What Is Cupping Therapy? Uses, Benefits and Risks

At the 2016 Rio Olympics, circular bruises on swimmer Michael Phelps's back attracted worldwide attention. They resulted from athletes' attempts to improve performance and relieve muscle pain through cupping therapy as a procedure. Recently, not only athletes but people with pain, inflammation, respiratory problems and skin conditions have turned to cupping seeking relief. With origins thousands of years old, it has regained popularity. So, what is cupping therapy, how is it performed, does it really help, and does it carry risks? This comprehensive article addresses all these questions in light of scientific evidence.

What Is Cupping Therapy?

Popularly called “glass cupping” or “cup pulling” , it is a traditional treatment applying vacuum to the skin. Glass, bamboo or plastic cups are placed directly on skin and air removed to create suction. The skin rises slightly, and in underlying capillaries, blood circulation increases with the aim of triggering natural healing. It is relatively inexpensive, drug-free and noninvasive (no surgical procedure required). It is usually applied to acupuncture points or near the problem area to increase effectiveness.

Cupping therapy belongs to traditional and complementary medicine and attracts interest as support for modern care. Vacuum aims to produce increased local blood flow , bringing cells more oxygen and nutrients and removing toxins. Practitioners say suction relaxes muscles, relieves pain and helps balance the body. Cupping therapy is also its English name, and it is tried for various conditions, particularly back and neck pain. Scientific evidence is mixed but it is generally considered low-risk when correctly performed.

History and Cultural Origins

Cupping has been practiced across many regions for thousands of years. Historical records show use in ancient China, India (Ayurveda), Egypt and the Middle East as cultures. For example, believed written around 1550 BCE, the Ebers Papyrus (an ancient Egyptian medical text) and notes of Greek physician Hippocratesmention drawing blood with vacuum vessels. Ancient Chinese texts from the 2nd century BCE also describe it. In the Middle East, particularly Islamic culture's “hijama” was widespread wet cupping, with traditions that Prophet Muhammad recommended it.

Cupping therapy belongs to Medieval Europe also used it widely. Practiced since the Bronze Age, before modern surgery it was, during the 17th and 18th centuries, part of doctors' routine treatments in England, France, Germany and even America as historical practice. Medical advances and new treatments later pushed it into the background.

In the late 20th and the 21st centuries, worldwide interest returned. In East Asian countries such as China and Korea, modern physicians and traditional specialists continued using it. Stronger alternative-medicine movements in Western countries increased use for performance and pain relief. Famous athletes and Hollywood celebrities using cupping brought it into modern popular culture. With deep historical roots and accumulated knowledge across cultures, it has become a universal traditional treatment over time.

How Is It Performed?

Cupping is based on creating a partial vacuum on the skin. Different techniques create this vacuum, leading to different methods. Main types include:

Dry Cupping

Dry cupping is the most common method. No skin cuts are made: suction holds the cup directly on skin for several minutes. Traditionally, the vacuum uses fire : burning alcohol-soaked cotton briefly heats the air, and the cup is immediately placed on skin. As air cools, pressure falls and skin is drawn inward. Modern glass or plastic cups instead use a valve through which air is removed by a pump to create vacuum. Both aim for negative pressure increasing local blood flow and stimulating tissue. Cups usually remain for 5-10 minutes on the skin. There is strong pulling but generally no sharp pain. The vacuum is gently released and cups removed, leaving red-purple circular marks (bruises) as visible effects. Dry cupping leaves only suction marks, fading spontaneously over several days.

Wet Cupping (Hijama)

Wet cuppingis popularly called hijama and is somewhat more invasive. Cups first suction the problem area for several minutes using dry cupping. After removal, a sterile scalpel or special blade makes very small, superficial cuts (incisions) in the suctioned skin. Superficial capillaries release some blood. Cups are immediately reapplied with suction, drawing blood through the cuts into them. Traditional practitioners believe this removes “dirty blood”, their term for stagnant blood. The amount is generally small and controlled; the aim is not significant blood loss but superficial stagnant blood removal. Cuts are disinfected and bandaged if needed afterward. Hijamahistorically spread particularly in the Middle East and Islamic culture and is still performed by certified practitioners. It leaves bruises like dry cupping, with blood also visible in cups. Sterile conditions and disposable materials are essential to avoid infection.

Moving Cup Massage

Moving cupping (sliding or gliding cupping) moves cups rather than holding them still. Massage oil or cream usually lubricates the area first. A cup attaches with gentle suction and, like massage, moves by sliding over the skin. This treats a larger area and increases circulation more broadly. It aims to relax muscles, disperse lactic acid accumulated after intense exercise and provide relief. Sports medicine and physiotherapy sometimes use it instead of deep tissue massage. Movement can leave linear redness as well as circular marks, both short-lived. It may produce massage-like benefits in relieving spasms and reducing muscle tension as an effective massage might.

