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

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

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

but use the index finger pressing method at the base of the cup and the suction will cease. Guanyuanshu BL-26. resulting in improvement in the wheezing but still very thick and persistent phlegm. Medication: inhaler 5-7 times a day. Zhongwan REN-12 and Pishu BL-20.-14. For Damp-Heat and stagnation of Qi. Jianjing GB-21. Bamboo cups can successfully be used over hairy areas. Zhangmen LIV-13. Shenshu BL-23. By my understanding. 3. Treatment: Chize LU -5. or back points. Feishu BL-13. The cups can normally only be retained for five to ten minutes before air seeps in and reduces the suction. in this case remove the cups without delay. Phlegm: thick phlegm. Jugu L. Avoid strong cupping in the abdomen and stomach. use the same points but use the moving method on Weishu BL-21 until bruises appear. The treatment of common complaints by cupping Frozen Shoulder: Binao L. the room should be well ventilated and one should avoid contact with the skin. Mingmen DU-4 and Shenshu BL-23. ii. Stay with the patient in the cubicle and remove the cups if they are hurting. eczema and psoriasis: Dazhui DU-14 and Geshu BL-17 (Influential point of the Blood). indicated by the appearance of bruising. Notes 1. wheezing. Also moving method can be used on the whole length of the Back-Shu points until heat comes up to the surface. worse in the mornings. usually CASE HISTORIES 1. Hold the cups away from your face when removing and wash the cups with soapy water. Riyue GB-24. Digestive weakness (Spleen-Qi Xu): Riyue GB-24. you are dealing with fire and alcohol at the same time. When the mother catches cold or over-indulges in cold food. I previously used Cidex solution for sterilising cups. Cold in the mother's milk: this is a very common syndrome with mothers who breast-feed their children. 2. If used. Feishu BL-13 (5 minutes cupping). heat represents energy in any form and shape. Knees: For painful and swollen knees Xiyan (Extra). Pishu BL-20 (moxibustion). Jianyu L. 4. As I mentioned earlier. your patient. During the removal of the cups. Menstrual disorders: Zhangmen LIV-13. Do not use cupping in any form on patients with Yin or Yang depletion. Liangqiu ST-34. When treating children ask the parent to remian and help you if necessary. It has just now been brought to my attention that Cidex solution is a highly dangerous carcinogenic agent and should be handled with care. Shenshu BL-23 and Pangguangshu BL-28.5 to 1 cun lateral to Dazhui DU-14) and Feishu BL-13. Reading. Lieque LU-7 (needles).-15. good build.I. furuncles. Do not apply cups over scaly or burned skin. Otherwise cupping can be used with safety up to the seventh month of pregnancy. 9 years old Complaint: asthma since birth. In cases of blood contaminating the cup. In Turkish folk medicine this is said to be due to 'weak back'. Bedwetting: Mingmen DU-4.I. Dingchuan (Extra). First published in Great Britain by Cox and Wyman Ltd. Male. 5. Berks. Rheumatic and arthritic conditions: Use local points and Dashu BL-11 (Influential point of the Bones). Heat syndromes: All types of boils.0. especially the lower back. Blisters can form very rapidly if the suction is strong. Digestive Complaints: Zhongwan REN-12. Lower backache: Mingmen DU-4. Weishu BL-21. hold the cup under running hot water and place in a bucket with Miltons solution for twelve hours before using the same cup again. Diagnosis: chronic cold with retention of phlegm. Before lighting the cotton wool make sure that you have squeezed out the excess alcohol. Hiccup: Strong method on Geshu BL-17 and Jueyinshu BL-14.16. Appearance: white forehead. never pulling them. using a light or medium method and with the liberal use of oil. and familiarise and relax them before applying the cups. Pangguangshu BL-28 and Zhishi BL-52. This condition is very common if children are frightened or experience some kind of shock which drains their Kidney energy. Asthma: Dingchuan (Extra . Do not use strong cupping method or long duration cupping at the first visit. Dahe KID-12. Mingmen DU-4 and Guanyuanshu BL-26. On following Conclusion Always remember the potential dangers of cupping treatment. 6. Inform 25 25 . her milk may become thick and her breasts painful. the equivalent of Kidney-Xu in TCM. Contraindications of cupping i. Alternatively sterilise in an autoclave.I. During pregnancy never apply cups to the abdominal or stomach regions. Be gentle when removing the cups. Headache due to hypertension and Yang excess: Dazhui DU-14 and Jianjing GB-21. you are bound to draw out some kind of energy.JOURNAL OF CHINESE MEDICINE NUMBER 37 SEPTEMBER 1991 ommended to start cupping with a low to medium strength. iii. Women are prone to miscarry between 3 and 5 months. and increase the suction as the treatment progresses. This condition is usually relieved by massaging with warm olive oil and drinking hot soup for a few days. Kidney Qi Xu: Jingmen GB-25. 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. Zhangmen LIV-13. On the first five visits I used acupuncture and moxibustion only. bedwetting is considered as lower back (Kidney energy) deficiency.

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