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Cupping & Gua Sha

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What is Cupping and Gua Sha?

Cupping and Gua Sha have been used to treat multiple ailments in the body for over 4000 years. Documented in both Egyptian and Chinese writings, the use of cupping and gua sha were believed to heal the body of stagnant energy by moving it manually. Cupping uses suction while gua sha uses scraping. Both therapies are known for the marks they may leave behind. The marks are unlike bruises because there is no trauma being made to the tissue. A bruise is often a result of trauma, while the marks from cupping and gua sha are a result of pulling the trapped blood cells, toxins, and inflammation to the surface for the lymphatic system to process quicker. These marks can last for as little as a day to as long as 3 weeks, depending on the individual. Because cupping opens the pores substantially, it is recommended to keep the areas covered for the first 4-6 hours. 

Cupping Therapy is performed by a knowledgeable practitioner who uses a variety of tools to create suction on the skin. Cupping uses suction to draw the skin, muscles, fascia, and interstitial tissues up and apart. This therapeutic treatment improves flexibility, range of motion, as well as improving circulation and reducing inflammation, which is the main cause of disease in the body.  The cupping tools can be made from glass, plastic, rubber, ceramic, metal, bamboo, silicone, and sometimes even animal horn. There are four technical types of cupping used today which are Wet, Dry, Flash, and Massage cupping. 

Dry and Massage cupping are more commonly used in massage therapy establishments, while Wet and Flash cupping include skin incisions and/or fire which require a certified medical provider to administer. 

Dry cupping has three different methods of suction; Manual, Automatic, and Self-suction. 

Manual suction is created by the therapist. There are different ways to create the suction manually depending on the type of tools used. Some rubber and plastic cups have vacuum pumps that are attached. The therapist squeezes the pump to pull the air out of the cup. Some sets come with a detachable vacuum pumping tool. There are also silicone cupping sets without a separate pump that only need to be squeezed to create the suction.  

Each method allows for light, medium, and strong suction strengths. The practitioner interprets the response to the suction by observing the discoloration and tissue's resistance to being pulled. This helps to determine the suction level needed in a specific area. 

Dry cupping is often stationary, placed on specific points and left in place for 5-15 minutes. 

Massage cupping uses suction to stretch and lengthen the tissue by moving the cupping tool across the muscle groups or over the joints. The movement of the cups helps release tension held in the fascia and move any stagnant blood or inflammation through the body, allowing fresh oxygenated blood into the area. This improves circulation and increases recovery from injuries. 


GuaSha Therapy is also performed by a knowledgeable practitioner who uses smooth flat tools made from natural items such as stone, wood, horn, bone and sometimes metal to scrape the tissue up and away. Gua Sha means "scrape toxins" or "rub trapped energy". Gua Sha dates back to the Ming Dynasty. The treatment is usually not painful, though marks often appear on the treated areas due to the movement of blood and byproducts being flushed out of the tissue. These marks usually disappear within a few days. 

Gua Sha works on the deeper layer of skin which include the connective tissues; the hypodermis. Gua sha helps to move fluid and inflammation through the lymphatic and circulatory systems. Gua sha is used to treat ailments such as constipation, neck pain, migraines, tennis elbow, carpal tunnel syndrome, plantar fascitis, repairing scar tissue to increases elasticity of ligaments and tendons, and reducing cellulite by smoothing the fascia and flushing the lymph system. 


"Cupping therapy contraindications can be classified into absolute and relative contraindications. Until we have sufficient information regarding the safety of cupping therapy, it is absolutely contraindicated in cancer patients and those with any organ failure (renal failure, hepatic failure, and heart failure). It is also absolutely contraindicated in patients using a pacemaker and those suffering from hemophilia or similar conditions. 

Relative cupping therapy contraindications include acute infection, using anticoagulants, severe chronic disease (such as heart diseases), pregnancy, puerperiummenstruation, anemia, recent wet cupping session, recent blood donation, medical emergencies, and patient's refusal of the procedure

In general, cupping is contraindicated directly on veins, arteries, nerves, skin inflammation, any skin lesion, body orifices, eyes, lymph nodes, or varicose veins. Cupping is also contraindicated on open wounds, bone fractures, and sites of deep vein thrombosis." 


Authored By: Miki Carrol LMT


M. Ahmedi, M.R. Siddiqui The value of wet cupping as a therapy in modern medicine – an Islamic perspective

Webmedcentral, 5 (12) (2014) 



Cupping therapy regulation rules for practitioners and facilities, National Center for Complementary and Alternative medicine- Ministry of Health, Saudi Arabia (2015), p. 14 


Traditional and complementary medicine practice guidelines: on bekam, Traditional and Complementary medicine division. Ministry of Health, Malaysia. Kuala Lumpur (2011), p. 4

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