Cupping for the Cure

Some believe that bruise-causing suction on the skin provides a variety of health benefits.

by Brian Dunning

Filed under Alternative Medicine, Consumer Ripoffs, Fads, Health

Skeptoid #359
April 23, 2013
Podcast transcript | Listen | Subscribe
Also available in Chinese | Russian
 

Today we're going to take a look at the practice of cupping, an alternative medicine scheme that involves placing suction cups on the skin. Cups, which are usually glass but can also be plastic, bamboo or anything, are placed on the skin, usually on the back, and the air pressure is reduced in them either by pumps or by heating them and causing cooling contraction. The placement of the cups is usually made according to traditional acupunture points. After a time, the cups are removed, and bruises remain. Various maladies are said to have been cured or treated. Cupping has been growing in pop culture lately, with even Hollywood celebrities such as Gwyneth Paltrow, Jennifer Aniston, and others going out of their way to wear low-cut dresses on the red carpet to show off their cupping bruises. It's an alternative medicine treatment that's also a fashion statement.

Cupping comes in a number of forms. Most popular today is fire cupping, where a cup (most often a glass bulb) is heated with a flame then pressed onto the person's back; as the hot air inside cools, the suction inside pulls blood to the surface and creates a bruise. Some cups have a valve to connect a suction pump. Wet cupping involves first making an incision, so the suction then causes profuse bleeding, and so it's basically a form of blood letting. Somewhat stunningly, this is still practiced today.

Cupping is almost always described as an ancient Chinese therapy, however it appears to have evolved independently all around the world at various times. The most frequently repeated history of cupping, that you'll find with most any Internet search, is that it comes from the Han Dynasty, and was referenced in a silk book from the year 168 BCE called 五十二病方 (The Fifty-Two Prescriptions). However, this is not true. The Fifty-Two Prescriptions described 52 healthy meals and did not include any sort of clinical treatments. However, by the time of the Tang Dynasty (618-907 CE), cupping was well established alongside acupuncture and was being taught in Chinese medical schools.

Native American tribes throughout North America were also discovered to use a form of cupping, though no written records tell us how long it had been in practice. They used wet cupping to bleed the patient. Usually animal horns were used, with a small hole at the narrow end through which the healer would suck with their mouth. Coastal tribes sometimes used shells.

But long before the Native Americans or the Chinese, the great Greek "Father of Modern Medicine", Hippocrates, recommended the best way that cupping could be used to treat a variety of maladies. According to the 19th century cupping practitioner Samuel Bayfield:

Hippocrates was a minute observer, and has left us some striking remarks on the shape and application of the cups. He recommends that they should be small in diameter, conical in shape, and light in their weight, even when the disease for which they are applied is deeply seated.

Even earlier than Hippocrates, cupping was being practiced in the Neo-Assyrian Empire, as described in cuneiform script impressed on clay tablets in about the year 700 BCE: "cupping by sucking, with the mouth or by using a buffalo horn."

But what's often claimed to be the oldest record of cupping comes from ancient Egypt. I visited a lot of web sites that promote the use of cupping while researching this article, and I found references to two ancient papyrii, called the Veterinary Papyrus and the Papyrus Ebers, which date from around 1800 BCE and are said to discuss the use of cupping. Both are fragmentary but the translations of what remains are available online, and in neither one could I find anything that could reasonably be interpreted as cupping. The oldest verifiable reference to Egyptian cupping that I did locate was a bronze cupping vessel in the collection of the Science Museum London, dated between 300 BCE and 300 CE, and a carved relief depicting medical instruments including suction cups in the Chapel of Sobek in the Temple of Kom Ombo, built in the 3rd century CE.

Why do cupping proponents reach for the oldest date they can find to attach to their practice? Trying to bolster your practice's credibility by claiming that it's really old says nothing about its validity; we call this the Appeal to Antiquity. In medical science, which has historically improved over time, antiquity is far more likely to be an indicator of obsolescence than of effectiveness.

