Cupping is a manual therapy used in traditional Chinese medicine and other medical systems. It involves applying negative pressure to the skin using cups, typically made of glass, plastic, or silicone. The suction draws superficial tissue into the cup and produces a localised mechanical effect on the skin and underlying structures.
What is Cupping
Cupping can be applied using different techniques:
- Dry cupping: suction only, with no skin penetration
- Wet cupping: involves superficial skin pricking followed by suction
- Moving (mobile) cupping: cups are glided across the skin using oil
- Retained cupping: cups remain in a fixed position for several minutes
The suction creates visible skin changes, commonly circular discolouration, which reflects capillary dilation and minor extravasation of blood into the superficial tissues.
From a biomedical perspective, proposed mechanisms include increased local blood flow, modulation of inflammatory mediators, and stimulation of the peripheral nervous system (Kim et al., 2010).
Clinical Applications Studied in Research
Cupping therapy has been investigated in a range of conditions, particularly those involving pain:
- Chronic low back pain: Randomised controlled trials have evaluated wet cupping in persistent non-specific low back pain, with reported changes in pain intensity compared to usual care (AlBedah et al., 2015).
- Musculoskeletal pain: Systematic reviews have examined cupping across different pain conditions, though study quality and consistency vary (Kim et al., 2010).
- Rheumatoid arthritis: Combined acupuncture and cupping interventions have been studied in controlled settings (Kim et al., 2011).
- Fibromyalgia: Reviews of complementary therapies, including cupping, suggest variable findings across studies (Lauche et al., 2016).
- Respiratory conditions: Some trials have explored wet cupping in chronic conditions such as COPD, with preliminary findings (Shiroodi et al., 2020).
Study designs, protocols, and outcomes differ across the literature, and results are not uniform.
Procedure
A typical cupping session may include:
- Selection of treatment areas based on clinical assessment
- Placement of cups and creation of suction using mechanical pumps or heat
- Retention of cups for approximately 5 to 10 minutes (may vary)
- Removal of cups with gradual release of pressure
In moving cupping, oil is applied to reduce friction and allow controlled movement across the skin.
Patients commonly experience a pulling or tight sensation during application.
Expected Skin Response
- Circular discolouration (ecchymosis) is common
- Colour may range from light pink to dark purple
- Marks usually resolve within several days to one week
- Mild tenderness may be present
These responses are expected physiological effects rather than tissue injury when performed appropriately.
Care After Cupping
- Keep the treated area warm and protected from wind exposure
- Avoid showering or bathing for approximately 4 to 6 hours
- Avoid strenuous physical activity on the same day
- Hydration is commonly advised, though evidence for “toxin release” is not established in biomedical literature
- Mild soreness can be managed with rest or cold application if required
Contraindications and Precautions
Cupping is not appropriate in all cases and requires screening.
Contraindications:
- Broken skin, infection, or ulceration
- Severe dermatological conditions (e.g. active eczema, psoriasis flare)
- Over major blood vessels or varicose veins
- Uncontrolled bleeding disorders
Precautions:
- Use of anticoagulant medication (increased bruising risk)
- Frail or thin skin (e.g. elderly patients)
- Pregnancy (avoid abdomen and lower back)
- Severe systemic illness or fever
- Reduced sensation (increased risk of skin injury)
Wet cupping involves additional considerations regarding infection control and is not routinely used in all clinical settings.
Adverse Effects
Reported adverse effects are generally mild and self-limiting:
- Bruising and skin discolouration
- Temporary discomfort
- Skin irritation
Rare complications may include blistering or burns if excessive suction or heat is applied.
References
AlBedah, A. M., Khalil, M. K., Elolemy, A. T., et al. (2015). The use of wet cupping for persistent non-specific low back pain: A randomized controlled clinical trial. Journal of Alternative and Complementary Medicine, 21(8), 504–508. https://doi.org/10.1089/acm.2015.0079
Kim, J.-I., Lee, M. S., Lee, D.-H., Boddy, K., & Ernst, E. (2010). Cupping for treating pain: A systematic review. Evidence-Based Complementary and Alternative Medicine, 7(3), 353–357. https://doi.org/10.1093/ecam/nen029
Kim, T.-H., Kang, J.-W., Kim, K.-H., Lee, M. S., & Lee, J.-D. (2011). Evaluating the effectiveness and safety of acupuncture and cupping in patients with rheumatoid arthritis: A randomized controlled trial. Evidence-Based Complementary and Alternative Medicine, 2011, 383042. https://doi.org/10.1155/2011/383042
Lauche, R., Cramer, H., Häuser, W., Dobos, G., & Langhorst, J. (2016). A systematic overview of reviews for complementary and alternative therapies in the treatment of the fibromyalgia syndrome. Evidence-Based Complementary and Alternative Medicine, 2016, 3641546. https://doi.org/10.1155/2016/3641546
Shiroodi, M. K., Yekaninejad, M. S., Ahmadi, A., Daneshmandi, M., & Torkamani, M. (2020). The effects of wet cupping on the severity of chronic obstructive pulmonary disease symptoms. Journal of Research in Medical Sciences, 25(1), 2. https://doi.org/10.4103/jrms.JRMS_626_18