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The Study of Blister Caused by Cupping Therapy
Abstract
Objectives : The aims of this study were to evaluate a blister caused by cupping. Methods : We searched relevant case reports, survey, and review articles using databases of online bibliography. Results : 1. The fluid in the blister caused by cupping therapy is normal substance by laboratory analysis. The fluid has no signs of infection in the culture, Gram stain, or tissue biopsy 2. In histological finding, the blister caused by cupping therapy is made by dermo-epidermal seperation at subcellular level. Suction blistering was neither inflammatory nor autolysis activation of lysosomal hydrolases. 3. Blistering times directly, related to suction pressure. Suction blister formation time is accelerated in older subjects compared with younger individuals and higher temperature was more susceptable to the blister compared with lower temperature. The flexor aspect of forearm is a easy site for suction blister formation compared with leg and abdominal site. 4. Blister caused by cupping therapy is treated by regular and judicious changes of sterile dressing over several weeks. The vesicles healed well and left no visible scar. Conclusions : Blister caused by cupping therapy is artificially controlled by doctor's therapeutic purpose. Blister is not histologically injurious to health and the blister is a natural concomitant after cupping therapy.
... Blisters that occur after cupping are more likely to happen if the pressure in the treatment area is high. In addition, the higher the temperature, the easier it is to form blisters even at the same pressure 7) . Accordingly, an experiment was conducted on the suction pump valve nozzle, which was developed to control the negative pressure and to minimize the side effects while achieving clinical therapeutic outcomes by limiting the maximum negative pressure not excessively. ...
... On the other hand, in the case of electric pumps, since the suction power varies from company to company, the operator had to arbitrarily stop suction at an appropriate pressure level, which made it difficult to control the pressure. Therefore, this device can be used as a stabilizer to minimize side effects such as coagulation reaction or blister reaction from cupping with excessive negative pressure 7) . However, when a manual suction pump was used, the number of pumping had to be increased in order to obtain a similar negative pressure to the existing one by using a pressure control valve (Table 4). ...
... A recent study investigated the dropout pressure based on bloodletting during the wet cupping procedure [8], however, because this is only one of the limited reports describing this detail, additional studies on the procedure pressure are warranted. Incorrect application of pressure can cause side effects during the procedure, especially strong pressure, which tends to generate blisters that can cause discomfort to the patient [13]. A survey in 2008 of Korean medical doctors reported that 38.3% of the surveyed doctors believed that blisters which occurred after cupping could be seen as an adverse side effect of an inappropriate level of pressure within the cups [3]. ...
... A survey in 2008 of Korean medical doctors reported that 38.3% of the surveyed doctors believed that blisters which occurred after cupping could be seen as an adverse side effect of an inappropriate level of pressure within the cups [3]. Additionally, western medicine practitioners and layperson patients, who lack knowledge in oriental medicine, view blistering as a result of mecical error as well [13]. ...
Background: Standardized procedures for the clinical application of fire cupping methods have not been established. In particular, the pressure parameters have not been fully characterized and described. Therefore, using various materials, this study investigated the pressure range exerted during fire cupping therapy. Methods: In this study, 3 differently sized (small, medium, large) glass and bamboo cups were used in the cotton ball fire cupping procedure to measure the pressure inside the cup applied to a human skin model. The pressure in each cup was measured 15 times for a total of 90 measurements. Results: A small bamboo cup had the minimum overall pressure (-305.4 mmHg), whereas the large glass cup exerted the maximum pressure (-401.3 mmHg), followed by the medium glass cup, large bamboo cup, small glass cup, and medium bamboo cup. The average pressure exerted by the cotton ball method for all cups ranged from -348.715 mmHg to -358.694 mmHg (95% confidence interval). Overall, the glass cups had a greater pressure than the bamboo cups in all groups (p < 0.001). Among the glass cups used, the larger the size of the cup, the higher the average pressure detected (-381.947 mmHg to -391.973 mmHg; p < 0.05). Conclusion: Large glass cups which are widely used in clinical practice, when used in the fire cupping method exerted pressure ranging from -381.947 mmHg to -391.973 mmHg (95% CI).
... In the case of using a manual suction pump, pressure has been reported to decrease rapidly in approximately 0.5 seconds by around 200 hPa during pumping, and the patient may feel discomfort in the treatment area [15]. If cupping therapy is misused and performed with a high negative pressure, blisters are likely to occur [17]. In contrast, in layer cupping therapy, even if the highest negative pressure is applied to the upper cup, a low negative pressure is applied to the lower cup, and the internal pressure inside the cup decreases relatively gradually. ...
