by Ilkay Chirali
When we look at the history of cupping therapy, we can see the enormous knowledge that existed across vast geographical locations in the days when it was practiced. From Far Eastern countries to the ancient Egyptians and the entire African continent; to the North and the South Americans; the entire Northern Europeans including Russia, Poland and the Scandinavian counties; all the Mediterranean countries including Turkey, Greece, Italy, France, as well as England practitioners all practiced cupping in one form or other. In the UK, Dr. William Marsden, the founder of the Royal Marsden Hospital, employed cupping therapy quite extensively at his ‘Free Hospital’ in Gray’s Inn Road during the 1830s.
In today’s modern practice, a thorough diagnosis must be made at all times before deciding on cupping treatment. This will determine the type of cupping method (10 methods) to be used as well as the suitability of the patient. In my book entitled “Traditional Chinese Medicine Cupping Therapy” I mention ten cupping methods and their safe application as well as contraindications. In my regular cupping workshops I teach the ten methods of cupping, as well as safety issues to remember during the application (both towards the patient and the practitioner). In order to decide the correct treatment one must pay special attention towards the patient’s present pattern analysis.
Preparing for Cupping
Glass cupping sets come in various sizes; number 1 is the smallest size and it is mostly used to treat facial points on adults as well as treating children under 7 years old. Number 5 is the largest cup size and it is often used to achieve a strong cupping sensation on adult patients. The vacuum that is required in cupping is generated by placing a flame (lit cotton wool bud) inside the cup, thereby burning away the oxygen. The cup is then quickly placed against the patient’s body. Cotton wool balls are prepared in advance and soaked in alcohol and kept in an air tight jar, ready for use.
Therapies that Benefit from Cupping
Generally speaking, most of the hands-on therapeutic techniques can include cupping in their therapy. The ultimate aim of all hands-on techniques is to use physical application in order to stimulate the body’s natural healing mechanisms by balancing the physical, mental and emotional energies and restore health to the individual. Apart from Chinese medicine, other therapies such as aromatherapy, massage, chiropractic, osteopathy, kinesiology, Alexander technique, shiatsu, reflexology, polarity and physiotherapy, can all incorporate cupping in their main treatment model.
Ten Methods of Cupping
1. Weak /Light Cupping (Tonifying method)
2. Medium Cupping (Tonifying method)
3. Strong Cupping (Draining method)
4. Moving Cupping (Draining method)
5. Needle Cupping (Draining method)
6. Moxa /Hot Needle Cupping (Tonifying method)
7. Empty /Flash Cupping (Tonifying method)
8. Full /Bleeding Cupping (Draining method)
9. Herbal Cupping (Tonifying method)
10. Water Cupping (Even method)
1. Weak (Light) Cupping Method (tonifying)
Weak cupping is employed when Qi and Blood are sluggish, deficient (Xu) or stagnant, and a reversal of these conditions is required. The action of weak cupping is to remove stagnation whilst at the same time tonify the weak Qi and Blood. It is therefore termed a ‘tonifying’ method. The key factor in deciding when to apply weak cupping is the present constitution of the patient. Pulse, tongue and observation diagnosis should all point towards a deficiency.
In practice the cups are prepared as mentioned earlier, and the skin moistened with oil. Light the cotton wool and wait for a few seconds so that the fire is less intense. Remember, the bigger the fire, the greater the suction! Apply the cups at the desired points until all cups are used. When all are in place, the practitioner should take immediate notice of the suction inside the cups. The amount of flesh drawn into the cups should be minimal and hardly raised inside the cup. Should the initial suction be stronger than originally planned, the practitioner should press the edge of the cup with an index finger and let some air into the cup. This action will reduce the strength of the suction to the desired level. At no time should the patient feel an uncomfortable sensation of pulling or pain on the treatment area. If this happens, the practitioner should continue with the reducing technique until the patient feels comfortable. Weak cupping is the gentlest technique out of the ten methods. This type of cupping method is particularly suitable for debilitated adults, elderly patients and young children, especially when under the age of seven. Light Cupping can be applied to almost anywhere on the body, but may cause a slight reddening on the skin, rather than a deep bruise or blister. The duration of a weak cupping application can be as long as 30 minutes.
