No, I don’t want to put you off your breakfast… but you probably have seen so many pictures of attractive athletes with cupping marks and read articles about the virtues of this ancient therapy, that I feel I have to put this into perspective:

Cupping burnsI am sure you agree that this is slightly less attractive. But, undeniably, these are also cupping marks. So, if you read somewhere that this treatment is entirely harmless, take it with a pinch of salt.

Cupping has existed for centuries in most cultures, and there are several variations of the theme. We differentiate between wet and dry cupping. The above picture is of wet cupping gone wrong. What the US Olympic athletes currently seem to be so fond of is dry cupping.

The principles of both forms are similar. In dry cupping, a vacuum cup is placed over the skin which provides enough suction to create a circular bruise. Eventually the vacuum diminishes, and the cup falls off; what is left is the mark. In wet cupping, the procedure is much the same, except that the skin is injured before the cup is placed. The suction then pulls out a small amount of blood. Obviously the superficial injury can get infected, and that is what we see on the above picture.

In the homeopathic hospital where I worked ~40 years ago, we did a lot of both types of cupping. We used it mostly for musculoskeletal pain. Our patients responded well.

But why? How does cupping work?

The answer is probably more complex than you expect. It clearly has a significant placebo effect. Athletes are obviously very focussed on their body, and they are therefore the ideal placebo-responders. Evidently, my patients 40 years ago also responded to all types of placebos, even to the homeopathic placebos which they received ‘en masse’.

But there might be other mechanisms as well. A TCM practitioner will probably tell you that cupping unblocks the energy flow in our body. This might sound very attractive to athletes or consumers, and therefore could even enhance the placebo response, but it is nevertheless nonsense.

The most plausible mode of action is ‘counter-irritation’: if you have a pain somewhere, a second pain elsewhere in your body can erase the original pain. You might have a headache, for instance, and if you accidentally hit your thumb with a hammer, the headache is gone, at least for a while. Cupping too would cause mild to moderate pain, and this is a distraction from the muscular pain the athletes aim to alleviate.

When I employed cupping 40 years ago, there was no scientific evidence testing its effects. Since a few years, however, clinical trials have started appearing. Many are from China, and I should mention that TCM studies from China almost never report a negative result. According to the Chinese, TCM (including cupping) works for everything. More recently,also some trials from other parts of the world have emerged. They have in common with the Chinese studies that they tend to report positive findings and that they are of very poor quality. (One such trial has been discussed previously on this blog.) In essence, this means that we should not rely on their conclusions.

A further problem with clinical trails of cupping is that it is difficult, if not impossible, to control for the significant placebo effects that this treatment undoubtedly generates. There is no placebo that could mimic all the features of real cupping in clinical trials; and there is no easy way to blind either the patient or the therapist.

So, we are left with an ancient treatment backed by a host of recent but flimsy studies and a growing craze for cupping fuelled by the Olympic games. What can one conclude in such a situation?

Personally, I would, whenever possible, recommend treatments that work beyond a placebo effect, because the placebo response tends to be unreliable and is usually of short duration – and I am not at all sure that cupping belongs into this category. I would also avoid wet cupping, because it can cause substantial harm. Finally, I would try to keep healthcare costs down; cupping itself is cheap but the therapist’s time might be expensive.

In a nutshell: would I recommend cupping? No, not any more than using a hammer for counter irritation! Will the Olympic athletes care a hoot about my recommendations? No, probably not!


101 Responses to The current cupping craze

  • As usual you have described, in measured tones, with references, your view of yet another bit of quackery. When I heard of athletes favouring this weird idea my thoughts were rather more succinct: what a load of b******s, how could that possibly work?!

    • I use dry cupping.

      My mom 83 had water in her knee (French translation of “de l’eau dans le genou”) and was going for infiltrations at the hospital every 3 months with no much result but pain. Her right knee was pretty much double size than the left.

      I take pictures (am a photographer also) so I took pictures of her knees using same light same angle each time. Obviously pictures are no scientific evidence… however they remain a type of evidence.

      After 6-7 months she returned to her doctor who noticed on her chart that my mom did not went for her last 2 infiltration appointments but that her knee size was back to normal (no more water). The doctor asked my mom how that was possible.

      Is that what you call placebo?

  • I’m aware that cupping can cause injuries similar to the ones in this picture, but are we sure this is entirely genuine? There’s something a little unnatural and graphically enhanced about it?

    • @Adam

      The photo used in the blog post is the first in a Google search for ‘cupping gone wrong’. It’s an extreme case but not particularly worse than the others on that page. For photos of Olympic athletes showing consequences of the idiotic procedure, look here.

      • Dry cupping is a great way of benefiting from the placebo effect Frank. The feel good factor afterwards may not be evidence based but I doubt if the Olympic athletes care.

        • I think Jonathon Edwards (World Record Triple Jumper) has gone on the record saying that his (now defunct) evangelical Christian beliefs probably gifted him a few extra centimetres. If true, and harm could be minimised, it might make sense for these gullible athletes to stick their fingers in their ears over the next couple of weeks.

    • I’m aware that cupping can cause injuries similar to the ones in this picture, but are we sure this is entirely genuine? There’s something a little unnatural and graphically enhanced about it?

      I very much doubt any prankster would bother photoshopping several images of the same back from varying angles and doing it so well that they all show exactly the same patterns. If this is not genuine, I would rather suspect theatrical make-up, but again why bother faking this?
      Having rather extended experience with trauma, I say these images look quite genuine.

  • Hijama, cupping is an Islamic way of treatment and works wonders?

    • Hijama, cupping is an Islamic way of treatment and works wonders?

      You may call the effects on the purveyor’s bank balance “wonders”, but the poor victims of foolish Hijama injury are definitely worse off.

    • @ Ms. Khan on Wednesday 10 August 2016 at 19:02

      “Hijama, cupping is an Islamic way of treatment and works wonders”

      It is NOT Islamic since it predates that barbarism by hundreds of years. It is one of the many aspects of Arabic and other cultures that were subsumed by a voracious ideology as its own over the last 1400 years. Read Hitchens and many others to discover how the “Golden Age” did not exist.

  • Excuse me Doctor but what weight of hammer would you recommend for a sore neck from an old rugby injury? I have several available from about 500gm to 6kg.

  • Dear Edzard Ernst,

    this issue has been broadcasted on BBC. There is a chiropractic on stage showing cupping. To talk about science, they interviewed David Colquhoun from UCL.

    Colquhoun starts talking at 2:15 and I think he did a great job on the interview “defending science”, explaining chiropractic do not have credible evidence and that cupping might harm too.

    He says cupping is “unproven”, while acupuncture has been “disproven”. Do you agree with that statement? I know most of good qualities of acupunture, as you have reported here many times, have show that acupunture is, if not all, due to placebo effect. But can we say, in a simple way, that acupuncture has been disproven, i.e as we can say homeopathy has been disproven?

    • @Felipe: “cupping” has nothing to do with chiropractics, or acupuncture, or “local blood flow improvement”. That’s why all these false sides are so easy defeated. The cupping causes non-invasive hemorrhages in human body, and body reaction to them somehow mobilizes physical resources. The effect must be similar to blood transfusion effects. But good doctors prefer to be obtuse and don’t want to spell this out.

