Review Article

Split Viewer

Journal of Acupuncture Research 2020; 37(1): 28-34

Published online February 20, 2020

https://doi.org/10.13045/jar.2019.00339

© Korean Acupuncture & Moxibustion Medicine Society

Pressure Levels in Cupping Therapy: A Systemic Review

Ku Weon Kim1, Tae Wook Lee1, Ha Lim Lee1, Soo Kwang An1, Hyo Sung Park1, Ji Won Choi2, Byung Ryul Lee2,3, Gi Young Yang2,3*

1School of Korean Medicine, Pusan National University, Yangsan, Korea;2Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea;3Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea

Received: November 21, 2019; Revised: December 21, 2019; Accepted: January 7, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

This is a systematic review of the clinical use of cupping therapy. Four domestic databases and 2 foreign databases were searched. Studies that reported the cupping pressure used during cupping therapy were included in this study. The types of cupping, cupping site, pressure, and duration of cupping were the main parameters analyzed. A total of 27 studies, including 24 experimental studies were analyzed. There were 12 constant negative pressure (domestic) studies with a range between 60 mmHg and 600 mmHg. There were 5 maximum negative pressure (domestic) studies and the maximum negative pressure was 620 mmHg. Three studies used a maximum negative pressure of 600 mmHg. There were 4 constant negative pressure (foreign) studies with a range between 75 mmHg to 750 mmHg. There were 3 maximum negative pressure (foreign) studies with a maximum pressure of 420 mmHg. The studies differed with regards to the materials used and the amount of pressure applied. Many studies had limited information and therefore generalizability of the results in this review is limited. Further experimental studies are required to establish the correlation between cupping pressure and treatment effects so that cupping therapy can be standardised.

Keywords cupping therapy, pressure, review

Cupping therapy is a treatment to release toxins from the body by using special cups to generate suction and adsorption at the surface of the skin. Both Eastern and Western countries have used cupping therapy since ancient times, and in Korea, the practice of cupping is included in Donguibogam [1].

Cupping therapy is simple, safe, and very effective. Given the simplicity of cupping treatment it can be used in clinical practice and its wider clinical applications, and it is now used regularly in modern medicine [2].

Cupping therapy has been covered as a medical procedure by the National Health Insurance in Korea since 1987. It is used as a treatment for various diseases, and many studies have been conducted on the efficacy of cupping therapy [3]. However, research on the effectiveness of treatment according to cupping pressure is insufficient, so cupping therapy remains nonstandardised. As there are no clear criteria for pressure settings during cupping therapy, scientists are conducting research in a random manner and clinicians are using cupping in various ways in clinical practice. In this study, we aimed to review the body of evidence detailing the cupping pressure used, with a view to standardising the practice of cupping therapy.

Research method

Database search

The following domestic (Korean) academic databases were searched: Korean Information Service System (KISS), National Securities Depository Ltd. (NDSL), Regional Information Sharing Systems (RISS), and DBpia. The following foreign databases were also searched: National Center for Biotechnology Information (NCBI) PubMed, Excerpta Medica database (EMBASE).

Search words

The search words are shown in Fig. 1.

Search period and method

The search period for domestic studies was inclusive until June 30, 2019 and included both dissertations, and studies published in academic journals. The search period for foreign studies was inclusive until June 30, 2019 using the search criteria “humans, English”.

Fig. 2 shows the flow chart of study selection. One researcher conducted the search and produced the results, and another researcher reviewed them and agreed on the final studies for inclusion in this review. These studies were checked to ensure that they conformed to the study topic, and duplicate studies were excluded.

Search results

A total of 27 studies were selected out of 65 studies that were retrieved in accordance with the search criteria, with the exception of those studies that did not include the pressure used during cupping, and those studies that were duplicates.

Characteristics of research studies

The characteristics of the included studies are summarized in Table 1 (domestic) and Table 2 (foreign).

In the domestic research studies, manual and plastic cupping devices were the most common types. The most common cupping site was the back. The number of studies that used silicon rubber plates increased after 2008. The thickness of silicon rubber sheets varied between 3 mm and 10 mm. Cupping pressure varied between 60 mmHg and 600 mmHg. The duration of cupping was between 1 minute and 20 minutes (Table 1).

In the foreign research studies, the most common types of cupping devices were motor-operated cups and glass cups. The most common cupping site was the lower back. The cupping pressure ranged from 60 mmHg to 750 mmHg (100 kPa). The cupping duration ranged between 6 minutes and 20 minutes (Table 2).

The biggest difference between the domestic and foreign studies was regarding the type of cupping device used.

The criteria to classify constant pressure or maximum pressure in the research articles included in this review, was according to the content of the article. If recorded measurements were up to the maximum pressure, it was classified as maximum pressure. Without any records of maximum pressure, if there were measurements taken at a specific pressure for specific time, it is classified as constant pressure (Tables 3-6).

Classification by year

Of the 27 total studies, 19 (70.4%) were domestic and 8 (29.6%) were foreign. Domestic studies that contained details of cupping pressure showed a frequency of 3 in 2008, 1 in 2009, 3 in 2010 and 2 in 2011 and the numbers of studies declined after 2013. Foreign studies showed an increase from 1 study before 2010, to 7 studies after 2010 (Fig. 3).

Categorisation by pressure

Domestic research - constant negative pressure

The constant negative pressure in the studies by Im and Moon [5], Park and Lee [7], Kweon et al [9], and Lee et al [10] was 60 mmHg. The constant negative pressure was 225 mmHg in the study by Kim et al [15], 240 mmHg in the study by Shin et al [6], and 400 mmHg in the study by Oh and Kim [8]. In comparison, the constant negative pressure in the studies by Shin [4], Ryu et al [11], Kim et al [16], Kim et al [18], and Kim et al [20] was 600 mmHg (Table 3).

