Key Learning Points
In essence, cupping is just this: you place a ‘cup’ open end downwards onto the skin. You withdraw air from it, which pulls or sucks the enclosed skin and its underlying flesh up into the evacuated space inside. You leave the cup in place for a period of time, after which you allow the air back in, remove the cup, and the skin gradually returns to its normal condition.
Theoretically any drinking cup or glass will do. In practice, various methods and designs have been used over the centuries. In early times they used hollow horns: anything that created suction.
For probably thousands of years, they used a flame to heat the air inside. As the air cooled it contracted, creating a vacuum. This is called ‘fire’-cupping.
In other methods, a small hand-pump withdraws the air, or by means of a squeeze-rubber balloon attached through a tube. When you pinch the balloon it expels air so that as it re-expands it draws air out, creating suction to draw skin up inside.
‘Cups’, once made of hollowed gourds, horns and bamboo, are nowadays mostly made of glass or plastic.
As long as they do their job without damage to the patient, anything will do, including mugs and jam jars! (But make sure they are clean…)
The tradition is so widespread that it is hard to know where it began.
Its main early use was probably to draw pus and blood out of boils and carbuncles without squeezing the flesh directly and without putting the mouth to it.
Certainly there are records of it in China from over 2200 years ago, where it has since been used for diseases ranging from tuberculosis to removing venom from snake-bites.
However, Egyptian and subsequent Greek records go back much further. They describe its use over 3500 years ago to extract offending matter, probably at infected wound sites. But later it was used for much more than this, bleeding and draining then being important forms of therapy.
In London in the 18th century both lay people and surgeons used it. 19th Century surgeons described it and the British Royal Family used it and it still remains in common use in many countries worldwide.
For example, many homes in Greece and Turkey keep a set with their first aid kit. However, its use declined in the 20th Century, probably because doctors became more dependent on, and recommended, antibiotics and other drugs to reduce fevers.
Given the psychological power we invest in our doctors, ‘Just take a pill and feel better’ presumably persuaded people to abandon old ways.
As we now know, however, antibiotics and other drugs are a mixed blessing as bacteria and viruses mutate and learn how to survive medication, leading to a desperate rush for ever more powerful drugs to combat the bugs.
When new drugs fail or we want to avoid overusing them, perhaps we should look at methods that our forbears tried and tested!
Cupping is not a lost art: it’s in worldwide use and you can learn how.
Traditionally there were two ways, dry and wet.
Wet cupping is when there is a wound, real or surgically produced. Cupping, by sucking up the skin, squeezes blood from the wound. (Another method to withdraw blood is Leeching.)
Dry cupping means the cup is placed on the skin (when there is no wound in it), and the skin is partially sucked up inside.
With dry cupping, once in position the cup is either left in place, or it can be slowly moved around across the surface of the skin. (This only works where the skin is clear of long hair: and it often works better after applying a little oil to the skin surface.)
During wet cupping it is usually unwise to move the cup much or at all.
If using acupuncture at the same time the cup can be placed over the needle after inserting the latter at the chosen acupuncture point. Here you do not move the cup once it is in position.
Cupping can be weak, medium or strong. Weak means mild suction, strong means strong suction. Medium means … well, you can probably work it out.
It can be used on children and the elderly, but if the patient has poor constitutional strength, only very mild treatment may be beneficial: another kind of treatment might be better.
What do I mean by ‘poor constitutional strength’? Someone who lacks vitality, weakens easily, is quickly affected by adverse events, catches every cold or illness going round, is of low spirits, and is probably fearful of his or her health and the future, and needs or looks for plenty of support.
Life can bring strong people low, so don’t assume because someone has been robustly independent all his or her life that his constitution remains strong. After severe acute illness, or after prolonged periods of ill-health, it takes time to recover. Here you should use mild cupping. Surprisingly, the effects can still be good.
Historically many containers have been used. Anything from which air can be evacuated and with a smooth rim will do.
The Egyptians appear to have used special glass vessels very similar to those we use today, with broad comfortable rims. They are easy to clean and sterilise so many practitioners use them.
The two main ways of evacuating air when fire-cupping are
In China, bamboo cups are widely used. For personal use they are fine but they cannot be sterilised properly so not many professional acupuncturists use them. They also have narrow rims, meaning that the suction produces deep skin imprints which are sore, though the Chinese don’t appear to mind. Also, being opaque, you can’t see how strong the suction is.
