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The Benefits of Cupping Therapy

Analysis by Dr. Joseph Mercola Fact Checked


Story at-a-glance -

  • 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.