In the 12 domestic studies, there were 5 studies that used 600 mmHg, 4 that used 60 mmHg, 1 that used 225 mmHg, 1 that used 240 mmHg, and 1 that used 400 mmHg. Reports that included the diameter and volume of the cups were insufficient.

Domestic research - maximum negative pressure

The maximum negative pressure in the studies by So et al [12] and Kim et al [20] was 300-400 mmHg for cup size 1. Size 1, 2, 3, 4 and 5 cups have the same diameter. The maximum negative pressure in the studies by Kim et al [13], Yi et al [14] and Yi et al [17] was 550-650 mmHg (Table 4).

In the 5 domestic studies, the maximum negative pressure was 550-650 mmHg in 3 studies, and 300-400 mmHg in 2 studies. Very few studies reported on the volume of the cups.

Foreign research - constant negative pressure

The constant negative pressure in the study by Blunt and Lee [22] was 75-150 mmHg, and 75 mmHg, 225 mmHg, and 375 mmHg in the study by Tham et al [21]. The constant negative pressure in the study by Teut et al [27] was 112.5-262.5 mmHg, and 750 mmHg in the study by Blunt and Lee [22] (Table 5).

There were 4 foreign studies using constant negative pressure. There were insufficient reports on the diameter and volume of cups in the foreign studies.

Foreign research - maximum negative pressure

The maximum negative pressure in the study by Huber et al [23] was 420 mmHg using the Alcohol Flame (AF) method. It was 236.3 mmHg in the study by Emerich et al [25] using the Healthy Volunteers (HV) method, and it was 60 mmHg in the study by Duh and Chiu [26] (Table 6).

Electronic cupping devices were used in 3 foreign studies. There were insufficient reports on the diameter of the cups in the literature.

Cupping therapy was introduced to Korea, Japan and Southeast Asia a long time ago and it is still used today. Specially made glass cups, ceramic cups or bamboo cups are placed on the part of the human body being treated for disease [28]. Over time, various technologies to assist cupping have been developed. Recently, interest in cupping methods has resurfaced and a number of studies on cupping therapy have been undertaken [29,30]. Currently, the majority of Korean medicine doctors perform cupping for musculoskeletal problems and internal diseases. Despite this, there are no studies on post-treatment side effects such as blisters, with the exception of 1 study by Yun et al [31], and no standardised treatment procedure. In this study, a total of 27 studies related to cupping therapy were reviewed to establish the correlation between cupping pressure and treatment effects so that cupping therapy can be standardised.

It was observed that constant negative pressure used in domestic research varied widely, ranging from 60 mmHg to 600 mmHg. The diameter of the cups also varied widely, ranging between 25 mm and 50 mm, and the volume of cups was largely unreported. Therefore, further experimental studies are needed on the relative results using different diameters and volumes of cups with the same constant negative pressure.

In addition, the maximum negative pressure used in domestic research varied widely, ranging from 300–400 mmHg to 540–660 mmHg (using an electronic cupping device). Only 5 studies actually reported maximum negative pressure settings. Therefore, due to insufficient reporting, a conclusion could not be proposed.

Moreover, the reported constant negative pressure in 4 foreign studies also varied widely, ranging from 75 mmHg to 375 mmHg depending on the method of cupping used. The reported maximum constant negative pressure in the 4 foreign studies also ranged widely. Only 2 studies reported on the diameter of the cups, and this range was 40 mm to 50 mm. The number of studies was quite small and there was limited information about the volume of the cups, so conclusions could not be drawn.

Furthermore, the reported maximum negative pressure in the foreign studies varied widely (between 60 mmHg and 420 mmHg) although electronic cupping was used for all studies. Two studies reported the volume of the cup which was 168 cc. Unfortunately, the information provided on maximum negative pressure in the foreign studies was not sufficient to generalise the results.

In conclusion, although we investigated 27 studies, including domestic and foreign studies, there were large differences in the cupping devices used, the constant negative pressure, the maximum negative pressure, the cup size, and the cup volume. It was evident that there are no specific criteria for standardised cupping treatment, and we could not directly compare the results of these studies. Furthermore, many studies lacked detail on the methods used for cupping. Therefore, we could not make any conclusive recommendations about cupping therapy. In this context, further experimental studies are needed to establish standardised cupping therapy procedures.

Fig. 1.

The search words used in domestic and foreign search engines.


Fig. 2.

Flow chart of study selection.


Fig. 3.

The published year of studies.


Summary Characteristics of Included Studies (Domestic).

