CUPPING

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine,

Portland, Oregon

Cupping refers to an ancient Chinese practice in which a cup is applied to the skin and
the pressure in the cup is reduced (by using change in heat or by suctioning out air), so
that the skin and superficial muscle layer is drawn into and held in the cup. In some
cases, the cup may be moved while the suction of skin is active, causing a regional
pulling of the skin and muscle (the technique is called gliding cupping).

This treatment has some relation to certain massage techniques, such as the rapid skin
pinching along the back that is an important aspect of tuina (12). In that practice, the
skin is pinched, sometimes at specific points (e.g., bladder meridian points), until a
redness is generated. Cupping is applied by acupuncturists to certain acupuncture points,
as well as to regions of the body that are affected by pain (where the pain is deeper than
the tissues to be pulled). When the cups are moved along the surface of the skin, the
treatment is somewhat like guasha (literally, sand scraping), a folk remedy of southeast
Asia which is often carried out by scraping the skin with a coin or other object with the
intention of breaking up stagnation. Movement of the cups is a gentler technique than
guasha, as a lubricant allows the cup to slide without causing as much of the
subcutaneous bruising that is an objective of guasha. Still, a certain amount of bruising
is expected both from fixed position cupping (especially at the site of the cup rim) and
with movement of the cups.

Traditional cupping, with use of heated cups, also has some similarity to moxibustion
therapy. Heating of the cups was the method used to obtain suction: the hot air in the
cups has a low density and, as the cups cool with the opening sealed by the skin, the
pressure within the cups declines, sucking the skin into it. In this case, the cups are hot
and have a stimulating effect something like that of burning moxa wool.

In some cases, a small amount of blood letting (luoci; vein pricking) is done first, using a
pricking needle, and then the cup is applied over the site. The pricking is usually done
with a three-edged needle, applied to a vein, and it typically draws 3–4 drops of blood
(sometimes the skin on either side is squeezed to aid release of blood). A standard thick-
gauge acupuncture needle or plum blossom needle may be used instead. This technique
is said to promote blood circulation, remove stasis, and alleviate swelling and pain. It is
employed especially when there is a toxic heat syndrome and for a variety of acute
ailments.

The following report is derived mainly from a survey of reported cupping techniques
published in 1989 (1), supplemented by information from acupuncture text books (5–9).

EARLY HISTORY
The earliest use of cupping that is recorded is from the famous Taoist alchemist and
herbalist, Ge Hong (281–341 A.D.). The method was described in his book A
Handbook of Prescriptions for Emergencies, in which the cups were actually animal
horns, used for draining pustules. As a result of using horns, cupping has been known as
jiaofa, or the horn technique. In a Tang Dynasty book, Necessities of a Frontier
Official, cupping was prescribed for the treatment of pulmonary tuberculosis (or a similar
disorder). More recently, Zhao Xuemin, during the Qing Dynasty, wrote Supplement to
Outline of Materia Medica, including an entire chapter on “fire jar qi” (huoquan qi). In
it, he emphasized the value of this treatment, using cups made of bamboo or pottery, in
alleviating headache of wind-cold type, bi syndrome of wind origin, dizziness, and
abdominal pain. The cups could be placed over acupuncture needles for these
treatments. One of the traditional indications for cupping is dispelling cold in the
channels. This indication is partly the result of applying hot cups. For example, bamboo
cups would be boiled in an herbal decoction just prior to applying to the skin (this is one
type of shuiguanfa, or liquid cupping, so-called because a liquid is incorporated into the
treatment). Both liquid cupping and cupping over an acupuncture needle are favored for
treatment of arthralgia. Cupping also is thought to dispel cold by virtue of its ability to
release external pathogenic factors, including invasion of wind, damp, and cold.

