Subconjunctival hemorrhage after wet cupping therapy: a case report

Introduction:Cupping therapy is an integrative and complementary medicine therapy that practiced worldwide by several civilizations for thousands of years.Cupping therapy is reported to be a relatively safe practice especially if performed by qualified therapists.Subconjunctival hemorrhage(SCH)is a common cause of eye redness and can be classified into traumatic and spontaneous.Case presentation:This case report discussed an adverse event related to wet cupping therapy.The patient developed SCH one day after performing cupping therapy.He was completely recovered after 2 weeks.This case report should increase the knowledge of cupping therapists regarding increasing safety of patient when performing wet cupping therapy on specific body parts especially,head,neck and cervical areas.Furthermore,it highlighted the importance of conducting research regarding the mechanical and physiological effects of cupping therapy.Conclusion:Adverse events related to cupping therapy should be reported with every patient.Cupping therapists should be aware of this possible mild adverse event.To the best of our knowledge,this is the first published adult case of SCH related to wet cupping therapy session.More studies are critically needed for evaluation of cupping therapy effects and adverse events especially when performed on head and neck.

Genetic Theory:An Illustration of a Theoretical Mechanism of Acton of Cupping Therapy

Cupping therapy is an ancient natural therapeutic modality which is widely practiced throughout the world.Cupping therapy mechanisms of action are not illustrated by research until now.This article gives a brief illustration of the genetic theory as a possible mechanism of action of cupping therapy.Genetic modulation is also a suggested mechanism of action of acupuncture and massage.

An overview of systematic reviews of clinical evidence for cupping therapy

Background:As a traditional treatment method,cupping therapy is widely used in Asian countries.This overview of systematic reviews (SRs) investigated the effectiveness and safety of cupping therapy through an evidence-based approach.Methods:SRs that assessed the effectiveness of cupping therapy for any type of disease were searched through 6 electronic databases.Target diseases,cupping methods,numbers and types of included studies,quality of included trials,main results (including meta-analysis re sults),and authors' conclusions of SRs were extracted.The Assessment of Multiple Systematic Reviews measurement was used to evaluate methodologic quality of the SRs.Results Eight SRs met the inclusion criteria and effectiveness and safety of cupping therapy for 11 diseases were assessed.All included SRs were of good methodologic quality.However,quality of trials included in the SRs was generally poor.Meta-analysis was performed in 4 studies.Results:showed cupping therapy (alone or combined with other interventions) was better than medications (or other interventions alone) for herpes zoster,acne,facial paralysis,low back pain,or cervical spondylosis.One review reported adverse events,including hematoma,increased pain and tingling following cupping treatment.Conclusions:Cupping therapy may be beneficial for pain-related conditions,acne,and facial paralysis.However,a firm conclusion could not be drawn due to the insufficient number of included reviews and the low quality of the original studies.

Cupping therapy for acute and chronic pain management:a systematic review of randomized clinical trials

Objective:Cupping as a traditional therapy is used to treat a myriad of health conditions,including pain.This systematic review assessed the effectiveness and safety of cupping for different types of pain.Methods:Thirteen databases and four trial registries were searched for randomized clinical trials.Meta-analysis of data was conducted if there was non-significant clinical and statistical heterogeneity(measured by I2 test)among trials.Results:Sixteen trials with 921 participants were eligible and included.Six trials were assessed as low risk of bias,another six trials were of unclear risk of bias,and the remaining four trials were of high risk of bias.Pain was related to three acute and seven chronic diseases.Metaanalysis showed a beneficial effect of cupping compared to wait-list control(visual analogue scale(VAS),MD
1.85 cm,95%CI
2.66 to
1.04)and heat therapy(numerical rating scale,MD
2.05 cm,95%CI
2.93 to
1.17).Cupping combined with acupuncture was superior to acupuncture alone on post-treatment pain intensity(VAS,MD
1.18 cm,95%CI
1.68 to
0.68),however,no difference was found between this comparison based on changes in pain intensity(difference of VAS,MD 0.16 cm,95%CI
0.54 to 0.87).Results from other single studies showed significant benefit of cupping compared with conventional drugs or usual care.Hematoma and pain at the treated site,increasing local pain or tingling were reported as mild adverse effects of cupping.Conclusion:This review suggests a potential positive short-term effect of cupping therapy on reducing pain intensity compared with no treatment,heat therapy,usual care,or conventional drugs.

