Author:Dr Faeeza Abdullatief
BSc Complementary Health Sciences (UWC)
B Complementary Medicine Unani Tibb (UWC)
Historical Origins of Cupping therapy
Cupping (Hijama in Arabic) is an ancient, holistic method for the treatment of a variety of diseases which has been documented in ancient Egyptian and Chinese texts as a form of medical treatment. The historical descriptions of cupping therapy were found in ancient human civilizations of the Eastern and Western world. Cupping therapy fell out of favor in 17th and mid-18th centuries but recovered popularity in modern medicine and unhygeinic practices by unqualified people. Currently, there has been a resurgence of cupping therapy is used for health promotion, treatment of various diseases and prophylactic treatment globally. With the improvement in safety protocols and scientific research, cupping therapy is performed by medically trained qualified practitioners safely and effectively to manage medical conditions. Currently, the scope of cupping therapy is expanding, and a growing body of research is providing additional evidence-based data for the further advancement of cupping therapy in the treatment of a variety of diseases .
Cupping therapy goes back to ancient times and was used around the world. In 400 BC, Herodotus listed wet and dry cupping as a treatment for many ailments including maldigestion, lack of appetite, and headaches. Hippocrates advocated cupping for gynecological complaints, back, and extremity illnesses, pharyngitis, lung diseases, and ear ailments. Cupping therapy was mentioned in the famous Papyrus Ebers in Ancient Egypt (1550 BC). In the Middle East, cupping was advocated by pioneers in Unani Tibb by prominent physicians like Abu Bakr Al-Razi (AD 854-925), Ibn Sina (AD 980-1037), and Al-Zahrawi (AD 936-1036) .
What is cupping therapy?
There are two types of cupping methods, dry and wet. Dry cupping is noninvasive with no bloodletting. Wet cupping is invasive and includes bloodletting. It is further is subdivided into traditional wet cupping and Al-hijamah. Al-hijamah comes from the Arabic word hajm which means sucking, expansion, and bloodletting. Traditional wet cupping is commonly used in China, Korea, and Germany. Al-hijamah is more common in the Middle East and North Africa .
How is cupping therapy used in Unani Tibb and how does is benefit your health?
The method used in Unani Tibb is called the Taibah method, suggests wet cupping mimics an artificial kidney. Where an in vivo kidney filters hydrophobic materials through the glomeruli via normal pressure filtration, wet cupping filters both hydrophilic and hydrophobic material through high-pressure filtration. The high pressure from suction leads to increased blood volume which leads to increased capillary filtration rate leading to the expulsion of filtered and interstitial fluid in the area. Filtered fluid collected contains disease-related and disease-causing substances as well as prostaglandins and inflammatory mediators. The scratches made with the scalpel increase innate and acquired immunity by stimulating inflammatory cell migration and endogenous opioid release. This action leads to improved blood flow, removal of toxins, restored neuroendocrine balance, improved oxygen supply, and tissue perfusion. While the exact mechanism of action of cupping therapy is not well-understood, multiple theories have been proposed. Six mechanisms of action have been suggested to describe the various effects of cupping therapy. Three of these theories are addressing the biological and mechanical basis of pain relief which results from cupping therapy. These theories are as follows: the pain-gate, the conditioned pain modulation, and the reflex zone. The remaining three proposed mechanisms of action are meant to explain the beneficial effects of cupping therapy which include an increase in blood circulation, immunomodulatory effects, and the removal of toxins and wastes . The former three theories which are related to pain relief will only be discussed here .
Many theories explain the mechanism of action of cupping. Guo et al. suggested the immune modulation theory, suggesting that cupping and acupuncture had the same mechanisms of action. Immune modulation theory suggests that changing the microenvironment by skin stimulation could transform into biological signals and activate the neuroendocrine immune system. Shaban and Rarvalia proposed the genetic theory, which suggested that skin's mechanical stress (due to subatmospheric pressure) and local anaerobic metabolism (partial deprivation of O2), during cupping suction could produce physiological and mechanical signals which could activate or inhibit gene expression. In wet cupping therapy, superficial scarifications could activate the wound-healing mechanism and gene-expression program .
What are the health benefits of Cupping therapy?
Fig 1. Reference: Al-Bedah, A., Elsubai, I. S., Qureshi, N. A., Aboushanab, T. S., Ali, G., El-Olemy, A. T., Khalil, A., Khalil, M., & Alqaed, M. S. (2018). The medical perspective of cupping therapy: Effects and mechanisms of action. Journal of traditional and complementary medicine, 9(2), 90–97. https://doi.org/10.1016/j.jtcme.2018.03.003
Cupping therapy has proven to be effective in various types of disease: 
Immune modulation to control your immune function if it is over or under active.