First author (y)Cupping device typeCupping positionCupping pressure (mmHg)Cupping duration (min)
Shin [4] (1979)Cupping deviceShuxue points of 12 meridiansConstant negative pressure: 6001
Cups
Im [5] (1980)Electronic cupping deviceBack-shu pointConstant negative pressure: 601
Glass cups
Shin [6] (1988)Cupping deviceBackConstant negative pressure: 2401-3
Ceramic cups
Park [7] (1995)Electronic cupping deviceBackConstant negative pressure: 601
Cups
Oh [8] (1999)Cupping deviceBack, abdominal areaConstant negative pressure: 4005
Cups
Kweon [9] (2002)Cupping deviceBackConstant negative pressure: 605
Cups
Lee [10] (2002)Cupping deviceChest, shoulder, upper extremity, handsConstant negative pressure: 100–20020
Plastic cups
Ryu [11] (2006)BUDDEUMIConstant negative pressure: 600
Sho [12] (2008)Manual cupping deviceSilicone rubber padMaximum negative pressure5
Plastic cupsThickness: 10 ± 1 mmSize 1 (B: 397.28 / C: 362.36)
Area: 100 × 100 mmSize 2 (A: 342.51 / B: 444.23)
Size 3 (A: 365.56 / B: 466.50 / C: 423.10)
Size 4 (A: 391.34 / B: 481.49 / C: 450.87)
Size 5 (B: 510.28 / C: 464.83)
Kim [13] (2008)Manual cupping deviceDanjeon (lower part of the abdomen) area, shoulder areaMaximum negative pressure: 580–620
Plastic cups
Yi [14] (2009)Electronic cupping deviceSilicone rubber padMaximum negative pressure: 600 ± 10%10
CupsThickness: 3 ± 0.5 mm
Area: 100 × 100 mm
Kim [15] (2010)Negative pressure control deviceMidway between xiabai (LU4) and chize (LU5) of lung meridian (LU)Constant negative pressure: 30 kPa (225 mmHg)5
Kim [16] (2010)Surface meridian/acupoint energy measurement systemBack-shu point of bladder meridian (BL)Constant negative pressure: 80 kPa (600 mmHg)5
Yi [17] (2010)Electronic cupping deviceSilicone rubber padMaximum negative pressure10
CupsThickness: 3 mmSeo-ryong (600)
Area: 100 × 100 mmNoel (600)
Hansol (550)
G.O.P.O. (570)
Seoul Medical (540)
Kim [18] (2011)Measurement system for changes in meridiansBack-shu point of bladder meridian (BL)Constant negative pressure: 80 kPa (600 mmHg)1
Kim [19] (2013)Electronic cupping deviceBack-shu point of bladder meridian (BL)Constant negative pressure: 80 kPa (600 mmHg)1
Cups
Kim [20] (2018)Manual cupping deviceSilicone rubber padMaximum negative pressure10
CupsThickness: 3 mmDongbang: Size 1 (323.2 ± 9.8)
Wet cuppingArea: 100 × 100 mmDE Medical: Size 1 (318 ± 7.0)
Hansol: Size 1 (381.8 ± 13.4)
Daegun: Size 1 (322.4 ± 9.8)

Summary Characteristics of Included Studies (Foreign).

First author (y)Cupping device typeCupping positionCupping pressure (mmHg)Cupping duration (min)
Tham [21] (2006)Manual cupping deviceSoft tissueConstant negative pressure
Skin: 2 mm100 mbar (75 mmHg)
Plastic cupsFat: 10 mm300 mbar (225 mmHg)
Muscle: 10 mm500 mbar (375 mmHg)
Blunt [22] (2010)Cupping deviceNeckConstant negative pressure: 100 kPa (750 mmHg)
Cups
Huber [23] (2011)Electronic cupping deviceSoft rubber padMaximum negative pressure
LF1: 200 ± 30 hPa (150 ± 22.5 mmHg)
Glass cupsLF2: 310 ± 30 hPa (232.5 ± 22.5 mmHg)
AF: 560 ± 30 hPa (420 ± 22.5 mmHg)
BA: 270 ± 16 hPa (202.5 ± 12 mmHg)
Teut [24] (2012)Electronic cupping deviceLower back, kneeConstant negative pressure: 100–200 mbar (75-150 mmHg)Lower back: 5
Silicone cupsKnee: 10
Emerich [25] (2014)Electronic cupping deviceLower backMaximum negative pressure15
HV: 315 ± 64 hPa (236.3 ± 48 mmHg)
Glass cupsNP: 283 ± 54 hPa (212.3 ± 40.5 mmHg)
WC: 299 ± 59 hPa (224.3 ± 44.3 mmHg)
Duh [26] (2015)Electronic cupping deviceForearm, palmMaximum negative pressure: 60 mmHg6
Vacuum chamber
Teut [27] (2018)Electronic cupping deviceLower backConstant negative pressure: 150-350 mbar (112.5-262.5 mmHg)8
Silicone cups

Constant Pressure Associated with Type, Diameter, and Volume of Cups (Domestic).

First author (y)Cupping device typeCup diameter (mm)Cup Volume (cc)Cupping pressure (mmHg)
Im [5] (1980)Electronic cupping device50Constant negative pressure: 60
Glass cups
Park [7] (1995)Electronic cupping deviceConstant negative pressure: 60
Cups
Kweon [9] (2002)Cupping device4573Constant negative pressure: 60
Cups
Lee [10] (2002)Cupping device25Constant negative pressure: 60
Plastic cups
Kim [15] (2010)Negative pressure control deviceConstant negative pressure: 225
Shin [6] (1988)Cupping deviceConstant negative pressure: 240
Ceramic cups
Oh [8] (1999)Cupping deviceConstant negative pressure: 400
Cups
Shin [4] (1979)Cupping device30Constant negative pressure: 600
Cups
Ryu [11] (2006)Moxa cuppingConstant negative pressure: 600
Kim [16] (2010)Surface meridian/acupoint energy measurement systemConstant negative pressure: 600
Kim [18] (2011)Measurement system for changes in meridiansConstant negative pressure: 600
Kim [19] (2013)Electronic cupping deviceConstant negative pressure: 600
Cups

Maximum Pressure Associated with Type, Diameter and Volume of Cups (Domestic).

