TMC - Cupping

With growing popularity, the general public has started asking more questions about Traditional Chinese Medicine (TCM). Acupuncture alone has become a widely accepted and a formidable therapy, especially for pain management. Many physicians are referring patients for acupuncture and hospitals have even started creating integrative care models within hospital settings that include therapies like acupuncture and massage. While you may have heard of acupuncture, it is only one part of the TCM model. Other modalities of TCM include: Chinese herbal therapy, internal martial arts (both static and moving exercises known as Taiqi and Qigong), Chinese nutritional therapy, Asian Bodywork Therapies/ABT (Shiatsu and Tuina), moxibustion, e-stim, and cupping.

Thanks to popular culture another branch of the TCM model is now trending - cupping. Early trendsetter Gwyneth Paltrow brought cupping to the red carpet in 2004, Michael Phelps brought cupping to the summer Olympics in 2016, and more recently Kim Kardashian Snapchatted about facial cupping in March 2017. However, cupping has been used in China for thousands of years. In fact, some of the earliest records of cupping can be dated back to the second century BC with the discovery of the Huang-Lao Boshu texts, five ancient manuscripts written on silk scrolls. These manuscripts were written to advise the authorities of the ruling Han dynasty on how to attune themselves to the cosmos at a time of rapidly changing social and political climate (Rochat de la Vallée, n.d.). Ge Hong (283-343 AD), a Taoist physician, alchemist, and herbalist wrote the Handbook of Prescriptions for Emergencies which documented effective uses for cupping, though it was most well known for its key insights on the treatment of malaria. In his descriptions, he elaborates on the use of animal horns as cups (a technique known as jiaofa), which he used to treat skin lesions. “Several centuries later another famous medical classic, Su Sen Liang Fang, recorded an effective cure for chronic cough and the successful treatment of poisonous snakebite using cupping therapy” (Upton, 2018). Eventually, in the 1950s, cupping was established as an official therapeutic practice used in hospitals across China after research was conducted by China and former Soviet Union acupuncturists confirming cupping’s effectiveness. 

Early understanding and applications of cupping held that illness and infection could literally be drawn out of the body through the skin. Ancient techniques often included wet cupping, using cups made from segmented bamboo or cattle horn to draw blood from the body. A partial vacuum was created by the heating and subsequent cooling of the air inside the horn. This vacuum then drew out the pathogenic factors. Several thousand years of accumulated clinical experience has since given way to a wide range of clinical applications. Current classifications are as follows: 

• Dry cupping - cupping over unbroken skin
• Wet cupping - blood which is drawn out of small incision
• Flash cupping - cups that are quickly placed and instantly removed, then repeated over different areas
• Stationary cupping - cups placed over specific acupuncture points
• Sliding cupping - cups gliding with or against a chosen meridian
• Herbal cupping - cups soaked in Chinese herbal concoctions prior to placement and/or herbal liquids that are retained inside the cups

Some practitioners also consider different levels of vacuum (soft, moderate, or strong suction), as well as graded temperatures. 

TCM theory asserts that cupping stimulates the opening of the pores, disperses stagnant qi and blood, and eliminates external pathogenic factors such as wind, damp, heat, and cold. It is therefore regarded as a reducing method to relieve the body of excess - blockages, toxins and impurities. However, in some cases a well trained practitioner can use soft, flash cupping as a tonifying method for deficiency type syndromes, such as skin numbness, flaccidity, or hypo-function. Clinical indications of cupping can include the treatment of “Bi” (syndrome caused by wind-dampness which manifests as pain in the lower back, shoulders, and legs), gastrointestinal disorders (stomach ache, vomiting, and diarrhea), and lung diseases (cough and asthma). Cupping combined with blood-letting is still suitable for the treatment of sprains and other soft tissue injuries with blood stasis (Lin, Wang, & Ng, p. 3). 

After a successful treatment you will see petechiae, or what TCM calls “sha” (literally means sand, or sediment, in reference to its appearance), or “yinzi” (marks). Petechiae consists of red or purple lesions that are similar to bruises, in that they result in the leakage of blood from the vessels into the tissues. However, petechiae is not the result of blunt force trauma, which is always the case with bruising. “According to every cupping tradition, the marks are always the result of certain pathological agents being released from deep within the body, or from the superficial level including the subcutaneous skin layers and the fascia. Thinking of cupping marks as bruises may conjure up the notion that they must be the result of a painful procedure. On the contrary, cupping performed correctly, with the appropriate choice of method and the correct level of suction to suit the patient’s strength and condition, is always a comfortable and satisfying experience” (Bentley, p. 2-3).

The basic principles, applications, and indications of cupping remain the same as were originally practiced in ancient China. However, the use of animal horns and bamboo have been replaced with cups made of glass, plastic, and silicone. Silicon cups are most commonly used today by licensed acupuncturists and other qualified healthcare practitioners, such as chiropractors, physical therapists, and licensed massage therapists. This is likely due to their affordability, flexibility, durability, and ease of movement. They can also be applied using mechanical pumps or simply squeezing and pressing the cups to the skin without the use of heat. 

Although cups are extremely safe to use and can even be self-applied, certain precautions should be considered. Cups should be applied in areas where muscles are abundant with few hairs and where there is no prominence or depression of the bones. Contraindications include skin ulcers, inflamed skin, tumors, scars, varicose veins, hypersensitive skin, sensory organs, large blood vessels, the apex of the heart, the lumbosacral and abdominal regions of pregnant women, convulsive disorders, cancer, and diseases with hemorrhagic tendencies (Lin et al., 2018, p. 5). Caution should also be used with children and seniors. 

If the concepts behind TCM cupping seem too antiquated, it might help to imagine the use of cups as an inverse massage. Rather than applying pressure to muscles, cups use gentle pressure to pull the muscles upward, easing areas of congestion, relieving muscle tension and fascial adhesions, sedating the nervous system, and encouraging circulation and detoxification. Despite the fact that cupping is not exclusive to TCM, it is generally combined with an acupuncture treatment during the last 10-15 minutes, with cupping marks resolving in three days to one week. Given the many benefits of this adjunctive therapy, it’s no wonder why cupping is all the rage. 

Resources:

1. Bentley, B. (2013). A Cupping Mark Is Not A Bruise. The Lantern Journal of Traditional Chinese Medicine, 12(2), pp. 2-3. Retrieved from https://www.healthtraditions.com.au/essays/a-cupping-mark-is-not-a-bruise.pdf
2. Lin, X, Wong, H.F., & Ng, S.C. (2018). Cupping, the Past and Present Application. Chinese Medicine and Culture, 1(3), pp. 3-5. doi: 10.4103/CMAC.CMAC_37_18.
3. Rochat de la Vallee, E. (n.d.). The Texts of Ma Huang Dui [Web log post]. Retrieved from www.elisabeth-rochat.com/texts/Ma_Wang_Dui.html
4. Upton, E. (2018). Alternative Medicine In Under An Hour: Easy-To-Follow Guide To Sorting Out Holistic Medicine, Ch. 3. Beverly Hills, CA: Fifth Element Press. Kindle file.