Begüm Ünlü and Ümit Türsen
Department of Dermatology, Mersin University, Mersin, Turkey
Cupping is a method of treatment that involves the application of a vacuum to a specific area of the skin in Traditional Chinese Medicine (TCM). The vacuum breaks superficial blood vessels in the papillary dermis and causes ecchymosis . It ıs also a non‐needle acupuncture method. There are numerous reports mentioned throughout history, including Herodotus’s (a Greek historian, 400 BCE) prescription related to wet and dry cupping therapy for treatment of headaches, lack of appetite, maldigestion, fainting, abscess evacuation, and narcolepsy. 
Method of Treatment
Cupping can be applied through several techniques. In dry cupping, the inside of a small, round cup is painted with alcohol . Alcohol is burned in the cup, and just before the flame dies out the edge of the cup is firmly applied to skin, and the vacuum pulls the skin into the cup. The vacuum created by suction of the skin causes trauma to superficial vessels, causing ecchymoses and purpura. In wet cupping a small incision is first made in the skin, and then the cup is applied as it is in the dry cupping method. Wet cupping therapy was found to be better than dry cupping therapy . Lubricants are used to move the cup around once it is placed on the skin to cover a wider area . A manual hand pump is used to create the suction in modern cupping methods .
In routine cupping procedures, sets of 4, 6, or 10 cups are applied for 5, 10, or more minutes . Therapists repeat cupping treatment every four to six months according to the symptoms of the patient . The most common sites on which the cups have been applied are the back, chest, abdomen, and buttock; however, other areas, including the face and scalp, are known to be treated [1, 2]. The effects of cupping on the skin include erythema, edema, and ecchymosis in a characteristic circular arrangement .
Traditionally, cups were made of glass. Flexible silicone cups allow comprehensive cupping of big joints . Different shapes of cups are available in variable sizes, ranging from 25 to 75 mm across the opening . The different types of cups available for cupping are listed in Table 30.1.
|Type of cup||Origin|
|Round glass cups or bell shape cups||Japan|
|Buffalo horn shape cups||North America|
|Hollow animal horn shape cups||Europe, Asia, Africa, and North America|
|Mouth or buffalo horn shape cups||Iraq to the Mediterranean|
|Shell shape cups||North America|
In ancient times, medicine men advised and practised cupping on the theory that illness was caused by “evil spirits” that entered the body and had to be driven out to cure the patient . Although its exact mechanism of efficacy remains obscure, there are various theories as to the benefits of this intervention. Some authors suggest that cupping increases circulation around the area of cupping and allows for the elimination of toxins trapped in the tissues . Another theory suggests that it is the process of transferring pathology from one site to another that may cure the original site of any disease . In cupping therapy, a vacuum is generated by mechanical withdrawal or thermal cooling of the entrapped air under the cup. Vacuum increases the perfusion of tissues and relieves painful muscle tension . It also increases the pain threshold of patient . Cupping involves improving microcirculation, promoting capillary endothelial cell repair, accelerating granulation, and angiogenesis in the regional tissues . This process provides muscle relaxation . The psychosomatic theory claims that the effect of cupping is a placebo effect . Cupping also makes a deep tissue massage . Cupping therapy can be helpful in regulating both innate and acquired immune responses . Cupping is usually described as treatment for chronic pain, including lower back pain and headache