The Effects of Cupping Therapy on Skin’s Biomechanical Properties in Wistar Rats

Cupping therapy has been widely used for clinical treatment of soft tissue lesions. The current study investigated the effects of cupping therapy on biomechanical properties of the skin in Wistar rats. 20 rats were divided into two groups: 10 in experimental and 10 in control group. Either the right or the left lower quadrants of the lumbar regions in the experimental group underwent 10 minutes daily cupping therapy for 12 days. The skin stiffness and ultimate tensile strength of all the rats were measured using tensiometer. The skin stiffness and ultimate tensile strength were decreased significantly in cupping side of the experimental group as compared with the non-cupping side and the control group. There were no significant differences between the non-cupping side of the experimental group and the control group. In conclusion, cupping therapy can be useful as a treatment method to reduce the skin stiffness and ultimate tensile strength.

Effects of Medicated Bamboo Cupping Therapy of Zhuang Nationality Medicine on Long-term Efficacy and Quality of Life in the Treatment of Functional Dyspepsia with Stagnation of Liver Qi and Spleen Deficiency Syndrome

Objective:To investigate the effect of medicated bamboo cupping therapy of Zhuang nationality medicine on long-term efficacy and quality of life in the treatment of functional dyspepsia with stagnation of liver Qi and spleen deficiency syndrome,and to provide a new,effective and easy to promote treatment method for functional dyspepsia.Methods:A total of 150 cases of functional dyspepsia treated in our hospital from March 2014 to October 2015 were selected as research subjects,and they were divided into the treatment group(medicated bamboo cupping therapy),the control A group(Omeprazole Enteric-coated Tablets+Domperidone Tablets)and the control B group(acupuncture),50 cases in each group.The clinical efficacy,the gastric electrical index,the recurrence rate and the quality of life were observed and compared.Results:The total effective rate in the treatment group was higher than that in the control A group and the control B group(P<0.05).Compared with before treatment,the main frequency and electrical amplitude in each group was significantly improved,and the rhythm disorder coefficient was significantly reduced(P<0.05).After treatment,compared with the control A group and the control B group,the difference of rhythm disturbance coefficient in the treatment group was statistically significant(P<0.05).The recurrence rate in the treatment group was lower than that in the control A group and the control B group at 1 month,3 months and 6 months after drug discontinuance,with no significant difference(P>0.05).Compared with before treatment,scores of each physiological function after treatment had no significant change(P>0.05),and the scores of physiological function,body pain,general health,vitality,social function,emotional function and mental health were significantly improved(P<0.05).The comparison of scores in each group had no significant difference(P>0.05).Conclusion:The medicated bamboo cupping therapy of Zhuang nationality medicine on functional dyspepsia with stagnation of liver Qi and spleen deficiency syndrome can significantly improve clinical efficiency,and reduce the coefficient of rhythm.The long-term recurrence rate is low,and the quality of life is significantly improved.It is a convenient and effective treatment,which is worthy of promotion.

Key elements that determine the efficacy of cupping therapy:A bibliometric analysis and review of clinical studies

Objective:The aim of this review was to identify the possible mechanisms behind cupping therapy by employing an evidence-based approach,and to explore its possible regional and systemic effects in the human body.Methods:We searched six electronic databases and four online trial registries for articles published up to January 1,2020.Clinical studies on the mechanisms of retained cupping,flashing cupping,moving cupping,and vacuum cupping were considered for this review.The methodological qualities of controlled studies were assessed using the National Institute for Clinical Excellence methodology checklist,the Newcastle-Ottawa Scale,and the Cochrane risk of bias tool.Characteristic statistical description and qualitative summary of results were used for data analysis.Results:Thirty-eight studies(37 full texts and one abstract)were included in this study.Due to the clinical heterogeneity among the studies,we could not conduct a meta-analysis.The results showed that the key factors that contribute to the efficacy of cupping therapy are negative pressure and temperature.Cupping therapy mainly causes local and systemic changes in hemodynamics,immune regulation,metabolism,and pain relief.Conclusion:We identified negative pressure as the key element behind cupping therapy.Cupping therapy may cause redistribution of oxygen at the cupping site and in neighboring tissues,thereby inducing a therapeutic effect by increasing regional blood flow.It may also induce metabolic change,immunomodulation,and neuromodulation.However,additional rigorous clinical research needs to be conducted to further clarify the mechanism behind cupping therapy.

