The heat inside the cup raises the skin
Olympian Michael Phelps has been seen swimming in the Rio Olympics with several large, round, red welts across his back and shoulders. What are they? To some they look a bit like tattoos. But those with a background in Chinese Medicine know they are the marks left by an ancient medical procedure called “cupping.”
Many other athletes and others have been finding relief using cupping treatments. Yet many conventional medicine pundits claim that cupping is not medically useful. What does the medical research say about cupping? Is there any clinical evidence for cupping treatments. You betcha.
What is cupping?
Cupping has been a part of a number of ancient therapies, including Traditional Chinese Medicine, ancient Greek medicine, ancient Egyptian medicine, Finnish medicine, Islamic medicine and others. The Egyptian Ebers Papyrus, more than 3,500 years old, discusses cupping. And the famous Greek physician Hippocrates utilized cupping in his practice.
Today cupping is often practiced by acupuncturists, but it is also performed by other specialists in different countries.
Cupping in general means to place heated and/or wet cups on the skin on certain areas of the body to increase microcirculation in that area. Traditional Chinese Medicine also describes that cupping can be used to move the qi (the energetic life force) through the meridian channels of the body.
This TCM method brings up the element of stasis – which is when the qi and blood pathways are blocked or inhibited, and circulation through the meridian or blood vessel is slowed. Many TCM treatments – including cupping and acupuncture – specifically aim at decreasing and removing stasis among certain meridians or other circulatory systems. This increase in qi circulation among the meridian systems is also called ‘moving the qi.’
While these sound foreign to Western medicine, the reality is that the foundation of Western medicine – that is, the medicine of Hippocrates – has embraced this method of opening channels and increasing circulation in order to heal for over two thousand years.
Cupping techniques
There are several techniques used and different instruments employed. Let’s summarize them quickly before we head to the research.
The general system utilized by acupuncturists is to heat up glass or ceramic cups or cupping balls and then apply them to the skin. This can be done by placing the cups into hot water or putting a flame under the cups to heat them up.
As soon as it becomes hot, the cup is placed on the skin. The heat inside the cup draws the skin and the blood underneath towards the cup. This typically yields a round reddened area on the skin that can last for days. It actually looks like a round welt or bruise.
This cupping mark is caused by the bursting of microcapillaries under the skin – which is also what takes place during bruising. As they burst, the microcapillaries deposit blood into the tissues under the skin. As we’ll discuss, this produces a number of physiological responses in the body.
Different types of Cupping
A newer form of cupping utilizes cups that are connected to a machine that slightly heats the cups as they are placed on the skin. One of the machines used for this is called an electromagnetic wave apparatus (or TDP).
Then there is moving cupping – where the cup is moved around the skin surface after being placed on the skin. Massage or essential oils are sometimes employed to make the cups more easily glide over the skin.
Other forms of cupping include acupuncture plus cupping. Here acupuncture needles are placed into the skin either alongside the cupping spots or underneath the cups. The circulatory effects of the cupping can complement the medicinal affects of the acupuncture.
Then there is pricking and cupping. This means the skin is slightly pricked in the region where the cup is placed. This draws some blood into the cup – also called bloodletting. This type of cupping is often criticized as being medieval, yet there is significant evidence showing the technique is actually clinically useful.
With this in mind, let’s review some of the research showing the evidence for the medical usefulness of cupping:
1. Knee osteoarthritis
Researchers from China (Wang et al. 2016) conducted a multi-center clinical trial with 171 patients with knee osteoarthritis. The subjects were divided into two groups. One group of 89 patients was treated with pricking-cupping therapy. The other group was treated with conventional acupuncture – proven in other research to reduce osteoarthritis pain.
Both groups were treated at the Neixiyan (EX-LE 4), Dubi (ST 35) and Ashi point for four weeks. Each patient was treated between five and 10 times total. The researchers judged pain scores using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the visual analogue scale (VAS). These also examined the patients for stiffness and physical function.
Both groups had decreased pain scores after the four weeks. However, the pricking-cupping group had significantly better pain and function scores than the acupuncture group. VAS pain scores and the WOMAC index scores were better in the cupping group.
2. Diabetes mellitus
Researchers (He et al. 2016) tested 216 patients with diabetes mellitus. They split the patients into two groups. For four weeks, one group was given what is called Hechelu moving cupping, while the other group was given conventional medicine – fluoxetine hydrochloride, prescribed as recommended.
The cupping group was given cupping 12 treatments every four days with a four-day break in between. The pharmaceutical group took their medicines every day.
After the four weeks, and after the 45-day follow-up period, the researchers found that the cupping improved diabetes symptoms in 91 percent of the cases, while the pharmaceutical group’s symptoms improved in 74 percent of the cases.
The researchers also found that glycosylated hemoglobin (HbA1c) scores were significantly less in the cupping group – similar to the drop experienced in the pharmaceutical group. The researchers also noted that the cupping resulted in less side effects among the patients. They stated:
“The Hechelu theory-based TCM treatment has better: efficacy for depression of diabetes mellitus than fluoxetine hydrochloride capsule, which has less adverse effects.”
