History of Cupping

The therapy of cupping has been used in China for thousands of years. At first it
was applied using cattle horn and consequently was also called ‘horn therapy’.
To create a negative pressure inside the horn, fire was ignited to expel the air. The
method was used primarily to withdraw pus and blood in the treatment of boils.
Another method was to create a hole in the top of the horn, around which the
practitioner would place his lips and physically suck out the air to create a
negative pressure. As far as safety was concerned, the length of the horn would
be the only protection afforded to the practitioner. This method is still employed
in many countries for treating boils and carbuncles. Cupping was then used as an
auxiliary method in traditional Chinese surgery. Later it was found to be effective
in other diseases, and developed into a special therapeutic method. (1)

Cupping therapy, more commonly known as “cupping” certainly came into the
limelight recently after American swimming star Michael Phelps’ was
photographed with purple-blotched shoulder at the Rio Olympic Games.
However, this alternative therapy is not new; there is a very long history of
cupping and it has remained an integral part of medicine for thousands of years.

With the passage of time and advancements in the world of medicine, cupping
therapy evolved over time. Animal horns were slowly replaced by bamboo cups,
which in due course were replaced with glass, metal or medical-grade silicone
cups. However, the basic philosophy behind this ancient alternative healing
practice remained the same, which is “to strengthen or activate the body’s natural
self-healing powers, at times when they are not able to do so, on their own.”
Cupping therapy involves creating a local suction on the skin by means of a
mechanical device (hand or electrical pump) or heat (fire). The underlying skin
is sucked or raised partway into the cup. As a result blood flow to the affected

1
area is enhanced, which in turn activates the immune system, flushes the area,
and stretches the tissue.

Brief History of Cupping

There is a growing body of evidence suggesting that cupping therapy remained
an integral part of ancient medicine in one form or another. There are conflicting
opinions regarding the pioneers of this ancient practice, some consider the
Chinese to be the inventors of cupping, while the earliest pictographic records
suggest that it is the ancient Egyptians who invented this technique at around
1500 B.C.

The Egyptian Connection

The Ebers Papyrus – one of the oldest medical textbooks – mentions the use of
cupping by the ancient Egyptians for treating various ailments such as menstrual
imbalances, weakened appetite, fever, vertigo and pain. Moreover, drawings of
cupping were also discovered on the Temple of Kom Ombo near Luxor. Kom
Ombo is regarded as one of the most ancient cities of Egypt.

Drawings on the entrance of one of the tombs in Luxor, Egypt, clearly show a cupping set,
most probably made of glass, among other medical instruments

The Chinese Connection | History Of Cupping

In the Chinese tradition, the evidence of the use of cupping therapy can be traced
back to the early Han Dynasty. Ge Hong – a famous herbalist and alchemist
during the Jin Dynasty is considered the first to use this technique in China. He

2
strongly believed that with “cupping and acupuncture combined, more than 1/2
of the ills can be cured”.

The Greek Connection | History Of Cupping

In ancient Greece, Hippocrates – a physician by profession and who is regarded
as the father of modern medicine, used cupping therapy for treating internal
disease and structural problems. Hippocrates recommended the use of cupping
for treating ailments such as angina, menstrual irregularities and other disorder in
his guide to clinical treatment.

The Islamic Connection

In the ancient Islamic world, the term used for cupping was “Al-hijamah” and
Prophet Muhammad (PBUH) said to his followers “indeed the best of remedies
you have is hijamah“. Famous Islamic physicians such as Al-Zahrawi (AD 936-
1036), Ibn Sina (AD 980-1037), and Abu Bakr Al-Rizi (AD854-925) described
cupping sites and illustrated cupping with diagrams in many of their literature.

The Western Connection | History Of Cupping

The practice of cupping spread to many European countries between the 14 th and
17th centuries, particularly during the Renaissance era. It was regarded as the most
popular treatment of arthritis and gout in Italy during this period. Throughout the
18th century, cupping therapy was practiced by a great majority of European
doctors who used it for the treatment of common cold and chest infections. With
the introduction of the newly established scientific model of medicine in the late
18th century, the popularity of cupping lessened.

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New Interest in Cupping Therapy
In modern times, cupping re-emerged as a popular holistic treatment approach,
thanks to a long list of celebrities who used it personally and to the vibrant media
(particularly social media) who spread the news about this ancient alternative
healing approach throughout the world. Moreover, with the increase in the
popularity and demand of complementary and alternative therapies, more and
more people are turning to holistic treatment options such
as acupuncture, remedial massage, myotherapy, reflexology, chiropractic, herbal
medicine, and cupping. Today, cupping therapy is used to treat a wide variety of
conditions, particularly those that cause muscle aches and pains. (2)

Evolution of Cupping

 Animal horn
 Bamboo
 Wood
 Clay
 Ceramic
 Metal
 Glass
 Plastic
 Silicone
 Rubber

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 • The word “cupping” was
derived from the Arabic
verbs “Hajama” and
“Haj’jama” which they
mean “to minimize” or “to
restore to basic size”, or
“to diminish in volume”
• In Arabic they say, “A
certain person diminished the problem”, they meant that
he returned the problem to its original size.
• There is also a verb “ahjama” which means “to withdraw or retreat
from attack”.

Cupping is a traditional Chinese medicine which relief pain instantly. It is broadly

used in several countries in the world as a popular method of treatment.
Cupping was not the earlier name, it was known as ‘horn therapy’ as it was
applied with cattle horn. Negative suction inside the horn was created by the
cupping practitioner.

5
It was then replaced by the bamboo and then by the glass cups. Cattle horn are
still in use in some parts of Africa to expel poison from bites. When cattle horn
was replaced by the glass cups, fire came into the picture to create negative energy
and expel the air

Classification of cupping therapy (3)

Early classification of cupping therapy categorized it broadly into dry and wet
cupping.(4) Another classification of cupping therapy was developed in 2013,
categorizing cupping into five categories. The classification was updated in
2016.(5) The updated classification categorized cupping therapy into six
categories. The first category is “technical types”, which includes dry, wet,
massage, and flash cupping. The second category is “power of suction”, which
includes light, medium, and strong cupping. The third category is “method of
suction”, which includes fire, manual vacuum, and electrical vacuum cupping.
The fourth category is the “materials inside cups”, which includes herbal, water,
ozone, moxa, needle, and magnetic cupping. The fifth category is “area treated”,
which includes facial, abdominal, female, male, and orthopedic cupping. The
sixth category is “other cupping types”, which includes sports, cosmetic, and
aquatic cupping.(5)
This article suggested a new update of cupping therapy classification by merging
category five and six into one main category: “condition and area treated”. The
name of the fourth category was changed from “materials inside cups” to “added
therapy types”, and aquatic cupping was added to this category. The aim of this
update is to give a precise classification of cupping therapy types

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Classification of cupping therapy sets
A typical cupping therapy set should contain six or more different-sized cups and
a method of suction. Cupping therapy sets can be classified into three main
categories: the first category is “cupping sets related to the types of cups”, which
includes plastic, glass, rubber, bamboo, ceramic, metal, and silicone cupping sets.
The second category is “cupping sets related to the methods of suction”, which
includes manual, automatic, and self-suction cupping sets. The third category is
“cupping sets related to uses”, which includes facial, female, male, and massage
cupping sets.(5)

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 Timing of application

• Annual time

• Seasonal time

• Monthly time

• Daily time

The Annual Time

The Messenger (cpth) said: “How good the wont in cupping is!”
Thus, it is usually performed from year to year for both the healthy and the
patient.So if requirement is there then it can be performed anytime.

