Cupping for the Cure

by Brian Dunning
April 23, 2013

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 websites 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.

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.

By Brian Dunning
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