- 1 Introduction
- 2 History
- 3 Different types of cupping
- 4 Different types of cups
- 5 Indications
- 6 Contraindications
- 7 Benefits
- 8 Effects
- 9 Side Effects
- 10 Pre Investigations for wet cupping or blood lenting
- 11 Procedure / Use of cupping in physiotherapy
- 12 References
Cupping therapy is one of the oldest and most effective method of releasing the toxins from body tissue and organs. It is also known as vacuum cupping, hijama cupping, horn treatment etc. It is a practice in which the therapist puts special cups on the skin to create suction. This causes the tissue beneath the cup to be drawn up and swell causing increase in blood flow to affected area. Enhanced blood flow under the cups draws impurities and toxins away from the nearby tissues and organs towards the surface for elimination.
Cupping is one of the oldest known treatment for multiple illness. Throughout history, cupping techniques and styles have often resembled the geographic locations they were practiced in, as well as utilizing a region’s local materials: animal horns, bamboo, ceramic, glass, metal, and plastic have all been used in this practice found in Ancient Egyptian, Chinese, Unani, Korean, Tibetan, and Latin American cultures, all of which have served the purpose of supporting the body’s ability to heal itself. In North Africa, cupping therapy was first documented on Eber’s papyrus (1550 BCE), where a cup is the Egyptian glyph to reference a physician. In Asia, during the Jin dynasty, Ge Hong (281-341 CE) mentions the use of animal horns as a means of draining fluids from the body.
In Arabic and Islamic countries, cups (Hijama) are recommended in the Al-Qanun Fi’l-Tibb, Canon of Medicine (1025CE), to treat menstrual conditions. Prophet Muhammed is reported to have been a user and also advocated about it.
According to Galen, the principle of indication for blood lenting is to eliminate residues or divert blood from one part to another.
In Chinese medicine, cupping and other similar therapies follow the Daoist model of holism. Holism is the philosophy that systems and their properties must be viewed together, not just as a collection of parts. Daoists contended that no single being or human could exist unless they are seen in relation to nature, as an extension of the universe and as such are impacted by natural phenomenon, such as the seasons and climate, as well as by internal states, such as emotional stress. Disease, according to this concept, is the result of climate, emotions, and/or trauma that create imbalance in the body.
Since Chinese medicinal researchers focus on observable principles of balance examined in living bodies, their traditional medicine practices are considered “alternative” by the dominant medical systems, despite having been practiced for centuries in cultures and countries around the world.
Alternative medicine is defined as “the promotion or use of practices which are unproven, disproven, impossible to prove, or excessively harmful in relation to their effect.” Unfortunately, medicine, particularly Western allopathic medicine, has been viewed solely from an epistemological framework. This framework establishes a theory of knowledge that distinguishes justified belief from opinion. Therefore, evidence-based medicine has been the adopted mode used, predominantly relying on anatomical dissection over any other form of inference or methodology in determining a diagnosis and/or treatment.
Different types of cupping
- Dry cupping
- Wet cupping / Hijama
- Oil cupping / Sliding cupping : Its a technique where massage oils are applied, cups are attached to the body and then slid across an area.
- Fire cupping
- Moxa cupping
- Horn cupping / Raktamokashan by shrung
- Flash cupping / Empty cupping : It involves quick repeated application of cups, with minimal retention. It reduces local congestion and stimulate circulation over a broader area.
- Deep tissue cupping / draining
- Liquid cupping
- Hot needle cupping
- Solar plexus cupping
- Accupuncture cupping
- Facial cupping
Different types of cups
- Horn / suction cups
- Glass / fire glass cups
- Plastic / hijama cups
- Bamboo / wooden cups
- Silicone / facial cups
- Nabhi pump
Cupping therapy is indicated for both healthy patients (anti ageing treatment, rejuvenation purpose) and those suffering from ailments. Localized ailments that benefit from cupping therapy include a headache, lower back pain, neck pain, and knee pain. Systemic illnesses that have seen benefits with cupping therapy include hypertension, rheumatoid arthritis, diabetes mellitus, mental disorders, heart disease, hypertension, infections. It can be used to treat skin diseases, respiratory, musculoskeletal, digestive, reproductive, and allergic conditions,
- Excessive dry or cracked skin
- Open wound or ulcer
- Fractured bone
- Dislocated joint
- Bleeding disorders
- Severe anaemia
- Muscle dystrophy
- Patients with fear of blood or bleeding, empty stomach, below 7 years of age (for wet cupping)
- Below 2 years of age for dry cupping
- Excessive swelling
- Cupping helps to reduce pain and inflammation.
