Cupping Therapy

  • Medical Author:
    Mimi Guarneri, MD, FACC, ABIHM

    Dr. Mimi Guarneri, MD, FACC, ABIHM, is board certified in cardiovascular disease, internal medicine, nuclear medicine, and holistic medicine. Dr. Guarneri is president of the American Board of Integrative Holistic Medicine and serves as Senior Advisor to the Atlantic Health System for the Center for Well Being and Integrative Medicine. Dr. Guarneri is founder and director of Guarneri Integrative Health, Inc. and Taylor Academy for Integrative Medicine Education and Research located at Pacific Pearl La Jolla in La Jolla, CA.

  • Medical Author: Erica Oberg, ND, MPH
    Erica Oberg, ND, MPH

    Dr. Erica Oberg, ND, MPH, received a BA in anthropology from the University of Colorado, her doctorate of naturopathic medicine (ND) from Bastyr University, and a masters of public health (MPH) in health services research from the University of Washington. She completed her residency at the Bastyr Center for Natural Health in ambulatory primary care and fellowship training at the Health Promotion Research Center at the University of Washington.

  • Medical Author: Ann Michelle Casco, L.Ac.
  • Medical Editor: Jerry R. Balentine, DO, FACEP
    Jerry R. Balentine, DO, FACEP

    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

Where did cupping come from?

Cupping is a therapy used in traditional Chinese medicine (TCM) to remove stagnation and stimulate the flow of qi (chi). Qi is the free flow of vital energy circulating through the body and the world around us, if the qi is disrupted or disturbed, it can create stagnation (blockages) or imbalances in the body.

What is cupping in a massage?

A therapeutic cupping treatment involves warming and placing cups, usually made of glass, on the skin. By warming the air within the cup, a vacuum is created, and when it is applied to the skin, the tissue is drawn up into the cup. This increases the blood flow, loosens the fascia or connective tissue, and is thought to stimulate healing. It is similar to the way deep tissue massage can be used to break up scar tissue and reduce pain. The cups are often placed on the back, neck, and shoulders or the site of pain. Cupping may cause temporary bruising and soreness, depending upon the degree of suction created by the vacuum and the level of internal stagnation. According to TCM, this would be a favorable outcome, suggesting the treatment has successfully removed toxins and stagnation. The cups are removed by lifting one edge, which allows air in and breaks the seal and vacuum.

What are the different types of cupping?

Different types of cupping are selected based on the treatment goals of the acupuncturist. There are also different types of cups. Most commonly, cups are made out of glass. However, a thousand years ago, cups were made of bamboo, clay, or animal horns. According to Ann Michelle Casco, L.Ac., a traditional Chinese medicine practitioner and acupuncturist, the classic cupping technique is called ba guan zi, which is fire or dry cupping. This involves placing the cup over an ashi (painful area) point or an acupuncture point along an energy meridian. The cups are left in place anywhere from five to 20 minutes depending on the nature of the individual's condition. A general course of treatment involves four to six sessions in intervals starting from three- to 10-day gaps.

The sliding cups technique is traditionally performed on large muscle groups of the back to treat pain and muscle spasms. Massage oil is applied to the skin prior to the cups being placed, which allows the cups to glide easily over the surface of the skin.

With air cupping, an alternative to fire cupping, a handheld suction pump is used to remove air from the cups, creating the vacuum without heat. Some clinical research from China suggests this innovation in cupping technology is more comfortable for patients.

Wet cupping combines an acupuncture technique called bleeding with cupping. A lancet is used to prick the skin before the cup is applied, which encourages a small amount of blood to flow from the area. This treatment is thought to dispel internal toxins. TCM practitioners in China use this technique for "cooling" inflammatory conditions.

Quick GuideAcupuncture Pictures: Acupuncture Points, What Kinds of Pain It Works for, and More

Acupuncture Pictures: Acupuncture Points, What Kinds of Pain It Works for, and More

Cupping Side Effects

Bruises

A bruise is caused when tiny blood vessels are damaged or broken as the result of trauma to the skin (be it bumping against something or hitting yourself with a hammer). The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury. A bruise is medically referred to as a contusion. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis.

What does cupping therapy do?