But for those who remain convinced that the value of cupping lies in its great antiquity, then it is considerably less valuable than they've been led to believe.

But more important than its history was its use and utility. What did all of these ancient civilizations use cupping for? Well, basically, anything and everything. Virtually every description in the ancient texts indicates cupping as a treatment for different ailments. The Chinese version depended on acupuncture's theoretical meridians of qi, and the suction was believed to manipulate the body's alleged life force. The Native American version tended more toward sucking evil spirits out of the body. The Roman version was more pragmatic, and was used for sucking out poisons or cleaning injuries. But all these cultures also used it for just about anything that someone wanted cured.

This has not changed. Alternative medicine practitioners and acupuncturists who sell cupping today also lack a coherent description of its utility. The Hollywood version usually rides the wave of the modern detoxification fad, claiming that the suction will remove undescribed and nonspecific "toxins" from the body; though I've not seen any description of how low pressure would cause sweat glands to secrete toxins instead of the sweat that they are biologically able to produce. Humans are not poison dart frogs; we don't have toxin glands.

The suction does rupture capillaries, which is what causes the bruising; but even this does not cause blood — or any alleged "toxins" — to actually leak through the skin. Red blood cells remain lodged in the skin, and as they die and go through autolysis and are metabolized by the body, go through a series of color changes — black, blue, green, yellow — as bruises do. This bruising is the only real physiological effect that fire cupping has, and so far as I could determine, bruising does not have any accompanying medical benefits. Evidently it has some fashion value in Hollywood, but that's a bit outside of our scope here today.

I searched and searched for any clinical trials of cupping as a treatment for any disease, but there simply aren't any. There is a large number of published articles in alternative medicine journals, nearly all from China, but none that come from any legitimate peer-reviewed journals. Part of the problem is that there is no specific condition that cupping is alleged to treat; even the Chinese articles are all over the map: herpes, muscle strain, "meridian" diagnosis, back pain, even the common cold. It's pretty hard to design a proper clinical trial when there's no specific claim of what the proposed treatment does.

However, there's one very good reason that probably explains cupping's popularity in the modern world, despite its lack of any credible value. Modern cupping practitioners usually sell the service along with a massage, often both before and after the cupping procedure. Massage is extremely relaxing. It feels great and is a proven treatment for stress, anxiety, plus any number of muscular injuries and other pains.

Tip Skeptoid $2/mo $5/mo $10/mo One time

Moreover, massage actually has a mechanism by which it provides relief. Popular research performed at McMaster University in Canada and published in 2012 analyzed samples of muscle tissue both before and after brutal, tissue-damaging exercise, and compared muscles that underwent therapeutic massage with muscles that did not. The analysis provided the mechanism and underscored what physical therapists and massage therapists have known for decades, that massage significantly improves the healing of muscle. For a long time, it was believed that lactic acid buildup (a biochemical byproduct of working out muscles) was reduced by the physical action of massage, but the researchers found no evidence of that. Instead they found — and I'll spare you the complex biochemical explanations, which are detailed in the paper if you want to look it up — that massage both reduces tissue inflammation and promotes cell regrowth.

Coupled with the relaxation benefits, massage is both a pleasurable and genuinely healthful experience. And this is the case even if you do combine it with beads and rattles, recanting of charms, scattering of chicken bones, or fire cupping. Don't pay for both of them unless you really want to show off the bruises.

And so, it's not surprising that conflating the cupping process with a before and/or after massage will result in a positive experience, which, coupled with its perceived essence of ancient wisdom, becomes a trendy thing to do. Being trendy is fine, if that's your preference. But it remains important not to confuse massage relief with alleged beneficial effects of cupping. In addition to having a history of prescientific medicine, cupping is a fashion statement, and nothing more. Anyone who sells it to you with any other claim is either ignorant of their own profession or a quack.

Brian Dunning

© 2013 Skeptoid Media, Inc. Copyright information

References & Further Reading

Bayfield, S. A Practical Treatise on Cupping. London: Joseph Butler, 1839. 51-52.