These are made of glass with an extension at the top to accommodate a rubber squeeze ball which when squeezed and released pulls air, followed by skin, up into the vacant area.
Easy to sterilise, broad-rimmed, these are generally good to use, but don’t have the capacity for strong suction. Excellent to keep at home and quick to apply.
The rubber here is corrugated so that one just presses it into position. Being rubber they accommodate to the terrain of the skin so may be useful where the mouths of glass cups are too broad. Comfortable and easy to use, cleaned and sterilised easily. Good for home use. However, they don’t produce strong suction.
Many devices exist, using cups which can be detached for cleaning and which have broad rims. Expensive to buy and probably mainly useful for professionals. Can produce very strong suction so must be used with care and consideration.
For full directions, see below under ‘Preparing the Patient for Cupping’.
Many patients are apprehensive their first time. It pays to show them how it works on the palm of your hand, by applying the cup there and once suction occurs, showing them how it stays in place even when you turn your hand to face downwards.
Consider your patient’s strength and state of health. Ask them to sit or lie, and keep them warm. Bare only as much skin as necessary.
To increase blood flow if the patient is cold or has poor circulation, either vigorously rub the area you will treat or have them take a warm bath or shower. Even better, do the treatment while they’re in the bath!
Otherwise, place a warmed pad or bean-bag or hot water bottle over the area for a while until it warms up. Only then start the treatment.
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This is a fantastic method of treatment for many kinds of condition. There is a Chinese saying to the effect that over half the ills of mankind are curable with acupuncture and cupping, but even on its own just cupping is pretty good.
To understand what kinds of illness it can benefit, one should understand what it aims to do.
It helps the following, where illness arises because of:
Taking those in order …
Many diseases in their early stages benefit from it: for example, what we call colds, chills, or fevers. These and other diseases start with an invasion of ‘wind-heat’ or ‘wind-cold’, or sometimes just ‘wind’. Also, have a look at Excess.
The Chinese understanding of this is that at an early stage, the disease remains near the surface of the body, so action there – on the skin – can often clear it.
Often in the early stage of wind-cold or wind-heat invasion, you feel alternately hot and cold, sweaty and shivery, as the battle between your body and the invader goes one way or the other.
Forget the idea of virus and bacteria for the moment, or at least consider it from another point of view. Especially at the early stages of a disease, the invading organism hasn’t taken hold: your body is fighting it. The signs of that fight are your symptoms of hot and cold, headache, itchy throat etc. Those symptoms have been instigated by the invader: your body merely responds as programmed over millennia.
Suppose you could remove the signs of the invader – wouldn’t that mean it had gone? This at any rate is the experience of Chinese medicine. If the ‘wind-heat’ or ‘wind-cold’ can be cleared [Wind is shivery and restless, Heat and Cold are the hot and cold sensations you feel], well: you’ll get better, or the illness will progress much more slowly or not as far.
Cupping has traditionally been used for this, and the literature is full of its benefits. Indeed, in the 1930s New York barbers advertised ‘cups for colds’.
The treatment pulls the invasive forces to the surface of the body, clearing them from the interior.
By the way, this form of treatment – cupping – is only one traditional way of dealing with such an ‘invasion’.
Another way, sometimes used in herbalism for Wind-Cold, is to help your body achieve a satisfactory fever more quickly, the fever being seen as your body’s best early response to making life hard for the invader.
In Western medicine, the fever may also hasten the production of the appropriate antibodies. Another method is gua sha, where gentle scraping on the surface of the body produces hyperthermia, drawing heat and blood to the area.
Read more about Excess here.
Blood stagnation includes poor circulation, many kinds of rheumatism, neuralgia and tension in muscles. Cupping is excellent in many diseases of the digestive system, the respiratory system and for general circulation, and it has a stimulating effect on the skin and its underlying tissues, can often help blood pressure, hardened arteries and stiffness: all of these if due to stagnation.
Are you wondering where Qi Stagnation comes in? It often causes Blood Stagnation. Read my book for much more on this.
Cupping helps the body clear out toxic matter, both old and new. This was perhaps its first use thousands of years ago. Forcing blood into an area stimulates movement of lymph, bringing new blood to old or damaged tissues, and making the skin glow as a result of healthier blood coursing through the area.
All these signs of blood stagnation potentially helped! Not bad, eh?!