      • when will you understand that there is not o jot of evidence that cupping mobilizes physical resources?

        • When you will understand that absence of evidence is not an evidence of absence?

          When you will admit that the dissing (dismissal) if “cupping” is based on irrelevant attributions and assumptions, while clearly identifiable parallels with blood transfusions are blatantly denied?

          • evidence please!

          • From the link: “Why are Michael Phelps and some of the other US swimmers using cupping?
            Cupping helps with microcirculation in the areas where the cups are placed. If there has been an injury or soft tissue restriction in a certain spot, cupping not only improves blood flow to it, but can actually create new blood vessels. It can also help flush out toxins as the excess blood is removed from the area and the body is healing the bruising. It can also dilute inflammatory markers by bringing more blood to the area that has been cupped.
            What advantage does cupping provide over other soft tissue techniques?
            Almost every other kind of soft tissue therapy is compressive. Cupping is distractive and pulls layers of muscle, skin and fascia away from each other as some tissue is sucked up into the cup. This creates micro-trauma that kicks the body’s healing mechanism into high gear. Cupping doesn’t replace other mobility work but can complement it.”

            That’s the wisdom of one “Sue Falsone, the first female head athletic trainer in any American major league sport.” Which only goes to show the level of ignorance of real-world biology and medicine possessed by some sports trainers.

            Sportspeople use cupping the way some of them always wear odd socks, or a particular necklace, mumble prayers before an event or even more bizarre rituals. It’s all subjective, superstitious belief. It doesn’t affect their performance other than to fill a hole in their possible self-doubt so that they don’t turn up for a global event watched by millions of people like abject gibbering wrecks, as I most certainly would if I tried!

          • @Al Chen

            Oh dear! I am afraid you are playing far out of your league. You quote something you find on a popular sports site that fits your beliefs and you cannot even get the credentials of the person right.
            What this girl says there is complete nonsense, probably cooked up by one of the cupping quacks.
            The injury of cupping is limited to the skin and underlying fat and does NOT, affect muscles. The swollen skin takes no part in the athletes performance and it DECREASES blood flow while the swelling is there. Repeat trauma may cause microscarring that will DECREASE blood flow permanently.
            If the swelling would involve muscle tissue it would IMPEDE its function, which I am sure Mr. Phelps would not like.

            ( “jm”s comment on this is surely his most intelligent contribution so far 😀 )

          • Bjorn

            Could you clarify? “The injury of cupping is limited to the skin and underlying fat and does NOT, affect muscles”

            Are you saying that cupping has no effect on muscles, or are they affected but not injured?

          • The injury of cupping does not involve muscle tissue in ordinary applications, it would need much more suction, which might produce skin breakdown and seriously painful muscular injury.
            The suction effect of cupping normally involves only the skin and subcutaneous fat, which become edematous. The subcutaneous tissue gives way much easier than the muscle fascia. The main effect of the negative pressure is at the surface where capillaries break and cause hemorrhages into the skin. As it goes deeper it dissipates. The more suction effect, the deeper the effect and the injury goes of course but to involve muscle it would need much more neg. pressure than is possible with fire application and even with mechanical suction you would have to have a very thin person and a ridiculous amount of suction to overcome the stability of the muscle fascia to begin to involve the underlying muscle. If you were able to do this without the victim crying for you to stop, you would produce swelling and injury to the muscle which is severely more painful. The muscles are much more pain sensitive and movement of them after such injury would be incapacitatingly painful because of the swelling. If you were able to produce hemorrhage into muscular tissue this would be so very painful that Michael Phelps or even a mediocre athlete would immediately feel that this hindered their performance.
            As has been pointed out before, if cupping really helped, it would be standard “doping” practice long ago and banned by the WADA and IOC and any other relevant committee 😉
            Cupping is theatrical nonsense used to fool gullible individuals like Michael Phelps and Gwyneth Paltrow and lighten their purses.

          • Thanks Bjorn. I’ve got several more questions for you as well. First though – in the past, you’ve said that inconsistent discolorations (sometimes there is none, for instance) is due to the ideomotor phenomenon. Or in the case of a moving/sliding cup, your explanation is that the cup loses suction as it travels.

            Could you explain, in the case of a sliding cup – why would discoloration happen at the end of a ‘slide’? Let’s say a cup was attached at the top of the back, left for a few moments, and no discoloration occurs. The cup is then moved down the body, and rests at the low back for a few moments – and discoloration occurs. (Or vice versa – attached at the low back/no discoloration, moved to the upper back/discoloration.) Why would the discoloration, in this case, only occur after the cup has lost suction?

          • “jm” back to her/his old antics trying to troll me into a dialectic around a false dilemma. 😀
            As I am idle anyway at the moment, procrastinating the after-breakfast dishwashing and cleaning, I will indulge this once, even if I know it is likely to be counterproductive.

            One of the theories (fantasies) of suckers and scrapers is that the markings do not become prominent or even appear at all unless there is an underlying problem being addressed and the markings are the signal that the sucking or scraping is having a healing effect. This is an unproven and unlikely (very unlikely) fantasy.
            We critics have pointed out that there are other physiological and psychological explanations that simply and credibly explain why cupping may to the purveyor seem to produce differently prominent markings. These explanations certainly do not include the one “jm” and her/his fellow injury salesmen adhere to, that an underlying problem predicts differently pronounced markings ceteris paribus.
            I and other critics of these parlor tricks propose that the explanations for the purveyor’s perception of differently prominent markings is to be found in several other factors including but not limited to:

            A. Different susceptibility of the skin to capillary breakage in different areas of the body. The skin is simply thicker and more sturdy in one place compared to another. The thickest skin is in the upper part of the back.

            B. The ideomotor effect subliminally fooling the practitioner to apply more pressure/suction to the area of perceived problem. This is a well documented effect at play in many altmed manipulations, perhaps best demonstrated in “applied kinesiology”.

            C. Confirmation bias (the suckers only notice when the effects match their fantasies)

            The onus of proving that their a-priory implausible (impossible?) theory holds is on the suckers themselves, if they indeed are interested in breaking the credibility barrier at the risk of failing.
            I or anyone else cannot refute such out-of-thin-air claims with other means or arguments than known facts and scientifically plausible and verifiable reasoning of how the body behaves and works.
            Purveyors of injurious quackery are of course welcome to apply the principles of scientific method to their theories and set up proper trials but before they start, they would have to demonstrate how and why such experiments involving injury and harm can be justified. They would also have to apply for and get the approval of ethical research review boards and other prerequisite barriers to unethical and harmful experimentation.
            Now… to the dishes 😀

          • @Bjorn

            Your comment raises two parallel questions about cupping: who are the suckers and what are the suckers?

          • Thanks Bjorn. Not trying to ‘troll’ you into anything. And, no mention of theory- sometimes cups produce discoloration, sometimes they don’t. I’m just looking for your explaination as to why.

            But my next question is about the coloring itself. Colorings brought up by cupping range from pink to bright red, dark red, purple, black. From your previous explainations, the red seems logical (bleeding from the capillaries, yes?). What is the purple color? If the suction is breaking capilaries, is purple a normal color? I’ve seen purple colorings from bruises that appear a day or two after the injury, but have never seen an injury where dark purple shows up right away. Since you have a vast amount of trauma experience, and are well versed in blood…what’s going on when a cup immediately pulls up purple color? Or black?

