Cupping therapy: a doctor’s approach

What cupping therapy is

You’ve seen the marks. Purple circles across an Olympic swimmer’s back, and the internet arguing over whether it’s medicine or fashion.

This page is my answer, as a doctor trained in both worlds.

Cupping is not a trend. It is one of the oldest continuously used medical interventions on earth. There is evidence of it in ancient Egypt ¹. Hippocrates himself used and prescribed it ². It runs through Arabic, Islamic, Prophetic and Unani traditions ³; traditional Chinese medicine ⁴; Tibetan medicine ⁵; Korean medicine; and Ayurveda ⁶.

Whilst cups may have changed - animal horn, bamboo, earthenware, ceramic, metal and eventually glass ⁷. I don’t think the intent has changed much: create suction, release what is stuck, restore the body.

Historically it was used to treat an astonishing range: fever, pain, vertigo, digestive and gynaecological complaints including dysmenorrhoea, musculoskeletal pain, urinary infections, respiratory illness, skin disease, rheumatic and inflammatory disorders, with ancient texts even recording its use in epilepsy, the violent diarrhoeal illness the ancients called cholera, abscesses, and venomous bites ⁸.

But history alone does not really prove anything from my perspective and popular does not necessarily mean effective.

Therefore, what genuinely interests me, and what I am primarily exploring on this page, is where ancient frameworks and modern physiology start to tell a similar story, and what happens when you deliberately combine them.

Cupping benefits: does cupping work?

Evidence strength varies by condition, and most benefits are “reported” from trials and systematic reviews of varying quality. With that caveat, here is what the literature shows:

Musculoskeletal. Lower back pain ¹⁸, neck and shoulder pain ^{19, 20}, stress-associated headaches and migraine ²¹, knee pain ²², acute facial paralysis ²³, carpal tunnel syndrome ^{24, 25}, ankylosing spondylitis ²⁶, myofasciitis of the back and shoulder, periarthritis ²⁷, and other musculoskeletal disorders ²⁸.

Skin. Plaque psoriasis ²⁹, acne vulgaris ³⁰, acute eczema, neurodermatitis, chronic idiopathic urticaria ³¹, chloasma ³². Notably, wet cupping has appeared superior to antiviral medication in resolving herpes zoster and lowering the incidence of post-herpetic neuralgia ^{33, 34}.

Respiratory. Chronic asthma, cough and shortness of breath ^{9, 23}, and exogenous fever ^{32, 35}, fitting, since fever seems to be the first condition the Ebers Papyrus recorded, and it makes sense once the mechanisms discussed below are understood.

Circulation, blood and metabolic health. Lower blood pressure over a few weeks alongside conventional antihypertensives ^{36, 37}; lowers LDL cholesterol in healthy young men ³⁸; reported benefits in thalassaemia ³⁹, obesity ⁴⁰, and combined with conventional treatment in the oral and genital ulceration of Behçet’s disease ²⁵.

Women’s health and digestion. Primary dysmenorrhoea ^{41, 42}; improved gastrointestinal function, including constipation ⁴³.

And one pattern that seems to recur in modern trials is similar to what has been practiced across millennia: cupping’s benefits are strongest in combination ^{23, 44}. I build treatment plans around that fact.

How does cupping therapy create these benefits?

Modern research seems to suggest that cupping works through several overlapping mechanisms.

It decompresses tissue. Negative pressure mechanically lifts skin and fascia - the connective tissue beneath the skin, stimulating sensory nerves that influence pain signals travelling to the spinal cord and brain. This dampens pain locally and in distant areas of the body, while influencing the muscles, organs and connective tissues those nerves supply ^{9, 10}.

It triggers a controlled, localised healing response. Suction dilates capillaries and produces the characteristic marks. The breakdown of that extravasated blood activates local cellular defences: immune regulators and antioxidant defences rise as inflammatory substances fall, while disease-related substances, prostaglandins and inflammatory mediators are drawn into the tissue - where increased lymphatic flow carries accumulated fluid and waste away ^{7, 11}.

It recruits your own pharmacy. Cupping appears to stimulate the release of endogenous opioids, the body’s own pain-relieving, mood-lifting compounds ¹², while widening blood vessels to increase local flow and volume: oxygen and nutrients in, metabolic waste out ^13–15. These effects can alter circulation elsewhere in the body and shift the activity of the autonomic nervous system ¹⁶.