Brockbank, W. "The Ancient Art of Cupping." The Journal of Chinese Medicine. 1 May 1986, Number 21: 22-25.

Crane, J., Ogborn, D., Cupido, C., Melov, S., Hubbard, A., Bourgeois, J., Tarnopolsky, M. "Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage." Science Translational Medicine. 1 Feb. 2012, Volume 4, Issue 119: 119.

Editors. "Bronze cupping vessel, Egypt, 300 BCE-300 CE." Brought to Life: Exploring the History of Medicine. Science Museum London, 18 May 2010. Web. 20 Apr. 2013. <http://www.sciencemuseum.org.uk/broughttolife/objects/display.aspx?id=4188>

Hayes, W. Principles And Methods of Toxicology. New York: Raven Press, 1982. 15.

Mettler, F. The History of Medicine. Philadelphia: The Blackiston Co., 1947. 320.

Reference this article:
Dunning, B. "Cupping for the Cure." Skeptoid Podcast. Skeptoid Media, Inc., 23 Apr 2013. Web. 21 Dec 2014. <http://skeptoid.com/episodes/4359>

Discuss!

10 most recent comments | Show all 61 comments

Speaking as a massage therapist (a real one, I don't just play one on the internet) - I would doubt very very much if cupping acted in any sort of toxin-drawing way; unless cupping also promotes a local rewriting of basic biology.

What cupping *might* promote - if the cup isn't held in a static position and dragged over the body (obviously combined with a lubricant like oil/ massage wax) - is with respect to myofascial relase.

I'm not saying it does, I'm not saying it doesn't (because I don't know) but, from a massage, and physiology, perspective that's all I can think Cupping would assist with ... other than making you look like an extra from Fight Club, that is.

John Iscariot, Wellington, New Zealand
May 13, 2013 11:31pm

Cupping is just as valid as any other form of acupuncture as it will illicit the same response;

Credibility failure and wallet lightening.

At the very other end of the scale, holding a warmed cup above somebody and pretending to massage or manipulate the victims energy field is more akin to vedic theosophies and

Credibility failure and wallet lightening.

Thank goodness we hve the opposite in homeopathy for;

Credibility and wallet lightening..

John I love your analogy to Fight club,

That would be acupressure or chiropracty ...

Think I should get some supplements and contemplate my innate energies to sort this ll out. Certainly exercising ones bullsniffer at cupping would be personal excess.

Moral Dolphin, Pho\\\'s Slave palace, Gerringong the Brave, NSW
May 14, 2013 5:32am

I use cups in my massage practice. As far as "toxins", i believe it's supposed to help increase blood flow to area...which could help bring a rush of nutrients and push "toxins" to the lymphatic system? I'm not sure... but I will tell you it works wonders on tight muscles. You can really tell a difference when using the cups versus not using them. Like another LMT said, it probably helps elicit a myofascial release.

Lena Gonzalez, Miami, Fl
May 23, 2013 6:42pm

Lena,

As far as "toxins", i believe it's supposed to help increase blood flow to area...

What area of interest?

"which could help bring a rush of nutrients and push "toxins" to the lymphatic system? I'm not sure..."

Its a guess and you should then desist from using it for money

"but I will tell you it works wonders on tight muscles. You can really tell a difference when using the cups versus not using them. Like another LMT said, it probably helps elicit a myofascial release."

You'd have to explain that one hell of a lot better for anyone of us here wishing to attend your premises let alone be victim to your attestations..Pay for them? No way.

