Cupping
Suction cups on the skin for pain and tension
Evidence grade 2 of 5, Thin. Read how the Atlas grades evidence.
Cupping shows large short-term pain reductions versus no treatment or waiting lists, but the effect collapses to non-significant when tested against sham cupping (Cho 2020, chronic pain meta-analysis: SMD -1.03 vs no treatment, -0.27 and non-significant vs sham), which points to placebo and counterirritation rather than the suction itself. The 2025 update of 72 RCTs with 5,720 participants found every included trial at high risk of bias and rated the evidence low to very low quality with no sham-controlled comparisons, so a preliminary/small-trial grade of grade 2 is honest, with confidence that the true sham-controlled effect is near zero.
- FDA
- Cupping is not an FDA-regulated medical treatment; in the US it is performed by acupuncturists, massage therapists, and others under state scope-of-practice rules, and wet cupping that draws blood may trigger additional health regulation.
- WADA
- Not applicable
Reference only. Not medical advice.
What can go wrong
PROMINENT RISK: Cupping routinely leaves circular bruise-like marks that can last one to three weeks; this is normal but cosmetically obvious. Fire or heated-glass cupping can cause burns. Wet cupping breaks the skin and carries real infection risk: documented case reports include skin abscesses, necrotizing soft-tissue infection, and bloodborne disease (hepatitis B and C) when equipment is reused without sterilization. Repeated wet cupping can cause iron-deficiency anemia from blood loss. People on blood thinners, with bleeding disorders, fragile skin, or diabetes should be especially cautious, and cups should never be placed over skin that is inflamed, broken, or sunburned.
Cupping places cups on the skin and creates suction, pulling the skin and surface tissue up into the cup. Dry cupping uses suction alone; wet cupping (hijama) makes tiny skin cuts first so a little blood is drawn out. Traditional systems explain it as moving stagnant blood or qi (the life energy in Chinese medicine) and clearing toxins, but those mechanisms are not confirmed by modern biology. What researchers can measure is increased local blood flow, mild tissue irritation, and a relaxing effect from the hands-on attention. The round bruise-like marks are expected, not an injury, and come from tiny burst capillaries (the smallest blood vessels) under the suction. Studies suggest it may ease some pain in the short term, but the quality of that evidence is low and much of the benefit may come from expectation and touch rather than the suction itself.
Ancient suction therapy
What people take it for
These are the reasons people give for taking it. They are not effects it has been shown to have.
Safety in detail
Dry cupping is generally low risk aside from the expected circular bruise-like marks (extravasated capillary blood, not toxins) lasting one to three weeks. Fire and heated-glass cupping can cause burns. Wet cupping (hijama) breaks the skin and carries documented infection risk, with case reports of disseminated Staphylococcus aureus, necrotizing fasciitis, and skin abscesses, plus a reported death associated with hijama; reused unsterilized equipment risks bloodborne disease (hepatitis B and C) and repeated bloodletting can cause iron-deficiency anemia. People on anticoagulants, with bleeding disorders, fragile or inflamed skin, or diabetes should be especially cautious.
What people get wrong
Often saidCupping pulls toxins out of the body.
ActuallyNo specific toxin has been identified or measured leaving the body; the marks are burst capillaries, not toxins.
Often saidThe darker the mark, the more healing or the sicker you are.
ActuallyMark color reflects local blood vessel fragility and suction strength, not the degree of illness or benefit.
Often saidCupping cures internal disease.
ActuallyEvidence supports at most modest short-term pain relief; it is not shown to treat or cure disease.
Who profits, and who pushes back
NCCIH (US National Center for Complementary and Integrative Health)
States the evidence is limited and low quality and that more rigorous studies are needed.
Edzard Ernst
Argues trial quality is poor and effects largely vanish against sham cupping, pointing to placebo.
Infectious-disease case reports
Document serious infections from wet cupping, underscoring that breaking the skin is not risk-free.
Hijama / cupping clinics and practitioners
Sells this. Has a commercial interest in a product sold as this compound, as of July 2026.
Sell sessions and certification courses; many frame hijama as prophetic medicine with broad health claims.
Sports and celebrity users
Endorse it for recovery and pain based on personal experience, which drove a surge in popularity.
Traditional Chinese and Unani medicine practitioners
Sells this. Has a commercial interest in a product sold as this compound, as of July 2026.
Offer cupping within a larger treatment framework; genuine belief plus commercial interest.