MODERN CUPPING

During the 20th century, new glass cups were developed (see Figure 1). Common
drinking glasses have been used for this purpose, but thick glass cupping devices have
also been produced and are preferred. The introduction of glass cups helped greatly,
since the pottery cups broke very easily and the bamboo cups would deteriorate with
repeated heating. Glass cups were easier to make than the brass or iron cups that were
sometimes used as sturdy substitutes for the others; further, one could see the skin within
the cup and evaluate the degree of response.

The glass cups are depressurized by providing some fire in the cup to heat up the air
within just prior to placement. For example, hold a cotton ball dipped in alcohol with a
pincer, ignite it, hold it in the cup, then rapidly apply to the skin; this is called shanhuofa
(flash-fire cupping; see Figure 2). Sometimes, a small amount alcohol is put in the cup
and lit; this method is called dijiufa (alcohol-fire cupping).

At the end of the 20th century, another method of suction was developed in which a valve
was constructed at the top of the jar and a small hand-operated pump is attached so that the
practitioner could suction out air without relying on fire (thus avoiding some hazards and
having greater control over the amount of suction). Both glass and plastic cups were
developed, though the plastic ones are not very well suited to moving along the skin once
in place, as the edges are not entirely smooth and the strength of the cups is limited. The
modern name for cupping is baguanfa (suction cup therapy).

In order to allow easy movement of the glass cups along the skin, some oil is applied.
Medicated massage oils (with extracts of herbs) are particularly useful for this purpose.
Since the cups are applied at room temperature, the indication of removing cold from the
channels is no longer as applicable, at least to stationary cups. There is some friction
generated with moving cups, so that there is a small but significant amount of heat
applied by that method, especially if a warming oil is used as lubricant.

Generally, the cup is left in place for about 10 minutes (typical range is 5–15 minutes).
The skin becomes reddened due to the congestion of blood flow. The cup is removed by
pressing the skin along side it to allow some outside air to leak into it, thus equalizing the
pressure and releasing it. Some bruising along the site of the rim of the cup is expected.

Today, cupping is mainly recommended for the treatment of pain, gastro-intestinal

disorders, lung diseases (especially chronic cough and asthma), and paralysis, though it
can be used for other disorders as well. The areas of the body that are fleshy are
preferred sites for cupping. Contraindications for cupping include: areas of skin that are
inflamed; cases of high fever, convulsions or cramping, or easy bleeding (i.e.,
pathological level of low platelets); or the abdominal area or lower back during
pregnancy. Movement of the cups is limited to fleshy areas: the movement should not
cross bony ridges, such as the spine. Following are some of the recommended treatment
sites for various disorders.

Respiratory Diseases

• For chronic bronchitis and asthma, one can apply cupping at the following points:
dingchuan, dazhui (GV-14), shenzhu (GV-12), geshu (BL-17), xinshu (BL-15),
jueyinshu (BL-14), feishu (BL-13), fengmen (BL-12), dashu (BL-11), tiantu (CV-22),
shanzhong (CV-17), huagai (CV-20), and zhongfu (LU-1). [see: Acupuncture
treatment of asthma for more information about several of these treatment sites].
• For pediatric bronchitis: blood letting followed by cupping at dazhui (GV-14).

• For pediatric acute bronchitis: feishu (BL-13), shenchang (KI-25), lingxu (KI-24).
Digestive Diseases

• For dysentery, early morning diarrhea, and acute and chronic gastritis, perform
cupping in the following areas: around the navel; at the bladder meridian shu points;
or these stomach meridian points: burong (ST-19), guanmen (ST-22), huaroumen
(ST-24), tianshu (ST-25).

• Pediatric indigestion: dachangshu (BL-25).

Pain Syndromes

• Shoulder blade: jianwaishu (SI-14) and tianzhong (SI-11).

• Loins: shenshu (BL-23), qihaishu (BL-24), guanyuanshu (BL-26).
• Head: taiyang and yintang for refractory headaches and migraines; dazhui (GV-14)
and baihui (GV-20) for parietal and occipital headaches; for trigeminal neuralgia:
qihu (ST-13), fengchi (GB-20), sizhukong (TB-23), jiache (ST-6); for toothache:
dashu (BL-11), with acupuncture, massage, and cupping at yifeng (TB-17), jiache
(ST-6), xiaguan (ST-7), and hegu (LI-4).

