Needle Cupping

Cupping before the combined technique

A narrative review of the history of cupping screened 625 articles and included 83. It reports that the exact origin of cupping is a matter of controversy, that its use is documented in early Egyptian and Chinese medical practices, and that data on origin, definitions, instruments and procedures are inconsistent. The review adds that cupping fell out of favor in the 17th and mid-18th centuries before regaining popularity. Only the abstract of this review was read for this page.

Combining cupping with needling

The sources reviewed for this page do not give a dated origin for placing cups over inserted acupuncture needles, or for pricking followed by cupping. A history specific to needle cupping was not found and is recorded as an open question. What the sources do show is that the combinations sit within current Chinese-medicine practice: a 2020 WHO training document for acupuncture lists the ability to combine acupuncture with moxibustion, cupping and scraping, as appropriate, among the abilities in its acupuncture learning module.

Where the modern literature comes from

Clinical studies of acupuncture combined with cupping, and of pricking and cupping, appear in the review literature mainly from the 2020s. A 2025 scoping review of acupuncture-related treatments for acne found 114 studies and reports that the vast majority were conducted in China. That statement describes where trials are done, not when the techniques began. A 2026 meta-analysis of bloodletting for knee osteoarthritis searched three Chinese databases, two English-language databases and one trial registry.

Names used in the literature

The sources reviewed use several overlapping names. A 2025 trial in knee osteoarthritis refers to acupuncture plus cupping and to combined therapy. A 2022 Chinese trial compares pricking-cupping with acupuncture-cupping therapy. Reviews use pricking-and-cupping bloodletting therapy and blood pricking and cupping. Because the labels are not standardized, a study titled with cupping and acupuncture does not by itself show how the cups and needles were used together.

Related techniques named only for contrast

This page uses needle cupping for cupping combined with acupuncture needles. Pricking and cupping, in which the skin is pricked and cupping follows, is a related technique that the reviews class as bloodletting. A 2026 review lists picking bloodletting, wet cupping and Zhuang medicine bloodletting as the bloodletting types in its included trials. Wet cupping has its own Machipedia page, Wet Cupping (Hijama), and is not covered here. No opened source gave a Chinese-language term for needle cupping, so none is asserted in this article.

How the combination appears in trials

In the trials and reviews read, acupuncture and cupping are delivered as parts of one course of treatment by practitioners of acupuncture or Chinese medicine and are compared with drugs, with other acupuncture-related treatments, or with sham versions. A 2025 Brazilian trial assigned 120 patients to four groups: sham acupuncture with sham cupping, sham acupuncture with true cupping, true acupuncture with sham cupping, and true acupuncture with true cupping. This page does not describe how the techniques are performed.

Pricking-cupping as a variant

A 2022 trial in 70 people with cervical spondylotic radiculopathy compared pricking-cupping, in which a needle is used on the skin until slight bleeding and cupping follows, with conventional acupuncture and cupping. Participants were treated three times a week for two weeks. The trial selected people by a Chinese-medicine pattern named qi stagnation and blood stasis.

Place within Machipedia and training frameworks

Needle cupping is a member of the Machipedia family page Cupping Therapy, which covers cupping in general. Dry Cupping, Wet Cupping (Hijama) and Fire Cupping have their own pages. Needle cupping also draws on Acupuncture and, in Traditional Chinese Medicine settings, sits beside Moxibustion. The WHO acupuncture benchmark document sets out categories, levels and learning modules for providers and treats combining acupuncture with moxibustion, cupping and scraping as one ability within acupuncture training.

Conditions studied

Trials and reviews of cupping combined with acupuncture, or of pricking and cupping, have studied pain in knee osteoarthritis, acute herpes zoster and postherpetic neuralgia, nonspecific low back pain, and cervical spondylotic radiculopathy. A 2025 scoping review also lists pricking-cupping among the interventions studied for acne. These are conditions studied by researchers and are not a list of recommended uses.

Stated aims

The authors of the knee osteoarthritis trial suggest a complementary role for acupuncture with cupping in preoperative management, based on lower pain scores and lower use of pain medication in people awaiting knee replacement. The Chinese cervical trial describes its aim as comparing clinical effect and measuring trapezius muscle stiffness with ultrasound elastography. These are the aims of the studies, not a finding that the combination achieves them.

Acupuncture combined with cupping

The clearest sham-controlled design found is the 2025 trial in 120 people with advanced knee osteoarthritis awaiting knee replacement. Pain on a visual analog scale differed between the sham group and the true acupuncture group and between the sham group and the combined group, and medication use differed across groups. The WOMAC pain score showed no difference between groups. The abstract reports no comparison of the combination against acupuncture alone, so the added contribution of cupping is not established by this abstract.

