The cupping therapy has been used in China for thousands of years. The cupping therapy in its primitive form using cattle horn was used primarily to withdraw pus and blood in the treatment of boils. Cupping was then used as an auxiliary method in traditional Chinese surgery, and in time developed into a special therapeutic method.
The earliest records of cupping in ancient China was found written in Bo Shu 帛书 ancient book written on silk. The text were buried 186 BC in Ma wang dui 马王堆 tomb. Through several thousand years of accumulated clinical experience, the clinical applications of cupping have become increasingly wide. During the Qing dynasty 清代 (1644-1911), the original natural horn cup has been replaced by bamboo, ceramic or glass cups. Because cupping is traditionally used in China, the technique has been inherited by the modern Chinese TCM doctors.
The ancient Egyptians were the first to use cupping therapy systematically. Ebers Papyrus, the oldest medical textbook 1550 BC, describes bleeding by cupping in order to “remove the foreign matter from the body”. Hippocrates and Galen were also great advocates of cupping. In the early days the technique was used solely for bleeding purposes.
In the book of Galen (c. 129-200 AD) on Bloodletting, disease and health are defined in terms of nature. “Disease is an unnatural state of the body”, states Galen, “which impairs a function. Health is a state in accordance with nature, and the cause of the functions”. Here we can see the similarities to the cause of disease and the theory of Traditional Chinese Medicine (TCM): disease occurs as a result of imbalance between the Yin and the Yang.
Galen states that: “The nature does its best to restore unnatural states to their healthy condition. The function of the Physician is to cooperate with her. The principal indication for Bloodletting, then, is to eliminate such residues or to divert blood from one part to another by the process known as Revulsion or Derivation”.
For thousands of years all medical authors have distinguished two forms of cupping, Dry and Wet. In Dry cupping no blood is actually removed from the body. A cup is drained of air and applied to the skin, causing the skin to swell. In Wet cupping the process begins with dry cupping and is followed by several incisions being made in the skin, in order to collect blood. Among the Egyptians, who introduced bloodletting to Greece, cupping was the usual remedy for almost every disorder, and they no doubt had received it from the more ancient nations of the East, from whom they had derived their other knowledge. In many cases, topical abstraction of blood alone is indicated, and this can only be effected by using leeches or cupping. Leeches have been found so uncertain in their application that various means have been prescribed to make them more effective.
Early cupping tools
Many authors believed that cupping was first used in the ancient practice of sucking blood from poisoned wounds. In any case, the earliest cupping instruments were hollowed horns or gourds with a small hole at the top, through which the cupper could suck out the blood from scarifications previously made by a knife. The Arabs called these small vessels “pumpkins”, to indicate that they were frequently applied to a part of the body in which the organs contained air, or that they were vessels that had to be evacuated before they could be applied.
From the Egyptians this ancient art was transferred to the Greeks by Cecrops, who emigrated with his companions from Egypt, established a colony in Greece (and built the city of Athens?). From Hippocrates, who died 361 B.C., the art passed through the hands of succeeding doctors who valued cupping.
During 5th century, the interruption of the Goths, Vandals and other barbarians, describe time when medicine sunk in the general wreck. Fortunately, during 9th century, after the Saracens had expelled the Goths, Arabians cultivated medicine for future four hundred years. Arabian Physician's began to extend itself into Italy; for Spaniards they established medical correspondence with the Italian physicians, and the Greeks were emigrating to Italy in the 15th century. At the time being, Italy became the favorite field of medical science.
European and American doctors and surgeons were employing cupping therapy to treat a variety of conditions up to the late 1860s. They mostly used the Wet type (bleeding method), which almost always involved some kind of scarification and bloodletting. However, after 1860 interest in the invention of new scarificators declined as Wet cupping decreased in popularity and medical attention shifted to the therapeutic virtues of Dry cupping. The Dry technique offered even greater opportunities for inventors.
Dry cupping, basically, as traditionally practitioners believed, act as a ‘revulsive’ or ‘derivant’. By the 19th century these once hotly debated terms had become almost interchangeable in discussions of cupping.
In either case the source of pain was presumed to be somewhere below the skin and the pain was relieved by moving blood away from the affected part up to the surface of the body. According to traditional theory, this was a mean of relieving an affected part by deliberately setting up a secondary inflammation or a running sore in another area of the body. Counterirritations were traditionally produced in a number of ways, among them blisters, cautery, moxibustion and dry cupping.
Dry cupping stimulated much of the debate on the subject of disease in the 19th century, as well as many physiological experiments. Although physicians generally agreed that dry cupping had a curative value if employed properly, they disagreed widely on when to employ this remedy, and on the manner in which it was best applied.
Mothers with breasts problems in the 19th century were treated by physicians with either large doses of tartar emetic - a strong purgative - or cupping. At first, breast cupping consisted of specially designed cupping with proliferated hole for nipple. Most breast pumps were exhausted by mechanical means. In the 1920’s some breast pumps were attached to electric motors. Breast pumps have continued to be employed up to the present day. From 1834 to 1975 more than 60 breast pumps were patented, the majority in the period from 1860 to 1920.
Cupping in the Middle East: Wet Cupping
‘Hijama’, as it is known in the Arabic world - which also translates “to restore to basic size” or “to diminish in volume” (bloodletting cupping) - has been quite extensively practiced by the Arab nations throughout history. The Prophet Mohammed is reported to have been a fervent user and advocate of cupping therapy. It was reported that the Prophet said:
Cupping is useful against the heat of the liver and spleen and various blood-related tumors in these two organs. It is also useful for tumors of the lungs, arterial pulsation, pleurisy and all blood-related diseases of vein in the lower part of the knee to the hip. Further, puncturing of the median vein helps against the various swellings that appear throughout the entire body, especially when the swelling is blood-related, and contains spoiled blood in general. In addition, puncturing of the arm’s vein helps against the ailments in the head and neck that result from excessive amounts of blood or from septic blood. Puncturing of the jugular vein helps against the ailments of the spleen, asthma, thoracic cavity and forehead pain. Cupping the upper section of the back helps against the aches of the shoulder and the throat. Further, cupping the two jugular veins helps against the ailments of the head, face, teeth, ears, eyes, nose and throat, if these ailments were caused by excessive presence of blood, soiled blood or both. The Messenger of Allah used to apply cupping on the two jugular veins and the upper part of the back. Although cupping therapy was regarded as ‘very effective’, it was also considered ‘quite dangerous’ in unskilled hands.
The Decline of Cupping
Cupping died out in America and Europe in the early 20th century, but its disappearance was gradual and scarcely noticed. Some of the most complex cupping devices were invented in a period when most physicians regarded cupping as ineffectual.
One of America’s last advocates of bloodletting, Heinrich Stern, writing in 1915, also recommended the use of an electric suction pump to evacuate blood. He declared that ecchymosis (red cupping marks on the skin) could be prolonged with the use of an electric motor for 15, 30 or more minutes. In addition to some sophisticated devices, simple cupping, especially dry cupping, continued well into the early 1940s. Although cupping was no longer generally recommended by physicians, most surgical companies advertised cups, scarificators and cupping sets in the 1920s and even as late as the 1930s.
The last bastions of cupping in the United States were the immigrant sections of large cities. In the Lower East Side of New York in particular, cupping was still flourishing in the 1930s. By then it was no longer performed by a physician but had been relegated to a barber’s task. Often an advertisement reading: “Cups for colds” could be seen in a barber’s shop window.
The invention of various medical diagnostic methods, new medical drugs, such as antibiotics and fever-reducing drugs has also contributed to the decline of cupping therapy