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The Therapeutic Technique of Cupping

The Application of a Vessel to the Skin to Draws Blood and Lymph to the Area.

In my search for information about cupping I have run across several news sources. Wikipedia, The American Cancer Society, The International Institute for Islamic Medicine, and countless testimony from anecdotal sources is available if you are willing to wade through advertisements for cupping treatments and cupping sets. I was dismayed to see how little information was actually available though. So this page is an attempt to concentrate the knowledge I have and present it in a readable format. If you have issues with the information on this page, feel it is incomplete, incorrect, please contact me with constructive criticism.

What is Cupping?

Cupping is the application of a vessel to the skin of a client where a vacuum is induced in the vessel causing the skin to rise in the vessel and seal it against the skin. This decrease in pressure creates a vacuum which draws blood and lymph to the area.

History of cupping

There are several semi-technical references to the history of cupping online, though many of them seem somewhat China-centric. All of these seem to agree that the earliest recorded history of cupping is in the book A Handbook of Prescriptions for Emergencies (Jou How Pei Jyi Fang), written by a Taoist alchemist Ge Hong (281-341 A.D.) However, in a translation of Timaeus (Plato ca. 360 B.C.) there is a reference to "medical-cupping glasses" some 500 years earlier. The next reference consistently used is the book Necessities Of a Frontier Official (Wai Tai Mich Yao) by Wang Tayr (Tang Dynasty 618-907 A. D.). Contemporarily to the Tang book is the Al-Tibb-Al-Nabawi, an arabic compliation of medical advice attributed to Muhammad (but more likely simply the medical practice of his contemporaries)(570-632 A.D.) which also contains references to cupping as a medical practice. Cupping is used in several treatments by Ibn Sina (980-1036 A.D.) including tractioning broken bones. The most recent agreed upon reference from Chinese history is Supplement to outline of Materia Medica (Ban Tsau Gang Mu Chyr Yi) written by Zhao Xuemin (Qing Dynasty 1644-1912 A.D.) Although this is a relatively sophisticated text (nearly an entire chapter was devoted to fire cupping) there are other more primitive references to cupping in African settings (1701 The Sudanese Travels of Theodoro Krump) at this time. More recently cupping was used by barbers and doctors in western medical practice in the 1800's. (A map of Allegheny County, Pennsylvania from 1862 contains advertisement for "Cupping, Leeching, Bleeding, and Tooth drawing".)

At present, cupping has been relegated by western science to "Folk Medicine", practices that have been discontinued, CAM (Complementary/Alternative Medicine) practices or BDSM play. In the realm of TCM and folk medicine, it is practiced in many countries around the world, including Poland, Russia, Khazakstan, Malta, Finland, Vietnam, Korea, Japan, China, and has achieved some fame in the United States. I believe it is in other places, but have no references for them. (If you have references for other countries, please contact me.)

Types of cupping

The two main divisions of cupping seem to be between "wet" cupping, a synonym for blood letting with cups, and "dry" cupping, or cupping over unbroken skin. I personally have no experience with "wet" cupping, but here is a link to a more authoritative source "Dry" cupping seems to be used for a variety of reasons, including tractioning broken bones in early medicine, relieving cold and flu symptoms, relaxation of an area, pain suppression and range of motion in joints that have been injured. TCM uses it as an adjunct to acupuncture/moxibustion and treatment, which is beyond the scope of this article.

Cupping Theory

The two theories of cupping that I have been taught are this:

  1. Western
    The vacuum in the cup brings blood and lymph to the area, promoting circulation and healing. In addition it will help break adhesions between the skin and underlying connective tissues, allowing for freer movement.
  2. Eastern (Generic)
    All pain and disease in the body is caused by stagnant chi. The reverse pressure of the cup pulls blockages out of the chi meridians, thus allowing for free flow of chi, and a return to healing and normal chi flow. (If chi confuses you, well join the club. I recommend taking a martial art for several years or coming from a non-western culture for better understanding.)

Techniques of cupping

One of the original forms of cupping involved a horn and a small ball of wax. The horn would be hollow and drilled with a small hole near the end. At this point, the cupping can be done by placing the large horn opening over the area to be cupped, and a practioner would place the wax in his/her mouth. Then the practioner would suction through the small hole to the desired pressure and with tongue manipulation, seal the horn with the small ball of wax. I have never seen this form of cupping, nor tried it. I have no idea if it works, or what effects it might have other than the generalized effects of suction.

