JOURNAL OF CHINESE MEDICINE NUMBER 37 SEPTEMBER 1991

PRACTICAL GUIDE T0 CUPPING THERAPY
by Ilkay Chirali

T

he first time I came across cupping was when I had a bad cold and my mother put some cups on my back. I could feel the edges of the glass sinking deep into my flesh. As the bruises appeared, my mother took the cups off, only to replace them with fresh ones! After cupping I was rubbed with home made alcohol and made to stay in bed, covered with plenty of blankets in order to make me sweat. Sure enough, within half an hour the bed was soaked with sweat. As soon as the sweating was over I was pushed into a hot bath and then returned to bed.The next day I was able to play outside with the other children and my cold was history. This story is, perhaps surprisingly, not one which took place in China, but in my native country of Cyprus. I was seven years old when I had my first cupping experience, and in the following years, I remember cupping was the only method used in our home for treating cold conditions such as sneezing and runny nose with headache and stiff back due to working in the rain or wind, and was even used for bed wetting (In Turkish folk medicine, bed wetting is considered to be a symptom of weak back due to “catching cold on the back”, or due to some kind of shock). My grandmother, who was the only midwife in the area, also used cupping quite extensively for the treatment of many female complaints, such as painful or irregular periods, cold in mother’s milk 1, miscarriage due to weakness of the back 2 and many more general complaints. She would use different sized drinking glasses and marmalade jars for cupping. Her favourite method was to take her patients to a Turkish bath, apply the cups in the cold

room, and then let them stay in the steam for ten to fifteen minutes in order to induce sweating. This was a useful approach since few people had Turkish baths in their own homes. Almost every home in Cyprus has a set of cups in their cupboards. In the old days olive oil wicks and ordinary drinking glasses or empty marmalade jars were used for cupping. Nowadays properly designed thick edged cupping glasses are imported from France or the Far East. This very ancient Chinese medicine practice was introduced to the Mediterranean region by the Ottoman Turks who originally came from Turkistan, now part of the People’s Republic of China (Sinkiang Uighur Autonomous Region of the People’s Republic of China, East Turkistan). As the Ottomans moved West, and eventually into Europe, this tradition came with them. Today most of the Mediterranean cultures still use cupping, especially the Turks, Greeks, Arabs, Southern Italians, Southern French and Spanish. While cupping was always a folk medicine in these countries, it was used more scientifically in English hospitals in the past. Frieda Sandwith in “Surgeon Compassionate”3 describes the work of her great grandfather William Marsden and the use of cupping in hospitals in the 1830’s to treat contagious diseases. She refers to “paid cuppers” working in these hospitals. Unfortunately, as modern drugs were developed, cupping along with other simple but effective methods, as well as the traditional Apothecary, were excluded from general practice, being contemptuously regarded as “old women’s remedies”. It is very ironic that we, as alternative practitioners, have to prove to today’s medical profession that cupping - and in-

