Cupping therapy

Early records and contested origins

Secondary reviews place the earliest written references to cupping in the Egyptian Ebers Papyrus, dated to about 1550 BC, and one adds a claim that cupping in Egypt goes back to 3500 BC on the basis of hieroglyphic writing. A narrative review of 83 articles describes the data on the origin of cupping, its definitions and its instruments as inconsistent, and a sports medicine review states that the true origin remains unknown. The reviews cited here did not examine the papyrus itself, so the dates are second-hand.

Greek, later European and Chinese accounts

A review in the Journal of Traditional and Complementary Medicine says that Hippocrates prescribed cupping for conditions of the back and limbs, gynaecological complaints, pharyngitis, ear ailments and lung disease, and that Galen described cups made of glass, horn and brass. Another review says cupping was later carried out by physicians, barber surgeons and bathhouse attendants, and that medieval Europeans used it to expel evil spirits. A narrative review states that it fell out of favour in the 17th and mid-18th centuries and later regained popularity.

For China, authors of a systematic review and of a reporting standard state that the earliest record is in the Bo Shu, a book written on silk that was found in a Han dynasty tomb in 1973. The same review says that other early Chinese books described cupping methods and treatment records, that bamboo, glass or earthen cups were used, and that Chinese acupuncturists and colleagues from the former Soviet Union established it as an official hospital practice in the 1950s. A sports medicine review gives 1999 for acceptance as an official therapeutic practice in Chinese hospitals, and the two dates are not reconciled in the sources.

Arabic and Islamic traditions

Reviews describe hijama as the Arabic name for cupping and list Arabic medicine and Prophetic medicine among the traditions in which cupping was practised, alongside Chinese, Greek, European and American medicine. One review says that cupping, called al-hijamah, was used by ancient Arabic cultures for conditions it lists as hypertension, polycythemia, headaches and drug intoxication, and translates the term as 'to restore to the original size'. Another says it is popular as al-hijama in Egypt and Arabic countries and is used within Unani, Ayurvedic, Chinese and Tibetan systems.

None of the sources opened for this page sets out the religious texts on hijama or their scholarly interpretation, so those texts are not described here and would need specialist scholarship.

Modern revival

A reporting-standard paper links a recent renewal of popular interest to athletic stars who have received cupping for musculoskeletal care. A sports medicine review says a broadcaster's statement that athletes use it to recover and perform at their best is unconfirmed, and cites a 2006 Korean survey in which 93.5% of 6,708 physicians used cupping.

Names and spellings

In English the procedure is called cupping or cupping therapy. Reviews give 'hijama' as the Arabic term and the Chinese term as bá guàn liáo fǎ. Usage differs: some authors use hijama for cupping in general, while another review says the cupping, puncturing and cupping method is traditionally known as al-hijamah, which narrows the term to a wet technique. Readers meeting the word in a service listing therefore cannot assume that it means dry or wet cupping without checking.

Dry, wet and fire cupping

Reviews usually divide the practice into dry cupping, in which suction is applied without cutting the skin, and wet cupping, which involves bloodletting. Fire cupping is better understood as a way of producing suction than as a separate category: in the flame method a glass cup is coated with alcohol, flamed, and applied just before the flame goes out so that the heated air creates negative pressure. A hand pump can be used instead, and the Chinese review describes flame as the usual way of creating suction in the retained method.

A review of Chinese clinical research lists seven major types: retained cupping, bleeding (wet) cupping, moving cupping, empty cupping in which cups are removed at once, needle cupping applied over acupuncture needles, medicinal or herbal cupping with bamboo cups boiled in herbs, and water cupping. Wet cupping has two forms in another review. One starts with dry cupping, then puncturing, then cupping again, and is described as more common in the Middle East. The other starts with puncturing and is described as common in the Far East and Europe.

Terms in research reports

Trial authors describe cupping with varied labels, pressures and numbers of cups, and a 2025 meta-analysis ran subgroup analyses by cupping type, pressure type and site. A reporting guideline, the Standards for Reporting Interventions in Clinical Trials of Cupping (STRICTOC), was published in 2020 with 6 items and 16 sub-items because incomplete reporting of the cupping intervention made trials hard to interpret and repeat.

Settings and practitioners

A sports medicine review says cupping is today most commonly used by Eastern medicine practitioners. A 2026 cross-sectional study surveyed 120 al-hijama practitioners working at five cupping community centres in Qatar, which shows one setting in which wet cupping is delivered. STRICTOC treats the background of the treatment provider as a reporting item for trials, but none of the sources reviewed sets out a shared training standard for practitioners, and requirements are likely to differ by country.