First author (y)Cupping device typeCup diameter (mm)Cup volume (cc)Cupping pressure (mmHg)
Sho [12] (2008)Manual cupping deviceSize 1: external diameter 50, internal diameter 48.8, height 71.2Maximum negative pressure
Size 2: external diameter 44.5, internal diameter 43.7, height 68Size 1 (B: 397.28 / C: 362.36)
Size 3: external diameter 39.7, internal diameter 39.1, height 68Size 2 (A: 342.51 / B: 444.23)
Plastic cupsSize 4: external diameter 32.7, internal diameter 32.3, height 68Size 3 (A: 365.56 / B: 466.50 / C: 423.10)
Size 5: external diameter 30.3, internal diameter 25.5, height 66Size 4 (A: 391.34 / B: 481.49 / C: 450.87)
Size 5 (B: 510.28 / C: 464.83)
Kim [13] (2008)Manual cupping deviceA: internal diameter 44.7, height 50.8A: 70.0Maximum negative pressure: 580-620
B: internal diameter 35.7, height 47.9B: 36.9
Plastic cupsC: internal diameter 28.3, height 47.9C: 26.1
D: 13.8
Yi [14] (2009)Electronic cupping deviceMaximum negative pressure: 600 ± 10%
Cups
Yi [17] (2010)Electronic cupping deviceSmall: external diameter 35–37Maximum negative pressure
Seo-ryong: 600
Middle: external diameter 42–44Noel: 600
CupsHansol: 550
Large: external diameter 52–54G.O.P.O.: 570
Seoul Medical: 540
Kim [20] (2018)Manual cupping deviceSize 1: external diameter 50, internal diameter 48.8, height 71.2Maximum negative pressure
Size 2: external diameter 44.5, internal diameter 43.7, height 68Dongbang Size 1: 323.2 ± 9.8
CupsSize 3: external diameter 39.7, internal diameter 39.1, height 68DE Medical Size 1: 318 ± 7.0
Wet cuppingSize 4: external diameter 32.7, internal diameter 32.3, height 68Hansol Size 1: 381.8 ± 13.4
Size 5: external diameter 30.3, internal diameter 25.5, height 66Daegun Size 1: 322.4 ± 9.8

Constant Pressure Associated with Type, Diameter and Volume of Cups (Foreign).

First author (y)Cupping device typeCup diameter (mm)Cup volume (cc)Cupping pressure (mmHg)
Teut [24] (2012)Electronic cupping deviceConstant negative pressure: 75-150
Silicone cups
Tham [21] (2006)Manual cupping device50Constant negative pressure: 75, 225 and 375
Cups
Teut [27] (2018)Electronic cupping deviceConstant negative pressure: 112.5-262.5
Silicone cups
Blunt [22] (2010)Cupping device40Constant negative pressure: 750
Cups

Maximum Pressure Associated with Type, Diameter and Volume of Cups (Foreign).

First author (y)Cupping device typeCup diameter (mm)Cup volume (cc)Cupping pressure (mmHg)
Huber [23] (2011)Electronic cupping device50168Maximum negative pressure:
LF1: 150 ± 22.5
Glass cupsLF2: 232.5 ± 22.5
AF: 420 ± 22.5
BA: 202.5 ± 12
Emerich [25] (2014)Electronic cupping device168Maximum negative pressure:
HV: 236.3 ± 48
Glass cupsNP: 212.3 ± 40.5
WC: 224.3 ± 44.3
Duh [26] (2015)Electronic cupping deviceMaximum negative pressure: 60
Vacuum chamber

