Cupping

What is Cupping?

In traditional Chinese medicine, cupping is a type of complementary and alternative medicine.[1] An ancient therapy, it involves placing round glass cups on selected skin points and creating a pressure by heat or suction.[2] There are ten different types of cupping methods, including weak/light, medium, strong, moving, needle, moxa/hot needle, empty/flash, full/bleeding, medicinal/herbal, and water cupping.[3] Different shapes of cups in variable sizes are used to treat different points of ailing parts. Each form of cupping therapy is used for different ailments.[4] Wet cupping involves making a small cut in the selected skin and placing a cup on the skin which are then suctioned with a pump to draw out a small quantity of blood; allowing the extraction of blood from the specific areas of ailing parts which may be harmful and helps to relieve the painful muscle tension.[5] It further promotes local blood circulation near the treated area, which is critical to the flow of “Qi”.[6] In needle cupping, needles are applied in which cups are then placed over the needles.[7] Medicinal or herbal types involve the use of bamboo cups wherein herbals which are boiled create aqueous dispersions.[8] Water cupping involves filling one-third of a glass or a bamboo cup with warm water and quick application.[9]

The idea of cupping therapy is to restore the flow of energy known as Qi as well as Yin and Yang.[10] It is targeted at strengthening the immune system, eliminating pathogenic factors and allowing the smooth circulation of blood to lessen the pain.[11] Cup sites are chosen according to the patient’s symptoms and the number of cups used will vary depending on the patient’s condition and the cup size. The most common site of application is the back, followed by the chest, abdomen, buttocks and legs.[12]

Historical background

Originating from China about 3000 years ago,[13] cupping therapy is used in a number of ancient healing systems, including Chinese, Tibetan, Oriental medicine, Unani and traditional Korean.[14] Traditionally, cups were made of glass, metal or bamboo.[15] Information regarding the therapy can be found in an old medical text Eber’s papyrus (1550 BC) from Ancient Egypt[16] and by Herodotus, a Greek historian (400BC).[17] Historically, it was also popular as “Al-Hijama” in Islamic and Arabic countries, being recommended by physicians such as Ibn Sina (AD 980-1037), Al-Zahrawi (AD 936-1036) and Abu Bakr Al-Razi (AD 854-925).[18] Subsequently, cupping therapy was introduced to Italy and the rest of Europe during the Renaissance period between 14th and 17th centuries.[19] It was ordinarily used by monastery practitioners and folk healer until the 19th century.[20]

Cupping leaves red marks, swelling and bruising as blood is drawn to the skin.[21] It is said that the darker the mark left by the cup, the poorer the blood circulation is in that point of the body.[22]

Does cupping work?

The benefits of cupping are yet to be scientifically proven. Nonetheless, cupping may help to:

  • Soothe the symptoms of coughs and cold
  • Assist the relief of muscular tension and pain in the body
  • Assist in the treatment of sports injuries
  • Ease lower back pain
  • Relieve stress

Is it safe?

Cupping therapy is relatively safe with infrequent and rare reports of adverse events.[23] Most adverse events relate to scar formations and burns and others include headaches, dizziness, fatigue, skin infection, pain at cupping site.[24] The associated side effects may be prevented by giving appropriate precautions and guidelines to patients, as well as the practice of maintaining clean and sterilised cups.[25]

Contraindications

Generally, cupping therapy is not to be performed directly on veins, nerves, open wounds, bone fractures or skin inflammation.[26] It does not treat internal organ disorders.[27] It is absolutely prohibited on cancer patients, those with organ failures (renal failure, hepatic failure and heart failure) and who suffer from haemophilia or similar conditions.[28] Cupping therapy may not be performed on patients with acute infection, severe chronic disease, anemia, recent blood donation and who are pregnant and during their menstruation and puerperium period.[29]

Does it hurt?

Every individual has a different experience, where some may find it painful while others do not. Generally, it may be said that the main sensation is one of tightness, pressure, slight discomfort and warmth, caused by the feeling of the skin being sucked upwards into a cup.[30]

Why are some Olympians using it?