          • break-down of red cells and haemoglobin mainly.
            you should go and get a ‘love bite’ from someone.

          • A good advice to those who wish to be active in commenting and taken seriously is to train their internet-searching skills.


          • Bjorn, according to the link you posted, the blue to purple takes hours to days. What we’re talking about here is a cup immediately pulling up deep purple to black coloring. The traditional thinking on that is the cup is pulling up material from a previous injury (which would fit with the info from your link). But previously, you’ve stated that idea is pre-scientific witchcraft, and not possible – that the coloring is from the injury inflicted by the cups.

            What would cause someone to bleed purple or black blood?

            @Edzard – I’m not an expert, but if a ‘love bite’ came up immediately black…I would head to the ER. But you think an instant black hickey is normal?

          • I have never seen a black mark as an instant reaction [and yes, I did quite a lot of cupping at one stage]; reddish-blue yes – and that is deoxygenated venous blood. if the vacuum breaks tiny arteriols, the mark is more in the red; if it breaks tiny venoles it’s more blueish. at least that’s my explanation. certainly ‘material from previous injury’ or ‘toxins’ is BS. If you do wet cupping, you can even analyse the material; we did that occasionally and never found anything but blood.

          • I’m surprised that you never ran across black colorings. But I am getting the sense that we’re headed (again) toward the distraction of semantics. You’ve done cupping – you know that ‘instant’ is the 10-20 minutes that the cup is on. Not hours or days later – which according to Bjorn’s link, is the time it would take blood from a fresh injury to turn that color. You also know that ‘material from previous injury’ is dead blood.

            Like in the photo in your post, for instance. Those marks more than likely came up black while the cup was on, not hours or days later. In my experience, fresh injuries don’t look like that. Which is why I’m asking Bjorn, as he’s probably seen a lot more trauma, and different types, than I have.

            Reddish-blue isn’t what I’m talking about. I’m sure you’ve seen deep purple colorings come up with cups, and we both know the difference between reddish-blue and deep purple colorings.

          • Edzard,

            You asked Ali Chen for “evidence please” after posting an opinion of one sport medicine professional. Makes sense that you would ask for evidence.

            Bjorn posted “Scientifically, cupping simply produces injury. Scientifically cupping does not produce any beneficial effect.”. Since you didn’t ask for evidence of injury production, and in your post, you say that there are very few studies, and not of very good quality – you must be familiar with the study(s) Bjorn is referencing for cupping producing injury. Could you post a link?

          • the injury is what you see after cupping; no evidence needed for things that are so clearly visible, I think.

          • Ah. In my experience, injury isn’t always visible – visual evidence doesn’t hold as much weight as palpation and feedback from the client/patient. Post cupping, the colorings that look like bruises aren’t painful to the touch, and aren’t painful with movement, etc. Injured tissue also has a different feel when palpated.

            Injury, on the other hand, is painful to the touch and often painful with movement. I guess I’m unclear as to when it’s scientifically appropriate to rely only on visual information.

            So when Bjorn says “Scientifically cupping does not produce any beneficial effect.”, why is visual information not applicable there? Cupping a frozen shoulder, for instance, produces visibly more range of motion. So why is that not scientifically a beneficial effect, if colorings qualify as scientifically proven injury? I really want to understand the methodology here.

          • “So when Bjorn says “Scientifically cupping does not produce any beneficial effect.”, why is visual information not applicable there?”
            because therapeutic claims require evidence, otherwise they are bogus.

          • “because therapeutic claims require evidence, otherwise they are bogus.”

            There’s visual evidence – just like the claim of injury is based on visual evidence. Is there any evidence (other than visual) to back up the injury claim?

          • if you don’t want to get it, I cannot help you.

          • I certainly do want to get it. Discoloration from cupping can look horrible (doesn’t always, but mild or no markings rarely get photographed). But other than looks, there is no indication that injury is happening. All other indicators point to cupping relieving injury (palpation, function, etc).

            “Scientifically, cupping simply produces injury.” I do want to understand how “it looks like an injury” is scientific.

          • So when Bjorn says “Scientifically cupping does not produce any beneficial effect.”, why is visual information not applicable there? Cupping a frozen shoulder, for instance, produces visibly more range of motion. So why is that not scientifically a beneficial effect, if colorings qualify as scientifically proven injury? I really want to understand the methodology here.

            Subjective, opinionated assessment of the object of study never got anyone the Nobel prize.

            The apparent lack of comprehension in “jm’s” naive ramblings is not to be attributed to inferior intellectual capacity. It can best be explained by the strong influence of self-deception generally afflicting purveyors of make-believe medicine.

            Harriet Hall just provided a marvelous quote in this respect. In todays review of a new book on quackery she told of the author quoting Peter Medawar, an eloquent biologist who was commenting on the author of a book of anti-evolutionary sentiment.
            I think this exceptional quote can be adapted perfectly to “jm” and his(her?) likes in the business of injurious quackery:
            He or she can be excused of dishonesty only on the grounds that before deceiving others (s)he has taken great pains to deceive him(her?)self.

          • So Bjoron (or Edzard, or anyone), explain how “it looks like an injury” is scientific.

          • not scientific perhaps, but obvious.

          • So Bjoron (or Edzard, or anyone), explain how “it looks like an injury” is scientific.

            Its not very constructive to write comments after more than a couple of the afternoon cocktails.
            The message becomes garbled and the commenter’s intellectual capacity might be unduly underestimated.

            The only one using the words: “it looks like an injury” in this discussion has been “jm” itself.
            (And it is Björn, not Bjoron)

          • Björn,

            Sorry for the typo – I’m normally typing these things with a 21 year old cat on my lap. Leads to a lot of typos…most I don’t care about, but I always try to double check people’s names. I added an umlaut this time, for balance.

          • Edzard

            Actually, there are quite a few things that are obvious after being cupped by a decent practitioner – and none of them suggest injury. Quite the opposite.

            Certainly can look like an injury, though. At first glance anyway.

          • @ jm on Friday 19 August 2016 at 03:36

            “Sorry for the typo – I’m normally typing these things with a 21 year old cat on my lap.”

            For some obscure reason, I’ve always had a mental image of you as a crazy old cat wo/man. This doesn’t do anything to shake it.

          • Bjorn

            “The only one using the words: “it looks like an injury” in this discussion has been “jm””

            Yes, I paraphrased your ” “Subjective, opinionated assessment of the object of study”. Which seems to be how you determined that “scientifically, cupping simply produces injury”. You assessment method seems to only include what it looks like.

      • Cupping has absolutely NO similarity to transfusions which replace missing or deficient blood factors or cells required to save and sustain lives. Cupping has everything to do with alternative fake medicine practices which is based on nonsense and lies. Do you really believe that junk or are you just messing with us?