And here is where two languages of medicine seem to say similar things.

In Chinese and Ayurvedic frameworks, cupping warms and releases stagnant qi or prana - roughly translated as life-force energy, and with it the blood, dispelling conditions attributed to cold, wind, dampness, heat and swelling ^{4, 17}. Chinese medicine aims to rebalance yin and yang: strengthen the body’s resistance, expel pathogenic factors, and promote circulation to ease pain ¹⁷. In Ayurveda, the same rationale appears as raktamokshana, refining the blood by drawing out deleterious substances, tailored to a person’s vata, pitta or kapha imbalance ⁶.

What I find truly fascinating is how traditions separated by oceans and millennia seem to converge on similar principles: restore flow, and the body follows. Modern physiology is now increasingly mapping why.

Wet cupping vs dry cupping: hijama, fire cupping and other types

The dividing line between cupping types is primarily: is blood removed, or not?

Dry cupping lifts tissue with suction alone, skin intact ⁴⁵, the form most common in physical therapy and sports rehabilitation. This is the reason you see athletes with cup marks across their backs ⁴⁶.

Wet cupping adds small incisions before suction, removing small quantities of blood and extracellular fluid ^{28, 45}. In the Middle East and North Africa it is known as al-hijama, loosely translatable as restoring the body to its natural state ⁸, and it continues to be practised across China, Korea and parts of Eastern Europe.

Fire cupping inserts a flame into the cup, heating and expanding the air before it is placed on the skin ⁴⁷.

Beyond these, cupping is genuinely customisable: flash and massage cupping, manual or electrical vacuum methods, deliberate blistering as a technique in its own right ⁴⁸, suction from light to strong to pulsatile, combinations with herbs, acupuncture, moxibustion, electrical stimulation or water, and applications from cosmetic and facial work to sports, orthopaedic and abdominal treatment, matched to the condition, the goal, and the practitioner’s knowledge and skill ^{49, 50}. Western practitioners typically favour dry cupping; Eastern traditions often draw on the full toolkit, fire, wet and beyond, as indicated ⁵¹.

Why I practise dry cupping. The honest reason is hygiene. Working in the West, I must be certain that blood or fluid from one patient can never reach another, and wet cupping demands far stricter sterility at every step. The first rule of medicine is to not harm the patient before you have helped them. I am actively working toward offering wet cupping, because I believe it adds real benefit in certain cases. But I will offer it only at the standard I would accept for my own family.

The dangers of cupping: side effects and risks

I personally think the practitioner matters more than the therapy. Technique, hygiene, and deep understanding of anatomy and physiology from multiple angles don’t just make cupping safer - they make it more effective ^{52, 53}. And knowing what a DVT is, what a dissection is, who is at risk of bruising or keloids is to me the difference between treatment and roulette.

Common and expected. As blood is drawn to the surface: tender red marks, bruising and swelling ⁴⁵. Marks range from the colour of your skin to light pink, dark red and purple, varying with skin sensitivity and treatment intensity ⁵⁴. They typically fade within several days, though they can take one to two weeks to fully resolve ⁴⁷. Soreness and skin tightness for a few days are common, and many people feel warm, occasionally with slight sweating, as the vasodilation takes hold.

Serious, but rare and largely preventable. Vasovagal attacks, infection, nerve phenomena, scarring, embolism and burns, depending on type and technique ^{53, 55, 56}. Also reported: bleeding (occasionally excessive), keloid scarring, blistering, hyperpigmentation and abscess formation ^57–59. Excessive wet cupping carries its own risk, severe anaemia has been reported with frequent, heavy treatment ^{60, 61}. There is even a published case of a child’s cupping marks being reported as suspected abuse before anyone recognised what they were ⁶².

“If a doctor says it is theatre”

I respect the scepticism. I see it as medicine’s immune system. I often start in the same place when analysing various therapies. But I would start by asking what makes them question it. Have they read the mechanism literature in detail? Do they know what suction does to fascia, capillaries, lymphatic flow, endogenous opioids? And honestly, I would invite them to experience it themselves under the hands of someone who knows what they are doing. I would advise them to read the trials. And after that, have a genuine think if the reason natural therapies like cupping are growing in popularity is because they genuinely work.