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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 room, and then let them stay in the steam for ten to
I had a bad cold and my mother put some fifteen minutes in order to induce sweating. This
cups on my back. I could feel the edges of the was a useful approach since few people had Turk-
glass sinking deep into my flesh. As the bruises ish baths in their own homes. Almost every home
appeared, my mother took the cups off, only to in Cyprus has a set of cups in their cupboards. In
replace them with fresh ones! After cupping I was the old days olive oil wicks and ordinary drinking
rubbed with home made alcohol and made to stay glasses or empty marmalade jars were used for
in bed, covered with plenty of blankets in order to cupping. Nowadays properly designed thick edged
make me sweat. Sure enough, within half an hour cupping glasses are imported from France or the
the bed was soaked with sweat. As soon as the sweat- Far East. This very ancient Chinese medicine prac-
ing was over I was pushed into a hot tice was introduced to the Mediterra-
bath and then returned to bed.The nean region by the Ottoman Turks
next day I was able to play out- who originally came from
side with the other children Turkistan, now part of the
and my cold was history. People’s Republic of
This story is, perhaps China (Sinkiang Uighur
surprisingly, not one Autonomous Region
which took place in of the People’s Re-
China, but in my public of China,
native country of East Turkistan). As
Cyprus. I was the Ottomans
seven years old moved West, and
when I had my eventually into
first cupping ex- Europe, this tra-
perience, and in dition came with
the following them. Today
years, I remem- most of the Medi-
ber cupping was terranean cul-
the only method tures still use cup-
used in our home ping, especially
for treating cold the Turks, Greeks,
conditions such as Arabs, Southern
sneezing and runny Italians, Southern
nose with headache French and Spanish.
and stiff back due to While cupping was al-
working in the rain or ways a folk medicine in
wind, and was even used for these countries, it was used
bed wetting (In Turkish folk more scientifically in English
medicine, bed wetting is considered hospitals in the past. Frieda Sandwith
to be a symptom of weak back due to “catch- in “Surgeon Compassionate”3 describes the
ing cold on the back”, or due to some kind of shock). work of her great grandfather William Marsden
My grandmother, who was the only midwife in and the use of cupping in hospitals in the 1830’s to
the area, also used cupping quite extensively for treat contagious diseases. She refers to “paid
the treatment of many female complaints, such as cuppers” working in these hospitals. Unfortunately,
painful or irregular periods, cold in mother’s milk 1, as modern drugs were developed, cupping along
miscarriage due to weakness of the back 2 and many with other simple but effective methods, as well as
more general complaints. She would use different the traditional Apothecary, were excluded from
sized drinking glasses and marmalade jars for cup- general practice, being contemptuously regarded
ping. Her favourite method was to take her pa- as “old women’s remedies”. It is very ironic that
tients to a Turkish bath, apply the cups in the cold we, as alternative practitioners, have to prove to
today’s medical profession that cupping - and in-

21 21

If children are enough oil. For the elderly and for people with severe With a new patient.Qi stagnation degree of discomfort when treated but we.helping to build up the patient’s confidence.Weak the suction will cause a pulling sensation on the skin but cupping should not induce bruising or any sensation of not pain. always ask the mother or father to be present Medium Cupping: with medium cupping. tion. . The suction is less noticeable with thin and pulling. It causes bruising very particular technique. As far as acupuncturists are con.chronic back aches due to kidney energy deficiency tion should be exercised when washing glass cups as . Before attempting to use cups. Chinese healing art.With bamboo cups there is no . as the edges are thinner . and increase the suction as the treatment progresses is advised. Most suppliers prefer to sell the cups as a set. and the skin rises just a little inside the cup. Cau. then the suction is too strong. If it does. Most sets include one . To ensure good suc- the first consultation. in the West .weakness of the digestive system (poor appetite. and show the cups to the enough to hold the cup in place. Any vegetable oil will do. Very little bruis- tion. and other tactile therapists. Most