Is Mysterious Cupping a Matter of Belief?

Note: a surprising update was added to this article after posting. (See at bottom.)

I recently received cupping. It wasn’t the first time in my life. I have had 4 or 5 multi-sessions before. This time, I stopped to ask myself “is this a matter of culture or science?” You may be asking yourself a more simple question — “WHAT IS IT?”

Okay, first, what it is not. It’s not using a saucer to cool a drink from your teacup. It’s not being fitted for the prefect sized bra. It’s not winning the prized two-handle silver trophy cup. And as a verb, I don’t mean curving my hands around my mouth to shout louder. No, I am referring to a very old medical procedure, which uses a type of suctioning cup to treat different ailments.

If you have been to a traditional Chinese doctor or an alternative type acupuncturist, you may have experienced this yourself. If not, you may wonder if it would be useful for you.

Would it Help Me?

You might be uninterested in cupping if you think it has no direct advantage to you. It’s not an easy proclamation to make, that ‘yes or no, it will or won’t help you.’ It depends. Like with so many systemic-based techniques, promoters tout its uses for a myriad of symptoms; research is more specific (and more limited). Confusing the matter, while some studies have tried to apply double-blind methods (see 2015 study in references), sham procedures are difficult to pull off. Participants have been quite accurate in picking who were the test subjects versus who the controls.

Other researchers conducting literature reviews have frequently expressed concern about bias and that better studies are necessary. Undoubtedly. Bias beliefs can come from patients and practitioners. And yet, there is the more nuanced inquiry of whether belief itself (even in a placebo) is healing. Thus, the full retort to ‘would it help me’ is hard to predict.

The most traditional maladies treated by cupping, meaning the longest on record, have been for metabolism and respiratory conditions: clearing congestion from common cold, improving lung function or controlling asthma. Indeed, there is strong modern research of successful results for Herpes Zoster (shingles), pain from cervical osteoarthritis and spondylosis, facial paralysis and acne. But when referenced by practitioners or institutions like the Pacific College of Oriental Medicine (NY, California, Illinois) or the British Cupping Society, the list of valuable treatment grows.

Those possibilities include:

• Back and muscle pain
• Improved circulation of lymph
• Improved circulation of blood flow through veins and arteries
• Blood disorders (such as anemia)
• Rheumatic diseases (such as arthritis)
• Skin problems (such as eczema and acne)
• High blood pressure
• Improved metabolism (helping digestion, relieving constipation)
• Migraines
• Fibromyalgia
• Joint stiffness
• Fertility and gynecological disorders
• Anxiety and depression
• Bronchial congestion caused by allergies or asthma
• Varicose veins

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According to what I know or have read, there isn’t firm research to back all this up, although there are survey responses and numerous anecdotal cases.

“I don’t think the science of whether it works is really solved.”
Dr. Brent Bauer,
director of the Mayo Clinic Complementary and Integrative Medicine Program.

He then added, however:
“If that’s the treatment that gives me benefit …
then I think we have to be a little more open to the idea of allowing patients some choice.”

Should I Try it?

Personally, the last source of endorsements I am swayed by are from TV and movie stars (they’ll try anything). And I’m only a bit more persuaded by athletes, in that they are starting from a far superior condition than my own and looking for every slight ‘edge.’ Still, cupping has gotten trendy. You may have heard some competitors, like Olympian swimmers, Michael Phelps and Wang Qun; tennis pro, Andy Murray or many METS players, explain the cupping marks noticed in the locker room.

“As an athlete, I want to play as long as possible,
in order to do that, I need to find ways to protect my body…
I’m always looking for something that might be better.”
Daisuke Matsuzaka, Mets Player [quoted in Wall Street Journal, August 2014.]

What he didn’t add was –‘well, at least it is better than doping.’ Couldn’t argue with that. So, what if you want to “protect” your body. Is cupping a suitable approach?

Considerations before Cupping

Cupping is not always preformed the same way; I’ll explain momentarily. First, I need to mention a few typical contraindications often citied.  These might either stop you in your tracks (to the practitioner’s office) or encourage consultation with your (knowledgeable / open-minded) doctor or family nurse practitioner (FNP) before proceeding.

Stop:

• if you are equipped with a cardiac pacemaker
• if you have swollen, or ulcerated skin (cups in that area should be avoided)

Seek Advice:

• if you are pregnant (not my typical reader – avoid cups over abdomen/lower back).
• if you have allergic skin reactions
• if you have hemophilia or thrombocytopenia (bleeding diseases). *

* Consult is strongly advised, despite the fact that the British Cupping Society recommends the procedure for hemophilia.

What Should I Expect from Cupping?