  1. Korean Acupuncture and Moxibustion Medicine Society. Acupuncture Medicine. Seoul (Korea): Hanmi Medical Science; 2016. 119 p. [in Korean]
  2. Ilkay, ZC. Traditional Chinese Medicine Cupping Therapy, 3rd ed. Amsterdam (Netherlands): Churchill Livingstone; 2014. p. 1-4.
  3. Lee, B, Song, Y, and Lim, H. Literature Investigation Regarding Cupping Therapy and Analysis of Current Professional’s Cupping Treatment. J Orient Rehabil Med 2008;18:169-191. [in Korean]
  4. Shin, H. A Study on the Color Reaction of Stroke Patients with Cupping Therapy. East West Med 1979;4:55-58. [in Korean]
  5. Im, J, and Moon, J. A Clinical Study on Symptoms of Stroke in the Color Reaction of Cupping Therapy. J Korean Med 1980;16:79-82. [in Korean]
  6. Shin, W, Kim, S, and Song, H. Clinical Observation of Blood-stasis Spots in Cupping Therapy on 3700 Cases of Back-Neck-Shoulder Pain Patients. J Haehwa Med 1988;6:303-311. [in Korean]
  7. Park, J, and Lee, C. Effects of Cupping Therapy on the Variation of back Temperature measured by Blood and D.T. in Healthy Adult Men and Women. J Orient Physiol Ther 1995;5:101-114. [in Korean]
  8. Oh, J, and Kim, S. Effect of negative therapy at back meridian points on blood gas components and immune functions in male college students. J Korean Orient Med 1999;37:75-83. [in Korean]
  9. Kweon, O, Kim, E, Kim, J, and Bae, S. Analysis of Blood Components in Skin Color Reaction after Cupping Glass Therapy. J Korean Soc Phys Ther 2002;14:57-75. [in Korean]
  10. Lee, H, Jun, H, Hwang, U, Nam, S, and Kim, Y. Effects of moving cupping therapy on the edematous hands of three patients with flaccid hemiplegia. J Korean Acupoint Moxib Soc 2002;19:231-237. [in Korean]
  11. Ryu, G, Lee, J, Kim, G, Yang, H, Park, S, and Kim, M. Study on the BUDDEUMI Structural Character and Treatment. J Physiol Pathol Korean Med 2006;20:522-526. [in Korean]
  12. Sho, M, Song, Y, and Lim, H. Comparative Study on Cupping Apparatuses for Medical Use by Mechanical Stability and Functional Test. J Orient Rehabil Med 2008;18:157-167. [in Korean]
  13. Kim, Y, Kim, D, Yeon, S, Lim, B, Choi, Y, and Lee, G. Experimental Study on the Pressure Characteristics in the Cupping Therapy. J Korean Acupoint Moxib Soc 2008;25:121-130. [in Korean]
  14. Yi, S, Kim, E, Shin, K, Nam, D, Kang, J, and Lee, S. Study on Developing Assessment Guideline for Safety and Performance of Electric Cupping Apparatus. J Korean Acupoint Moxib Soc 2009;26:101-110. [in Korean]
  15. Kim, S, Lee, N, Joo, Y, Jung, B, and Lee, Y. Analysis of Moisture, Elasticity and EMG Change on Meridian Acupoints by Cupping (Negative Pressure) Stimulation. J Korea Inst Marit Inf Commun Sci 2010;14:2747-2754. [in Korean]
  16. Kim, S, Lee, N, Kim, Y, Lee, J, Song, G, and Jung, B. Analysis of Meridians Energy change by Cupping Stimulation. Korean J Acupunct 2010;27:49-57. [in Korean]
  17. Yi, S, Kim, E, Shin, K, Nam, D, Kang, J, and Lee, S. Study of Mechanical Characteristics of Electric Cupping Apparatus in Korea for Suggestion of its Assessment Guideline. J Korean Acupoint Moxib Soc 2010;27:1-10. [in Korean]
  18. Kim, S, Lee, N, Jung, B, and Lee, Y. Evaluation of Significance & Development of Quantitative Measurement System for Acupoint Pigmentation by Cupping Therapy. Korean J Acupunct 2011;28:63-71. [in Korean]
  19. Kim, S, Jung, B, Shin, T, and Lee, Y. A New Method for Measuring Acupoint Pigmentation After Cupping Using Cross Polarization. Korean J Acupunct 2013;30:252-263. [in Korean]
  20. Kim, D, Bae, E, Park, J, Kim, S, and Lee, S. Change in Risk of Dropout Due to Bleeding during Bloodletting-Cupping Therapy. Korean J Acupunct 2018;35:41-45. [in Korean]
  21. Tham, LM, Lee, HP, and Lu, C. Cupping: From a biomechanical perspective. J Biomech 2006;39:2183-2193.
  22. Blunt S, B, and Lee, H. P. Can traditional “cupping” treatment cause a stroke?. Med Hypotheses 2010;74:945-949.
  23. Huber, R, Emerich, M, and Braeunig, M. Cupping - Is it reproducible? Experiments about factors determining the vacuum. Complement Ther Med 2011;19:78-83.
  24. Teut, M, Kaiser, S, Ortiz, M, Roll, S, Binting, S, and Willich, SN. Pulsatile dry cupping in patients with osteoarthritis of the knee - A randomized controlled exploratory trial. BMC Complement Altern Med 2012;12:184.
  25. Emerich, M, Braeunig, M, Clement, HW, Lüdtke, R, and Huber, R. Mode of action of cupping - Local metabolism and pain thresholds in neck pain patients and healthy subjects. Complement Ther Med 2014;22:148-158.
  26. Duh, FC, and Chiu, YH. Vacuum Cupping Under Various Negative Pressures: An Experimental Investigation. J Multidiscip Eng Sci Tech 2015;2:1907-1911.
  27. Teut, M, Ullmann, A, Ortiz, M, Rotter, G, Binting, S, and Cree, M. Pulsatile dry cupping in chronic low back pain - a randomized three-armed controlled clinical trial. BMC Complement Altern Med 2018;18:115.
  28. Kim, Y, Song, B, Koo, S, Cho, N, Yoon, H, and Lee, E. Easy-to-know Cupping Therapy. Seoul (Korea): Uiseongdang; 2009. p. 15-18. [in Korean]
  29. Rozenfeld, E, and Kalichman, L. New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. J Bodyw Mov Ther 2016;20:173-178.
  30. Aboushanab, TS, and AlSanad, S. Cupping Therapy: An Overview from a Modern Medicine Perspective. J Acupunct Meridian Stud 2018;11:83-87.
  31. Yun, H, Kwon, S, Kim, S, Park, H, Hahm, D, and Lee, H. The Study of Blister Caused by Cupping Therapy. Korean J Acupunct 2011;28:141-150. [in Korean]

Article

Review Article

Journal of Acupuncture Research 2020; 37(1): 28-34

Published online February 20, 2020 https://doi.org/10.13045/jar.2019.00339

Copyright © Korean Acupuncture & Moxibustion Medicine Society.

Pressure Levels in Cupping Therapy: A Systemic Review

Ku Weon Kim1, Tae Wook Lee1, Ha Lim Lee1, Soo Kwang An1, Hyo Sung Park1, Ji Won Choi2, Byung Ryul Lee2,3, Gi Young Yang2,3*

1School of Korean Medicine, Pusan National University, Yangsan, Korea;2Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Korea;3Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea

Received: November 21, 2019; Revised: December 21, 2019; Accepted: January 7, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This is a systematic review of the clinical use of cupping therapy. Four domestic databases and 2 foreign databases were searched. Studies that reported the cupping pressure used during cupping therapy were included in this study. The types of cupping, cupping site, pressure, and duration of cupping were the main parameters analyzed. A total of 27 studies, including 24 experimental studies were analyzed. There were 12 constant negative pressure (domestic) studies with a range between 60 mmHg and 600 mmHg. There were 5 maximum negative pressure (domestic) studies and the maximum negative pressure was 620 mmHg. Three studies used a maximum negative pressure of 600 mmHg. There were 4 constant negative pressure (foreign) studies with a range between 75 mmHg to 750 mmHg. There were 3 maximum negative pressure (foreign) studies with a maximum pressure of 420 mmHg. The studies differed with regards to the materials used and the amount of pressure applied. Many studies had limited information and therefore generalizability of the results in this review is limited. Further experimental studies are required to establish the correlation between cupping pressure and treatment effects so that cupping therapy can be standardised.

