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Traditional Cupping Therapy in Unani (Greco-Islamic) and Chinese Medicine



In: Encyclopedia of Immigrant Health (2012) Sana Loue and Martha Sajatovic, eds. New York: Springer Science & Business Media, pp. 522-24.
Suggested Resources
Oberg, K. (1954). Culture shock. (Bobbs-Merrill Reprint Series
in the Social Sciences, A-329). Indianapolis: Bobbs-Merrill.
Retrieved March 7, 2009, from
Culture-Bound Syndromes
Culture-specific diagnoses
Department of Sociology & Anthropology, Carleton
University, Ottawa, ON , Canada
Origins of Cupping
Cupping therapy (huoquan qi in Chinese; and al-
hijamah in Arabic) is a practice whereby glass or bam-
boo cups are applied to the surface of the skin and
through suction and negative pressure, the skin and
superficial muscle are gently drawn into and held in the
cups. Based on the holistic principle that the body relies
on a balance of energies to function properly, cupping
is used to remove accumulated stress, tension, and cold
channels from the body; promote blood flow and
healing; and restore balance. Widely practiced in
China, Taiwan, India, Pakistan, Iran, Saudi Arabia,
the Gulf States and parts of Africa and the Middle
East, cupping is commonly used in immigrant com-
munities (e.g ., Asian, Arab, Mediterranean) in the
USA, Canada, Europe, Australia, and New Zealand.
The earliest recorded use of cupping is in the Ebers
Papyrus of ancient Egypt (1550 BCE) where cupping
was indicated for the removal of foreign matter from
the body. Hippocrates (ca. 460–370 BCE) and Galen
(ca. 129–200 CE) also described cupping as an effe ctive
remedy for num erous disorders and a means to evacu-
ate toxins, reduce inflammation, arrest fevers, and
restore humoral balance. One of the first records of
cupping in China is by Taoist alchemist and herbalist
Ge Hong (281–341 CE) who prescribed the use of cups
in the form of cattle horns for the draining of pustules,
boils, and car buncles. During the Qing Dynasty, Zhao
Xuemin (1719–1805) included an extensive chapter in
his materia medica on huoquan qi or “fire cupping”: the
use of bamboo or pottery cups to treat headache, diz-
ziness, abdominal pain, and snakebite.
In the 1950s, cupping was established as an official
therapy throughout China; and today there are numer-
ous Traditional Chinese Medicine ( TCM) research
institutes with ongoing clinical trials in cupping ther-
apy (see below). In South Asia, cupping is a common
therapeutic practice in Unani-tibb or Greco-Islamic
medicine. Based on the principles of Hippocrates, Avi-
cenna, al-Majusi and others, Unani-tibb advises the use
of cupping (al-hijamah) to draw inflammation toward
the surface of the body; divert inflammation from an
important organ to a less important one; dispel humors
from an affected organ; and alleviate pain. Unani phy-
sicians or hakims, like their TCM counterparts, use
cupping to treat a number of muscular, circulatory,
and neurological disorders.
Current Use of Cupping
In most parts of Asia and the Middle East, cupping is
administered by medical practitioners, usually TCM
doctors or Unani haki ms. In the USA and other West-
ern countries, cuppi ng was historically introduced and
practiced by immigrants from the Mediterranean and
Asia in the 1800s and then spread to many par ts of the
USA flourishing as late as the 1930s in immigrant
sections of large cities. On the Lower East Side of New
York, cupping shifted from the domain of family doc-
tors to barber shops, and one could see sign boards
reading “cups for colds” on barber shop windows.
Today, in rural parts of the Mediterranean, cupping is
still practiced at home by families who put a set of cups
in their first aid boxes or simply use a set of jam jars.
In the USA, Canada, Europe, Australia, and New
Zealand, where there are sizable Asian communities
(and hence an availability of trained practitioners)
cupping is used alone or in tandem with other tradi-
tional therapies such as acupuncture, herbal medicine,
massage, medicated steam, hydrotherapy, nutritional
therapy, and in combination with biomedical treat-
ments, such as pharmaceutical analgesics, nonsteroidal
anti-inflammatory medica tions, orthoped ic surgery,
and physical and rehabilitative therapies.