But don’t forget acupuncture – also really good for helping to clear external pathogenic factors, as they are called! There’s a whole section of this site explaining the matter. See Four Levels for example.
If you judge that your patient is weak, tired, lethargic, slow, heavy, easily put out of breath, pale, discouraged and in low spirits, mild cupping can be great. Read more about this at Deficiency.
But it needs to be done quickly and repeated a number of times.
The upper back is a good place to do it: place the cups, mild suction, between shoulder blades and spine: remove and replace.
Keep doing this for a few minutes until you see the area reddening. Then stop.
Alternatively, once placed on the skin, pull it gently along the surface of the skin, up and down the back, again for just a few minutes.
With frail people like this, treatment should be mild and frequent.
Done this way it has a great stimulating effect on the metabolism.
You may think hygiene is not an issue. That’s fine until one day you do it on someone who gets infected because you took no precautions.
The skin is our first line of defence. It’s under constant attack from chemicals in the atmosphere, from abrasions, cuts, bites, wounds and tears. It is amazingly flexible and durable: it repairs itself all the time, shedding the old skin and replacing it with new skin which pushes up from inside.
Fortunately it’s waterproof too!
But all those tears and abrasions mean that really unpleasant bacteria can, given half a chance, find an entrance.
Our skins are occupied by an extraordinary array of bacteria, viruses and other inhabitants too small to see. Some are friendly some are not. You may not like the idea, but the MRSA (methicillin resistant staphylococcus aureus) bacteria is probably living quietly on your skin right now – and if you are healthy it’s fine there. In fact it is probably keeping what are generally described as ‘good’ bacteria in check – and vice versa.
But when you are less than healthy, MRSA can take advantage of your weakness and pounce.
Likewise, if infected skin is treated with cups which without being properly cleansed are then used on someone else, the second person may acquire the skin infection of the first.
After use, lightly wipe the cups with a clean cloth or paper tissue, then immerse them in bleach for five minutes. Finally wash them in soapy water, rinse and leave to dry naturally or wipe dry with a new clean tissue. If you are a practitioner, wear surgical rubber or latex gloves.
Ensure the patient understands what the treatment is and does and is not apprehensive. As the patient will have to remove some clothing, make sure the room is warm and draft-free.
Ask the patient to remove clothes covering the area you will be treating.
Discuss with the patient what position will be suitable. If you are treating his back, then probably he should lie on his front or sit in a chair the reverse way round and lean forward on its back.
If treating someone’s chest or abdomen, lying supine is usually best.
On the shoulder or neck area? Do it sitting.
Treating the legs? Make sure the patient is lying in a position from which he won’t need to move for a while.
If someone gets cold easily, have a warm towel handy to cover the exposed area after the cups have been applied there.
As previously explained, the area to be treated may need to be warmed, either by rubbing it, or by a warm water bottle or beanbag. (If at home, the patient could have a warm bath.)
(Note: because of safety considerations, we do not recommend using fire cups at home unless you have been shown and taught how to do it. Although it is the oldest method and has much to commend it, modern squeeze rubber cups are very effective and much safer.)
A small matter but … make sure the floor is covered in carpet or matting. If glass falls on a hard floor it may shatter. Not only will the noise be a shock, but clearing it up can be embarrassing.
Warn the patient that if suction fails the cup will fall away from the body and that this is quite all right! It only reduces the effect of the treatment at that point.
People’s skin varies. The amount of hair varies. Good suction is achieved when there is excellent contact between skin and rim of the vessel.
If the skin is very rough or hairy, suction may be poor, meaning it won’t remain in place for so long and will fall off. Unless you stay to replace it, the patient will be disturbed.
Often patients like to be left alone when the containers are in place, so achieving good contact in the first place is best.
If in doubt, apply massage oil over the area first. This improves contact and makes it easier to move the cup’s position.
When the patient is ready, in the right position and with the skin exposed, place the cupping vessel over the area and squeeze the rubber ball.
If a patient has never had it before and is apprehensive, or has poor constitutional strength or is weakened by age or infirmity, apply only mild suction the first few times.
Strong suction has a draining effect and is excellent when there is an invading pathogen but done on somebody frail, can weaken them.
So if in doubt use mild suction!
If it is being done over a boil or where there is toxic matter, with the intention of drawing out the pus, have several cups of different widths available.
A narrow cup here will concentrate pressure round the boil or abscess, which may be intolerably painful, especially if the boil is at the red and inflamed stage without much pus production. A wider one may be better, but patient feedback is what you need.