Active sham cupping therapy technique:identification of limitations and suggesting enhancements

Cupping therapy is an ancient healing modality that has been used for thousands of years.There are two types of sham cupping techniques:passive type which used no suction,and active type which suction was rapidly released through a hole on the top of the cup.This narrative review aimed to identify limitations and suggest enhancements in the current use of active sham cupping therapy technique.Three medical databases were searched for identification of clinical trials that used active sham cupping device.201 published papers were retrieved.195 papers were excluded after applying inclusion/exclusion criteria.Finally,6 clinical trials were selected for this review.This paper identified multiple limitations of the active sham cupping procedure which include failure of blinding,heterogenicity of the characteristics of used devices including heterogenicity in reporting active sham cupping intervention,and the limitation of the sham technique to be used for dry cupping only.The recommended enhancements included using bigger cups holes for release of suction,standardization of characteristics of used sham devices,standardization in reporting,and suggesting recruiting patients without prior experience of cupping for better blindness success in sham cupping clinical trials.This paper suggested reporting criteria for sham cupping clinical trials.In conclusion,this paper identified the limitations of the current sham cupping technique and suggesting enhancements regarding active sham cupping technique.Continues evaluation of the current active sham cupping technique and development of new sham cupping devices and techniques for various types of cupping therapy are highly recommended.

Abul-Qasim Al-Zahrawy’s practice of cupping therapy(Hijama)during the tenth century:a documentation

Abul-Qasim Al-Zahrawy’s(Albucasis)(936-1013 AD)was one of the greatest Andalusian scientists and surgeons.Al-Zahrawy illustrated his pioneering medical and surgical information on his book(“At-Tasrif liman‘Azija‘an at-Ta’lif)or(The method of medicine).He illustrated the cupping therapy practice in the treatise 30 of this book.The aim of this article is to give an anthropological and historical medical information about Al-Zahrawy’s practice of cupping therapy(Hijama in Arabic).This article is a method of documentations of cupping therapy practice during the 10th century.Safety concerns including innovation cup safety design were the most noticed subjects in practicing cupping therapy by Al-Zahrawy.This attitude should be continued.

A meta-analysis on the clinical efficacy of fire dragon cupping in the treatment of lumbar disc herniation

Background:The incidence of lumbar disc herniation(LDH)is notably high.Consensus among experts highlights non-surgical treatments as the primary therapeutic approach for LDH.Contemporary medicine frequently employs pharmacotherapy and epidural injections in such treatments,which are associated with numerous adverse effects.Prolonged use can severely impair the liver and kidney functions of patients.Hence,the role of safe and effective traditional Chinese medicine techniques becomes pivotal.Among various traditional Chinese medicine approaches for treating LDH,fire dragon cupping,renowned for its remarkable efficacy,cost-effectiveness,and ease of application,is extensively utilised in clinical settings for managing LDH.Nonetheless,there is a scarcity of systematic and standardised evidence from evidence-based medicine studies.Therefore,conducting a meta-analysis is imperative.Methods:A comprehensive computerised search was conducted in databases including China National Knowledge Infrastructure,WanFang Data,VIP,China Biology Medicine disc,PubMed,EMbase,The Cochrane Library,Web of Science,and CINAHL.The search aimed to gather randomised controlled trials on fire dragon cupping therapy for LDH,spanning from the inception of these databases until December 2023.Two researchers independently screened the literature according to inclusion and exclusion criteria,extracted data,and assessed the methodological quality of the studies included,utilising RevMan 5.3 software for meta-analysis.Results:The results show that the fire dragon cupping therapy group had better clinical effectiveness(relative risk=1.23,95%confidence interval(CI)(1.14,1.33),P<0.00001),less pain(standardized mean difference=–1.33,95%CI(–1.49,–1.16),P<0.00001),and some improvement in lumbar function(Japanese Orthopaedic Association scores:mean difference=3.37,95%CI(2.31,4.43),P<0.00001.Conclusion:The fire dragon cupping therapy significantly alleviates LDH,warranting its extensive application.However,considering the limitations in the number and quality of studies included,the aforementioned conclusion necessitates further validation through more high-quality research.