  • Maybe you should familiarize yourself with a medical technique called “hemotherapy”. Most extreme form is a total blood transfusion, for use of which Lance Armstrong was totally disqualified and stripped of all medals. The next level is re-injecting of few syringes of blood back into body muscles. Obviously this method will be hardly approved by sport polices. The easiest non-invasive form is this “cupping”. In all cases the re-injected blood (or hemorrhages from cupping) activates hemostasis with some serious body reaction: intensifies blood cell function, activates autoimmune response, gives more “body energy” to heal and recover, from almost anything. This therapy is the last resort in treating,for example, severe chronic forms of pneumonia. Face it, cupping is a form of doping.

    • @Ali Chen
      Wrong, on all counts.
      Nothing of what you propose is consistent with how the body or biology in general works. Where do you pick up such nonsense?

      • I am not “proposing” anything. Everybody with a normal medical education knows this.
        And I guess you know exactly how biology works? Are you basing your opinion on “success” of liposuction and a great successes of treating obesity?

        As I said, please make yourself familiar with facts:

        Or you can start with common collection of facts
        and put forth your arguments that “all counts” are “such nonsense”.

        And I had personal interactions with some friends who had a health misfortune and were subjected to transfusions, and how they describe their energetic state . You can call this “anecdote evidence”, but I will remain you of an astute life observation: for a hammer everything looks like a nail.

        • @Ali Chen

          Your links make no reference to “total blood transfusion”.

          Your statement: “The easiest non-invasive form is this “cupping”. In all cases the re-injected blood (or hemorrhages from cupping) activates hemostasis with some serious body reaction: intensifies blood cell function, activates autoimmune response, gives more “body energy” to heal and recover, from almost anything.” is total bovine diarrhoea. Small wonder you have been taken to task by Bjorn Geir.

          “And I had personal interactions with some friends who had a health misfortune and were subjected to transfusions, and how they describe their energetic state.” is not merely anecdotal evidence, it makes no sense. Every day thousands of people are subjected to blood transfusions because they have had a “health misfortune” (trauma or surgery) that results in blood loss. I am not interested in how they feel their “energetic state”: typically their lives have been saved. I will remind you of another astute observation: for the gullible and uninformed, everything looks like magic.

          • My mistake. Please remove the word “total” and start over again.

            I am obviously not a professional in this area, so please forgive me if few terms were not used in full accord with your strict taste. I am merely objecting to the massive campaign where “cupping” (intentionally or not) is misrepresented as “pain medicine”, or “acupuncture”, and dismissed on these false premises.

            Few points for you:

            (1) how liposuction is related to hematology;

            (2) You are “not interested in how they feel their “energetic state””, but athletes apparently do. I didn’t mean people dying from massive blood loss, I was talking about nearly healthy well-recovering individuals who get blood transfusion per their treatment plan.

            (3) Are you dismissing the case of Lance Armstrong?

          • @Ali Chen

            “Are you dismissing the case of Lance Armstrong?” Certainly not. He and his team used transfusions of their own blood, taken weeks before a race, to boost the numbers of circulating erythrocytes and thus enhance their blood’s capacity to deliver oxygen to their muscles. That’s a perfectly rational, medically plausible mechanism for cheating. The blood was injected into the cyclists’ veins, not into their muscles, as you ignorantly claim.

            But what’s all that got to do with cupping?! How does cupping provide extra erythrocytes? The procedure will actually destroy them. If cupping worked as you claim, don’t you think Lance Armstrong would have used it? After all, it’s not outlawed by any sports authority. Don’t you think the various sport authorities would have outlawed cupping by now if it really boosted performance?

            I am sure if healthy people have an autologous (IV) blood transfusion it can affect their ‘energy state’ — in other words the subjective way they feel about themselves. Subjective feelings are, however, not the stuff of reason. Ask any drunk about his or her ‘energy state’.

            PS I wrote this response before I read Bjorn’s comment below. He already made the same points about blood transfusion compared to cupping.

        • @Ali Chen

          I have both a normal medical education and a whole lot of specialisation on top of that, and a bunch of academic eduction to put icing on the cake. Part of my education and experience is in traumatology, which means I should know better than you what happens with the injury that is produced by cupping and other injury producing quackery.

          You obviously know nothing of medicine and you are misunderstanding just about everything you are trying to write about.

          ‘Blood doping’ is a collective term for anything that increases the number of red blood cells in the hope that this will increase the oxygen carrying capacity of blood. Cupping DECREASES the number o red blood cells slightly by destroying a small number of them. Wet cupping even more by removing blood.
          Did you read the references you are referring to? Or you do not understand them, which I find more likely.

          It says in the first ref. that Lance Armstrong used (among other illegal procedures) ‘blood transfusions’. That is not what happens with cupping. With autotransfusion as it is called because autologous blood is used, you draw and store a bag or two of someone’s blood. When the body has produced replacements, you give back the blood from store so the total result is an increase in blood cells.
          That is totally different from what happens with cupping!
          In cupping, blood is forced out of the small blood vessels of the skin and into the surrounding tissues. The blood cells are destroyed. The body needs to clean up the mess and that takes resources to break down the blood, remove it and eliminate. Some is repurposed but nothing is added to the body as is the case with blood doping. The repair process and the products of destroyed blood may also put a load on other systems. Instead of increasing resources for athletic performance, cupping would be more likely to decrease them by “redistributing” them to injury repair. Luckily most cupping charlatans make do with a harmless demonstration of a few dry cups that only make a visual impression. If they were foolish enough to do extensive, hard cupping or even wet cupping, they might certainly do unwanted harm to the performance of an athlete.
          The “energetic state” your friend(s) experienced were most probably because the reason for their transfusions (usually lack of blood – ‘anaemia’) was relieved by administering blood, not the transfusions as such giving an ‘energy boost’ or whatever wonders you are imagining. If you give blood to someone who does not need it, they will not experience any increase in energy, they will just be at risk for complications of the transfusion and from too much blood cells.
          I have administered many more transfusions than I can recall so I should know a thing or two about them, don’t you think?

          And what on earth are you carrying on about liposuction?? That is a surgical procedure that removes fat and a lot of blood along with it. It is not treatment for obesity. After liposuction, most people have lost significant amounts of blood and are not in their best performing shape.

          • Thank you Dr. Geir for your elaborate and polite response.

            I would totally agree that the current state of cupping is maintained by charlatans, since the scientific basis of this technique has not been established. Since the cupping can be applied to a very different degree (as you rightfully noted), the results can differ drastically. However, I am also of opinion that the article used to debunk the cupping, “Cupping for treating pain: a systematic review”, is also charlatanism, because one cannot establish a “system” if underlying mechanism is not known. So it is very expected that the sum of “multi-dimensional” studies comes to an average of zero, and experimental methods in those studies can’t be meaningfully developed without proper “null hypothesis”.

            I appreciate your explanation about “energetic state” my friend(s), it makes a good sense. However, after that you wrote: “If you give blood to someone who does not need it, they will not experience any increase in energy”. Wouldn’t this statement of yours be in contradiction with Lance Armstrong case?

            Also, you treat the effects of blood transfusions as a mechanical addition of red cells. However, the body also produces the red cells by itself. Apparently this self-production is based on some biochemical criteria. Could you shed some insight on how this self-production is regulated? Could it be that application of various transfusion methods have some common effect by shifting sensitivity of the self-production mechanism?

