference between the groups (p<0.001). Fever, cough, dyspnea, and anorexia alleviated in the galbanum group more than the control (p=0.003, 0.001, 0.01, and 0.04, respectively). No adverse effects were reported due to galbanum oil and cupping therapy.
Conclusion: Dry cupping with galbanum oil alongside the routine therapeutic regimen could be more effective than the routine therapeutic regimen alone for improving SpO2 level and alleviating fever, cough, and dyspnea in COVID-19 patients.

Keywords


Abd al-Jawad MEM, Saeed AM, Badawy AE,
Abde alfattah N. 2011. Evaluation of wet
cupping therapy (Hijama) as an adjuvant
therapy in the management of bronchial
asthma. Indian J Physiother Occup Ther, 5:
122-126.
Aboushanab TS, AlSanad S. 2018. Cupping
therapy: an overview from a modern
medicine perspective. J Acupunct Meridian
Stud, 11: 83-87.
Ahmed SM, Madbouly NH, Maklad SS, AbuShady EA. 2005. Immunomodulatory
effects of blood letting cupping therapy in
patients with rheumatoid arthritis. Egypt J
Immunol, 12: 39-51.
Al-Bedah AM, Elsubai IS, Qureshi NA,
Aboushanab TS, Ali GI, El-Olemy AT,
Khalil AA, Khalil MK, Alqaed MS. 2019.
The medical perspective of cupping
therapy: Effects and mechanisms of action.
J Trad Complement Med, 9: 90-97.
Ang L, Lee HW, Choi JY, Zhang J, Lee MS.
2020. Herbal medicine and pattern
identification for treating COVID-19: a
rapid review of guidelines. Integr Med Res,
9: 100407.
Chen Y, Liu Q, Guo D. 2020. Emerging
coronaviruses: genome structure,
replication, and pathogenesis. J Med Virol,
92: 418-423.
Consortium WST. 2021. Repurposed antiviral
drugs for COVID-19, interim WHO
solidarity trial results. New Engl J Med,
384: 497-511.
Ebrahimzadeh M, Nabavi SM, Nabavi SF,
Dehpour A. 2011. Antioxidant activity of
hydroalcholic extract of Ferula gummosa
Boiss roots. Eur Rev Med Pharmacol Sci,
15: 658-664.
Eftekhar F, Yousefzadi M, Borhani K. 2004.
Antibacterial activity of the essential oil
from Ferula gummosa seed. Fitother, 75:
758-759.
Emami-Razavi SZ, Khamessi M, Forough B,
Karimi M, Mansoori K, Sajadi S, Azadvari
M. 2016. Effects of galbanum oil on
patients with knee osteoarthritis: a
randomized controlled clinical trial. Trad
Integr Med, 1: 101-107.
Fallah F, Emadi F, Ayatollahi A, Taheri S,
Yazdi MK, Rad PK. 2015. The antimycobacterial activity of the extract of
Ferula gummosa. Int J Mycobacteriol, 4:
166.
Fang L, Karakiulakis G, Roth M. 2020. Are
patients with hypertension and diabetes
mellitus at increased risk for COVID-19
infection? Lancet Respir Med, 8: e21.
Feyzabadi Z, Pasalar M. 2016. Analysis of
Almond-Violet oil by gas chromatography
(A traditional formula). Iran J Med Sci,
41(3 Suppl): S2.
Habibzadeh S, Zohalinezhad ME. 2022.
Evaluation of the inhibitory activities of
Ferula gummosa bioactive compounds
against the druggable targets of SARSCoV-2: molecular docking simulation.
Biointerface Res Appl Chem, 12: 6382-
6392.
Hekmatpou D, Moeini L, Haji-Nadali S. 2013.
The effectiveness of wet cupping vs.
venesection on arterial O2 saturation level
of cigarette smokers: A randomized
controlled clinical trial. Pak J Med Sci, 29:
1349-1353.
Ibn-Sina H. 2004. Qanon fi-Altib, p. 484,
Bairut, Dar al-kotob al-Ilmiyah.
Ismail AM, Abdelghany AAI, Elfahl AMA.
2021. Immediate effect of interscapular
cupping on blood pressure, oxygen
saturation, pulse rate and chest expansion
in sedentary smoker students. J
Complement Integr Med, 18: 391-396.
Jahansooz F, Ebrahimzadeh H, Najafi AA,
Naghavi MR, Kouyakhi ET, Farzaneh H.
2008. Composition and antifungal activity
of the oil of Ferula gummosa samples from
Iran. J Essent Oil- Bear Plants, 11: 284-
291.
Joushan A, Choopani R, Agin K, Kenari HM.
2020. The role of manual therapy/practices
(dry cupping, wet cupping, leech therapy,
venesection, or phlebotomy) in lung
diseases. Eur J Mol Clin Med, 7: 4444-
4454.
Karimi M, Kazemi AH, Asadi A, Zarei A,
Zargaran A, Moravej A, Jazayeri F,
Nabavian O, Ahmadi A, Alipour R. 2022.
Warm cupping of the posterior thorax in
combination with standard conventional
therapy for ARDS in COVID-19 patients in
ICU: a case series. J Acupunct Meridian
Stud, 15: 194-200.
