Introduction
Many patients in developing countries use alternative, complementary or traditional therapies before seeking medical advice. This may be due to social or religious beliefs. Kaiy (Arabic for cauterisation) is one such traditional therapy which should be discouraged.
Complementary, alternative and traditional therapies are becoming ever more popular, being used by 33 to 42 per cent of the general US population.Reference Eisenberg, Davis, Ettner, Appel, Wilkey, Van Rompay and Kessler1 Commonly utilised therapies include acupuncture, homeopathy and herbal medicine.Reference Baguley, Humphriss, Butler, Knight, Dawson and Vickers2 The major areas of Arab traditional therapy are herbal, kaiy and cupping.Reference Albilani Hajar3 Islamic sources state that the Prophet Muhammad, Peace be upon Him, said that, ‘…there are three methods to cure illness: “a drink of honey, a scratch of hijamah and Kaiy”. But He was not too keen on the last one’.Reference Albilani Hajar3, Reference Al-Kotb and Al-Bukhary4 This Hadith (the Prophet Muhammad's words) is also recorded in another way: ‘if there is healing in anything, then it is in three things; a gulp of honey, cupping, or branding with fire (Kaiy) that pains, but I hate Kaiy and do not like it’.Reference Al-Kotb and Al-Bukhary4 In many Arabic villages in the past (and even up to 30 years ago), barbers would perform circumcision, hijamah (sucking of blood by cupping) and kaiy.
This study reports two cases treated with kaiy, one with aural pain and the second with thyroid pain (later diagnosed as malignancy).
Case report one
In December 2006, a 35-year-old woman presented to the ENT clinic at GNP (Ghassan Najeep Pharoan) Hospital in Khamis Mushayt, Saudi Arabia, complaining of severe pain in her left ear of two days' duration, with no history of tinnitus or discharge. She had a history of nasal discharge and sneezing of one week's duration.
On examination, the patient's left tympanic membrane was retracted and congested, with loss of the ‘cone of light’. There was nasal congestion with mucopurulent nasal discharge.
A diagnosis was made of acute rhinitis with left acute catarrhal otitis media. An analgesic (paracetamol), systemic decongestant, nasal vasoconstrictor and systemic antibiotic (amoxicillin) were prescribed.
On reviewing the patient one week later, 14 burn areas, each 5 × 5 mm in size, were seen on the left side of the neck below the left auricle (Figure 1). On enquiring about these lesions, the patient admitted going to a traditional therapist three days prior because of persistent aural pain. The traditional therapist had advised the patient on the kaiy procedure and had persuaded her that it was a better approach than drugs. The patient was asked whether the kaiy treatment had helped; she replied that the resultant pain had masked her aural pain for several hours, but that she had then wanted help for the skin pain.
Fig. 1 Kaiy administered for left aural pain, below the auricle.
On examination of the patient's ear, the tympanic membrane was much improved compared with the initial visit. The patient was advised to continue the same medical treatment, and was referred to a dermatologist.
Case report two
In January 2007 (one month after the above case), a 45-year-old woman presented to the same clinic complaining of painful swelling in the front of the neck of one month's duration.
Examination revealed multiple areas of burns of different sizes, ranging from 1 mm in diameter to 10 × 20 mm (Figure 2), involving the right side of the anterior neck, over a 5 × 7 cm thyroid swelling which moved with swallowing, was firm to hard in consistency, and was not fixed to the surrounding tissue. A diagnosis of a thyroid mass was made. On enquiring about the burns, the patient admitted visiting a traditional therapist for help with pain control, who had advised her to undergo kaiy treatment.
Fig. 2 Kaiy administered for thyroid pain, on the right anterior neck.
The patient was referred to a general surgeon. After investigation, the thyroid mass proved to be malignant, and the patient was referred to another hospital for management.
As this was the second case of kaiy treatment encountered in a short space of time, the author enquired about the source of treatment. Surprisingly, such treatment was found to be available in one medical polyclinic in Hijamah, which claimed that kaiy was one of the medical procedures available during the days of The Prophet Muhammad (Peace be upon Him), and that The Prophet Himself (Peace be upon Him) had advised this treatment. Kaiy treatment is also available locally in many areas of southern Saudi Arabia.
Discussion
In the past (and as recently as 30 years ago), many Arabic village barbers performed circumcision, hijamah (sucking of blood by cupping) and kaiy. Such barbers were held in high esteem by the local community.
Patients who have received kaiy treatment report that it gives temporary relief followed by severe pain. Such treatment may possibly act in the same way as acupuncture, stimulating the release of endogenous opioids and other neurotransmitters such as serotonin.Reference Vickers and Zollman5 Countless other traditional health practices have been practised in the past, related to sexual behaviour, pregnancy, child birth, child-rearing and feeding;Reference Hizel, Ceyhun, Tanzer and Sanli6 however, Kaiy is arguably the worst because how we burn patients making them suffering more pain to treat pain. Pain for pain is non-sense.
• Many patients in developing countries use alternative, complementary or traditional therapies before seeking medical advice
• Kaiy is the use of localised cautery by traditional healers
• This paper describes the use of kaiy in two patients and its adverse effects
• This treatment modality is potentially harmful
The ancient Egyptians used cautery to stop bleeding, and Hippocrates recommended it. The ancient Arabs had great faith in the therapeutic value of fire, applied in techniques such as kaiy,Reference Albilani Hajar7 and this technique became an Arabic tradition. An Arab proverb states that ‘Kaiy is the final remedy’. Kaiy is similar to the moxabustion practised in traditional Chinese medicine, with the belief that the formation of blisters is essential if healing is to occur.Reference Albilani Hajar7 Arab kaiy therapists use metal rods, heated over a fire until red hot. These are then placed on a specified skin location for a few seconds. The number of cauteries in one session varies between one and more than seven.Reference Albilani Hajar7 Deep skin burns are the expected result. The location of the burns depends on the patient's complaint. This type of therapy is rarely used in contemporary Arab society. It is surprising that such treatment is evidently still trusted by some. Such individuals have misunderstood the words of The Prophet Muhammad (Peace be upon Him); He (Peace be upon Him) did not recommend kaiy. Cautery is practised within modern medicine in other ways, for example, the use of unipolar and bipolar diathermy and laser treatment (e.g. for tonsillectomy).
Conclusion
In these days of modern health care, the practice of kaiy is not science-based and is associated with considerable health risks. Health authorities in the relevant societies should move towards banning this undesirable practice; they should also use multi-media health education to advise of its dangerous outcomes, and enlist the help of community religious leaders to change public opinion and belief.
