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Is Cupping an Effective Treatment? An Overview of Systematic Reviews

Authors:
Myeong Soo Lee at Korea Institute of Oriental Medicine
Myeong Soo Lee
Jong-In Kim at Kyung Hee University
Jong-In Kim
Edzard Ernst at University of Exeter
Edzard Ernst
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Abstract

Several systematic reviews (SRs) have assessed the effectiveness of cupping for a range of conditions. Our aim was to provide a critical evaluation and summary of these data. Electronic searches were conducted to locate all SRs concerning cupping for any condition. Data were extracted by two authors according to predefined criteria. Five SRs met our inclusion criteria, which related to the following conditions: pain conditions, stroke rehabilitation, hypertension, and herpes zoster. The numbers of studies included in each SR were small. Relatively clear evidence emerged only for one indication, that cupping may be effective for reducing pain. Based on evidence from the currently available SRs, the effectiveness of cupping has been demonstrated only as a treatment for pain, and even for this indication doubts remain.
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Is Cupping an Effective Treatment? An Overview of Systematic Revie
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... The word is taken from Arabic language, meaning -to suck and to return to normal state of internal balance‖ [2]. The definite mechanism of action of this therapy is unknown although various postulates have been published which includes its boosting action on the circulatory and immune system, relaxing effect on the tense muscles and nerves and cleansing and detoxifying effect on the body [3][4][5]. For which it is generally recommended as treatment of muscular, skeletal, neurological, immunological, cardio-vascular, respiratory and digestive tract problems [6]. ...
... More people are suffering from depression than they ever were in the past [14]. According to Waheed et al.,4.4% of the total global population is affected with depression. The frequency of disease is greater in females (5.1%) than males (3.6%), and elderly person are more prone than adults [15]. ...
Al-Hijama-A Possible Cure for Depression: A Pilot Study
Article
Full-text available
  • Jan 2021
Background: Al-Hijama is an ancestral treatment option used in different societies for the cure of various diseases. Depression is now become epidemic in in several countries. Objectives: In this pilot study we have investigated the probable effects of Al-Hijama on improving depression symptoms with the score of geriatric depression scale (GDS) in local population. Methods: 132 eligible participants were enrolled in this open label single arm pre and post clinical trial for 3 months. Depression was assessed by using geriatric depression scale (GDS) before and after Al-Hijama therapy. Results: The mean score of depression calculated by GDS in study group were 8.95 ± 2.09 before intervention and 6.05 ± 1.54 after one month and 4.63 ± 1.47 after 3 months of continue Al-Hijama sessions. The decrease in depression scale between pre and post intervention was statistically significant (p< 0.001). Conclusion: Our study showed statically significant improvement in depression after Al-Hijama therapy. In future more studies should be conducted on larger scale to assess the effectiveness of this treatment option.
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... This difference may be due to the use of the same patients for both therapies, indicating that the effect of cupping therapy in early Hijri could have influenced the results of the mid-Hijri therapy. It aligns with the research of Lee et al. [18]. whose Randomized Controlled Trial (RCT) study demonstrated that a single cupping therapy can significantly reduce blood pressure by increasing vascular compliance and enhancing vascular filling. ...
Integrating Mid-Hijri Wet Cupping Therapy into Hypertension Treatment: A Quasi-Experimental Approach to Complementary Therapy
Article
Full-text available
  • Nov 2024
Complementary therapy has recently gained popularity in several countries, with some therapies widely used for disease prevention and treatment. Blood cupping is one such complementary therapy for hypertension. According to hadith, the optimal time for blood cupping is during the mid-Hijri months to manage blood pressure. This study aims to assess the effect of blood cupping performed during mid-Hijri months on hypertension outcomes. A quasi-experimental design with a one-group pretest-post-test approach was used. Samples were selected by purposive sampling. The study was conducted at a private clinic in Yogyakarta, Indonesia, involving 13 patients. Blood cupping therapy was administered twice: at the beginning and middle of the Hijri month. Outcomes were measured by changes in blood pressure. Paired Ttests compared blood pressure before and after cupping treatment. Results showed significant blood pressure changes with cupping at the beginning of Hijri (p-value of 0.004) and mid-Hijri (p-value of 0.000). Both treatments significantly reduced blood pressure, with average reductions of 9 mmHg for the beginning of Hijri and 7 mmHg for mid-Hijri. Thus, blood cupping therapy at the beginning of Hijri was more effective than at mid-Hijri.