Over a boil, don’t move it around: once in place, leave it there.
However, for invasive pathogens, such as when you are catching a cold, (wind-cold or wind-heat in Chinese medicine), stronger cupping is usually possible.
If performed on the patient’s back, it’s a great treatment, skin texture allowing, to draw the cup up and down the area between the shoulder blades and the spine, and parallel to the spine. Do this slowly to maintain suction, and keep doing it for as long as it takes to produce really good redness on the skin.
How far down the back should you go? Until about the 11th vertebra which is just under the lower edge of the shoulder-blade. (In a woman, this is usually just below the bra-strap so women should be asked to let you undo the strap – note which catch they are using! Don’t forget to do it up afterwards in the same place before asking them to move.)
NB Some patients have skins that go red very easily. Here you should continue for five minutes anyway, unless the patient requests you stop.
Unless the patient is very bony, you can draw it up and down over the spine, and from side to side over it. But not where the vertebrae stick out: it’s too painful.
After, say, five minutes of this, leave them, one cup on either side, near the upper edge of the shoulder-blades, at around the level of the second or third dorsal vertebra. This position has benefits for the underlying acupuncture points there which help clear the qi of exterior invasions.
If they are being left in place, the main aim is to leave them there until the colour of the skin in the cup has become slightly dark, and then for another minute or two.
However, many patients like to remain undisturbed for ten or fifteen minutes and unless the patient is frail and you’ve applied suction that is too strong, this doesn’t seem to matter, and may actually help. Just be aware that the longer the cups remain on the skin, the longer the skin marks will remain … so warn your patient.
In the case of Wind-Cold invasion-type colds, you would normally apply heat (moxibustion) after cupping – as well as acupuncture, if you know where to put the needles. The aim, with Wind-Cold, is to provoke the body into getting warm and perspiring a little.
If moxibustion is not available, try a warm bath!
Theoretically, where there is Cold, Fire cupping is better, being yang and warming.
If using a glass cup, press the skin beside its rim to let air seep in slowly. Note that when you’ve left it in place for some time, using strong suction, it may be sore, so warn your patient and do it gradually.
With rubber squeeze-top cups, just squeeze the top to reduce the vacuum, then lift it away.
Offer the patient the opportunity to rest a little while after they are removed: cover the patient with a warm towel. The reason is that you have moved blood around in various ways, either to clear an invading pathogen or to release pus. This is a bit of a shock to the system, so allow time for rest.
Cupping can also temporarily reduce blood pressure which may be a problem if the patient already has low blood pressure: if the patient rises too fast, he or she may feel faint, which can be alarming for both of you.
So allow a few minutes rest. Meantime or soon after the rest, clean the area: using a paper tissue, now rub the area you treated. Unless you cupped a boil, when you must wipe very carefully round the skin opening and may wish to wash the area with a little soapy water or with alcoholic swabs, you can rub it quite firmly. This helps the blood move again and may reduce soreness from any bruising caused by the cup rim’s pressure on the skin.
If to achieve good suction you had to apply lots of oil in the first place, this rubbing will remove most of the oil but not all of it. So discuss with your patient whether they will mind the slight smell and sensation of the oil on their clothing.
Sometimes you will need to apply a cleanser to the area. Such skin cleansers are familiar products in many shops.
Alternatively, acquire neat alcohol if legally available, and use this to rub the area: but don’t do it too slowly because as the alcohol evaporates it cools the skin. Instead rub firmly and the effect can be nicely invigorating.
Where and when NOT to use cupping
Cupping is a wonderful therapy, safely used for thousands of years by people the world over. That doesn’t mean that there are no contraindications. The main ones are:
To get some cupping done for you, contact a qualified acupuncturist!
The book is a great resource, easy to understand and with plenty of illustrations.
It’s written by someone from Turkey, who says he learned it from his grandmother.
Years later, he discovered its use by practitioners of Chinese medicine, who had worked out the theory behind it.
He’s a warm and engaging enthusiast and you’ll enjoy the read.
And yes, well, it’s expensive. This page is much cheaper and tells you pretty much everything you need to know. But still, the book is worth reading.
Check my collection of books:
Master Tung’s acupuncture is a hidden treasure, lost to China but recovered in Taiwan from where it spread round the world.
Knee pain has five main causes. It’s certainly worth trying acupuncture before you resort to surgery!
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