particularly suitable for debilitated patients and for chil- people will tell you that they have indeed seen cups on dren. and integrated to suit their or weak or elderly patients. Strong cupping is best used on robust adults.cold and wind attacking and penetrating the body than those of the glass cups. Bamboo cups can also be found but. so that they know what to expect. Cups are normally left for 10-20 minutes in adults television programs and read about the technique but and 2-5 minutes in children. Needle Cupping. of thick glass. it is advised not to leave the cups in place for more than 3-5 When and where to use cups minutes. I would Firm suction is desirable in order to achieve good advise all practitioners never to apply strong cupping at therapeutic results from cupping. Explain that can be kept in place for a longer period if needed. always moisten the treatment area with oil. and Clove. It is done by moving the cups while they are in turists who do not make use of this valuable traditional 2222 . It is also remove the cups and and re-apply. but olive oil is particularly benefi. Whenever strong cupping is used for the first time. . shoulders and most frequently used on their own. rather diarrhoea and dull ache in the lower abdomen) than supplying single size cups. cupping can be used independently or in con. comfortable. Medium cupping can also be applied You can apply cups with the patient in a sitting posi- to adults on the stomach and abdomen. especially when therapeutic applications. involved.on Ashi points to relieve blood stagnation they break quite easily. More emphasis on cupping and its do work effectively and are as cost effective today benefits during practical as well as theoretical training as they were then. rapidly and drains the energy if the cups are left for a cerned. about a fire lit next to their skin. Strong Cupping: strong cupping should normally only be cial. Many people are nervous ping. and can add strength and effectiveness to a great many personally. acupressure (shiatsu) the cups. long time. It is particularly beneficial in it comes to sterilisation4. arthritic joints able from Chinese medicinal suppliers. Moving. and Full cupping (bleeding). It is advisable to try to firmer. used on patients who have experienced medium strength Avoid irritating oils such as Eucalyptus. This type of cupping is not suitable for children. and it makes me very sad to see so many acupunc. or lying prone or supine. Both types of cups are easily obtain. and one very small size. In addition. but in weak cupping they have never actually seen it done to anybody. teen years of age. Empty cupping. Coconut oil may be used for more sensitive skins.poor circulation should try and make the treatment as pleasant as possi. ble. The Chinese accept some . Moxa Cup- your patient is fully relaxed. Cupping therapy in knees. Wintergreen cupping previously. I usually start with medium cup- asthmatic or heart conditions an upright sitting position ping.to draw out pathogenic dampness. . especially from danger of breaking. would be helpful. cupping. whichever is the more ing will appear even if the cups are left for a long time.asthmatic conditions very large. Moving Cupping: this is the most painful method of ists. two medium. in order to reduce their fear method is suitable for children between seven and four- to a minimum. junction with acupuncture (while the needles are in Strong cupping is not suitable on the abdomen or stom- position or following their removal). and is mainly applied on the back. Which cups to use Benefits Sets of cups are available in different sizes and are made Cupping regulates the flow of Qi (energy) and blood. Strong. Each time new cups important that you ask your patient to sit still and not to are applied make sure that the skin is moistened with make sudden movements while cupping. always make sure that Medium. Explain your intentions Weak Cupping: this is done with minimum suction. just and the benefits of cupping. This hide the fire from the child. although cups are ach. I do not find them practical. this country is unfortunately used by few acupunctur. the suction is in the treatment room with you. and more on smooth and fat skin. and always massage the area after removing Cupping may be used by massage. the bamboo version the following situations: tends to cause more discomfort. JOURNAL OF CHINESE MEDICINE NUMBER 37 SEPTEMBER 1991 deed many more previously practised therapies . so hairy people5.This type of cupping is patient (and let him or her touch and feel them). The Eight Methods of Cupping Before using cups There are eight different methods of cupping: Weak.