Therefore cupping must be performed before the summer season because heat is
most intense at this time of the year. Hence the best season is the spring. Cupping
must be performed every year in the spring season, namely in April and May.

Before giving the scientific interpretation of this appointed time (its physiological
effect on our bodies), we must give a simple glimpse about the function of the
blood in regulating the animal heat. As it is known that water constitutes the
maximum proportion in the blood, (90%) of its plasma. Since water has basic
properties that differentiate it from other liquids known in nature, these properties
make water thebest assistant liquid to help regulating the animal heat in a living
being.

8
 The Monthly Time
The Messenger of God (cpth) said, “Cupping is most detestable at the beginning
of the crescent, but it is curing when the full moon begins to decrease.” on the
lunar month when the time of the annual cupping comes (springtime in its two
months, April and May). For example, when April comes we follow up the
progression of the lunar month which comes in this month (April), and when the
seventeenth day of the lunar month comes, it will certainly be the first day for
performing Cupping. Therefore, cupping starts from the seventeenth day
(inclusive) until the twenty-seventh day (inclusive)
We know that the moon has a pull effect on the earth despite its little diameter
(3478 km), and its mass constitutes one part out of (80) parts of the mass of the
earth, and the distance of it from the earth is a distance of (385.000 km), this short
distance makes its pulling force have a great influence on the oceans where they
rise to form the tide, even the earth's crust is never free from these effects.

If the cupping operation is performed in the middle of the lunar days (12-13-14-
15), the strong pull of the moon stimulates the blood, so there will be more blood
loss. Don’t prefer this time for cupping
It is believed that after strong attraction (lunar attraction towards earth) of the
moon in it’s first 15 days the impurities started to settle down in the major joint
parts of the body. So 17th day is the ideal for 1st sitting.

9
 Daily time

It is better for cupping to be performed at the first hours of the day (because
cupping must be performed while the person is still without having breakfast).

10
 YANG & YIN
heaven (Yang) and earth (Yin)
• The concept of Yin–Yang is
probably the single most
important and distinctive theory
of Chinese medicine. It could be
said that all Chinese medical
physiology, pathology and
treatment can, eventually, be
reduced to Yin–Yang. The
concept of Yin–Yang is
extremely simple and yet very
profound. One can understand it
on a rational level, and yet
continually find new expres-
sions of it in clinical practice
and, indeed, in life.
• The concept of Yin–Yang,
together with that of Qi, has
permeated Chinese philosophy over the centuries and is radically different
from any Western philosophi- cal idea. In general, Western logic is based
upon the opposition of contraries, which is the fundamental premise of
Aristotelian logic. According to this logic, a pair of contraries (such as ‘The
table is square’ and ‘The table is not square’) cannot both be true. This
approach has dominated Western thought for over 2000 years. The Chinese
concept of Yin–Yang is radi- cally different from this system of thought:
Yin and Yang represent opposite but complementary qualities. Each thing
or phenomenon could be both itself and its contrary. Moreover, Yin
contains the seed of Yang, so that Yin can transform into Yang, and vice
versa.
• The Qi flow in the channels is always from distal (coming from the
Exterior, entering at the tips of the extremities) to proximal (towards the
centre, flowing towards the internal organs).

• The earliest reference to Yin and Yang is probably the one in the ‘Book of
Changes’ (Yi Jing), dating back to about 700 bc. In this book, Yin and Yang
are represented by broken and unbroken lines

11
 Yin–Yang in the daily cycle Yin–Yang in the seasonal cycle

cyclic movement 2 stages of density of matter

YANG YIN YANG YIN
• Light • Darkness • Immaterial • Material
• Sun • Moon • Produces energy • Produces form
• Brightness • Shades • Generates • Grows
• Activity • Rest • Non-substantial • Substantial
• Heaven • Earth • Energy • Matter
• Round • Flat • Expansion • Contraction
• Time • Space • Rising • Descending
• East • West • Above • Below
• South • North • Fire • Water
• Left • Right

12
Yang & Yin in Medicine

13
CUN Measurement

14
 Danger of Cupping

Where not to apply Cup

• Over an artery

• DVT

• Over an ulcer

• Where you can feel pulse

Absolute Contraindicated

• Patient with cardiac pacemaker

• Swollen, bruised area

• Ulcerated skin

• Cancer patient

• Muscle spasm due to fracture

• Pregnant & menstruating women

• Wet cupping in female breast

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 Precaution should be taken……….

 Hemophilia
 Thrombocytopenia
 Pregnant
 Allergic skin reaction
 Dizziness
 If the patient feel dizzy or fainting then
stop application & give thepatient fluid and
rest
 Electronic equipment should not use at the time of electro cupping
 Dry cupping below 3 years can not apply
 Wet cupping below 11 years & above 65 years should be avoided
 Pt with high fever, convulsion should not cupped
 Abdominal point is contraindicated for pregnant
 Should not done in fatigued, hungry/thirsty, or patient who indulge
in alcohol

Safety aspect:

• Use of disposable latex gloves is must

• BP & pulse should be checked prior to cup

• Surgical blades used for incision in wet cup should be disposable

• Incision should be done superficial, only the epidermis

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 Technical aspect:

• Obese patient suffering from polycythemia(increase in

no of RBC & decrease in plasma volume, blood gets
thickened) should take shower 1-2 hrs before cupping to
stimulate peripheral blood flow

• Patients should be anxiety free

• Wet cupping better not to do in empty stomach

• Area of application should be hair free

After Care

• Antiseptic cream should apply at incision point

• Advice the patient for adequate fluid intake
• Solid food preferably avoided up to 3 hours after strong cupping, wet
cupping and needle cupping
• Pt can take shower after 12 hours of cups
• Sexual activities should be refrained for 1 day

The drawbacks of Cupping Therapy as a treatment

 Lack of good quality evidence for efficacy

 Vasovagal symptoms (dizziness, etc)
 Insertion site infection ( this is considered rare, as needles are sterile and the
use of disposable needles has become the norm)
 Red or purplish circular marks may appear on the skin for a few days

17
18
 Cupping Equipment's

Materials mostly made by fire resistance tough glass or clear Perspex material (it
canwithstand temperature, electrical frequency & also has volume resistivity)
Earthenware and bamboo cups are still used in developing countries. In the West,
however, the use of earthenware and bamboo cups is now discontinued.

Electromagnetic Cupping apparatus

Electric cupping machine is expensive & heavy

The cup is attached to the machine through an
umbilical suction cord. At the same time, if
necessary, a separate cable can be fitted to activate
an electromagnetic probe inside the cup. Suction
strength and duration can be adjusted and controlled
electronically by the operator.