• Soft tissue injury: treat local pressure pain points and area of swelling; use plum
blossom needling followed by cupping; additionally or alternatively use points above
or below the site of injury along the channels that pass through the injury.

Gynecological Disorders

• Infertility and irregular menstruation: shenshu (BL-23) with movement of cup

downward (treat with acupuncture first, then do cupping).
• Leukorrhea: yaoyan (extra point under the 3rd lumbar vertebra) and around baliao
(BL-31 through BL-34).

• Uterine cramps: needle zusanli (ST-36) and guanyuan (CV-4) and do cupping at
guanyuan (CV-4).

Miscellaneous

• Common cold: dazhui (GV-14).

• Insomnia: xinshu (BL-15), geshu (BL-17), shenshu (BL-23).

• Facial paralysis: needling and cupping dazhui (GV-14), along with needling local
facial points.

RECENT RESEARCH:
The following protocols were reported to provide good results in individual clinical
research reports:
a. Head pain (2): headache, toothache, sore throat, redness and soreness of the eyes,
treated with blood letting followed by cupping. Treatment is applied to dazhui (GV-
14) and dingchuan.
b. Frozen shoulder (3): after acupuncture at jianyu (LI-15) and jianliao (TB-14) to get
propagated qi reaction, use pricking of ashi points followed by cupping over the
bleeding area for 10–15 minutes. Ten treatments is a course of therapy.
c. Acute trigeminal neuralgia treating with blood letting followed by cupping (4):
treatment is applied to dazhui (GV-14) and feishu (BL-13).
d. Acne (10): treatment is to use bloodletting followed by cupping at feishu (BL-13) and
geshu (BL-17) on one day, then xinshu (BL-15) and ganshu (BL-18) the next day,
alternating treatments for a total of eight days.
e. Urticaria (11): perform cupping at shenque (CV-8) three times consecutively for ten
minutes each time. This is done for three days, followed by one day rest, and another
three days as needed.

f. Acute diseases (13): fever and headache due to infection, acute conjunctivitis, lumbar
sprain; perform blood letting at dazhui (GV-14), and then cupping (which promotes
further bleeding).
TREATMENT SUMMARY

Cupping therapies often follow the point selection pattern that is used for standard
acupuncture therapy, with somewhat greater emphasis on the use of back points (due to
the ease of performing this technique there). In particular, most practitioners rely on
using back shu points (bladder meridian) and dazhui (GV-14). Cupping is frequently
applied after treatment by acupuncture, blood letting, or plum blossom treatment.

REFERENCES

1. Cui Jin and Zhang Guangqi, A survey of thirty years’ clinical application of cupping,
Journal of Traditional Chinese Medicine 1989; 9(3): 151–154.
2. Wu Jiashu, Observation of analgesic effect of acupuncturing dazhui point, Journal of
Traditional Chinese Medicine 1989; 9(4): 240–242.
3. Ju Huadong, 30 cases of frozen shoulder treated by needling and cupping,
International Journal of Clinical Acupuncture 1998; 9(3): 327–328.
4. Zhang Zhilong, Observation on therapeutic effects of blood-letting puncture with
cupping in acute trigeminal neuralgia, Journal of Traditional Chinese Medicine 1997;
17(4): 272–274.
5. Cheng Xinnong, Chinese Acupuncture and Moxibustion, 1987 Foreign Languages
Press, Beijing.
6. State Administration of Traditional Chinese Medicine and Pharmacy, Advanced
Textbook on Traditional Chinese Medicine and Pharmacology, volume IV, 1997
New World Press, Beijing.
7. O’Conner J and Bensky D (translators), Acupuncture: A Comprehensive Text,
1981 Eastland Press, Seattle, WA.
8. Zhang Ruifu, Wu Xiufen, and Nissi Wang (compilers), Illustrated Dictionary of
Chinese Acupuncture, 1986, Sheep’s Publications, Hong Kong.
9. Academy of Traditional Chinese Medicine, An Outline of Chinese Acupuncture,
1975 Foreign Languages Press, Beijing.
10. Chen Decheng, Jiang Nawei, and Cong Xin, 47 cases of acne treated by prick-
bloodletting plus cupping, Journal of Traditional Chinese Medicine 1993; 13(3): 185–
186.
11. Wang Huaiping, Treatment of urticaria with cupping, Journal of Traditional Chinese
Medicine 1993; 13(2): 105.
12. Li Jiang, A miraculous spinal pinching therapy, Journal of Traditional Chinese
Medicine 1996; 16(3): 228–229.
13. Yin Ying, Blood-letting at a single point for treatment of acute diseases, Journal of
Traditional Chinese Medicine 1997; 17(3): 214–216.
 March 1999

