Cupping therapy

Cupping therapy (or cup massage) is a pseudoscientific treatment method in which a local suction is created on the skin by using heated cups. As an alternative medicine practice, it is primarily used in Asia, but it is also used in Eastern Europe, the Middle East, and Latin America. There is no conclusive evidence supporting the claimed health benefits of cupping, and critics have characterized the practice as quackery. However, there are some risks of harm, especially from wet cupping and fire cupping.

In ancient Greece, Hippocrates () used cupping for internal disease and structural problems, and Roman surgeons used it for bloodletting. The method was highly recommended by Islamic Prophet Muhammad Cupping was also mentioned in Maimonides' book on health and was used within the Eastern European Jewish community. William Osler recommended its use for pneumonia and acute myelitis in the early twentieth century.

Scientific evaluation

The American Cancer Society notes that "available scientific evidence does not support claims that cupping has any health benefits" and also that the treatment carries a small risk of burns. A review of literature in 2011 determined that "the effectiveness of cupping is currently not well-documented for most conditions", and that systematic reviews showing efficacy for the treatment of pain "were based mostly on poor quality primary studies." This was further supported by a review in 2014 which demonstrated that previous evidence supporting cupping has resulted from "unreasonable design and poor research quality". Subsequent systematic reviews have also identified poor research quality, inconsistent approaches to study blinding, and varying methodologies among studies.

There is a lack of evidence to support the use of cupping therapy for acne. Additionally, cupping is often practiced along with other acupuncture therapies and therefore cannot exclusively account for resultant positive benefits. Many reviews suggest there is insufficient scientific evidence to support the use of cupping techniques to combat relevant diseases and chronic pain.

The lack of apparent benefits of cupping treatments are discussed by Simon Singh and Edzard Ernst in their 2008 book Trick or Treatment.

As a pseudoscientific detoxification ritual, proponents of cupping falsely claim that it can remove unspecified toxins from the body. Proponents also falsely claim that cupping "improves blood flow" to help sore muscles. James Hamblin notes that a bruise caused by cupping "is a blood clot, though, and clotted blood is definitionally not flowing."

Critics of alternative medicine have spoken out against cupping therapy. Harriet Hall and Mark Crislip have characterized cupping as "pseudoscience nonsense", "a celebrity fad", and "gibberish", and observed that there is no evidence that cupping works any better than a placebo. Pharmacologist David Colquhoun writes that cupping is "laughable... and utterly implausible." Practicing surgeon David Gorski observes that "it's all risk for no benefit. It has no place in modern medicine, or at least shouldn't."

Safety

Cupping is generally considered safe for most people when performed by trained practitioners; however, it may not be suitable for everyone. According to the NCCIH "Cupping can cause side effects such as persistent skin discoloration, scars, burns, and infections, and may worsen eczema or psoriasis".

Cupping causes breaks in the capillaries (small blood vessels) in the papillary dermis layer of the skin, resulting in the appearance of petechiae and purpura. although the benefits may be indistinguishable from those of a placebo.

While details vary between practitioners, societies, and cultures, the practice consists of drawing tissue into a cup placed on the targeted area by creating a partial vacuum – either by the heating and subsequent cooling of the air in the cup or via a mechanical pump. The cup is usually left in place for somewhere between five and fifteen minutes.

Cupping therapy types can be classified using four distinct methods of categorization. The first categorization system relates to "technical types" including dry, wet, massage, and flash cupping therapy. The second categorization relates to "the power of suction-related types" including light, medium, and strong cupping therapy. The third categorization relates to "the method of suction-related types" including fire, manual suction, and electrical suction cupping therapy. The fourth categorization relates to "materials inside cups" including herbal products, water, ozone, moxa, needle, and magnetic cupping therapy.

Further categories of cupping were developed later. The fifth relates to areas treated including facial, abdominal, female, male, and orthopedic cupping therapy. The sixth relates to "other cupping types" that include sports and aquatic cupping.

Dry cupping

Dry cupping involves the application of a heated cup on the skin of the back, chest, abdomen, or buttocks.

Wet cupping

Wet cupping, also known as hijama () or medicinal bleeding, is where blood is drawn by local suction from a small skin incision.

The first reported usages are found in the Islamic hadith, sayings attributed to or describing the actions of the Islamic prophet Muhammad. Hadith from Muhammad al-Bukhari, Muslim ibn al-Hajjaj Nishapuri and Ahmad ibn Hanbal support its recommendation and use by Muhammad. As a result, wet cupping has remained a popular remedy practiced in many parts of the Muslim world.

In Finland, wet cupping has been done since the 15th century, and it is done traditionally in saunas. The cups were made of cattle horns with a valve mechanism inside to create a partial vacuum by sucking the air out. Cupping is still practiced in Finland as part of relaxing and/or health regimens.

The points used in wet and dry cupping are varied and intended to correspond to areas of pain and blockage. Over the years treatment plans have been created but, due to their holistic nature, the points used may vary depending on the individual.

File:Hijama therapy1.jpg|A person receiving wet cupping

File:Drawn_blood.jpg|Blood drawn by wet cupping

</gallery>

Traditional Chinese medicine

thumb|Woman receiving fire cupping at a roadside business in [[Haikou, Hainan, China]]

In Chinese, cupping is known as "pulling-up jars" (). According to traditional Chinese medicine (TCM), cupping is done to dispel stagnation (stagnant blood and lymph), thereby improving qi flow, Cupping is not advised, in TCM, over skin ulcers or to the abdominal or sacral regions of pregnant women.

Society and culture

Cupping has gained publicity in modern times due to its use by American sport celebrities including National Football League player DeMarcus Ware, National Basketball Association star Shaquille O'Neal, Olympians Alex Naddour, Natalie Coughlin, and Michael Phelps and tennis player Ben Shelton. Medical doctor Brad McKay wrote that Team USA was doing a great disservice to their fans who might "follow their lead", calling cupping an "ancient (but useless) traditional therapy." Steven Novella noted "It is unfortunate that elite athletics, including the Olympics, is such a hotbed for pseudoscience."

There is a description of cupping in George Orwell's essay "How the Poor Die", where he was surprised to find the antiquated practice applied to another patient in a Paris hospital. In the 1964 Hollywood film Zorba the Greek, cupping is depicted with the character Zorba, played by Anthony Quinn, performing it on the character played by Lila Kedrova.

The perceived benefits of cupping have often been perpetuated by celebrities and athletes who use these therapeutic interventions in their daily lives. Professional swimmer Michael Phelps received publicity during the 2016 Olympics for the purple bruises evident on his back resulting from cupping. He has been known to "do it before every meet he goes to to "speed up recovery". Celebrity endorsements such as these may bias individuals to feel benefits from the practice.