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Dwi Setiani Sumardiko1, Sujono2, Risa Herlianita3

Student of Nursing Science Program, Faculty of Health Science, Universitas Muhammadiyah Malang
Lecturer of Nursing Science Program, Faculty of Health Science, Universitas Muhammadiyah Malang

Universitas Muhammadiyah Malang, Jalan Bendungan Sutami No.188, Sumbersari, Malang 65145

Corresponding Author:

Introduction: Hypercholesterolemia is a condition where cholesterol levels in the body exceed

normal value. Hypercholesterolemia is a risk factor for stroke, coronary heart disease,
myocardial infarction and premature death. Many people who suffer from
hypercholesterolemia use cupping therapy. Wet cupping therapy is a process of removing dirty
blood from the body through the skin surface. The purpose of this study was to determine the
effectiveness of wet cupping therapy to decrease cholesterol levels in blood in
hypercholesterolemia patients.
Method: This research is a pre-experimental using one group pretest-posttest design. The study
was conducted in January-February 2012 at Rumah Sehat Dompet Dhuafa Balikpapan. The
population was all hypercholesterolemia patients. The number of samples were 25 respondents,
taken based on the method of non-probability sampling technique which was purposive
sampling. Data were collected using questionnaires and cholesterol levels examination. Data
then analyzed using dependent T-test with significance level α <0,05.
Result: Dependent statistical analysis using paired T-test showed that 25 respondents had high
cholesterol level with average cholesterol level before cupping therapy was 219,52 mg/dl and
after cupping therapy was 185,76 mg/dl. In the hypothesis test using the dependent T-Test
found t-count was greater than t-table (6,414> 2.064) and had significance value less than alpha
(0,000<0,050). Therefore H0 was rejected and H1 was accepted, meaning there was difference
of result between variable before treatment and after treatment by using wet cupping therapy.
Conclusion: Wet cupping therapy is effective to decrease cholesterol level in blood in patients
with hypercholesterolemia at Rumah Sehat Dompet Dhuafa Balikpapan, with average
reduction of 34,16 mg/dl.

Key words: Hypercholesterolemia, Wet Cupping Therapy, Cholesterol level reduction, blood
cholesterol level

Stroke, acute myocardial infarction and coronary heart disease (CHD) in Indonesia still

occupy the first position as a disease causing death. Household Health Survey (SKRT) in 1998

diseases classified in the disease circulatory system reached a number of 24.4%, an increase

from 1985 at 5.9%. Ministry of Health Research and Development Agency stated that the

percentage of deaths due to cardiovascular disease increased from 5.9% (1975) to 9.1% (1986)

and 19.0 (1995). One of the major risk factors for cardiovascular disease is high cholesterol or

so-called hypercholesterolaemia. Hypercholesterolemia is always identified with coronary

heart disease (CHD) (Saryono, 2010).

Hypercholesterolemia is a state of cholesterol in the body beyond normal (Oetoro,

2007). According to a 2002 World Health Organization (WHO) report, 4.4 million deaths were

due to hypercholesterolemia or 7.9% of total deaths at a young age (WHO, 2008). In Indonesia

the incidence of hypercholesterolemia based on the study of MONICA I (1994) amounted to

13.4% for women and 11.4% for men, whereas in MONICA II (1998) study increased to 16.2%

for women and 14% for men. The prevalence of hypercholesterolemia in rural communities in

2004 reached 200-248 mg / dl or reached 10.9% of the total population. Patients in the younger

generation of the age of 25-34 years reached 9.3%. Women became the group most suffered

from this problem that is 14.5% or almost double the male group. Factors causing

hypercholesterolemia include heredity, high-fat diet, lack of exercise and smoking habits

(Setiati, 2009).

Treatment of pharmacologic hypercholesterolemia is done by administering various

drugs of normolipidemia, statins, fibrates, resins, selective cholesterol absorption inhibitors

and nicotinic acid. Treatment of hypercholesterolemia is considered to be ineffective, as nearly

70% of hypercholesterolemic patients in Indonesia fail to achieve cholesterol levels according

to treatment guidelines, relatively expensive drug prices, frequent recurrences and more

dangerous side effects (Prince and Wilson, 2005).