- Improves blood flow.
- Used for relaxation, well being and deep tissue massage.
- It is safe, non invasive and inexpensive treatment.
- Rejuvenation of body organs.
- Facilitates healing process and strengthens immune system.
- Used to treat:
- Blood disorders such as anemia and hemophilia
- Rheumatic diseases such as arthritis and fibromyalgia
- Gynecological disorders
- Skin problems: eczema and acne
- High blood pressure
- Migraines, Anxiety and depression
- Varicose veins
- Skin: Improved metabolism in skin tissue, better functioning of sebaceous and sweat glands, improved healing and improved skin resistance.
- Muscles: Stimulates blood flow and lymphatic drainage.
- Joints: Increased blood flow and secretion of synovial fluid.
- Digestive system: Increased peristalsis and secretion of digestive fluids, better digestion and excretion.
- Blood: Improved blood circulation, improved functioning of RBC and WBC.
- Nervous System: Stimulates sensory nerves of skin, Improves ANS.
Cupping is a low-risk therapy. The side effects will typically occur during your treatment or immediately after. Lightheadedness or dizziness, sweating or nausea may be experienced.
After treatment, the skin around the rim of the cup may become irritated and marked in a circular pattern. There may be risk of Infection after undergoing cupping therapy and it can be avoided if practitioner follows the right methods for cleaning skin and controlling infection before and after the session.
- Burns from heated cups.
- Muscle tension or soreness.
- Skin infections, bruising, itching or scarring.
Pre Investigations for wet cupping or blood lenting
- Must: Haemogram, BT, CT, BSL.
- Optional: HIV, HBSAG, VDRL, PT INR
Procedure / Use of cupping in physiotherapy
A Physiotherapist utilizes a rubber pump to create a vacuum and this causes the skin to rise. The blood vessels will expand and is used to create a massage effect. 
The sites are selected according to the treated ailment. The cups are commonly placed on areas with abundant muscles. The back is the most common site of application, followed by the chest, abdomen, buttocks, and legs. Other areas, such as the face, may also be treated by cupping. According to research studies, it is recommended that cups should be on the skin for no more than 5-10 minutes.The residual marks left from cupping disappear in 1-10 days.
- Cupping helps to increase the blood flow to sore areas in muscles.
- It provides necessary nutrients to the area being treated and promotes healing.
- Cupping can provide pain relief and help ease the symptoms of many common disorders of the bones and muscles. It does this by exciting small nerves inside muscles so that they release pain-killing chemicals.
- Cupping Therapy can be very relaxing and help to reduce muscular restrictions, scars and adhesions, to decrease swelling, increase range of motion.
Pre and post procedure
- Proper counselling should be done to the patient about the procedure and about post treatment marks or scars.
- Take consent if required.
- Surface should be cleaned or disinfected before cupping.
- Use new sterile disposable needle or surgical blade and disposable cups for wet cupping.
- Check for cracks, wound and raised local temperature.
- Check for sensitive skin.
- After the procedure, apply moisturizer or antiseptic cream to prevent any possible infection.
- After hijama cupping, dressing must be done.
- WebMD. Cupping Therapy. Available from https://www.webmd.com/balance/guide/cupping-therapy#1 [last accessed 14/10/2020]
- Chirali I Z. Traditional Chinese medicine: cupping therapy. Elsevier Health Sciences.1999.
- Dinall AM. A reflection on cupping therapy and historical medical dominance. Int J Complement Alt Med. 2019;12(2):66-8.
- ICAHT Centre Of Integrative Medicine. Dry Cupping Massage Treatment At ICAHT Centre Leicester . Available from https://www.youtube.com/watch?v=yvA8g4B1Ces
- ICAHT Centre Of Integrative Medicine. Performing Hijama (Wet Cupping) at Cardiff Hijama Center UK - Testimonial By Mustafa. Available from https://www.youtube.com/watch?v=mhOdwwuMJPQ
- Price S. Aromatherapy for Common Ailments: How to Use Essential Oils--Such as Rosemary, Chamomile, and Lavender--To Prevent and Treat More Than 40 Common Ailments. Simon and Schuster; 2003 Dec 23.
