RECENTLY, my mother was hospitalised for burns on her limbs. A sinseh attending to her had spilt lit alcohol on her. He also sustained some burns trying to put out the fire. What he was administering to her was something called “therapeutic cupping”. Indeed, my mother had previously come home on a few occasions with big, round, red bruises on her back after being cupped. These would take weeks to heal.
Cupping is an ancient form of treatment (used in many cultures) for ills ranging from back spasm to hypertension and strokes. Negative pressure is created inside a cup to suck the skin up inside the glass. To create that negative pressure, sinsehs paint the inside of a small, round cup made of thick glass with alcohol, which is then lit. The combustion uses up oxygen, creating a partial vacuum – and raised temperatures – inside the glass. As the flame is dying, the cup’s mouth is firmly applied to a fleshy area of the body. At this, the skin and superficial muscles rise slowly into the glass, like a balloon. The cup is then kept in place for, say, 10 minutes. Several cups are used.
One theory is that the vacuum sucks out the body’s toxins. Alternatively, cupping over acupuncture points supposedly opens up blocked meridians and removes any stagnation of the “qi”, or life force, so it can flow freely again. This putatively rejuvenates organs that are not functioning optimally due to an imbalance of “qi”. Some practitioners resort also to quickly cutting the skin with a lancet just before the cup is applied. The partial vacuum then causes blood to ooze into the glass. This supposedly lets out “bad blood”, which is said to help in hypertension especially. There are also local Malay practitioners of this cupping combined with bloodletting who call their technique “bekam”.
The clinical effectiveness of cupping is unestablished. There is to be found in the medical literature in English, Chinese and Korean several studies of cupping in a variety of conditions. Several systematic reviews of these studies have also been done without reaching a consensus mainly because the primary trials they looked at were almost always of very poor quality.
Recently, the Korea Institute of Oriental Medicine decided to look at the best of these systematic reviews. Published in 2011 in the Journal of Acupuncture Meridian Studies, the Korean review of reviews included only those systematic reviews of clinical trials that had been done exclusively on cupping. (Studies of cupping in combination with needle acupuncture were excluded.) Only five such systematic reviews were found worth reviewing. Even so, each of these systematic reviews was based upon just two to eight primary studies. But 60 per cent of the primary studies were not only small but also non randomized and non-blinded.
The gold standard in all therapeutic trials is the randomised and blinded approach. That is, subjects must be chosen randomly and are not permitted to know whether they are getting the “real” treatment being tested or a “sham” treatment (or placebo) that looks, feels, tastes, smells, and/or sounds exactly the same. All five reviews in the Korean study were hamstrung by primary studies that did not meet this gold standard. It concluded that “some uncertainty persists about the value of cupping as a treatment of pain”. Any pain relief that cupping offers is probably a counter-irritant effect like any liniment rubbed on hurting muscles. The tingling skin sends signals to the brain to “drown” out pain signals from the hurting muscles themselves.
The primary trials were of such poor quality that the Korean study had to also conclude that “the value of cupping is not well-documented” for stroke and hypertension too. In general, “for most conditions, considerable uncertainty remains about the therapeutic value of cupping”.
In another recent review published in 2010 in a journal called BioMedCentral Complementary and Alternative Medicine, some 550 primary studies on cupping for over 50 kinds of diseases or symptoms were examined. The Beijing University of Chinese Medicine, looking at these studies, found none of them to be unbiased, with 78 per cent highly biased. A third of the primary studies did not report any diagnostic criteria and two-thirds of them did not explain how subjects were included or excluded based upon what criteria. Some 70 per cent of the primary studies reported outcomes of treatment using non-standard and undefined terms like “cure”, “markedly effective”, “effective” or “ineffective”. The Beijing study concluded: “The current evidence is not sufficient to allow recommendation for the clinical use of cupping therapy for... diseases of any aetiology in any age group. The long-term effect of cupping therapy is not known.”
In sum, two comprehensive reviews done by researchers sympathetic to alternative medicine did not find evidence to support the use of therapeutic cupping. So why run the risk of being burned?