3. Herpes zoster
Researchers (Hao et al. 2016) tested 60 patients with acute herpes zoster. They divided them into two equal groups. One group was given pricking and cupping with followup acupuncture every day for the first three days, then weekly. The other group was given the pharmaceutical treatment via intravenous drip of the acyclovir drug along with oral vitamin B1 and B12 – recommended for herpes zoster.
Both groups saw a significant drop in the VAS pain scores. However, the cupping/acupuncture group’s VAS pain scores were better (lower) than the drug group.
The researchers also tested the patients’ blood. They found that lymphocyte levels were and was significantly reduced in both, and their neutrophil leverls were increased.
The researchers concluded:
“The efficacy of bloodletting pricking, cupping and surrounding acupuncture on acute herpes zoster is positive, and it can significantly lower the number of lymphocytes in the local blood and increase the number of neutrophil, which is likely to be one of the anti-virus mechanisms and pain scores.”
A 2010 review (Cao et al.) of eight other studies on herpes zoster treatment with cupping also found that cupping reduced zoster symptoms.
4. Chronic Shoulder and Neck Pain
Researchers from Tzu Chi University (Chi et al. 2016) tested 60 people with chronic shoulder and neck pain. The patients were split into two groups and one group was given cupping at the SI 15, GB 21, and LI 15 acupuncture points.
The treatment reduced pain intensity from 9.7 to 3.6 in the cupping group, while the control group’s pain intensity remained stable, from 9.7 to 9.5.
Researchers (Yuan et al. 2015) tested 42 patients with cervicogenic periarthritis of the shoulder. This is a painful shoulder pain that is indicative at the beginning of arthritis.
The researchers gave half the group routine acupuncture. The other half was given red-hot needle therapy combined with acupuncture. The cupping was given on the painful side, at points SI 11, GB 21 and SI 15. The red-hot needle group received cauterized filiform needles followed by the cupping. The patients were treated once a day for two weeks.
The researchers found that scores in the shoulder function measured by the adjusted Constant-Murley test found that both groups had significantly greater range of motion and significantly less pain – though the hot needle-cupping group’s scores were better.
Of the two 21 cases treated by either treatment, 8 of the hot needle-cupping group was completely cured, while 4 of the acupuncture treated group was cured. The effective rate of the hot needle-cupping was 95 percent, while the conventional acupuncture group had an 86 percent effective rate. The researchers stated:
“The red-hot needle therapy combined with cupping is effective in relieving cervicogenic shoulder periarthritis and is remarkably superior to routine acupuncture combined with cupping in improving shoulder periarthritis patients’ symptoms.”
5. Low Back Pain / Neck Pain
Researchers (Li et al. 2015) used two types of cupping therapies with 50 low back and neck pain patients. They gave each patient a conventional cupping treatment on one side and a new medicinal cupping device, each using the Quyuan (SI 13) and Dachangshu (BL 25) acupoints.
The researchers found that both cupping therapies decreased pain for the patients. The new cupping equipment was also more comfortable for the patients.
Research from Saudi Arabia’s 5 King Salman Hospital (AlBedah et al. 2015) studied cupping on 80 people with persistent nonspecific low back pain. After six wet cupping sessions over a two-week period (using acupuncture points BL23, BL24, and BL25), researchers found that the cupping therapy significantly decreased pain and mobility over conventional treatment. Scores were (NRS) 29 versus 58, (PPI) 1.2 versus 2.3 and (ODQ) 20 versus 35. The improvement continued over the two weeks of follow up. Cupping also reduced the use of NSAID use.
A number of other studies have also shown that cupping helps reduce low back pain.
6. High blood pressure
Researchers from Saudi Arabia’s Ministry of Health and the King Abdulaziz University (Aleyeidi et al. 2015) tested 80 people with high blood pressure. Half were given three wet cupping treatments every other day and the other group was given pharmaceutical hypertension treatment (drugs).
The researchers found that the wet cupping for four weeks reduced systolic blood pressure by 8.4 mmHg more than the conventional treatment. After eight weeks, the two groups had similar blood pressure reduction. However, the cupping “did not result in any serious side effects.”
7. Hives (chronic urticaria)
Researchers (Zhang et al. 2014) tested 104 chronic urticaria patients with moving cupping therapy combined with autohemotherapy (acupaint injection at acupoints) or drug therapy (cetirizine).
The researchers found that the cupping resulted in a cured and markedly effective rate of 90.4% (47 of 52 patients) compared to 79 percent (41/52) in the drug group. The recurrence rate was also lower in the cupping group, yielding…
“better efficacy on chronic urticaria compared with the routine western medicine treatment and the recurrence rate is low.”
8. Allergic rhinitis
Researchers (Ke and Long 2014) tested 82 people with allergic rhinitis (hay fever). They split the patients into two groups. One was given herbs and cupping at the Shenque (CV 8) point. The other group was given loratadine and budesonide nasal spray.