Lee SK, Hong CH, Huh SK, Kim SS, Oh OJ,
Galbanum oil with dry cupping in COVID-19
AJP, Vol. 13, No. 4, Jul-Aug 2023 399
Min HY. 2002. Suppressive effect of
natural sesquiterpenoids on inducible
cyclooxygenase (COX-2) and nitric oxide
synthase (iNOS) activity in mouse
macrophage cells. J Environ Pathol Toxicol
Oncol, 21: 141-148.
Lee DY, Li QY, Liu J, Efferth T. 2021.
Traditional chinese herbal medicine at the
forefront battle against COVID-19: clinical
experience and scientific basis.
Phytomedicine, 80: 153337.
Liu Y. 2002. Cupping therapy for 103 cases of
high fever due to infection of the upper
respiratory tract. J Tradit Chin Med, 22:
124-125.
Lowe DT. 2017. Cupping therapy: An analysis
of the effects of suction on skin and the
possible influence on human health.
Complement Ther Clin Pract, 29: 162-168.
Luo H, Tang QL, Shang YX, Liang SB, Yang
M, Robinson N, Liu JP. 2020. Can chinese
medicine be used for prevention of corona
virus disease 2019 (COVID-19)? A review
of historical classics, research evidence and
current prevention programs. Chin J Integr
Med, 26: 243-250.
Mahboubi M. 2016. Ferula gummosa, a
traditional medicine with novel
applications. J Diet Suppl, 13:700-718.
Mahboubi M, Kashani LMT. 2018. A
Narrative study about the role of Viola
odorata as traditional medicinal plant in
management of respiratory problems. Adv
Integr Med, 5: 112-118.
Mandegary A, Sayyah M, Heidari MR. 2004.
Antinociceptive and anti-inflammatory
activity of the seed and root extracts of
Ferula gummosa Boiss in mice and rats.
DARU J Pharm Sci, 12: 58-62.
Mehraban MSA, Shirzad M, Kashani LMT,
Ahmadian-Attari MM, Safari AA, Ansari
N, et al. 2023. Efficacy and safety of addon Viola odorata L. in the treatment of
COVID-19: A randomized double-blind
controlled trial. J Ethnopharmacol, 304:
116058.
Moosavi SJ, Habibian M, Peeri M,
Azarbayjani MA, Nabavi SM, Nabavi SF,
Sureda A. 2015. Protective effect of Ferula
gummosa hydroalcoholic extract against
nitric oxide deficiency-induced oxidative
stress and inflammation in rats renal
tissues. Clin Exp Hypertens, 37: 136-141.
Moradi MT, Karimi A, Lorigooini Z,
Pourgheysari B, Alidadi S, Hashemi L.
2017. In vitro anti influenza virus activity,
antioxidant potential and total phenolic
content of twelve Iranian medicinal plants.
Marmara Pharm J, 21: 843-851.
Mrityunjaya M, Pavithra V, Neelam R,
Janhavi P, Halami P, Ravindra P. 2020.
Immune-boosting, antioxidant and antiinflammatory food supplements targeting
pathogenesis of COVID-19. Front
Immunol, 11: 570122.
Muscogiuri G, Barrea L, Savastano S, Colao
A. 2020. Nutritional recommendations for
CoVID-19 quarantine. Eur J Clin Nutr, 74:
850-851.
Rahmanzade R, Rahmanzadeh R, Hashemian
SM, Tabarsi P. 2020. Iran's approach to
COVID-19: evolving treatment protocols
and ongoing clinical trials. Front Public
health, 8: 551889.
Qasemzadeh MJ, Sharifi H, Hamedanian M,
Gharehbeglou M, Heydari M, Sardari M,
Akhlaghdoust M, Minae MB. 2015. The
effect of Viola odorata flower syrup on the
cough of children with asthma: a doubleblind, randomized controlled trial. J Evid
Based Complementary Altern Med, 20:
287-291.
Shi Y, Wang Y, Shao C, Huang J, Gan J,
Huang X, Bucci E, Piacentini M, Ippolito
G, Melino G. 2020. COVID-19 infection:
the perspectives on immune responses. Cell
Death Differ, 27: 1451-1454.
Tafazoli V, Shahriari M, Heydari M, Nikbakht
HA, Zarshenaas MM, Nimrouzi M. 2020.
The effect of Viola odorata L. oil for fever
in children: A randomized triple-blinded
placebo-controlled clinical trial. Curr Drug
Discov Technol, 17: 696-703.
Tagil SM, Celik HT, Ciftci S, Kazanci FH,
Arslan M, Erdamar N, Kesik Y, Erdamar
H, Dane S. 2014. Wet-cupping removes
oxidants and decreases oxidative stress.
Complement Ther Med, 22: 1032-1036.
Wang SZ, Lu YH, Wu M, Chen KJ, Liu Y,
Liu LT. 2021. Cupping therapy for
diseases: an overview of scientific evidence
from 2009 to 2019. Chin J Iintegr Med, 27:
394-400.
Zhang Q, Wang X, Yan G, Lei J, Zhou Y, Wu
L, Wang T, Zhang X, Ye D, Li Y. 2018.
Anti-versus pro-inflammatory
metabololipidome upon cupping treatment.
Cell Physiol Biochem, 45: 1377-1389.