Cupping

Cupping refers to an ancient Chinese practice in which a cup is applied to the skin and the pressure in the cup is reduced (by using change in heat or by suctioning out air), so that the skin and superficial muscle layer is drawn into and held in the cup. In some cases, the cup may be moved while the suction of skin is active, causing a regional pulling of the skin and muscle (the technique is called gliding cupping).

During the 20th century, new glass cups were developed. Common drinking glasses have been used for this purpose, but thick glass cupping devices have also been produced and are preferred. The introduction of glass cups helped greatly, since the pottery cups broke very easily and the bamboo cups would deteriorate with repeated heating. Glass cups were easier to make than the brass or iron cups that were sometimes used as sturdy substitutes for the others; further, one could see the skin within the cup and evaluate the degree of response.

The glass cups are depressurized by providing some fire in the cup to heat up the air within just prior to placement. For example, hold a cotton ball dipped in alcohol with a pincer, ignite it, hold it in the cup, then rapidly apply to the skin; this is called shanhuofa. Sometimes, a small amount alcohol is put in the cup and lit; this method is called dijiufa (alcohol-fire cupping).

At the end of the 20th century, another method of suction was developed in which a valve was constructed at the top of the jar and a small hand-operated pump is attached so that the practitioner could suction out air without relying on fire (thus avoiding some hazards and having greater control over the amount of suction). Both glass and plastic cups were developed, though the plastic ones are not very well suited to moving along the skin once in place, as the edges are not entirely smooth and the strength of the cups is limited. The modern name for cupping is baguanfa (suction cup therapy).

In order to allow easy movement of the glass cups along the skin, some oil is applied. Medicated massage oils (with extracts of herbs) are particularly useful for this purpose. Since the cups are applied at room temperature, the indication of removing cold from the channels is no longer as applicable, at least to stationary cups. There is some friction generated with moving cups, so that there is a small but significant amount of heat applied by that method, especially if a warming oil is used as lubricant.

Generally, the cup is left in place for about 10 minutes (typical range is 5–15 minutes). The skin becomes reddened due to the congestion of blood flow. The cup is removed by pressing the skin along side it to allow some outside air to leak into it, thus equalizing the pressure and releasing it. Some bruising along the site of the rim of the cup is expected.




==Method==
Instead of using a vacuum pump, a vacuum is created by air (heated by fire) in a glass cup placed flush against the patient's skin. As the air cools in the cup, a vacuum forms that pulls up on the skin, stimulating the acupressure effect.

The cups are usually roughly bell shaped with a capacity of about 4 fluid ounces. Most commonly, a total of from 8 to 12 cups are applied to the subject's back in two parallel 'vertical' columns, midway between the spine and each edge of the body, spaced about 4 inches on center within each column.


There are several ways of heating the air in the cup with fire:

1. One can swab rubbing alcohol (70% or 90%) into the bottom of a cup, then light it and place the cup immediately against the skin. By creating the seal the immediate loss of oxygen puts the fire out, preventing the person from being burned. The smaller the amount of alcohol, and the quicker the flame is extinguished by application of the cup, the better, so long as there is no risk of the cups falling off due to lack of a proper seal.

2. One can hold the cup inverted over a flame (e.g. a lit candle), heating the air, then place the cup immediately against the skin. Care must be taken not to heat the glass itself. Even so, the person to whom the cup is applied will feel distinctly more heat than in the previous method.

3. One can ignite a flame with a small alcohol-soaked cotton wad resting on a small pad of leather or other insulating material that rests directly on the patient's skin, then place the cup immediately over the flame, putting out the fire. The quickness with which the flame is extinguished depends on the size and shape of the cup.

Methods 1 and 2 heat the glass to some extent and have a risk of burning the patient if not carefully executed. Method 3 risks the cotton falling off the insulating pad onto the patient's skin, and leaves the pad and cotton wadding inside the adhering cup which could be considered cumbersome.

