Cupping therapy can generally be described as a technique that uses cups placed over the skin to create negative pressure through suction.

Cupping therapy goes back to ancient times and was used around the world. In 400 BC, Herodotus listed wet and dry cupping as a treatment for many ailments including maldigestion, lack of appetite, and headaches.[1] Hippocrates advocated cupping for gynecological complaints, back, and extremity illnesses, pharyngitis, lung diseases, and ear ailments.[1] Cupping therapy was mentioned in the famous Papyrus Ebers in Ancient Egypt (1550 BC).[1] In the Middle East, cupping was advocated for by prominent physicians like Abu Bakr Al-Razi (AD 854-925), Ibn Sina (AD 980-1037), and Al-Zahrawi (AD 936-1036).[2] In China, cupping was recorded as a medical treatment in the Mawangdui Silk texts (sealed in 168 BC).[3] Cupping therapy was used in ancient Europe as well. In the first century AD, Celsus advised cupping therapy for extracting poison from bites and for abscesses.[1] In the 2nd century AD, Aretaeus treated prolapse of the uterus, cholera, epilepsy, and ileus with wet cupping.[1] Galen was an advocate for cupping therapy and detailed variarity of materials that could be used for cups like horn, glass, and brass.[1]

There are two types of cupping methods, dry and wet. Dry cupping is noninvasive with no bloodletting. Wet cupping is invasive and includes bloodletting. It is further is subdivided into traditional wet cupping and Al-hijamah. Al-hijamah comes from the Arabic word hajm which means sucking, expansion, and bloodletting.[4] Traditional wet cupping is commonly used in China, Korea, and Germany.[1] Al-hijamah is more common in the Middle East and North Africa.[1][5]

The specific mechanism in which cupping exerts its therapeutic effect has not been identified. However, a number of theories have been proposed. One method, called Taibah, suggests wet cupping mimics an artificial kidney.[4] Where an in vivo kidney filters hydrophobic materials through the glomeruli via normal pressure filtration, wet cupping filters both hydrophilic and hydrophobic material through high-pressure filtration. The high pressure from suction leads to increased blood volume which leads to increased capillary filtration rate leading to the expulsion of filtered and interstitial fluid in the area.[4] Filtered fluid collected contains disease-related and disease-causing substances as well as prostaglandins and inflammatory mediators. The scratches made with the scalpel increase innate and acquired immunity by stimulating inflammatory cell migration and endogenous opioid release.[4] This action leads to improved blood flow, removal of toxins, restored neuroendocrine balance, improved oxygen supply, and tissue perfusion.[4]

There are many anatomical sites used in cupping therapy. These sites are chosen based on the ailment being treated. Areas where there are abundant muscles are the most common points where cups are placed. These include the back, chest, abdomen, and buttocks.[1]

Anatomical sites avoided are those with abundant hair, those that have little muscle tissue, and those that don’t have enough surface area to place the cups.[6]

Cupping therapy is indicated for both healthy patients and those suffering from ailments.[6] Localized ailments that benefit from cupping therapy include a headache, lower back pain, neck pain, and knee pain.[2][6] Systemic illnesses that have seen benefits with cupping therapy include hypertension, rheumatoid arthritis, diabetes mellitus, mental disorders, heart disease, hypertension, infections, and skin disorders.[2][6]

Absolute contraindications to cupping therapy include cancer patients, those suffering from any organ failure and those using a pacemaker or suffering from hemophilia or a similar blood disorder.[2] Cupping therapy is not recommended for geriatric patients, pediatric patients, and pregnant and menstruating women.[1] Those with high serum cholesterol are at higher risk of developing cardiovascular ailments with cupping.[1]

Anatomical contraindications include sites with deep vein thrombosis, open wounds, and bone fractures.[2] Cupping should not be done directly on nerves, arteries, veins, varicose veins, skin lesions, body orifices, lymph nodes, eyes or areas with skin inflammation.[2] Cupping done over excoriated, oozing or infected areas may cause an increase in D-dimer levels.[1]

Those suffering from chronic diseases (like cardiovascular diseases), using anticoagulants or have an acute infection should generally avoid cupping therapy.[2]

Cups can be fabricated from a variety of different materials including bamboo, glass, and clay.[7] However, disposable cups are preferred, as non-disposable cups require advanced sterilization and disinfection procedures before they are reusable.[8] Size of the cups is dependent upon the location they are being used.[8]

A sharp surgical blade is commonly used to create the superficial lacerations in al-hijamah wet cupping.(4) An auto-lancet needle is more commonly used in the two-step traditional wet cupping method.[9]