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I have had many patients and therapists asking me if they can use topical ointments such as numbing creams to avoid pain in the process of scarification (incisions).
I have outlined below the physiological aspects as to why we must not use numbing creams whilst administering hijamah treatment.
These numbing creams are referred to as “Local Anaesthetics” or topical Anaesthetics.

What is a local anaesthetic?

Local anaesthetic drugs are used widely for the provision of anaesthesia and analgesia both intra- and post-operatively. Understanding the pharmacology of these agents as a group, as well as the differences between specific drugs, enables the anaesthetist to use them safely to maximum effect.

Definition of a local anaesthetic

A local anaesthetic can be defined as a drug which reversibly prevents transmission of the nerve impulse in the region to which it is applied, without affecting consciousness. There are many drugs which exert local anaesthetic activity in addition to their main clinical uses, but here we shall focus on those drugs which are principally used for their local anaesthetic properties.

The action of local anaesthetic on the nervous system

Local anaesthetics disrupt ion channel function within the neurone cell membrane preventing the transmission of the neuronal action potential. This is thought to occur via specific binding of the local anaesthetic molecules (in their ionised form) to sodium channels, holding them in an inactive state so that no further depolarisation can occur. This effect is mediated from within the cell; therefore the local anaesthetic must cross the cell membrane before it can exert its effect.
A second mechanism is also thought to operate, involving the disruption of ion channel function by the incorporation of local anaesthetic molecules into the cell membrane (the membrane expansion theory). This is thought to be mediated mainly by the unionised form acting from outside the neuron. Nerve fibres differ in their sensitivity to local anaesthetics. Small nerve fibres are more sensitive than large nerve fibres while myelinated fibres are blocked before non-myelinated fibres of the same diameter. Thus the loss of nerve function proceeds as loss of pain, temperature, touch, proprioception, and then skeletal muscle tone. This is why people may still feel touch but not pain when using local anaesthesia.

The affects of topical anaesthetics on the physiology of blood vessels

Normally, blood vessels supplying the skin provide nutrition, allow for tissue metabolism, and provide an important way to maintain a normal body temperature. Specialized skin blood vessels constrict or narrow in response to cold temperatures. This reaction, called “vasoconstriction,” decreases blood flow to the skin, which helps to minimize heat loss and preserve a normal internal or “core” temperature. In warm temperatures, these same blood vessels dilate, allowing heat to leave the body. The blood vessels in the skin that react to temperature changes are called thermoregulatory vessels. These specialized blood vessels are controlled by the sympathetic nervous system, the same system that reacts when we are nervous or upset emotionally. This explains why both cold and emotional stress can trigger vasoconstriction of these blood vessels, causing cold fingers and toes. Thus, cold hands and feet occur normally in everybody when we are exposed to cold temperatures.

However when the mechanisms that control vasoconstriction or vasodilation are manually altered these blood vessels recess deeper and further into the muscle tissue. This in turn causes vessels to constrict further once more in an exaggerated way in response to the action of the local anaesthetic.

Local anaesthetics and Hijamah.

Severe vasoconstriction reduces blood flow to the skin of the affected areas, causing the skin surface to feel cold to touch and to have a white colour. The pale white colour is due to virtually no blood flow to the skin. The skin then typically becomes a purplish-blue colour (called acrocyanosis), as a reduced flow of blood through the skin returns. When the vessel fully recovers, it dilates, allowing blood flow to resume; the skin may blush, becoming very pink or red.

By considering the biomechanisms involved in the use of numbing creams , it has clearly been deduced that their use in this therapy is completely irrelevant as it causes the recession of blood vessels and the restriction of blood flow in the region to where it is exercised therefore it would be impossible to exhume blood stasis in the area where hijamah is to applied.
In such an event if any blood stasis was to be extracted then it would be negligible as compared to hijamah conducted without the use of a topical local anaesthetic.
Vasoconstrictors are the most powerful numbing agent you’ll be able to use. Vasoconstrictors include epinephrine, and they work by causing blood vessels to constrict which reduces bleeding. These chemicals also slow down absorption, which means that, when mixed with other numbing agents, they allow them to last longer because they cut down on bleeding and swelling.
Hence It is non conducive if an anaesthetic (topical) was to be incorporated in this noble therapy rendering the practice useless and defying the whole purpose of removing morbid matter(blood stasis)
Then Allah knows best.


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