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cold and wind attacking and penetrating the body . and is mainly applied on the back. Strong cupping is not suitable on the abdomen or stomach. just enough to hold the cup in place. Coconut oil may be used for more sensitive skins. Strong. As far as acupuncturists are concerned. cupping can be used independently or in conjunction with acupuncture (while the needles are in position or following their removal). rather than supplying single size cups. Medium cupping can also be applied to adults on the stomach and abdomen. although cups are most frequently used on their own. If it does. It is particularly beneficial in the following situations: . in the West should try and make the treatment as pleasant as possible.poor circulation . diarrhoea and dull ache in the lower abdomen) . Weak Cupping: this is done with minimum suction. For the elderly and for people with severe asthmatic or heart conditions an upright sitting position is advised.With bamboo cups there is no danger of breaking. as the edges are thinner than those of the glass cups. especially from arthritic joints Before using cups Before attempting to use cups. and integrated to suit their particular technique. It is done by moving the cups while they are in When and where to use cups Cupping may be used by massage.Qi stagnation . The suction is less noticeable with thin and hairy people5. Many people are nervous about a fire lit next to their skin. The Eight Methods of Cupping There are eight different methods of cupping: Weak. Benefits Cupping regulates the flow of Qi (energy) and blood. Moxa Cupping. I do not find them practical.chronic back aches due to kidney energy deficiency . Firm suction is desirable in order to achieve good therapeutic results from cupping. This method is suitable for children between seven and fourteen years of age. Which cups to use Sets of cups are available in different sizes and are made of thick glass. and show the cups to the patient (and let him or her touch and feel them). In addition. but olive oil is particularly beneficial. so remove the cups and and re-apply. personally. always ask the mother or father to be present in the treatment room with you.helping to build up the patient’s confidence. and can add strength and effectiveness to a great many therapeutic applications. it is advised not to leave the cups in place for more than 3-5 minutes. and increase the suction as the treatment progresses . It causes bruising very rapidly and drains the energy if the cups are left for a long time. then the suction is too strong. Empty cupping. Medium. Medium Cupping: with medium cupping. always moisten the treatment area with oil. whichever is the more comfortable. the bamboo version tends to cause more discomfort. Strong Cupping: strong cupping should normally only be used on patients who have experienced medium strength cupping previously. Each time new cups are applied make sure that the skin is moistened with enough oil. I usually start with medium cupping. The Chinese accept some degree of discomfort when treated but we. Very little bruising will appear even if the cups are left for a long time. shoulders and knees. Explain that the suction will cause a pulling sensation on the skin but not pain. but in weak cupping they can be kept in place for a longer period if needed. Most suppliers prefer to sell the cups as a set.This type of cupping is particularly suitable for debilitated patients and for children. and more on smooth and fat skin. Chinese healing art. Caution should be exercised when washing glass cups as they break quite easily. and the skin rises just a little inside the cup. Wintergreen and Clove. two medium. This type of cupping is not suitable for children. Avoid irritating oils such as Eucalyptus. Moving. It is also important that you ask your patient to sit still and not to make sudden movements while cupping. It is advisable to try to hide the fire from the child. acupressure (shiatsu) and other tactile therapists. and it makes me very sad to see so many acupuncturists who do not make use of this valuable traditional 22 22 . Whenever strong cupping is used for the first time. Moving Cupping: this is the most painful method of cupping. Most sets include one very large. Cupping therapy in this country is unfortunately used by few acupuncturists.on Ashi points to relieve blood stagnation . You can apply cups with the patient in a sitting position. always make sure that your patient is fully relaxed.weakness of the digestive system (poor appetite. Explain your intentions and the benefits of cupping. Cups are normally left for 10-20 minutes in adults and 2-5 minutes in children. the suction is firmer. and one very small size. and Full cupping (bleeding). especially when it comes to sterilisation4.asthmatic conditions . so that they know what to expect. If children are involved. To ensure good suction. Any vegetable oil will do. Strong cupping is best used on robust adults. or weak or elderly patients. More emphasis on cupping and its benefits during practical as well as theoretical training would be helpful. or lying prone or supine. Both types of cups are easily obtainable from Chinese medicinal suppliers. Bamboo cups can also be found but.Weak cupping should not induce bruising or any sensation of pulling. and always massage the area after removing the cups. in order to reduce their fear to a minimum.JOURNAL OF CHINESE MEDICINE NUMBER 37 SEPTEMBER 1991 deed many more previously practised therapies do work effectively and are as cost effective today as they were then. With a new patient. Most people will tell you that they have indeed seen cups on television programs and read about the technique but have never actually seen it done to anybody. I would advise all practitioners never to apply strong cupping at the first consultation.to draw out pathogenic dampness. Needle Cupping.