After two weeks, the effective rate was 88 percent in the herb/cupping group and 79 percent in the drug group. Both groups had similar reductions of IgE, IL-4, IL-5 and TNF-α.
9. Oxidative stress
Oxidative stress is often the basis for a number of disorders, from liver issues to heart and artery issues – many of which are treated with cupping in traditional medicines.
On the issue of oxidative stress, researchers from Turkey’s Turgut Ozal University (Tagil et al. 2014) studied cupping with 31 healthy volunteers. The researchers found:
“Wet cupping blood had higher activity of myeloperoxidase, lower activity of superoxide dismutase, higher levels of malondialdehyde and nitricoxide compared to the venous blood.”
The researchers concluded:
“Wet cupping removes oxidants and decreases oxidative stress.”
10. Carpal tunnel syndrome
Researchers from Germany’s Immanuel Hospital Berlin (Michalsen et al. 2009) tested 52 carpal tunnel patients for seven days. Half were treated with wet cupping, while the other half were treated with the application of heat.
The researchers found the cupping reduced pain from 61.5 to 22.7 mm on day seven and function scores were also better in the cupping group. The researchers stated:
“The results of a randomized trial on the clinical effects of traditional cupping therapy in patients with carpal tunnel syndrome are presented. Cupping of segmentally related shoulder zones appears to alleviate the symptoms of carpal tunnel syndrome.”
11. Chronic fatigue and Fibromyalgia
Researchers from China’s Third People’s Hospital of Hangzhou City (Xu et al. 2012) tested 72 cases of chronic fatigue syndrome. 37 patients were given cupping and acupuncture and 35 patients were given prednisone drug therapy (conventional therapy).
After two weeks of treatment, the researchers found that the cupping group had an effective rate of 92 percent while the prednisone group had an effective rate of 71 percent. The researchers stated:
“The therapeutic effect of chronic fatigue syndrome treated with coiling dragon needling and moving cupping on back is positive, superior to that of Prednisone with oral administration.”
Also see Cao et al. 2011 for another cupping study on fibromyalgia.
12. Postherpetic neuralgia (post-herpes pain)
Researchers from the China Academy of Chinese Medical Sciences (Tian et al. 2013) tested 64 patients with post-herpes pain. They treated half the patients with cupping and pricking and gave 32 patients conventional treatment – with the drug pregabalin. After 16 days of treatment, the researchers found that the effective rate of the cupping was 94 percent compared to 46 percent in the drug treatment group.
The researchers also found that serum substance P levels were significantly lower by the cupping. The researchers concluded that lowering substance P was at least one of the analgesic effects of the cupping.
Other proven medical conditions treated by cupping
There is more. At the expense of boring you out of your skull with more details, below is a summary list of other medical conditions that have been proven to be successfully treated with cupping.
Most of these studies are very similar to the ones above – with the treatment groups randomly divided into two groups with one group being a control group, typically with the conventional (drug) treatment to compare with the effectiveness of the cupping treatment.
13. LDL-cholesterol
(Niasari et al. 2007)
14. Stress-associated headaches
(Ahmadi et al. 2008)
15. Improving generalized pain
(Lauche et al. 2012)
16. Skin ulcers
(Erras et al. 2013)
17. Asthma and bronchitis
(Zhang et al. 2006)
18. Fatigue after Stroke
(Zhou et al. 2010)
19. Hiccups
(Hongliang et al. 2006)
20. Mild insomnia
(Yuefeng et al. 2010)
21. Ankylosing spondylitis
(Wan et al. 2005)
22. Dysmenorrhea (painful menstruation)
(Ming-gao et al. 2012)
23. Multiple sclerosis
Improving symptoms and increasing quality of life. (Namjooyan et al. 2014)
24. Gouty arthritis
(Shijun et al. 2010)
25. Acne vulgaris
(Hua 2005)
26. Cervical spondylosis
(Yan 2012)
27. Asthma symptoms
(Ying 2006)
28. Neurodermatitis and dermatitis
(Zhang et al. 2013)
29. Back Myofascitis
(Shuliang 2007)
30. Erysipelas (skin infections) in lower limbs
(Jianhua et al. 2003)
31. Acute eczema
(Yao and Li 2007)
32. Facial paralysis
(Cao and Liu 2012)
33. Rheumatoid arthritis
(Ahmed et al. 2005)
Believe it or not, there are many more studies on cupping over the past few decades – on these and a number of other conditions.
As we can see from the above evidence, there has been a lot of research done on cupping therapy. Why? Because cupping therapy has been used successfully for centuries. The expense of conducted a clinical study is considerable. With this much evidence, there is a considerable case for the use of cupping therapies.
Practically every study above noted the safety and lack of side effects for cupping treatments.
Where to go for cupping therapy
In Western countries, the primary practitioners of cupping are acupuncturists. Many of these will combine acupuncture with cupping as stated above.
Cupping should not be tried at home. One can be severely burned by applying heated cups to the skin. Better leave this to an expert.
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