Cupping as Medicine

Cupping is a healing modality with ancient roots that is still widely practiced today. Traditionally cupping was used to treat disease by pulling pathogenic factors such as excess cold, heat, wind, or stagnant blood and fluids to the surface of the skin to clear out through the pores.

In Chinese medicine cupping is used to treat disease, including arthritis, chronic pain, colds, flus, and liver disorders. Cupping is also practiced as manual therapy to resolve pain and tension, decompress restricted fascia, and increase circulation.

Mechanism of Action

Cupping uses a negative pressure created by a pump, suction, or vacuum. Cupping draws stagnant blood and fluid to the superficial vessels, thereby increasing circulation and lymph flow within the layers of the fascia.

The Discoloration/ Cupping Marks/ Sha

Cupping draws blood and fluids to the superficial vessels, temporarily filling them and creating a mark that looks like a bruise or rash. This discoloration is temporary and usually fades in a couple of days to a week. Unlike a bruise, the treated area feels immediate pain relief and resolution of tension.

Even if the discoloration does not appear there are still beneficial changes in the texture, temperature, and appearance of the skin and myofascia.

Styles of Cupping

All cups have a way to create a negative pressure. The most common styles of cups we see today are fire cups, external pump cups, silicone cups, and facial cups.

Fire Cupping

How Fire Cupping Works

Fire cupping uses simple cups made of non-flammable material, usually glass but sometimes bamboo or ceramic. A vacuum is created by removing the oxygen in the cup with a controlled flame, such as a lit cotton ball soaked in rubbing alcohol or a small charcoal on a metal handle. The flame is inserted into the cup and quickly removed and the cup placed on the skin. The vacuum created inside the cup causes the muscle tissues to be pulled up inside.

Fire Cupping and Traditional Chinese Medicine

Fire cups are necessary in order to use several techniques of traditional Chinese medicine including bleeding cupping, herbal medicinal cupping, and combined moxibustion or needling with cupping. Fire cups are the most traditional form and that style has a special place in the heart of many practitioners.

Practical Considerations

Tthe glass cups can get very warm and can create a very strong suction, arguably the strongest potential suction of all the types of cups. The glass cups are easy to clean and disinfect, but can break when dropped, or the rim can become chipped..

Fire cupping is somewhat difficult to learn at first and requires some practice, and there is a danger of burning when not done properly, mostly from the possibility of the cup getting too hot.

Glass cups can glide on the back but do not glide very well on other parts other body, and they are difficult to control the suction level. Overall fire cups are best used by acupuncturists using traditional techniques.

Fire Cupping and Massage Therapy

While cupping is in the scope of practice for massage therapists in most states, fire cupping in particular is not covered by many of the professional massage liability insurance carriers. To find out if this applies to you check with your state massage board and professional liability insurance carrier.

External Pump Cups

This style of cups usually come in a set of multiple size cups made of either plastic or polycarbonate, with an external pump. Suction is created by using the pump to draw the muscle tissues inside the attached cup. The most common type is the hand pump or pump gun, but there also exists a machine pump.

How External Pump Cups Work

The cups pop right into the pump and suction is created by squeezing the pump or setting the machine. With the pump it is possible to control the suction easily, and without taking the cup off the body. External pump cups can be used for self-care even on the back and shoulders. They attach easily to areas around joints such as elbows, wrists, the lateral and posterior neck, knees, and ankles.

These cups are somewhat difficult to clean and properly disinfect because of the valve in the cups and the possibility of body fluids entering the pump. The cheaper plastic cups are breakable, the polycarbonate cups are much more sturdy. With their thin rim and domed shape these cups are difficult to do gliding techniques.

The biggest cups in the sets still tend to be smaller than the large fire cups or silicone cups. However in the machine pump sets there are very large cups.

Silicone Cups

Silicone cups are made of medical-grade silicone and are self-suctioning. The common types are the mushroom shaped cups and the dome shaped cups.

