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
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).
The earliest use of
cupping that is recorded is from the famous Taoist alchemist and
herbalist, Ge Hong (281–341 A.D.). The method was described in
his book A Handbook of Prescriptions for Emergencies, in
which the cups were actually animal horns, used for draining
pustules. As a result of using horns, cupping has been known as
jiaofa, or the horn technique. In a Tang Dynasty book,
Necessities of a Frontier Official, cupping was
prescribed for the treatment of pulmonary tuberculosis (or a
similar disorder). More recently, Zhao Xuemin, during the Qing
Dynasty, wrote Supplement to Outline of Materia Medica,
including an entire chapter on “fire jar qi” (huoquan qi).
In it, he emphasized the value of this treatment, using cups
made of bamboo or pottery, in alleviating headache of wind-cold
type, bi syndrome of wind origin, dizziness, and abdominal
pain. The cups could be placed over acupuncture needles for
these treatments. One of the traditional indications for
cupping is dispelling cold in the channels. This indication is
partly the result of applying hot cups. For example, bamboo
cups would be boiled in an herbal decoction just prior to
applying to the skin (this is one type of shuiguanfa, or
liquid cupping, so-called because a liquid is incorporated into
the treatment). Both liquid cupping and cupping over an
acupuncture needle are favored for treatment of arthralgia.
Cupping also is thought to dispel cold by virtue of its ability
to release external pathogenic factors, including invasion of
wind, damp, and cold.
During the 20th
century, new glass cups were developed (see
Figure 1). Common drinking glasses have been used for this
purpose, but thick glass cupping devices have also been produced
and are preferred. The introduction of glass cups helped
greatly, since the pottery cups broke very easily and the bamboo
cups would deteriorate with repeated heating. Glass cups were
easier to make than the brass or iron cups that were sometimes
used as sturdy substitutes for the others; further, one could
see the skin within the cup and evaluate the degree of
The glass cups are depressurized by providing
some fire in the cup to heat up the air within just prior to
placement. For example, hold a cotton ball dipped in alcohol
with a pincer, ignite it, hold it in the cup, then rapidly apply
to the skin; this is called shanhuofa (flash-fire
cupping; see Figure 2). Sometimes, a
small amount alcohol is put in the cup and lit; this method is
called dijiufa (alcohol-fire cupping).
At the end
of the 20th century, another method of suction was developed in
which a valve was constructed at the top of the jar and a small
hand-operated pump is attached so that the practitioner could
suction out air without relying on fire (thus avoiding some
hazards and having greater control over the amount of suction).
Both glass and plastic cups were developed, though the plastic
ones are not very well suited to moving along the skin once in
place, as the edges are not entirely smooth and the strength of
the cups is limited. The modern name for cupping is baguanfa
(suction cup therapy).
In order to allow easy movement of the glass
cups along the skin, some oil is applied. Medicated massage
oils (with extracts of herbs) are particularly useful for this
purpose. Since the cups are applied at room temperature, the
indication of removing cold from the channels is no longer as
applicable, at least to stationary cups. There is some friction
generated with moving cups, so that there is a small but
significant amount of heat applied by that method, especially if
a warming oil is used as lubricant.
Generally, the cup is left in place for about 10
minutes (typical range is 5–15 minutes). The skin becomes
reddened due to the congestion of blood flow. The cup is
removed by pressing the skin along side it to allow some outside
air to leak into it, thus equalizing the pressure and releasing
it. Some bruising along the site of the rim of the cup is
Today, cupping is mainly recommended for the
treatment of pain, gastro-intestinal disorders, lung diseases
(especially chronic cough and asthma), and paralysis, though it
can be used for other disorders as well. The areas of the body
that are fleshy are preferred sites for cupping.
Contraindications for cupping include: areas of skin that are
inflamed; cases of high fever, convulsions or cramping, or easy
bleeding (i.e., pathological level of low platelets); or the
abdominal area or lower back during pregnancy. Movement of the
cups is limited to fleshy areas: the movement should not cross
bony ridges, such as the spine. Following are some of the
recommended treatment sites for various disorders.
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).
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).
Shoulder blade: jianwaishu (SI-14) and
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
Infertility and irregular menstruation: shenshu
(BL-23) with movement of cup downward (treat with acupuncture
first, then do cupping).
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).
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.
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
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
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. March 1999