Cupping Pumps Portable

Powered by small petrol engines or batteries

Noisy to operate
Difficult to clean
Average weight is around 5kgs

Screw-Top Cups

• Inexpensive

• adjustable screw-threaded handle located on top

• Made of Perspex material

• Anti-clock wise movement push down the piston ring downwardsup to the patient
19
 skin, thus locking happen. Then piston rotate
clock wise to create suction effect

• Sterilization cannot done properly, so this

method is not sopopular

Pistol-Handle Valve Cups

• Perspex material used here. It also has valve attached
with it atthe top
• Strength of the suction can be adjusted by valve
• Generally the sensitive area like face or boil can be
cupped bypistol handle valve cups
• Proper sterilization can be done
• Inexpensive & very popular

• Types of cup used by this apparatus :

• Light cupping method = one complete pull of

the pistol handle

• Medium cupping method = two complete

pulls of the handle

• Strong cupping method = three complete pulls of the handle

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 Some difficulties in Pistol-Handle Valve Cups

• Strong suction cannot obtained, pistol handle feels tight when pulled

• Cups falling out shortly after the application

• Check and make sure that the cups are not cracked or the edges
broken(sometimes the cup develops hairline crack, which is not always
visible).

• Apply oil liberally to the cupping location if treating hairy or dry skin
conditions.

• Check the seal and the valve for foreign substances and remove if any.
• Vacuum handle not pulling:

• Check the gun barrel for dirt and clear all foreign substances.
• Lubricate the gun if dry.

Cups with Squeeze Rubber Tops

• Made up with hollow rubber top,

squeezing the rubber top will create the
suction effect
• Weak cupping and medium cupping only
can done by this as the suction is not
strong here. The amount of air present
inside the rubber, can only suction out
• It is ideal for children and if there is no
requirement of fire

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 Magnetic Squeeze Rubber Cups
• Used for weak and medium cupping
• However, these cups are attributed extra
benefits owing to the magnetic field created
by the magnet, which is fixed on theinside
to the upper part of the cup
Benefits of magnetic cup
• Increase blood circulation
• Boost immune system
• Relieve Pain
• Reduce Inflammation
• Restore energy
• Support body’s natural healing process
• Promote metabolic processing of toxins

Bamboo Cupping
• Most ancient forms of cupping
• Inexpensive and widely used till now

• Disadvantages of bamboo cupping –

• edge is not smooth, which is result
uncomfortable and painful for the
patient
• can’t see inside, so therapist will not be
able to observe the strength of
suctioning and whether blister is
developing or not
• adequate sterilization cannot be achieved as the bamboo is very porous and
absorbent, and a strong suction may draw blood or bodyfluids into the
fibres of the cup
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 • cross infection can be there as bamboo is difficult to sterilize

Glass Cup

• Glass was invented by Egyptian around 2500 BC, soon after it was

introduced for Cupping

• It can properly sterilized
• As it transparent, the
suction intensity and skin
changes caneasily
monitored
• Different desirable size can
help the therapist to place it indifferent places of the body
• But it is expensive

Rubber Cup

• In1999 rubber cup was invented by

ILKAY ZIHNI CHIRALI
• It can produce strong suction effect.

Medium & Strong cupping

can be given by this

• It is well tolerated by children
• Sterilization cannot be done properly
• It is expensive
• Rubber cups can safely be used on
the face, stomach, legs andother tender parts of the body
• It is popular for moving cupping method

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 Silicon Cups

• It was invented by ILKAY ZIHNI CHIRALI in 2011

• It is more resistance to oil or damage or sterilizing materials
• Edges are smooth
• Popular in use cosmetically especially in cellulite and for
facialmuscles

Disposable Cupping Sets

• Most recent one and most trust worthy

• It can be used for only one session
• Most suitable for wet cupping like
bleeding cupping
• This disposable cup are made up by
plastic materials

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 Cupping set with Stimulation
• Here low frequency current can continuously
given by cupping sets. TENS or Faradic
stimulation can be given along with suction effect
• 2 cups in the desirable area are needed
• First obtained the suction effect according to the
need
• Then start the TENS machine and complete the
treatmentprotocol
• Before withdrawing the suction effect you have to

switch of the TENS

It cann ot be given to pregnant women and patient with cardiac history,

especiallypatient with cardiac pacemaker

Though there is no studies suggested the risk for cardiac pacemaker patient with
low frequency current

25
 Physiological background

Effect on Skin

• Rise in skin temperature

• Promotion of metabolism in skin tissue
• Better function of sweat & sebaceous gland
• Accelerates the secretion of salts & sebaceous matter andexcretion of
water
• Stimulate the renewal power of the skin
• Increase skin resistance to various harmful conditions

26
 Effect on Muscles
• Stimulate the expansion
of blood vessels in the
muscle hence increase
blood flow
• Facilitate the flow of
lymph
• Release of spasm
• Pain gate mechanism
• It works on TrPs and
dissolve it, and reduce
the pain

Effect on nervous system

• Stimulates sensory nerves of the
skin
• Affects ANS
• Any entrapment in the nerve root
can be treated with cupping (13)

See the reference 6 for details

27
 Effects on joints
• Increase blood flow to the joint
• Increase the secretion of synovial fluids

Effect on blood
• Increase in blood circulation
• Rise in low blood pressure
• Influence the composition of blood : RBC and WBC, pH level

28
digestive organs

 - stimulates the target organ

 - increase in peristalsis movements
 - increase secretion of digestive fluids

Analgesic effect

• Cupping produces stimulation of superficial A delta fibers in the skin6.

• Stimulation of the sensory afferent A δ activates enkephalinergic,
serotonergic, and noradrenergic inhibitory systems. Together they work as
opioid mediated analgesia system (OMAS).
• This analgesic system involves segmental as well as suprasegmental
pathwaysworking through Substantia Gelatinosa of Rolando (SGR) in the
spinal cord.

• The following description of needling related pain modulation is based on

Bowsher’s work

Theory behind cupping

• Reflex zone theory

• Pain gate theory
• Conditioned Pain Modulation theory
• Increasing blood circulation theory
• Nitric oxide theory
• Genetic theory
• Meridian theory

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Reflex zone theory

Reflex Zone Theory proposes that there is an existing link between one organ of
the body and another one. This link is mediated by interaction between nerves,
chemicals, and muscles. Thus, a disturbance in one organ causes external
manifestations which can be detected at a site distal to the disturbed organ. The
external manifestations are dependent on the organ manifesting them. For
example, skin can become cold and pale due to vasoconstriction or it can become
warm and red due to
vasodilatation. The organ
functions are affected due to a
reduction in the circulating
blood and tissue fluids.
Animal studies showed that
somatic stimulation of the
skin or the peripheral joints
could lead to significant
effects on the cardiovascular,
urinary, and gastrointestinal
functions. These reflexes can
be either excitatory or
inhibitory in terms of organ
function. Their main action is attained through spinal pathways, supra-spinal and
cortical canters. Therefore, it is hypothesized that the application of the cupping
therapy cups over the skin result in the stimulation of the skin receptors which
will eventually lead to an improvement in the blood circulation through the neural
connections to the affected organ