Cupping therapy-induced elevated D-dimer

46-year old non-snloking Chinese man was found Laccidently elevated D-dimer during his annual health accidently elevated D-dimer during his annual health checkup on June 10, 2010. The value of his D-dimer was found substantially elevated （6110 ng/ml） （reference range 〈350 ng/ml） by automated latex-enhanced light-scattering immunoassays. Prothrombin time, activated partial thromboplastin time and fibrinogen were within the reference range.

A complication of wet cupping therapy： vesiculobullous plaque on an erythematous base

Wet cupping therapy （WCT） is a traditional complementary therapy, which has been in use for many centuries. WCT is used as an alternative and complementary medicine in the treatment of low back pain, migraine headaches, hypertension, brachialgia, carpal tunnel syndrome, oxygen saturation in smokers with chronic obstructive pulmonary disease and metabolic syndrome,tll WCT is also used in dermatological diseases, such as psoriasis, atopic dermatitis acne and urticaria.E2} Side effects of WCT, such as hypotension and bradycardia, rarely occur during application. However, dermatitis, localized infection, scarring and abscess have been reported following WCT.TM In some cases, bubbles of fluid may form at the treatment sites of WCT; these deposits may be located in the epidermis only or in both the epidermidis and the dermis. Fluid deposits of 〈 5 mm in diameter are defined as vesicles and when diameter of fluid deposits 〉 5 mm, they are called bullae.E41 Here we present a case of vesiculobullous lesions after WCT and discuss the physiopathology.

A model to standardize safety and quality of care for cupping therapy

Cupping therapy has historical, traditional and religious value. It is increasingly popular in the field of complementary, alternative and integrative medicine. However, standards for safety and quality of service are absent. Although it is generally considered safe, cupping therapy can cause adverse events.Most of these events are predictable and preventable. A comprehensive approach to patient eligibility and therapist selection, along with compliance with standard operational procedures is essential to regulate the safety of the practice. Here we discuss a model framework for standardizing safety and quality of care. We recommend that this model be used routinely by cupping therapists and their associations on a nation-wide scale.

Hemogram Parameters in Fibromyalgia and Effects of Wet Cupping Therapy on Hemogram Parameters

Objective:Wet cupping therapy(WCT)is one of the complementary and traditional therapies that are still must be scientifically interpreted.This study aimed to assess hemogram parameters that are subclinical inflammatory markers in patients with fibromyalgia syndrome(FMS)and observe how they were affected with WCT.Methods:The present study consisted of two groups;patient group included participants who were diagnosed with FMS and who received WCT and control group included healthy participants who received WCT within the concept of preventive medicine.Results:Neutrophil-to-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)values were higher in the patient group(P=0.029and P=0.003,respectively).Considering that the participants had FMS,the optimal cutoff value for PLR was≥1.62,sensitivity was 70%,specificity was 56%,positive predictive value was 61.7%,and negative predictive value was 65.3%.Receiver operating characteristic(ROC)curve revealed a significant sensitivity and specificity(ROC area=0.664),(confidence interval[CI]:0.530–0.781)(P<0.023).The optimal cutoff value for PLR was≥146,sensitivity was 60%,specificity was 83%,positive predictive value was 78%,and negative predictive value was 67%.ROC curve revealed a statistically significant sensitivity and specificity(ROC area=0.726),(CI:0.59–0.83)(P<0.001).The optimal cutoff value for platelet was≥284,000,sensitivity was 83%,specificity was 40%,positive predictive value was 58%,and negative predictive value was 70%.ROC curve revealed a significant sensitivity and specificity(ROC area=0.65),(CI:0.51–0.76)(P=0.036).Conclusion:NLR,PLR,and thrombocyte count parameters can be useful in the process of diagnosing FMS.In addition,NLR,PLR,and MPV decreased in patients who received WCT.