Hot Cupping Treatment

Hot cuppingcreates vacuum with heat. The traditional form of dry cupping, it heats air to lower pressure (the fire cupping technique). Burning cotton is briefly held inside a glass cup, then the cup immediately placed on skin. Cooling air reduces pressure and draws skin in. The cup itself also warms, producing a heat effect that may further relax muscles. Hot cupping is particularly known as “fire cupping” and is the oldest historical form. Today, cold cupping sometimes refers to pumped suction without fire. Experienced practitioners must control fire to avoid burns. Correctly performed, hot cupping resembles dry cupping, with heat potentially increasing blood flow further.

The General Steps Are: First, preparation means cleaning the area, usually muscular back, neck, shoulders or legs. Moving cupping requires massage oil for lubrication. Next comes creating vacuum : after placement, fire or a pump removes air and starts suction. Once the desired vacuum is reached, cups remain in place generally for 5-15 minutes. Strong pulling is felt while capillaries dilate and blood flows into the area. For wet cupping, cups are then removed, skin cut and suction repeated for blood drawing as the next step. Finally comes cup removal and aftercare : cups are removed individually by slowly releasing suction. Antiseptic cleaning follows, with soothing cream and bandaging if needed. Circular purplish marks generally fade within days and disappear in about a week. Color varies from pink-red to dark purple with suction and skin sensitivity. Traditional interpretations of darker marks as excess accumulated toxins have no scientific basis.

Cupping sessions may be one-off or repeated as needed. Some receive treatment for pain once a week while traditional hijama practitioners may suggest once a month or at seasonal changes. Modern medicine has no defined session protocol; allow skin time and avoid overly frequent treatment of one area. Do not reapply before complete healing.

What Are the Benefits?

Many potential benefits are attributed to cupping. Practitioners and users report effects from pain relief to stronger immunity. Commonly reported benefits and proposed mechanisms follow:

Pain Relief

Cupping is best known for pain-relieving effects, particularly musculoskeletal back, neck, shoulder and knee pain. Reduced muscle pressure, relaxed spasms and increased blood flow may reduce pain. One proposed explanation is “gate control theory” : suction stimulation may temporarily inhibit nervous-system pain signal transmission. It may also release natural painkillers such as endorphins as chemicals. Studies show short-term relief in chronic neck and lower-back pain, fibromyalgia and arthritis. A review in 2012 examining 135 clinical studies reported greater improvement than standard care for shingles (herpes zoster) pain and back/neck pain. In conclusion,after cupping, patients commonly report a sense of relaxation and pain relief in the treated area.

Supporting Blood Circulation

Vacuum at the application site accelerates blood flow. Dilated capillaries near the skin bring fresh blood, oxygen and nutrients while facilitating metabolic waste removal, thought to accelerate cellular renewal and healing. Particularly in chronic wounds or muscle strains and other locally impaired circulation, increased flow is claimed to support healing. Tissue becomes warmer and pinker immediately afterward. Some studies report increased tissue oxygenation and muscle relaxation. Better circulation may also help reduce inflammation by clearing inflammatory substances. In summary, cupping revitalizes microcirculation to contribute to natural repair.

Strengthening Immunity

Advocates suggest regular cupping can stimulate and strengthen the immune system as an effect. Traditional views hold that removing “bad blood” through wet cupping and improving circulation clears toxins and increases infection resistance. Modern research has also examined effects on immune responses as a possibility. Some studies report increased activation of lymphocytes, macrophages and other immune cells after hijama in healthy people. A review conducted in Türkiyestates cupping may be used preventively even in healthy people to strengthen immunity. Microscopic suction-induced tissue damage is thought to activate defense mechanisms in the body. Increased flow draws white blood cells to the site, supporting action against potential pathogens. Research has also found increased blood anti-inflammatory substances after cupping. Although scientific evidence is limited, some regular users report fewer illnesses or greater energy. Nevertheless, immune effects need more scientific research for clarification.

Effects on Stress and Muscle Tension

Cupping is also described as a relaxing and soothing experience. Suction on skin and muscle resembles deep tissue massage, potentially releasing muscle knots, reducing muscle tension and producing physical relaxation. Combined with increased circulation, this may create a stress-reducing effect throughout the body. Lying quietly and focusing on the body for several minutes may also rest the mind. Some users report deep warmth and relaxation during and afterward. Psychology may contribute: believers in traditional treatments may actually feel better through expectation (placebo). Cleveland Clinic information also states that cupping may encourage whole-body relaxation to raise pain threshold and reduce stress. Suction may also activate the parasympathetic nervous system (rest-and-relax system), slowing heart rate and lowering blood pressure to promote calm. Thus cupping may provide not just physiological but psychological relaxation that contributes to stress management.