Keywords: cupping therapy, pressure, review

Introduction

Cupping therapy is a treatment to release toxins from the body by using special cups to generate suction and adsorption at the surface of the skin. Both Eastern and Western countries have used cupping therapy since ancient times, and in Korea, the practice of cupping is included in Donguibogam [1].

Cupping therapy is simple, safe, and very effective. Given the simplicity of cupping treatment it can be used in clinical practice and its wider clinical applications, and it is now used regularly in modern medicine [2].

Cupping therapy has been covered as a medical procedure by the National Health Insurance in Korea since 1987. It is used as a treatment for various diseases, and many studies have been conducted on the efficacy of cupping therapy [3]. However, research on the effectiveness of treatment according to cupping pressure is insufficient, so cupping therapy remains nonstandardised. As there are no clear criteria for pressure settings during cupping therapy, scientists are conducting research in a random manner and clinicians are using cupping in various ways in clinical practice. In this study, we aimed to review the body of evidence detailing the cupping pressure used, with a view to standardising the practice of cupping therapy.

Materials and Methods

Research method

Database search

The following domestic (Korean) academic databases were searched: Korean Information Service System (KISS), National Securities Depository Ltd. (NDSL), Regional Information Sharing Systems (RISS), and DBpia. The following foreign databases were also searched: National Center for Biotechnology Information (NCBI) PubMed, Excerpta Medica database (EMBASE).

Search words

The search words are shown in Fig. 1.

Search period and method

The search period for domestic studies was inclusive until June 30, 2019 and included both dissertations, and studies published in academic journals. The search period for foreign studies was inclusive until June 30, 2019 using the search criteria “humans, English”.

Fig. 2 shows the flow chart of study selection. One researcher conducted the search and produced the results, and another researcher reviewed them and agreed on the final studies for inclusion in this review. These studies were checked to ensure that they conformed to the study topic, and duplicate studies were excluded.

Search results

A total of 27 studies were selected out of 65 studies that were retrieved in accordance with the search criteria, with the exception of those studies that did not include the pressure used during cupping, and those studies that were duplicates.

Results

Characteristics of research studies

The characteristics of the included studies are summarized in Table 1 (domestic) and Table 2 (foreign).

In the domestic research studies, manual and plastic cupping devices were the most common types. The most common cupping site was the back. The number of studies that used silicon rubber plates increased after 2008. The thickness of silicon rubber sheets varied between 3 mm and 10 mm. Cupping pressure varied between 60 mmHg and 600 mmHg. The duration of cupping was between 1 minute and 20 minutes (Table 1).

In the foreign research studies, the most common types of cupping devices were motor-operated cups and glass cups. The most common cupping site was the lower back. The cupping pressure ranged from 60 mmHg to 750 mmHg (100 kPa). The cupping duration ranged between 6 minutes and 20 minutes (Table 2).

The biggest difference between the domestic and foreign studies was regarding the type of cupping device used.

The criteria to classify constant pressure or maximum pressure in the research articles included in this review, was according to the content of the article. If recorded measurements were up to the maximum pressure, it was classified as maximum pressure. Without any records of maximum pressure, if there were measurements taken at a specific pressure for specific time, it is classified as constant pressure (Tables 3-6).

Classification by year

Of the 27 total studies, 19 (70.4%) were domestic and 8 (29.6%) were foreign. Domestic studies that contained details of cupping pressure showed a frequency of 3 in 2008, 1 in 2009, 3 in 2010 and 2 in 2011 and the numbers of studies declined after 2013. Foreign studies showed an increase from 1 study before 2010, to 7 studies after 2010 (Fig. 3).

Categorisation by pressure

Domestic research - constant negative pressure

The constant negative pressure in the studies by Im and Moon [5], Park and Lee [7], Kweon et al [9], and Lee et al [10] was 60 mmHg. The constant negative pressure was 225 mmHg in the study by Kim et al [15], 240 mmHg in the study by Shin et al [6], and 400 mmHg in the study by Oh and Kim [8]. In comparison, the constant negative pressure in the studies by Shin [4], Ryu et al [11], Kim et al [16], Kim et al [18], and Kim et al [20] was 600 mmHg (Table 3).

In the 12 domestic studies, there were 5 studies that used 600 mmHg, 4 that used 60 mmHg, 1 that used 225 mmHg, 1 that used 240 mmHg, and 1 that used 400 mmHg. Reports that included the diameter and volume of the cups were insufficient.

Domestic research - maximum negative pressure

The maximum negative pressure in the studies by So et al [12] and Kim et al [20] was 300-400 mmHg for cup size 1. Size 1, 2, 3, 4 and 5 cups have the same diameter. The maximum negative pressure in the studies by Kim et al [13], Yi et al [14] and Yi et al [17] was 550-650 mmHg (Table 4).

In the 5 domestic studies, the maximum negative pressure was 550-650 mmHg in 3 studies, and 300-400 mmHg in 2 studies. Very few studies reported on the volume of the cups.

Foreign research - constant negative pressure

The constant negative pressure in the study by Blunt and Lee [22] was 75-150 mmHg, and 75 mmHg, 225 mmHg, and 375 mmHg in the study by Tham et al [21]. The constant negative pressure in the study by Teut et al [27] was 112.5-262.5 mmHg, and 750 mmHg in the study by Blunt and Lee [22] (Table 5).

There were 4 foreign studies using constant negative pressure. There were insufficient reports on the diameter and volume of cups in the foreign studies.