Baby oil massaged onto the skin first causes a better seal to form, making it possible to use this therapy with less heating of the cup. It is often possible to slide the adhered cup around on the skin, preserving the suction seal as it glides. Care must be taken not to move the cup over protruding moles, skin tags, scabs, etc.

The longer a cup is left on, the more of a circular mark (like a hickey) is created. The skin pores are more open, and the patient may have a feeling like sunburn. An application of about 20 minutes is average, for the back; however this varies with the individual. In no case should the cups be left in place if the subject reports noticeable discomfort.

Cupping has never been shown to be effective in a clinical trial. It can leave temporary unsightly marks on the skin and there is also a small risk of burns. Persons who claim this therapy to be beneficial report that its effect is a long lasting feeling of relaxation and invigoration. It is possible that whatever relief is obtained by this procedure is derived from the same principles that are employed in [[shiatsu]] massage, where instead of the outward sucking of the cups, strong inward pressure is directed at the muscles of the [[dorsal]] ribcage and abdomen.
Today, cupping is mainly recommended for the treatment of pain, gastro-intestinal disorders, lung diseases (especially chronic cough and asthma), and paralysis, though it can be used for other disorders as well. The areas of the body that are fleshy are preferred sites for cupping. Contraindications for cupping include: areas of skin that are inflamed; cases of high fever, convulsions or cramping, or easy bleeding (i.e., pathological level of low platelets); or the abdominal area or lower back during pregnancy. Movement of the cups is limited to fleshy areas: the movement should not cross bony ridges, such as the spine. Following are some of the recommended treatment sites for various disorders.
Respiratory Diseases

· For chronic bronchitis and asthma, one can apply cupping at the following points: dingchuan, dazhui (GV-14), shenzhu (GV-12), geshu (BL-17), xinshu (BL-15), jueyinshu (BL-14), feishu (BL-13), fengmen (BL-12), dashu (BL-11), tiantu (CV-22), shanzhong (CV-17), huagai (CV-20), and zhongfu (LU-1). [see: Acupuncture treatment of asthma for more information about several of these treatment sites].

· For pediatric bronchitis: blood letting followed by cupping at dazhui (GV-14).

· For pediatric acute bronchitis: feishu (BL-13), shenchang (KI-25), lingxu (KI-24).

Digestive Diseases

· For dysentery, early morning diarrhea, and acute and chronic gastritis, perform cupping in the following areas: around the navel; at the bladder meridian shu points; or these stomach meridian points: burong (ST-19), guanmen (ST-22), huaroumen (ST-24), tianshu (ST-25).

· Pediatric indigestion: dachangshu (BL-25).

Pain Syndromes

· Shoulder blade: jianwaishu (SI-14) and tianzhong (SI-11).

· Loins: shenshu (BL-23), qihaishu (BL-24), guanyuanshu (BL-26).

· Head: taiyang and yintang for refractory headaches and migraines; dazhui (GV-14) and baihui (GV-20) for parietal and occipital headaches; for trigeminal neuralgia: qihu (ST-13), fengchi (GB-20), sizhukong (TB-23), jiache (ST-6); for toothache: dashu (BL-11), with acupuncture, massage, and cupping at yifeng (TB-17), jiache (ST-6), xiaguan (ST-7), and hegu (LI-4).

· Soft tissue injury: treat local pressure pain points and area of swelling; use plum blossom needling followed by cupping; additionally or alternatively use points above or below the site of injury along the channels that pass through the injury.

Gynecological Disorders

· Infertility and irregular menstruation: shenshu (BL-23) with movement of cup downward (treat with acupuncture first, then do cupping).

· Leukorrhea: yaoyan (extra point under the 3rd lumbar vertebra) and around baliao (BL-31 through BL-34).

· Uterine cramps: needle zusanli (ST-36) and guanyuan (CV-4) and do cupping at guanyuan (CV-4).

Miscellaneous

· Common cold: dazhui (GV-14).