Uses of Cupping

Historically, cupping was used so broadly it was sometimes considered a cure-all. Such a broad claim is unsupported today, but certain conditions and fields commonly use it. Main uses of cuppinginclude:

Athletic Performance and Rehabilitation

Athletesmay use cupping to reduce training/competition muscle pain, recover faster and improve performance. It aims to disperse metabolic waste such as lactic acid after intense exercise and speed repair of microscopic muscle damage. Olympic swimmer Michael Phelps helped popularize it through competition preparation. Its deep-tissue suction, similar to sports massage, accelerates blood flow and oxygen delivery to muscles, potentially reducing pain and stiffness before the next workout.

It is also supportive in sports injury rehabilitation. For muscle strains, connective tissue injuries or IT band syndrome, moving cup massage alongside physiotherapy may increase local circulation. Some sports physicians say it increases athletes' flexibility and and releases muscle knots as effects. A study in 2018 found greater tissue elasticity and pain threshold at treated sites in elite athletes. Athletes also use it as part of warm-up or cool-down as part of their routine as well. For example, practices include preparing muscles with a short cupping massage before intensive training or using cupping to relax them after a competition. In conclusion, when applied correctly, cupping therapy is a method that athletes prefer to support their performance and reduce the risk of injury, as a complementary care method athletes choose to support performance and reduce injury risk.

Chronic Pain Management

Many with chronic pain see cupping as an additional tool alongside conventional care. Lower-back pain, neck stiffness, shoulder stiffness, knee osteoarthritis, migraine and fibromyalgiaare commonly treated. A person with chronic lower-back pain may report relief and improved mobility after regular cupping. Some report fewer headaches after neck and upper-neck applications aimed at reducing migraine attacks.

Research partly supports these observations. Many studies report that patients' pain scores fall substantially from baseline. A review in 2023 of sports and musculoskeletal conditions found some short-term relief in neck and back pain but limited-quality evidence. A review in 2022 on chronic lower-back pain concluded wet cupping (hijama) might help. Its appeal is as a drug-free alternative or supportive method, particularly for people avoiding long-term painkillers or benefiting insufficiently from them.

In chronic pain, cupping should generally be used as an addition rather than alone, alongside physiotherapy, exercise and medical treatment as support. Someone with fibromyalgia may improve quality of life through periodic cupping alongside exercise and dietary changes. Pain causes and physiology differ: benefit may be substantial in some and limited in others. Nevertheless, its low adverse-effect profile attracts interest as an option worth trying.

Respiratory Diseases

Historically, cupping was often used for respiratory conditions as well. Traditional Chinese and Middle Eastern medicine used back and chest cups for cough, phlegm, colds and bronchitis. Vacuum is thought to reduce congestion in the lungs and help expel phlegm. Gentle back suction in asthma or chronic bronchitis is claimed to dilate bronchi and ease breathing.

Some modern alternative practitioners also recommend it to relieve asthma attacks or shorten colds. Cups on the upper back at lung level and chest are claimed to increase circulation, facilitating more immune cells reaching lung tissue. A literature review in 2012 reported widespread traditional use for chronic cough and dyspnea. Physicians historically even used it supportively in pneumonia and tuberculosis.

Of course, in respiratory disease, cupping should not be the main treatment as an approach. Asthma primarily requires inhalers and prescribed care; cupping may only be tried as additional support with medical approval. Some report chest relief and easier breathing afterward. In bronchitis with heavy phlegm, it is said to loosen secretions and facilitate expulsion. Thus it continues as complementary support for colds, upper respiratory infections and asthma as a complementary form of support, and it continues to be used for these conditions in certain circles. However, it must be remembered that when breathing difficulties are severe, modern medical treatment should be sought without delay.

Digestive and Metabolic Effects

Cupping therapy belongs to digestive system and metabolism may also be affected. Traditional practitioners claim abdominal cups regulate stomach and bowel function, using gentle suction to stimulate appetite or moving massage for chronic constipation to encourage bowel movements. Indigestion (dyspepsia), stomach pain and gas have also historically been indications. Increased abdominal blood flow is thought to help digestive organs work more effectively.

For metabolic effects, cupping is claimed, through toxin removal and increased flow, to ease the burden on detoxifying organs such as liver and kidneys. Some sources claim regular hijama benefits cholesterol and triglycerides. Cleveland Clinic information mentions potential toxin clearance, cholesterol reduction and even lower atherosclerosis risk. Most such claims lack sufficient evidence but are common in complementary-treatment circles.

