Cupping is an
ancient medical treatment, its Chinese roots dating back thousands of
years. Egyptian, Greek, Roman and Middle Eastern cultures also have
ancient records of the practice
In cupping,
suction cups of varying sizes are attached to the body. The suction
draws stagnant blood to the surface of the skin and improves blood
circulation through the tissues, which can speed healing
Research has
found cupping may benefit conditions such as chronic neck and shoulder
pain, arthritis of the knee, herpes zoster, facial paralysis and
cervical spondylosis
So-called “wet
cupping” may be beneficial for the treatment of chronic acne, persistent
low back pain, carpal tunnel syndrome, acute soft tissue injury and a
variety of headaches. Combined with herbal remedies, wet cupping may
improve acute gouty arthritis
Cupping has gained popularity among athletes for its benefits on pain and sports performance
Cupping1 is an ancient medical treatment, its Chinese roots dating back thousands of years.2 Egyptian, Greek, Roman3 and Middle Eastern cultures also have ancient records of the practice,4 including Saudi Arabia, where the practice is called Al-Hijamah.5
According to a 2010 review6 of the medical literature published in the BMC Complementary & Alternative Medicine journal, cupping
was established as an official therapeutic practice in Chinese
hospitals after its clinical efficacy was confirmed by a joint team of
researchers from China and the former Soviet Union in the 1950s, and
it’s a standard practice in traditional Chinese medicine (TCM) to this
day.
Between 1959 and 2008, 550 clinical studies were published,
including 73 randomized controlled trials and 22 clinical controlled
trials, none of which reported any serious adverse effects.7
The U.S. National Center for Complementary and Integrative Health,
on the other hand, warns that “Rare cases of severe side effects have
been reported, such as bleeding inside the skull (after cupping on the
scalp) and anemia from blood loss (after repeated wet cupping),” and
that it “can cause side effects such as persistent skin discoloration,
scars burns, and infections, and may worsen eczema or psoriasis.”8
Types of Cupping Therapy
Cupping involves attaching suction cups of varying sizes to the bod.
The suction draws blood to the surface of the skin; hence the
bruise-like marks. Cupping therapy, as practiced in China, can be
sorted into seven major types:9,10,11
Retained cupping — This most
commonly used technique involves rinsing the glass cup with a small
amount of methylated spirits, then setting it temporarily aflame to heat
the inside of the cup to create negative pressure and blowing out
the flame before quickly applying the cup to the skin
Wet cupping (bleeding cupping) — A small incision is made on an acupuncture point with a triangle-edged needle, after which the cup is placed on top
Moving cupping — Oil is first applied to the area to allow the cup to be moved back and forth
Empty cupping — Here, the cups are attached and quickly removed after suction has been achieved
Needle cupping — Acupuncture needles are inserted into the appropriate points first, and the cups are placed on top of the needle
Medicinal or herbal cupping —
Bamboo cups are placed into a pot and boiled with herbs for 30 minutes
before being applied. The steam from the boiled cups create the
suction, in lieu of a flame
Water cupping — A glass or bamboo cup is filled one-third of the way with warm water and then quickly applied to the skin
Cupping — Helpful or Harmful?
The treatment is said to improve blood circulation, thereby speeding up healing, reducing pain and easing muscle soreness. According to the BMC Complementary & Alternative Medicine review 12
published in 2010, a majority of the 73 randomized controlled trials
published between 1959 and 2008 “show potential benefit on pain
conditions, herpes zoster and other diseases.”
Still, skeptics abound. A recent Forbes article13
by Steven Salzberg, “The Ridiculous and Possibly Harmful Practice of
Cupping,” paints the practice in a less than flattering light. Salzberg
also wrote a scornful piece14 on cupping after Michael Phelps brought attention to its benefits during the 2016 Olympics.15
“Cupping is ridiculous. There's no scientific or medical evidence
that it provides any benefit, and it clearly carries some risk of
harm,” Salzberg writes,16 thereby sweeping several hundred studies under the rug of “ridiculousness.”
In a 2016 Science Blogs entry,17
an American surgeon highlights the potential danger of cupping, showing
a photo of a man’s badly burned back. Clearly, incorrect application
of cups heated with an open flame (retained cupping technique) can
cause grave burns.
However, this is due to serious incompetence by the health care
provider. This is an example of a preventable medical error, not
evidence that cupping, done correctly, is harmful. For perspective,
preventable medical errors in conventional medicine is the third leading cause of death in the U.S., and has been for decades, yet few question the sensibility of conventional treatments.