Currently found alternative and complementary medicine trends (Complementary and

Alternative Medicine) to handle hypercholesterolemia. One of them is cupping therapy or

cupping therapy that has recently become more popular in the community and gained

credibility in the world of health biomedicine (Hill, 2003). The survey showed that about one-

third of the UK population (Ernst, 1996) and slightly higher in the United States (Wootton and

Sparber, 2001) use bruises in addressing various health problems such as hypertension,

headache, low back pain, stroke rehabilitation, and hypercholesterolemia ( Lee, 2001).

Therapeutic techniques of cupping therapy (Cupping Therapy) is a process of disposing of

dirty blood in the form of toxids / toxins from the body through the skin surface (Jide, 2008).

Cupping itself is divided into four kinds, namely dry bruises, cupping skates, cupping and wet

bruises (Zhen, 2011). The benefits of cupping therapy are among others to increase

endurance (promotif), prevention of disease (preventive), cure of disease (curative) and post-

sickness treatment (rehabilitative). Cupping therapy does not cause severe side effects can

only cause inconvenience caused by the former pengepokan and penyayatan dikulit but the

former will disappear within 2-3 days. So the cupping therapy is safe to do. In this study the

curing is done by a professional and trained therapist. Based on this, researchers are

interested to see the phenomenon that exists to be able to prove the "Effectiveness of Wet

Cupping Therapy on Reduced Cholesterol Levels in Blood on Patients with

Hypercholesterolemia in a Healthy House Dompet Dhuafa, Balikpapan, East Kalimantan".


This research is pre-experimental study without control group with One Group Pretest-

Posttest Design approach done in the period of January 2012 until February 2012. Population

was the patient who have hypercholesterolemia at Rumah Sehat Dompet Dhuafa, Balikpapan,

East Kalimantan. The samples were taken by purposive sampling technique and 23 patients

with inclusion criteria were male or female, age 25-50 years old, had history or suffered

hypercholesterolemia, willing to be respondent, following wet cupping therapy at Rumah Sehat

Dompet Dhuafa, Balikpapan, and they did not use other therapies.

Independent variable of research was wet cupping therapy and dependent variable was

the reduction of cholesterol level. While confounding variable were consumption pattern of

food containing high fat, weight, smoking, history of hypertension, diabetes, stroke, and

frequency or interval of previous cupping therapy conducted by respondent. Instruments used

were an observation sheet and digital cholesterol monitoring system (cholesterol monitoring


The research data will be analyzed by a dependent T-Test. H1 hypothesis is accepted if

t count is greater than t table with degrees of freedom (db = n-1) and alpha 5% (t hit> t table)

or significance value less than alpha 5% (sig <alpha). For analysis we used Statistical Package

for the Social Sciences (SPSS) software 20. (SPSS, Inc., Chicago, IL)

3.1 General Characteristic of Respondent

Research subjects were 25 respondents. Respondents grouped by age with average value

43.12, median 42 and standard deviation 9.67. The percentage of respondents was mostly in

middle age group (between 40-60 years old) with 52% percentage. (Table 1) Respondents

consisted of 13 female or 52% and 12 male or 48%. The highest percentage of respondents was

in the overweight group with BMI 23-27,49 with 52% percentage. Based on family history that

has high cholesterol or hypercholesterolemia there were 13 respondents (52%) answered yes

and 12 respondents (48%) who answered no. The respondents who used therapy other than wet

cupping therapy which is medical therapy (doctor) amounted to 4 people or (16%), while

respondents who use wet cupping therapy alone were 21 respondents (84%).

Based on the physical activity characteristics of respondents, 16 (64%) of them answered

that they never had any physical activity/exercise. Respondents who answered rarely doing

exercise were 4 people (16%), who answered doing fitness 1 person (4%), who answered

jogging and fitness 1 person (4%) and who answered doing morning walk 3 people (12%).

(Figure 5) Respondents who did not have a history of diseases other than cholesterol amounted

to 14 people (56%), who had a history of hypertension as many as 7 people (28%), 1 person's

had heart history (4%), history of hypertension and vertigo numbered 2 people 8%), and for

the history of ulcer disease only 1 person (4%).