Pain gate theory

This theory proposes that cupping therapy could reduce pain intensity by
influencing the communication routes of pain transmission from a stimulated area
to the brain and backward. Following a painful stimulus, pain signals are carried
by both the small-diameter (A-delta and C) and the large-diameter (A-beta)
nociceptive nerve fibers to synapse into a transmission cell in the dorsal horn of
the spinal cord. In this area pain modulation takes place through a network of
interneurons and presynaptic pain gates. The small fibers have an obstructive
effect on the inhibitory cells thus allowing the flow of the transmission signals to
the spino-thalamo-cortical pain pathway and then to the brain. While the large
30
fibers stimulate the inhibitory cells and tend to inhibit transmission of pain
signals. Thus, pain intensity is expected to be reduced when large nerve fibers are
stimulated by touch or pressure or vibration. Based on this theory, both small and
large nerve fibers are stimulated during cupping therapy. During the initial stage
of cupping therapy, the afferent large nerve fibers will partially close the
presynaptic gate as a result of the application of pressure to the skin. As the
stimulus intensity is increased, the number of activated units of nerve fiber
increases. The subsequent positive and negative effects of the small and large
nerve fibers responses tend to counteract each other. However, prolonged
stimulation will lead to adaptation of the large fibers which will eventually result
in opening of the presynaptic pain gates. This adaptation can be modulated by
employing additional stimuli during cupping therapy such as vibration and
scratching to stimulate the large fibers again. This increased activity will lead to
the closure of the pain gates and experiencing further pain relief. More research
is needed to validate the application of this theory in cupping therapy.

31
 Conditioned Pain modulation

⚫ A delta primary afferent receptors project to marginal cells (M) which carries
pinprick sensations in the lateral spinothalamic tract.
⚫ The A delta primary afferent receptors also project to enkephalinergic stalked
cells (ST) in the spinal cord, which inhibits the SGR cells and blocks the
transmission of C pain
This theory has been also known by the term “Diffuse Noxious Inhibitory
Controls (DNICs).” It is based on the assumption that “pain inhibits pain,” or
one type of pain masks another. DNIC comprises a spinal-medullary-spinal
pathway that is activated when two concomitant painful stimuli are applied at
the same time. The activation of this pain pathway, which is triggered by a
distant noxious stimulus, causes inhibition of the primary pain at the level of
the nociceptive spinal neurons. This pain inhibitory system has been
successfully demonstrated in animal studies. Furthermore, findings from
clinical studies on the idiopathic pain syndromes such as irritable bowel
syndrome, temporomandibular disorders, fibromyalgia, and tension-type
headache had confirmed the relevance of this theory to chronic pain in
humans. According to this theory, local vibration or scratching done during
cupping therapy causes a nociceptive stimulus that triggers the activation of
DNICs which eventually lead to the relief of the primary pain

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 Increasing blood circulation theory
• Increase blood circulation as a result of applying negative pressure,
hemodynamic mechanism and removing of inflammatory product and toxin in
wet cupping

Nitric oxide theory

• Nitric oxide cause vasodilatation
• Anti-thrombotic effect protect vessel from thrombosis
• Prevent stenosis

Genetic theory
• Cupping effect differently in different races

Meridian theory (7)

The meridian network is typically divided into two categories, the jingmai or
meridian channels and the luomai or associated vessels (sometimes called
"collaterals"). The jingmai contain the 12 tendinomuscular meridians, the 12
divergent meridians, the 12 principal meridians, the eight extraordinary vessels
as well as the Huato channel, a set of bilateral points on the lower back whose
discovery is attributed to the ancient physician Hua Tuo. The collaterals contain
15 major arteries that connect the 12 principal meridians in various ways, in
addition to the interaction
with their associated
internal organs and other
related internal structures.
The collateral system also
incorporates a branching
expanse of capillary-like
vessels which spread
throughout the body,
namely in the 12 cutaneous
regions as well as
emanating from each point
on the principal meridians.
33
If one counts the number of unique points on each meridian, the total comes to
361, which matches the number of days in a year, in the moon calendar system.
Note that this method ignores the fact that the bulk of acupoints are bilateral,
making the actual total 670.
There are about 400 acupuncture points (not counting bilateral points twice) most
of which are situated along the major 20 pathways (i.e. 12 primary and eight
extraordinary channels). However, by the second Century AD, 649 acupuncture
points were recognized in China (reckoned by counting bilateral points twice).
There are "12 Principal Meridians" where each meridian corresponds to either a
hollow or solid organ; interacting with it and extending along a particular
extremity (i.e. arm or leg). There are also "Eight Extraordinary Channels", two of
which have their own sets of points, and the remaining ones connecting points on
other channels.

34
 Methods of Application

Weak Cupping
• weak cupping also known as light cupping and can be applied in all parts
of thebody. It is also known as light cupping. It increases the blood flow and also
known astonifying method. It can applied for 30 minutes. Slight reddening of the
skin happen.
• Indication –

• cough and cold

• Sore throat
• Asthma
• Anemia
• Multiple sclerosis
• Tonsillitis
• Fatigue
• Cancer patients
• it is popular method for child patients
• Psychosomatic & emotional conditions
Procedure

• Patient preparation should be done as described earlier

• Suction effect can be obtain through fire or suction pistol

35
• If you are applying fire then you should have to be careful about the amount of
suctioning by measuring the height of flame, more or big flame means more
suction & less flame means less suction
• If you are using pistol for suctioning then one single suctioning is sufficient for
weak cupping

Medium Cupping
• This method is frequently used. This cannot be applied to children below 7 years.
The suction is firmer than weak cupping. Medium cupping cannot be used for
more than 30 minutes, otherwise it will drain the patient’s Qi and the patient will
feel extremely lethargic.

Indication –

• hot or cold ‘Bi’ syndrome(disorder

resulting from obstruction of meridians,
sluggishness of Qi and blood circulation
after invasion of pathogen)

• Headache
• Stress
• Sports injuries and musculoskeletal pain
• Tremors and fits
• Infertility
Procedure

• Bigger fire is required for better suctioning

• The cups must also be held closer to the patient, to enable the practitioner to be
quick in applying them; the suction will be firmer as the fire draws out the oxygen,
thus creating a stronger vacuum
• Skin should draw stronger and wait for 30 min
• It can safely use anywhere of the body including face and abdomen

36
 Strong Cupping

• This method also known as draining method

• Blood and internal wind are the target for strong cupping
• Significant amount of blood and Qi is manipulated from this method, sothe
patient should be stable enough to be treated by this method
• The main aim of this type of cupping is to eliminate the internal pathogen
• Red visible marks can be seen after strong cupping, which will be visible for up
to 15 days after the application. The duration of cupping should be short,3 to 5
min in the first session and can be increased to a maximum of 20 minutes in a
single session

Indication

• hypertension
• Headache
• Internal organ heat
• Boils
• Muscular cramps
• Sports injury
• Low back pain
• Upper & lower limb radiating
pain