The technique of squeezing and applying the cup to the body can be mastered in minutes. These cups contour to the body and glide easily. They can be easily cleaned and disinfected, and do not break down, fray, or lose shape over time.

Amplifying the Suction

Even though silicone cups have limited suction compared to other styles, it is possible to amplify the suction by placing multiple cups in one area, or by pulling up on the cup when gliding. The mushroom shaped cups are easier to glide and provide greater suction than the dome shaped cups.

The quality varies somewhat, which is true of all the styles of cups. Be wary of silicone cups that have a visible center seam, which shows a cheap manufacturing process and compromises the smoothness of the cup.

The mushroom shaped silicone cups are better to use in clinical practice because they get strong suction than the dome shaped cups and are easier to grip for gliding. The silicone cups are easy to clean and disinfect, they never break when dropped, and are not destroyed by oil like equipment made from vinyl.

Facial and Jaw Cupping

Facial cupping requires specialized cups with very limited suction. Facial cups are either very small cylindrical glass cups with a small rubber bulb, or small conical silicon cups. The technique can be a gentle pumping suction to mimic the lymphatic system or gliding along the face. Facial cupping is meant to improve circulation of blood and fluid and is generally for cosmetic purposes.

Jaw cupping uses a slightly larger cup, usually the largest in the glass facial cupping set and is applies to the muscles of the jaw for therapeutic decompression. This technique is more likely to leave discoloration on the face but is very effective for TMD, facial tension, neck pain, and headaches.

Qi is foundational in the theory and practice of Chinese medicine. Qi as a concept is widely accepted in East-Asian cultures, but in the West is often negated or ignored, leading to misunderstandings about the validity of Chinese medicine.

Qi is often described as “energy”, an invisible force that exists in all of nature. Chinese medicine theory tells us that qi travels along channels that connect all parts of the body and disease is the result of the qi being blocked, deficient, or otherwise imbalanced. The use of acupuncture needles or other stimulation at responsive points along the channels rebalances the qi and restores health.

There are a few keys for a deeper understanding of qi and a better appreciation of the sophistication and insight of ancient Chinese medicine.

Qi is movement and functionality

This wonderful illustration is from The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine by Shigehisa Kuriyama, showing the difference between the body as purely function or structure.

Life is movement, everything in our bodies from our heart beat and blood flow, to the delicate balancing of hormones and cellular respiration, is a constant dance of movement.

Functionality in the body is always related to physiological movement on some level. The exchange of ions that generate nerve signals, muscle contraction and relaxation, fluid regulation, blood and lymph circulation, the processes of digestion and so on, are all movement.

Qi is invisible because it is the actual activity and function of everything working together in a healthy human person. Qi is the natural movement of our life processes and we cannot see it because it is a description of the healthy functioning of our very lives. When the qi is blocked- that is, when our cells, biochemistry, or organs are not functioning properly- then we have disease and illness.

Modern Western medicine is based on the ancient Greek worldview which emphasized structure and form. We see this in the beauty of Greek art with its perfection of visible structures of the human body.  Greek medicine was based on the body structures found in a dissected cadavers. As the medicine developed into modern allopathic medicine the understanding all of health and life was still based on physical, inert forms. The focus stayed on structure, the keys to health being sought through reductionism instead of holism.

Chinese medicine is based on the ancient Eastern worldview of movement and natural changes. The Chinese model is based on observable function in a living person, within the context of nature, making it a holistic system of medicine. The acupuncture illustration is depicting life and dynamic movement, something time-based in the human body, not static.

Qi is a confluence of several body systems working together

Modern Western medicine divides biological systems into discrete functions based on structures.
The basic systems of the body from a Western perspective are musculoskeletal, nervous, integumentary, reproductive, urinary, digestive, endocrine, cardiovascular, respiratory, and lymphatic. Psychological and behavioral functions are considered somewhat separate, unless there is psychological pathology and neurological drugs are brought in.