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... Research from previous studies has illustrated the efficacy of moxibustion in treating a wide array of ailments, including fetal malposition, diarrhea, and colitis [9]. Cupping therapy has demonstrated potential benefits in alleviating neck pain, knee osteoarthritis, plaque psoriasis, chronic urticaria, and migraines [10]. These interventions exhibit their therapeutic efficacy by enhancing local circulation of qi and blood, relieving pain associated with qi stagnation, or modulating autoimmunity through various methods targeting meridians, acupoints, and specific anatomical sites [11][12][13][14]. ...
Suboptimal reporting of randomized controlled trials on non-pharmacological therapies in Chinese medicine
Article
Full-text available
  • Aug 2024
With the successive release of the CONSORT extensions for acupuncture, moxibustion, cupping, and Tuina/massage, this review aims to assess the reporting characteristics and quality of randomized controlled trials (RCTs) based on these specific guidelines. A comprehensive review was conducted by searching multiple databases, including Embase, Ovid MEDLINE(R), All EBM Reviews, AMED, CNKI, VIP Chinese Medical Journal Database, and Wanfang Data, for publications from January 1 to December 31, 2022. Two reviewers independently evaluated the eligibility of the records, extracted predetermined information, and assessed the reporting based on the STRICTA, STRICTOM, STRICTOC, and STRICTOTM checklists. Among the included 387 studies (acupuncture, 213; Tuina/massage, 85; moxibustion, 73; cupping, 16), the overall reporting compliance averaged 56.0%, with acupuncture leading at 62.6%, followed by cupping (60.2%), moxibustion (53.1%), and Tuina/massage (47.9%). About half of the evaluated items showed poor reporting (compliance rate < 65%). Notably, international journals demonstrated significantly higher reporting quality than Chinese journals (P < 0.05). Although acupuncture trials had relatively higher compliance rates, deficiencies persist in reporting non-pharmacological therapies of Chinese medicine, particularly in areas like treatment environment details and provider background information.
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... The technique involves placing a dome-shaped cup on the skin and creating negative pressure either through heat or an air pump. Wet cupping includes making a small skin incision before applying the cup to draw blood, whereas dry cupping involves placing the cup without incisions, either statically or by moving it along the skin with lubricants (11). The negative pressure within the cup is believed to lift and separate tissues, facilitating the release of adhesions between soft tissues, including skin, fascia, neural tissues, muscles, ligaments, and tendons (12). ...
Effectiveness of Dry Needling versus Cupping Therapy for Pain in Piriformis Syndrome
Article
Full-text available
  • May 2024
Background: Piriformis syndrome is characterized by discomfort in the buttocks and throughout the course of the sciatic nerve. Dry needling modulates pain perception, disrupts pain signaling pathways, and induces local tissue responses. Cupping therapy facilitates localized blood flow, lymphatic drainage, and tissue oxygenation to alleviate muscular tension and improve circulation. Both interventions have shown promise in improving symptoms of piriformis syndrome. Objective: The purpose of this study was to evaluate the efficacy of dry needling versus cupping therapy in managing piriformis pain syndrome. Methods: This experimental study was conducted at Chaudhary Muhammad Akram Teaching and Research Hospital, Lahore, from October 2023 to May 2024. Eighty participants diagnosed with piriformis syndrome, aged between 18 and 65 years, were randomly assigned to one of two groups: Group A (dry needling) and Group B (cupping therapy). Exclusion criteria included pregnancy and previous surgical interventions for piriformis syndrome. Both groups received their respective treatments three times a week for six weeks. Pain intensity was measured using the Visual Analogue Scale (VAS), disability was assessed with the Oswestry Disability Index (ODI), and quality of life was evaluated using a standardized questionnaire. Data were analyzed using SPSS version 25, with paired sample t-tests used for within-group comparisons and independent sample t-tests for between-group comparisons. Statistical significance was set at p < 0.05. Results: In the dry needling group, the mean VAS score decreased from 6.216 ± 1.931 to 3.432 ± 0.987 (p < 0.001), while the cupping therapy group saw a reduction from 6.108 ± 2.195 to 4.189 ± 1.697 (p < 0.001). The mean ODI score in the dry needling group decreased from 27.432 ± 7.617 to 10.054 ± 3.036 (p < 0.001), and in the cupping therapy group from 26.270 ± 7.209 to 12.918 ± 7.495 (p < 0.001). Quality of life scores improved significantly in both groups, with the dry needling group showing a mean reduction from 12.702 ± 3.673 to 7.270 ± 1.627 (p < 0.001), and the cupping therapy group from 13.027 ± 3.523 to 8.270 ± 1.609 (p < 0.001). Conclusion: Both dry needling and cupping therapy are effective interventions for managing piriformis pain syndrome, with dry needling showing greater improvements in pain reduction, disability reduction, and quality of life. These findings support the use of dry needling as a preferred therapeutic option for piriformis syndrome.
