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Table of Contents
REVIEW ARTICLE
Year : 2018  |  Volume : 1  |  Issue : 3  |  Page : 121-126

Cupping, the past and present application


1 International Education College, Shanghai University of Traditional Chinese Medicine, China
2 International Education College, Shanghai University of Traditional Chinese Medicine, China; Department of Chinese Medicine, Centre for Complementary and Alternative Medicine, International Medical University, Malaysia

Date of Web Publication8-Jan-2019

Correspondence Address:
Mr. Shih Chau Ng
Lecturer, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CMAC.CMAC_37_18

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  Abstract 


Cupping is a therapy in which a cup is applied to the skin surface to cause local congestion through negative pressure. It has a long history in many places such as China, Greece, Egypt, and the Middle East. The ancient Chinese used animal horns as their cupping instrument, whereas in modern days there are a wide variety of choices ranging from bamboo cup to glass cup. Cupping is simple, inexpensive and yet has wide indications. Research has shown that it can promote blood circulation, stimulate nerve and muscle functions. In terms of application methods, fire cupping, liquid cupping and vaccum cupping were discussed. The five application techniques (flashing, retaining, moving, needle retention and bleeding) and precautions of cupping are also discussed in detail. Lastly, pathological reactions observed during the cupping process can be used to support Chinese Medicine diagnosis.

Keywords: Application, cupping, history


How to cite this article:
Lin X, Wong HF, Ng SC. Cupping, the past and present application. Chin Med Cult 2018;1:121-6

How to cite this URL:
Lin X, Wong HF, Ng SC. Cupping, the past and present application. Chin Med Cult [serial online] 2018 [cited 2019 Mar 23];1:121-6. Available from: http://www.cmaconweb.org/text.asp?2018/1/3/121/249582





Cupping is a therapy in which a cup is applied to the skin to cause local congestion through negative pressure created by heat or vacuum. Cupping therapy has been practiced for more than 5000 years worldwide. Although the effect of cupping remains the same, the instruments and techniques have changed over the years. The use of cupping has been a part of most cultures in the world.

There are some characteristics of cupping, such as remarkable therapeutic effect, wide indications, safe techniques, simple manipulation, inexpensive, and easy to use. It is attracted with great attention and applied in a large scale by general public and is also used as an axillary method of acupuncture or needling.

As an ancient therapy, cupping has a long history in many places, such as China, Greece, Egypt, and the Middle East.

In China, cupping has been practiced for more than 2000 years. In ancient China, it was called Jiao Fa (角法 horn method), as animal horns [Figure 1] and [Figure 2] were used as cupping instrument, but nowadays it is also called Huo Guan (火罐Fire Cupping). The cupping method that we are using nowadays was developed during the Song dynasty.[1],[2]
Figure 1: Animal horn that is used as cupping instrument

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Figure 2: Animal horns that are used as cupping instrument

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Cupping therapy can also be found in the records of the ancient Greek medicine [Figure 3], and it is thought to be introduced by the Egyptian physician. Both Hippocrates and Galen were staunch advocates and users of cupping therapy. Cupping was also used to treat severe illnesses in ancient Greece.[3],[4],[5]
Figure 3: Cupping instrument that used in ancient Greek

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In western countries, cupping therapy is originated from Egypt. Records of cupping therapy [Figure 4] were found in the Ebers Papyrus, the world's earliest medical text written circa 1550 BCE. The main purpose for ancient Egyptian to perform cupping was removing foreign matter from the body.[6]
Figure 4: Ancient Egyptian medical instrument was depicted in a Ptolemaic period inscription at the Temple of Kom Ombo

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Cupping therapy was then introduced to the Islamic world [Figure 5] and Persians through the Alexandrians and Byzantines. Cupping is called “Hijamah” in traditional Islam medicine, and it is still been practiced in the Middle East. It is also one of the therapeutic methods recommended and used by the founder of the Islam religion, the Prophet Muhammad.[7],[8]
Figure 5: Islamic physician is performing cupping therapy

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There are a great variety of cups or jars used in cupping, but the commonly used cups are glass cups [Figure 6] and bamboo cups. Between the two, glass cups are the most widely used in clinical practice. It is transparent, and hence, the local congestion at the cupping site can be seen to control the treatment. Bamboo cups are made from bamboo segment, with one end opening and the other end closed. The opening end should be made smoothly, as it is the area in contact with the skin. It is light, economical, easy to manufacture, and is available in many places.
Figure 6: Glass cupping instrument used in the Middle East

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As the most favorable instrument for all practitioners, glass cups have the merit of easy to use, sterilize and observe the suction progress inside the cup. However, glass cups [Figure 7] have the demerit of breaking easily when dropped and are difficult to replace. Cups are normally distributed in set.[9]
Figure 7: Glass cups