Dry cupping sessions

Cups of thick glass are placed most often on the back, chest, abdomen or buttocks, and negative pressure is made with a flame or a hand pump. A review says the cup stays in place for around 10 to 15 minutes. Lubricant can allow the cup to be moved over the skin to cover a larger area, which is called moving cupping, and in needle cupping the cups are applied after acupuncture needles have been inserted.

Wet cupping sessions

In the sequence described for wet cupping, dry cupping is applied for several minutes, the suction is released, a small skin incision is made after disinfection, and suction is applied again to draw out the blood that collects. The skin is disinfected again afterwards. Chinese sources describe incisions made with a triangle-edged needle or a plum-blossom needle. Because the skin is broken, hygiene steps such as hand hygiene, sterilised equipment and disposable lancets are relevant, and a person can ask about them.

What a participant may notice

A sports medicine review says cupping typically produces characteristic skin changes in a circular pattern, which may include petechiae (tiny red or purple spots), redness, swelling and bruising, and that these may take days to weeks to resolve. The sources reviewed do not report how often these marks occur, and a person who has had a session may need to explain them to other clinicians.

Traditional and historical indications

Reviews describe historical uses that vary by tradition. The Greek use is listed as back and limb disorders, gynaecological complaints, pharyngitis, ear ailments and lung disease, and the ancient Arabic use as hypertension, polycythemia, headaches and drug intoxication. In traditional Chinese medicine one review says cupping plays the role of leak or purging. A narrative review says that cupping is currently used for health promotion, prophylaxis and treatment of a variety of diseases. These are claims within traditions and are not findings from tested outcomes.

Uses reported in clinical research

A review of 550 Chinese clinical studies published between 1959 and 2008 found that cupping was commonly used for pain conditions, herpes zoster and cough or asthma. An overview of systematic reviews in 2011 found reviews on pain conditions, stroke rehabilitation, hypertension and herpes zoster. Later syntheses have addressed musculoskeletal and sports conditions, migraine, and rheumatic diseases, in which one review reports variable outcomes. Practitioners describe four broad aims: reducing pain, reducing inflammation, immunomodulation and adjusting blood parameters.

Sport and recovery

Cupping gained wider public attention through athletes, and a review of musculoskeletal and sports rehabilitation analysed 22 randomised and case-series studies from 1990 to 2019. The sports medicine review above says cupping may be a useful adjunct because it is inexpensive and non-invasive, but also says the claim that it helps athletes recover and perform is unconfirmed.

Overviews of the evidence

A 2011 overview identified five systematic reviews, covering pain conditions, stroke rehabilitation, hypertension and herpes zoster, each based on small numbers of studies. Its authors judged evidence clear only for pain, with doubts even there. A 2010 review of 550 Chinese clinical studies found 73 randomised trials, generally of poor quality.

A 2025 update by a Beijing evidence-based medicine centre searched seven databases from January 2014 to January 2023 and included 72 trials with 5,720 participants in pain management. All trials were assessed as having a high risk of bias. Most reported benefit on response and pain scores, but the authors graded the evidence as low quality.

Chronic musculoskeletal pain

A 2025 meta-analysis in BMJ Open included randomised trials in adults with musculoskeletal pain lasting more than three months. Control groups were waiting list (5 trials), sham or placebo cupping (3 trials) or rest (2 trials). Pain intensity was lower with cupping (standardised mean difference -1.17, 95% confidence interval -1.93 to -0.42) (GRADE moderate, per the authors), but heterogeneity was very high (I-squared 94%). Function (-0.24, -0.93 to 0.46) and mental health outcomes did not differ significantly, and only immediate effects were analysed.

A review of musculoskeletal and sports rehabilitation (22 studies, most using dry cupping) judged the evidence for soft-tissue flexibility moderate, for low back or cervical pain low to moderate, and for other musculoskeletal conditions very low to low.

Trials with sham cupping

A 2026 meta-analysis compared dry cupping with placebo cupping for musculoskeletal pain and found five trials with 281 participants, four of them at high overall risk of bias. Certainty was very low at every time point. At the short term the mean difference on a 0 to 100 pain scale was -9.9 (95% confidence interval -30.5 to 10.7), spanning trivial harm to meaningful benefit against a 15-point threshold. The authors concluded that effects were very uncertain.

