Cupping Therapy: An Overview from a Modern Medicine Perspective

Introduction and a brief overview

Cupping therapy is a traditional method of healing [1It is an ancient method of healing [1. Cupping is done by placing cups on selected skin areas and generating an atmosphere-wide pressure via suction or heat 2.

The papyrus of Eber (1550 BC) from Ancient Egypt is among the oldest medical texts that refer to cupping therapy. Cupping therapy is part of various ancient healing methods, including Chinese, Unani, traditional Korean, Tibetan, and Oriental medicine [33. The early Greek physician Hippocrates wrote extensive descriptions of cupping applications. He defined two distinct kinds of cups: one with a narrow opening, an extended handle, and one with a larger opening. The first was used to treat the infiltration of fluids, whereas the second was utilized to alleviate pain [4The second type was used to treat pain spread [4]. The practice of cupping was a well-known practice in the past as a therapy in Arabic as well as Islamic countries. It was suggested by Arabic as well as Islamic doctors such as Ibn Sina (AD 980-1037), Al-Zahrawi (AD 936-1036), and Abu Bakr Al-Razi (AD 854-925). Al-Zahrawi wrote about cupping locations and illustrated cupping tools using diagrams [55. Cupping therapy was widespread in Italy and throughout Europe during the 14 and 17 to 17 centuries during the Renaissance. Cupping therapy was a popular treatment for arthritis and gout in Italy during this time [66.

Mechanisms of action as well as reported results of cupping therapy

The mechanism for cupping therapy’s effect was fully understood in [7The mechanism of action of cupping therapy was not precise until now [7. The principal mechanisms proposed for effect were suctioning at the subatmospheric level, believed to improve circulatory blood flow in the peripheral area and increase the immune system. [8].

The reported effects of cupping therapy include the stimulation of circulation of blood to the skin [9], altering the biomechanical properties of the skin [10and a rise in pain thresholds and enhancing local anaerobic metabolism [11], decreasing the inflammation of [12], along with enhancing the function of the immune system’s cellular component. [13].

Many theories describe the mechanism of cupping. Guo et al. have proposed the idea of immunomodulation in which cupping and Acupuncture were the same in terms of mechanism of action. Immunomodulation theory suggests that altering your microenvironment through stimulating the skin may change into biological signals and activate the neuroendocrine system [1414. Shaban and Rarvalia developed the genetic theory that suggested that the skin’s mechanical stress (due the subatmospheric stress), as well as local anaerobic metabolism (partial reduction in O 2.) in the course of cupping suction, could trigger mechanical and physiological signals that can trigger or block gene expression. In the wet cupping treatment, superficial scarifications may activate the wound healing mechanism and gene-expression program [15The mechanism for healing and gene expression could be activated [15. Modulation of gene expression was documented in a variety of acupuncture research studies [16and [17]. [17].

In sum, an established mechanism of action for cupping therapy could be more precise. Studies in cupping therapy’s mechanisms of action are highly advised.

Types of cupping therapy that are classified

The early classification of cupping therapy categorizes it broadly into wet and dry cupping [1818. Another classification for cupping therapy was established in 2013, dividing the process into five categories. The classification was revised to reflect the 2016 year [1919. The revised classification classified cupping into six different categories. One category includes “technical types,” which comprises dry, wet flash cupping, and massage. A second grouping is the “power of suction,” which includes medium, light, and powerful cupping. Thirdly, there refers to the “method of suction,” which comprises manual vacuum and electrical vacuum cupping. The fourth is “materials inside cups,” which include water, herbal moxa, ozone needles, and magnetic cupping. The fifth category is “area treated,” which comprises abdominal, facial male, and female orthopedic cupping. The sixth category, “other cupping types,” includes cosmetic, sports cupping, and aqua [1919.

The article recommended a fresh treatment classification for cupping by combining categories five and six in one primary class: “condition and area treated.” It also changed the name from “materials inside cups” to “added therapy types,” aqua cupping was added to this classification. This update aims to provide a specific categorization of the different types of cupping [Fig. 1].

Cupping therapy sets are classified according to their cupping type.

A typical cupping set must include at least six different-sized cups and a suction method. Cupping therapy sets can be divided into three major categories. The first includes “cupping sets related to the types of cups,” which include glass, plastic bamboo, rubber ceramic, metal, and cupping set made of silicone. The third grouping comprises “cupping sets related to the methods of suction,” which includes automatic, manual, and self-suction cupping sets. The third includes “cupping sets related to uses,” including male, female, and facial massage cupping sets.


Cupping therapy is used to aid in the promotion of health and for preventive and therapeutic purposes. Cupping therapy has shown advantages in treating lower back discomfort [2122], [23] shoulder and neck pain [2425] (26, 27migraine and headache [2829 knee pain facial paralysis [3132brachialgia carpal tunnel syndrome [34 hypertension [35and [36] diabetic mellitus, rheumatoid joint [38] as well as asthma [39] and 40as well as asthma [39], 40. These illnesses can be classified into localized disorders (neck pain, lower back pain, and knee pain) and systematic disorders (diabetes mellitus and hypertension, and Rheumatoid arthritis).

The locations for therapy with cups are chosen depending on the disease. It is most commonly applied to the back. Popular area for cupping and is followed by the abdominal, chest, and buttocks. The legs are also a popular choice. Other parts, such as the face, can be treated with cupping.


It is generally accepted that cupping is not explicitly recommended on veinsarteries, nerves, skin inflammations, skin lesions or body orifices, lymph nodes, eyes, and varicose veins. It is also not advised for open injuries, bone fractures, and locations with deep vein thrombosis.

Contraindications to cupping therapy can be classified as both relative and absolute contraindications. As long as we do not have enough information about the benefits of cupping therapy, it is entirely unsuitable for treating cancer patients and patients with organ dysfunction (renal failure, liver failure, or the heart). It is also not recommended for patients with pacemakers and patients suffering from hemophilia or similar disorders. Cupping therapy contraindications for cupping include acute infections, the use of anticoagulants and severe chronic diseases (such as heart disease), pregnancy, puerperium, menstrual cycle, anemia, a recent wet cupping sessions and blood donations that have occurred recently, medical emergencies, as well as the patient’s refusing to undergo the procedure.


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