“Where there’s stagnation, there will be pain.
Remove the stagnation, and you remove the pain.”
Ancient Chinese medical maxim

Whether you have a condition that has a noted history of success or just want the “detoxification” or relaxation that many proclaim, what should you expect from cupping?

Let me admit that I find cupping quite relaxing, although more so when Shiatzu (a trigger-point therapy) is part of the treatment. Only once, after perhaps a hundred cups in all, did I have one so uncomfortable (painful?) that I asked for immediate adjustment of the placement. [I can just imagine a therapist reading that and thinking, “that was probably exactly where you needed it most.” Luckily, my doctor didn’t voice that point-of-view and removed it almost before I was done talking.] Thus, my experience from a comfort perspective has been pretty terrific. I say this to minimize the fright-factor as I begin to describe it.

Once called the “fire jar qi,” that may also hint at the process. In cupping, the treatment begins with the doctor, or therapist, putting special cups on your skin (especially fleshy parts) to create suction. I have read several authors describe it as “inverse massage.” They mean that instead of applying pressure to muscles, the cup uses suction pressure to pull tissue and superficial muscles upward into the cup area.

The accouterments and methods vary however. Some cup sellers claim that most cupping is now done with silicone cups, which have rubber tubing and valves to manage the suction. Other materials include bamboo, earthenware or glass; the latter the only type I remember being used for me. One of my therapists did have built-in suction cups on his treatment table. I may not have been able to discern the difference, although supposedly the silicone type can create a stronger suction.

Sticking to what I know – the more traditional type – the doctor rubs a flammable substance, like an alcohol swab, on the inside of a cup. It is then lit on fire. What? Yes, fire. Straightaway, the cup is placed upside down on the skin. No, it’s not hot. Open flames are never used near the skin. The cooling of the heated air in the cup causes the suctioning and partial vacuum. [I guess you could think ‘leeches.’ Yuckily, even they have made a come-back of sorts in new research.] Once the cup is place, you can feel a kind of tightness, almost a pinching; nevertheless, it feels rather comforting.

Like with acupuncture, modern cupping follows “meridian” lines, a non-western system similar, but not identical, to nerve route pathways. What makes a good practitioner is targeting the right meridians and striving to “open” the “blocked” energy flow of these channels. Even the time can vary, but generally the cups are left in place for 3-15 minutes (less commonly up to 30 minutes).

 

Each cup will almost certainly leave a deep darkening on the skin (blue, red or various surprising shades of purple). These ‘bruises’ can look dreadful and painful. It’s hard to believe that they are neither sore nor tender, even immediately afterwards. Not even if you poke at them. They are however (to put it mildly) not particularly attractive. They generally start to fade by day 3 (see picture of my arm on day 3) and are routinely gone in a week. It isn’t uncommon for very deep purple, raised cup marks to last 10-14 days.

 

Different Types of Cupping

There are actually several more, but cupping is usually described as having two types: ‘dry’ (fixed) or ‘wet’ (moving).

The process I outlined above is known as “dry” or fixed cupping. Kind of an obvious name. Historically, there was another aspect sometimes added to the fixed method; evidently, still found today. A very small incision is made before the cup is placed, which is believed to draw out toxins. [Okay, I guess now you might think “blood-letting.”] I am unaware of this incision-type approach being used commonly anywhere, but the colleges still teach about it. To ease your mind, dry (fixed) cupping generally does not involve any cutting.

In wet (moving) cupping the practitioner applies medicinal cream or massage oil before placing cups. This allows the cups to be easily moved around the area. It’s also known as “gliding or sliding” cupping. I have never experienced this type but am told it is very relaxing, and may leave fainter cupping marks than dry. Some proponents claim it is superior for general “detoxing” (if indeed there is detoxing).

There are other cupping types as well, some which combine techniques, like placing acupuncture needles under the cups. Aside from the various types, it is good to realize that these are not “cookie-cutter” treatments. No session is the same for one person to the next, or one day to the next (at least not exactly).

Short History

Most people assume that cupping is an “oriental art,” first developed in China. The Taoist and medicinal herbalist, Ge Hong, supported cupping in the ancient Chinese “Handbook of Prescriptions for Emergencies” in 281 A.D. – a long way back. Closer to us in the Quing Dynasty, bamboo cups and wet cupping were popularized by a physician still famous in China (Zhao Xuemin) in the medical book “Supplement to Outline of Materia Media.” In the 20^th century, the method was enshrined in Chinese medicine following Russian and Chinese research. Hospitals there established it as ‘official’ therapeutic practice in the 1950s.