A 2021 randomised trial of 90 people with chronic non-specific low back pain gave weekly dry cupping or sham cupping for eight weeks, with blinded participants and assessors. Pain at rest differed negligibly, for example by 0.6 points on a 0 to 10 scale at eight weeks (95% confidence interval -0.4 to 1.6), and the authors concluded that dry cupping was not superior to sham cupping. These results do not transfer to wet cupping or other conditions.

Migraine and wet cupping

A 2024 meta-analysis of 18 trials with 1,446 participants reported a higher treatment success rate with cupping in migraine (risk ratio 1.83, 95% confidence interval 1.52 to 2.21), with the significant result seen only for wet cupping, and no quality-of-life gain on the Migraine Disability Scale. The abstract did not report a risk-of-bias rating, and its adverse-event figure duplicates the success figure, so it needs checking.

Trial quality and heterogeneity

Across the reviews, concerns about risk of bias recur. The 2010 review rated most randomised trials as generally poor, the 2025 pain review rated every included trial at high risk of bias, and a 2026 review found four of five sham-controlled trials at high risk. The authors of STRICTOC say incomplete reporting of cupping interventions contributes to doubts about efficacy and safety. Heterogeneity in the BMJ Open meta-analysis was 94%, so the pooled estimate hides large differences between trials.

Mechanisms and the placebo question

A sports medicine review lists proposed mechanisms, among them enhancing skin circulation, loosening connective tissue, changing pressure pain thresholds, stimulating the peripheral nervous system, reducing oxidative stress and modulating the immune system. It also notes a psychosomatic view that the effect is a placebo effect alone. A rheumatology review cites a rat study in which wet cupping raised the pain threshold and the expression of HSP70 and beta-endorphin. Proposed mechanisms and animal findings do not establish a clinical benefit in people.

Sham cupping is itself a design question: the trials above used a reduced version of cupping as the comparator, and the sources do not state whether participants could tell which treatment they received. The sham-controlled trials found small or uncertain differences, while waiting-list and no-treatment comparisons, which cannot separate the effect of cups from attention and expectation, produced the larger pain differences.

Overlap and unanswered questions

The 2010 and 2025 evidence reviews on pain share an author, Huijuan Cao, and both come from the Beijing evidence-based medicine group, so they are not fully independent of each other. Longer-term outcomes were largely absent from the sources, and the sources reviewed contain no head-to-head trial of dry, fire and wet cupping that would show whether the technique matters.

Adverse events in reviews

The 2010 Chinese review reported no serious adverse effects in its included studies. A review of musculoskeletal and sports use rated the incidence of adverse events as very low, and the 2025 pain review found low or very low quality evidence that adverse events were less frequent with cupping than in control groups, which often received drugs. A dermatology case report with review states that the most common adverse events occur at the skin level. Absence of reports in trials does not show that harms did not occur, because reporting methods varied.

Infection and serious complications in case reports

A 2025 review of case reports on neurological complications examined 280 reports and series and included 12 studies describing 14 patients. Subdural haemorrhage was the most common complication (4 of 14), complications were vascular and infectious, and all but 3 patients recovered after surgical or medical treatment. The authors concluded that such complications are rare but can be severe and life-threatening. A 2023 case report describes disseminated Staphylococcus aureus infection in a 33-year-old immunocompetent woman after wet cupping, and its authors recommend high hygiene standards.

A rheumatology review says reports of serious rheumatic side effects led some medical providers to speak against cupping, and a review of cupping notes a report of haemophilia A in a patient undergoing wet cupping. The sources do not establish how often these events occur or that cupping caused them.

Hygiene, training and practice standards

In the 2026 Qatar survey of 120 al-hijama practitioners, about half did not adhere to established safety guidelines, and hand hygiene, equipment sterilisation, use of disposable lancets and documentation were frequently neglected. The authors called for regular training and standardised safety protocols. This is one country and one practitioner group, and it should not be generalised. No statutory regulation or training standard for cupping practitioners was sought or described here, and professional-body registers were not verified.

Suitability and care boundaries

None of the sources reviewed provides a verified list of contraindications, so this page does not set one out. Wet cupping breaks the skin, and a person can ask the practitioner about hygiene, about the equipment used and about any bleeding or infection concerns, and can ask to pause or stop. Fever, spreading redness or discharge at a cupping site, severe pain, or new weakness or neurological symptoms after cupping are reasons to seek prompt medical assessment, in line with the infectious and neurological complications reported. Cupping should not delay or replace necessary care. This information is educational and not individual medical advice.