            Thank you in advance,
            – Ali Chen

          • “…one cannot establish a “system” if underlying mechanism is not known…” WRONG AGAIN! at least, if the “systems” is a systematic review.

          • …the current state of cupping is maintained by charlatans

            Cupping is charlatanry whoever is administrating the injury.

            …the scientific basis of this technique has not been established

            Depends on what you mean by scientific basis. Scientifically, cupping simply produces injury. Scientifically cupping does not produce any beneficial effect. The addition of fantasies does not make them true.

            …I am also of opinion that the article used to debunk the cupping, “Cupping for treating pain: a systematic review”, is also charlatanism, because one cannot establish a “system” if underlying mechanism is not known. So it is very expected that the sum of “multi-dimensional” studies comes to an average of zero, and experimental methods in those studies can’t be meaningfully developed without proper “null hypothesis”.

            As the professor pointed out you are making no sense. The underlying mechanism of cupping is well known and scientifically established. It can be summed up in two words: Suction injury.

            … Wouldn’t this statement of yours be in contradiction with Lance Armstrong case?

            No. Try reading my comment and the blood doping chapter on WP again

            Could you shed some insight on how this self-production is regulated?

            Try reading this and this. If after reading you still do not understand why we are saying your ideas about cupping are incoherent and unrealistic, you are simply not equipped to deal with complex biological knowledge and we cannot help you further.

  • Thank you Dr. Geir:
    It is becoming quite clear that my concern and inquiry into cupping was ill-formulated. It appears that all mechanisms and associated analysis mentioned in this blog are revolving around “healing” processes and general homeostasis of hematopoiesis (WOW!). Time-constant of these processes is of the order of days and weeks. The swimming athletic event however lasts typically under 60 seconds. Therefore it becomes apparent that the quasi-well-studied long-term “underlying mechanism of cupping” has nothing to do with short-term athletic performance. Obviously it would be pointless to ask about possibility of short-term effects from cupping.
    But I appreciate your time and confidence.

    • @ Ali Chen on Monday 15 August 2016 at 20:18

      Ask yourself how a minor vacuum applied to the skin would have any affect on the muscles, heart, circulatory system, lungs, or any other part of the body? If your answer is anything but “nothing”, you have a case of wishful thinking that nothing will cure.

    • @Ali Chen
      Your perseverance is interesting but you are not making any sense. Probably because you do not have what it takes to understand complex systems and interactions. Better turn your efforts towards less demanding tasks than trying to support quackery.

  • Bjorn

    Based on the nature of this blog and the comments, I assumed you meant there was a study or two done. So when you say scientifically, you mean subjective, opinionated assessment of the subject of study.

    Good to keep in mind that injury, what cupping is affecting, etc is your subjective opinion. If you know of any actual research, please share.

    You never answered my purple question. The blue/purple/black coloring is mainly the breakdown of haemoglobin and red cells (according to Edzard), and it takes hours or days (according to the link you posted) for that to happen. If the suction is breaking capillaries, what is the purple color that appears while the cup is on? It seems implausible (impossible?) that applying vacuum to the surface of the body would accelerate the breakdown process.

    What is the scientific explanation of blue/purple/black discoloration that appears while the cup is on?

    • “What is the scientific explanation of blue/purple/black discoloration that appears while the cup is on?”

      Extortion is the most likely explanation.

    • “jm” obviously failed to comprehend prof. Ernst’s adequate response to the question as well as the satiric pun in mine. Leave her/him to wonder… 🙂

    • Bjorn

      Edzard’s response was “reddish-blue yes – and that is deoxygenated venous blood. if the vacuum breaks tiny arteriols, the mark is more in the red; if it breaks tiny venoles it’s more blueish. at least that’s my explanation.” That doesn’t answer my question. I didn’t ask you about reddish-blue – I said red marks would make sense based on your explanation. I asked about purple and black.

      Once again, according to the link you posted – a blue coloring would take hours, purple would take days. What is the scientific explanation of blue/purple/black discoloration that appears while the cup is on? The only explanation I’ve ever heard was that it’s from previous illness or injury, which you have repeatedly said is impausible (impossible?), pre-scientific nonsense.

      It’s not a trick question – I’d really like your explanation, if you have one.

      • Soot?
        My father was a photographer and an expert in color processes. He taught me how light and colour behave and how to measure, assess and balance colours (in photographs) At seventy he was our countries foremost expert and teacher in digital colour processes.
        Among other things I learned was that people’s perception of colour is highly variable and subjective and last but not least it is totally dependent on the colour and quality of the ambient light in which the colour is assessed. So it may just be different light conditions that explain “jm’s” bewilderment.

        If “jm” has patients with skin turning genuinely black after his(her?) sucking assaults, I would be worried. Black skin is usually a bad sign of death and destruction.
        His/her impression of the colour hue of these iatrogenic injuries is highly subjective and may even be biased/opinionated as I alluded to in semi-sarcasm before.
        If “jm” wants to know why some turn purple (red+blue) and some black (as per subjective assessment of course) (S)he will have to do an elaborate study comparing the hues to standardised colorimetric charts and write up different clinical and phenotypic (and genotypic?) parameters to find correlations and analyse them carefully with reference to likely causal reasons (a-priori hypotheses).
        One of necessary parameters would be simultaneous study of red cell fragility capillary fragility, collagen content and quality… and many more things that may cause a difference in the resulting appearance of suction injury.

        Why am I even bothering to give this stupid matter my attention when I should be packing for a poolside-relaxing week away from the professor’s blog? 😀

        • Bjorn,

          There’s a photo at the top of this post. What color would you subjectively assess the marks to be?

          You seem to be creatively dodging the question. (Although the whole colormetric chart dodge gets extra style points.) I’m just asking if you have an answer – if you can’t explain why colors that normally take days to show up appear during a 10 minute cupping session, that’s perfectly fine, too.

          • @ jm on Friday 19 August 2016 at 07:50

            “There’s a photo at the top of this post. What color would you subjectively assess the marks to be?”

            They may well be dark, dark purple probably, but you are suggesting any bruising should be a distinct colour, according to your palette, rather than what they will be; a blend of venous and arterial blood in proportions related to how many vessels the witchdoctor has managed to damage. The range of colour will be variable because the nature of the skin, subcutaneous fat, and the myriad of other factors.

            I suspect, however, as usual you think you are being devilishly clever in trying to trap Björn into some minor misuse of a word or phrase so you can pounce on it and claim an extraordinary victory. No secret, you’ve tried this crap before.

            I would rather you answer questions put to you, in a comprehensible manner based on science as we know it.k. I think most think you are a loon, a persistent one at that.

          • Seems like the fool wasn’t referring to his/her own experience of blackened skin. Lucky for his/her victims. The black areas in the photo look like dead skin i.e. gangrene.

          • I see. If you ever do run across an explanation, let me know. I was hoping we could get to why cupping marks don’t behave like bruises.. Normally, bruises will change color as they heal (green, yellow, etc). Cupping marks don’t do that – they simply fade progressively, without the color change.

            I probably should have asked about the lack of progressive color change (and a couple other things) before asking about the immediate presentation of days old colorings. But apparently we’ve already reached the point of elaborate color tests, gangrene, name calling, and Collins rantings.