Figure 1: Three types of cups.

Figure 2: Flash-fire cupping.

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:

High fever and/or convulsions

Moderate to severe cardiomyopathy
Hemophilia
Generalized edema (swelling)
Areas with skin ulcers or an unhealed wound
Extreme debility with loss of skin elasticity
Women during pregnancy
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.

Cautions

It should not be used in patients with high fever and convulsion, edema as well as areas with
large blood vessels, allergic skin or skin ulcer and the abdominal and lumbosacral regions of
the gravida.

Cares should be taken to avoid burning or scorching the skin; retention of the cup should not
be too long lest impairment of the skin be caused.

If the local congestion is severe after the removal of the cup, it is forbidden to perform
cupping on the region again.

• PRECAUTIONS AND CONTRAINDICATIONS:

• Not on the abdomen/sacral area during pregnancy

• Not on contraindicated points

• Not on areas with an inflammed organ

• Not on inflammed areas in general (can cup distally a/or around it)

• Not on patients with cardiac disease a/or aneurysms

• Not on patients with extreme fatigue a/or anemia

• Not on patients who have just finished exercising or taking a hot bath or shower

• No sliding cups over the spine, moles or other skin abnormalities

• GENERAL GUIDELINES:

• Deficient patient or weak pulse - use 2-3 cups w/less suction for less time (20 seconds to 2
minutes)
• Excess patient - use 7-10 cups w/more suction for more time (5-10 minutes)
• Removing Cups

• After removal perform 1 round of Chinetsukyu or use the tiger warmer on the cupped area

• If using pump cups clean them with alcohol, unless you have performed bloodletting then use a 9:1
bleach solution

• Patient reactions

• Some patients may feel too light headed or chilled, in this case use chinetsukyu on GV 14, GV 20
a/or ST 36
• As always, communicate with the patient about the marks left by cupping, some of which may stay
for 2 days to a couple of weeks

• SPECIFIC TECHNIQUES:

• Skin diseases anywhere on the body (some also use this tx for repeated miscarriages - inbetween
pregnancies) - perform cupping over the naval w/mild - moderate pressure, retain for 2-3 minutes,
can repeat up to 3 times
• Disorders of the entire body - GV 14 & GV 12

• Respiratory disorders - UB 12, UB 13, UB 20, LU 1 & CV 17

• Lumbar pain - GV 4, UB 23, UB 20, GV 3, UB 37 & ashi "sensitive" points

• Dermatological disorders - UB 12, UB 13, UB 18, UB 20 & ashi points

• Chronic Constipation

• Works very well if done on a daily basis (front day 1, back day 2), but can also be performed within
one treatment
• Cup on the abdomen first, retaining for about 10 minutes

•
• Perform Bunshi Shiroda's total body treatment

• Cup the back points, retaining for about 10 minutes

 •

Examples of Devices for Cupping

These are examples of different modern cupping vessels.