3.2 Distribution of Pretest- Posttest Total Cholesterol in Hypercholesterolemia


The distribution of cholesterol levels based on the total cholesterol prestest classification,

obtained an average value of 219,52 mg/dl, median 218 mg/dl and standard deviation 16,84

mg/dl, with minimum value 202 mg/dl and maximum value 260 mg/dl. Total cholesterol levels

after treatment (posttest) were obtained an average value of total cholesterol 185,76 mg/dl,
median 192,00 mg/dl and standard deviation 32,97 mg/dl, minimum value 116 mg/dl and

maximum value 244 mg/dl. (Table 2)

3.3 Distribution of Total Cholesterol Reduction After Wet Cupping Therapy in

Patients with Hypercholesterolemia in Rumah Sehat Dompet Dhuafa, Balikpapan

The result of cholesterol calculation of hypercholesterolemia patients after wet cupping therapy

was found to decrease by 34,16 mg/dl with median value 28 mg/dl and standard deviation

(Sd)= 26,11 mg/dl, with minimum value 0 mg/dl and maximum value 105 mg/dl. (Table 3)

3.4 Normality Test and Research Hypothesis

Normality test was done by Kolmogorov-Smirnov method using computerized program

/ SPSS 15 (attached) on variable Cholesterol levels before treatment (pretest) and after

treatment (posttest). In table 5.5 we get the value of significance for the variable before

treatment got P value/significance = 0203 (P> 0,05) and variable after treatment got P value /

significance = 0,843 (P> 0,05). Both of these variables follow normal distribution because the

value of significance is greater than alpha 5% (0.05). From these results we can use the

parametric test with paired T-test statistic for further analysis (Table 4).

H1 hypothesis is accepted if t-count is greater than t-table with degrees of freedom (db=n-

1) and alpha 5% (t-count> t-table) or the significance value smaller than alpha 5% (sig <alpha).

The value of t-table obtained with n=24 was 2.064. The results of the T-Test Dependent (paired

sample test) using computerized program/SPSS 15 (attached) on the variable cholesterol levels

before treatment (pretest) and after treatment (posttest). The value of t-count was 6.414 and

significance/P value of 0.000. Because t-count> t-table (6,414> 2,064) and significance

value<alpha (0.000<0.05), hence H1 hypothesis is accepted and H0 is rejected. So it can be

said that there is a very significant difference between the variables before and after treatment

that means wet cupping therapy was effective in reducing cholesterol levels in patients with

hypercholesterolemia (Table 4). The result from descriptive statistical data showed that average
cholesterol level before treatment equal to 219,52 mg/dl and after treatment equal to 185,76

mg/dl (attached). From the average it can be concluded that there is a decrease in cholesterol

levels after the implementation of wet cupping therapy. (Figure 1)


The average age of respondents were 43.12 years, and most respondents were aged

between 40-60 years, as many as 13 people or 52%. The results of the analysis found the

relationship between age and total cholesterol level, total cholesterol will increase with age

(Robbins and Kumar, 2000). Increasing the age of a person will decrease the ability of LDL

receptors, this causes LDL in the blood increases. In the United States cholesterol levels in both

men and women begin to increase at the age of 20 years. The cholesterol level of women before

menopause (45-60 years) is lower than in men of the same age. After menopause women's

cholesterol levels will usually increase to be higher than men (Imam, 2004).

Based on the American Heart Association in 2007 that men have a greater risk (within

a certain period) of heart attack and the incidence is earlier than in women. Some women use

oral contraceptives and during pregnancy will increase cholesterol levels. In pregnant women

cholesterol levels will return to normal 20 weeks after giving birth. Premenopausal women

appear to be more protected from CHD because they have higher HDL levels than men and

postmenopausal women (Robbins and Kumar, 2000). Estrogen is believed to prevent the

formation of plaque in arteries by raising HDL levels and decreasing LDL levels (Umar 2004)

Therefore, postmenopausal women have a higher risk than before (A.Maximin, LS Rust, and

LWKenyon, in the book Heart Therapy (1997).

Most respondents were overweight with BMI between 23-27.49. The result of previous

research on the relationship between age and BMI was found the prevalence of CHD by 17.5%,

12.5% were men and 22.5% were women. Total cholesterol levels between men (231.1±43.2

mg/dL) and women (225.3±39.0 mg/dL) did not differ significantly, but there was a significant
difference between HDL cholesterol and triglyceride levels (Martiem Mawi (2003) The total

cholesterol in men and women is increasing with increasing BMI values.The results of this

study are consistent with studies conducted in Finland showing that serum cholesterol levels

are positively associated with BMI. others showed that increased BMI was associated with

increased cholesterol and tyriglyceride levels, lower HDL cholesterol and increased LDL

cholesterol levels (Lemieux L et al (2000)

Thirteen respondents (52%) had a family history of hypercholesterolemia. This is

related to the results of the study of medical experts who showed that various diseases have a

relationship with offspring. In a family, the resilience or susceptibility of a family member to

the illness seems to be linked. This situation can be explained by the biological or genetic

sciences that chromosomes are part of the cell that contains the properties of offspring


Most respondents who have high cholesterol never do physical activity that is as much

as 16 people (64%). Physical activity in question is a daily activity and exercise habits. Exercise

can raise HDL cholesterol levels. Exercise is also very beneficial because it can improve lung

and myocardial function, decrease body weight so as to reduce LDL cholesterol levels, and

lower blood pressure (T. Bahri Anwar, 2004).