Wet cupping(Al-hijamah)as a strange cause of ear trauma:A case report

BACKGROUND Cupping therapy is used across the globe since ancient Egypt.It is used as a complementary or alternative to daily clinical practice.Cupping therapy could be dry or wet(Al-hijamah)type.It is considered a relatively safe procedure for a variety of clinical problems like lower backache,shoulder pain,neck pain,headache,and migraine.Application of cupping therapy over body orifices is contraindicated.CASE SUMMARY A 27-year-old gentleman presented with sudden left-sided hearing loss and tinnitus for 7 d.He gave a history of upper respiratory tract infection 14 d before his complaints.He received Al-hijamah over his left ear 3 d before seeking advice from the Otolaryngology clinic,but without benefit.Physical examination showed a dull-looking left ear drum,hemotympanum in the posterior part of the tympanic cavity,two blood clots over the eardrum,and multiple bleeding points over the external ear canal and tympanic membrane.A pure tone audiogram and tympanogram confirmed the diagnosis of middle ear effusion.Conservative treatment(avoidance of water entry,antibiotics,and local and systemic decongestants)was given for 5 d.The presenting symptoms as well as ear injuries resolved completely two weeks after the follow-up.CONCLUSION We do not recommend using Al-hijamah directly over the ear as a treatment option for hearing loss to avoid unwanted ear trauma as well as there is no benefit from this kind of treatment.

Short-term effects of cupping and scraping therapy for chronic nonspecific low-back pain:A prospective,multicenter randomized trial

Background As one of the most common musculoskeletal ailments,chronic nonspecific low-back pain(CNLBP)causes persistent disability and substantial medical expenses.Epidemiological evidence shows that the incidence rate of CNLBP in young and middle-aged people who are demanded rapidly recovery and social contribution is rising.Recent guidelines indicate a reduced role for medicines in the management of CNLBP.Objective The present study investigates the short-term effects of cupping and scraping therapy using a medicated balm,compared to nonsteroidal anti-inflammatory drug(NSAID)with a capsaicin plaster,in the treatment of CNLBP.Design,setting,participants and interventions We designed a prospective multicenter randomized clinical trial enrolling patients from January 1,2022 to December 31,2022.A total of 156 patients with CNLBP were randomized into two parallel groups.Diclofenac sodium-sustained release tablets were administered orally to participants in the control group for one week while a capsaicin plaster was applied externally.Patients in the test group were treated with cupping and scraping using a medical device and medicated balm.Main outcome measures Primary outcome was pain recorded using the visual analogue scale(VAS).Two secondary outcomes were recorded using the Japanese Orthopedic Association low-back pain scale(JOA)and the traditional Chinese medicine(TCM)syndrome integral scale(TCMS)as assessment tools.Results Between baseline and postintervention,all changes in outcome metric scales were statistically significant(P<0.001).Compared to the control group,patients in the test group had a significantly greater treatment effect in all outcome variables,as indicated by lower VAS and TCMS scores and higher JOA scores,after the one-week intervention period(P<0.001).Further,according to the findings of multivariate linear regression analysis,the participants’pain(VAS score)was related to their marital status,age,smoking habits and body mass index.No adverse reactions were reported for any participants in this trial.Conclusion The effectiveness of TCM combined with the new physiotherapy tool is superior to that of NSAID combined with topical plasters,regarding to pain intensity,TCM symptoms and quality of life.The TCM plus physiotherapy also showed more stable and long-lasting therapeutic effects.

Evaluation of blended internet and face-to-face continuous medical education for cupping providers in Saudi Arabia