Recently cupping has also been studied for metabolic syndrome and Type 2 diabetes and related diseases. Some small studies suggest regular wet cupping in diabetes may improve blood glucose levels as an effect. Reports describe lower fasting glucose and HbA1c with monthly hijama. Theories include a possible increase in red blood cell (erythrocyte) count and improved insulin sensitivity. Claims also include better liver enzyme balance through suction or indirect thyroid benefits.

Considering these proposed digestive and metabolic effects, traditional practice has also used cupping to improve general health as a goal. People fasting or on detox diets may choose hijama for support. However, serious digestive or metabolic disease requires medical treatment; cupping should only be supportive and physician-approved.

Who Should Not Receive Cupping?

Although generally considered safe, cupping is not suitable for everyone. Certain situations and health problems make it inadvisable. General health and risk factors must be assessed first. Main situations where it is not recommended follow:

Is Cupping Therapy Safe During Pregnancy?

Cupping therapy for pregnant women is generally not recommended. There are several reasons for this: First, there is insufficient research on the effects of cupping during pregnancy, and whether it could harm the baby or the mother is unclear. In particular, there are concerns that vacuum applied to the abdomen and lower back could trigger miscarriage or premature birth. Traditional Chinese medicine also considers applying cups to certain acupuncture points during pregnancy inadvisable (for example, the lower abdomen and lower back). Because the skin is more sensitive and blood vessels are more dilated during pregnancy, cupping can cause more bruising or pain than usual. In conclusion,, expectant mothers should not undergo any traditional treatment, including cupping therapy, during pregnancy without consulting their doctor. Even with a doctor's approval, avoiding this method during pregnancy is generally safest. (Cupping therapy while breastfeeding is considered relatively safer, but it should still not be applied to the breast area and should be performed by qualified practitioners.)

Risks for People Taking Blood Thinners

For people taking blood-thinning (anticoagulant) medication or with a bleeding or clotting disorder , cupping therapy may be risky. Cupping, especially the wet cupping (hijama) method, involves making incisions in the skin and drawing some blood. In people taking blood thinners, even these small incisions can cause bleeding that cannot be stopped or more blood loss than expected. Blood thinners also make the skin bruise more easily; therefore, even dry cupping can cause extensive bruises that take a long time to disappear. For example, performing hijama on patients who regularly take medicines such as warfarin, heparin or clopidogrel carries a serious bleeding risk. It is therefore strictly not recommended for these individuals.

In addition, patients with bleeding disorders such as hemophilia or blood cell problems such as thrombocytopenia should also avoid cupping therapy. Procedures that could affect circulation should also be carefully evaluated in patients who have had deep vein thrombosis (DVT) or a stroke. If blood thinners are being used, the relevant doctor must be consulted and approval obtained before cupping therapy. Although some patients taking mild blood thinners undergo cupping with very few cups and gentle suction, the general rule is that cupping therapy is not safe for people at high risk of bleeding.

Side Effects in People with Skin Conditions

If a serious skin condition is present in the area where cups will be applied, cupping therapy there is not recommended. For example, with conditions such as eczema, psoriasis, fungal infection, open wounds, skin rashes or sunburn , the skin is already sensitive and may be inflamed. The vacuum effect of cupping can further irritate these lesions, cause them to spread or lead to infection. In particular, cupping over active skin infections (such as boils or impetigo) carries a risk of spreading the infection to deeper tissues.

In addition, in people with very thin and sensitive skin (for example, older people or patients whose skin has thinned due to prolonged cortisone use), cupping can cause side effects such as skin tears and blisters. Broken capillaries, varicose veins or a tendency to bleed under the skin are also situations in which the negative pressure created by cupping may be harmful. For example, applying cups to the legs of someone with extensive varicose veins can damage the veins and cause bleeding.

Therefore, healthy skin integrity in the area planned for cupping therapy is very important. If there is a local skin problem, treatment should either be moved to a different area or canceled entirely. Even if a skin problem occurred in the past but is not currently active (for example, previous psoriasis lesions), obtaining a doctor's approval before cupping that area is a good idea. Remember: Although cupping therapy applied to healthy skin is generally safe, unexpected side effects can occur on problematic skin.

There are also other situations beyond those listed that require caution. Severe heart disease or a cardiac pacemaker are conditions in which the stress and pain response caused by cupping therapy can adversely affect heart rhythm. Epilepsy is considered a risk, particularly because fire cupping may trigger seizures in patients with this condition. Severe anemia is a condition in which hijama is not recommended because it can worsen the existing anemia. A physician must assess whether people with medical conditions such as these are suitable for cupping therapy.