There is a significant relationship between hypertension and cholesterol levels in the

blood. Cholesterol in the blood generally comes from the diet that is consumed. High

cholesterol can be obtained from fatty food habits such as fried coconut oil, palm oil, avocado,

durian, meat, fatty, innards and peanuts. (Khomsan (2003)

The average cholesterol level before wet cupping therapy was 219.52 mg/dl with a

median data point of 218 mg/dl means that 50% of the cholesterol content was above 218 mg/dl

and the rest was below, with a standard deviation of 16.84 mg/dl. Minimum value was obtained

to be 202 mg/dl and maximum value was 260 mg/dl. Cholesterol levels measured were total
cholesterol levels. So the average cholesterol level was ≥ 200 mg/dl. A person is said to be

suffering from hypercholesterolemia when the total plasma cholesterol level is ≥200mg / dl.

Total plasma cholesterol levels of 200mg/dl are equivalent to LDL cholesterol levels of 130

mg/dl (Anwar, 2003). There is no influence of other factors in the measurement of cholesterol

levels before treatment was given, such as drugs. So the cholesterol level measured is the total

pure cholesterol level.

The average total cholesterol level of pretest in hypercholesterolemia patients was

obtained to be 219,52 mg/dl and after treatment by wet cupping therapy was 185,76 mg/dl. The

average total cholesterol reduction after wet cupping therapy was done in 25

hypercholesterolemia patients was 33,76 mg/dl. So that there was a significant change from

the results before therapy and after therapy wet bruise.

The results of this study were the same as the previous study done by Suyono (2010)

that the average value of cholesterol before wet cupping therapy was 204.93 mg/dl and after

the therapy was 187.53 mg/dl. The difference is indicated by the decrease total cholesterol

levels between before and after cupping therapy with average reduction value of 17,4

Meanwhile, if seen from significance value (p = 0.0001), the value was less than α = 0.05 which

means that blood cholesterol level can be decrease using wet cupping therapy.

Cupping therapy was performed at specific points associated with the mechanism of

the disease. Cupping therapy is done by giving injuries to the three points of the body, namely

hump, right scapula and left scapula. Hump point is a point that serve as a source of healing

various diseases. This point is the meeting point of all the blood that flows throughout the body

(Ahmadia (2008), Fatahillah (2007) and Firy (2007) so that the placement was done in the hope

it will clean the blood circulation and also gives autoregulation effect. There are 3 physiological

mechanism influenced by wet cupping therapy, they are the nervous system, the hematological

system and the immune system (Ahmadia et al., 2009) The mechanism of the nervous system
provides regulatory effects of neurotransmitters and hormones such as serotonin, dopamine,

endorphin, CGRP (Calcitoni-Gene Related Peptide) and acetylcholine (Ahmadia et al, 2009;

Ullah, 2007) All the hormones are excreted as toxic substances in the body. Other toxic

substances that come out of the body were histamine and bradykinin (Nilawati et al, (2008).

The mechanism of the hematological system gives the main effect through coagulation-

anticoagulation regulation system such as decreased blood elements (fibrinogen), decreased

hematocrit, increased blood flow and increased oxygenation of organ(Ahmadia et al, 2008).

Wet cupping therapy provides a primary effect through immune system irritation with

local inflammation and complementary system activation and enhancement of immune

products such as interferon and TNF (Tumor Necrotizing Factor), the influence of thymus,

regulates lymph metabolism (Ahmadia et al, 2008). The curing attempt of wet cupping therapy

using peripheral blood excretion by performing an excitation of the noradrenergic sympathetic

nervous system of the kidney. Strong stimulation of the noradrenergic sympathetic nervous

system of the kidney causes a considerable decrease in the blood of the kidneys. This effect is

mediated by α1-adrenergic receptors and a small portion by α2-adrenergic post synapse

receptors (Ganong, 2003).

