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

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

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

Also moving method can be used on the whole length of the Back-Shu points until heat comes up to the surface. On the first five visits I used acupuncture and moxibustion only. In Turkish folk medicine this is said to be due to 'weak back'. Medication: inhaler 5-7 times a day. Kidney Qi Xu: Jingmen GB-25. Be gentle when removing the cups. Zhangmen LIV-13. Lieque LU-7 (needles). Dingchuan (Extra). Blisters can form very rapidly if the suction is strong.16. using a light or medium method and with the liberal use of oil. Stay with the patient in the cubicle and remove the cups if they are hurting. or back points. Alternatively sterilise in an autoclave.-15. Feishu BL-13. Riyue GB-24. never pulling them. When treating children ask the parent to remian and help you if necessary. Weishu BL-21. and increase the suction as the treatment progresses. you are bound to draw out some kind of energy. good build. 6. Mingmen DU-4 and Guanyuanshu BL-26. Zhangmen LIV-13. your patient. Heat syndromes: All types of boils. Notes 1.I. The cups can normally only be retained for five to ten minutes before air seeps in and reduces the suction. The treatment of common complaints by cupping Frozen Shoulder: Binao L. During pregnancy never apply cups to the abdominal or stomach regions. Shenshu BL-23 and Pangguangshu BL-28. Phlegm: thick phlegm.I. In cases of blood contaminating the cup. 3. Pangguangshu BL-28 and Zhishi BL-52. Cold in the mother's milk: this is a very common syndrome with mothers who breast-feed their children. especially the lower back. Shenshu BL-23. eczema and psoriasis: Dazhui DU-14 and Geshu BL-17 (Influential point of the Blood). Digestive weakness (Spleen-Qi Xu): Riyue GB-24. Hold the cups away from your face when removing and wash the cups with soapy water. wheezing. 5.0. and familiarise and relax them before applying the cups. Diagnosis: chronic cold with retention of phlegm. Mingmen DU-4 and Shenshu BL-23. hold the cup under running hot water and place in a bucket with Miltons solution for twelve hours before using the same cup again. Jugu L. Do not use strong cupping method or long duration cupping at the first visit. Headache due to hypertension and Yang excess: Dazhui DU-14 and Jianjing GB-21. Menstrual disorders: Zhangmen LIV-13. First published in Great Britain by Cox and Wyman Ltd. her milk may become thick and her breasts painful. This condition is very common if children are frightened or experience some kind of shock which drains their Kidney energy. Appearance: white forehead. It has just now been brought to my attention that Cidex solution is a highly dangerous carcinogenic agent and should be handled with care. 4. furuncles. This condition is usually relieved by massaging with warm olive oil and drinking hot soup for a few days. Contraindications of cupping i. Berks. On following Conclusion Always remember the potential dangers of cupping treatment. If used. Hiccup: Strong method on Geshu BL-17 and Jueyinshu BL-14. I previously used Cidex solution for sterilising cups. Zhongwan REN-12 and Pishu BL-20. in this case remove the cups without delay. By my understanding. Women are prone to miscarry between 3 and 5 months. Guanyuanshu BL-26. Bamboo cups can successfully be used over hairy areas. the equivalent of Kidney-Xu in TCM.-14. ii. Treatment: Chize LU -5. Liangqiu ST-34. Reading. As I mentioned earlier. use the same points but use the moving method on Weishu BL-21 until bruises appear. Rheumatic and arthritic conditions: Use local points and Dashu BL-11 (Influential point of the Bones). heat represents energy in any form and shape. For Damp-Heat and stagnation of Qi. Dahe KID-12. Knees: For painful and swollen knees Xiyan (Extra). Inform 25 25 .JOURNAL OF CHINESE MEDICINE NUMBER 37 SEPTEMBER 1991 ommended to start cupping with a low to medium strength. During the removal of the cups. Avoid strong cupping in the abdomen and stomach. 9 years old Complaint: asthma since birth. Feishu BL-13 (5 minutes cupping). Male.I. the room should be well ventilated and one should avoid contact with the skin. 2. Before lighting the cotton wool make sure that you have squeezed out the excess alcohol. When the mother catches cold or over-indulges in cold food. Otherwise cupping can be used with safety up to the seventh month of pregnancy. usually CASE HISTORIES 1. Jianyu L. bedwetting is considered as lower back (Kidney energy) deficiency. Digestive Complaints: Zhongwan REN-12. Bedwetting: Mingmen DU-4.5 to 1 cun lateral to Dazhui DU-14) and Feishu BL-13. Do not apply cups over scaly or burned skin. indicated by the appearance of bruising. resulting in improvement in the wheezing but still very thick and persistent phlegm. but use the index finger pressing method at the base of the cup and the suction will cease. worse in the mornings. you are dealing with fire and alcohol at the same time. Asthma: Dingchuan (Extra . iii. Jianjing GB-21. Do not use cupping in any form on patients with Yin or Yang depletion. Pishu BL-20 (moxibustion). Lower backache: Mingmen DU-4. 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.

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