When light cupping is performed on a hairy or a very dry skin, the suction is likely to cease much earlier than planned. In this case, apply oil liberally and repeat the cupping procedure. The gentle pulling action of this method stimulates the Qi movement within the meridian system, bringing benefit to the patient and tonifying the Qi and Blood, without the risk of further depletion of energies to the weak and frail.
2. Medium Cupping Method (tonifying)
This is the most frequently used cupping method on patients with relatively stronger constitutions. As well as on adults, medium cupping can be safely administered to children over the age of seven. With medium cupping the suction is firmer, but as the patient’s own energies are also good, it will act as a tonifying method. However, there is a real danger of draining the patient’s Qi if the cups are left on for longer than 30 minutes. Despite the medium strength suction, prolonged application will cause Qi deficiency, thus leaving the patient lethargic after treatment.
To achieve a medium suction, the practitioner needs to use a bigger flame than with the light method. The practitioner also holds the cups closer to the patient. This will enable the practitioner to apply the cups quicker and the suction will be firmer, the amount of oxygen re-entry will be lower, thus creating a stronger vacuum. With this method, the skin is pulled well into the cup, creating a slight redness on top of the skin inside the cup. If the cups are left on for a long period the redness will turn to purple, indicating a ‘stronger application’. If glass cups are used instead of the more traditional bamboo cups, the progress can be observed closely and early adjustments can be made if desired. Medium cupping can be safely applied anywhere on the body, including the face and abdomen. Hot or Cold Bi patterns, stress related conditions, Qi and Blood tonification, and children’s ailments can all benefit from medium cupping.
3. Strong Cupping Method (draining)
This is one of the most draining techniques of all, (moving cupping is the other). Therefore before deciding on using strong cupping, the practitioner must ensure the suitability of the patient. Significant amounts of Qi and Blood are manipulated by this method, sometimes leaving the patient tired following treatment. Pulse, tongue and observational diagnosis should all emphasise an Excess, Full (Shi) condition (do not use in cases of False Heat patterns).
Defensive energy (Wei Qi) is greatly affected and influenced by this method. The purpose of a strong cupping treatment is to move Qi and Blood to eliminate internal/external pathogenic factors and stagnation from patients with relatively strong Wei Qi.
Prepare the patient and have the cups close at hand. For a strong cupping technique, a big flame is necessary in order to achieve a strong vacuum and pulling action. For this reason, use a large ball of cotton wool, or 2 pieces of cotton wool held together by forceps. On igniting the cotton wool, insert the fire into the cup without delay, simultaneously turning the cup onto the skin. A strong vacuum will be produced, giving a strong pulling sensation of the skin inside the cup. Because of the strong nature of the pulling action, redness, and shortly after, purple-coloured skin will quickly appear inside the cup (figure 1). It is preferable to avoid the strong method during a patient’s first visit, and introduce the treatment using a much weaker version, while explaining that the following cupping treatments will be slightly stronger. When using a strong cupping method the first time, a very dark purple bruise is inevitable, and it can take up to 15 days before diminishing completely.
Figure 1. Strong Cupping.
Cupping-time should also be short in a strong cupping treatment, certainly not more than 10 minutes during the first application. This can be increased up to 20 minutes in later applications. Dark bruises will become much lighter and the dispersing-time of the bruise will also be much shorter, sometimes lasting only a day or two. Following an acupuncture session, a strong cupping treatment may cause a small amount of blood to be drawn into the cup. This is quite normal given the strength of the suction applied by this method. Fine capillaries under the skin can also break relatively easily with strong suction, causing deeper and longer lasting bruises. This is also the only method of cupping that can cause blisters to form quickly. Therefore, it is strongly advised that the practitioner should remain with the patient at all times during the treatment, observing the progress of the suction, and if necessary, removing the cups earlier than planned. The strong cupping method should be avoided on the face, stomach, abdomen, and on children under the age of 14, the elderly and frail, and during the entire pregnancy period. It is particularly beneficial in the treatment of Hot Bi and Frozen Shoulder patterns.
