Cupping Therapy

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.


Cupping therapy can generally be described as a technique that uses cups placed over the skin to create negative pressure through suction.

Cupping therapy dates back to ancient times and was used around the world. In 400 BC, Herodotus listed wet and dry cupping as a treatment for many ailments, including maldigestion, lack of appetite, and headaches. Hippocrates advocated cupping for gynecological complaints, back and extremity illnesses, pharyngitis, lung diseases, and ear ailments. Cupping therapy was mentioned in the famous Papyrus Ebers in Ancient Egypt (1550 BC). In the Middle East, cupping was advocated for by prominent physicians like Abu Bakr Al-Razi (AD 854-925), Ibn Sina (AD 980-1037), and Al-Zahrawi (AD 936-1036). In China, cupping was recorded as a medical treatment in the Mawangdui Silk texts (sealed in 168 BC). Cupping therapy was used in ancient Europe as well. In the first century AD, Celsus advised cupping therapy for extracting poison from bites and for abscesses. In the 2nd century AD, Aretaeus treated prolapse of the uterus, cholera, epilepsy, and ileus with wet cupping. Galen was an advocate for cupping therapy and detailed a variety of materials that could be used for cups like horns, glass, and brass.

There are two types of cupping methods, dry and wet. Dry cupping is noninvasive with no bloodletting. Wet cupping is invasive and includes bloodletting. It is further subdivided into traditional wet cupping and Al-hijamah. Al-hijamah comes from the Arabic word hajm, which means sucking, expansion, and bloodletting. Traditional wet cupping is commonly used in China, Korea, and Germany. Al-hijamah is more common in the Middle East and North Africa.

The specific mechanism in which cupping exerts its therapeutic effect has not been identified. However, a number of theories have been proposed. One method, called Taibah, suggests wet cupping mimics an artificial kidney. Where an in vivo kidney filters hydrophobic materials through the glomeruli via normal pressure filtration, wet cupping filters both hydrophilic and hydrophobic material through high-pressure filtration. The high pressure from suction leads to increased blood volume, increased capillary filtration rate, and the expulsion of filtered and interstitial fluid in the area. Filtered fluid collected contains disease-related and disease-causing substances as well as prostaglandins and inflammatory mediators. The scratches made with the scalpel increase innate and acquired immunity by stimulating inflammatory cell migration and endogenous opioid release. This action leads to improved blood flow, removal of toxins, restored neuroendocrine balance, improved oxygen supply, and tissue perfusion.

Cupping therapy has been used for centuries to treat a wide variety of health disorders. However, to improve patient outcomes, clinicians should understand that cupping therapy is not a substitute treatment for conventional therapies but a complementary therapy. Health professionals should also be aware evidence to support its use for treating most medical disorders is lacking and that some health professionals may mistake cupping bruises as evidence of abuse.

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