Healing & Wholeness

Cupping is a therapy used by acupuncturists to treat pain and other medical conditions.

Why you should try cupping and gua sha:

Ever since the 2016 Olympics when Michael Phelps re-entered the pool with dark purple circles covering his shoulders, cupping has entered mainstream western consciousness. But, why? And how does it work?

Both cupping (or baguan) and gua sha, which is an instrument assisted press-stroke technique, are topical therapies that have been in use for thousands of years by physicians of Traditional Chinese Medicine, and as a home remedy primarily in Asia, Eastern Europe, and the Middle East.₁ Each is an ancient therapy that has withstood the test of time – they are still in use today because they work!

We are now beginning to understand the science behind their effectiveness. In the US most acupuncturists are trained as physicians and are well versed in the art of cupping and gua sha. While each have distinct functions and uses, I’ll be discussing them together here due to their similarities as adjunctive therapies in acupuncture and Traditional Chinese Medicine. Your acupuncturist can help you decide which is best for you.

But first, what are cupping and gua sha good for?

Gua sha and cupping are best known for their pain relieving properties for both chronic and sub acute pain. What comes as a surprise is the long list of additional therapeutic benefits. Cupping and gua sha reduce inflammation, oxidative and muscular stress and have immunoprotective benefits. They are able to help with colds and infections, asthma, bronchitis and respiratory problems, digestive disorders, hepatitis, stress and emotional disturbances.

How cupping and gua sha work:

The Traditional Chinese Medicine model: I’ll get to the science shortly, but first, in it’s own terms: Traditional Chinese Medicine is a holistic approach to disease management and wellness based on a 2500- year history. The principal aim of treatment is to restore and maintain equilibrium between a patient’s physical, emotional and spiritual aspects. The ancient philosophy guiding the medicine describes the universe, and the body, in terms of two opposing forces: yin and yang. When these forces are in balance, the body is healthy. Balance allows the body’s “vital energy” known in part, as qi, to flow in a smooth way along specific pathways called meridians through the body. Like a garden is irrigated by water, our bodies are nourished by qi and blood. If the flow of energy gets blocked, like water getting stuck behind a dam the disruption can cause pain, lack of function, or illness. In Chinese medicine, pathogenic forces such as heat, cold and wind can get trapped in the body. For example, heat can cause fever, or damp in the joints cause arthritis. Acupuncture therapy can release blocked qi in the body and stimulate function, evoking the body’s natural healing response through various physiological systems. Cupping and gua sha function in general, to break up and release stasis along specific channels to restore balance. Specifically, they are used to clear heat and fever during infections, or wind and cold, which can manifest as common colds, stiff neck and shoulders, neck pain or even TMJ. They are used to remove blood stagnation from acute injuries and release old memories from emotional trauma.

The science of cupping and gua sha: Here’s where the modern science gets cool. Dry cupping and gua sha both pull blood up to the surface of the body, just below the skin. Gua sha (also referred to as spooning, scraping, coining, or cao gio), does this via friction, and cupping does it via suction. This process called extravasation doesn’t damage blood vessels, nor break the skin, but it will cause markings ranging from light red to dark purple in color. Note that while they appear and fade like such, they are not typical bruises, nor are they painful.

The marks produced by cupping have therapeutic benefits

When this blood on the surface is reabsorbed back into the blood stream (a process called echymosis), a little bit of magic occurs. The body sends out a highly specialized cleanup crew with a host of anti-inflammatory and anti-pain biochemicals, a key player being heme-oxygenase-1._{1, 2, 3}  Modern research shows the therapeutic benefits of this biochemical cascade to include anti inflammatory, anti-oxidant and immuno-protective effects, which last for days following a single treatment._{3, 4, 5}  We believe that these effects are responsible for the immediate relief that patients feel from pain, stiffness, fever, chill, cough, nausea and vomiting etc, and why such therapies, particularly gua sha are effective in acute and chronic internal organ disorders including liver inflammation in hepatitis._{1, 3, 4, 5, 7}

Also important is the mechanical work that both cupping and gua sha do to stretch muscle and connective tissue while breaking up adhesions between the skin, the fascia, and the muscles._{2, 6}  Cupping pulls with suction, while gua sha pushes with a blunt, smooth edges instrument. In either case, the physical stretch plays a role in reducing pain and increasing normal glide and function, while it also enhances microcirculation, cellular metabolism, and regeneration._{8, 9}  Like massage, these therapies are highly effective at reducing the stress associated with muscle tension.

