Although the true origin of cupping still remains uncertain, the consensus is that the action of suction has been part of therapeutic efforts throughout human history. The application of suction cups is recorded in ancient Egyptian, Hindu, Greek, and Chinese medical writings. Ancient cultures used hollowed-out animal horns, bones, bamboo, gourds, and seashells to purge animal bites, pustules, infections, and skin lesions from the body. Some ancient healers also used cupping devices to draw evil spirits out of the body and balance bodily fluids. Over many centuries, earthenware and metal were fashioned into cupping vessels before the development of ceramic and glass cups.
Ancient Therapeutic Arts, written by William Brockbank and published in 1954, has 38 pages on cupping and leeching. The author explains in-depth many cupping methods used by well-known ancient physicians over 2,000 years. In this history section of cupping, I have expanded the historical background of physicians that Brockbank mentioned in his book and have added recent advancements in cupping devices and modern cupping techniques. I will also introduce customized glass cups designed by myself and my father, a retired acupuncturist and herbalist, and modified fire wet and dry cupping techniques.
Although some consider the Chinese to be responsible for cupping therapy, the earliest pictorial records date back to the ancient Egyptians around 1500 B.C. Translations of hieroglyphics in the Ebers papyrus, the oldest medical textbook, detail the use of cupping for treating various symptoms including pain, fever, and menstrual imbalances. Similarly, in ancient Greece, early Greek medicine was influenced by the ancient Egyptians and their belief in the world of spirits and the supernatural. Diseases were regarded as punishments or even gifts from the gods, perhaps angered by sins and misdemeanors.
As Greek medicine developed, gradually disease was seen more as a natural phenomenon or product of the earthly body, rather than a punishment from gods. Symptoms, diagnosis, and treatment then began focusing on the human rather than on the supernatural and spiritual. Hippocrates wrote, “Sickness is not sent by the gods, find the cause, we can find the cure.”
Hippocrates (460-370BC) used both wet and dry cupping for internal diseases to balance four humors in the body. Philosophers and thinkers such as Socrates, Plato, and Aristotle also greatly contributed to the evolution of Greek medicine. They formulated the notion of the four classical roots or elements: air, fire, earth, and water. These were incorporated into Greek medicine as the four humors: blood, yellow bile, black bile, and phlegm. The theory of four humors fitted harmoniously with other quartets in Greek scientific philosophy, such as the four elements as aforementioned, the four attributes of matter (hot, cold, moist, and dry), the four seasons (spring, summer, fall, and winter), the four stages of life (childhood, manhood, old age, and decrepitude), and the four temperaments (enthusiastic, irritable, analytical, and peaceful).
Hippocrates believed that moods and disorders result from an imbalance in the humors. Polybus, one of the pupils of Hippocrates, and his son-in-law wrote in his De Natura Hominis, “Humors are the things that make up the body’s constitution and cause its pains and health.”
The earliest recorded use of cupping in China came from Ge Hong (283-343 AD), a famous alchemist and herbalist, in 300 A.D. In his writing, he mentioned “more than half of ills cured” using acupuncture and cupping. In his book, A Handbook of Prescriptions for Emergencies, he elaborates on the use of animal cups to drain pus which he named as the horn technique. During Tang dynasty (618- 907) other Chinese practitioners later expanded the use of cupping therapy to treat headache, abdominal pain, dizziness, and pulmonary tuberculosis by combining cupping with acupuncture, moxibustion, and Chinese herbs.
Wet cupping techniques were described in the Supplement to Outline of Materia Medica written by Zhao Xuemin during Qing dynasty (1644-1912). During wet cupping, either bamboo or ceramic pottery cups were applied over areas that were pierced with acupuncture needles to treat knotted muscles, arthralgia, common cold and abdominal pain. Cupping is still used in China today utilizing the same techniques, with the only difference being that plastic and glass cups have replaced ancient cups. Horns and other cupping instruments have also been discovered in other East Asian countries including Korea, Japan, and Vietnam.
Just about 1,400 years ago, cupping was introduced to Islamic areas. Since then cupping was practiced all over the Islamic Empire, especially after Prophet Muhammad prescribed it as the “best of all medicines.” Over time and extensive research, Muslims were able to develop Hijima Cupping Therapy into a fine healing art form. Abu Bakr Mohammad Ibn Zakaria al-Razi (865-925), known in the West as Rhazes, was the leading scholar of the early Islamic world. In the days of Rhazes bloodletting was very popular. Four methods of blood-letting were employed which included leeching, cupping, venesection, and arteriotomy. Rhazes advised the use of a glass or cupping instrument over the leech bites if considerable local bleeding is required. Avicenna Ibn Sina (980-1037), a Persian physician who wrote over 40 medical books, mentions Hijama (literally means “suction”) in his The Cannon of Medicine. He states “It is enjoined not to use cupping at the beginning of the month, because the humors have not yet risen and become active, and not at the end of the month, because they are reduced and become little. In the middle of the month the humors are very active and are increasing because of the increase in light due to the size of the moon.”