522 C Culture-Bound Syndromes
Citation: Bright, Kristin 2012 Cupping therapy in Unani (Greco-Islamic) and Chinese medicine. In The Encyclopedia of Immigrant
Health, Volumes 1-2. Sana Loue and Martha Sajatovic, eds. Pp. 522-23. New York: Springer.
For patients with arthritis, fibromyalgia, carpal tun-
nel syndrome, chronic back pain, chronic headache,
and joint injuries, the appeal of cupping therapy is its
use of low-tech equipment, its low cost, and its lack of
side effects that might otherwise be experienced with
analgesics. In the past decade, cupping has seen
renewed popularity in the USA in the domain of com-
plementary and alternative medicine (CAM) and
health spas, with growing numbers of the general pub-
lic using cupping, and more TCM and CAM practi-
tioners training in the use of this therapy. New versions
of “cellulite trimming” and “stress relief cupping have
cropped up on the menu of health spas in cities like
New York and Los Angeles, creating an interesting
contrast with the no-frills offerings found in Asian
neighborhoods in Chicago, Los Angeles, New York,
San Francisco, Toronto, Vancouver, and other cities,
where cupping is still practiced in much the same way
it has been for decades. Differences in technique and
cultural milieu are reflected in cost: while a 30–40 min
session with a holistic practitioner or spa techn ician
can cost anywhere from $30 to $100, a session with
a TCM practitioner in New York’s Chinatown is closer
to $10–$20. By contrast, in China the average cost of
a session is 12 Yuan ($1.60) compared with an average
56 Yuan ($7.30) for herbal therapy.
The Procedure and Outcome
There are two primary types of cupping: dry and wet.
In dry cupping, glasses are applied to the skin and either
a gentle vacuum pump or flame heat is used to purge
air from the cup. As the glass cup cools on the skin and
a seal is formed, pressure within the cup declines,
sucking the skin into the cup. Cupping glasses are
typically applied for 10–15 min to the back, neck,
hips, legs, knees, or arms. Wet cupping involves minor
scarification of the skin so that a small amount of blood
is drawn. Today, wet cupping ser ves as a modern sub-
stitute for venesection, in which larger quantities of
blood were let out. Two other classifications exist in
cupping as well: stationary cupping, where each glass
cup is left in position on the skin and the cup is not
moved; and massage cupping, where the g lass cups are
moved around the skin in a massage-like technique.
In regard to clinical evidence for the efficacy of
cupping, a 2010 meta-review of the clinical literature
conducted by Huisstede and colleagues found no
evidence of long-term results of cupping in the treat-
ment of carpal tunnel syndrome, but did find evidence
for short-term benefit and relief of symptoms. The
combination of acupuncture and cupping has been
found to be of greater benefit in the reduction of pain
and inflammation associated with acute ar thritis and
the reduction of pain associated with fibromyalgia,
compared to the use of either cupping or pharmaco-
therapy alone. Cupping has also been found to be
effective in the treatment of acute arthritis when com-
bined with herbal medicine; in the treatment of fibro-
sitis; and in the treatment of intractable migraine, when
combined with acupuncture.
From a sociocultural standpoint, qualitative studies
of cupping therapy and its rich historical and contem-
porary uses in immigrant communities are seriously
needed. Such studies will enable public health and
medical providers to understand the range of thera-
peutic applications of cupping in TCM, Unani, CAM,
and biomedical contexts and the cultural meanings of
cupping in widely diverse immigrant communities
(e.g., African, Asian, Arab, Mediterranean). Impor-
tantly, as the number of individuals seeking cupping
therapy increases in Western countries, providers
should also be familiar with this practice so as to
prevent any soc ial and legal conflicts that may emerge
from mistaken diagnosis, such as when cupping welts
are misinterpreted as signs of violence or abuse as has
been the case in Europe and in the USA.
Related Topics
Alternative and complementary medicine
Chronic pain
Cross-cultural medicine
South Asians
Traditional Chinese medicine
Suggested Readings
Ahmadi, A., Schwebel, D. C., & Rezaei, M. (2008). The efficacy of wet-
cupping in the treatment of tension and migraine headache. The
American Journal of Chinese Medicine, 36(1), 37–44.
