Cupping Therapy

Original Editor - Chelsea Mclene

Top Contributors - Chelsea Mclene, Rasha Moghanam and Rujuta Naik  

Introduction[edit | edit source]


Cupping therapy is one of the oldest and most effective method of releasing the toxins from body tissue and organs.[1] [2]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.[3][4]

History[edit | edit source]

Cupping is a treatment that has been used for a number of ailments for thousands of years. Over the centuries, cupping techniques and styles have often been influenced by their geographical location, as well as by the materials used in that area: animal horns, bamboo, ceramic, glass, metal, and plastic have all been used in this procedure found in Ancient Egyptian, Chinese, Unani, Korean, Tibetan, and Latin American cultures, whose purpose has been to assist the body in self-healing. Eber's papyrus (1550 BCE) is the first documented instance of this therapy in North Africa. A cup refers to the Egyptian glyph for doctor. According to Ge Hong (281-341 CE), animal horns were used to drain body fluids in Asia during the Jin dynasty. Additionally, it was popular during the Greek Bronze era, when bronze cups were used.[5]

Cupphistory 2008.jpg

As prescribed by Al-Qanun Fi'l-Tibb, Canon of Medicine (1025 CE), cups are often used to treat conditions related to menstruation in Arabic and Islamic countries. It is reported that Prophet Muhammed used it and advocated its use.

According to Galen, the principle of indication for blood lenting is to eliminate residues or divert blood from one part to another.

The Daoist model of holism informs the practice of cupping and other similar therapies in Chinese medicine. The holistic philosophy maintains that systems and their properties can only be understood as a whole and not as parts. According to Daoist philosophy, no individual could exist unless it is connected to nature. This is because it is influenced both by natural phenomena, such as the seasons and climate and by internal states, such as emotional stress. An imbalance in the body is caused by climate, emotions, and/or trauma, according to this concept.[6]

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.

As defined by the Alternative Medicine Association, alternative medicine refers to practices that are unproven, disproven, impossible to prove, or excessively harmful relative to their effects. Unfortunately, medicine has been viewed solely from an epistemological standpoint, particularly Western allopathic medicine. By defining justified beliefs and opinions, this framework establishes a theory of knowledge. As a result, evidence-based medicine has been adopted, predominantly relying on anatomical dissection for diagnostic and/or therapeutic purposes.[7]

Modern Cupping as western based cupping uses the plastic, silicon or glass cups with a vacuum seal to influence the myofascial tissue physiology.

Different classifications of Cupping[edit | edit source]

1-Techniques[edit | edit source]

  • Dry cupping : The air inside a plastic or glass cup is suctioned or vacuumed out by placing the cup on the skin. In most cases, the cups can be used at rest or while moving.


  • Wet cupping / Hijama / Bleeding : Wet cupping creates a mild suction by leaving a cup in place for about 3 minutes. The therapist then removes the cup and uses a small scalpel to make light, tiny cuts on your skin. Next, they do a second suction to draw out a small quantity of blood[9]


  • Oil cupping / Sliding cupping : Its a technique where massage oils are applied, cups are attached to the body and then slide across an area.[11][12]
  • 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.[13][12]

2-Method of Suction[edit | edit source]

  • Manual Suction: use of manual pump of plastic cups to control the suction.
  • Fire cupping


  • Moxabustion cupping : Moxibustion Cupping is the same as Weak or Medium Cupping, with the addition of moxibustion. Moxibustion is a therapy used in TCM where a moxa made of dried mugwort (or artemisia) is burned directly, or indirectly, on the skin.[15]


  • Horn cupping / Raktamokashan by shrung


  • Pulsatile cupping: in which mechanical device generates a pulsatile suction with a pump. 15

3- Added Therapy Cupping[edit | edit source]

  • Accupuncture cupping


  • Hot needle cupping

4- other:[edit | edit source]

  • Deep tissue cupping / draining
  • Solar plexus cupping
  • Facial cupping


Different Materials Of Cups[edit | edit source]

