Cupping as a Special Therapy for Health Services in Tourist Attractions: Literature Review

Introduction: Cupping is one of the traditional health therapies that has existed in the world since 1550 BC in the ancient Egyptian era, based on Riskesdas data in 2018 it was found that 31.4% of people in Indonesia used traditional health services including cupping in it, although medically there have not been many studies that explain about the benefits of cupping against certain diseases. Method: Search articles via Science Direct, PubMed and Google Schoolar, search year restricted from 2014-2020. Result: There were 11 journals found from 9,864, this literature review generally recommended the provision of traditional cupping therapy for the community while still paying attention to safety, sterility and security in performing the given cupping action. Conclusion: cupping can be done in tourist spots to help tourists who may experience aches or to provide healing and feel a comfortable sensation in cupping, cupping options at tourist attractions.


Introduction
Cupping therapy is a therapy that has existed for thousands of years, and is believed to be one of the oldest health treatments that was practiced in ancient Egypt (Risniati, Afrilia, Lestari, & Siswoyo, 2019). Cupping as we know it is not only in Indonesia, but in western countries such as America and Europe also experiencing rapid development along with research related to the benefits of cupping (Risniati et al., 2019). Indonesia is one of the countries in Asia where the scientific development of cupping is very rapid. It is proven by the existence of an organization called the Indonesian Cupping Association (PBI) both at the center and in the regions (Divisi Diklat dan Litbang, 2018).
The Indonesian people, based on data compiled by the 2018 Basic Health Research, stated that 31.4% of people had used traditional health services (yankestrad).
Of those who have used Yankestrad, 98.5% used traditional healers (Kementerian Kesehatan Republik Indonesia, 2018). This includes cupping skills (Kementerian Kesehatan Republik Indonesia, 2018). Seeing the large number of cupping therapy enthusiasts in Indonesia, according to data compiled by Riskesdas. So this has good potential so that cupping is increasingly widely introduced to the public, for example by providing cupping services in tourist attractions.
Tourist attractions visited by tourists certainly have their own value for these tourists. For example, because the place is exotic, the culture is very stunning and so on.
This will have added value if the tourist site provides health services such as cupping.
The purpose of this literature review is to explain about the benefits of cupping and the introduction of cupping in tourist attractions so that it has more value and helps tourists to get to know cupping and use cupping in tourist attractions.

Method
The literature search method in conducting this literature review is done by searching the literature based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method (Liberty, Altman, Tetzlaff, & Mulrow, 2009). Dwi Indah Lestari, Siti Riskika, Alwan Revai, Destia Widyarani: Cupping as a Special Therapy for Health Services in Tourist Attractions.....

Data search
Literature searches were carried out on international and national databases including Science Direct, Pubmed and Google Schoolar related to cupping and its benefits. Program. The data included in this literature review is in the form of a study of cupping, both its benefits and other reviews as well as its relation to tourist attractions.

Literature Search
Literature identification was carried out on 1277 studies identified in the database search. A total of 37 literatures were included. A total of 18 articles were then reviewed based on full-text manuscripts so that 11 manuscripts were included in this literature review study. The authors also add selected and relevant books as literature to supplement this literature review.

Discussion
The results obtained are described in the history, mechanism, classification and benefits of cupping as well as tourist attractions.

History of Cupping
Cupping comes from the Malay language, while in Javanese it is called cantuk or kop. In Arabic it is called "Al-Hijamah", and in English it is called Blood Cupping or blood letting or cupping therapy (Divisi Diklat dan Litbang, 2018). Cupping therapy has been known sincethousands of years ago and has been applied by many epochs of civilization including in Egypt, Persia, Babylon, China, India, Greece and Rome. Therefore, it is not surprising that until now cupping is in demand by many people (Divisi Diklat dan Litbang, 2018).
At the time of the Prophet Muhammad SAW, he used buffalo or cow horns, camel bones, elephant tusks as cupping tools. While people in ancient China called hijamah a "horn treatment" because horns were used instead of glass, it was different with people in Europe using leeches as a tool for cupping (Divisi Diklat dan Litbang, 2018).
Curtis suggests that cupping has existed since the oldest medical record (Papyrus Ebers), which was written in 1550 BC in ancient Egypt. The Papyrus Ebers itself is described in Ancient Egyptian language, which describes the implementation of medical practice in Ancient Egypt, which includes medicinal and therapeutic ingredients in various aspects, including cupping (Divisi Diklat dan Litbang, 2018).
Hieroglyphic writing on one page in his book states that the Papyrus Ebers (a document of historical evidence found in the 16th century BC, and contains ± 800 formulas on recipes which also includes 700 kinds / types of medicinal ingredients), explained that cupping can be used as therapy for menstrual disorders, fever, appetite disturbances and various kinds of pain. In addition, cupping is also a therapy that can support to speed up the process of curing disease (Risniati et al., 2019).
There is no official explanation about how the development of cupping in Indonesia began, but there is a strong suspicion that this method of cupping entered when traders from Arabia began to enter Indonesia and coincided with the entry of