Bright, K. (1998). The traveling tonic: Tradition, commodity, and the
body in Unani (Greco-Arab) medicine in India. Ph.D. disserta-
tion, University of California, Santa Cruz, USA. Retrieved March
Cupping C 523
Citation: Bright, Kristin 2012 Cupping therapy in Unani (Greco-Islamic) and Chinese medicine. In The Encyclopedia of Immigrant
Health, Volumes 1-2. Sana Loue and Martha Sajatovic, eds. Pp. 522-23. New York: Springer.
7, 2011, from Dissertations & Theses: Full Text. (Publication No.
AAT 9913732).
Cao, H., Liu, J., & Lewith, G. T. (2010). Traditional Chinese medicine
for treatment of fibromyalgia: A systematic review of random-
ized controlled trials. Journal of Alternative and Complementary
Medicine, 16(4), 397–409.
Chirali, I. Z. (1999). Traditional Chinese medicine: Cupping therapy.
Philadelphia, PA: Churchill Livingstone.
Hameed, H. A. (1977). Arab medicine and its relevance to modern
medicine. New Delhi: Institute of the History of Medicine and
Medical Research, Jamia Hamdard University.
Huisstede, B. M., Hoogvliet, P., Randsdorp, M. S., Glerum, S., van
Middelkoop, M., & Koes, B. W. (2010). Carpal tunnel syndrome.
Part I: Effectiveness of nonsurgical treatments a systematic
review. Archives of Physical Medicine and Rehabilitation, 91(7),
Rahman, H. S. Z. (2001). Unani Medicine in India: Its origin and
fundamental concepts. In Subbarayappa, B. V. (Ed.), History of
science, philosophy and culture in Indian civilization (Vol. IV Part
2, pp. 298–325). New Delhi: Centre for Studies in Civilizations.
Sherman, K. J., Cherkin, D. C., Deyo, R. A., Erro, J. H., Hrbek, A.,
Davis, R. B., et al. (2006). The diagnosis and treatment of chronic
back pain by acupuncturists, chiropractors, and massage thera-
pists. The Clinical Journal of Pain, 22(3), 227–234.
Ullmann, M. (1997). Islamic medicine. Edinburgh: Edinburgh Uni-
versity Press.
Department of Anthropology, Calif ornia State
University San Marcos, San Marcos, CA, USA
Curandero is a Spanish term meaning “healer.
Curanderos (male healers) and Curanderas (female
healers) are important community-based “folk”
healers held in high regard within Latin Ameri can
and Latino immigrant and transnational communities.
Contemporary curanderos’ medical knowledge, beliefs,
and practices are generally a mixture of pre-Hispanic
medical cultures with Span ish and Catholic symbols
and beliefs. The term curandero is a broad term that
refers to a whole set of healers who utilize diverse
methods in their practice. Ea ch specialty has specific
methods and a title that accompany it, and some
curanderos specialize in more than one method.
A yerbero/a is a herbalist who utilizes her bs to address
health issues. A Sobador/a is a healer who utilizes
massage to help alleviate pain or help a client recover
from an illness or trauma. A Huesero/a is a bonesetter
who manipulates injured bones, tendons, and muscles
to alleviate pain and facilitate recovery from an injury.
A espiritisto/a is a psychic medium who channels spirit
beings and/or utilizes prayer to rid clients of physical,
psychological, spiritual, and even social problems.
A partera is a midwife who cares for pregnant women
providing prenatal care as well as assistance with the
birth of the child. Utilization of parteras in Latin Amer-
ica is widespread. For example, in some Mexican com-
munities, parteras oversee a significant percentage, if
not the majority, of births.
Curanderos often hear a calling” to their profession
and view this calling as a gift from God or other super-
natural beings. Curanderos undergo an intense period
of training during which their practical and spiritual
knowledge is tested and affirmed. Generally, curanderos
have a vast and specialized knowledge of the physical
and supernatural worlds and employ this knowledge in
their practice. Some curanderos/as are shamans who
communicate directly with the supernatural through
trance to heal. Curanderos attend to an individual’s
physical, psychological, spiritu al, and social well-
being. This holistic approach to health is why many
Latino immigrant communities seek out curanderos/as
instead of, or in addition to, conventional medical care.