Another early form was to cut bamboo in such a way that one end was sealed by the natural growth of the grass. You can see an example here. From there, the cups could be boiled in a pot, then the opening wrapped with a cool towel for a few seconds to make the edge bearable. Then the cups were placed upended on the area to be cupped. The advantage of this is that the cups could be boiled in a specified set of herbs that were a remedy to the condition. The disadvantage is that the cup must be held on the skin for a while to cool, and a new set of cups must be manufactured for each person and for each ailment. Or you can soak a small piece of paper in alcohol, light it on fire and then clap the cup to the area where you wish to cup. The best example of this I have seen is in the movie Iron Monkey also known as Siu nin Wong Fei Hung ji Tit Ma Lau. The advantage of this is that the cup itself can be reused from patient to patient, allowing more time for crafting of the cup (i.e. better quality), and that it is quick. The disadvantage of this is that the paper, soaked and burning is *supposed* to adhere to the bottom of the cup. That does not always happend. Often the burning paper will dislodge and fall inside the cup onto the skin of the client.

Cupping with glass has a few techniques as well. One of these is to place a drop or two of alcohol in the glass, swirl it around to coat the interior of the cup, then light it on fire and place over the area to be cupped. The theory is that the alcohol will burn off, creating the heat to expand the gas in the cup and then burn the alcohol off. In practice it is difficult to get the quantity of alcohol correct for each size cup and suction. If you get too little, the cup doesn't stay on. if you get too much, you drip burning alcohol on the client. In theory you could use this with bamboo cups, but the alcohol would likely absorb into the cup and be even more difficult to work with.

This brings us to "Lightening Flame" technique with which I am most familiar. I also believe that this is the safest technique involving fire. A cotton ball is soaked in alcohol and clamped in a hemostat. The cups is placed on it's side and the lit cotton ball is held in the cup for a few seconds before removal of the flame and placing of the cup on the skin. It is possible to burn the skin with this technique, but with practice it is much easier not to (my opinion).

Why do people get cupped?

The reasons that people will have a cupping treatment are varied. Most people who are familiar with cupping as a folk treatment use it as a treatment for relieving symptoms of the common cold or flue. In such cases the cups are placed in rows down the back next to the spine for 10-20 minutes. Other people come across cupping as an adjunct to TCM in which case they are looking to solve a specific medical condition. Qualified practitioners will often place cups on acupuncture points in pattern specific to the issue. With the media "discovering" cupping via some Hollywood stars, there are people who try cupping for the novelty. Occasionally I will see women seeking to lessen the "dimpling" effect of cellulite with "walking" cups. Cupping is also used for relaxation and stress relief. But most people (in my experience) are looking for pain suppression. Back pain, neck pain, frozen shoulder, old football/Rugby injuries, repetitive stress injuries are all reasons I have had people on my table for cupping.

In most cases folk medicine cupping is done at home by family members. TCM treatment is done in a clinic setting by (hopefully) qualified practitioners. Cellulite reduction is often offered in spas, and relaxation pain suppression is offered by a variety of practitioners from the local wican guild to licensed massage therapists.

Because it is part of cupping I feel I must mention it, but frankly I do not know anything about, nor do I want to know anything about cupping as part of the BDSM community. If you want to know more about this I recommend searching on google.

Evidence for/against cupping

At this current time I have been unable to find any rigorous scientific evidence for or against cupping. The American Cancer society said that they do not have access to any studies currently. There are many, many testimonials (anecdotal evidence) for cupping, and some that are ambivalent. I have run across few that are against, with a notable exception being Quackwatch, a vehemently anti-non-western-medicine site. I have provided a link, but be aware that this site is so conservative that occasionally I find incorrect "scientific" evidence on it to support their views. It often uses technical language to confuse and impress people in my opinion, though they do provide a good guide (albeit heavily biased) to alternative medicine should you wish to investigate. Just realize that anything you find on there will be against any usage, whether it is indicated, or useful.

Why do I use cupping in my practice?

The theories of cupping are, in my opinion, supportive of using cupping in a massage practice, especially since one of my goals is help people heal themselves. Improved circulation, chi flow and easing of adhesions are all good steps toward that goal. But that is not why I use cupping in my practice.