Is Cupping Therapy Harmful? Possible Side Effects and Risks

When performed correctly, cupping therapy is generally not harmful and does not cause serious complications. According to data from the American Centers for Disease Control, the risk of complications from properly performed cupping treatment is very low. However, like any treatment, cupping therapy has some possible side effects and carries small risks. Most effects observed after the procedure are mild and temporary. Nevertheless, before undergoing cupping therapy, it is important to understand its possible side effects . Here are the most common side effects and potential risks of cupping:

Bruising and Skin Irritation

The first side effect that comes to mind when discussing cupping therapy is the formation of circular bruiseson the skin. The vacuum temporarily damages the capillaries beneath the skin and causes minor bleeding, leaving a purplish-red mark. These bruises (ecchymoses) are generally painless and are not wounds; they can be compared more closely to bruises that occur after an intense massage. The bruises are dark red or purple on the first day, then turn yellow-green over the following days and disappear completely within about 1 week. These marks, also called cupping marks, are sometimes mistakenly interpreted by the public as signs of violence. For example, marks left after cupping therapy in children can occasionally cause misunderstandings and raise suspicions of child abuse.

Skin irritation is another common side effect. Particularly during moving cupping massage, friction from the cup can cause redness and tenderness of the skin. Very rarely, fire cupping can cause superficial burns on the skin; this is generally associated with mistakes such as leaving the cup on the skin too long or using excessive alcohol. Some people with sensitive skin may experience itching, dryness or mild swelling in the area subjected to suction. This generally results from the skin's inflammatory response to the vacuum effect and subsides within a few hours.

Bruising and mild irritation are among the normal expected effects after cupping therapy, so they are not actually considered complications. Still, skin care is important: Keeping the area clean after the procedure and, if possible, applying a soothing cream containing aloe vera may help bruises heal faster. Avoiding intense sunlight on the area until bruises have completely disappeared and not washing it with very hot water are also recommended. In summary, bruising and temporary skin irritation are common but harmless side effects of cupping therapy.

Risk of Infection

Although cupping therapy is generally a sterile procedure, wet cupping (hijama) in particular carries some risk of infection. Because incisions are made in the skin and blood is drawn, germs may enter the body through these openings. Serious infections can occur if the scalpel, cups or other materials used have not been properly sterilized. Hepatitis B, hepatitis C and HIV are examples of blood-borne diseases that theoretically pose a transmission risk if materials are shared or inadequately disinfected. Fortunately, this risk is extremely low because trained and licensed practitioners use disposable scalpel blades and sterile equipment.

After wet cupping, if the incised areas are not cleaned and bandaged, infection may occur. For example, neglecting hygiene after hijama and being in a dusty or dirty environment, or allowing contact with dirty water, can infect those tiny incisions. This manifests as redness, swelling, pain and fever in the area. In such a situation, seeking immediate medical attention and receiving appropriate antibiotic treatment may be necessary.

Because dry cupping does not break skin integrity, the risk of infection is very low, but thorough disinfection of the cups is important. Glass cups used on multiple people, particularly in hospitals or clinics, should be sterilized after each use. Unclean surfaces in contact with the skin can create conditions for fungal or bacterial skin infections.

In conclusion,, we can say that the risk of infection from cupping therapy is negligible. Nevertheless, this risk depends entirely on the practitioner's adherence to hygiene protocols . Infection complications are almost never seen in cupping therapies performed at licensed traditional and complementary medicine centers using devices and techniques approved by the Ministry of Health. Still, if you are considering cupping, make sure your chosen specialist works under sterile conditions and uses disposable or sterilized materials.

Effects on Blood Pressure

During and after cupping therapy, there may occasionally be changes in blood pressure . Some people may have a vagal reflex in response to strong suction: The heart rate may slow and blood pressure may fall. This can occur particularly when blood is drawn during wet cupping or when standing up suddenly after the procedure. Vasovagal syncope is the name of this reaction, which can cause dizziness or fainting. As Cleveland Clinic notes, fainting due to a drop in blood pressure can occur very rarely after cupping, generally in sensitive individuals with a history of fainting during injections. For this reason, someone undergoing hijama is advised to rest lying down for a while rather than standing up immediately afterward.

Conversely, some people may experience increased blood pressure during cupping. Pain or excitement experienced while cups are applied can stimulate the sympathetic nervous system, accelerate the heartbeat and cause a temporary hypertensive response. However, this is generally brief and resolves spontaneously once the person calms down.

Particularly in patients with high blood pressure (hypertension) , cupping therapy may even help balance blood pressure by relaxing the body. A study conducted in 2014 showed that controlled hijama treatment reduced systolic blood pressure in hypertensive patients for several weeks. Nevertheless, caution is needed when cupping therapy is performed in people with blood pressure problems, and blood pressure should be monitored if possible.

Another rare condition after cupping therapy, particularly if too much blood has been drawn, is mild anemia and a feeling of weakness. Therefore, undergoing hijama very frequently in succession is not recommended; the body needs time to produce blood.