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... Cupping has shown potential benefits for neck pain, osteoarthritis of the knee, plaque psoriasis, chronic urticaria, and migraines [8]. The NPTCM interventions of acupuncture, moxibustion, cupping and Tuina massage share similar mechanisms of action, which involve different forms of stimulation of meridians, acupoints, and specific anatomical sites to promote localized circulation of qi and blood, or relieve pain caused by stagnation [9][10][11][12]. ...
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... A Ventosaterapia ou Cupping Therapy é uma técnica antiga do Leste da Asia com prevalência Chinesa e outros países têm sido utilizada há milhares de anos para tratar uma variedade de condições de saúde, incluindo dor e inflamação, e tem se tornado popular em países ocidentais. Segundo Lee, Kim, e Ernst, (2011), envolve a aplicação de copos de vidro, acrílico ou silicone na pele do paciente podendo ser seca ou úmida sobre pontos de acupuntura, áreas dolorosas e trigger points. Os copos de aplicação podem ser mobilizados por várias técnicas, como a modalidade fixa que é a mais conhecida, há a deslizante onde há uma movimentação dos copos sob pressão do vácuo aplicado na derme, flash onde os copos são aplicados criando um vácuo e logo são retiradas sob tração da derme, ventosa associadas a sangria ou mais conhecida como ventosa úmida Choi (2021). ...
Ventosaterapia como tratamento complementar da enxaqueca: uma revisão sistemática
Article
Full-text available
  • Jun 2023
A enxaqueca atinge cerca de 15% da população brasileira, sendo que 11% dos indivíduos relatam uma forma transitória da doença, com sintomas aliviados em até 48 horas. Diversas teorias foram propostas para explicar sua causa, incluindo o envolvimento do V par de nervos cranianos, bem como alterações neurogênicas e vasculares. Entre as técnicas utilizadas para tratar a dor e a inflamação, destaca-se a ventosaerapia, uma antiga prática originária da Ásia, aprimorada pela china. Essa técnica envolve a aplicação de copos de vidro, acrílico ou silicone sobre a pele, podendo ser seca ou úmida, em pontos de acupuntura, áreas dolorosas e pontos de gatilho. Com o objetivo de analisar a eficácia da ventosaterapia como tratamento complementar para enxaqueca, com foco na redução do consumo de medicamentos, foi realizada uma revisão sistemática. A pesquisa abrangeu as bases de dados BVS, PubMed e Science, a seleção dos artigos ocorreu em três etapas: título, resumo e leitura completa. Os estudos que respaldaram a aplicação da técnica foram incluídos na análise, e foi elaborada uma tabela PICO (Population, Intervention, Comparison, Outcome) e um fluxograma PRISMA para justificar as exclusões e facilitar a coleta de dados. Embora haja poucos estudos sobre relacionados a ventosaterapia no tratamento da enxaqueca, os dados obtidos permitem observar sua eficácia. Destaca-se a ventosa úmida ou sangria como uma das técnicas mais promissoras, podendo ser utilizada por profissionais de saúde como ferramenta complementar na fisioterapia, com o intuito de reduzir a incapacidade causada pela intensa dor associada a essa condição.
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... Because it involves piercing the skin and removal of body fluids, the physiological response to wet cupping would be expected to be different than its "dry" counterpart, and is not evaluated in this paper. Moving cupping is a technique in which a lubricant is used and after the cups are applied, they are slid along the skin [8] . ...
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USING OF CUPPING TECHNIQUE AS A THERAPEUTIC MODEL IN TREATMENT OF NON-DISCOGENIC LOW BACK PAIN
Article
Full-text available
  • Feb 2024
Background: Cupping therapy is one of the traditional medical technologies practiced for thousands of years. it might have some additional benefits on early rehabilitation for post-stroke complications. Aim of the work: to examine if the use of cupping technique as a therapeutic model in treatment of discogenic low back pain has a significant impact or not. Methodology: 60 Patients divided into two equal groups were participated in this study: Group 1 treated by conventional post-stroke therapy and Group 2 treated by wet cupping in addition to conventional post-stroke therapy. The national institute of health stroke scale (NIHSS) index was sed as patients assessment tool for neurologic deficit evaluation motor functions is assessed by the Fugl-Meyer assessment (FMA) scale, the healing process depended on the bedside swallowing assessment (BSA). For cognitive function, the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) have been used, and any undesirable effect of wet cupping were noted for safety evaluation. Results: Better results have been documented with wet cupping therapy. Statistically significant improvement in pain reduction for both techniques of cupping (dry & wet) when compared to conventional medical therapy without augmentation with cupping therapy. Conclusion:Significant Effect of Hijama (Wet cupping) in post-stroke rehabilitation.
