Cupping has become the latest fad with many professional athletes being seen with the cupping marks on their bodies during competition. Cupping is the process of using glass, plastic or other cups to the skin to change the body’s energy system. Cupping is said to remove stagnation, dilates blood vessel to draw toxins to the skin surface to be released from the body through the skin. Blood is said to be the conveyer of chi in traditional Chinese medicine. Chi is said to be the animating force of all life yet no scientist has ever observed or quantified chi in the physical world. Is Chi real?

Reported effects of cupping therapy include promotion of the skin’s blood flow, changing of the skin’s biomechanical properties , increasing pain thresholds, improving local anaerobic metabolism, reducing inflammation, and modulation of the cellular immune system. 

Cupping Therapy: An Overview from a Modern Medicine Perspective Tamer S.Aboushanab, SaudAlSanad. Journal of Acupuncture and Meridian Studies Volume 11, Issue 3, June 2018, Pages 83-87

History of Cupping

The first mention of cupping in history that we are aware of is from Eber’s Papyrus in 1550 BC. The Papyrus, an ancient medical textbook discussed the application of cups for fever, pain, vertigo, dysmenorrhea, lack of appetite and constipation.

It has been a part of many cultures such as the Chinese, Koreans, Tibetan and Unani traditional healing methods. (Unani” or “Yunani medicine” (is the term for Perso-Arabic traditional medicine as practiced in Muslim culture in South Asia and modern day Central Asia. Unani medicine is pseudoscientific.)

Ge Hong (281-341 A.D.) who was a minor southern official during the Jin Dynasty was the first to use it in China. He mentions it in his book: A Handbook of Prescriptions for Emergencies. Ge Hong popularized the saying “Acupuncture and cupping, more than half of the ills cured.” Later on, this method found its way throughout Asia and Europe. The cups were actually animal horns, used for draining pustules.  As a result of using horns, cupping has been known as jiaofa, or the horn technique.

Historically, cupping tools such as animal horns and and more recently, cups made of various materials such as glass, rubber and silicone are used. New machines have been made using electric suction now replace the manual suction tools. Bloodletting has also been said to be a form of cupping in history.

Hippocrates, Galen (Greek Physician in Roman Empire), Herodotus (Greek Historian) all talked about the use of cupping for various conditions. Egyptians were thought to have been practicing it in ancient Egypt. Cupping use in Egypt dates to 3500 B.C. and its practice is documented in hieroglyphic writing with Drawings of cupping instruments found at the Temple of KomOmbo, Luxor. The ancient Egyptians introduced CT to the Greeks and subsequently cupping spread to other European countries and eventually to the Americans.

The Arabic name for Cupping therapy is Al-Hijama, which means literally “to reduce in size,” and more generally “to return the body back to its natural state.”

The ancient Greek physician Hippocrates compiled extensive descriptions of the cupping application. He described two different types of cups: one with a narrow opening and a long handle and the other with a wider opening. The first type was used to treat deep accumulation of fluids, while the second type was used to treat the spread of pain [4]. Cupping therapy was a popular historical treatment in Arabic and Islamic countries. It was recommended by Arabic and Islamic physicians such as Ibn Sina (AD 980–1037), Al-Zahrawi (AD 936–1036), and Abu Bakr Al-Razi (AD 854–925). Al-Zahrawi described cupping sites and illustrated cupping tools with diagrams [5]. Cupping therapy practice spread to Italy and, subsequently, the rest of Europe between the 14th and 17th centuries, during the Renaissance. Cupping was a very popular treatment of gout and arthritis in Italy during this period [6].

Traditional Cupping that is done by an acupuncturist or Traditional Chinese Medicine practitioner usually apply cups along meridians and on acupuncture points. Massage therapy cupping usually uses the cups to address musculoskeletal issues and focus on muscles and soft tissue rather than acupuncture points.

How does cupping work?

Suction cups are used to pinch and squeeze the skin. The cupping often results in a pink or purple rash on the skin which is blood being drawn to the surface. It is said that cupping will break up stagnation and remove toxins from the body. The red spots are actually Petechiae or bleeding into the skin (intradermal hemorrhage) from the blood moving from the capillaries into the skin.  