Chinese Style Molded Glass Cup

 This is a Chinese style molded glass cup. Note the wide rolled rim which softens the impact of cupping on
the skin. These cups are fairly ubiquitous in the cupping world, due to the fact that they work well, are very
durable (have dropped several on a tile floor and they bounce, not break) and are relatively cheap. This mold is
also used for vacuum gun cups because you can drill the small resting point on the top of the dome to fit a seal,
but glass vacuum gun cups are comparatively expensive.

Different Sized Glass Cups

 The glass cups come in different sizes for different parts of the body. I usually use the smallest for arm work
and for the acupressure point/trigger point in the center of the subscapularis muscle.

Maltese Art Glass Cup

This is an art glass cup from Malta (Mtarfa/Valletta Glass). Note that it has a more vase like shape.

Set of Art Glass Cups

A set of art glass cups from Malta. Note the variance in shape since these are hand blown and not molded.

Plastic Cups
 A set of plastic vacuum gun cups and the gun. Note that the rubber "lips" at the top are sometimes difficult
to maintain a seal with and the rims are much smaller and apt to "cut" into the skin.

Bamboo Cups
 A set of bamboo cups. These cups are used with fire cupping and with the more traditional form of cupping
where they were boiled with a set of herbs for a specific remedy. The lip of these cups is very thin and usually
are a bit uncomfortable. The bamboo also tends to split and crack in dry environments, sabotaging any attempt
at a seal.
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Chinese Cupping
If you still haven't undergone Chinese cupping treatment you're probably
asking the million dollar question: how does cupping heal?

Well, for starters, it would be best to view cupping based on its

philosophical principle. Chinese traditional medicine believed in the
balance between Yin energy and Yang energy. These can be translated
loosely to positive and negative energies.
Achieving balance means good health, while an imbalance or disruption
means sickness and the occurrence of diseases. Through cupping,
traditional Eastern medicine seeks to establish balance and good harmony
of your body by restoring the Yin and Yang equilibrium.

If you get sick, then your Yang factor probably is greater thus tilting the
health equilibrium. Through the application of cupping treatment methods,
some of the Yang factor can be flushed out and the Yin restored to full
vitality. In this way, optimum health is restored.

It is in this light that cupping works and this is the basic philosophy for its
curative and healing powers. It may sound too metaphysical and surreal
but these philosophical bases do have scientific underpinnings.

In fact, the body is a comprehensive system that needs to be balanced in

order to work properly. An imbalance to your system can make you sick.
For example, if too much toxin made their way inside your system, it will
create enormous disruptions in your body which could lead to sickness. In
like manner, if cold air packets have penetrated your muscles nerves, it
could cause common sickness and pains.

Cupping will use heat to suck out those toxins and accumulated stress and
tensions. The suction created through cupping method will loosen
impacted nerve endings thus restoring them to their original state.

If these happen, healing will occur. This is especially true if the therapist
will use heat promoted cupping method. Heat has been used since ancient
times for medical practices. Through the application of heat, the cold
channels inside your body can be eliminated thus restoring balance of heat
and cold.

The essential oils applied on the skin and the rubbing action associated
with cupping also provides an effective healing solution. Normally, your
back will receive liberal amounts of oils during cupping sessions. After
establishing the cups on their appointed spots, the therapist will run the
cups along your muscles and nerve endings. The massaging action coupled
with the suction technique can stimulate activity of health cells. This is
made possible through the promotion of excellent blood circulation. With
good circulation and healthy activity and growth of cells, your body
immune system can effectively fight diseases. This then will lead to good
health.

Cupping is recommended principally for respiratory and lung disorders. It

is believed that its action against colds is not through direct combat against
virus, but through strengthening the capacity of the body to produce more
 anti-virus. Its action against arthritis and rheumatism can be attributed to
the stimulation of muscles through the application of heat and friction
during cupping sessions.

Cupping has been used in Traditional Medicine as a powerful and very

effective method of fighting diseases and illnesses. Since ancient time to
the present, voluminous records of anecdotal evidences and eyewitness
testimonials have shown that indeed, cupping certainly heals.

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