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Wet cupping therapy for treatment of herpes zoster: a systematic review of randomized controlled trials
Article
Full-text available
  • Nov 2010
  • Alternative Ther Health Med
Wet cupping is a traditional Chinese medicine therapy commonly used in treating herpes zoster in China, and clinical studies have shown that wet cupping may have beneficial effect on herpes zoster compared with Western medication. We included randomized controlled trials (RCTs) on wet cupping for herpes zoster. We searched PubMed, the Cochrane Library (Issue 3, 2008), China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journals Fulltext Database VIP, and Wan Fang Database. All searches ended in February 2009. Two authors extracted data and assessed the trials' quality independently. RevMan 5.0.18 software (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI). Eight RCTs involving 651 patients were included, and the methodological quality of trials was generally fair in terms of randomization, blinding, and intention-to-treat analysis. Meta-analyses showed wet cupping was superior to medication in the number of cured patients (RR 2.49, 95% CI 1.91 to 3.24, P < .00001), the number of patients with improved symptoms (RR 1.15, 95% CI 1.05 to 1.26, P = .003), and reducing the incidence rate of postherpetic neuralgia (RR 0.06, 95% CI 0.02 to 0.25, P = .0001). Wet cupping plus medication was significantly better than medication alone on number of cured patients (RR 1.93, 95% CI 1.23 to 3.04, P = .005) but demonstrated no difference in symptom improvement (RR 1.00, 95% CI 0.92 to 1.08, P = .98). There were no serious adverse effects related to wet cupping therapy in the included trials. Wet cupping appears to be effective in the treatment of herpes zoster. However, further large, rigorously designed
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CONSORT 2010 statement: updated Guidelines for Reporting Parallel Group Randomised Trials
Article
Full-text available
  • Mar 2010
  • BMC MED
The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials. Kenneth Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience. To encourage dissemination of the CONSORT 2010 Statement, this article is freely accessible on bmj.com and will also be published in the Lancet, Obstetrics and Gynecology, PLoS Medicine, Annals of Internal Medicine, Open Medicine, Journal of Clinical Epidemiology, BMC Medicine, and Trials.
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Cupping for Treating Pain: A Systematic Review
Article
Full-text available
  • Jun 2011
  • EVID-BASED COMPL ALT
The objective of this study was to assess the evidence for or against the effectiveness of cupping as a treatment option for pain. Fourteen databases were searched. Randomized clinical trials (RCTs) testing cupping in patients with pain of any origin were considered. Trials using cupping with or without drawing blood were included, while trials comparing cupping with other treatments of unproven efficacy were excluded. Trials with cupping as concomitant treatment together with other treatments of unproven efficacy were excluded. Trials were also excluded if pain was not a central symptom of the condition. The selection of studies, data extraction and validation were performed independently by three reviewers. Seven RCTs met all the inclusion criteria. Two RCTs suggested significant pain reduction for cupping in low back pain compared with usual care (P < .01) and analgesia (P < .001). Another two RCTs also showed positive effects of cupping in cancer pain (P < .05) and trigeminal neuralgia (P < .01) compared with anticancer drugs and analgesics, respectively. Two RCTs reported favorable effects of cupping on pain in brachialgia compared with usual care (P = .03) or heat pad (P < .001). The other RCT failed to show superior effects of cupping on pain in herpes zoster compared with anti-viral medication (P = .065). Currently there are few RCTs testing the effectiveness of cupping in the management of pain. Most of the existing trials are of poor quality. Therefore, more rigorous studies are required before the effectiveness of cupping for the treatment of pain can be determined.
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Do Certain Countries Produce Only Positive Results? A Systematic Review of Controlled Trials
Article
  • Apr 1998
  • Contr Clin Trials
To determine whether clinical trials originating in certain countries always have positive results. Abstracts of trials from Medline (January 1966-June 1995). Two separate studies were conducted. The first included trials in which the clinical outcome of a group of subjects receiving acupuncture was compared to that of a group receiving placebo, no treatment, or a nonacupuncture intervention. In the second study, randomized or controlled trials of interventions other than acupuncture that were published in China, Japan, Russia/USSR, or Taiwan were compared to those published in England. Blinded reviewers determined inclusion and outcome and separately classified each trial by country of origin. In the study of acupuncture trials, 252 of 1085 abstracts met the inclusion criteria. Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR. In studies that examined interventions other than acupuncture, 405 of 1100 abstracts met the inclusion criteria. Of trials published in England, 75% gave the test treatment as superior to control. The results for China, Japan, Russia/USSR, and Taiwan were 99%, 89%, 97%, and 95%, respectively. No trial published in China or Russia/USSR found a test treatment to be ineffective. Some countries publish unusually high proportions of positive results. Publication bias is a possible explanation. Researchers undertaking systematic reviews should consider carefully how to manage data from these countries.
