Traditional Cupping Therapy

Cupping: What is it, and how does it work?


Traditional cupping therapy has been around for so long that it’s origins seem lost in history. Moreover, some from of suction cupping therapy has evolved in almost every culture, in almost every part of the world independent of each other. But what is it? How does it work? Let’s take a look at some empirical data, and some science.

Heat being briefly applied inside a glass cup to super heat the air, creating a vacuum as it cools when placed over the skin.

Heat being briefly applied inside a glass cup to super heat the air, creating a vacuum as it cools when placed over the skin.

Traditional cupping performed today isn’t much different than it was thousands of years ago. A glass, fishbowl shaped jar with a thick, rounded lip is cradled close to the skin and a lit brand is held briefly inside to super-heat the air for one to one-and-a-half seconds. The cup is immediately placed on the skin as the super-heated air cools, and creates vacuum suction; a method known as “Huǒ guàn zǐ” or “fire jar qi.” [right image] Sometimes bamboo cups are boiled in an herbal decoction before applying them to the skin in another technique known as “shuiguanfa”, or “liquid cupping.” The very first cupping therapy’s used animal horns super-heated with the fire jar method, hence the Chinese pronunciation “jiǎofa” or “horn technique.” [below image]

A traditional medicine practitioner using the fire-bowl technique to secure animal horn cups.

A traditional medicine practitioner using the fire-jar technique to secure animal horn cups on a patient.

The earliest written accounts of cupping are from Taoist alchemist and herbalist, Ge Hong (281–341 A.D.) who prescribed it for pulmonary tuberculosis, or like diseases. More recently Qing Dynasty doctors would use it to treat headache of wind-cold type, bi syndrome of wind origin, dizziness, and abdominal pain. Primarily, it was commonly used to dispel cold in the channels and was though to do so by virtue of its ability to release external pathogenic factors such as wind-invasion, dampness, and of course, cold.

In the modern medicine era, medical grade plastics took the place of glass and fire and new types of cup designs made cupping safer, easier, and more effective at fine-tuning the suction.

Rubber suction cups

Swedish style medical rubber suction cups.

Often, practitioners will perform a deep massage beforehand to loosen up the muscle tissue. When the cups are statically placed or slid along the skin with the help of oil or some other lubricant, a phenomenon known as “shā” appears. Shā is stagnation in the muscle tissues and organs, which can build up, causing pain.

All cells in the body produce metabolic waste during their normal day-to-day function. This waste is expelled from the cell into our body’s extracellular fluid and eventually finds it’s way to our lymphatic system where it can be processed and excreted, along with lactate and other metabolites. Increased acidity of the muscle cells, along with these other metabolic disruptions, hinder the breakdown of glucose into energy, and build up inside the muscle causing soreness, diminished function, and knots.

It’s this environment within muscle tissue that creates shā, and only tissue that has this buildup of extracellular waste will exhibit markings on the skin when cupping is applied. Detractors of traditional cupping therapy will often cite common bruising or the rupturing of blood vessels on a patient’s skin as an explanation for the shā markings, but the speckled red, purple, and sometimes black markings bear little to no resemblance to yellowish bruising or the spidery pattern of a broken blood vessel. It should be noted, however, that bruising can occur during treatment, but isn’t common and is usually an indication of too much suction being applied.

Dark purple shā, indicative of old, stagnant, metabolic waste, arising to the surface of a patient's skin where it can be eliminated.

Dark purple sha, indicative of old, stagnant, metabolic waste, arising to the surface of a patient’s skin where it can be eliminated.

The void created by cupping causes a vacuum inside the body that penetrates a bit less than two inches from the skin’s surface. It’s the old, used blood and fluids that are sucked up to the surface of the skin. Depending on the type, age, and severity of the stagnation or injury in the affected tissue, the resulting shā color can range from very light pink to black. Patients usually feel relief instantaneously and old waste can be effectively eliminated with one to three treatments.

Among the traditional styles of cupping around the world is a technique called blood-cupping that is practiced in the Middle East and combines the practice of blood letting with cupping in order to facilitate the extraction of waste from a patients body. Small scrapes are incised in the surface of the patients skin, just enough to break the first and second dermal layers, really no more than a scratch, in the center of an area that has just been cupped. The suction cups are then re-applied where blood is able to escape the body and thus presumably carry metabolic waste with it. Afterward, the incisions are wiped with alcohol or other antiseptic. There is usually no need for bandages because the cuts are shallow enough that they won’t bleed on their own. This style of cupping is nearly unheard of in the West and it would be very uncommon to book a cupping session with a therapist who uses this technique. Besides being unnecessary, blood cupping is very wasteful due to the plastic suction cups being one-time use items. [blood cupping below]

Blood cupping being applied to a patient's back.

Blood cupping being applied to a patient’s back.

Generally, for soreness or injury, traditional medical practitioners will use plastic, rubber, or glass cups in a sliding fashion along the fiber direction of the muscle they wish to affect. For deeper sub-layered muscles like the rhomboids, or obliques, practitioners will slide across the grain of superior tissue to reach the targeted muscle underneath. Sliding cups produce a very different pattern of shā on the skin from static cups, and are often more effective at relieving acute muscle pain from poor ergonomics, new sports injury, or bad posture. Static cupping, as seen in the last picture, is best for old injuries or for getting deep suction energy into the organs like the lungs, liver, and kidneys. Most people find the feeling of static cupping pleasant, while sliding cups can be somewhat uncomfortable to people unfamiliar with the sensation. In either case the markings will generally last 3-5 days and feel like a mild sunburn. Old injuries with dark markings can last up to 2 weeks from the therapy, but should not be any more painful.

SlidingCupsEffect[sliding cups left]

On the left we see a patient who has received a sliding cup treatment on his back, with the focus being on the trapezius, obliques, latissimus dorsai, and serratus posterior muscles. The patient is exhibiting a normal reaction to the cupping and is likely simply looking for relief from minor back pain or stiffness. If an old injury were present, the markings would be darker, or in some localized cases black, where the injury exists.

Patients new to cupping may want to try it on a smaller area first in order to become familiar with the effects cupping can have on the body. During cupping, the body’s “wei chi”, which is the Traditional Chinese Medicine equivalent of the immune system, is compromised and may leave the patient vulnerable to airborne pathogens and invasions. This is usually why only small areas of the body are cupped at a time, and why people who suffer from wasting diseases, who are elderly, or who already have compromised immune systems aren’t good candidates for cupping therapy.

If your traditional doctor or therapist does recommend cupping, they will also recommend that you avoid stimulants like tobacco, coffee, and even spicy food for a few days after the session. Alcohol is similarly discouraged. For areas like the neck and shoulders which could be exposed even when fully clothed, it is recommended that the affected area be kept covered, especially from cold wind and cold dampness, because the body will be particularly susceptible to external pathogens in that area.

FullBackResultsCupping, when performed properly, is perfectly safe for healthy individuals who want to relieve aching muscles or lack of range of motion  caused by old injuries. Oftentimes, cupping can even draw out toxins from people who have been exposed to smoke or chemical inhalation, or excessive pharmaceutical or drug usage. These patients will often describe smelling smoke or chemicals during a session that correspond with the toxic substance that was ingested or inhaled. As you might imagine, this type of therapy can be especially beneficial to structure fire victims, firefighters, or anyone who works around compromised environments.

Have you ever experienced cupping? Please leave a comment and tell us about your experience!