TCM teaches that it is the stagnation of qi and blood that causes pain and disease. Cupping invigorates local circulation of qi and blood in the area being treated, resolving swelling, pain, and tension. By drawing impurities to the surface, it removes toxins. From a Western physiology perspective, cupping loosens connective tissue or fascia and stimulated blood flow to the surface. Cupping stimulates tissue relaxation and better cell-to-cell communication. The research of U.S. physiologist and acupuncturist Helene Langevin has documented cell-level changes using an ultrasound camera. She has demonstrated that techniques like cupping, acupuncture, and massage relax tissue and reduce markers of inflammation. Inflammatory cytokines (chemical messengers) are reduced, and cytokines that promote healing and relaxation are increased.

What are the benefits of cupping?

The benefits of cupping include local pain relief and muscle relaxation. Cupping improves overall health by removing the energy blockages that TCM practitioners identify as barriers to the flow of healthy energy or qi. For athletes, cupping may help increase blood flow to a particular muscle region or help reduce pain. Numerous athletes from the Olympics in Rio 2016 used cupping. This was easily seen by circular markings on some of the U.S. swim team members.

What conditions does cupping treat?

Cupping is traditionally used to treat lung disorders like

It is also traditionally used for

Researchers have studied cupping primarily in China, finding benefit in conditions such as anxiety, depression, back pain, varicose veins, high blood pressure, eczema, acne, fertility, arthritis, fibromyalgia, diabetes, anemia, shingles (herpes zoster), insomnia, and gout.

While the quality of some of these clinical trials is not to U.S. standards, the findings of actual benefit are significant, especially given the low risk of the side effects.

What specialists perform cupping?

Cupping is generally performed by practitioners of traditional Chinese medicine.

Cupping techniques are described and can be found in the textbooks of TCM from over 1,000 years ago. To find a practitioner skilled and licensed to provide cupping, look for an acupuncturist licensed by a national or state accrediting agency such as, the State of California Acupuncture Board or the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). Practitioners with these certifications have had over 3,000 hours of training at a reputable school and passed examinations required for the safe and legal practice of acupuncture and cupping.

What are potential side effects of cupping?

Cupping frequently causes marks on the skin. This is due to bringing blood to the surface, similar to a bruise. For patients with bleeding disorders such as hemophilia or who are being treated with anticoagulants, cupping may not be the best treatment option. People with these conditions should discuss the pros and cons of treatment with their acupuncturist or doctor before receiving cupping. Cupping should not be performed on skin sites with active inflammation, burns, infection, or open wounds. Some discomfort can occur but should not be considered a side effect. Moderate, temporary discomfort is expected as stagnation is removed and connective tissue and muscles are loosened.

Practitioners (especially traditional Western health-care providers) need to be aware of cupping as a treatment modality. In children, the bruising and discolorations post-cupping can be mistaken as a sign of child abuse.

How long do cupping bruises last?

The bruises for cupping can last for a few days up to two weeks. According to TCM practitioner Casco, it is expected that over several weeks of repeated cupping treatments the bruising will decrease as the stagnation resolves. This indicates a successful result of a cupping treatment protocol.

REFERENCES:

Fox, J.R., W. Gray, C. Koptiuch, G.J. Badger, and H.M. Langevin. "Anisotropic tissue motion induced by acupuncture needling along intermuscular connective tissue planes." J Altern Complement Med 20.4 April 2014: 290-294.

Li, J., H. Zhang, J. Yang, X. Xu, Y. Niu, and J. Cai. "Innovation of characteristic medicinal cupping devices." Zhongguo Zhen Jiu 35.8 August 2015: 819-822.

National Certification Commission for Acupuncture and Oriental Medicine. <http://www.nccaom.org/>.

Wang, B., et al. "YANG's pricking-cupping therapy for knee osteoarthritis: a multi-center randomized controlled trial." Zhongguo Zhen Jiu 36.2 February 2016: 113-118.

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Reviewed on 10/31/2016
References
REFERENCES:

Fox, J.R., W. Gray, C. Koptiuch, G.J. Badger, and H.M. Langevin. "Anisotropic tissue motion induced by acupuncture needling along intermuscular connective tissue planes." J Altern Complement Med 20.4 April 2014: 290-294.

Li, J., H. Zhang, J. Yang, X. Xu, Y. Niu, and J. Cai. "Innovation of characteristic medicinal cupping devices." Zhongguo Zhen Jiu 35.8 August 2015: 819-822.

National Certification Commission for Acupuncture and Oriental Medicine. <http://www.nccaom.org/>.

Wang, B., et al. "YANG's pricking-cupping therapy for knee osteoarthritis: a multi-center randomized controlled trial." Zhongguo Zhen Jiu 36.2 February 2016: 113-118.

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