Procedure
• Generally fire is needed for strong suction
• Fire is inserted in between the cup to obtain suction effect. Fire can be produce
withlarge cotton ball

37
• After ignition of cotton ball fire is inserted into cup without any delay and
apply onthe skin very fast. So you have to make ready everything
• First session 3 to 5 min and later on it can increase up to 20 minutes
• There may be blister or purple color cup mark, so have to be careful

Skin layers in different types of Cupping

Moving Cupping

• This is also another draining method

• It draws out more blood than fluid and Qi
• Moving cupping covers a larger area and patient should have a strong Qi
before being treated by this method
• This is the most painful form of cupping

Indication

• Acne
• Skin lesion
• Inflammation
• Neurological conditions like post-stroke weakness, paralysis
38
 • Excess heat condition
• Febrile disease
• Muscle & Tendon
relaxation

• Sports injury
• Cellulite
• Weight loss program

Procedure
• Oil should apply prior to cup
• One single cup is used with medium strength
• Edge should be smooth for moving the cup, bamboo cup cannot use
• Suction should be less otherwise movement of the cup cannot be done
• It works on or move on meridians
• In open wound it cannot be done
• First session 5 min, later it can increase to 20 min

Light Moving Cupping

• This can be used with glass, rubber or a silicon type cup
• It is same as moving cupping but the suction intensity is less here
• It is used in those patients who feel very weak or lethargic with moving cupping
and
is generally used for old age patients and child patients
• Moving & light moving cupping both leave a pinkish mark on the skin.

39
 Indication –

• Old and frail patient

• Infertility
• Cancer patients
• Immune deficiency syndromes
• Edema
• Lymphedema
• Stress release
• Stomach pain

Procedure

• Glass, rubber and silicon cup can be use here

• Everything is same like moving cupping but only the amount of suction is less
• Broken skin surface, cuts, bruise mark, open wounds area should be avoided

40
 Empty or Flash Cupping

• Flash cupping is a technique used to apply suction

to the skin in short intervals or ‘flashes’
• This means that the cup is placed on the skin for
approximately 5 seconds before the pressure
inside it is released and it is taken off again
• This is repeated along the patch of skin that has
been selected for treatment.
• It is also known as empty cupping as suction is
given at intervals. So in between two suctions,
there is an empty period.

Indication

• Digestion and GI problems

• Tiredness & emotional distress
• Good for children
• Common cold and fever
• Facial treatment & cosmetic purpose

Procedure

• Up to 10 cup applied at same time

• Should apply oil prior to application
• Application time is 5 to 10 minutes
• Once finish with all cup (10 cup) then start
removing from thefirst applied cup
• Slight pinkish mark can be there afterwards

41
 Silicon Cups

• It was invented by ILKAY ZIHNI CHIRALI in 2011

• It is more resistance to oil or damage or
sterilizing materials
• Edges are smooth
• Popular in use cosmetically especially in
cellulite and for facial muscles

Indication

• used in children
• this is a safe method & drainage intensity is less
cellulite

• weight loss program

• heavy leg syndrome
• tonification & other cosmetic use
42
Procedure

This type of cupping can be used by the patient, it is easy to use, and the suction
level is very little. The way of application is to hold it in your hand and first
determine the area of application, then create negative suction by folding it
opposite side. After this apply it over the desirable area.

BLEEDING/WET/FULL CUPPING
This is a draining cupping and was most popular in the ancient time in Middle
East &European countries. This method is the fastest to give relaxation to the
patient. Toxic substances in form of blood seem to purge out from the patient’s
body.
Before applying the cup, needle is inserted and removed to create the
channel forblood to come out
In a single cup, 20 ml to 100 ml of blood can be drawn out in about 5
minutes ofmaximum time. It is better not to apply it more than 5 minutes

Indication

• Asthma
• Shortness of breath
• Hair loss
• Skin purpura
• Frozen shoulder
• Hemiplegia
• Eczema
• Acne
• Gout
• Hypertension
• Insect bites
• Fibromyalgia
• Sports injuries
• Blood poisoning

43
 Procedure

• There are 3 way to make incision

 Surgical blade

 Dry Needle

 Plumblossom needle

Item required

o Surgical blade, plum blossom needle

o Cup with suction unit
o T - Bact ointment
o Gauze
o Micropore

44
 Procedure:

o First demark the area of cupping. It can be done by applying

weak cupping prior to incision.
Most preferable is Du – 14 for
wet cupping.
o Then make several incision in
shorter period of time &
remember about the bleeding
time (1 to 9 min) & clotting time
(8 to 15 min). So the whole
process shouldbe completed
within 9 to 15 min
o Generally, 20ml to 100ml blood
collected in the cup
o At the time of removal be careful
with hygiene

Du-14 Dazhui (great vertebrae)

• Location: On the posterior median line, in the depression below the spinous
process of the 7thcervical vertebra. Underneath muscle - trapezius
• Indications:
• Febrile disease, malaria, hectic
fever, and nightsweats
• Aversion to cold, common cold,
redness, swellingand pain of the
eye,neck rigidityand pain
• Epilepsy
• Cough
• Functions: Clears Heat, releases
the Exterior, dispels Wind,
regulates Wei and Ying Qi,
treatsmalaria.
Notes: Du 14 it is a main point in
treating SummerHeat

45
 MOXA CUPPING & HOT NEEDLE CUPPING

 This is also known as tonifying method.

 Moxa is obtained from dried leaves of mugwort plant. It can be found in
loose type, smokeless charcoal type, round, long, cigar shaped long type
and smokeless dry cut form. Dry cut form fits into needle handle.
 Moxa rolls are divided further according to their strength like medium
moxa, hot moxa and very hot moxa.
 Hot cupping can be divided into hot needle cupping and moxa cupping,
where needle not used

Indication

• Asthma
• Spleen or stomach cold type patterns
• Wind-Cold Bi syndrome
• Cough
• Anemia
• Infertility, impotence
• Low back pain
• Dysmenorrhea

Procedure

• Insert 40 mm of needle to the desired area

• Left 10 mm not to enter completely & apply moxa roll at rootand shaft of
the needle
• Insert a fire resistance paper above the skin to avoid the fallingashes from
moxa
• Now fire the moxa and wait until it completely burn, it maytake up to 10
min
• After it completely burn, apply cup without touching theneedle or ash

46
• After successfully completing the cupping remove it carefully without
touching theneedle
• Then put out the needle and moxa and apply ginger slice on that needle area
• Now put 10 mm of moxa above ginger and light it, and again put cup on it
• During the suctioning the moxa should lose its heat, if not then remove it and
stop the treatment

47
 Herbal Cupping
• Natural herbs are used here along with cupping method. Patient’s condition will
determine which herbs should be used. It can be further classified into
a.Bamboo cuppingb.Herbs in the cup

• a. Bamboo cupping – here bamboo cup is boiled for 30 minutes with herbs, prior
to applying. There may be chance of burns and blisters after application of hot
bamboo.
• b. Herbs in the cup – herbs are prepared separately and poured at the time of
cupping. Suction should be medium if practitioner uses herbs in the cup