Foreign research - maximum negative pressure

The maximum negative pressure in the study by Huber et al [23] was 420 mmHg using the Alcohol Flame (AF) method. It was 236.3 mmHg in the study by Emerich et al [25] using the Healthy Volunteers (HV) method, and it was 60 mmHg in the study by Duh and Chiu [26] (Table 6).

Electronic cupping devices were used in 3 foreign studies. There were insufficient reports on the diameter of the cups in the literature.

Discussion

Cupping therapy was introduced to Korea, Japan and Southeast Asia a long time ago and it is still used today. Specially made glass cups, ceramic cups or bamboo cups are placed on the part of the human body being treated for disease [28]. Over time, various technologies to assist cupping have been developed. Recently, interest in cupping methods has resurfaced and a number of studies on cupping therapy have been undertaken [29,30]. Currently, the majority of Korean medicine doctors perform cupping for musculoskeletal problems and internal diseases. Despite this, there are no studies on post-treatment side effects such as blisters, with the exception of 1 study by Yun et al [31], and no standardised treatment procedure. In this study, a total of 27 studies related to cupping therapy were reviewed to establish the correlation between cupping pressure and treatment effects so that cupping therapy can be standardised.

It was observed that constant negative pressure used in domestic research varied widely, ranging from 60 mmHg to 600 mmHg. The diameter of the cups also varied widely, ranging between 25 mm and 50 mm, and the volume of cups was largely unreported. Therefore, further experimental studies are needed on the relative results using different diameters and volumes of cups with the same constant negative pressure.

In addition, the maximum negative pressure used in domestic research varied widely, ranging from 300–400 mmHg to 540–660 mmHg (using an electronic cupping device). Only 5 studies actually reported maximum negative pressure settings. Therefore, due to insufficient reporting, a conclusion could not be proposed.

Moreover, the reported constant negative pressure in 4 foreign studies also varied widely, ranging from 75 mmHg to 375 mmHg depending on the method of cupping used. The reported maximum constant negative pressure in the 4 foreign studies also ranged widely. Only 2 studies reported on the diameter of the cups, and this range was 40 mm to 50 mm. The number of studies was quite small and there was limited information about the volume of the cups, so conclusions could not be drawn.

Furthermore, the reported maximum negative pressure in the foreign studies varied widely (between 60 mmHg and 420 mmHg) although electronic cupping was used for all studies. Two studies reported the volume of the cup which was 168 cc. Unfortunately, the information provided on maximum negative pressure in the foreign studies was not sufficient to generalise the results.

Conclusion

In conclusion, although we investigated 27 studies, including domestic and foreign studies, there were large differences in the cupping devices used, the constant negative pressure, the maximum negative pressure, the cup size, and the cup volume. It was evident that there are no specific criteria for standardised cupping treatment, and we could not directly compare the results of these studies. Furthermore, many studies lacked detail on the methods used for cupping. Therefore, we could not make any conclusive recommendations about cupping therapy. In this context, further experimental studies are needed to establish standardised cupping therapy procedures.

Fig 1.

Figure 1.

The search words used in domestic and foreign search engines.

Journal of Acupuncture Research 2020; 37: 28-34https://doi.org/10.13045/jar.2019.00339

Fig 2.

Figure 2.

Flow chart of study selection.

Journal of Acupuncture Research 2020; 37: 28-34https://doi.org/10.13045/jar.2019.00339

Fig 3.

Figure 3.

The published year of studies.

Journal of Acupuncture Research 2020; 37: 28-34https://doi.org/10.13045/jar.2019.00339

Table 1 .. Summary Characteristics of Included Studies (Domestic)..

First author (y)Cupping device typeCupping positionCupping pressure (mmHg)Cupping duration (min)
Shin [4] (1979)Cupping deviceShuxue points of 12 meridiansConstant negative pressure: 6001
Cups
Im [5] (1980)Electronic cupping deviceBack-shu pointConstant negative pressure: 601
Glass cups
Shin [6] (1988)Cupping deviceBackConstant negative pressure: 2401-3
Ceramic cups
Park [7] (1995)Electronic cupping deviceBackConstant negative pressure: 601
Cups
Oh [8] (1999)Cupping deviceBack, abdominal areaConstant negative pressure: 4005
Cups
Kweon [9] (2002)Cupping deviceBackConstant negative pressure: 605
Cups
Lee [10] (2002)Cupping deviceChest, shoulder, upper extremity, handsConstant negative pressure: 100–20020
Plastic cups
Ryu [11] (2006)BUDDEUMIConstant negative pressure: 600
Sho [12] (2008)Manual cupping deviceSilicone rubber padMaximum negative pressure5
Plastic cupsThickness: 10 ± 1 mmSize 1 (B: 397.28 / C: 362.36)
Area: 100 × 100 mmSize 2 (A: 342.51 / B: 444.23)
Size 3 (A: 365.56 / B: 466.50 / C: 423.10)
Size 4 (A: 391.34 / B: 481.49 / C: 450.87)
Size 5 (B: 510.28 / C: 464.83)
Kim [13] (2008)Manual cupping deviceDanjeon (lower part of the abdomen) area, shoulder areaMaximum negative pressure: 580–620
Plastic cups
Yi [14] (2009)Electronic cupping deviceSilicone rubber padMaximum negative pressure: 600 ± 10%10
CupsThickness: 3 ± 0.5 mm
Area: 100 × 100 mm
Kim [15] (2010)Negative pressure control deviceMidway between xiabai (LU4) and chize (LU5) of lung meridian (LU)Constant negative pressure: 30 kPa (225 mmHg)5
Kim [16] (2010)Surface meridian/acupoint energy measurement systemBack-shu point of bladder meridian (BL)Constant negative pressure: 80 kPa (600 mmHg)5
Yi [17] (2010)Electronic cupping deviceSilicone rubber padMaximum negative pressure10
CupsThickness: 3 mmSeo-ryong (600)
Area: 100 × 100 mmNoel (600)
Hansol (550)
G.O.P.O. (570)
Seoul Medical (540)
Kim [18] (2011)Measurement system for changes in meridiansBack-shu point of bladder meridian (BL)Constant negative pressure: 80 kPa (600 mmHg)1
Kim [19] (2013)Electronic cupping deviceBack-shu point of bladder meridian (BL)Constant negative pressure: 80 kPa (600 mmHg)1
Cups
Kim [20] (2018)Manual cupping deviceSilicone rubber padMaximum negative pressure10
CupsThickness: 3 mmDongbang: Size 1 (323.2 ± 9.8)
Wet cuppingArea: 100 × 100 mmDE Medical: Size 1 (318 ± 7.0)
Hansol: Size 1 (381.8 ± 13.4)
Daegun: Size 1 (322.4 ± 9.8)