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Bamboo cups [Figure 8] are most commonly used in China. They are durable, inexpensive, easy to obtain, and lightweight for mobile use. The bamboo cups have some demerits too, such as sharp edges which will cause pain or discomfort, difficulty observing the suction progress and difficult sterilization.[10]
Figure 8: Bamboo cups

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Air pressure cups are another popular cups among the practitioners. It has the merit of safe to manipulate, controllable vacuum strength, inexpensive, easily obtainable, possible to apply in any posture, and even easily operable by layman [Figure 9]. To apply it, no fire is required.[11]
Figure 9: Pistol-handle valve cups

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There are many other cups or jars [Figure 10] such as cups with squeeze rubber tops, rubber cups, and DIY with syringe and vial.[12],[13],[14]
Figure 10: Other cups and jars

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Cupping has many functions, such as warming and promoting the free flow of Qi and blood in the channels, dispelling cold-dampness, and diminishing swellings and pains. In clinical practice, it is mainly used to treat Bi (痹 syndrome caused by wind-dampness which is pain in the lower back, shoulders, and legs), gastrointestinal disorders (stomachache, vomiting, and diarrhea), and lungs diseases (cough and asthma). The cupping method combined with bloodletting (放血疗法) [Figure 11] is suitable to treat sprains with blood stasis.[15]
Figure 11: Bloodletting cupping

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Many studies have been conducted regarding the physical stimulation function of cupping and its interior biological effect.

In physical stimulation, mechanical stimulation is used. Negative pressure inside the cup would cause body tissues become hyperemia, hydropsy, and increasing capillary permeability. It would cause capillary bleeding and blood leaks into tissue. The blood thus becomes stagnant. The red blood cell breaks down, and hemoglobin would be released body. Neuroendocrine reactions can also be observed as a result of the suction. The heat generated from the cupping therapy also promotes blood circulation.

In terms of interior biological effects, research found that the functions of cupping include promoting local and whole body blood circulation, promoting metabolism, and stimulating nerve and muscle functions.

There are three ways of performing cupping. They include fire cupping, liquid cupping, and suction cupping.

In fire cupping, by creating a negative pressure in the cup with open flame, the air in the cup is ridded as much as possible. The cup is then immediately applied to the skin. Factors that affect the negative pressure (suction) inside the cup are size of the cup, time of flame combustion inside the cup, and speed of attaching the cup to the skin.

There are four types of fire cupping. They are flashing fire cupping, throw fire cupping, fire-retention cupping, and fire stacking cupping.

For flashing fire cupping, doctor clamps with tweezers or forceps a cotton ball soaked with 95% alcohol. After igniting the cotton ball, the doctor places it into the cup and either move it one or two times around the cup or briefly hold it. The cotton ball is then quickly removed and the cup is placed onto the selected area. When inserting the flamed cotton into the cup, the most important thing is to be careful not to burn the edge of the cup. Make sure to avoid burning the skin. It can be used in any body position to produce strong suction. It is commonly used in the clinic.

The priority of using fire cupping is safety. Caution with the use of fire! Excess alcohol must be squeezed out of the cotton ball before igniting it [Figure 12].[16]
Figure 12: Flashing fire cupping

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For throw fire cupping [Figure 13], fold a piece of paper into a wide strip. After that, ignite one end and throw it into the cup. At last, place the cup onto the skin immediately. This method can only be used when the body position is upright and the cup must be placed horizontally.[16]
Figure 13: Throw fire cupping

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For fire-retention cupping [Figure 14] and [Figure 15], soak a piece of cotton (about 2 cm in diameter) with a little 95%v/v alcohol. The cotton would be attached to the inner wall of the cup. Ignite the cotton and place the cup onto the skin. Oversoaking the cotton with alcohol may cause droplets of alcohol to drip and thus result in skin burn. This method is mostly applied when the body position is upright, and the cup is placed horizontally to the body.[16]
Figure 14: Fire-retention cupping

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Figure 15: Fire stacking cupping

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In liquid cupping, the bamboo cup is first boiled in water or herbal decoction, then removed it by thongs with the cup's mouth facing downward. Quickly cover the mouth of the cup with a wet towel and place the cup on the skin while it is still hot. However, the suction power is relatively light and requires quick manipulation. This method can be used on all parts of the body.

In suction cupping, the cup is first put on the skin. Using an air-extracting pump the cup is then tightened. This method is suitable for any part of the body.

There are five types of cupping techniques. They are flashing cupping, retained cupping, moving cupping, cupping with needle retention, and bleeding cupping (wet cupping).