Maitre Henri de Mondeville (1260-1320), a surgeon to King Phillipe of France, included a section on cupping in his textbook on surgery. He wrote, “Never cup in foggy weather or when a south wind blows. The humors are most abundant at full moon, so cup then. Do not apply cups after the patient has had a bath. The cupped person can eat one hour later. Never do a cupping with scarification until you have done one without scarification on the same spot.” He also gave specific instructions for certain conditions. According to Henri Mondeville, use of wet cupping “near the naval to bring back a displaced uterus; over the naval itself to reduce a hernia or stop excessive menstruation in girls; over the liver if the right nostril is bleeding; over the spleen if the left nostril is bleeding; on both liver and spleen if both nostrils bleed; on the path of a renal stone coming down to the bladder, a little below the pain so as to draw the stone downwards.”
Herman Boerhaave (1668-1738), a Dutch physician who is regarded as the founder of clinical teaching and modern academic hospital, prescribed cupping to treat respiratory illnesses including asthma, uterine bleeding, and inflammation and swelling of breasts. He states that “Too great a Flux from the Uterus, is moderated by the Application of Cupping-glasses to the Breasts, in the same manner as Inflammations and Swelling of the Breasts are allayed by Cupping in the Legs and Thighs.”
Richard Mead (1673-1754), one of the brilliant English physicians at the beginning of 18th century, treated apoplexy by “cupping the nape and sides of the neck with pretty deep scarifications. He cupped with deep scarifications under the occiput to treat eye disease and with slight scarification around the naval for acute abdominal conditions.” He also discussed limitation of cupping in treating pains in the joints. “In this disease, little is to be expected from cupping or blistering the part; for the acid humor lies too deep fixed in the membrane surrounding the bone, to be drawn out by these means.”
William Herberden (1767-1845 AD), who presented a classic description of angina pectoris, described in his book, Commentaries on the History and Cure of Diseases, how he successfully treated a 68- year-old woman with giddiness (dizziness) using cupping therapy every six weeks until she died at the age of 85.
The practice of cupping continued in Europe even into the early 19th century. Napoleon Bonaparte is among some famous historical figures on whom cupping was used for healing and wellness. Dominique Jean Larrey (1766-1842 AD), the father of modern military surgery, used cupping methods to treat wounds and other ailments during battles, and won the admiration of Napoleon. He later became the principal surgeon of the French army and followed Napoleon in almost all of his campaigns.
By the late 1800s, cupping in Europe lessened in popularity and was severely criticized and discredited by the newly established scientific model of medicine. As progress in the field of medicine continued in the 19th and 20th centuries with the advancements in antibiotics, new vaccines, blood transfusions, implantable prosthetics, andiscovery of hormones and new drugs, cupping therapy gradually became reduced to a mere curiosity of the past. This ostracization occurred mainly because it didn’t fit the newly adapted modern scientific medical model, as well as its lack of consistency in effectiveness.
In the 1970s, my father recognized these drawbacks of modern cups, and designed over 40 different shapes of glass cups ranging from 1cm to 15cm in diameter to fit all parts of the body. He also developed his unique fire cupping technique by using a wick made from commercially available paper towers. The wick is made by taking an approximately 3-inch square relatively hard paper tower and rolling it into a long, cylindrical, 0.5cm thick diameter wick. The wick is dipped partially into an ethanol alcohol jar, which is then set on fire. While holding the bottom end of the burning wick over the problem area of the body with one hand, an appropriate size and shape of cup is then placed
directly over the wick with the opposite hand. The holding hand is then removed quickly before the cup is tightly pressed down on the skin surface.
This modified fire cupping technique creates a similar but much strong vacuum than Dong Wee cups. Larger cups can create more than -300 millimeters of mercury (mm Hg) of negative pressure. This is necessary because greater negative pressure is often needed to treat both larger and deeper areas of the body. Smaller customized cups can be placed with sufficient suction on fingers, toes, the areas near the eyebrows, forehead, coccyx, and even conception vessel 1.