Generally, cupping therapy does not cause serious fluctuations in blood pressure, and a risky cardiovascular effect is not expected. However, performing the procedure in a calm environment, helping the person relax psychologically and ensuring rest afterward help prevent these unwanted effects. If excessive sweating, palpitations or dizziness are noticed during cupping, the therapist should stop the suction immediately and lay the person on a flat surface with their feet elevated. This simple measure will prevent possible fainting.

The following table summarizes the possible benefits and risks and side effects of cupping therapy in comparison:

Table: Comparison of the main benefits attributed to cupping therapy and its potential risks. As shown, when performed correctly, the benefits are varied while the risks are generally mild and manageable.

To make an overall assessment, although the experience of cupping therapy may vary from person to person, the risk of serious side effects is very low. As stated in Harvard Health publications, the prevailing view is that “although cupping therapy seems to really work for some people, a strong placebo effect may also explain its success; on the other hand, because the method does not carry many risks when performed correctly, there is no harm in trying it.” Nevertheless, consulting your healthcare professional before trying any alternative treatment and receiving cupping therapy from a competent, trained practitioner are important for your safety.

What Does Scientific Research Say About Cupping Therapy?

Scientific studies on cupping therapy have increased in recent years. Academic researchers are conducting various clinical studies to understand whether this ancient method truly works and what effects it produces. Modern medicineevaluates the place of cupping therapy in light of evidence-based data, while some healthcare institutions also include cupping in complementary treatment protocols. In this section, we will examine prominent scientific research findings on cupping therapy and its position in modern medicine.

Clinical Studies and Their Results

Many studies on cupping therapy have been conducted to date. In 2012, a comprehensive review published in PLoS One analyzed studies published between 1992-2010, encompassing 135 randomized controlled trials (RCTs) . This review found that cupping therapy was most commonly used for conditions such as herpes zoster (shingles), Bell's palsy (facial paralysis), chronic cough, asthma, acne, herniated lumbar discs and cervical osteoarthritis . Wet cupping was used in most of the studies examined, while variations such as dry cupping and moving cupping appeared less frequently. The meta-analysis results were quite striking: Cupping therapy, particularly when combined with other traditional treatments, showed higher recovery rates for conditions such as shingles, acne, facial paralysis and cervical osteoarthritis compared with conventional treatments alone. Another important finding was that no serious side effects were reported in these studies.

However, it should be emphasized that many of these RCTs had low methodological quality. Some studies did not use blinding, had small sample sizes or relied on subjective questionnaire results rather than objective measurements. This requires cautious interpretation of the positive findings on the effectiveness of cupping therapy. A review conducted in 2011 also stated that “the effectiveness of cupping therapy has not yet been well documented.”

Looking at the current literature, between 2018-2023 systematic reviews of cupping therapy have been published, particularly concerning pain management. Journal of Sports Rehabilitationpublished a review in 2023 evaluating the effect of cupping therapy on musculoskeletal and sports injuries; it emphasized that although some studies reported short-term improvements in neck and back pain, the overall quality of evidence was low and more comprehensive research was needed. BMJ Openpublished a meta-analysis in 2018 reporting that cupping treatment significantly reduced pain compared with placebo in patients with chronic neck and lower back pain. Another study, published in 2022 in BMC Complementary Medicine and Therapies , found that wet cupping was effective in reducing pain and functional limitations in chronic lower back pain ; however, it found no similar effect for dry cupping and reported this finding.

The effects of cupping therapy on other conditions are also being investigated. For example, a small study in patients with migraine found that dry cupping treatment applied twice a week for 4 weeks reduced the frequency of migraine attacks. Rheumatoid arthritis was examined in a pilot study of patients, which reported that cupping briefly relieved joint pain and morning stiffness but did not produce significant changes in inflammatory markers. High blood pressure was examined in a few small studies assessing the effectiveness of hijama in lowering blood pressure in patients, and temporary decreases in systolic blood pressure were observed.

In summary, clinical research indicates that cupping therapy may offer potential benefits particularly for pain and certain skin conditions . However, scientists state that strong and definitive evidence of cupping's effectiveness is still lacking, and existing studies primarily indicate “potential benefit” . Therefore, it is currently not possible to call cupping therapy a “proven effective treatment.” Researchers emphasize the need for studies with more robust methodologies, including placebo-controlled, double-blind designs. This would allow clearer understanding of cupping's actual effects, possible mechanisms and the conditions in which it is most beneficial.