· Insomnia: xinshu (BL-15), geshu (BL-17), shenshu (BL-23).

· Facial paralysis: needling and cupping dazhui (GV-14), along with needling local facial points.

RECENT RESEARCH:

The following protocols were reported to provide good results in individual clinical research reports:

a. Head pain (2): headache, toothache, sore throat, redness and soreness of the eyes, treated with blood letting followed by cupping. Treatment is applied to dazhui (GV-14) and dingchuan.

b. Frozen shoulder (3): after acupuncture at jianyu (LI-15) and jianliao (TB-14) to get propagated qi reaction, use pricking of ashi points followed by cupping over the bleeding area for 10–15 minutes. Ten treatments is a course of therapy.

c. Acute trigeminal neuralgia treating with blood letting followed by cupping (4): treatment is applied to dazhui (GV-14) and feishu (BL-13).

d. Acne (10): treatment is to use bloodletting followed by cupping at feishu (BL-13) and geshu (BL-17) on one day, then xinshu (BL-15) and ganshu (BL-18) the next day, alternating treatments for a total of eight days.

e. Urticaria (11): perform cupping at shenque (CV-8) three times consecutively for ten minutes each time. This is done for three days, followed by one day rest, and another three days as needed.

f. Acute diseases (13): fever and headache due to infection, acute conjunctivitis, lumbar sprain; perform blood letting at dazhui (GV-14), and then cupping (which promotes further bleeding).

TREATMENT SUMMARY

Cupping therapies often follow the point selection pattern that is used for standard acupuncture therapy, with somewhat greater emphasis on the use of back points (due to the ease of performing this technique there). In particular, most practitioners rely on using back shu points (bladder meridian) and dazhui (GV-14). Cupping is frequently applied after treatment by acupuncture, blood letting, or plum blossom treatment.

REFERENCES

1. Cui Jin and Zhang Guangqi, A survey of thirty years’ clinical application of cupping, Journal of Traditional Chinese Medicine 1989; 9(3): 151–154.

2. Wu Jiashu, Observation of analgesic effect of acupuncturing dazhui point, Journal of Traditional Chinese Medicine 1989; 9(4): 240–242.

3. Ju Huadong, 30 cases of frozen shoulder treated by needling and cupping, International Journal of Clinical Acupuncture 1998; 9(3): 327–328.

4. Zhang Zhilong, Observation on therapeutic effects of blood-letting puncture with cupping in acute trigeminal neuralgia, Journal of Traditional Chinese Medicine 1997; 17(4): 272–274.

5. Cheng Xinnong, Chinese Acupuncture and Moxibustion, 1987 Foreign Languages Press, Beijing.

6. State Administration of Traditional Chinese Medicine and Pharmacy, Advanced Textbook on Traditional Chinese Medicine and Pharmacology, volume IV, 1997 New World Press, Beijing.

7. O’Conner J and Bensky D (translators), Acupuncture: A Comprehensive Text, 1981 Eastland Press, Seattle, WA.

8. Zhang Ruifu, Wu Xiufen, and Nissi Wang (compilers), Illustrated Dictionary of Chinese Acupuncture, 1986, Sheep’s Publications, Hong Kong.

9. Academy of Traditional Chinese Medicine, An Outline of Chinese Acupuncture, 1975 Foreign Languages Press, Beijing.

10. Chen Decheng, Jiang Nawei, and Cong Xin, 47 cases of acne treated by prick-bloodletting plus cupping, Journal of Traditional Chinese Medicine 1993; 13(3): 185–186.

11. Wang Huaiping, Treatment of urticaria with cupping, Journal of Traditional Chinese Medicine 1993; 13(2): 105.

12. Li Jiang, A miraculous spinal pinching therapy, Journal of Traditional Chinese Medicine 1996; 16(3): 228–229.

13. Yin Ying, Blood-letting at a single point for treatment of acute diseases, Journal of Traditional Chinese Medicine 1997; 17(3): 214–216.