  • Horn / suction cups
  • Glass / fire glass cups
  • Plastic / hijama cups
  • Bamboo / wooden cups
  • Silicone / facial cups
  • Nabhi pump[13]

Indications[edit | edit source]

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.[20][21] It can be used to treat skin diseases, respiratory, musculoskeletal, digestive, reproductive, and allergic conditions,

Absolute Contraindications[edit | edit source]

  • 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
  • Abcess
  • Excessive swelling[21][22]
  • Pacemaker (refer)

Benefits[edit | edit source]

Fire Cupping 2008.jpg
  1. Cupping helps to reduce pain and inflammation.[23]
  2. Improves blood flow.
  3. Used for relaxation, well being and deep tissue massage.
  4. It is safe, non invasive and inexpensive treatment.[22]
  5. Rejuvenation of body organs.
  6. Facilitates healing process and strengthens immune system.
  7. Used to treat:
    • Blood disorders such as anemia and hemophilia
    • Rheumatic diseases such as arthritis and fibromyalgia
    • Gynecological disorders
    • Skin problems: eczema and acne[24]
    • High blood pressure
    • Migraines, Anxiety and depression
    • Varicose veins

Effects[edit | edit source]

  1. Skin: Improved metabolism in skin tissue, better functioning of sebaceous and sweat glands, improved healing and improved skin resistance.[25]
  2. Muscles: Stimulates blood flow and lymphatic drainage.
  3. Joints: Increased blood flow and secretion of synovial fluid.
  4. Digestive system: Increased peristalsis and secretion of digestive fluids, better digestion and excretion.
  5. Blood: Improved blood circulation, improved functioning of RBC and WBC.
  6. Nervous System: Stimulates sensory nerves of skin, Improves ANS.

Side Effects[edit | edit source]

Side effects cupping.jpg

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.
  • Blisters : second degree 0f burn than can caused by dry cups if stayed for long time.
    Blisters of cupping.webp
  • Fatigue.
  • Headaches.
  • Muscle tension or soreness.
  • Nausea.
  • Skin infections, bruising, itching or scarring.[24][26]

Pre Investigations For Wet Cupping Or Blood Lenting[edit | edit source]

  • Must: Haemogram, BT, CT, BSL
  • Optional: HIV, HBSAG, VDRL, PT INR

Who Can Perform Cupping Therapy?[edit | edit source]

Cupping is easy, very safe modality to practice. It is completely unregulated, and therefore it can be performed by anyone. If it is practiced within a regulated health practice, it must adhere to the contraindications and legislation indicated within the scope of practice. If the therapist/practitioner don't belong to a college or association, or not sure, the therapy cannot be performed until satisfactory response is found. If therapist/practitioner have not had training in a modality, or are not taking extra training to treat certain conditions, then precaution must be taken.[27]

Procedure / Use Of Cupping In Physiotherapy[edit | edit source]

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. [28]

The sites are selected according to the treated ailment. The cups are commonly placed on areas with abundant muscles.[29] 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.[30] 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.[31]

Significance[edit | edit source]

  • Cupping helps to increase the blood flow to sore areas in muscles.[32]
  • 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.[33]

Pre and post procedure[edit | edit source]

  • 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.

(Refer the videos below for more information)



Recent Developments in use of Cupping Therapy[edit | edit source]

It is known through research over years that cupping can improve local blood flow, alleviate muscle pain and reduce muscle stiffness. It has an added proven benefit to cure a disabling, excruciatingly painful condition of 'Nocturnal Leg Cramps'. Combining the methods of cupping therapy can bring about benefits in various conditions. A case has been reported for having a lasting effect of hot water cupping therapy[36]combined with moving cupping therapy in the case of nocturnal leg cramps. More research is required to prove the benefit of such method in exercise associated muscle cramps as an adjuvant to traditional regimen for managing leg cramps.