The Place of Cupping Therapy in Modern Medicine

In modern medical practice, cupping therapy is positioned as a complementary (supportive) treatment . In other words, it is considered an additional intervention alongside conventional treatments rather than a method used on its own. Many healthcare professionals acknowledge that traditional methods such as cupping therapy can help patients relax when performed under appropriate conditions, but strongly emphasize that they must not replace evidence-based treatments . Cleveland Clinic specialists indeed recommend that cupping be used only in combination with traditional Western medicine, as an element of complementary medicine ; they emphasize that it should not be regarded as a treatment on its own.

In Türkiye, the Ministry of Health defined cupping therapy/hijama as a legal method that may be performed by physicians who have completed specific training, through the “Regulation on Traditional and Complementary Medicine Practices” published in 2014. Many university hospitals have established Traditional and Complementary Medicine (GETAT) centers , where physicians perform cupping alongside methods such as acupuncture, ozone therapy and music therapy. This development shows that the modern medical community is opening its doors to traditional methods under controlled conditions. Cupping treatment has even been integrated into conventional healthcare systems in some European countries. For example, certified physicians in Germany can use vacuum cupping therapy in pain clinics.

On the other hand, organizations such as the American Cancer Society (ACS) take a very cautious approach. According to ACS, “the available scientific evidence on the health benefits of cupping therapy is insufficient,” and there is no evidence supporting its ability to treat any disease. ACS also states that cupping carries some risks, albeit small ones (such as skin burns), and therefore should not be used with the aim of treating serious illnesses such as cancer. The American Medical Association (AMA) similarly recommends that physicians remain neutral or reserved toward cupping therapy because of the lack of evidence. Nevertheless, some physicians perform it or arrange for it at patients' request, provided it does no harm.

The key points regarding the place of cupping therapy in modern medicine are patient safety and a holistic approach. If a patient wants cupping, many doctors prefer to refer them to professionals who can perform the procedure in a safe environment under sterile conditions rather than completely discouraging them. The patient can thus satisfy their traditional beliefs while continuing medical treatment without interruption. Doctors are particularly more receptive to controlled cupping sessions for chronic pain, stress and muscle spasms. Some physiotherapists and massage therapists even receive training and add dry cupping massage to their treatment protocols.

In conclusion, modern medicine has positioned cupping therapy as a complementary and supportive option. When performed for the right indication, by the right person and with the right technique, it can positively contribute to patients' quality of life. However, it must never replace proven treatments (medication, surgery, physical therapy, etc.). Patients must consult their physicians before starting cupping therapy; physicians should approach this preference with understanding and guide their patients as safely as possible. Meanwhile, the scientific community continues researching the secrets and true effectiveness of this centuries-old method.

Frequently Asked Questions

How Long Should Cupping Therapy Be Applied?

A cupping therapy session generally lasts 10-20 minutes . Cups remain on the skin for an average of about 5-10 minutes; if multiple areas are treated, the total duration can reach 20 minutes. Cups are left for shorter periods in beginners and people with sensitive skin, while experienced practitioners may leave them for up to 15 minutes in some cases. Session frequency varies according to need: For pain treatment, 1-2 sessions a week may be recommended, while hijama for general health purposes is usually performed once a month . Although traditional practice recommends certain date intervals for hijama (for example, according to the Hijri calendar), modern medicine has no fixed protocol. What matters is allowing time for the skin to heal between consecutive sessions and avoiding very frequent applications to the same area. Experts recommend not applying cups again to the same point without a break of at least 2 weeks. In brief, each cupping application is completed within minutes, and sessions take place at intervals determined according to need.

Is Cupping Harmful?

When performed correctly by qualified practitioners, cupping is generally not harmful. This method has been practiced for thousands of years, and serious side effects have rarely been reported. The most common side effect of cupping therapy is bruising on the skin, which disappears spontaneously within a few days. Although the infection risk is low, infection can occur if sterility is neglected, particularly during hijama. In competent hands , cupping therapy is generally considered safe; institutions such as the American Hospital also state that the risk of complications is very low. Cleveland Clinic publications, for example, describe cupping as a generally low-risk treatment. However, burns, skin infections or excessive bleeding may occur when it is performed by unqualified people or those who do not follow hygiene rules. Therefore, if you want cupping therapy, you must consult professionals trained in this field and approved by the Ministry of Health. In addition, because cupping therapy can be harmful for pregnant women and people with bleeding disorders or serious skin problems, it should not be performed in these individuals. In summary, although the method itself is not particularly harmful when performed correctly, it should be remembered that it is not suitable for everyone and must be applied with care.

Is Cupping Therapy Used in Cancer Treatment?