To apply flashing cupping, remove the cup immediately after placing it onto the skin and repeat the procedure till the skin is flushed. Flashing cupping can be applied to skin numbness, hypofunction of the body due to deficiency, flaccid muscle, where it is difficult to create suction and retain cups. It is commonly used in clinical practice.

To apply retained cupping, retain the cup for 5–15 min. To avoid blistering, retention time should be reduced during summer, on location with thin muscles, or when using a large cup with strong suction. Retained cupping is suitable to be applied to general diseases. It is also commonly used in clinical practice.

Moving cupping [Figure 16] is also called pushing cupping. To apply moving cupping, spread a little lubricating cream, herbal ointment, or vaseline on the mouth of a glass cup. After attaching the cup onto the skin, hold the base of the cup and move it slowly, with half of the distal rim pressed firmly against the skin and the other half of the proximal rim slightly lifted. Repeat several times till the skin turns reddish, congested, or stagnant blood is produced. Moving cupping is suitable for large area with thick muscle groups, such as the back, lumbar, and thigh region.[16]
Figure 16: Moving cupping application

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To apply cupping with needle retention, retain the needle after the arrival of Qi and place a cup covering the needle. Retain for 10–15 min. Cupping with needle retention is suitable for localized diseases requiring both acupuncture and cupping treatment. It is usually applied on areas with abundant muscles. It is commonly used in clinical practice as well.

To apply bleeding cupping (wet cupping or pricking collateral cupping), first prick the selected area with a three-edged needle, dermal needle, or thick filiform needle. After that, apply cupping over the needled area. Bleeding cupping can strengthen the effect of bloodletting and is applicable for soft tissue injury, acne, neurodermatitis (神经性皮炎), erysipelas (丹毒), and shingles (带状疱疹). To avoid excessive bleeding, apply bleeding cupping on large blood vessels is not allowed.

When removing cup at the end of the treatment, hold the cup with one hand and press the skin next to the cup's mouth with the other hand. Once the air is pushed into the cup, the cup will detach spontaneously. For air pressure cups, pull up the air inlet valve. Avoid pulling the cup forcefully before releasing of vacuum to prevent damage to the skin.

There are seven main precautions of cupping. First of all, attention should be paid to the area to be cupped, where muscles are abundant with fewer hairs and where there is no prominence or depression of the bones. Prohibited areas include skin ulcer, inflamed skin, tumor, scar, varicose vein, hypersensitive skin, sensory organs, large blood vessel, apex of the heart, and lumbosacral and abdominal region of pregnant women. Contraindications such as diseases with hemorrhagic tendencies and convulsion need to be considered. Manipulation should also be steady, accurate, gentle, and rapid. The patient should find a comfortable position and remain still after the cups are applied. The distance between cups should not be too close. When cupping with needle retention, avoid touching the needle handle with cup. Bruise will normally disappear within 1–2 weeks, whereas small blister will absorb naturally several days later. If the blisters are severe, draw out the fluid, apply some medicated ointment, and cover them with gauze to prevent infection. Cups (glass) used after bloodletting should be sterilized with autoclave to prevent cross infection.

Blister, edema, and water vapor are the common pathological reactions seen during cupping. What do they mean? Blister, edema, or water vapor means excessive dampness or cold-dampness. Water vapor in yellowish color means dampness-heat. If blisters are in color of red or black, it means chronic diseases with dampness and blood stasis. Cupping mark in purplish color means blood stasis, whereas cupping mark in dark purplish black color, with tenderness and fever means stagnation of heat-toxin. There is a chance that no changes will happen during the treatment, and the local area is not warm. This means deficiency cold. Cupping mark with itchiness means exposure to exogenous wind. If the marks or blisters come with light bleeding color, it means deficiency syndrome. When applying cupping with needle retention, dark reddish bleeding color means heat and blue-greenish bleeding color means cold stagnation and blood stasis. All of the above-mentioned pathological reactions should be used in conjunction with the Chinese medicine diagnosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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[Figure 3]: A traditional hajjam sucking on a horn applied near the shoulder, in Hajar Albinali HA. Chairman's Reflections: Blood-letting. Heart Views (Journal of Gulf Heart Association). 2004;5:74-85. Available from: http://www.heartviews.org/text.asp?2004/5/2/74/64567 [Last accessed on 2018 Dec 13].  Back to cited text no. 7
    
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[Figure 7]: Glass cup with build-in sucking tube used as mihjamah, in Hajar Albinali HA. Chairman's Reflections: Blood-letting. Heart Views (Journal of Gulf Heart Association). 2004;5:74-85. Available from: http://www.heartviews.org/text.asp?2004/5/2/74/64567 [Last accessed on 2018 Dec 13].  Back to cited text no. 8
    
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