Cupping
Cupping comes from the Arabic "Hijamah" which means to prevent, suck, turn away, keep away(Divisi Diklat dan Litbang, 2018) (Al-bedah et al., 2018). In English it is known as "Blood Cupping" and in Malay it is known as "Cupping", and in Indonesia it is known as "cantuk" or "kop" (Nurhikmah, 2017). Cupping treatment or therapy is an effort to remove static blood (toxins and toxins) from the body through the skin surface (Divisi Diklat dan Litbang, 2018).
Cupping therapy as we know it is divided into two types, namely wet cupping and dry cupping (Mehta & Dhapte, 2015). Dry cupping includes slide cupping, fire cupping, and pull cupping, which distinguishes between cupping. Wet cupping and dry cupping are withdrawals accompanied by the presence of blood being released, if wet cupping is accompanied by bleeding (Chen, Li, Liu, Guo, & Che, 2014). The sliding cupping technique is done by giving the header a certain body part and running (launching) the cup to a predetermined body part and moving around, while the pull cupping technique is done by placing the cup at several predetermined points then pulling it back and affixing it to the skin.
The process of cupping, especially in dry cupping, occurs local dams in the area of the skin that is given the cupping, so that hypoxia and inflammation occur in that area which can improve micro-circulation and cell function in the area very quickly (Aboushanab & Alsanad, 2018). After 15 days from the process of cupping the skin area that the cupping process does willthere is an increase in the elasticity of spectrin which can help stimulate the work of the immune system in this case are natural killer cells, so this can increase a person's resistance to disease (Pratama, Rasni, & Wantiyah, 2018) (Maulana, 2020).
The process of cupping with a wet cupping technique (wet cupping) occurs when there is bleeding in the cupped area at a certain predetermined point (Al-bedah et al., 2018). The process of blood letting (blood letting) performed on cupping is one of the minor surgical procedures, in which a cupping therapist applies negative pressure (with suction strength to the previously performed cupping) which is applied to the surface of the patient's skin using a cup, so that the patient's skin will sucked with negative force into the cup (Setyawan, Sari, & Budiyati, 2020). The pulling process given in the cup then causes the filtration rate in the capillaries in the cupping area to increase and makes the absorption in the venous capillaries decrease (Nurhikmah, 2017) (Risniati et al., 2019).
The process of insertion and withdrawal of the cupping cup, which increases the absorption (filtration) of the skin capillaries, causes a large amount of fluid and harmful substances to accumulate in the cupping area (Maulana, 2020) (Setyawan et al., 2020).
Chemicals, mediators of infection and mediators of pain will stimulate sensory nerve endings in the area where the cupping process is carried out so that pain is reduced.
After the cupping process with traction, an injury (minor surgery) will be carried out in the cupping area which will open the skin layer to then remove fluid in the form of blood along with harmful substances and prevent its absorption at the end of the venous capillary (Risniati et al., 2019).
The cupping process which is accompanied by this injury causes the expulsion of blood along with blood plasma and other hazardous materials, such as disease-causing free radicals, chemicals, cholesterol, and other harmful substances in the body (Risniati et al., 2019) (Al-bedah et al., 2018. Therefore, the cupping must be carried out by experts who are competent in their fields, in order to allow the implementation of cupping to be carried out optimally. For example, in this case, it is carried out by nurses who are experts in practicing cupping. A nurse is someone who has passed a higher education in Nursing, both at home and abroad, which is recognized by the Government in accordance with the provisions of the legislation (Menteri Kesehatan Republik Indonesia, 2019).
Cupping if performed by nurses who do have a scientific background on health and also knowledge about cupping, then the implementation will be more optimal so as to ensure the safety and comfort of the clients served (Risniati et al., 2019). The benefits of cupping that can be felt include: (Mehta & Dhapte, 2015) reduce headache (cephalgia), provide a sense of comfort, lower mean arterial pressure in high blood pressure (Setyawan et al., 2020), lowers systolic blood pressure in the elderly (Pratama et al., 2018), reduce pain, and lower cholesterol levels (Hidayat et al., 2018).

Tourist attraction
Objects and tourist attractions according to Law no. 10 of 2009 concerning tourism is everything that has uniqueness, beauty and value, in the form of a diversity of natural wealth, culture, and man-made products that are the target or destination of tourist visits and destinations. According to law no. 10 of 2009 a tourist destination or a tourism destination is a geographical area located in one or more administrative areas in which there are tourist attractions, public facilities, tourism facilities, accessibility and communities that are interrelated and complementary.

Conclusion
Cupping technique is divided into 2 parts, namely dry cupping and wet cupping, cupping can be done in tourist spots to help tourists who may experience aches or to provide healing and feel a comfortable sensation in cupping, cupping options at tourist attractions can be done with wet cupping techniques and dry cupping according to requests from visiting tourists. Judging from the benefits and enthusiasm of the community in cupping, it is important to introduce cupping to a wider audience because it is possible that in modern times there are still those who do not know cupping, this effort can be done by opening cupping services, for example at tourist places while still paying attention cleanliness and safety in the process.