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Benefits of Cupping
The paper,18
“Cupping Therapy: A Prudent Remedy for a Plethora of Medical Ailments,”
published in the Journal of Traditional and Complementary Medicine in
2015 notes cupping “is believed to act by correcting imbalances in the
internal bio field, such as by restoring the flow of Qi.”
Under “Pharmacological Actions,” this paper describes some of the
ailments for which the seven types of cupping methods may be useful. For
example, wet cupping may be beneficial for the treatment of chronic acne, persistent low back pain, carpal tunnel syndrome and a variety of headaches.
Cupping therapy in combination with acupuncture has been shown to relieve moderate insomnia and improving fibromyalgia-related pain and depression.
Wet cupping in combination with herbal remedies may improve acute
gouty arthritis, while wet cupping alone may be beneficial in the
treatment of acute soft tissue injury. The paper further notes: 19
“Cupping therapy is also useful in various conditions like gout
and other forms of arthritis, lumbago, and as epithelial grafts for
vitiligo management. It is also commonly used in reducing pain, and
muscle tenderness, and improving a range of motions.
Cupping therapy is not limited only to the above pharmacological
actions, but it is also helpful in regulating both innate and acquired
immune responses. By comparison, wet cupping therapy was found to be
better than dry cupping therapy, because it is able to eliminate the
causative pathological substances (CPS) and restore the normal
physiology, while dry cupping therapy depends on dilution and
redistribution of CPS to new sites.”
Athletes Swear by Cupping
Cupping has gained popularity among athletes for its benefits on
pain and sports performance. Aside from Phelps, Cody Miller and Dana
Vollmer, two Olympic swimmers, and Olympic gymnast Alex Naddour have
sported the telltale welts.20,21 Vollmer and Miller explained the perceived benefits of cupping during a 2016 news conference.
During the Olympics, Naddour also told USA Today22
that cupping has been a “secret … that keeps me healthy. It’s been
better than any money I’ve spent on anything else.” An editorial23
in the Journal of Functional Morphology and Kinesiology, “Could
Cupping Therapy Be Used to Improve Sports Performance?” published in
2016, cites a variety of studies and notes:
“It is hypothesized that, with cupping therapy, ‘congested’
blood is sucked out of the skin, thereby increasing blood and lymphatic
circulation and relieving painful muscle tension. Within the last
years, interest in traditional cupping has arisen, and there is growing
evidence that cupping might be effective in various pain conditions ...
In the course of cupping treatment, blood and other interstitial
fluids are drawn out from the skin by the vacuum. Traditional cupping
is mainly used in patients with local blood congestion, swelling, and
adhesions of the connective tissue in the neck region. Cupping might
therefore take the pressure off the tissue and relieve the neck area
from these toxic congestions, which also increases circulation and
lymphatic flow.
Since circulation has been shown to be dysfunctional in chronic
neck pain patients, cupping might restore normal circulation. Increased
circulation in turn improves oxygen supply and cell metabolism,
reducing the amount of inflammatory or toxic substances. This might
also explain the significant effects of cupping on pressure pain
thresholds at pain-related areas.
Muscle spasm, congestion, and restricted blood flow can cause
ischemic pain. Accumulated inflammatory substances in skin and tissue
might further induce hypersensitivity to noxious stimuli, which is
reflected by lowered pressure pain thresholds.
Since traditional cupping is supposed to evacuate toxins and
inflammatory agents from the affected area and restore normal
circulation, this might explain the local effects on pressure pain
thresholds. The blood volume loss, together with the local vasodilation
might further increase parasympathetic activity by somatosympathetic
reflexes, which matches well with the observed self-reported
relaxation.”
Cupping May Offer Relief for Many Painful Conditions
Pain reduction appears to be a common denominator in many of the
studies showing beneficial effects. As noted in a 2014 systematic review24 of 16 randomized clinical trials assessing the use of cupping for pain:
“Cupping combined with acupuncture was superior to acupuncture
alone on post-treatment pain intensity … Results from other single
studies showed significant benefit of cupping compared with
conventional drugs or usual care …
This review suggests a potential positive short-term effect of
cupping therapy on reducing pain intensity compared with no treatment,
heat therapy, usual care, or conventional drugs.”
In an earlier systematic review,25
published in 2011, two of the seven randomized clinical trials included
(in which pain of any origin was the focus), found “significant pain
reduction for cupping in low back pain compared with usual care and
analgesia.”
Another two studies “showed positive effects of cupping in cancer
pain and trigeminal neuralgia compared with anticancer drugs and
analgesics, respectively.” Two more “reported favorable effects of
cupping on pain in brachialgia compared with usual care or heat pad,”
while the seventh and last trial “failed to show superior effects of
cupping on pain in herpes zoster compared with antiviral medication.”