But long before this, long before the time of Christ, in the BCE (Before Common Era) year of 1550, the ancient Egyptians used and recorded cupping in one of our oldest known medical books, Ebers Papyrus. Evidently, the Greek “Great Physician,” Hippocrates, known as the “Father of Modern Medicine” also recommended cupping in his clinical treatment guidelines. Later, wet cupping was used by Muslims, but termed “Hijama.” There is now archeological evidence that the method (although incorporating animal horns instead of lovely cups) was used by North American Indians, early Greeks and several other Asian and European countries. The more we look, the further back cupping goes.

FINAL QUESTION: 

Is Cupping just a Placebo? Belief? Yet-to-be-Proved Science?

I don’t feel confident to give a clear answer to the question of proof. Still, I wouldn’t want to say “it’s just belief” to its millions of users, many practitioners, or try to debunk its history of thousands of years.

Unfortunately, you can’t prove, its success, even anecdotally, through me. At least not for my recent experience, which admittedly was only one treatment for a bronchial ailment while out of the country. Perhaps that doesn’t count. But neither did I have success for a past shoulder condition. Most of my other treatments had not been symptom-specific, so who knows? However, I feel that I can verify that cupping is not a magic bullet. Yet, it’s interesting, isn’t it, that for all my pooh-poohing, something keeps me returning.

 

UPDATE:
I had a FASCINATING response from a Finnish descendant, Karen Michael, regarding this article on Cupping. I feel it is worthwhile to share. Hope everyone finds it as surprising as I did. drb —

I have been meaning to email you about your “Aging with Pizzazz” article on Cupping. When I was a kid in Minnesota, the grandma of one of my good friends who lived down the block from us was a ‘cupper’. I can remember ‘peaking’ once when she had a client. Bev and I stood on a toilet and looked through a window into their kitchen. “Grandma” had a wood stove on which she boiled water — the client sat on a kitchen chair with his feet in a washtub filled with warm water and Grandma used horns from cows and a very sharp knife (kind of X-acto type?) to make cuts in the person’s legs using suction. I do recall there was quite a bit of blood (at least in the eyes of someone who was probably 7 or 8) coming from those cuts in the person’s legs and that the water in the tub soon became quite red!

I wish I had been older so I could remember more. I do recall that a year or two after Grandma died, a car stopped us as we were riding our bikes and asked where Grandma lived. The car had Michigan license plates (we lived in northeaster MN) so we, of course, were interested! [Out-of-state plates were unusual, but because many Iron Rangers had relatives in the Upper Peninsula of Michigan they weren’t totally uncommon.] The people were sorely disappointed when we told them she’d died. “Kupperiis” (I think that is close to the Finnish spelling) or ‘cuppers’ as said in English were quite popular in the area. Yet, I don’t remember hearing of any beyond what would have been my grandparent’s generation – but who knows. At the Finnish American Heritage Center in Hancock Michigan, there is a collection of cow horns and other ‘stuff’ used by cuppers. Very interesting to say the least. I am glad that you had an issue covering this subject. Supposedly, it helped those with high blood pressure! And probably a whole lot of other ailments.

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References:

Chinese Cupping. The History of Chinese Cupping. http://www.chinesecupping.com/history_of_chinese_cupping.html

Conrad, Mary. The Basics of Dry Cupping. Beginners Guide on the Benefits of Dry Cupping with Simple How-To Guide. (Cupping therapy book 1). https://www.goodreads.com/book/show/32724772-the-basics-of-dry-cupping

Huijuan Cao, et al. Cupping therapy for acute and chronic pain management: a systematic review of randomized Clinical trials. Journal of Traditional Chinese Medical Sciences, Vol 1:issue 1, July 1, 2014. P.49-61. https://www.sciencedirect.com/science/article/pii/S2095754814000040

Lauche, Romy, et al. Efficacy of cupping therapy in patients with the fibromyalgia syndrome – a randomized sham-controlled controlled trial. Integrative Medicine Research May 2015, Vol 4, Issue 1, Supplement, page 20. https://www.sciencedirect.com/science/article/pii/S2213422015003595?via%3Dihub

Pacific College of Oriental Medicine. (San Diego, NY and Chicago). https://www.pacificcollege.edu/prospective/programs/chicago/medicine

Rettner, Rachael, Senior Writer. Live Science. August 8, 2016 “Michael Phelps’ Weird Bruises: Does Cupping Therapy Really Work?” https://www.livescience.com/55698-cupping-therapy-olympics.html

WebMD Medical Reference Reviewed by David Kiefer, MD on August 10, 2016. Cupping Therapy

Watch process on YouTube video entitled: Chinese Cupping Therapy – Michael Phelps Olympics Bruise Mystery Solved | Pain Relief and Therapy https://www.youtube.com/watch?v=L94OETMNzWQ

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Picture credit: Cupping Glasses via Invia at Pixabay

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