Where the research comes from
| Place | Share of published research |
|---|---|
| East Asia | 40% |
| Middle East and North Africa | 30% |
| North America | 12% |
| Europe | 12% |
| Other | 6% |
Research published from: Multiple ancient origins (Egypt, China, Greece, Middle East).
How we got here
Cupping has no single birthplace and predates any modern school. Chinese practice is documented for over two thousand years, with the alchemist and physician Ge Hong (281 to 341 CE) describing it in his Handbook of Prescriptions for Emergencies, where it became ba guan within traditional Chinese medicine alongside acupuncture. In the Middle East and North Africa it took the form of hijama, an incision-and-suction bloodletting associated with prophetic tradition and later systematized inside Unani Tibb, the Greco-Arabic medical system. The Ebers Papyrus of ancient Egypt (around 1550 BCE) records suction therapy, and the technique passed through Greek and Roman medicine, then back to the Arab and Persian world, before spreading with trade across Asia, Europe, and the Americas. Its modern revival owes much to athletes and celebrities, especially the visible marks seen at the 2016 Rio Olympics, which turned a folk and religious practice into a wellness and recovery trend.
Cupping has no single birthplace. The Ebers Papyrus of ancient Egypt (around 1550 BCE) describes suction therapy, and the Greek physician Hippocrates wrote about it around 400 BCE; the bowl-and-snake staff of medicine is sometimes linked to cupping vessels. In China it has been used for over two thousand years, woven into traditional Chinese medicine alongside acupuncture and herbs and described by physicians such as Ge Hong (281 to 341 CE). In the Islamic world it became hijama, recommended in prophetic tradition and developed by Muslim physicians, and it also lived inside Unani Tibb, the Greco-Arabic medical system. The technique traveled with trade and conquest across Asia, the Middle East, Europe, and eventually the Americas. Its modern revival owes much to athletes and celebrities, especially the visible marks seen at the 2016 Rio Olympics, which turned an ancient folk and religious practice into a mainstream wellness and recovery trend.
- -1550Ebers Papyrus (Egypt) records early suction therapy
- -400Hippocrates describes cupping in Greek medicine
- 300Ge Hong and Chinese physicians document cupping in TCM
- 800Cupping established as hijama in Islamic and Unani medicine
- 2016Rio Olympics make cupping marks globally visible and trendy
At a glance
- Two main types
- Dry (suction only), wet (suction plus small skin cuts to draw blood)
- Telltale sign
- Round red-to-purple circular marks that fade in days to weeks
- Suction source
- Heated glass, or silicone or pump cups
- Islamic name
- Hijama (from the Arabic for sucking)
What this entry does not yet cover
What follows is unfinished work on our side, not a finding about Cupping. A short entry is not a safe entry.
- Cost and market. We have not documented what it sells for or who sells it.
- Supply chain. We have not mapped where it is made.
- Who uses it. We have not documented the user groups.
- What could change. No forward-looking summary yet.
- How it compares. We have not set it against the alternatives.
- Children and teenagers. We have not checked what is known about younger people.
Sources
2025 systematic review of 72 RCTs (5,720 participants) found all trials at high risk of bias, evidence low/very low quality, and no sham-controlled comparisons.
Cupping produced large short-term pain reduction vs no treatment (SMD -1.03) but no significant effect vs sham cupping (SMD -0.27), suggesting placebo/counterirritation; evidence limited by heterogeneity and risk of bias.
Dry cupping showed no meaningful benefit over placebo cupping for musculoskeletal complaints.
Cupping for chronic musculoskeletal pain: risk of bias assessed with Cochrane and Evidence Project tools; evidence quality varies and is limited.
Low back pain meta-analysis of 11 RCTs (921 participants) reported mixed methodological quality and modest, uncertain benefit.
Wet cupping can cause serious bloodborne infection: disseminated Staphylococcus aureus with iliopsoas abscess, acute liver and kidney injury after scarification wet cupping.
First reported case of bilateral necrotizing fasciitis of the lower extremity following wet cupping.
Necrotizing Fasciitis Following Wet Cupping: A Case Report (PMC)
Systematic review of adverse events in Korean cupping studies: scar formation and burns are the most frequent, plus headache, pruritis, dizziness, anemia, and panniculitis.
Adverse events related to cupping therapy in studies conducted in Korea: a systematic review
Fatal outcome reported in association with wet cupping (hijama), underscoring the invasive-bloodletting risk profile.
Historical origins: Ebers Papyrus (Egypt, around 1550 BCE), Ge Hong in China (281 to 341 CE), and hijama in Islamic tradition; narrative review of cupping history.
History of cupping (Hijama): a narrative review of literature