Integration of Unani Therapy (Ḥijāma bi’l Sharṭ) in Vasomotor Rhinitis: A Case Report

Vasomotor rhinitis (VMR) is a form of non-allergic rhinitis that clinically resembles nasal allergy but lacks an IgE-mediated basis. It is characterized by nasal obstruction, rhinorrhoea, sneezing, and mucosal hyperreactivity to nonspecific triggers such as temperature fluctuations, dust, or smoke. Conventional management relies on antihistamines and decongestants, which offer only symptomatic relief without addressing the underlying imbalance. In the Unani system of medicine, Nazla Ḥārr is considered analogous to VMR, attributed to humoral imbalance and autonomic dysfunction. Classical physicians including Galen and Zakariya al-Rāzī recommended Ḥijāma bi’l Sharṭ (wet cupping) at the nape of the neck (Nuqra/Qafā) for its role in evacuating morbid humors, reducing inflammation, and relieving symptoms such as sneezing and nasal irritation. This case report describes a 28-year-old female with a two-year history of recurrent nasal congestion, sneezing, and rhinorrhoea, unresponsive to standard pharmacotherapy. The patient underwent weekly sessions of wet cupping for three weeks at the nape of the neck, following standard procedural protocols. The Total Nasal Symptom Score (TNSS) was used to monitor symptom severity objectively. At baseline, TNSS was 11/12, indicating severe disease. Following intervention, TNSS progressively improved to 8 after the first session, 5 after the second, and 1 after the third session, reflecting near-complete resolution of symptoms. No adverse effects were reported. This case highlights the therapeutic potential of Ḥijāma bi’l Sharṭ in managing vasomotor rhinitis by balancing humors, modulating autonomic function, and reducing mucosal hyperreactivity. Larger controlled studies are warranted to validate these findings. Keywords: Ḥijāma bi’l Sharṭ, Ilaj bi’l Tadbeer, Unani concept, Vasomotor rhinitis