Dry Cupping

Early records and disputed origins

A narrative review of the history of cupping, which screened 625 articles and included 83, reports that the exact origin of cupping is a matter of controversy and that its use has been documented in early Egyptian and Chinese medical practices. The authors describe inconsistent data on origin, definitions, instruments and procedures, and say that cupping fell out of favor in the 17th and mid-18th centuries before regaining popularity in modern medicine.

Secondary reviews give dated examples. A sports medicine review states that the earliest known record dates to 1550 BC in the Egyptian Ebers Papyrus, and a review of cupping tools and techniques also cites Herodotus (about 400 BC) and Hippocrates in Greek medicine. These accounts describe wet and dry cupping together, so the sources reviewed here do not show which early records concern bloodless cupping specifically.

Spread across regions and professions

The sports medicine review says cupping spread widely and was performed by physicians, barber surgeons and bathhouse attendants, and that it is now most commonly used by Eastern medicine practitioners. It also states that the Arabic term Al-hijamah was used in ancient Arabic cultures. The Mehta review lists Unani, Ayurvedic, Chinese, Tibetan and other Asian systems among those that use cupping, and describes Al-Hijama as the popular name in Egypt and Arabic countries.

The sources reviewed for this page do not name individual early Chinese authors or give a dated Chinese lineage for dry cupping, so this page does not attribute the practice to a named person. Readers who want the traditional Chinese framing will find it on the Traditional Chinese Medicine page.

Dry cupping as one variant of a wider family

Machipedia covers the whole family on its Cupping Therapy page, and this page covers only the variant that applies suction to intact skin. Reviews of trials describe wet cupping as dry cupping with blood-letting added, and a systematic review of cupping for pain included trials of cupping with or without drawing blood. Wet Cupping (Hijama) has its own page.

Names and the dry versus wet distinction

The Mehta review uses the Chinese term bá guàn liáo fǎ for cupping therapy, uses the keywords dry cupping and wet cupping, and describes bloodless cupping as the form used for muscular tension and musculoskeletal pain such as chronic neck pain. In trial reports the same bloodless technique may appear as dry cupping, traditional cupping or cupping therapy without further qualification, which can make it hard to tell which method a study tested.

Related variants have separate Machipedia pages: Fire Cupping describes heated cups, which the Mehta review gives as the classic way of creating the vacuum, and Moving Cupping covers cups that are slid over the skin. Pneumatic pulsation devices, described in the same review as a method that incorporates massage, overlap with both cupping and Massage.

Marks after cupping

A case report describes cupping as generating local hyperemia and disrupting superficial vessels in the dermis, leading to circular erythema, edema and then ecchymosis. A meta-analysis of chronic pain trials says the normal impacts are circular reddish spots without painful sensation, and a sports review links the characteristic markings to elite athletes at the 2016 Olympic Summer Games. Gua Sha, another skin-marking practice, is covered on its own page.

What sessions are described as involving

Descriptions in the reviews are general. The Mehta review describes round glass cups placed on painful body parts to create a partial vacuum, and a case report describes glass dry cupping. The cups stay on the skin without incision and the skin is left intact, which is what separates the dry form from Wet Cupping (Hijama).

Trials vary in how many sessions they use. A review of trials in athletes reports cupping applied between 1 and 20 times at daily or weekly intervals, alone or with other methods such as acupuncture, and a sham-controlled trial in chronic low back pain used weekly sessions for 8 weeks with cups placed alongside the lumbar spine. This page does not give pressure settings, durations or technique, which are outside its scope.

Variation and combinations

A meta-analysis of chronic musculoskeletal pain ran subgroup analyses by type of cupping, pressure type, painful site, age group and treatment frequency, showing how varied the interventions are. It also notes that some trials combine cupping with other physical approaches such as pulsatile cupping and cupping massage. Trials in athletes and in fibromyalgia have combined cupping with Acupuncture, which makes the effect of cupping alone hard to isolate. Tui Na and Massage are separate hands-on practices with their own pages.

Uses described in traditional frameworks

The Mehta review states that cupping is believed to act by correcting imbalances in an internal bio field, for example by restoring the flow of Qi, and describes Qi as the vital energy that determines health in Chinese medical thought. These are statements of belief within the tradition, not tested mechanisms. The same review reports that Hippocratic writers prescribed cupping for musculoskeletal, gynecological and respiratory complaints.

The sports medicine review adds that Arabic cultures used cupping for conditions that include hypertension, polycythemia, headaches and drug intoxication. Such uses are reported as historical practice, and the review does not present them as established.

