Cupping refers to an ancient Chinese practice in which a cup is applied to the skin and the pressure in the cup is reduced (by using change in heat or by suctioning out air), so that the skin and superficial muscle layer is drawn into and held in the cup. In some cases, the cup may be moved while the suction of skin is active, causing a regional pulling of the skin and muscle (the technique is called gliding cupping).
This treatment has some relation to certain massage techniques, such as the rapid skin pinching along the back that is an important aspect of tuina (12).
In that practice, the skin is pinched, sometimes at specific points (e.g., bladder meridian points), until a redness is generated. Cupping is applied by acupuncturists to certain acupuncture points, as well as to regions of the body that are affected by pain (where the pain is deeper than the tissues to be pulled). When the cups are moved along the surface of the skin, the treatment is somewhat like guasha (literally, sand scraping), a folk remedy of southeast Asia which is often carried out by scraping the skin with a coin or other object with the intention of breaking up stagnation. Movement of the cups is a gentler technique than guasha, as a lubricant allows the cup to slide without causing as much of the subcutaneous bruising that is an objective of guasha. Still, a certain amount of bruising is expected both from fixed position cupping (especially at the site of the cup rim) and with movement of the cups.
Traditional cupping, with use of heated cups, also has some similarity to moxibustion therapy. Heating of the cups was the method used to obtain suction: the hot air in the cups has a low density and, as the cups cool with the opening sealed by the skin, the pressure within the cups declines, sucking the skin into it. In this case, the cups are hot and have a stimulating effect something like that of burning moxa wool.
In some cases, a small amount of blood letting (luoci; vein pricking) is done first, using a pricking needle, and then the cup is applied over the site. The pricking is usually done with a three-edged needle, applied to a vein, and it typically draws 3-4 drops of blood (sometimes the skin on either side is squeezed to aid release of blood). A standard thick-gauge acupuncture needle or plum blossom needle may be used instead. This technique is said to promote blood circulation, remove stasis, and alleviate swelling and pain. It is employed especially when there is a toxic heat syndrome and for a variety of acute ailments.
The following report is derived mainly from a survey of reported cupping techniques published in 1989 (1), supplemented by information from acupuncture text books (5-9).
Respiratory Diseases
- For chronic bronchitis and asthma, one can apply cupping at the following points: dingchuan, dazhui (GV-14), shenzhu (GV-12), geshu (BL-17), xinshu (BL-15), jueyinshu (BL-14), feishu (BL-13), fengmen (BL-12), dashu (BL-11), tiantu (CV-22), shanzhong (CV-17), huagai (CV-20), and zhongfu (LU-1). [see: Acupuncture treatment of asthma for more information about several of these treatment sites].
- For pediatric bronchitis: blood letting followed by cupping at dazhui (GV-14).
- For pediatric acute bronchitis: feishu (BL-13), shenchang (KI-25), lingxu (KI-24).
Digestive Diseases
- For dysentery, early morning diarrhea, and acute and chronic gastritis, perform cupping in the following areas: around the navel; at the bladder meridian shu points; or these stomach meridian points: burong (ST-19), guanmen (ST-22), huaroumen (ST-24), tianshu (ST-25).
- Pediatric indigestion: dachangshu (BL-25).
Pain Syndromes
- Shoulder blade: jianwaishu (SI-14) and tianzhong (SI-11).
- Loins: shenshu (BL-23), qihaishu (BL-24), guanyuanshu (BL-26).
- Head: taiyang and yintang for refractory headaches and migraines; dazhui (GV-14) and baihui (GV-20) for parietal and occipital headaches; for trigeminal neuralgia: qihu (ST-13), fengchi (GB-20), sizhukong (TB-23), jiache (ST-6); for toothache: dashu (BL-11), with acupuncture, massage, and cupping at yifeng (TB-17), jiache (ST-6), xiaguan (ST-7), and hegu (LI-4).
- Soft tissue injury: treat local pressure pain points and area of swelling; use plum blossom needling followed by cupping; additionally or alternatively use points above or below the site of injury along the channels that pass through the injury.
Gynecological Disorders
- Infertility and irregular menstruation: shenshu (BL-23) with movement of cup downward (treat with acupuncture first, then do cupping).
- Leukorrhea: yaoyan (extra point under the 3rd lumbar vertebra) and around baliao (BL-31 through BL-34).
- Uterine cramps: needle zusanli (ST-36) and guanyuan (CV-4) and do cupping at guanyuan (CV-4).
Miscellaneous
- Common cold: dazhui (GV-14).
- Insomnia: xinshu (BL-15), geshu (BL-17), shenshu (BL-23).
- Facial paralysis: needling and cupping dazhui (GV-14), along with needling local facial points.
RECENT RESEARCH:
The following protocols were reported to provide good results in individual clinical research reports:
- Head pain (2): headache, toothache, sore throat, redness and soreness of the eyes, treated with blood letting followed by cupping. Treatment is applied to dazhui (GV-14) and dingchuan.
- Frozen shoulder (3): after acupuncture at jianyu (LI-15) and jianliao (TB-14) to get propagated qi reaction, use pricking of ashi points followed by cupping over the bleeding area for 10-15 minutes. Ten treatments is a course of therapy.
- Acute trigeminal neuralgia treating with blood letting followed by cupping (4): treatment is applied to dazhui (GV-14) and feishu (BL-13).
- Acne (10): treatment is to use bloodletting followed by cupping at feishu (BL-13) and geshu (BL-17) on one day, then xinshu (BL-15) and ganshu (BL-18) the next day, alternating treatments for a total of eight days.
- Urticaria (11): perform cupping at shenque (CV-8) three times consecutively for ten minutes each time. This is done for three days, followed by one day rest, and another three days as needed.
- Acute diseases (13): fever and headache due to infection, acute conjunctivitis, lumbar sprain; perform blood letting at dazhui (GV-14), and then cupping (which promotes further bleeding).
TREATMENT SUMMARY
Cupping therapies often follow the point selection pattern that is used for standard acupuncture therapy, with somewhat greater emphasis on the use of back points (due to the ease of performing this technique there). In particular, most practitioners rely on using back shu points (bladder meridian) and dazhui (GV-14). Cupping is frequently applied after treatment by acupuncture, blood letting, or plum blossom treatment.
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