to maintain cleanliness and eliminate the risk of transferring perverse 23 23 . less than one minute. This may take up to 5 minutes. i. children and adults. remembering to wash them with soapy water after each use. movement of the cups while in place will be uncomfortable to say the least. painful and swollen knees and shoulders.and the cup is placed over the cut.e. The vacuum created will draw blood into the cup which will fill rapidly. The amount of blood drawn may vary from half a cup to one cup at a time. I remember very clearly the tragic story of how our neighbour burned her husband to death after attempting cupping. the full understanding and cooperation of the patient is essential. and while it is still very hot.g. This is quite normal. As soon as the moxa has stopped smoking. she burned him alive! This horrifying example clearly emphasises the dangers of cupping if not correctly applied. Consequently.whilst the needles are in the desired position. and it can therefore be applied to very weak persons. as she struck the match. replacing it with a new one. Needle Cupping: cups can be applied over needles. This method is very effective when the effect of “drawing out cold” is desired. It is mostly used in excess heat conditions. The most common area of application is the back. and there is a feeling of heaviness over the shoulders and neck). You must remember that you are dealing with oil. Empty Cupping: this is actually a strong cupping method. then immediately remove the first one. Again this method is used in Shi conditions. Obviously one should not attempt the moving method while the needles are in position. is to massage the patient with alcohol and cover them in order to promote sweating. some blood may be drawn into the cup. especially if the suction is strong. indicating heat coming to the surface. This will cause bruising very rapidly. It will be noticed that. but it does not take long to make a bad name for your clinic. Careful sterile technique is essential both during and after the treatment. The purpose of moving cupping is to draw out pathogenic heat and regulate the flow of blood. as treatment progresses. This method is used when tonifying and moving the Qi.JOURNAL OF CHINESE MEDICINE NUMBER 37 SEPTEMBER 1991 place on the skin. Do not apply this method on children or patients with weak constitution. How to apply cups Prepare the cups beforehand. Safety First I always make safety a top priority when I use cupping treatment. such as dropping the burning cotton wool on the carpet (or worse on your patient). this was the method used to draw out and elimi- nate poisons and infections from the body. alcohol and fire all at the same time! Never rush when using cupping. the eyes are bloodshot. Also when moving the cups. With this method. It is advisable to use a small piece of paper or card over the skin to protect it from hot ash. A small cut is made on the back . especially the Back-Shu points.usually in the upper part of the body . Before attempting the moving method. and lit. Full Cupping (Bleeding): with this method. which is the desired effect. Continue replacing the cups until bruises appear. Moxa Cupping: moxa is placed on the needle in the normal way for warm-needle technique. red. The bleeding method should be used with caution and not more than once a month. There should be no inflammable objects nearby. The bleeding method is only used when excess Blood-Heat is involved. When in a hurry you are liable to make costly mistakes. In this case the poor woman used the alcohol to massage her husband before she put the cups on. Whether the suction applied is medium or strong. after cupping. In the 1830’s when antibiotics were unknown in England. like plastic bags or polyester covers (cotton covers are warmer and safer). and only on strong adults. but the duration of the suction is very short. The technique is easy: choose the cupping area and apply five to ten cups simultaneously. He had a bad cold and instead of curing him. less bruising will appear in subsequent sessions. In Turkish folk medicine this bleeding method was used when a sudden rise in blood pressure endangered life (the face appears to be ready to burst with blood. The traditional practice in Turkish homes. since it does not drain the energy excessively. it is essential to make sure that enough oil has been used on the desired area. place the cup over the needle. especially on Xu patients. rest between movements and apply massage to the bruised area. her husband caught fire. e. It takes a long time to build up a successful practice.

and all Back-Shu points can be used safely. When the desired cupping time is complete. as patients will not be pleased when having to explain unsightly bruises on exposed flesh. remove the cups by pressing firmly with the index finger between the base of the cup and the skin. it is rec- 24 24 . Apply oil to the skin area to be cupped to ensure a good suction (see above). so before the cups are turned on the skin. and the cups can be left in place for longer time (20-30 minutes) and the strong or moving method can be used. and then turn it upside down and place it on the skin. there will be nearly always be a bruise mark at the site of application. As mentioned earlier. It is preferable to stay with your patient all the time and monitor the progress. bruises are much reduced. close to the skin. the quicker you will get. Children generally prefer cupping to acupuncture. but as this may not be practicable in western countries. Cupping on Adults When using cups on adults one must consider the energetic level and age of the person.This is done with a piece of cotton wool which is held in a long pair of forceps. particularly when strong cupping is applied on a very sensitive skin. on younger adults with any deficiency syndrome. Small rolls of cotton wool can be prepared beforehand and kept soaked in alcohol in a tightly closed jar. Decide the location of the cupping. One golden rule when using cups on children is never to leave the cups on for more than five minutes as this can cause bad blisters and bruises and also drain the Wei-Defensive Qi. and each time cupping takes place they can be left for a longer period. and if blisters start to appear then use your index finger to reduce the suction. and explain the importance of relaxing the whole body. dipped into alcohol and lit. leaving them more tired than when they arrived. When I am convinced that the child is ready I then proceed. before introducing the flame into the cup. The reason for this age limit is the fact that the skin of a child under three years old is very susceptible to blisters and bruises. Cupping time should also be short. I find that no matter how healthy the elderly look. When cupping children use small size cups. soak in Miltons solution for twelve hours or sterilise in an autoclave. I usually ask the mother if I can demonstrate the technique on her. The parent can help by holding the child and talking to them. In any case it will fade away in a week or less. once a week is a typical frequency. quickly and briefly introducing the flame into the mouth of the cup.g. so when cupping is performed on the elderly. but remember that some children are petrified of fire. When removing cups. In winter months the glass cups are very cold. Remember to explain beforehand what you are about to do and why you are doing it. until the circulation improves and stagnation disperses. This is a normal energetic situation. I put a small cup there for the child to touch and feel. Zhongwan REN-12. The same index finger pressing technique is used when the suction is too strong and you wish to reduce the strength. elderly people or children. Firmly squeeze the cotton ball to remove any excess alcohol (to prevent flaming alcohol dropping on to the skin). do not leave the cups on for a long time. all Back-Shu points. Where cupping is done for the first time. and take them close to the location. The strength of the cupping should be low to medium. lightly pierce the skin and let the fluid out. Hold the cup in one hand.When blisters do occur. The most common sites for cupping on adults are: the knees (Xiyan). as they can turn very suddenly and touch your hand or try to push the flame away. One can use cups on the same points even when the bruises are not cleared completely. In this way suction is created and the cup will be held in the desired position. and do not use the strong method as their energies can be drained. How often can cupping be used? Cupping can be used every day until the condition improves. but not strong. If the cups have been in contact with blood. Cupping on Children Cupping is very safe for children over three years of age. to eliminate the risk of absorbing perverse energies which have been drawn out 6. In some cases a blister can appear. there is always an energy deficiency. Children under five need most attention. leave the cups on for a shorter period the first session. so ask the parent to hold the child firmly. Give the cups to the child to see and hold. choose the size and number of cups to be used. When cupping is applied to the same area for a second time. so clean the area using soft paper. and a low to medium strength method used. the degree of bruising depending on the strength of cupping. As a a rule. Summer holiday months are not the best time for cupping. Over-heating the rim of the cup can result in burning the skin of the patient! After applying the cups. the shoulders and points on the lower back . the skin will be hot and tender in places. In syndromes of Yang excess. Never force cupping on a child if he or she is showing substantial fear. so take extra care to relax them before treatment. allowing some air into the cup for the suction to cease . e. The most common complaints for which cupping is used on children include asthmatic and digestive conditions. Zhangmen LIV13.JOURNAL OF CHINESE MEDICINE NUMBER 37 SEPTEMBER 1991 energies between patients. and are even lighter at the third and subsequent applications until they disappear totally as the stagnation in the affected area disappears and the flow of blood and energy is regulated. cover the patient and keep them warm. the rims should first be warmed by briefly holding the flame just below the rims. and using her forearm. Suction strength can be regulated by the size of the flame and the length of time you leave the flame in the cup. The more you practice. Suction is created by briefly introducing a flame into the cup. but do not apply cups to the affected area until the blister heals. The suction of these small cups is quite sufficient for children. make sure that the cup is held away from your face. After the cups are removed the skin becomes very tender. and apply fresh oil while gently massaging the area to relax the patient. Once the cup is on they usually don’t mind at all.