I use cupping because as a side effect of whatever it may or may not do, it produces profound relaxation in the area around the cup. I have had clients where I could have worn my elbows out on them with no results. I put a cup on and the transformation from spasming muscles to relaxation was incredible. I put cups on injured joints because the relaxation that comes with the cupping allows people to re-explore the limits of the joint. I do it, because I see it work. And that is a testimonial. It is not a rigorous scientific study with a placebo group, so do not represent my opinion that way. I am waiting for a study (or the money and expertise to do it myself), but until then I find it worthwhile enough to continue to practice the technique.

How does it feel to be cupped?

Cupping is a process that looks pretty scary from the outside and once you have had it done a few times becomes routine and in some cases, boring. The first thing is to clear up the pain issue. Cups are put on with suction. It stands to reason that if the practitioner puts cups on with very weak suction you will feel hardly anything at all, except that pressure of the cup on your skin. With medium suction you can feel a "drawing" or "pinching" of the skin. At more extreme suction you will feel "painful pinching". A skilled cupper will put cups on with medium pressure.

Depending on what kind of cupping technique you are having done, there are other concerns. Any type of cupping involving fire produces some anxiety in the general populace. The concept of having an open flame near your skin generally is not what most people consider "relaxing". It is important to note that most practitioners have practiced their technique on themselves first, so they have learned first hand what getting too close means. A good cupper will have practiced a lot on them self before even thinking about trying it on another person. Thus what people usually feel when being "fire" cupped is pretty much the opposite of what they expect. Fire cupping generally uses glass cups because of durability and consistency and glass cups at room temperature feel cold to your skin. This is important because the temperature of the glass is what causes the heated air inside to contract once the cup has sealed against the skin. So despite the fact that it is called "fire" cupping, it is usually the pressure of cold glass that you feel on your skin. After a few seconds of contact the glass will warm a bit, but expect it to be a bit cool.

One of the other issues that almost always is discussed is the marks that cupping tends to leave. It can truly look like you had a fight with an octopus for several days. Or you can have redish rings from the edge of the cup that last a few hours. Or, if the cups are on too tightly, you can have bruising show up. The marks that normally come up under cups (redish brown to black in color) look like Hickeys. Some western medical practitioners have defined the mark to be a bruise like a hickey. However in my experience and from my teachers it is not. A medium pressure cup may produce color that does not yellow or fade like a true bruise, and not hurt like a bruise. Chinese practitioners call this mark "Shaw". In my experience it does not affect the effectiveness of the treatment whether or not color comes up. There are people who swear that "shaw" is an indicator of past or current issues, but I have cupped over areas that benefited from it and no color came up at all. In rare occasions I have seen small blisters come up under the cup. Depending on the illness of the client, they have been either filled with clear, or a strange bright orange fluid. These blisters can either be left alone, (your body will take care of them) or popped and treated with an anti-biotic cream and covered with a bandage until they heal over (a couple of days). I do need to stress though that I have RARELY seen them. A D.O. hypothesized to me that the "shaw" was red blood cells that had migrated from capillary beds into the surrounding tissue without breaking the actually capillary bed (thus not meeting several requirements for a "bruise".) He also considered it might be dead red blood cells that were being drawn out of the tissue (this would account for the difference in color I have seen: from purple to black in rare cases.) In any case, it is wise if you are going to be donning a swimsuit or evening gown that reveals parts of your body and you do not wish to be explaining what you have done that you do not engage in cupping at that time.

When should I NOT have cupping?

It is important to note that cupping is a relatively non-invasive technique. As such you generally don't have much to worry about with it. But there are times when it is best NOT to have it. There are some rules you should follow. Do not get cupped if you have any of these conditions:

  1. High fever and/or convulsions
  2. Moderate to severe cardiomyopathy
  3. Hemophilia
  4. Generalized edema (swelling)
  5. Areas with skin ulcers or an unhealed wound
  6. Extreme debility with loss of skin elasticity
  7. Women during pregnancy
  8. Very young children or weak elderly people

Cups should also not be used over thin muscles, uneven bony structures or over extremely hairy areas. Have some common sense. Cupping is not a silver bullet.

Index of References

And in addition I used the information given to me in class at Big Sky Somatic Institute. If you would like a link to any of the above sources, please email me.