            Have a great vacation, and thanks for the input up to this point – I really do appreciate it.

          • The continued depth of wilful obscurantism, wilful ignorance, and science denialism in jm’s comments is alarming, but not at all unexpected from any charlatan who’s a purveyor and/or an advocate of quackery.

            The term “sha” used in Paida (slapping therapy), PaidaLajin (slapping and stretching), Gua Sha, and Cupping, refers to the change in skin colour both during and after the (mis)treatment; and these colour changes ‘inform’ the practitioner as to the type of bad Qi/Chi/Ki that is being released by the victim of their (mis)treatment modality.

            Obviously, to properly assess these changes in skin colour — in accordance with the pre-scientific tenets of CTM, TCM, and its kindred delusions — the modern practitioner of these outdated philosophies really does need to properly understand Colourimetry and its international standards[1]. Why? Because fluorescent tubes, and other modern ‘spiky spectrum’ lighting, preclude the practitioner from making reasonably accurate assessments of colours — especially the colours depicted in web sRGB images that have been recorded using uncalibrated light sources and cameras, then displayed on uncalibrated monitors in an uncalibrated viewing environment.

            It came as no surprise to me when “jm” misinterpreted the scientific term used by Björn, “colorimetric charts”, to mean “colormetric charts”. That wasn’t a typo by “jm”, it was a clear demonstration of his wilful ignorance, hence his reply to Björn: “You seem to be creatively dodging the question. (Although the whole colormetric chart dodge gets extra style points.)”.

            There are many alternative-to-medicine (sCAM) commentators on this website who try their utmost to either ridicule Professor Ernst directly, or indirectly by attacking the commentators who currently practise (and have a great deal of expertise in) 21st Century medicine. They ridicule the experts who very kindly share their in-depth knowledge with the readers who are genuinely trying: to learn the truth [independently verifiable facts]; and to let go of their previously-held false beliefs, despite this being a slow and painful task to undertake.

            For those of us who deeply appreciate the work of Professor Ernst, it is the relentless stream of pathetic comments by “jm”, Tom Kennedy, et al. that enable us to realize how much progress we’ve made since reading the book Trick or Treatment? Alternative Medicine on Trial, by Simon Singh and Edzard Ernst.


          • Damn you, Pete! I’ve spent my entire life trying to avoid any information about colorimetric charts! Ever since that nasty run-in with a rogue densitometer. Alas, I will never be able to regain my ignorance…

            But really Pete, if anyone offers to assess an injury for you based on a photo – don’t take them up on it. They’re a quack. Even if their monitors are calibrated.

            I’m in no way trying to ridicule Edzard, or Bjorn. I truly appreciate Bjorn’s explaining his thought process about cupping marks. Bjorn made it quite clear from our first interaction that he wasn’t interested in pleasantries. I appreciate that, too. And, if this were a different setting, I’d love to hear more about Edzard’s cupping experiences – particularly about some of the details in his post.

            I’m not sure why this question is so hard to understand. Everyone (including the 2nd grade teachers that SCox recommended) knows that bruises change color over time. Fresh injuries present a very different color than they do a couple of days later. Sometimes a cup will bring up colorings that only happen many hours or days after an injury. What’s the expanation for that?

            Cupping marks also won’t change color – they will fade. That is not how every other bruise behaves. None that I’ve seen, anyway.

            As I’ve told Bjorn, the traditional explanation is that the negative pressure is bringing up dead blood from some previous event. Bjorn says that’s implausible (impossible?). Wouldn’t you assume that Bjorn has an explanation? I’d love an explanation from modern medicine – people ask all the time.

            Well done cupping doesn’t cause injury, even when markings appear. It doesn’t hurt (it actually feels amazingly good), even when dramatic markings show up. Other than a first glance look, there’s no indication of injury. And if you watch the marking over time, it’s obvious that what looked like a bruise, wasn’t.

            With all the Olympic stuff, chances are good that there will be people out there cupping themselves or each other with zero training. Howard Wu started to bring this up on another thread – cupping is not very complicated at all. (Training someone to do some good, basic cupping takes very little time.) But there are a few guidelines to keep in mind. One general guideline – if it hurts, you’re using too much vacuum.

            If you think the goal is to bruise yourself, you might be tempted to cup hard enough to do it. That’s not good cupping – that’s listening to bad information, and it’s all over the media lately.

          • @jm

            I notice that if I scratch myself hard, the area of scratched skin turns red and later fades without going through the colour changes associated with bruising, so I guess the extent of skin injury determines the level and extent of damage to superficial capillaries: the greater the damage the more intense the colours. So what?

            What’s important is whether cupping has any demonstrable benefit. I was drawn to this website, which explains how cupping therapy can improve immunity and digestion.

            The website is chock full of familiar pseudoscientific nonsense, typical of proponents of Big Snakeoil, but my eye was caught by the following: “Wondering if cupping really works? A 2012 report published in the Journal PLoS ONE reviewed 135 studies on cupping therapies published between 1992 and 2010. Researchers concluded that cupping is more than just a placebo effect — it has benefits similar to acupuncture or herbal treatments for treating various digestive, skin, hormonal and inflammatory diseases. (7)”

            PLoS ONE is an open-access journal, so I searched for the paper. (The citation 7 given is not a link to the paper!) Here is the actual PLoS ONE publication intended. The conclusion is “Numerous RCTs on cupping therapy have been conducted and published during the past decades. This review showed that cupping has potential effect in the treatment of herpes zoster and other specific conditions. However, further rigorously designed trials on its use for other conditions are warranted.” (And the abstract also notes “The studies were generally of low methodological quality.”)

            Now, I don’t know your definitions of disingenuity or dishonesty, but a statement “A 2012 report published in the Journal PLoS ONE reviewed 135 studies on cupping therapies published between 1992 and 2010.” followed by “Researchers concluded that cupping is more than just a placebo effect…” would suggest to any reader that the PLoS ONE authors reached that conclusion. In fact they don’t even discuss whether cupping has more than a placebo effect.

            Pardon me if I conclude this is a blatant example of the approach we see from the websites of snake-oil merchants. Deception, horse-shit pseudo-scientific explanations, and unsupported (and unsupportable) claims of benefit (usually involving weasel words). Just looking at this stuff makes me turn purple with irritation, and you don’t need colorimetry to measure that.

          • Jm,

            Applying increased pressure (above atmospheric) to the skin — compression — is different from applying suction (pressure below atmospheric) to the skin — expansion. Both forms of differential pressure will result in injury when the magnitude of the differential pressure is sufficient to cause damage — injury. The injury response (visible bruising) will be different for compression than for expansion. Why? Because skin is a complex asymmetric multilayered material: all such materials respond asymmetrically to differential pressure, e.g., armour plate. Skin is our ‘armour plate’ that protects our bones and organs from frequent impacts (increased pressure), and only rarely does it need to protect us from a level of suction that is sufficient to cause injury.

            The skin response to cupping is, at best, a bruising injury. Only a charlatan would attempt to claim otherwise.

            Gorski, David (July 1, 2016). “What’s the harm? Cupping edition”:

            You have been relentless in your pathetic attempts to discredit Björn Geir. All that you’ve actually achieved is to totally discredit yourself.