5. On following Conclusion Always remember the potential dangers of cupping treatment.JOURNAL OF CHINESE MEDICINE NUMBER 37 SEPTEMBER 1991 ommended to start cupping with a low to medium strength. Jianjing GB-21. For Damp-Heat and stagnation of Qi. Diagnosis: chronic cold with retention of phlegm.I. bedwetting is considered as lower back (Kidney energy) deficiency. Weishu BL-21. furuncles. Dingchuan (Extra). Contraindications of cupping i. The cups can normally only be retained for five to ten minutes before air seeps in and reduces the suction. hold the cup under running hot water and place in a bucket with Miltons solution for twelve hours before using the same cup again. End the cupping treatment with a gentle massage to the treated area and reassure your patient that any bruising should fade away within a week. Do not use strong cupping method or long duration cupping at the first visit.5 to 1 cun lateral to Dazhui DU-14) and Feishu BL-13. ii. Phlegm: thick phlegm. Zhangmen LIV-13. worse in the mornings.-15. heat represents energy in any form and shape.16. Treatment: Chize LU -5. Feishu BL-13 (5 minutes cupping). Blisters can form very rapidly if the suction is strong. resulting in improvement in the wheezing but still very thick and persistent phlegm. Avoid strong cupping in the abdomen and stomach. Heat syndromes: All types of boils. Kidney Qi Xu: Jingmen GB-25. Zhangmen LIV-13. Mingmen DU-4 and Shenshu BL-23. and increase the suction as the treatment progresses. In Turkish folk medicine this is said to be due to 'weak back'. Lieque LU-7 (needles). Otherwise cupping can be used with safety up to the seventh month of pregnancy. her milk may become thick and her breasts painful. 6. your patient. good build. especially the lower back. I previously used Cidex solution for sterilising cups. Liangqiu ST-34. 9 years old Complaint: asthma since birth. If used. and familiarise and relax them before applying the cups. Knees: For painful and swollen knees Xiyan (Extra). 3. Do not apply cups over scaly or burned skin. On the first five visits I used acupuncture and moxibustion only. Jianyu L. As I mentioned earlier. Also moving method can be used on the whole length of the Back-Shu points until heat comes up to the surface.I. 4. wheezing. By my understanding.-14. Notes 1. but use the index finger pressing method at the base of the cup and the suction will cease. Berks. During pregnancy never apply cups to the abdominal or stomach regions. Shenshu BL-23. Medication: inhaler 5-7 times a day. the room should be well ventilated and one should avoid contact with the skin.I. Alternatively sterilise in an autoclave. Reading. you are dealing with fire and alcohol at the same time. use the same points but use the moving method on Weishu BL-21 until bruises appear. Zhongwan REN-12 and Pishu BL-20. When treating children ask the parent to remian and help you if necessary. Dahe KID-12. First published in Great Britain by Cox and Wyman Ltd. Inform 25 25 . you are bound to draw out some kind of energy. Be gentle when removing the cups. Lower backache: Mingmen DU-4. Pishu BL-20 (moxibustion). Digestive Complaints: Zhongwan REN-12. Guanyuanshu BL-26. Jugu L. Riyue GB-24. Bedwetting: Mingmen DU-4. using a light or medium method and with the liberal use of oil. In cases of blood contaminating the cup. This condition is usually relieved by massaging with warm olive oil and drinking hot soup for a few days. Pangguangshu BL-28 and Zhishi BL-52. never pulling them. 2. During the removal of the cups. in this case remove the cups without delay. iii. usually CASE HISTORIES 1. Bamboo cups can successfully be used over hairy areas. Feishu BL-13. Digestive weakness (Spleen-Qi Xu): Riyue GB-24. Shenshu BL-23 and Pangguangshu BL-28. Do not use cupping in any form on patients with Yin or Yang depletion. Asthma: Dingchuan (Extra . This condition is very common if children are frightened or experience some kind of shock which drains their Kidney energy. Before lighting the cotton wool make sure that you have squeezed out the excess alcohol. Male. Menstrual disorders: Zhangmen LIV-13. Stay with the patient in the cubicle and remove the cups if they are hurting. Appearance: white forehead. Headache due to hypertension and Yang excess: Dazhui DU-14 and Jianjing GB-21. Hold the cups away from your face when removing and wash the cups with soapy water. eczema and psoriasis: Dazhui DU-14 and Geshu BL-17 (Influential point of the Blood). the equivalent of Kidney-Xu in TCM. Hiccup: Strong method on Geshu BL-17 and Jueyinshu BL-14. It has just now been brought to my attention that Cidex solution is a highly dangerous carcinogenic agent and should be handled with care. The treatment of common complaints by cupping Frozen Shoulder: Binao L.0. Cold in the mother's milk: this is a very common syndrome with mothers who breast-feed their children. indicated by the appearance of bruising. Rheumatic and arthritic conditions: Use local points and Dashu BL-11 (Influential point of the Bones). or back points. Women are prone to miscarry between 3 and 5 months. Mingmen DU-4 and Guanyuanshu BL-26. When the mother catches cold or over-indulges in cold food.