Procedure (Bamboo Cup)

• Select the desire hurb
• Boil it with bamboo cup for 30 min
• Use metal clamps to take it from boiling pot and apply it to the patient, be
careful as
bamboo may be too hot, wait for bamboo to cool down and apply
• Here fire is used for suction effect

Procedure (HERBS IN THE CUP)

 Herbs is prepared separately and pour into the cup

 Suctioning effect can be obtain with fire or with pistol suctioning. Vacuum
operated cup also can be used
 Luke warm water is used in vacuum operated cup
48
 Indication-
 Joint stiffness and pain
 Bed wetting of the children
 Asthma Infertility
 GI problemsEmphysemaCough
 General relaxation purposeIncontinence

 Neck & shoulder pain

Water Cupping

• Water cupping treatments require a highly

experienced practitioner.
• This method involves the very quick and
dexterous application of a glass or bamboo
cup filled with one-third full warm water,
without spilling the water.
• It is not so popular and it requires very
expert hands, and moreover the therapeutic
effect is less for this type of cupping

Indication
 Asthma
 Dry skin
 Rheumatism
 Localized swellingPain

Procedure:

 Luke warm water used here

 Fire or pistol both can use as suction
 Apply fire, create the suction(be close to the cup area)
 Pour warm water very first and apply it on desired area
 There may be some slippage of water at the time of applying and
removing(candecrease the suction effect and draw it up to shoulder
49
 Ice Cupping
• Ice cupping is not TCM, it is a very new method and was first started by a
Physiotherapist
• In TCM it is said that “cold is death”, so ice cupping is against the principle

of TCM,

but it is giving excellent outcome in sports injury patients as well as other patients
• It gives anti-inflammatory effect and it reduces pain efficiently

Indication -
 Joint pain
 Sports injury
 Traumatic injuries

 Muscular pain accompanied by heat

pattern

Procedure

• Process is same like weak, medium & strong cupping. Only there will be
insertion ofIce before obtaining suction
• Be careful about ice burn, if skin color is changing rapidly as like ice

burn then stop the treatment

50
 NEEDLE CUPPING

• Needle cupping is used to remove excess pathogen as well as

reduce pain
• This releases the active trigger points and also the muscles.
Needle size(0.5-1inch is safe) depends as per the need
• Insertion of needle followed by the application of the cup.
Total treatment time may vary from 10 to 20 minutes. Some
blood may purge out during this process
• There should be needle clearance after application of cup

Indication

 Muscular spasm and pain

 Sports injuries
 Stiff joint
 Arthritis(osteoarthritis, rheumatoid arthritis
etc)
 Range of motion limitation due to muscle
stiffness

Procedure:

• Select the target TrP

• Apply oil & use sanitizer
• Needle the area
• Apply big size cup to accommodate the needle
• Keep it for 10-15 min
• Blood may come out
• Use 13 mm or 25 mm needle
• Not safe for child

51
 Myofascial cupping

 Placing two cups at the same muscle belly and stretching them inopposite
direction
 Ideal for quadriceps, calf and back
 Myofascial Cupping is being widely used in athletic training, physical
therapy, and remedial massage therapy clinics. It was recently used in the
2016 Rio Olympic games for pre- and post-competition recovery and
detoxification

Indication

 Decompress adhesion’s and scar tissue

 Relax muscles in spasm decrease
trigger point pain
 Decrease tissue changes and
inflammation following trauma
Cumulative treatments increase muscle
endurance, circulation,increase lymphatic
drainage and enhances overall ability to
recover from workouts and strenuous activity

Sports Cupping
o Dynamic
moving cup in opposite direction while
muscle fiber getting stretch
o Static
Place cups on stretched muscle fiber so
apply stretching before applying cup

52
 Fire Cupping or Alcohol Cupping

• It involves soaking a cotton ball in almost pure alcohol. The cotton is clamped by
a pair of forceps and lit via matches orlighter, and, in one motion, placed into the
cup and quicklyremoved, while the cup is placed on the skin.
• Fire heats inside of the cup and small amount of suction is created by the air
cooling down again and contracting.
• Dark circles may appear where the cups were placed becauseof rupture of the
capillaries just under the skin.

There are many types of cupping, but fire cupping is the most traditional,
original form of Chinese medicine. It uses glass cups (also traditional) and the
fire "creates a better suction with glass cups,". Fire cupping removes the "cold"
in the body — cold is considered
one of the "evils" in Chinese
medicine of which practitioners
aim to rid the body.
"practitioners prefer to use the
elements in their practice," and
that "heat is nourishing for people
who are drained and tired." So fire
cupping could give you the boost
you need!
Also known as flash fire cupping
or Shanhoufa in Chinese cupping

53
 Patient preparation & assessment

• Massage the area properly prior to applying Cupping

• Palpate the skin & search for local trigger points
• Extreme cold environment is contraindicated for cupping, so keep the
room warm

• Dehydration is very common during treatment. So enquire for it and

arrange waterso patient can have water during treatment

• Dry skin is contraindicated for Cupping, good amount of suction

cann ot obtain indry skin

• Hairy surface is generally gives poor suction effect. Removal of hair

is necessary ifthe area is very hairy

54
 Various position of Cupping application

Head & Neck

Indication
 Headache
 Migraine
 Eye & ear complain
 Nasal problem
 Neck pain

 Spasm of SCM, Upper Traps, spelinus cervicis, levator scapulae etc

 Bells palsy

 Torticollis

 Dry mouth
 Tonsillitis

Standing

Indication
 Sciatica
 any radiculopathy
 PIVD
 Dysfunction
 Knee pain

55
• Apply on back(L4 – S1) and course of the nerve
• First apply on the back then in the course

Joint

Indication
 Swollen joint
 Osteo arthritis
 Rheumatoid arthritis
 Edema
 Paralysis

56
 Face

Always use weak Cupping

Indication
o Facial palsy
o bell’s palsy
o stroke
o toothache
o nasal congestion
o eye problems

Under the feet

• Contraindicated for diabetic patient

Indication-
o Planter fasciitis
o Sports injury
o Calcaneal spur pain

57
Abdomen

Indication

• Gynaecological problems
• Infertility (evidence is doubtful)
• Abdominal spasm
• Indigestion
• Constipation
• Diarrhoea
• Weight loss programme

58
 Cupping Assessment form

Patient Name :
Age/Sex :
Chief Complain :

Present Medical History :

Past Medical History :

Reason for Cupping : Diagnosis :

Precautions (RED Flags / YELLOW Flags) :

Do’s & Don’t after Cupping session :

Target area / structure :

Numbers of Cupp used : Types of Cupp used :

Duration : Size of Cupp :

Skin color (after removal of cupp) : No of sessions :

Other treatment protocol along with Cupp :

Home exercise & activity guideline :

59
SAMPLE CONSENT FORM

CUPPING THERAPY CONSENT FORM

I (patient’s full name) . . . . . . . . . . . . . . . . . . . . . . . . . declare that the cupping therapy practitioner
(practitioner’s full name) . . . . . . . . . . . . . . . . . . . . . . . . . has fully explained to me the cupping therapy
procedure, benefits, contraindications and possible side effects. I have been made aware that
cupping marks may last between 8 and 20 days.