There are 10 types of different cupping methods viz. weak/light cupping, medium cupping, strong cupping, moving cupping, needle cupping, moxa/hot needle cupping, empty/flash cupping, full/bleeding cupping, herbal cupping, and water cupping. Cupping therapy: A prudent remedy for a plethora of medical ailments Piyush Mehta and Vividha Dhapte.

Evidence Based or Pseudoscience

In order for cupping to be evidence based, one has to be able to show that Chi is real. It isn’t real like water or air. Some make the stretch and say it doesn’t have to be real and define it as a concept which allows cupping to move into the evidence based category. Others will try to explain it saying that if we just change the narrative (explanations) many use saying it removes toxins and stop saying that the clients’ energy is bad, it will make it OK to cup. Technically, it still remains in the pseudoscience category. Cupping done by acupuncturists and TCM practitioners has more to do with a sense of culture and identity than with scientific validity. Cupping done by massage therapists has taken cupping and distorted it’s use and applications from traditional healing methods into a tool to do massage.

Cupping is often said to do things like remove toxins, Increase circulation, break up adhesions and scar tissue when all of these are really disproven already. Many will want to learn or get cupping just because it seems to work and that is fine.

Research on Cupping:

Cupping for Patients With Chronic Pain: A Systematic Review and Meta-Analysis. J Pain

There is a growing interest in nonpharmacological pain treatment options such as cupping. This meta-analysis aimed to assess the effectiveness and safety of cupping in chronic pain. PubMed, Cochrane Library, and Scopus were searched through November 2018 for randomized controlled trials on effects of cupping on pain intensity and disability in patients with chronic pain. Risk of bias was assessed using the Cochrane risk of bias tool. ““Meta-analyses found large short-term effects of cupping on pain intensity compared to no treatment (standardized mean difference [SMD] = 1.03; 95% confidence interval [CI] = 1.41, .65), but no significant effects compared to sham cupping (SDM = .27; 95% CI = .58, .05) or other active treatment (SMD = .24; 95% CI = .57, .09). For disability, there were medium-sized short-term effects of cupping compared to no treatment”

“Adverse events were more frequent among patients treated with cupping compared to no treatment; differences compared to sham cupping or other active treatment were not statistically significant. Cupping might be a treatment option for chronic pain, but the evidence is still limited by the clinical heterogeneity and risk of bias.”

Cramer H, Klose P, Teut M, Rotter G, Ortiz M, Anheyer D, Linde K, Brinkhaus B. Cupping for Patients With Chronic Pain: A Systematic Review and Meta-Analysis. J Pain. 2020 Sep-Oct;21(9-10):943-956. doi: 10.1016/j.jpain.2020.01.002. Epub 2020 Jan 23.

Resources on Cupping Therapy:

History of cupping (Hijama)(PDF from Science Direct) : a narrative review of literature
Naseem Akhtar Qureshi, Gazzaffi Ibrahim Ali, Tamer Shaban Abushanab, Ahmed Tawfik El-Olemy, Meshari Saleh Alqaed, Ibrahim S. El-Subai, Abdullah M.N. Al-Bedah National Center of Complementary and Alternative Medicine, Ministry of Health, Riyadh 11662, Saudi Arabia

Cupping Therapy: An Overview from a Modern Medicine Perspective Tamer S.Aboushanab. SaudAlSanad

Cupping therapy versus acupuncture for pain-related conditions: a systematic review of randomized controlled trials and trial sequential analysis – Cupping is an effective pain-reducing method.

The Effects of Cupping Massage in Patients with Chronic Neck Pain – A Randomised Controlled Trial. Cupping therapy and acupuncture are potentially safe, and they have similar effectiveness in relieving pain.

The effect of cupping therapy for low back pain: A meta-analysis based on existing randomized controlled trials. Cupping massage appears to be effective in reducing pain and increasing function and quality of life in patients with chronic non-specific neck pain.