More recently, a 2016 study26
published in Evidence-Based Complementary and Alternative Medicine
found cupping significantly reduced chronic neck and shoulder pain,
compared to no intervention. In the cupping group, the intensity of the
neck pain was reduced from a severity score of 9.7 to 3.6.
Among controls, pain was reduced from 9.7 to 9.5. The study also
evaluated measurable physical effects, including changes in skin
surface temperature and blood pressure. Both measurements showed
statistically significant improvements among those who received
cupping.
A PLOS ONE study27 published in 2013, which compared cupping to progressive muscle relaxation,
found both treatments provided similar pain relief for patients with
chronic neck pain after 12 weeks. However, those who received cupping
did report significantly greater “well-being” and higher pressure pain
thresholds compared to those who practiced progressive muscle
relaxation.
Research28 published in 2012 also reported beneficial results on patients with arthritic knee pain, and a 2012 meta-analysis29
of 135 randomized controlled trials published between 1992 and 2010
found cupping “is of potential benefit for pain conditions, herpes
zoster, and cough and dyspnea.” According to the authors:30
“Meta-analysis showed cupping therapy combined with other TCM
treatments was significantly superior to other treatments alone in
increasing the number of cured patients with herpes zoster, facial
paralysis, acne, and cervical spondylosis. No serious adverse effects
were reported in the trials.”
Cupping May Reduce Pain by Activating Your Innate Immune Response
Dr. Leonid Kalichman, a senior lecturer at Ben-Gurion University of
the Negev in Israel, has written more than 150 papers on physiotherapy
and rheumatology. He believes that by causing localized inflammation,
cupping helps trigger cytokine production that modulate your immune
system response.31
In a review paper on cupping research, published in the Journal of
Bodywork and Movement Therapies, Kalichman and his co-author Efgeni
Rozenfeld note that:32
“Mechanically, cupping increases blood circulation, whereas
physiologically it activates the immune system and stimulates the
mechanosensitive fibers, thus leading to a reduction in pain.
There is initial scientific evidence that dry cupping is able to
reduce musculoskeletal pain. Since cupping is an inexpensive,
noninvasive and low-risk (if performed by a trained practitioner)
therapeutic modality, we believe that it should be included in the
arsenal of musculoskeletal medicine.”
Anecdotal Reports
While more research may help explain the exact mechanisms behind
cupping’s healing power, many patients are satisfied knowing it works
for them — regardless of the how or why.
As noted by Jessica MacLean, acting director of the International Cupping Therapy Association,33
"When people get the treatment and they recover really fast, they don’t
care about the scientific evidence — they just care that it works."
The following anecdotal success story was reported by Desert News Utah:34
“It works for 33-year-old Maria, who was at Master Lu's … for
acupuncture and cupping therapy for several herniated discs in her
lower back. She said she's tried many options, but the pain gets so bad
at times, she can't move. ‘As soon as I had it done, it was immediate
relief,’ she said. ‘I never went back to anything else.’
Maria … injured her back lifting and moving a lot of boxes. She
said that in addition to immediate and long-lasting pain relief, the
acupuncture and cupping procedure is "relaxing" to go through. She will
have about three appointments within the week and then not need to
return until pain flares up again from overuse, Lu said.”
Are You Ready to Try Cupping?
Cupping is easy to do and vacuum sets can be purchased online for as
little as $30. However, I would strongly recommend going to a trained
TCM practitioner. Licensed doctors of TCM have a minimum of 3,000 hours
of training and know how to perform cupping safely and effectively.
Absolutely do not engage in retained cupping (open flame-heated
cupping) without proper training and certification.
Care to avoid excessive suction must be taken when treating certain
areas of the body. While your back and thighs can safely handle heavy
suction, it could be risky to cup certain areas of your neck, for
example, unless you know what you’re doing.
Cupping is also not done on your head or face, so if you have a
headache, you would typically treat your neck, shoulder and/or back
muscles; the cups would NOT be placed on the temples or forehead.
Cupping is also contraindicated for certain serious health conditions.
So, could cupping work for you? You’ll simply have to try it before
writing it off. Studies and anecdotal evidence suggests cupping can be a
helpful adjunct to other therapies for pain. In some cases it may even
work as a stand-alone treatment, although this is not the norm.
The good news is, if it works, you’ll notice a difference. And if it
doesn’t, no harm will come to you. The procedure itself is typically
painless (provided excessive suction is not used), and the bruises —
which indicate that stagnant blood has been drawn from the tissue to
the surface — will typically disappear within days. If blood stagnation
is not an issue, you will not experience any bruising at all.
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