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

and are even lighter at the third and lower back . and apply cups on for a long time. The the flame and the length of time you leave the flame in parent can help by holding the child and talking to them. Children generally prefer cupping to acu- Small rolls of cotton wool can be prepared beforehand puncture. as they can turn very the cups are turned on the skin. as patients will not be pleased when having to used. The same index but not strong. allowing some The strength of the cupping should be low to medium. When the desired cupping time is complete. cups on for more than five minutes as this can cause bad remove the cups by pressing firmly with the index finger blisters and bruises and also drain the Wei-Defensive Qi. Never force then turn it upside down and place it on the skin. One can period. dipped into alcohol and lit. Cupping is very safe for children over three years of age. As a a rule. Apply oil to the skin area to be cupped to ensure Cupping on Children a good suction (see above). there is always an energy energies which have been drawn out 6. I find that no matter your face. The more you practice. before introducing the flame into the cup. the cup. but as this may not be practicable in western time cupping takes place they can be left for a longer countries. When cupping children use small size cups. I put a small cup the cup in one hand. and bruises. and take them close to the location. and do not use the strong method fresh oil while gently massaging the area to relax the as their energies can be drained. e. When cup- the knees (Xiyan). than when they arrived. make sure that the cup is held away from getic level and age of the person. number of cups to be used.When blisters do occur. and beforehand what you are about to do and why you are if blisters start to appear then use your index finger to doing it. Remember to explain your patient all the time and monitor the progress. In this cupping on a child if he or she is showing substantial way suction is created and the cup will be held in the fear. close to the skin. bruises 13. but remember that some children are petrified and kept soaked in alcohol in a tightly closed jar. Suction is created by briefly introducing a flame into The reason for this age limit is the fact that the skin of a the cup. squeeze the cotton ball to remove any excess alcohol (to I usually ask the mother if I can demonstrate the tech- prevent flaming alcohol dropping on to the skin). In syn- the degree of bruising depending on the strength of dromes of Yang excess. When re- When using cups on adults one must consider the ener- moving cups. Over-heating The most common complaints for which cupping is used the rim of the cup can result in burning the skin of the on children include asthmatic and digestive conditions.g. so ask the In winter months the glass cups are very cold. and each improves. cover the patient and keep rule when using cups on children is never to leave the them warm. Children under five need most attention. finger pressing technique is used when the suction is too Cupping on Adults strong and you wish to reduce the strength. but do not apply cups to the Decide the location of the cupping. and explain the importance of relaxing the reduce the suction. lightly pierce whole body. not cleared completely. so clean the area using soft paper. so take extra care to relax them before treatment. the shoulders and points on the are much reduced. deficiency. and the cups can be left in place for longer time Summer holiday months are not the best time for cup- (20-30 minutes) and the strong or moving method can be ping. all Back-Shu points. younger adults with any deficiency syndrome. the skin and let the fluid out. JOURNAL OF CHINESE MEDICINE NUMBER 37 SEPTEMBER 1991 energies between patients. leaving them more tired patient. and a low to medium strength method used. It is preferable to stay with hours or sterilise in an autoclave. air into the cup for the suction to cease . patient! and all Back-Shu points can be used safely. Zhangmen LIV- ping is applied to the same area for a second time. and using her forearm. subsequent applications until they disappear totally as the stagnation in the affected area disappears and the How often can cupping be used? flow of blood and energy is regulated. Hold nique on her. quickly and briefly there for the child to touch and feel. This is a normal energetic situation. Firmly of fire. One golden After applying the cups. away. on nearly always be a bruise mark at the site of application. it is rec- In some cases a blister can appear. do not leave the tender. leave Cupping can be used every day until the condition the cups on for a shorter period the first session. If the cups have been in strong cupping is applied on a very sensitive skin. the skin will be hot and tender in cupping. Give the cups to the child to see and hold. As mentioned earlier. the rims should first be suddenly and touch your hand or try to push the flame warmed by briefly holding the flame just below the rims. so before parent to hold the child firmly. Cupping time should also be Where cupping is done for the first time. to eliminate the risk of absorbing perverse how healthy the elderly look. places. The most common sites for cupping on adults are: explain unsightly bruises on exposed flesh. When I am con- introducing the flame into the mouth of the cup. Once the cup is on they usually don’t mind at all. Suction strength can be regulated by the size of dren. particularly when 2424 . and vinced that the child is ready I then proceed. so when After the cups are removed the skin becomes very cupping is performed on the elderly. choose the size and affected area until the blister heals.This is done with a piece of cotton wool which is child under three years old is very susceptible to blisters held in a long pair of forceps. there will be short. once a week is a typical frequency. until the circulation improves and stagnation use cups on the same points even when the bruises are disperses. The desired position. soak in Miltons solution for twelve elderly people or children. Zhongwan REN-12. between the base of the cup and the skin. the quicker you suction of these small cups is quite sufficient for chil- will get. In any case it will fade away in a week or less. contact with blood.