- Dantian health acupuncture herbs. Cupping. Available from https://www.dantianhealth.com.au/cupping-types/#flash-cupping [last accessed 14/10/2020]
- ToHealth. How to do cupping therapy. Available from https://www.youtube.com/watch?v=V8ntyHPvRnw
- AmouraProductions. Moxa Cupping Massage Angie Schnell. Available from https://www.youtube.com/watch?v=kjnC1ZTAP1M
- Anadolu Agency. Cupping therapy with buffalo horns in Indonesia . Available from https://www.youtube.com/watch?v=znxjK_HS3Wk
- Mehta P, Dhapte V. Cupping therapy: A prudent remedy for a plethora of medical ailments. Journal of traditional and complementary medicine. 2015 Jul 1;5(3):127-34.
- Staten Island Advance. Amanda tries Acupuncture and Cupping. Available from https://www.youtube.com/watch?v=iFW5cn6ICuA
- Beauty Insider. Face Cupping Gives Instant Facelift. Available from https://www.youtube.com/watch?v=zBDSsBPnnF8 [last accessed 14/10/2020]
- Nimrouzi M, Mahbodi A, Jaladat AM, Sadeghfard A, Zarshenas MM. Hijamat in traditional Persian medicine: risks and benefits. J Evid Based Complementary Altern Med. 2014 Apr;19(2):128-36.
- Aboushanab TS, AlSanad S. Cupping therapy: an overview from a modern medicine perspective. Journal of acupuncture and meridian studies. 2018 Jun 1;11(3):83-7.
- Ilkay Zihni Chirali MBAcC RCHM. Benefits of Cupping Therapy. Traditional Chinese Medicine Cupping Therapy (Third Edition), 2014
- Timothy Huzar. Medical News Today. What to know about cupping therapy? Available from https://www.medicalnewstoday.com/articles/324817#pain-relief [last accessed 14/10/2020]
- Healthline. Cupping therapy. Available from https://www.healthline.com/health/cupping-therapy#conditions [last accessed 14/10/2020]
- Al-Bedah AMN, Elsubai IS, Qureshi NA, et al. The medical perspective of cupping therapy: Effects and mechanisms of action. J Tradit Complement Med. 2018;9(2):90-97. Published 2018 Apr 30. doi:10.1016/j.jtcme.2018.03.003
- Cleveland Clinic. Cupping: Risks / Benefits. Available from:https://my.clevelandclinic.org/health/treatments/16554-cupping/risks--benefits [last accessed 14/10/2020]
- Bay state physical therapy. Cupping. Available from https://baystatept.com/physical-therapy-services/cupping/#:~:text=Physical%20therapists%20may%20sometimes%20use,ligaments%2C%20muscles%2C%20and%20tendons. [last accessed 14/10/2020]
- Furhad S, Bokhari AA. Cupping Therapy. Available from https://www.ncbi.nlm.nih.gov/books/NBK538253/ [last accessed 14/10/2020]
- Yoo SS, Tausk F. Cupping: east meets west. International journal of dermatology. 2004;43(9):664-5.
- Moura CC, Chaves ÉCL, Cardoso ACLR, Nogueira DA, Corrêa HP, Chianca TCM. Cupping therapy and chronic back pain: systematic review and meta-analysis. Rev Lat Am Enfermagem. 2018 Nov 14;26:e3094.
- PT health. what is cupping therapy? Available from https://www.pthealth.ca/blog/what-is-cupping-therapy/#:~:text=Cupping%20increases%20the%20blood%20flow,they%20release%20pain%2Dkilling%20chemicals. [last accessed 26/10/2020]
- Best Health Physio. Cupping therapy. Available from https://besthealthphysio.ca/cupping-therapy/ [last accessed 26/10/2020]
- The lowa clinic. Cupping Therapy | Physical Therapy | The Iowa Clinic. Available from https://www.youtube.com/watch?v=na3eN1SrhPE
- OSC. Cupping - What is it, and how is it used in our Physical Therapy clinic? Available from https://www.youtube.com/watch?v=PdClg0xvOl0