Individuals and famili es seek out care from curanderos
for diverse health issues that could range from cold
relief to cancer. Certain curanderos can also address
stresses associated with psychological or social states.
For example, it is not out of the ordinary for an indi-
vidual to approach a curandero for a limpia cleansing
with the goal of ridding themselves of a rash of bad luck
that they are experiencing. A curandero is able to not
only cleanse the person of the bad luck but provide
for them an explanation of why they had the bad luck
in the first place. Curanderos are the only source of care
for common ethnospecific illnesses among Latino
immigrant communities such as susto fright, mal de
ojo the evil eye, or coraje
anger. Curanderos have the
knowledge necessary to diagnose and treat these ill-
nesses which historically have been dismissed by con-
ventional medicine. There is, however, a growing set of
research studies examining these types of ethnospecific
illnesses and how they parallel the symptoms of condi-
tions readily diagnosed in conventional medicine.
524 C Curandero
Full-text available
Officially recognized as an Indigenous System of Medicine in India, Unani has been intimately connected to Muslim culture in South Asia. However, this connection has been downplayed by the government of India, which stressed the secular character of Unani and its Greek origins. Hijamah, or cupping therapy, is considered to be part of the regimental therapies of Unani medicine. Because hijamah has been mentioned in several Hadiths, it is also considered prophetic medicine. After what seems to be a long neglect of hijamah in the practice of Unani medicine, various hakims (Unani practitioners) are now promoting this therapy as a “forgotten Sunna.” This paper attends to the revival of hijamah in India at the intersections of Unani and prophetic medicine through an examination of clinical practices and advertisements. It argues that this revival is contributing to a re-Islamization of Unani medicine. The article suggests that this development is not just the product of an interest among Muslims in India to live according to the Sunna, but it is also influenced by the global market of Complementary and Alternative Medicine which the government of India seeks to lead.
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To review literature systematically concerning effectiveness of nonsurgical interventions for treating carpal tunnel syndrome (CTS). The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs). Two reviewers independently applied the inclusion criteria to select potential studies. Two reviewers independently extracted the data and assessed the methodologic quality. A best-evidence synthesis was performed to summarize the results of the included studies. Two reviews and 20 RCTs were included. Strong and moderate evidence was found for the effectiveness of oral steroids, steroid injections, ultrasound, electromagnetic field therapy, nocturnal splinting, and the use of ergonomic keyboards compared with a standard keyboard, and traditional cupping versus heat pads in the short term. Also, moderate evidence was found for ultrasound in the midterm. With the exception of oral and steroid injections, no long-term results were reported for any of these treatments. No evidence was found for the effectiveness of oral steroids in long term. Moreover, although higher doses of steroid injections seem to be more effective in the midterm, the benefits of steroids injections were not maintained in the long term. For all other nonsurgical interventions studied, only limited or no evidence was found. The reviewed evidence supports that a number of nonsurgical interventions benefit CTS in the short term, but there is sparse evidence on the midterm and long-term effectiveness of these interventions. Therefore, future studies should concentrate not only on short-term but also on midterm and long-term results.
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Traditional Chinese Medicine (TCM) is popular for treatment of fibromyalgia (FM) although there is a lack of comprehensive evaluation of current clinical evidence for TCM's therapeutic effect and safety. Objective: To review systematically the beneficial and harmful effects of TCM therapies for FM. We searched six English and Chinese electronic databases for randomized clinical trials (RCTs) on TCM for treatment of FM. Two authors extracted data and assessed the trial quality independently. RevMan 5 software was used for data analyses with an effect estimate presented as mean difference (MD) with a 95% confidence interval (CI). Twenty-five RCTs were identified with 1516 participants for this review. Seven trials (28%) were evaluated as having a low risk of bias and the remaining trials were identified as being as unclear or having a high risk of bias. Overall, ten trials were eligible for the meta-analysis, and data from remaining 15 trials were synthesized qualitatively. Acupuncture reduced the number of tender points (MD, -3.21; 95% CI -4.23 to -2.11; p < 0.00001, I(2) = 0%), and pain scores compared with conventional medications (MD, -1.78; 95% CI, -2.24 to -1.32; p < 0.00001; I(2) = 0%). Acupuncture showed no significant effect, with a random-effect model, compared with sham acupuncture (MD, -0.55; 95% CI, -1.35-0.24; p = 0.17; I(2) = 69%), on pain reduction. A combination of acupuncture and cupping therapy was better than conventional medications for reducing pain (MD, -1.66; 95% CI, -2.14 to -1.19; p < 0.00001; I(2) = 0%), and for improving depression scores with related to FM (MD, -4.92; 95% CI, -6.49 to -3.34; p < 0.00001; I(2) = 32%). Other individual trials demonstrated positive effects of Chinese herbal medicine on pain reduction compared with conventional medications. There were no serious adverse effects reported that were related to TCM therapies in these trials. TCM therapies appear to be effective for treating FM. However, further large, rigorously designed trials are warranted because of insufficient methodological rigor in the included trials.