but use the index finger pressing method at the or stomach regions. DU-14) and Feishu BL-13.I. 9 years old Pangguangshu BL-28. Jugu L. Appearance: white forehead.-14. On following 25 25 . good build. During pregnancy never apply cups to the abdominal them. 5. Also moving method can be used retained for five to ten minutes before air seeps in and on the whole length of the Back-Shu points until heat reduces the suction. comes up to the surface. If used. Before lighting the cotton wool make sure On the first five visits I used acupuncture and moxi- that you have squeezed out the excess alcohol. Headache due to hypertension and Yang excess: Dazhui 3. Jianyu L. Liangqiu ST-34. Reading. Avoid strong cupping in the abdomen and stomach. Mingmen DU-4 and contact with the skin. eczema areas. and familiarise and relax them before strength. This condition is usually relieved by Zhangmen LIV-13. Dingchuan (Extra). Knees: For painful and swollen knees Xiyan (Extra). never pulling iii. worse in the mornings. using a light or medium method and with the and psoriasis: Dazhui DU-14 and Geshu BL-17 (Influen. breasts painful. Stay with the patient in the cubicle and remove the cups if they are Contraindications of cupping hurting. massaging with warm olive oil and drinking hot soup for a few days. Shenshu BL-23. Shenshu BL-23. Do not apply cups over scaly or burned skin. This condition is very common if children are frightened Phlegm: thick phlegm. furuncles. CASE HISTORIES Dahe KID-12. in cold food. Pishu BL-20 (moxibustion). End the cupping treatment with a gentle 16. Notes Digestive Complaints: Zhongwan REN-12. long duration cupping at the first visit. treatment. Women are prone to miscarry between 3 and 5 months. When treating children ask the parent to remian i. bedwetting Complaint: asthma since birth. Lower backache: Mingmen DU-4. Cold in the mother's milk: this is a very common LIV-13. Do not use strong cupping method or progresses.. same time. In cases of blood contaminating the cup. hold the cup under running hot water and place in The treatment of common complaints a bucket with Miltons solution for twelve hours before by cupping using the same cup again. massage to the treated area and reassure your patient that any bruising should fade away within a week.-15. Be gentle when removing the cups. As I mentioned earlier. use the same points but use the moving method on dren. Weishu BL-21. Lieque LU-7 (needles). liberal use of oil. Conclusion Treatment: Chize LU -5. Otherwise cupping can be used with safety up to away from your face when removing and wash the cups the seventh month of pregnancy.I. or back points. Do not if the suction is strong. is considered as lower back (Kidney energy) deficiency. usually BL-14. and help you if necessary. The cups can normally only be tial point of the Blood). I previously used Cidex solution for sterilising cups. the room should be well ventilated and one should avoid Kidney Qi Xu: Jingmen GB-25. heat represents energy in any bruising. 