4. Moving Cupping - Tui Guan Fa (draining)
As mentioned earlier, moving cupping is the second most draining of all the cupping methods. The object of this treatment technique is to apply strong cupping therapy to a much larger area of the body. Like the strong cupping method, the patient should have a strong constitution before moving cupping is employed. Strong energetic features are needed in order to withstand the not so gentle pulling and moving action of the cup. Without any doubt, this is the most painful cupping method. For this reason alone, if the patient’s energy is Empty (Xu), and therefore weak, moving cupping can only help to diminish it further. It is mostly applied on the Bladder channel on the back (about 1.5 and 3 inch either side to the spine), especially when Excess Heat conditions are present, or in some neurological conditions such as paralysis or post stroke weaknesses.
Oil the skin liberally and apply a single medium size and medium strength cup on the treatment area. Before applying the cup, make sure the edges of the glass cups are smooth, even, and without any chips. This is one method in which bamboo cups are of no use. The sharp edges of the bamboo cups make it impossible to move the cup once the suction takes place. On application of the cup, control the suction by gently moving the cup in any one direction. The cup should move freely and without requiring a great deal of effort from the practitioner. If the suction is strong, moving the cup will be difficult, and any attempt to move it will result in extreme pain. Grip the cup with one hand, while supporting the skin close to the cup with the other. Pull and slide the cup alongside the meridian using long strokes. Do not apply short, up and down movements as this may cause unnecessary pain. If difficulty is experienced in moving the cup, it is an indication that the suction is too strong and needs to be reduced by letting a small amount of air into the cup. The primary objective of moving cupping is to manipulate the Excess Qi and bring up the Heat to the surface of the skin. After only a few strokes, bruising will appear alongside the line of movement. The more internal Heat is present, the quicker the bruising will appear. This bruising can also be used as a diagnostic tool as far as the Qi and Blood congestion and internal Heat are concerned; deep and darker bruising indicates a Full (Shi) or an acute condition. Light colour bruising indicates Empty (Xue) conditions, requiring less vigorous treatment. During the application of moving cupping, some air will almost always escape into the cup, resulting in cessation of suction. All that is necessary is to reapply the cup and continue with the movement. Avoid using the moving method on an open wound or lesions, as the skin must be smooth and unbroken.
This treatment is not recommended for children under the age of 14, or for the frail and weak. The first treatment should not exceed 5 minutes, building up to a maximum of 15 minutes per session. For Hot skin conditions like eczema, psoriasis and acne, or painful Hot Bi syndromes, moving cupping is greatly beneficial, though it is important to avoid direct application on lesions. If the condition to be treated is on the hands, face or front of the body, moving cupping can be applied on the Bladder channel on the back of the body instead. The same principle applies with painful Bi patterns, i.e. avoid moving cupping directly on painful points, and use the surface 1.5 to 2 cun close to the trauma for treatment.
5. Needle Cupping Method (draining)
Needle cupping is mostly used for Re (Hot) type painful Bi patterns, i.e. red and painful knee and elbow joints, where there is a need to stop the pain and remove the excess pathogenic Heat at the same time. The practitioner should administer the acupuncture treatment as intended under normal circumstances, leaving the needles in place as long as necessary. One can reduce the acupuncture treatment-time by 10-15 minutes if needle cupping is intended to follow the acupuncture.
Following the acupuncture treatment, leave the needles in the present position and apply oil to the skin where the acupuncture needles are situated. Choose a bamboo or large glass cup in order to accommodate the acupuncture needle. Apply the cups over the acupuncture needles. A medium to strong application is necessary if the treatment is over the joints, and weak to medium cupping if the treatment is over muscular areas. Retain the cups in position for 10 to 15 minutes. Some blood may be drawn into the cup through the needles. This is normal especially if the suction is strong.
Avoid practising needle cupping on the Back Shu points, as there is a real danger of the cup pushing the needle deeper than originally inserted, thus causing a pneumothorax. To be on the safe side, use short 0.5 to 1 inch needles during the treatment. This is one occasion when the tall bamboo cups are preferable to the more round glass cups, as the height of the bamboo cups are ideal for needle clearance, making the application much safer to administer. This method is not recommended for children under the age of 16.
Ilkay Chirali qualified as a TCM practitioner in 1985 in Melbourne, Australia where he opened his first clinic. He later returned to England in 1987 where he set up his own clinic in South East London and is still practicing. He has presented numerous papers on cupping at five international seminars and held well over 40 cupping therapy workshops as well appearing as an ‘expert’ on BBC TV and radio programmes. For details of forthcoming cupping workshops, contact Ilkay Chirali via email: firstname.lastname@example.org