An integrative discipline called psychoneuroendocrinoimmunology is a Western medical study of how human psychology, neurology, endocrine, and immune systems interact and effect one another. This is a a limited holistic outlook based on a reductionist model, trying to reintegrate systems that are already divided.

Chinese medicine, developed thousands of years ago, started with the philosophy of holism of the body, community, nature, and spirit.

Chinese medicine uses qi to describe the natural confluence among all the systems, including the psychological state, the shen or heart-mind. In Chinese medicine, if the qi is flowing properly then everything is in working physiological and psychological order. If one of the systems is injured or blocked then it naturally effects several other systems simultaneously.

As a simple example is a severe injury to a limb that effects what the Western model would consider 5 different systems: nervous, musculoskeletal, lymphatic, circulatory, and integumentary, the injury causes lack of function in all these areas.

From a qi-based model,  pathology is in the channel of functionality, causing pain and lack of flow of qi (lymph, blood, correct nerve signaling, mobility etc). Stimulating responsive points in the area or in another area to release blockages in the fascia will resolve the issue.

The treatment approach of unblocking the qi with acupuncture, massage, or herbal medicine simply returns the musculoskeletal structure, blood flow, nerves, and lymph flow to proper functioning. Qi in this case is an elegant shorthand for describing the function or lack thereof of several body systems.

Pathology on deeper levels can effect the hormones, immune system, digestion, the psychological state etc, which is still a pathology of qi – a disruption of physiological function– in these interdependent systems.

Qi travels along the fascial planes, which connect limbs and organs

Fascia is the great ignored organ of the human body. Fascia is a gossamer-thin yet strong and impervious connective tissue that wraps every muscle, bone, and organ.

Fascia layers in between the muscle cells and binds the body together. It also creates important compartments on the body between the organs and different muscles. Fascia connects and creates boundaries and without it the body would not be able to function.

The purpose of fascia is difficult to appreciate from a structural perspective based in cadaver dissection. Early anatomist would have to cut through all this web-like material in the cadaver to get to the muscles, bones, and organs. Most of modern Western medicine anatomy is based on the information from cadavers, not living, breathing, moving, people. The role of fascia was minimized until a more recent interest in the Western medical community rediscovered its importance.

Daniel Keown in The Spark in the Machine: How the Science of Acupuncture Explains the Mysteries of Western Medicine, attributes the mysterious triple burner (san jiao) organ of Chinese medicine to the fascia. In an important Chinese medicine text, the Huang Di Nei Jing, the triple burner is said to have “name but no form”. The fascia is an organ with many specific functions, and has been overlooked in Western medicine, but helps to explain acupuncture channel theory and qi.

Fascia physically connects organs and limbs. The fascial planes often line up exactly with acupuncture channels, at both superficial and deep levels. This is one way of understanding why stimulating a point on the arm can effect lung function.

Fascia is composed of collagen, which is piezoelectric, meaning it generates an electric charge with mechanical stress. Our bodies have mechanical stress all the time from gravity, not to mention movement and exercise, and the electrical charge generated through the collagen keeps bones strong because the charge signals osteoblasts to lay down more fibers on the bones.

According to Daniel Keown we can see the absence of this in astronauts in space, who lacking the mechanical stress of gravity, lose at least 1 percent of their bone mass per month, even with vigorous exercise.

This is all to say that the body has an innate electrical charge which has vital properties, and travels along lines of the fascia, mirrored in the acupuncture channels.

Qi is electricity, the life force of our body

The picture above uses Kirlian photography to capture the electrical energy of a living flower. Electricity can also be defined as energy, or a type of energy, which is matter in movement. The famous axiom E=MC2 is a way to express that qi is everything (matter) in movement.