            PS: A densitometer has nothing whatsoever to do with Colourimetry.

          • Pete

            Yes, that seems like a better answer than “extortion”. Thanks. So you’re saying that the different form of differential pressure causes the visible difference.

            If you cup with appropriate vacuum, there’s no pain (when touched or with movement), colorings can be more dramatic but don’t behave like a normal bruise, tissue doesn’t feel like an injury with palpation, markings fade rather than change color, etc.

            If you put a cup on too strong, the body will react like a normal injury – pain (when touched and with movement), bruising (of the type you would expect when you hear the word ‘bruise’), tissue feels like an injury with palpation, colorings change over time, etc.

            Do you suppose that the increase of vacuum (to an inappropriate level) creates a compression type injury?

            Again, I’m not trying to discredit Bjorn. Bjorn is providing explanations based on his background. I appreciate Bjorn’s willingness to talk about this from a modern medical point of view. I sincerely hope that if there’s ever a study done on cupping, Bjorn will do his best to shoot holes through it. In my opinion, the worst thing that could happen for cupping is something like ‘study shows that cupping is effective for x condition’. Treating it like a paint by numbers type of thing leads to the photo at the top of Edzard’s post.

            PS You should let wikipedia know that a densitometer crashed the colorimetry party, in the instruments section. (And, a densitometer does have something to do with colorimetry – it’s handy for honing in on base + stain in relation to color for a batch of film stock. I wouldn’t get one just for that purpose…but if you have one laying around, why not use it? Then again, who shoots film anymore?)

          • Frank

            I agree with you. And, you can find deception, horse-shit pseudo-scientific explanations, and unsupported (and unsupportable) claims of injury from cupping on various sites, too. You have to be careful if the web is your only source of info.

          • “Jm” has provided us with samples of the whole pathetic spectrum of quackadelic fallacies. Now its special pleading and a dash of sycophancy. 😛

          • Bjorn,

            I’ll quit asking about the whole days old coloring thing – unless you’d like to comment on Pete’s idea that the different form of differential pressure changes the way dead blood turns color. But one last question came up (Pete posted a link that had a link, etc etc.) and I was hoping you (or Edzard) could shed some light.

            You said “Scientifically, cupping simply produces injury. Scientifically cupping does not produce any beneficial effect.” We’ve gone over the first part (where, by ‘scientifically’ you mean “subjective, opinionated assessment of the object of study”).

            The second part, about “scientifically, cupping does not produce any beneficial effect” – Pete’s link led to a Novella piece where he quotes what he believes to be the definitive review (by Edzard):

            “In conclusion, this overview of SRs suggests that cupping may be effective for reducing pain. The evidence is insufficient for other indications. All SRs are based on primary studies with a high risk of bias. Therefore, considerable uncertainty remains about the therapeutic value of cupping.”

            The “definitive review” was from 2010, but Novella’s piece was from a week and a half ago. You seem pretty certain there’s no benefit, but Edzard’s definitive review makes it seem…well…uncertain. Is there newer stuff that Novella isn’t aware of? Or is it all still considerably uncertain (with a suggestion of being effective for reducing pain)?

          • Jm,

            I really wish you would learn to understand modern epistemic logic because only then would you begin to understand why we are sick to death of your endless stream of logical fallacies. It is impossible to have a reasonable discussion with you about anything because you do not abide by the modern rules of reason. Your thinking skills are frequently (if not always) in direct opposition to critical thinking skills.

            I stated: A densitometer has nothing whatsoever to do with Colourimetry. Your reply demonstrates that you don’t even understand the difference between “a” and “the”. You have told us many times that yin-yang theory is a way of comparing things; and your comments have made it clear why yin-yang ‘theory’ [an ancient philosophical hypothesis] has no place in the modern world of epistemic logic, mathematics, science, international standards, test & measurement, and other forms of independently verifiable empirical evidence.

            NB: None of the above is intended to be an insult. Your comments, especially your replies to experts in various fields, come across as being a deliberately-contrived epicyclic mixture of the following techniques: insults; nitpicking [fussy or pedantic fault-finding]; “You don’t understand the Chinese term…”; childishness; stubbornness; deliberately obtuse questions and statements [wilful obscurantism] to enable you to swiftly dismiss those who disagree with you by stating “I never said…”; and to add insult to injury, you occasionally claim that you genuinely wish to learn from experts! These are the hallmarks of Internet trolls; they are definetely NOT the hallmarks of a person who is genuinely interested to learn the truth. This is exactly the type of behaviour that we have witnessed, and have come to expect, from the practitioners of, and the apologists for, alternatives-to-medicine (sCAM).

            As to your questions to Bjorn on Sunday 21 August 2016 at 08:30, I’m not going to respond with an essay that properly explains the relevant aspects of cognitive neuroscience, because you do not begin to know nearly enough about this field of science to understand what it is that you don’t know that you don’t know. Professor Ernst has explained it succinctly — to you and to everyone else — in his article above on which you are commenting:

            The most plausible mode of action is ‘counter-irritation’: if you have a pain somewhere, a second pain elsewhere in your body can erase the original pain. You might have a headache, for instance, and if you accidentally hit your thumb with a hammer, the headache is gone, at least for a while. Cupping too would cause mild to moderate pain, and this is a distraction from the muscular pain the athletes aim to alleviate.

            The only point that I shall add at this juncture is that ‘counter-irritation’ is just one specific instance of the several things that cause the clients of cupping therapy and gua sha to shift their locus of attention. Cupping therapy and gua sha are very similar parlour tricks. All parlour tricks rely on shifting the locus of attention of their audience — aka: sleight of hand; skilful deception.

            Jm, broken blood vessels are an injury, irrespective of whether or not the injury leads to pain and/or swelling. You continually attempt to obfuscate cause and effect; the logical antecedent and the logical consequent. Hence many of your arguments contain the same tired old logical fallacies: affirming the consequent; denying the antecedent; appeals to ignorance; the fallacy of division; and the fallacy of composition (your comments about a densitometer exemplify this fallacy!).

          • Pete

            None of this is intended to be an insult either – to you or anyone else. But, you’re full of crap. I won’t go through everything in your comment (for instance, densitometers & colourimetry) but here are some things that strike me as strange.

            First off, it seems odd to me that you (and others) can come to a conclusion about something like yin yang theory, for instance, without knowing what it means. Understanding what the term means and how it is used isn’t fussy or pedantic – it’s step 1.

            The idea that counter-irritation is the most plausible action of cupping (or gua sha) is horse shit. You certainly could use either tool that way, just as you could use compressive massage, a hammer, a loud noise, or anything else for counter irritation. But that’s not the primary use or action of cupping or gua sha. Or a hammer.

            The whole parlor trick idea is also in the horse shit realm. Particularly Bjorn’s ideomotor phenomenon, cups losing suction as they travel, varying the vacuum or pressure to get a pre-determined effect, etc. All that sounds good on paper (except for the losing suction as a cup moves…that’s just weird), but impossible in practice, with those particular tools. There is no objective way to come to the conclusion that inconsistent marking is slight of hand.