Background:In regulating cupping therapy in Saudi Arabia,there was a need to develop a system for continuous medical and professional development for cupping practitioners.The current study aimed to evaluate the effect of blended-internet continuing-medical-education(CME)on knowledge,knowledge retention,and intellectual skills in cupping providers compared with conventional,face-to-face CME.Methods:Participants were recruited from a list of registered cupping providers(physicians,nurses,and physiotherapists trained and licensed to practice cupping therapy)for a randomized,open,controlled trial.After providing informed consent,participants were allocated into three groups(classes).Classes were randomized to(1)blended-internet CME(n=31);(2)conventional,face-to-face CME(n=31);and(3)control group receiving no intervention(n=32).Results:Posttest knowledge scores were increased to a greater extent by blended-internet CME training compared to conventional CME(P=0.002)or no training(P<0.001).Similarly,knowledge retention was significantly higher in the blended-internet CME group compared to the conventional CME group(P=0.011).Posttest skills scores immediately after the course were significantly higher in the blended-internet CME group compared to the conventional CME group(mean difference:1.408,95%confidence interval:0.728–2.088,P<0.001).Conclusion:Although the current study aimed to determine if blended-internet CME is as effective as conventional,face-to-face CME,the results showed that cupping providers who participated in blended-internet CME had significantly higher scores for posttest knowledge,knowledge retention,and posttest intellectual skills.

The effect of dry-cupping combined with lavender oil massage on postpartum perineal pain:a case study

to examine the effect of dry cupping therapy with lavender oil massage on the intensity of postpartum perineal pain.Methods:A 33 years old female had suffered with postpartum perineal pain.She experienced bilateral episiotomy on the third birth.Dry cupping therapy was administrated on selected areas two times.Before giving cupping therapy,at the 4th and 24th hours of birth was investigated effectiveness of dry cupping therapy on postpartum perineal pain based on the short-form of McGill pain scale.Results:According to the McGill pain scale,the mean of postpartum perineal pain intensity decreased from 37.9±10.5 before the dry cupping therapy with lavender oil massage to 12.1±5.3 in 4th hour,and 6.3±1.3.2 in 24th hour after delivery.The patient on cupping therapy with lavender oil message showed better results terms of pain intensity(P<0.001).Conclusion:The study confirmed that dry cupping therapy with lavender oil massage reduced postpartum perineal pain.In this regard,this intervention may be considered as affective method for reducing postpartum perineal pain.However,further trials are required to identify the effectiveness of this therapy regiment.

Clinical Research on Treatment of Migraine with Combination of Characteristic and Superior Techniques of Zhuang Medicine

Objective:To study the application effect of the combination of special advantages of Zhuang medical technology for migraine patients.Methods:80 patients with migraine were selected and all were admitted to Mingxiu Branch of International Zhuang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine from February 2019 to February 2020.Random number table method was used to divide patients into two groups,with 40 patients in each group.Among them,the patients in the study group were treated with the therapy combining characteristics of Zhuang medicine and superior technology,that is,Zhuang medicine meridian tendon therapy+Zhuang medicine lotus needle cupping blood stasis removal therapy+Zhuang medicine thread moxibustion therapy+Zhuang medicine acupuncture therapy;the patients in the control group were treated with conventional Western medicine.The efficacy of the two treatments were compared.Results:After treatment,the total effective rate of clinical treatment in the study group was higher than that in the control group(P<0.05),and the visual analogue scale(VAS)score and integral improvement rate were higher than those in the control group(P<0.05).The onset time of action was statistically shorter than that of the control group(P<0.05).There was a statistically significant difference in the adverse reaction rate between the two groups(P<0.05).Conclusion:The combination of Zhuang medicine’s characteristic and superior techniques for patients with migraine has a significant curative effect.

Using simulation in complementary medicine education:an overview of clinical trials

Backgroundand Aim:Using simulation in learning medical interventions is a common practice.Simulation techniques provided a safe environment for trainees and students to acquire clinical skills and knowledge to practice in a real clinical environment.The aim of this review is to assess the use of health simulation in the field of complementary medicine education.Methods:Three medical databases were searched from inception to 15 November 2021.The inclusion criteria were clinical trials that used simulation in the field of complementary medicine training and in English language and the full text can be retrieved.Results:After searching,495 articles were retrieved,235 articles were excluded for duplication and 249 articles were excluded after screening of titles/abstracts and applying inclusion and exclusion criteria.Finally,11 articles were included in this review.These clinical trials had 719 participants and reported positive impact of using simulation in complementary medicine education.Conclusion:Simulation wasused for training of some complementary medicine therapies such as chiropractic,acupuncture,massage therapy,cupping therapy and osteopathy.Using simulation in complementary medicine education is recommended to ensure a safe environment for training.Conducting high quality clinical trials to evaluate the use of simulation in complementary medicine education is highly recommended.