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Cupping for Hypertension: A Systematic Review
Article
The objective of this review is to assess the clinical evidence for or against cupping as a treatment for hypertension. We searched the literature using 15 databases from their inception to 30 June 2009, without language restrictions. We included all clinical trials (CTs) of cupping to treat hypertension in human patients. Risk of bias was assessed using the Cochrane criteria. Two CTs met all inclusion criteria. One RCT (randomized CT) assessed the effectiveness of dry cupping on changes in cerebral vascular function compared with drug therapy. Their results suggested significant effect in favor of cupping on vascular compliance and degree of vascular filling. One uncontrolled observational study (UOS) tested wet cupping for acute hypertension and found that a one-time treatment reduced blood pressure. In conclusion, the evidence is not significantly convincing to suggest cupping is effective for treating hypertension. Further research is required to investigate whether it generates any specific effects for that condition.
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[CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials (Chinese version)]
Article
  • Jul 2010
The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials. Kenneth Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience. To encourage dissemination of the CONSORT 2010 Statement, this article is freely accessible on bmj.com and will also be published in the Lancet, Obstetrics and Gynecology, PLoS Medicine, Annals of Internal Medicine, Open Medicine, Journal of Clinical Epidemiology, BMC Medicine, and Trials.
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Cupping for stroke rehabilitation: A systematic review
Article
  • Jul 2010
Cupping is often used for stroke rehabilitation in Asian countries. Currently, no systematic review of this topic is available. The aim of this systematic review is to summarize and critically evaluate the evidence for and against the effectiveness of cupping for stroke rehabilitation. Thirteen databases were searched from their inception through March of 2010 without language restrictions. Prospective clinical trials were included if cupping was tested as the sole treatment or as an adjunct to other conventional treatments for stroke rehabilitation. We found 43 potentially relevant articles, of which 5 studies including 3 randomized clinical trials (RCTs) and 2 uncontrolled observational studies (UOSs) met our inclusion criteria. Cupping was compared with acupuncture, electro-acupuncture and warm needling. Some superior effects of cupping were found in two of the RCTs when compared to acupuncture in hemiplegic shoulder pain and high upper-limb myodynamia after stroke. The other RCT failed to show favorable effects of cupping when compared to acupuncture and warm needling in patients with hemiplegic hand edema. The two UOSs reported favorable effects of cupping on aphasia and intractable hiccup after stroke. There are not enough trials to provide evidence for the effectiveness of cupping for stroke rehabilitation because most of the included trials compared the effects with unproven evidence and were not informative. Future RCTs seem warranted but must overcome the methodological shortcomings of the existing evidence.
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Validation of an index of the quality of review articles
Article
  • Feb 1991
  • J CLIN EPIDEMIOL
The objective of this study was to assess the validity of an index of the scientific quality of research overviews, the Overview Quality Assessment Questionnaire (OQAQ). Thirty-six published review articles were assessed by 9 judges using the OQAQ. Authors reports of what they had done were compared to OQAQ ratings. The sensibility of the OQAQ was assessed using a 13 item questionnaire. Seven a priori hypotheses were used to assess construct validity. The review articles were drawn from three sampling frames: articles highly rated by criteria external to the study, meta-analyses, and a broad spectrum of medical journals. Three categories of judges were used to assess the articles: research assistants, clinicians with research training and experts in research methodology, with 3 judges in each category. The sensibility of the index was assessed by 15 randomly selected faculty members of the Department of Clinical Epidemiology and Biostatistics at McMaster. Authors' reports of their methods related closely to ratings from corresponding OQAQ items: for each criterion, the mean score was significantly higher for articles for which the authors responses indicated that they had used more rigorous methods. For 10 of the 13 questions used to assess sensibility the mean rating was 5 or greater, indicating general satisfaction with the instrument. The primary shortcoming noted was the need for judgement in applying the index. Six of the 7 hypotheses used to test construct validity held true. The OQAQ is a valid measure of the quality of research overviews.
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