Full-text available
Wet-cupping is an ancient medical technique still used in several contemporary societies, but little empirical study has been devoted to test its efficacy to treat tension and migraine headache. Using a pre-post research design, 70 patients with chronic tension or migraine headache were treated with wet-cupping. Three primary outcome measures were considered at the baseline and 3 months following treatment: headache severity, days of headache per month, and use of medication. Results suggest that, compared to the baseline, mean headache severity decreased by 66% following wet-cupping treatment. Treated patients also experienced the equivalent of 12.6 fewer days of headache per month. We conclude that wet-cupping leads to clinical relevant benefits for primary care patients with headache. Possible mechanisms of wet-cupping's efficacy, as well as directions for future research are discussed.
This new edition continues to offer readers a comprehensive exploration and description of techniques of cupping in the context of Traditional Chinese Medicine theory. Extensively updated throughout, and with a new website containing videos and a downloadable image bank, this volume will be ideal for students and practitioners of Traditional Chinese Medicine, and all other complementary health practitioners looking to expand their skill base.
To describe the diagnostic and therapeutic content of visits for chronic back pain to acupuncturists, chiropractors, and massage therapists. Randomly selected acupuncturists, chiropractors, and massage therapists in two states were surveyed, and then eligible providers collected data on consecutive patient visits. The authors analyzed information on diagnosis, treatment, and self-care recommendations for chronic back pain patients collected during consecutive patient visits to these complementary and alternative medicine (CAM) providers. Back pain was the most common reason for visits to each of these providers, with chronic back pain representing about 10% of visits to acupuncturists, 20% of visits to chiropractors, and 12% of visits to massage therapists. Diagnosis by acupuncturists included traditional questioning and inspecting the patient as well as pulse and tongue assessment and palpation of the acupuncture meridians. Treatments usually included acupuncture needling, heat of some sort, and other modalities, such as East Asian massage, herbs, and/or cupping (application of suction cups to the skin). Lifestyle recommendations were common, particularly exercise and dietary counseling. Visits to chiropractors usually included spinal and muscle/soft tissue examinations and spinal manipulation. Soft tissue techniques (eg, "active release"), stretch or strength training, and home exercise recommendations were much less common. Massage therapists usually performed a tissue assessment and commonly assessed range of motion. They emphasized Swedish, deep tissue, and trigger point massage techniques and usually made self-care recommendations, particularly increased water intake, hot/cold therapy, exercise, and body awareness. Information on the care patients routinely receive from CAM providers will help physicians better understand these increasingly popular forms of care.
Arab medicine and its relevance to modern medicine
  • H A Hameed
Hameed, H. A. (1977). Arab medicine and its relevance to modern medicine. New Delhi: Institute of the History of Medicine and Medical Research, Jamia Hamdard University.
The traveling tonic: Tradition, commodity, and the body in Unani (Greco-Arab) medicine in India
  • K Bright
Unani Medicine in India: Its origin and fundamental concepts
  • H S Z Rahman
Rahman, H. S. Z. (2001). Unani Medicine in India: Its origin and fundamental concepts. In Subbarayappa, B. V. (Ed.), History of science, philosophy and culture in Indian civilization (Vol. IV Part 2, pp. 298-325). New Delhi: Centre for Studies in Civilizations.