Background: Cupping is widely used in Korean medicine, but there is a risk of bacterial infection if the suction pump (used for inducing negative pressure) and the patients’ skin are not separated. This study aimed to investigate the effect of layer cupping by comparing the pressure changes between layer cupping and conventional cupping.Methods: To evaluate pressure changes the study was designed with 3 types of conditions applied to a skin model: (1) a Dongbang cup with a manual or motor suction pump (conventional cupping); (2) layer cupping with 2 Dongbang cups; and (3) layer cupping with a cup made by 3D printing and a Dongbang cup.Results: When a manual suction pump was used (conventional cupping), the pressure did not decrease steadily, and in 1 section there was an increase in pressure. When layer cupping was used, the pressure in the lower cup (which would be directly applied to the patient’s skin), decreased steadily.Conclusion: In the pressure change graph for layer cupping in this skin model, the pressure in the lower cup (which would be placed on the patient’s skin) steadily decreased, and reached equilibrium. Therefore, the layer cupping model may help to reduce the risks of bacterial infection.
... Currently, the majority of Korean medicine doctors perform cupping for musculoskeletal problems and internal diseases. Despite this, there are no studies on post-treatment side effects such as blisters, with the exception of 1 study by Yun et al [31], and no standardised treatment procedure. In this study, a total of 27 studies related to cupping therapy were reviewed to establish the correlation between cupping pressure and treatment effects so that cupping therapy can be standardised. ...
This is a systematic review of the clinical use of cupping therapy. Four domestic databases and 2 foreign databases were searched. Studies that reported the cupping pressure used during cupping therapy were included in this study. The types of cupping, cupping site, pressure, and duration of cupping were the main parameters analyzed. A total of 27 studies, including 24 experimental studies were analyzed. There were 12 constant negative pressure (domestic) studies with a range between 60 mmHg and 600 mmHg. There were 5 maximum negative pressure (domestic) studies and the maximum negative pressure was 620 mmHg. Three studies used a maximum negative pressure of 600 mmHg. There were 4 constant negative pressure (foreign) studies with a range between 75 mmHg to 750 mmHg. There were 3 maximum negative pressure (foreign) studies with a maximum pressure of 420 mmHg. The studies differed with regards to the materials used and the amount of pressure applied. Many studies had limited information and therefore generalizability of the results in this review is limited. Further experimental studies are required to establish the correlation between cupping pressure and treatment effects so that cupping therapy can be standardised.
Suction blister grafting is a useful modality of treatment of patients with resistant and stable vitiligo. However, there have been no detailed studies to find out the best donor site for blister formation.
The study was conducted between the period of October 2004 and February 2005 in the dermatology department at a tertiary care center. Nine patients with vitiligo (focal vitiligo, 3; mucosal vitiligo, 2; acrofacial vitiligo, 2; vitiligo vulgaris, 1; and segmental vitiligo, 1) were selected for blister harvesting and grafting. The blisters were raised using the method described by Gupta et al.
Suction blisters were attempted to be raised at 52 sites, but only 38 blisters could be raised, 24 complete and 14 incomplete. Blisters were raised in all the three cases on the flexor aspect of the arm (100%), 15 of 17 cases (88.2%) on the flexor aspect of the forearm, 4 of 5 cases (80%) on the abdomen, 11 of 16 cases (68.7%) on the anterolateral thigh, and less frequently over leg or foot. Complete blisters were formed in 13/15 cases (86.6%) on the flexor aspect of the forearm, 6/11 cases (54.5%) on the anterolateral thigh, and in all cases over leg.
The flexor aspect of the forearm is a good site for suction blister harvesting.
The influence of skin temperature on dermal-epidermal adherence was investigated. The adherence was measured by eliciting suction blisters; blistering time was determined under controlled skin temperature. In the range of skin temperatures investigated (20°–43° C) the adherence decreases continuously with increasing temperature. Adherence is, approximately, an exponential function of temperature; an increase of skin temperature by 10° C decreases blistering time by a factor of about 4. This type of relationship supports the hypothesis that epidermis and dermis are connected by a viscous bond. The strong influence of skin temperature suggests that a high viscosity is involved.
Cupping is a traditional method for treating pain which is investigated nowadays in clinical studies. Because the methods for producing the vacuum vary considerably we tested their reproducibility.
In a first set of experiments (study 1) four methods for producing the vacuum (lighter flame 2 cm (LF1), lighter flame 4 cm (LF2), alcohol flame (AF) and mechanical suction with a balloon (BA)) have been compared in 50 trials each. The cupping glass was prepared with an outlet and stop-cock, the vacuum was measured with a pressure-gauge after the cup was set to a soft rubber pad. In a second series of experiments (study 2) we investigated the stability of pressures in 20 consecutive trials in two experienced cupping practitioners and ten beginners using method AF.