What you really need to know:

• Clinically, cupping and gua sha reduce pain, inflammation, and oxidative stress and have immunoprotective benefits. They treat pain, fever, infections, asthma, gastrointestinal and hepatic disorders, stress and trauma.

• They have two thousand of years of positive results and modern randomized clinical studies to back them up._{11, 12}      Systematic reviews of clinical trials for cupping to date highlight the need for more studies, due to the fact that it’s nearly impossible to apply randomized, double blind clinical trial in manual therapies that are meant to be felt, and the effects meant to be seen.

• Considering the cost and side effects of many remedies that western medicine currently offers for pain management, cupping and gua sha from a licensed acupuncturist or medical professional should be considered a valid first line of defense. While they may seem foreign at first glance, these are incredibly benign and low risk procedures that effectively treat a host of maladies.

• Both cupping and gua sha show cumulative effects, and are best performed as an adjunct to acupuncture treatments and in a series over the course of several weeks or months. The procedures are often performed once a week or sometimes every other week.

• They are safe for all ages, in fact gua sha is regularly employed in pediatrics to treat colds, fevers and ear infections to name a few. They should be used with caution during pregnancy, and in the case of notable weakness or deficiency, and only at specific times when a patient is undergoing chemotherapy and radiation treatments for cancer. You will be marked up after treatments, but they make a good story and your body will thank you for the natural boost!

1. Nielsen, Arya, A Traditional Technique for Modern Practice Second Edition, 2013 (Elsevier: Churchill Livingston, 2013).

2. Lauche, Romy, et al., The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain – a randomized controlled pilot study, BMC Complementary and Alternative Medicine. 2011, (ISCMR)201111:63, https://doi.org/10.1186/1472-6882-11-63

3. Kwong, Kenneth K., et all., Bioluminescence Imaging of Heme Oxygenase-1 Upregulation in the Gua Sha Procedure, Journal of Visualized Experiments. 2009; (30): 1385.

4. Soares, Miguel P., et al., Immunoregulatory effects of HO-1: how does it work?, Current Opinion in Pharmacology. Volume 9, Issue 4, August 2009, Pages 482-489 https://doi.org/10.1016/j.coph.2009.05.00
5.  Chen, Tingting, et.al., Gua Sha, a press-stroke treatment of the skin, boosts the immune response to intradermal vaccination., PeerJ. 2016; 4: e2451.Published online 2016 Sep 14. doi:  10.7717/peerj.2451
6.  Braun M¹, Schwickert M, Nielsen A, Brunnhuber S, Dobos G, Musial F, Lüdtke R, Michalsen A., Effectiveness of traditional Chinese “gua sha” therapy in patients with chronic neck pain: a randomized controlled trial., Pain Med. 2011 Mar;12(3):362-9.

7. Chan. St, et al., Guasha-induced hepatoprotection in chronic active hepatitisB: a case study, International Journal of Clinical Chemistry. 2011 Aug 17;412(17-18):1686-8. doi: 10.1016/j.cca.2011.05.009. Epub 2011 May 13.

8. Nielsen, A, et all., The effect of GuaShatreatment on the microcirculation of surface tissue: a pilot study in healthy subjects, J. Explore., 2007 Sep-Oct;3(5):456-66.

9. Bouffard NA, Cutroneo KR, Badger GJ, White SL, Buttolph TR, Ehrlich HP, Stevens-Tuttle D, Langevin HM: Tissue stretch decreases soluble TGF-beta1 and type-1 procollagen in mouse subcutaneous connective tissue: evidence from ex vivo and in vivo models, J Cell Physiol. 2008, 214 (2): 389-395. 10.1002/jcp.21209.

10. Aung, Steven K.H., et al., Traditional Chinese Medicine as a Basis for Treating Psychiatric Disorders: A Review of Theory with Illustrative Cases, Med Acupunct. 2013 Dec 1; 25(6): 398–406.doi:  10.1089/acu.2013.1007

11. Kim, Jong-In, et al., Cupping for Treating Pain: A Systematic Review, Evidence Based Complement Alternat Med. 2011; 2011: 467014. Published online 2011 Jun 23. doi:  10.1093/ecam/nep035

12. Cao, Huijuan, et al., Cupping therapy for acute and chronic pain management: a systematic review of randomized clinical trials, Journal of Traditional Chinese Medical Sciences, V. 1 2014 July; 49-61.