            “…and to add insult to injury, you occasionally claim that you genuinely wish to learn from experts!” I do want to learn from experts – but you continually confuse (on various threads) areas of expertise. For instance, Edzard seems to be an expert in research – but not an expert in massage for fibromyalgia. He comes to the conclusion that massage for FM “might be worth a try”, and yes, I am very interested in learning how he came to that misguided conclusion. That particular example was very useful for me, to see the relationship betwen research and application.

            Bjorn might be an expert in modern physiology, and ham radio. But he’s not an expert in gua sha or cupping. You continually assume that expertise in one area leads to expertise in another. Which logical fallacy is that? If you think the definition of gua sha is to produce injury (which he has said many tmes), you’re not only not an expert – you’re a dictionary definition quack.

            I am also very interested in how folks come to the conclusion that cupping or gua sha is injury. There is no way to objectively assess competent cupping or gua sha as injury. But to watch how objective assessment is overwhelmed by the look of the markings is quite educational.

          • Jm,

            In which areas of 21st Century medicine — or any other branches of 21st Century science — are you a qualified expert?

            Broken blood vessels are an objective, not a subjective, manifestation of injury.

            I refuse to call you a clown because clowns are delightfully entertaining. I shall leave it to the readers to draw their own conclusions from your relentless stream of ‘comments’.

          • “Jm” is an interesting phenomenon. Keeps trolling for answers but when they come, completely unable to grasp them and perseveres on about the same fantasies. When asked to clarify and explain yin, yang, qi and other terms that no one has been able to cinfirm, “jm” dodges the question blindly. Then (s)he accuses us of the same fallacy and gets all haughty about us not understanding something that not even she/he can explain realistically.
            As a wise man (Upton Sinclair) said: “It is diffcult to make someone understand something when his or her income depends on not understanding it” (or something to that effect)
            I almost wrote: Poor pathetic ” jm”… but then came think of Hanlon’s razor.
            Let’s put it this way: Poor, gullible souls who let a nincompoop like that fleece them with harmful hokus-pokus.

          • Bjorn

            Just because I tell you that your answers don’t match with experience, don’t take that to mean I don’t understand and appreciate your explanations. I do, and I thank you for your time. Sorry you don’t like my answers regarding terms, but my answers will continue to be: go talk to practioners, have them explain. You’ll only get a simplistic overview from Wikipedia and other sites. If you want to understand what these terms mean and how they are used, you need to talk to people who are using them. More than one, because the more practitioners you talk to, the clearer your understanding will be.

            And, have them demonstrate gua sha and cupping – again, from more than one practitioner. (it’s perfectly safe) And, try it from different traditions (Chinese, Greek, Russian…). Based on your comments on other threads, you seem to enjoy a good, deep massage. Try some Russian cupping – you’ll be delighted. It’s like a negative pressure deep tissue massage – your low back will thank you, and you’ll understand why cupping has stuck around all these years and why professional athletes (and anyone else with aches and pains) find it valuable.

          • “jm” does not realise her (his?) “experiences” (perceived) do not match reality 🙂

          • jm is a True Believer and is as convinced of his “powers” as anyone could be. (

            Nothing will shake his/her views about witchcraft because the essence of their being is so aligned to the nonsense. Admitting the basis of their thought processes and world view is flawed and unsustainable is not ever going to happen. The Wiki page describes it as a cognitive disorder.

          • Bjorn

            Simple enough for you (or anyone else) to verify. You said scientifically cupping simply produces injury, and does not produce any beneficial effect – and you said by scientifically, you mean subjective, opinionated assessment of the object of study.

            Take a friend with you, have them get some lovely sliding cupping done on their back. Palpate the tissue before and after. Then have your friend buy you lunch, since you treated them to a lovely negative pressure massage. 🙂

          • @ jm on Tuesday 23 August 2016 at 16:15

            Well, what did I write above? jm is a true Believer.

            “you mean subjective, opinionated assessment of the object of study”

            The same “subjective, opinionated assessment of the object of study” you have after zero time studying medicine or practising it through consultations, surgery, and confronting death, or the kind Björn has after taking a scalpel to flesh and speaking to the patient not long after?

            If you are so dismissive of experienced doctors, please don’t see one if/when you develop a cancer. I would hate to think of you as a hypocrite, albeit a dead one.

      • Google colors or ask a 2nd grade teacher: Purple(a secondary color)is made by mixing blue and red(primary colors). Venous blood is blue and arterial blood is red.

        • SCox

          I bet if you ask every 2nd grade teacher out there, none will have ever seen an injury immediately produce deep purple or black coloring. That takes some time. Bjorn posted a link that explains the process – you should have a look.

          • And I forgot to say above; a smartarse as well.

            Why do you believe you have such great skills? You don’t operate, inject, refer, test, X-ray and anything else Dr Cox does in the course of a normal day. You aren’t even allowed to lance a boil but you think you have such a command of medicine. Truly bizarre.

  • During my Soviet childhood dry cupping was a mainstream treatment for lower airway inflammation (not sure brondchitis only or also pneumonia). I did not have problems with my lungs, but I spent several months at the hospital and encountered a couple of patients, and cupping was a standart procedure shown in family films in case of serious colds (like painting chicken-pox rash with brilliant green) – I did no question efficacy (at least brilliant green is a disinfectant), but at least doctors seen to be aware now that phenomenon that was called “chronic bronchitis” in the USSR are several diseases and many other things.

    • Chest physical therapy is often used in respiratory disorders like Cystic Fibrosis where patients have difficulty mobilizing secretions. It is a simple clapping technique with cupped hands over the chest to loosen inspissated mucous that can then be expectorated more easily. It is usually done by Respiratory Therapists or PT”s and has no relation to “cupping,” which would not help any lung disease.

    • Flash cupping is often used with respiratory issues when people have difficulty mobilizing secretions. It is a simple technique involving attaching (oftentimes ‘clapping’ them on to the body) and removing cups on the chest repeatedly, to loosen inspissated mucous that can then be expectorated more easily.

      If you don’t have cups available, you can simulate this with your hands.

      • LOL! Quacks, such as “jm”, are ‘experts’ at simulating [imitating the appearance or character of] modern therapeutic techniques, while being hopeless at emulating [matching or surpassing] the efficacy of the therapeutic techniques.

        I’m still waiting for Microsoft to add yin-yang theory to its set of Excel spreadsheet comparison operators. Without this vital addition, modern science cannot possibly be successful. The forthcoming James Webb Space Telescope is doomed to failure unless it includes the ancient wisdom of “jm” and his ilk.

        Here’s how yin yang theory would be used in relation to the following:
        A gas turbine engine – off, yin. On, yang. Same with a television system. The internet, yang, an intranet, yin. The Hubble Space Telescope, yang. My binoculars, yin. The human body…yin compared to a mountain. Yang compared to a mole hill.

      • Clapping cupped hands on the chest to loosen inspissated mucous is not a modern therapeutic technique. It’s been around for thousands of years.

  • Cupping is commonly referred to as ventosa therapy here in the Philippines. I haven’t tried it but I know some people who already did. I didn’t know it’s an ancient form of alternative medicine that originated from China as I’ve only heard about this kind of therapy only a few years ago. I am interested in learning more about cupping.

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