Magnanamous Dinoflagellate, sin city, Oz
May 24, 2013 3:16am

I was interested in this because I am a proud skeptic and a user of cupping. It has very good uses: It allows a form of massage that is impossible any other way, pulling up, away from the body instead of just pressure. If a muscle is sore or bruised already the only massage one can take is light cupping.
One thing that wasn't mentioned is that therapy requires *MOVING* the cups around the muscle, up and down just the same as a massage with hands using pressure.
But sometimes a muscle needs to be moved out of the way to get to lower ones and cupping and pulling muscles helps do that faster. Sometimes pressure isn't helpful but the muscle needs more than light touch therapy, which is good to get lympatic drainage which alleviates inflammation. The only way to do that is with cupping.
I can't tell you how unusual it feels because it certainly isn't something we evolved doing but all you need to experience is one bad muscle problem getting fixed by someone pulling your muscles out a bit.
I get particular relief on my knees when I use small, plastic cups to help massage the tendon connections to the underlying bone. It was intense how much pleasure I experienced, I nearly giggle on the massage table since it is so strange even after years of doing this.
Any claims beyond simple massage that is impossible to do any other way then you are being BS'd.
It's a wonderful massage tool, that's all. Sometimes it is the only answer!
I just felt a need to explain cupping without BS

J. Allen, Seattle
June 3, 2013 2:09am

My grandma was coerced into being a midwife in Ukraine in 1908. She was 16, and didn't want to do it, but the old midwide was going to retire and had her picked out as the apprentice. Baba did indeed become the next village midwife. As she recounted, husbands would come knocking on the door in a panic, their wives in labour all alone, and with the equivalent of a medical centre many hours away on horseback, she couldn't say no. Along the "village healer" path, she picked up cupping as well as other forms of "healing," which included card reading (the latter of which she also didn't want to do, but the knocks on the door kept on coming.)

When she came to Canada, she abandoned almost all of her repertoire - after burying 6 of her 9 kids back in Ukraine, Penicillin was 'way cool'. Cupping, however, she kept ... much to my mom's chagrin. Baba taught my mom how to cup so that she could apply the treatment to my grandma's aching back. I was about 4, and it was very scary to see my grandmother lying with little glasses lit with fire, down her back in tidy rows. Luckily, Mom never tried cupping on us. But Baba always said she felt better after a treatment. Placebo? Or relief she didn't get burnt? Nonetheless, back in the old country, with little medical help available, people still had to try and relieve the suffering of others. It was probably just one of the few things they had that made them feel better. Today it's all marketing hype of a magic cure-all, and that's just wrong.

Irene, Toronto
September 8, 2013 4:43pm

You guys speak like you are the authority on the subject. Making a claim that there is not medical research confirming benefits therefore, it must not have benefits is ludicris, naive, and pretty much just plain ignorant. Do you guys read these articles than comment about how thoroughly you agree to simply be part of the herd? I find most of these comments thoroughly comedic and utterly naive.

With that said, I am neither a proponent or a detractor of the practice, but to watch all of you including Mr. Brian Dunning act like the authority on the subject is laughable.

Thanks for the laughs.

Skeptic of Skeptic, Irvine, CA
October 9, 2013 9:37am

I had cupping done for pancreatitis, and during the time when the blood was being sucked out of my back, i felt a need to smile, so strange was the feeling which i was feeling. And after 4 days i had an ultra sound done and they told me that my pancreas was now normal.

So cupping really works and I would like to recommend the same for any person with acute pancreatitis.

It looks as if the toxic blood does not really leave the point of problem.

My cousin had back problem (due to an accident) and now he is fine after having a cupping session.

So make up your own minds about this.

I searched the net and a woman with arthritis had a bad tooth taken out and in a few days her arthritis had gotten quite better. The doctor then inserted the bad tooth under the skin of a rabbit and it developed arthritic symptoms in 48 hours.

sethi, pakistan
January 11, 2014 3:07am

Cupping was always recommended in Islam... Study this religion, and u will understand the need of cupping... If God's willing

Yuna, South-East Asia
January 25, 2014 8:55am

This is a very silly article. You spout a lot about the history without doing any research on how cupping really works. The entire body depends on circulation. Much pain and disease causes and/or results in stagnation of the circulation due to swelling and infection. This is not voodoo, this is basic biology 101. Cupping pulls the blood, lymph and cells into the capillaries and lymph channels where it can be moved out of the stagnated tissues. a patient usually experiences instant relief. Try it.

had pain, washington dc
March 18, 2014 8:14pm

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