References[edit | edit source]

  1. Jamal MA, Shaiqua A, Zeenat F, Ahmad W. Hijamah: An important regimen of Ilaj bit Tadbeer.
  2. Al-Bedah AM, Elsubai IS, Qureshi NA, Aboushanab TS, Ali GI, El-Olemy AT, Khalil AA, Khalil MK, Alqaed MS. The medical perspective of cupping therapy: Effects and mechanisms of action. Journal of traditional and complementary medicine. 2019 Apr 1;9(2):90-7.
  3. Mashlool ZT, Aowada MA. Effect of cupping treatment on some biochemical variables of thi-qar province. Int. J. Res. Appl. Nat. Soc. Sci. 2016;4:93-104.
  4. Bhikha R, Saville J. Cupping: time to re-evaluate its position. Tibb Institute. A Science of Medicine. The Art of Care. 2015 Feb;1(1):1-0.
  5. Cupping Massage Therapy: What Is It and What Are the Benefits?
  6. Chirali I Z. Traditional Chinese medicine: cupping therapy. Elsevier Health Sciences.1999.
  7. Dinall AM. A reflection on cupping therapy and historical medical dominance. Int J Complement Alt Med. 2019;12(2):66-8.
  8. ICAHT Centre Of Integrative Medicine. Dry Cupping Massage Treatment At ICAHT Centre Leicester . Available from
  9. Cupping Therapy
  10. ICAHT Centre Of Integrative Medicine. Performing Hijama (Wet Cupping) at Cardiff Hijama Center UK - Testimonial By Mustafa. Available from
  11. 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.
  12. 12.0 12.1 Dantian health acupuncture herbs. Cupping. Available from [last accessed 14/10/2020]
  13. 13.0 13.1 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.
  14. ToHealth. How to do cupping therapy. Available from
  15. Cupping Therapy for Muscles and Joints: An Easy-to-Understand Guide for Relieving Pain, Reducing Inflammation and Healing Injury
  16. AmouraProductions. Moxa Cupping Massage Angie Schnell. Available from
  17. Anadolu Agency. Cupping therapy with buffalo horns in Indonesia . Available from
  18. Staten Island Advance. Amanda tries Acupuncture and Cupping. Available from
  19. Beauty Insider. Face Cupping Gives Instant Facelift. Available from [last accessed 14/10/2020]
  20. 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. 
  21. 21.0 21.1 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.
  22. 22.0 22.1 Ilkay Zihni Chirali MBAcC RCHM. Benefits of Cupping Therapy. Traditional Chinese Medicine Cupping Therapy (Third Edition), 2014
  23. Timothy Huzar. Medical News Today. What to know about cupping therapy? Available from [last accessed 14/10/2020]
  24. 24.0 24.1 Healthline. Cupping therapy. Available from [last accessed 14/10/2020]
  25. Al-Bedah AMN, Elsubai IS, Qureshi NA, et al. The medical perspective of cupping therapy: Effects and mechanisms of actionJ Tradit Complement Med. 2018;9(2):90-97. Published 2018 Apr 30. doi:10.1016/j.jtcme.2018.03.003
  26. Cleveland Clinic. Cupping: Risks / Benefits. Available from: [last accessed 14/10/2020]
  27. Contraindications for Cupping. Available from [last accessed 05/11/2020]
  28. Bay state physical therapy. Cupping. Available from,ligaments%2C%20muscles%2C%20and%20tendons. [last accessed 14/10/2020]
  29. Furhad S, Bokhari AA. Cupping Therapy. Available from [last accessed 14/10/2020]
  30. Yoo SS, Tausk F. Cupping: east meets west. International journal of dermatology. 2004;43(9):664-5.
  31. 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.
  32. PT health. what is cupping therapy? Available from,they%20release%20pain%2Dkilling%20chemicals. [last accessed 26/10/2020]
  33. Best Health Physio. Cupping therapy. Available from [last accessed 26/10/2020]
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  35. OSC. Cupping - What is it, and how is it used in our Physical Therapy clinic? Available from
  36. Naik, R. Role of water cupping therapy in nocturnal leg cramps - a case report. International Journal of Emerging Technologies and Innovative Research. 2021 Dec. 8, 836.