by Ilkay Chirali


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-

21 21

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

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

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

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

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