In the Rio Olympics 2016, many athletes were spotted with marks scattering of round bruises on their bodies, which are the result of cupping.[31] These included many swimmers and gymnasts particularly from Team USA, most famously Michael Phelps.[32] Although there are no scientifically proven benefits, athletes provide that cupping treatment alleviates pains and enhances the recovery process after many hours of physical training.[33] In 2016, Dr Ayaaz Farhat, the co-director of the London Cupping Clinic said: “The main benefits are encouraging the inflammatory response of the body and speeding up muscular and soft tissue recovery after injury and strain. Cupping therapy has widened significantly though in the last few years and newer techniques are being used for conditions and diseases away from sports therapy such as migraines and eczema.”[34]

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[1] Mehta, Piyush and Dhapte, Vividha, ‘Cupping therapy: A prudent remedy for a plethora of medical ailments’ (2015) 5 Journal of Traditional and Complementary Medicine 127. Accessed 11 March 2019 < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488563/>.
[2] Ibid.
[3] Christopoulou-Aletra, Helen, Papavramidou, Niki, ‘Cupping: an alternative surgical procedure used by Hippocratic physicians’ (2008) 14(8)  The Journal of Alternative and Complementary Medicine 899 < https://www.liebertpub.com/doi/abs/10.1089/acm.2008.0238>.
[4] Mehta and Dhapte above n 1.
[5] Ibid.
[6] Ibid.
[7] Ibid.
[8] Ibid.
[9] Cao, H et al, ‘Clinical research evidence of cupping therapy in China: a systematic literature review’ (2010) 10 BMC Complementary and Alternative Medicine < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000376/>.
[10] Ailes, Emma, ‘Why are so many Olympians covered in large red circles?’ BBC News (online), 9 August 2016. Accessed 11 March 2019 < https://www.bbc.com/news/health-37009240>.
[11] Liemi, H, ‘Comparison of the effects of electro acupuncture plus cupping with that of the electrical pulse therapy for different types of cervical spondylopathy’ (2004) 24 Journal of Traditional Chinese Medicine.
[12] Aboushanab, Tamer S., AlSanad, Saud, ‘Cupping Therapy: An Overview from a Modern Medicine Perspective’ (2018) 11(3) Journal of Acupuncture and Meridian Studies 83. Accessed 11 March 2019 <https://www.sciencedirect.com/science/article/pii/S2005290117302042#!>.
[13] Ailes, above n 10.
[14] Qureshi, NA et al, ‘History of cupping [Hijama]: a narrative review of literature’ (2017) 15(3) Journal of Integrative Medicine 172 < https://www.ncbi.nlm.nih.gov/pubmed/28494847>.
[15] Teut, M et al, ‘Pulsatile dry cupping in patients with osteoarthritis of the knee- a randomized controlled exploratory trial’ (2012) BMC Complementary and Alternative Medicine <https://www.ncbi.nlm.nih.gov/pubmed/23057611>.
[16] Aboushanab and AlSanad, above n 12.
[17] Mehta and Dhapte above n 1.
[18] Aboushanab and AlSanad, above n 12.
[19] Ibid.
[20] Mehta and Dhapte above n 1.
[21] Ibid.
[22] Ailes, above n 10.
[23] Aboushanab and AlSanad, above n 12.
[24] Al-Bedah, AM et al, ‘Safety of cupping therapy in studies conducted in twenty one century: a review of literature’ (2016) 15(8) British Journal of Medicine and Medical Research 1 <https://www.researchgate.net/publication/302979273_Safety_of_Cupping_Therapy_in_Studies_Conducted_in_Twenty_One_Century_A_Review_of_Literature>.
[25] Mehta and Dhapte above n 1.
[26] Aboushanab and AlSanad, above n 12.
[27] Mehta and Dhapte above n 1.
[28] Aboushanab and AlSanad, above n 12.
[29] Ibid.
[30] Ailes, above n 10.
[31] Ibid.
[32] Ibid.
[33] Ibid.
[34] Cockburn, Harry, ‘What are those spots on Rio’s top athletes?’ Fraser Coast Chronicle (online), 9 August 2016 <https://www.frasercoastchronicle.com.au/news/what-are-those-spots-rios-top-athletes/3074255/>.
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