No, cupping therapy is not used as cancer treatment and should not be used for this purpose. Scientific research to date has found no evidence that cupping cures cancer or shrinks tumors. According to the American Cancer Society, there is no scientific evidence supporting a direct benefit of cupping therapy for any disease. Cancer is a serious illness that must be addressed with evidence-based treatments such as surgery, chemotherapy, radiotherapy or immunotherapy planned by oncologists. Cupping treatment, at most, may be considered a complementary intervention to relieve certain symptoms associated with cancer treatment. For example, with a doctor's approval, cupping therapy may be used supportively for muscle pain or stress related to chemotherapy in cancer patients. However, its aim should be to improve the patient's quality of life, not to treat cancer.

Conversely, uninformed use of hijama in active cancer may even be harmful. Hijama can cause serious bleeding, particularly in cancer patients taking blood thinners or whose blood counts have fallen because of chemotherapy. The infection risk is also higher in immunosuppressed patients. Therefore, a cancer patient should not turn to cupping therapy independently or through an alternative medicine center. In summary, cupping therapy is not used as a curative method for cancer. Cancer patients should discuss any complementary treatment with their own doctor first; if the doctor considers it appropriate, they should receive such support at reliable centers.

Where on the Body Are Cups Applied?

Cupping therapy can be applied to various parts of the body, but the most commonly preferred areas are the back, neck and shoulders. The upper back (between the shoulder blades) and lower back are common treatment areas because they offer a broad surface and contain substantial muscle. Cupping on the back of the neck is preferred for tension headaches and stiff necks. The shoulder and arm areascan receive cupping for conditions such as muscle pain or frozen shoulder syndrome. On the legs, it can be applied to the thighs and calves for sports injuries or pain from varicose veins.

Cupping on the chest is generally performed for respiratory problems (cough, bronchitis) together with the back; cups can be placed carefully on the front of the chest with gentle suction. However, strong suction directly over the heart on the front of the rib cage is avoided. Gentle cupping on the abdomen may be used for digestive problems or to relieve menstrual pain, but caution is also required here because the internal abdominal organs are sensitive.

Facial cupping therapyis performed using special small silicone cups for cosmetic purposes (for example, facial massage and wrinkle reduction). However, applying cups to the face and head in the sense of traditional cupping is uncommon because the dense capillary network can result in unwanted bruising.

There are also areas where cups should not be applied: Areas traversed by major blood vessels (for example, the main vessels in the groin), areas with broken skin integrity, eyelids or areas with very thin skin, and mucosal surfaces (such as inside the mouth) are unsuitable for cupping. Cups also cannot be placed over bony prominences (such as the kneecap or tip of the elbow) because the vacuum cannot adhere and causes discomfort.

In summary, cupping therapy is most commonly applied to fleshy, muscular areas such as the back, nape, shoulders, lower back and calves . The treatment area is determined by the person's complaint; for example, cups may preferably be placed around the knee for knee pain, on the nape for headaches or on the upper back for stress. In all cases, care is taken to apply cups symmetrically or in a balanced distribution on both sides of the body.

What Should You Pay Attention to After Cupping Therapy?

After a cupping therapy session, resting your body and taking some simple care measures are important. After the procedure, drinking plenty of wateris recommended to replace fluids and toxins removed from the body. To allow bruises and incisions in the cupped areas to heal, these areas should be kept clean and, if possible, should not come into contact with water for the first 24 hours (particularly after hijama, keeping incision sites dry for one day helps reduce the risk of infection). If small incisions were made, leaving the antiseptic ointment applied by the practitioner unwashed that evening and gently cleaning the area with lukewarm water the following day is appropriate.

For a few hours after cupping therapy, it is advisable to avoid strenuous exercise or physical exertion . Excessive exertion while the body adapts to the session's effects may cause dizziness or exhaustion. Similarly, on the first day, avoiding saunas, hot baths and other extreme temperature changes protects the skin from irritation. A lukewarm shower is generally not a problem, but very hot water can increase bruising.

Take care with the marks caused by cupping on your skin not to scratch or rub them . Trying to disperse a bruise by massage or removing scabs from incisions can increase the infection risk. If the rare fluid-filled blisters (bullae) develop after cupping, do not burst them under any circumstances; wait for them to subside naturally and keep them clean.

Some people feel very relaxed after the procedure, while others may feel slightly tired. This is normal. If you have had cupping for the first time, going to bed a little earlier that day if possible and allowing your body to recover may help. Regarding nutrition, eating foods rich in protein and iron is recommended (especially to compensate for the small blood loss after hijama).

Finally, observing your body's reactions after cupping therapy is important. If excessive redness, swelling, fever or pain develops, consult a healthcare professional without delay. These symptoms may indicate infection and can easily be controlled with early intervention.

In summary

after cupping resting, taking fluids, observing hygiene and avoiding overexertion are the basic principles. In this way, you can maximize the benefits of cupping therapy while minimizing potential unwanted effects. Remember, if anything about your treatment concerns you, you can always consult the practitioner who performed it or your doctor.