In study 1 all four methods yielded consistent pressures. Large differences in magnitude were, however, observed between methods (mean pressures -200±30 hPa with LF1, -310±30 hPa with LF2, -560±30 hPa with AF, and -270±16 hPa with BA). With method BA the standard deviation was reduced by a factor 2 compared to the flame methods. In study 2 beginners had considerably more difficulty obtaining a stable pressure yield than advanced cupping practitioners, showing a distinct learning curve before reaching expertise levels after about 10-20 trials.
Cupping is reproducible if the exact method is described in detail. Mechanical suction with a balloon has the best reproducibility. Beginners need at least 10-20 trials to produce stable pressures.
Burns inflict serious injuries both psychologically and physically as a consequence of deformity and disfiguration (scarring) which is the most obvious and most probable outcome of burn injury. Thus the major challenge encountered by the healthcare team, as regards, burn management is not only in saving life but also in improving quality of life of psychologically and emotionally distressed and physically deformed patient, so that he is able to perform the day to day activities as nearly as possible, in the normal state of mental and physical health. To achieve the positive outcomes, an efficient coordination of healthcare team is required. For understanding the burn resuscitation, handling, transfer, management, medication and counseling for improvement in quality of life of patient, a study is carried out on thirty hospitalized patients (Mayo, Ganga Raam and Jinnah Lahore) by the use of well designed Performa and the data was evaluated. The results showed that mostly burns are encounteredaccidentally with adult males forming the major proportion, presenting 21-40%TBSA as a major surface area involved. Nelbine, ranitidine and amoxicillin came out to be the most commonly prescribed medicines for pain management; prophylaxis of stress induces ulcer and sepsis respectively. Septicemia came out to be the most fatal post burn complication. Most burn patients were satisfied at the care provided to them and there was a small mortality ratio among the burn victims, indicating provision of efficient burn care.
Blistering of the skin can be due to a number of diverse aetiologies. Pattern and distribution of blisters can be helpful in diagnosis but usually biopsy is required for histopathology and immunofluoresence to make an accurate diagnosis.
This article outlines the clinical and pathological features of blistering skin conditions with a particular focus on bullous impetigo, dermatitis herpetiformis, bullous pemphigoid and porphyria cutanea tarda.
Infections, contact reactions and drug eruptions should always be considered. Occasionally blistering may represent a cutaneous manifestation of a metabolic disease such as porphyria. Although rare, it is important to be aware of the autoimmune group of blistering diseases, as if unrecognised and untreated, they can lead to significant morbidity and mortality. Early referral to a dermatologist is important as management of blistering skin conditions can be challenging.
A process of rapid repair of dermal-epidermal adherence, as found in experiments with interrupted suction, was investigated electron microscopically. Biopsies in different stages of the process of suction blister formation and of the repair process were studied. Results show that suction blister formation occurs by successive detachment of hemidesmosomes from the basement membrane, and that, after partial separation of the epidermis from the dermis, a rapid regeneration of the dermal-epidermal junction takes place. This regeneration process apparently consists of two steps: realignment of basal cells to the basement membrane accompanied by autophagocytosis of detached hemidesmosomes, and de novo formation of hemidesmosomes. The time required for this structural regeneration corresponds well with the speed of the functional repair of dermal-epidermal adherence measured with the technique of interrupted suction.
The regulation of cutaneous immune responses in health and disease is mediated locally by proteins such as cytokines and chemokines. We used a novel approach involving proteomic profiling of fluid drawn from suction blisters to compare and contrast protein expression in normal skin with that in nonlesional skin from a patient with plaque psoriasis. We also examined the impact of exogenous interleukin-1beta, a proinflammatory cytokine, on protein expression in these tissues. Described here are the results of proteomic profiling of 670 proteins from blister fluid, and the identification by differential expression of nine proteins between one volunteer with psoriasis and one normal volunteer. Although the apparent disease association of these nine proteins will require validation using additional volunteers, the identification of candidate protein biomarkers through proteomic analyses of blister fluid represents a promising approach for monitoring the disease activity and efficacy of therapeutic intervention in human skin diseases.
The application of suction cups or cupping is a medicinal practice that is very widespread in Asian countries. The presence of circular areas of erythema, ecchymosis or blood blisters symmetrically distributed on the shoulders, back, thorax or lumbar area should suggest the use of this technique. The number of followers of traditional Chinese medicine is increasing in the Western world, so we should be familiar with these practices in order to prevent social and/or legal conflicts that may arise from mistaken diagnoses of abuse. We present the case of a 65-year-old male with multiple circular, erythematous, bullous lesions, symmetrically distributed, which occurred after the application of suction cups in the context of polymyalgia rheumatica.
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