Uses described in current practice

Current uses described in the reviews range from musculoskeletal pain, most commonly of the back, neck and shoulders, to medical conditions such as hypertension. An overview of systematic reviews identified reviews covering pain conditions, stroke rehabilitation, hypertension and herpes zoster. Elite and recreational athletes have also used cupping for recovery and performance, a use the sports reviews examine separately.

Overviews and pain reviews

An overview of systematic reviews published in 2011 found five reviews, each with small numbers of studies, and concluded that relatively clear evidence emerged only for pain, with doubts remaining even there. A systematic review of cupping for pain by Kim and colleagues in the same year found seven randomized trials, some with and some without blood drawn, and said most were of poor quality. Several trials compared cupping with usual care, analgesics or heat pads rather than with a sham.

A 2025 meta-analysis of randomized trials in chronic musculoskeletal pain, which searched five databases including the Chinese database CNKI, reported a large pooled reduction in pain intensity (standardized mean difference -1.17, 95% CI -1.93 to -0.42) with very high heterogeneity (I2 94%), rated by the authors as moderate quality. It found no improvement in disability or mental health, and only immediate effects were analyzed.

Dry cupping against sham or placebo cupping

A randomized trial of 90 people with chronic non-specific low back pain compared dry cupping with sham cupping once a week for 8 weeks, with blinded participants and assessors. Pain at rest differed negligibly between groups (mean difference 0.6 on a 0 to 10 scale at 8 weeks, 95% CI -0.4 to 1.6), and the authors concluded dry cupping was not superior to sham.

A systematic review of dry cupping against placebo cupping in musculoskeletal pain, searched to June 2025, included five trials with 281 participants. It rated the evidence as very low certainty at every time point, with a short-term mean difference of -9.9 points on a 0 to 100 scale (95% CI -30.5 to 10.7), with four of five trials at high risk of bias.

An earlier pilot trial in 50 people with chronic neck pain compared a single cupping treatment with a waiting list and reported less pain three days later (about 18 mm on a 100 mm scale). A waiting list cannot blind participants, so expectation cannot be separated from a cupping-specific effect.

Sports use and athlete claims

A systematic review of cupping in amateur and professional athletes included 11 trials with 498 participants. Cupping was reported as beneficial for perceived pain and disability, range of motion and creatine kinase compared with mostly untreated controls, yet most trials had an unclear or high risk of bias, none reported safety, and the authors made no recommendation for or against its use.

A sports medicine review notes the markings seen on swimmers at the 2016 Olympic Games and says a broadcaster claim that cupping helps athletes recover and perform has not been validated. The review called for higher-quality studies.

Gaps in the evidence

The reviews that were read in full for this page do not report a publication-bias test for dry cupping, and the sources do not allow a count of Chinese-language trials. Fibromyalgia reviews combined cupping with acupuncture, so they cannot show an effect of cupping alone. No readable review on cupping for knee osteoarthritis and no Cochrane review of dry cupping were identified.

Reported harms

The sports medicine review lists documented harms across cupping types as abscess formation, post-inflammatory hyperpigmentation, anemia requiring transfusion, keloids, burns and blistering. It cites a trial in which four of 40 participants (10%) had adverse events such as skin laceration, itching and pain at the cupping site, and a survey in which none of 45 respondents did. A dermatology case report and review likewise says the most common adverse events of cupping occur in the skin.

A systematic review of case reports from 2000 to 2011 found 10 adverse events linked to cupping from four countries. Most were minor (keloid scarring, burns and blisters), while several were serious, including acquired hemophilia A, a stroke 14 hours after cupping on the back and neck, panniculitis, reversible cardiac hypertrophy and iron deficiency anemia. The last two involved cupping with bleeding. Case reports cannot give a frequency, and the review does not separate dry from wet cupping for every case.

Contraindications and cautions

The Mehta review states that cupping is contraindicated in deep vein thrombosis and in some patient groups, naming children, older adults, and pregnant and menstruating women. It also describes the Koebner phenomenon at cupped sites in a patient treated for psoriasis. The sources reviewed for this page do not give a graded list covering anticoagulant use, bleeding disorders or skin disease, so those questions belong with a clinician.

One case report describes a man receiving the anticancer drug bevacizumab who had glass dry cupping without overt skin events or bleeding, and the authors note there are no data on safety in that setting and that cupping plans should be shared with the treating team. Cupping should not delay or replace necessary medical care.

Training and standards

No professional-body training standard, register or code of ethics specific to dry cupping was found in the sources reviewed. The case-report review notes that in six of the 10 cupping cases there was no information on the practitioner training and in the other four the treatment was self-administered, so training and hygiene practice cannot be assumed from the literature.