Cupping therapy

Cupping is poorly supported by scientific evidence, with a 2014 review of recent evidence finding that "because of the unreasonable design and poor research quality, the clinical evidence of cupping therapy is very low."[3] A 2011 review found that "the effectiveness of cupping is currently not well-documented for most conditions", and that systematic reviews showing efficacy for the treatment of pain "were based mostly on poor quality primary studies."[4] The American Cancer Society notes that "available scientific evidence does not support claims that cupping has any health benefits" and also that the treatment carries a small risk of burns.[5] Cupping has been characterized as quackery.[2]

In their 2008 book Trick or Treatment, Simon Singh and Edzard Ernst write that no evidence exists of any beneficial effects of cupping for any medical condition.[6] Critics of alternative medicine such as Harriet Hall and Mark Crislip have characterized cupping as "pseudoscience nonsense", "a celebrity fad", and "gibberish", and observed that there is no evidence that cupping works any better than a placebo.[7][8] Pharmacologist David Colquhoun writes that cupping is "laughable... and utterly implausible."[9] Practicing surgeon David Gorski observes, "...it’s all risk for no benefit. It has no place in modern medicine, or at least shouldn’t."[10]

While ineffective, cupping is generally safe when applied by trained professionals on people who are otherwise healthy. Cupping may result in bruising, burns, pain, and/or skin infection, and is not recommended for people with health problems, due to side effects. In 2016, the Cambodian Ministry of Health warned that cupping could be a health risk and particularly dangerous for people with high blood pressure or heart problems.

Research suggests that cupping is harmful, especially in people who are thin or obese: According to Jack Raso (1997), cupping results in capillary expansion, excessive fluid accumulation in tissues, and the rupture of blood vessels.

Cupping therapy adverse events can be divided into local and systemic adverse events. The local adverse events were scar formation, burns, skin infection, panniculitis, abscess formation, pain at the cupping site, and systemic adverse events including: anemia, dizziness, vasovagal attack, insomnia, headaches, and nausea.

According to the NCCIH "Cupping can cause side effects such as persistent skin discoloration, scars, burns, and infections, and may worsen eczema or psoriasis".[11]

Mishaps associated with the use of easily spilled fuel in combination with fire, during the fire cupping procedure, can result in burning of skin, eye injury, and lung injury. Severity of the injury depends on the amount of fuel spilled and ignited on the patient, and the time before extinguishing the fire.

Some contraindications for cupping may include: pregnancy, swelling, dry or cracked skin, hypotension, open wounds, or thin blood.

While details vary between practitioners, societies, and cultures, the practice consists of drawing tissue into a cap placed on the targeted area by creating a partial vacuum – either by the heating and subsequent cooling of the air in the cup, or via a mechanical pump.[12] The cup is usually left in place for somewhere between five and fifteen minutes.

Cupping therapy types can be classified using four distinct methods of categorisation. The first system of categorisation relates to "technical types" including: dry, wet, massage, and flash cupping therapy. The second categorisation relates to "the power of suction related types" including: light, medium, and strong cupping therapy. The third categorisation relates to "the method of suction related types" including: fire, manual suction, and electrical suction cupping therapy. The fourth categorisation relates to "materials inside cups" including: herbal products, water, ozone, moxa, needle, and magnetic cupping therapy.[13]

Further categories of cupping were developed later. The fifth relates to area treated including: facial, abdominal, female, male, and orthopedic cupping therapy. The sixth relates to "other cupping types" that include sports and aquatic cupping.[14]

Fire cupping

A person receiving fire cupping

Fire cupping involves soaking a cotton ball in almost pure alcohol. The cotton is clamped by a pair of forceps and lit via match or lighter, and, in one motion, placed into the cup and quickly removed, while the cup is placed on the skin. The fire uses up all the oxygen in the cup which creates a negative pressure inside the cup. The cup is then quickly placed onto the body and the negative pressure "sucks" the skin up. Massage oil may be applied to create a better seal as well as allow the cups to glide over muscle groups (e.g. trapezius, erectors, latissimus dorsi, etc.) in an act called "gliding cupping" or "sliding cupping". Dark circles may appear where the cups were placed because of capillary rupture just under the skin. There are documented cases of burns caused by fire cupping.[16][17]

Traditional Chinese medicine

Woman receiving fire cupping at a roadside business in Haikou, Hainan, China

According to traditional Chinese medicine (TCM), cupping is done to dispel stagnation (stagnant blood and lymph), thereby improving qi flow,[25] in order to treat respiratory diseases such as the common cold, pneumonia and bronchitis. Cupping also is used on back, neck, shoulder and other musculoskeletal conditions. Its advocates claim it has other applications as well.[25] Cupping is not advised, in TCM, over skin ulcers or to the abdominal or sacral regions of pregnant women.[26]

Cupping has gained publicity in modern times due to its use by American sport celebrities including National Football League player DeMarcus Ware and Olympians Alexander Naddour, Natalie Coughlin, and Michael Phelps.[27] Medical doctor Brad McKay wrote that Team USA was doing a great disservice to their fans who might "follow their lead", calling cupping an "ancient (but useless) traditional therapy."[28] Steven Novella noted "It is unfortunate that elite athletics, including the Olympics, is such a hot bed for pseudoscience."[29]

There is a description of cupping in George Orwell's essay "How the Poor Die", where he was surprised to find it practiced in a Paris hospital.[30]

An illustration from the medical textbook Exercitationes practicae, published in 1694, shows a man undergoing cupping on his buttocks

The origin of cupping is unclear. For over 3,000 years, the practice has been typically performed unsupervised, by individuals without any medical background. Iranian traditional medicine uses wet-cupping practices, with the belief that cupping with scarification may eliminate scar tissue, and cupping without scarification would cleanse the body through the organs.[31] Individuals with a profound interest in the practice are typically very religious and seek "purification."

There is reason to believe the practice dates from as early as 3000 BC. The Ebers Papyrus, written c. 1550 BC and one of the oldest medical textbooks in the Western world, describes the Egyptians' use of cupping, while mentioning similar practices employed by Saharan peoples. In ancient Greece, Hippocrates (c. 400 BC) used cupping for internal disease and structural problems. The method was highly recommended by Muhammad[20] and hence well-practiced by Muslim scientists who elaborated and developed the method further. Consecutively, this method in its multiple forms spread into medicine throughout Asian and European civilizations. In China, the earliest use of cupping that is recorded is from the famous Taoist alchemist and herbalist, Ge Hong (281–341 A.D.).[32] Cupping was also mentioned in Maimonides' book on health and was used within the Eastern European Jewish community.[33]

As of 2012 cupping was most popular in China. Cupping has been a formal modality in Chinese hospitals since 1950.[34]

• Bloodletting
• Gua Sha
• List of ineffective cancer treatments
• Moxibustion
• Ear candling