Qi is the movement and function of the piezoelectric charge that runs along the fascia, as well as the motor and sensory nerve signals, the autonomic signals that keep our heart beating, the blood flowing in the vessels, the release of hormones from glands, the balance of fluids in the body, the metabolism of cells etc. etc.

Electricity is invisible but we know it exists by its effects. Qi is invisible and will never be found in a cadaver, but we know it exists because of its effects. Electricity has healing and regenerative properties, and modern hospitals use special machines that induce piezoelectricity to help heal bones.

Qi is intelligent and works within a model of universal order

Qi is an intelligent force within the body that creates order, organization, healing, and proper function. The organization and development of a living human from two cells in only nine months is still the great mystery of embryology.

Qi reminds us that our bodies function is a holistic system that cannot be divided up to be healed. We are a part of nature, and we are all connected through a shared life force, and none of this is an accident. It is no surprise then that the best way to achieve health is with good nutrition, moving and exercising every day, appreciating nature, and honoring our community. The qi will do the rest.

The Emperor

“The Heart is the emperor, the supreme controller. The Heart is the fire at the center of our being, from which the spirit radiates.” 
-Neijing Suwen (Yellow Emperor’s Classic of Internal Medicine)

From a Chinese medicine perspective, the organs of the body are not just physical but include functional, emotional, and spiritual aspects.

The Heart is called the Emperor because it is the seat of the most important part of our being- the shen, or spirit. According to Chinese medicine and its Taoist roots, humans are of an earthly nature and the divine cosmos. The shen is the divine spark within and governs the individual spiritual aspect of all the other organs.

Shen literally translates to “heart-mind” and mental illness is considered to be a disorder of the shen.

Fire Element

In the body, as in nature, the fire element warms, burns fuel, transforms fluid into vapor, and energizes. In its grossest state it provides metabolic function and in its more rarified state it is the fire of the spirit and of love.

There are two pairs of organ systems classified as fire element: Heart and Small Intestine, and Pericardium and Triple Burner.

Small Intestine

Just as the Heart is the throne of the shen, the Small Intestine is the repository of the blood which is the substance that allows the shen to interface with the body’s function.

“The link with the Heart is key to understanding the subtle levels of the Small Intestine function. The Shen, or pure awareness housed in the Heart and whose influence is distributed throughout the body via the Blood, arrives in the physical body at birth like a ‘stranger in a strange land’. In order to be rooted in the physical confines of the human condition and function appropriately within human existence, it must perform the massive task of assimilating the experience of the physical environment and its conditions.” [source]

Pericardium

Also called the Heart Protector. The Pericardium acts as an intermediary between the Heart and the outside world, functioning on the emotional level as interpersonal love and warmth. Because the Heart is considered sacred and the repository of the divine spirit, in some earlier traditions of acupuncture the Heart channel is not needled. The Pericardium is paired with the Triple Burner organ.

Triple Burner 

Also called the Triple Warmer, Triple Heater, Triple Energizer, or the Chinese term San Jiao. This organ has important functions within the body of metabolizing fluid and regulating temperature.

There is discussion that the Triple Burner corresponds to the lymphatic or fascial systems, but it really has no physical biomedical counterpart.

Chinese Medicine and the Heart

Disorders of the Heart in Chinese medicine are related to anxiety, sleep disorders, and mental illness. Basically an over or under-functioning fire element in relation to general enthusiasm about life. The Heart can be treated directly, or through supporting the Pericardium or Small Intestine systems.

Love and the Heart

“I am certain of nothing but the holiness of the heart’s affections, and the truth of imagination.”
-John Keats

A broken heart is not just an expression but a real understanding that the heart is affected physically by emotional turmoil and trauma. Loving involves an opening of the heart, a connection of the fire element to another person, and even an electromagnetic connection. Loss and heartbreak affects us on an electro-magnetic level and takes time and therapies to heal.

A connection to something greater than ourselves is crucial for a healthy heart whether it is a spiritual, humanistic, community, family, or creative connection.