Signed . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . . . . . . . . . . . . . . . . .

60
 Cupping in Diseases

Asthma

• Aetiology and Pathology

‘wheezing’ is looked upon as the first indication of asthma. During sleep, at rest
or on exertion, wheezing, which is often accompanied by coughing or
shortness of breath, is a clear indication of Lung-Qi deficiency.
In general there are two types of asthma: the Deficient (Empty) type, and the
Excessive (Full) type.

 InWind-Cold
the Excessive type the Lung-Qi is exhausted as a result of invasion by
or Wind-Heat, and the onset is usually sudden. In the Deficient
type the Lung-Qi deficiency is also accompanied by Kidney-Qi deficiency,
and the manifestation is more of a chronic nature.

 Inof breath,
Deficient-type asthma the clinical manifestations are wheezing, shortness
pallor, tiredness, a feeble continuous cough and cold extremities.

• Treatment
Deficient Asthma – Lung and Kidney-Yin Deficiency
• Treatment Principle:
Remove the external pathogen, nourish the Lungs,
tonify theStomach / Spleen and the Kidneys, resolve
Phlegm and stop the coughing

• Cupping Application
Light to Medium cupping on Ren-12 Zhongwan, Liv-
13 Zhangmen, Dingchuan Extra, BL-13 Feishu, BL-
20 Pishu and BL-23Shenshu; use the Empty method
on the Back-Shu points if the patient is listless and
lethargic

61
 Cupping Duration

Children
 Under 5 years: 2–3 minutes of Weak or Empty cupping
 5–7 years: Up to 10 minutes of Weak or Empty cupping
 7–14 years: Up to 15 minutes of Weak or Medium cupping

Adults
 Young adults: Medium to Strong cupping, up to 20 minutes
 The weak and the frail: Weak or Empty cupping, up to 10 minutes

62
 BACK PAIN AND SEXUAL DISORDER

• Back pain is very common and it can be divided into upperback

and lower back pain
• Generally lower back pain sometime associated with sexual
problems

Upper Back Treatment

• Treatment Principle: Remove thepathogenic factors, i.e. Cold,

Damp or Wind-Cold, open the channels and stop the pain

• GB-21 Jianjing, Du-14 Dazhui, BL-12

Fengmen and SI-11 Tianzong

Cupping Duration
Children
 Under 5 years: 2–3 minutes, Empty cupping
 5–7 years: Up to 10 minutes, Empty or Light cupping
 7–14 years: Up to 15 minutes, Light or Medium cupping
Adults
 Young adults: Medium, Strong or Moving cupping, up to 20minutes
 The weak and frail: Weak or Empty cupping, up to 10 minutes

Lower back treatment

• Treatment Principle:
Tonify the Kidney-Qi,
particularly the Kidney-
Yang, remove
pathogenic factors and
relieve stagnationof Qi
and Blood.
• Dry cupping on Du-3
Yaoyangguan, Du-4
Mingmen, BL-23
Shenshu, BL-25
Dachangshu and BL-54
Zhibian or GB-30
63
 Huantiao.
• Hot Needle cupping on Ren-4 Guanyuan, Du-4 Mingmen and BL-23
Shenshu when the patient presents a Wind-Cold or Wind-Damp syndrome.

Cupping Duration
Children
 Under 14 years: up to 10 minutes, Empty or Medium cupping.
Adults
 Young adults: Medium, Strong or Moving cupping, up to 20minutes
The weak and frail: Empty or Medium cupping, up to 10minutes.

• Cupping and its Effect on the Sex Mechanism:

Cupping on Du-3 Yaoyangguan and Du-4 Mingmen removes the
obstruction, relaxes the muscle and improves the Qi and Blood circulation to
the second, third and fourth lumbar vertebrae, which has a particular
influence on the nerves supplying the sexual organs

64
 BED-WETTING (NOCTURNAL ENURESIS)

 Bed-wetting after the age of 3 years is considered to be aproblem and one

that needs to be treated. This is one childhood problem that Western
medicine fails to treateffectively
 Chinese Medicine, however, is highly successful, especially when
combined with cupping. The majority of nocturnal enuresis cases seen in
the clinic are between 7 and 12 years old

Treatment

• Treatment Principle: Warm and tonify the

Kidneys; strengthen the Bladder.

• Cupping Application
Medium cupping on Ren-3 Zhongji, Ren-6

Qihai, Du-4 Mingmen, BL-23

Shenshu and BL-28 Pangguangshu

• Cupping Duration
Children
● Under 5 years: 2–3 minutes, Empty or

Light cupping
● 5–7 years: Up to 10 minutes, Empty or
Light cupping
● 7–14 years: Up to 15 minutes, Light or Medium cupping
14–16 years: Up to 20 minutes, Medium cupping

65
 CONSTIPATION

• Using western style lavatory results in constipation now a days. This is one of the
‘secret’ complaints of Western society. Most of the patient believe in self-
medication and it became permanent problem for the patient
• Cupping Application
• Medium cupping on ST-25 Tianshu, Ren-12 Zhongwan, Liv-13 Zhangmen,
BL-20 Pishu and BL-25 Dachangshu.
For children under 7 years, massage the abdomen with olive oil using aclockwise
circular motion.
Hot, Excessive-Type Constipation

• Treatment Principle: Remove Heat, regulate the Large Intestineand move the
bowels.
• LI-4 Hegu, LI-11 Quchi, ST-44 Neiting and Liv-2 Xingjian. Cup the same points
as before, using a Stronger method when draining the Heat.
Cupping Duration: Apply 10 minutes of Moving cupping (clockwise) twice a
week around the umbilicus

DYSMENORRHOEA

• Dysmenorrhoea is very common complaint in modern society. The clinical

manifestations include abdominal pain before, during or after the onset of
menstruation, often accompanied by other symptoms such as lower backache,
dizziness, nausea,restlessness, agitation, tiredness and heart palpitations.
• Failure to protect and nurture the body during menstruation is a key factor in
dysmenorrhoea

Treatment
 Stagnation of Liver-Qi and Blood
 Clinical manifestations include
breast distension, pain before or
during the flow, some blood clots,
agitation and restlessness.
 Treatment Principle: Remove the Liver-
Qi stagnation, move Qi andBlood, and
stop pain.
 Cold-Damp Invading the Uterus
 Clinical manifestations include feeling
cold, especially in the lower extremities
66
 and abdomen, colicky pain before or during menstruation, lower backache,
tiredness and pain relieved by hot water bottle application.
 Treatment Principle: Warm the lower abdomen with Moxa, remove Cold, and
restore the movement of Qi and Blood

PRECAUTION

o Do not apply Strong or Moving cupping to the abdominal points

FEVERS

Complementary medicine practitioners, when presented witha condition that

accompanies a fever, are sometimes
placed in a dilemma whether to advise
the use of antibiotics, or to try to manage
the disease and reduce the fever using
alternativeremedies alone.
Treatment

 Treatment Principle: Always

disperse the Heatfirst, before
dealing with other symptoms.
 Cupping Application
Bleeding cupping method on the Du-
14 is the most effective for treating
Fever attacks. Alternatively, you can
use Strong cupping method on Du-14
Dazhui, Du-10 Lingtai and BL- 17
Geshu. Apply Empty cupping method on the upper back if the patient is
lethargic
If fever cross 100°F then refer to hospital

67
 GROWING PAINS

• Growing pains mostly occur in children between the ages of 3 and 12 years. The
pain is usually concentrated in the muscles and not the joints. The thighs,
calves and backs of the kneesare the common pain locations.