Female. Pulse: rapid at all levels. 45 years Complaint: arthritic knees for five years. riasis sufferers is Yin-Xu and wind in the channels indicated by dryness and itching. and Needle-Cupping method at bilateral Xiyan (Extra) and Liangqiu ST-34. Medium cupping was applied to the Back-Shu points weekly to help reduce heat in the channels and restore energy circulation. damp-heat rising. He still continues treatment once a month. Qihai REN-6. Pulse: rapid. wind. HRT for two years. Medical history: breast cancer surgery five years ago. 2. Treatment: the most common syndrome I find with pso- 26 26 . Medication: various types of corticosteroids for three years resulting in fine creases on the face. Treatment: moxibustion and reinforcing acupuncture on points such as Zhongwan REN-12. After three months of treatment her psoriasis has almost cleared. Female. Tongue: dry with red tip. Zhangmen LIV-13. After three such treatments the quantity of phlegm was significantly reduced. generally feels tired and has stopped working. Tongue: thick whitish coating. At the end of a course of treatment both knees were free of pain and she was able to return to work.JOURNAL OF CHINESE MEDICINE NUMBER 37 SEPTEMBER 1991 weeks I added cupping to the treatment. itchy. Zusanli ST-36 and Sanyinjiao SP-6. Zusanli ST-36 and Sanyinjiao SP-6. She has relapses with flare-ups especially when under emotional stress and still comes for treatment andCASE HISTORIES evaluation once a month. Reinforcing needling was applied to Zhongwan REN-12. 3. Diagnosis: Blood-Xu with phlegm retention. age 24 Complaint: psoriasis spreading all over the body. thirsty. he was able to stop using the inhaler and was much more active at school. Qihai REN-6. Diagnosis: Yin-Xu. Zhangmen LIV-13.

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