A 2022 randomized trial in 70 people compared two combined treatments and found a higher total effective rate with pricking-cupping (91.4 percent) than with acupuncture-cupping (68.6 percent). It had no sham or no-treatment arm, was published in a Chinese-language journal, and only its English abstract was read.

Pricking-and-cupping reviews

A 2026 meta-analysis of 31 trials with 2,443 people with herpes zoster compared pricking-and-cupping with conventional Western medicine and reported lower pain scores and lower postherpetic neuralgia incidence, while rating the certainty as very low. A 2024 network meta-analysis of 59 trials ranked electroacupuncture plus pricking and cupping first for pain against pharmacotherapy and called for higher-quality trials. For nonspecific low back pain, a 2022 meta-analysis of 13 trials with 1,088 participants found lower pain and disability scores and noted few high-grade studies.

A 2026 meta-analysis of bloodletting for knee osteoarthritis included 15 trials with 1,108 patients, eight of which compared bloodletting plus acupuncture with acupuncture. It rated the evidence as low or very low quality because of methodological limitations and heterogeneity.

Cupping reviews and acne

A 2025 review of cupping for pain included 72 trials with 5,720 participants and rated all of them at high risk of bias. It reported benefit on several measures for cupping alone or with other therapy, from low-quality evidence. The 2025 scoping review of acne mapped 114 studies, 48 of them randomized, and judged randomized trial quality as moderate with few high-quality studies. Its authors call for larger standardized trials. The US National Center for Complementary and Integrative Health states that most cupping research is low quality and that evidence for pain relief is weak.

Limits of the evidence

PubMed searches for acupuncture combined with cupping, needle-retaining cupping and pricking-and-cupping found no Cochrane review specific to the combination; this describes the searches run and is not a statement that none exists. The reviews found concern pricking and cupping or cupping in general, and none isolated cups placed over retained needles. Much of the trial evidence is from China and often compares the combination with drugs or with acupuncture alone, so blinding and placebo effects are difficult to separate.

Harms reported for cupping

NCCIH lists lasting skin discoloration, scars, burns and infections among the side effects of cupping, says it may worsen eczema or psoriasis, and notes that shared or unsterilized equipment can spread bloodborne diseases such as hepatitis B and C. It describes bleeding inside the skull after scalp cupping and anemia after repeated wet cupping as rare severe effects. A review of case reports published from 2000 to 2011 found 117 reports of 308 adverse events, of which 10 involved cupping and 294 acupuncture.

Harms reported with needling

A review of case reports found infection the main complication of acupuncture, mostly bacterial and linked to skin contact at needle sites, and recommends Clean Needle Technique. NCCIH states that improperly performed acupuncture can cause infections, punctured organs and injury to the central nervous system.

Case reports describe serious events after acupuncture with cupping. In one, a woman developed a collapsed lung an hour after acupuncture and cupping for neck pain and needed a chest tube. In another, a man treated for neck and back discomfort died about 30 hours later of bilateral tension pneumothorax, with more than 20 pinprick marks over the back. The reports are single cases and do not say whether needling or cupping contributed. A separate case describes a broken needle that stayed in a man's body for two years and migrated into the abdomen, requiring laparoscopic removal.

Bleeding variants

In the 2026 knee osteoarthritis meta-analysis, adding bloodletting to acupuncture may have raised the risk of adverse effects compared with acupuncture alone. In the 2022 low back pain meta-analysis, seven trials reported no adverse reactions and one reported mild fainting in three people, which resolved with rest. The 2025 cupping pain review found, from low or very low quality evidence, fewer adverse events in cupping groups than in control groups.

Suitability and care boundaries

NCCIH does not give a specific list of people who should avoid cupping, and no review found in the searches listed contraindications for needle cupping. The sources do say that eczema or psoriasis may worsen, that scalp cupping and repeated wet cupping carry rare severe risks, and that acupuncture should not be used to delay seeing a health care provider. Anyone considering these treatments is advised to discuss them with a health care provider.

Training and standards

The 2020 WHO benchmark document replaces earlier WHO guidance and sets categories and levels of acupuncture training with learning modules covering acupuncture, Chinese medicine, conventional medical knowledge and other subjects. The acupuncture module includes infection prevention and control and the ability to combine acupuncture with moxibustion, cupping and scraping. Registers and codes of individual acupuncture bodies were not reviewed, and no training standard specific to needle cupping was found.