• Treatment
• Treatment Principle: Tonify the Spleen and
promote blood circulation to the legs.
• Cupping application: Alternate the cupping
treatment between moving the Blood and Qi
and tonifying the Spleen, treating twice a week
if possible. Apply a Flash or Light cupping
method for between 3 and 5 minutes to each
leg, concentrating on the Liver and the Gall
Bladder channels. On alternate days apply
Weak cupping for 3 to 5 minutes to the Liv-13
Zhangmen, Ren-10 Xiawan,Ren-6 Qihai, ST-30
Qichong, BL-20 Pishu and BL-28
Panggunagshu points

Hypertension

• Blood pressure is considered to be elevated when the systolic (upper) value

is 160 mmHg or above, and the diastolic (lower) value is 90 mmHg or above.
Both these values indicate the pressure of the blood on the walls of the
vessels, the former being during heart contraction and the latter being the
resting period between contractions.

68
 Treatment
• Treatment Principle: Tonify the Kidneysand subdue the Liver-Yang.
• Cupping Application
• Bleeding cupping on Du-14; up to 100mL of blood can be extracted

STROKE (WIND-STROKE), BELL’S PALSY – FACIAL

PARALYSIS

• This condition was definitely the most common disorder treated in the
acupuncture departments in various Nanjing Hospitals during my studies
there – so much so that quite a few of my colleagues complained of not being
able to treat conditions other than facial paralysis! Electromagnetic
stimulation of the acupuncture points alongside cupping was a popular
treatment protocol.

• Treatment
• Treatment Principle: Treatment for both conditions is
very similar: clear the Windfrom head and face,
remove the obstruction from the channels invigorate
Qi and Blood locally throughout.

• Cupping Application
• Cupping to be the most effective therapy when
treating facial paralysis.
it can be main treatment modality,supported by
acupuncture and moxibustion. Apply up to ten small

69
 cups(number 2 to 3) cups to both sides (five on each side), daily or twice a week
for better and faster results .
Cupping Duration
 Children
Under 14 years: Up to 10 minutes, Empty or Light cupping.
 Adults
Young adults: Light to Mediumcupping, up to 20 minutes
The weak and frail: Empty toMedium cupping, up to 10
minutes.

Caution
 Be careful about blister
 Don’t use strong cupping
 Be careful if you are using moxa

ANKYLOSIS SPONDYLITIS
• This is a chronic arthritis condition where the spinal joints, ligaments and the
sacroiliac joints become inflamed. Bones of a joint can also fuse together. This
causes pain and stiffness in theneck and back.
• Cupping Therapy. Apply 15–20 minutes of Light to Medium cupping, to both
sides of the Bladder channel, across the lower back including Du-3
Yaoyangguang, BL-26 Guanyuanshu, BL-28 Pangguangshu and GB-30
Huantiao. If the patient can tolerate it,apply a further 5 minutes of Lightmoving
cupping on both side ofthe spine Huatuo Jiaji Extra points

70
 CARPAL TUNNEL SYNDROME

• This condition is an obstruction or entrapment

of the mediannerve at the wrist, causing
paraesthesia
• (numbness and tingling feeling, like pins and
needles) and painin the affected wrist and
fingers.
• Treatment Principle. Clear the obstruction in
the channels andreturn the normal flow of Qi
and Blood to the wrist and fingers.

Cupping therapy apply four to five Medium

to Strong strength cups on the inner aspect of
the arm starting 1 cun above the P-4 Ximen,
and terminating at P-8 Laogong, making sure that a cup is also placed on P-7
Daling

Gout
Gout is considered to be a disorder of the metabolism, in which there is anexcessive
build-up of uric acid in the blood. Symptoms are a sudden and intense pain in one or
morejoints, typically the big toe.
 Cupping Therapy: Apply Moving cuppingto the Bladder channel on the back of
the body. Apply Bleeding cupping to the affected joint. Avoid foods that are
high in purines anddrink plenty of water (2–3 litres per day)

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 HEADACHE / MIGRAINE
• Headaches are probably the most common of all
complaints seen in the clinic; between 6 and 12% of
adults experience a headacheat least once a week
• The most common factors that bring on headaches are
worry in various forms (in particular over finances),
tension, tiredness and emotional upset. Less commonly,
a headache may accompany an infection, such as of the
teeth or sinuses. Some eye conditions can also precipitate
headaches. Migraine is a special type of severe headache
that usually affects only one side of the head
and isfrequently accompanied by other symptoms, such
as nausea, vomiting and vision disturbance.

• Cupping Therapy: For frontalheadaches, treatment

by cupping of Taiyang Extra and Yintang Extra
(acupuncture) is administered. For migraine,
cupping on Taiyang Extra and Du-14 Dazhui is
administered

TORTICOLLIS (WRY NECK)

• Torticollis (also known as wry neck) is due to

the involuntary contractions of neck muscles,
where the head is twisted to oneside by
tightening of the sternocleidomastoid muscle.
Headdeviation to one side, shaky head, neck
pain and abnormal posture are among the
symptoms. In TCM, torticollis is considered
as Wind attack that injures the channels.

Treatment is aimed atremoving the Wind

factor from the channel involved by
using acupuncture, moxibustion and cupping therapy. Torticollis is treated
by applying acupuncture to GB-39 Xuanzhong in anupward direction, followed
bycupping therapy to the affected site

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References:
1. Traditional Chinese Medicine Cupping Therapy 3rd edition by ILKAY ZIHNI CHIRALI
MBAcC RCHM
2. https://melbournenaturaltherapies.com.au/the-history-of-cupping/
3. https://www.sciencedirect.com/science/article/pii/S2005290117302042
4. https://www.sciencedirect.com/science/article/pii/S2005290117302042#bib18
5. https://www.sciencedirect.com/science/article/pii/S2005290117302042#bib19
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1&originCreation=20220813062719
7. https://en.wikipedia.org/wiki/Meridian_(Chinese_medicine)
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12. https://www.statpearls.com/ArticleLibrary/viewarticle/20172
13. https://www.performancehealthcarepdx.com/evolveu/2018/8/7/where-should-we-
cup-common-areas-to-find-peripheral-nerve-entrapment
14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488563/
15. https://www.intechopen.com/chapters/73348
16. The Foundation of Chinese Medicine 3rd edition by Giovanni

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