Haematological effects: changing the contents of blood and its products e.g. iron levels, glucose levels, cholesterol levels etc.
Reduces inflammation and improves circulation
Herpes zoster and associated pain and acne, facial paralysis, and cervical spondylosis.
Lowering blood pressure and prevents the development of cardio vascular diseases CVDs in healthy people.
Wet cupping in conjunction with conventional treatment is reported to effectively treat oral and genital ulceration in patient with Behçet's disease
Wet cupping is effective in musculoskeletal pain, nonspecific low back pain, neck pain, fibromyalgia and other painful conditions. Michalsen et al. (2009) concluded that cupping therapy may be effective in alleviating the pain and other symptoms of Carpal Tunnel Syndrome.
Cupping therapy is also found to be effective in headache and migraine.
Evidently, cupping therapy is effective in the treatment of cellulitis.
Cupping therapy has been used with various level of evidence (I to V) in many conditions such as cough, asthma, acne, common cold, urticaria, facial paralysis, cervical spondylosis, soft tissue injury, arthritis and neuro-dermatitis.
How is cupping therapy done?
Cupping therapy preceded by light massage with a suitable oil and optionally essentail oils suitable for the patient's condition. It is done by applying small round cups which are made of glass, bamboo, ceramic or plastic to the area of pain. The cup has a rolled rim to ensure tight contact with skin to preserve the negative pressure created . The mouth of the cup is placed firmly over the preferred location against the skin. The negative pressure is generated by heat or by other vacuums like manual pumps. This negative pressure fixes the cup onto the skin and creates suction effect which pulls the skin upwards into the cup. Sometimes, the practitioner uses lubricants to facilitate the movement of the cups to cover a wider area . The common application sites are the back, chest, abdomen, buttock, and areas of abundant muscle. Traditionally, the cupping therapy is done in sets of four, six or ten. The cups are usually kept in place for 5 to 20 minutes. The common side-effects of cupping therapy are erythema (redness) , oedema (swelling), and ecchymosis (bruising) in the area where the cup rim was placed. These effects may take several days to weeks to disappear. The cupping therapy process usually consists of the following five main steps:
The practitioner assigns and disinfects the designated area for cupping therapy.
A suitable sized cup is positioned on the selected area and the practitioner uses a method of suction to suck the air inside the cup. The cup will be left on the skin for 3–5 minutes. If it is wet cupping, then superficial incisions are performed on the skin by a sterile surgical scalpel blade.
The cup is placed again on the skin for 3–5 minutes.
The cup is removed.
The treated area is cleaned, disinfected, and a dressing is applied. The dressing is usually kept for 48 hours following the session of therapy 
How do I ensure that Cupping Therapy is safely done?
Cupping therapy is increasing in popularity but with it comes the risk of unqualified persons who would perform this form of therapy which can cause harmful outcomes to the patient if done incorrectly. Certain basic medical screening is needed with consultation to ensure that cupping therapy is suitable for the patient and to exclude any contraindications. In South Africa, practitioners who are registered and clinically trained in Cupping therapy is Unani Tibb and Chinese Medicine Practitioners regulated under the minister of health through the Allied Health Professions Council of South Africa (AHPCSA). To ensure your safety, please check that your practitioner is registered with AHPCSA https://ahpcsa.co.za/
The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. Please consult a qualified practitioner if you suffer from any of the conditions mentioned.
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Qureshi NA, Ali GI, Abushanab TS, El-Olemy AT, Alqaed MS, El-Subai IS, Al-Bedah AMN. History of cupping (Hijama): a narrative review of literature. J Integr Med. 2017 May;15(3):172-181. doi: 10.1016/S2095-4964(17)60339-X. PMID: 28494847.
Furhad S, Bokhari AA. Cupping Therapy. 2020 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30855841.
Tamer S. Aboushanab, Saud AlSanad, Cupping Therapy: An Overview from a Modern Medicine Perspective, Journal of Acupuncture and Meridian Studies,Volume 11, Issue 3, 2018, Pages 83-87, ISSN 2005-2901, https://doi.org/10.1016/j.jams.2018.02.001.
Al-Bedah, A., Elsubai, I. S., Qureshi, N. A., Aboushanab, T. S., Ali, G., El-Olemy, A. T., Khalil, A., Khalil, M., & Alqaed, M. S. (2018). The medical perspective of cupping therapy: Effects and mechanisms of action. Journal of traditional and complementary medicine, 9(2), 90–97. https://doi.org/10.1016/j.jtcme.2018.03.003
Asma Al-Shidhani and Abdulaziz Al-Mahrezi, The Role of Cupping Therapy in Pain Management: A Literature Review, Submitted: May 21st 2020Reviewed: September 2nd 2020Published: September 25th 2020, DOI: 10.5772/intechopen.93851