The decline in cholesterol levels influenced by cupping therapy intervention is thought

to be due to the influence of hematologic system mechanisms that have a major effect through

the coagulation-anticoagulation regulatory system with increased blood flow and increased

oxygenation of organs (Ahmadia et al, 2008). Given liver is a place of blood filtration for

various toxic substances that enter into the body through the mechanism of the hematological

system and this mechanism that can decrease the blood cholesterol level can be done (Ahmadia

et al, 2008).

Decreasing cholesterol can slow pfatty laque buildup and can also reduce the size of

existing plaque. Intervention by providing cupping therapy can help prevent heart attacks,
strokes, and reduce the risk of death. Several factors influence the decrease of cholesterol level

such as knowledge of hypercholesterolemia patient, low fat diet, exercise, and medicine. In

addition to cupping therapy with the aim of lowering cholesterol levels, factors that affect the

reduction of cholesterol levels should also be considered and cannot be ignored. That's why

cupping therapy is not a substitute for treatment but as a complement or companion treatment

for nursing in lowering cholesterol.

Based on the Dependent T-Test (simple paired test) it was found that giving wet

cupping therapy was effective on reducing cholesterol level in hypercholesterolemia patient.

This is because in every process of cupping therapy skin suction was done and then followed

by collecting dead tissue and blood under the skin. It has the potential to heal the disease, which

after skin exploitation will continue by removing blood, the skin temperature in the local area

will increase. This is accompanied by capillary dilatation and increased vascular permeability,

resulting in improved metabolism. This process also results in improved blood circulation,

removes static blood, removes pathogens and wet pathogens and relieves pain, releases blood

so that cholesterol in the blood may drop.

The results of this study are the same as the research done by Fikri (2010). His

study obtained the average value of cholesterol before the therapy was given a bruise of 238.7

mg/dl and obtained the average cholesterol levels after the therapy cupping amounted to 207.9,

so the average decline was 30.78, after cupping therapy. Cupping therapy was performed

within approximately 30-45 minutes each person, as well as a significant reduction of the

results before and after broth therapy. The majority of respondents experienced a cholesterol

decrease due to the effects of cupping therapy, this is because cupping therapy pull out toxic

substances including cholesterol that is not excreted by the body through the surface of the skin

by injuring the skin and exploitation. Cupping therapy also provides the effect of relaxation

and vasodilation on the blood vessels so that it can improve blood circulation (Umar, 2010).

Based on the pretest-posttest value of total cholesterol in patients with hypercholesterolemia

and based on T-dependent test results found that wet cupping therapy was effective as a

treatment to decrease cholesterol levels in patients with hypercholesterolemia.

Table 1 Sampling Distribution by Age of Hypercholesterolemia Patients at Rumah Sehat
Dompet Dhuafa, Balikpapan (n = 25) January 2012
No Age Frequency Percentage
1. Young Adult (20-39 years old) 10 40%
2. Mature Adult (40-60 years old) 13 52%
3. Elderly (>60 years old) 2 8%
Total 20 100%

Table 2 Distribution of Total Cholesterol Level Based on Total Cholesterol Pretest-Posttest

Hypercholesterolemia Patients at Rumah Sehat Dompet Dhuafa, Balikpapan (n = 25) January
SD (Standard Min Max
Median deviation)
No Group Mean (mg/dl) (mg/dl) (mg/dl)
1. Total Pretest 219,52 218 16,84 202 206
2. Total Post 185,76 192 32,97 116 244

Table 3 Distribution of Total Cholesterol Reduction Based on Cholesterol Total Pre-Post in

Patients with Hypercholesterolemia at Rumah Sehat Dompet Dhuafa, Balikpapan (n = 25)
January 2012

Cholesterol Median SD (Standard deviation)

No Reduction Mean (mg/dl) (mg/dl) (mg/dl)
1. Pre-post cholesterol 34,16 28 26,11
Min = 0 Max = 105

Table 4 Normality Test Result and T-Dependen test (Paired Sample Test)

Variable Significancy/ T -count Significancy Information

P Value
Cholesterol level 0.203 - - Normal
before treatment
Cholesterol level after 0.843 - - Normal
Cholesterol level 6,414 0.000 Significantly
before and afer different

FIGURE 1 Average Distribution of Cholesterol Reduction in Hypercholesterolemia at Rumah

Sehat Dompet Dhuafa, Balikpapan (n = 25) January 2012