2. Menstrual disorders: Zhangmen LIV-13. Male. Jianjing GB-21.5 to 1 cun lateral to Dazhui 4. Guanyuanshu BL-26. JOURNAL OF CHINESE MEDICINE NUMBER 37 SEPTEMBER 1991 ommended to start cupping with a low to medium your patient. Bedwetting: Mingmen DU-4. autoclave. with soapy water. Pangguangshu BL-28 and Zhishi In Turkish folk medicine this is said to be due to 'weak BL-52. form and shape. When the mother catches cold or over-indulges Weishu BL-21 until bruises appear. back'. or experience some kind of shock which drains their Medication: inhaler 5-7 times a day. you are dealing with fire and alcohol at the Feishu BL-13 (5 minutes cupping). Ltd. Riyue GB-24. agent and should be handled with care. especially the lower base of the cup and the suction will cease. For Damp-Heat and stagnation syndrome with mothers who breast-feed their chil- of Qi. Feishu Always remember the potential dangers of cupping BL-13. you Hiccup: Strong method on Geshu BL-17 and Jueyinshu are bound to draw out some kind of energy. Kidney energy. wheezing. Blisters can form very rapidly ii. Zhangmen 1. During the removal of the cups. Shenshu BL-23 and 1. It has just now been brought to my attention that Rheumatic and arthritic conditions: Use local points Cidex solution is a highly dangerous carcinogenic and Dashu BL-11 (Influential point of the Bones). in this case remove the cups use cupping in any form on patients with Yin or Yang without delay. Bamboo cups can successfully be used over hairy Heat syndromes: All types of boils.I. Berks. her milk may become thick and her Digestive weakness (Spleen-Qi Xu): Riyue GB-24. Diagnosis: chronic cold with retention of phlegm. Alternatively sterilise in an Frozen Shoulder: Binao L.0. Asthma: Dingchuan (Extra . resulting in improvement in the wheezing but still very thick and persistent phlegm. Mingmen DU-4 and Guanyuanshu BL-26. Hold the cups back. the equivalent of Kidney-Xu in TCM. depletion. First published in Great Britain by Cox and Wyman DU-14 and Jianjing GB-21. indicated by the appearance of 6. By my understanding. Inform bustion only. Zhongwan REN-12 and Pishu BL-20. and increase the suction as the treatment applying the cups.

Zusanli ST-36 and Sanyinjiao SP-6. wind. Female. thirsty. Zhangmen LIV-13. Qihai much more active at school. Tongue: dry with red tip. Medium once a month. Diagnosis: Blood-Xu with phlegm retention. After three months of treatment her psoriasis has Pulse: rapid at all levels. age 24 Complaint: psoriasis spreading all over the body. He still continues treatment REN-6. itchy. 3. Qihai REN-6. HRT for two years. almost cleared. treatment andCASE HISTORIES evaluation once a month. Pulse: rapid. After three such riasis sufferers is Yin-Xu and wind in the channels indi- treatments the quantity of phlegm was significantly cated by dryness and itching. She has relapses with flare-ups espe- Tongue: thick whitish coating. JOURNAL OF CHINESE MEDICINE NUMBER 37 SEPTEMBER 1991 weeks I added cupping to the treatment. Treatment: moxibustion and reinforcing acupuncture on points such as Zhongwan REN-12. Treatment: the most common syndrome I find with pso- 2626 . Diagnosis: Yin-Xu. Female. Zusanli ST-36 and Sanyinjiao SP-6. Reinforcing needling was reduced. he was able to stop using the inhaler and was applied to Zhongwan REN-12. cupping was applied to the Back-Shu points weekly to help reduce heat in the channels and restore energy 2. 45 years circulation. cially when under emotional stress and still comes for Medical history: breast cancer surgery five years ago. Zhangmen LIV-13. At the end of a course of treatment both knees were free of pain and she was able to return to work. generally feels tired and has stopped working. Complaint: arthritic knees for five years. Medication: various types of corticosteroids for three years resulting in fine creases on the face. damp-heat rising. and Needle-Cupping method at bilateral Xiyan (Extra) and Liangqiu ST-34.