Table 2 .. Summary Characteristics of Included Studies (Foreign)..

First author (y)Cupping device typeCupping positionCupping pressure (mmHg)Cupping duration (min)
Tham [21] (2006)Manual cupping deviceSoft tissueConstant negative pressure
Skin: 2 mm100 mbar (75 mmHg)
Plastic cupsFat: 10 mm300 mbar (225 mmHg)
Muscle: 10 mm500 mbar (375 mmHg)
Blunt [22] (2010)Cupping deviceNeckConstant negative pressure: 100 kPa (750 mmHg)
Cups
Huber [23] (2011)Electronic cupping deviceSoft rubber padMaximum negative pressure
LF1: 200 ± 30 hPa (150 ± 22.5 mmHg)
Glass cupsLF2: 310 ± 30 hPa (232.5 ± 22.5 mmHg)
AF: 560 ± 30 hPa (420 ± 22.5 mmHg)
BA: 270 ± 16 hPa (202.5 ± 12 mmHg)
Teut [24] (2012)Electronic cupping deviceLower back, kneeConstant negative pressure: 100–200 mbar (75-150 mmHg)Lower back: 5
Silicone cupsKnee: 10
Emerich [25] (2014)Electronic cupping deviceLower backMaximum negative pressure15
HV: 315 ± 64 hPa (236.3 ± 48 mmHg)
Glass cupsNP: 283 ± 54 hPa (212.3 ± 40.5 mmHg)
WC: 299 ± 59 hPa (224.3 ± 44.3 mmHg)
Duh [26] (2015)Electronic cupping deviceForearm, palmMaximum negative pressure: 60 mmHg6
Vacuum chamber
Teut [27] (2018)Electronic cupping deviceLower backConstant negative pressure: 150-350 mbar (112.5-262.5 mmHg)8
Silicone cups

Table 3 .. Constant Pressure Associated with Type, Diameter, and Volume of Cups (Domestic)..

First author (y)Cupping device typeCup diameter (mm)Cup Volume (cc)Cupping pressure (mmHg)
Im [5] (1980)Electronic cupping device50Constant negative pressure: 60
Glass cups
Park [7] (1995)Electronic cupping deviceConstant negative pressure: 60
Cups
Kweon [9] (2002)Cupping device4573Constant negative pressure: 60
Cups
Lee [10] (2002)Cupping device25Constant negative pressure: 60
Plastic cups
Kim [15] (2010)Negative pressure control deviceConstant negative pressure: 225
Shin [6] (1988)Cupping deviceConstant negative pressure: 240
Ceramic cups
Oh [8] (1999)Cupping deviceConstant negative pressure: 400
Cups
Shin [4] (1979)Cupping device30Constant negative pressure: 600
Cups
Ryu [11] (2006)Moxa cuppingConstant negative pressure: 600
Kim [16] (2010)Surface meridian/acupoint energy measurement systemConstant negative pressure: 600
Kim [18] (2011)Measurement system for changes in meridiansConstant negative pressure: 600
Kim [19] (2013)Electronic cupping deviceConstant negative pressure: 600
Cups

Table 4 .. Maximum Pressure Associated with Type, Diameter and Volume of Cups (Domestic)..

First author (y)Cupping device typeCup diameter (mm)Cup volume (cc)Cupping pressure (mmHg)
Sho [12] (2008)Manual cupping deviceSize 1: external diameter 50, internal diameter 48.8, height 71.2Maximum negative pressure
Size 2: external diameter 44.5, internal diameter 43.7, height 68Size 1 (B: 397.28 / C: 362.36)
Size 3: external diameter 39.7, internal diameter 39.1, height 68Size 2 (A: 342.51 / B: 444.23)
Plastic cupsSize 4: external diameter 32.7, internal diameter 32.3, height 68Size 3 (A: 365.56 / B: 466.50 / C: 423.10)
Size 5: external diameter 30.3, internal diameter 25.5, height 66Size 4 (A: 391.34 / B: 481.49 / C: 450.87)
Size 5 (B: 510.28 / C: 464.83)
Kim [13] (2008)Manual cupping deviceA: internal diameter 44.7, height 50.8A: 70.0Maximum negative pressure: 580-620
B: internal diameter 35.7, height 47.9B: 36.9
Plastic cupsC: internal diameter 28.3, height 47.9C: 26.1
D: 13.8
Yi [14] (2009)Electronic cupping deviceMaximum negative pressure: 600 ± 10%
Cups
Yi [17] (2010)Electronic cupping deviceSmall: external diameter 35–37Maximum negative pressure
Seo-ryong: 600
Middle: external diameter 42–44Noel: 600
CupsHansol: 550
Large: external diameter 52–54G.O.P.O.: 570
Seoul Medical: 540
Kim [20] (2018)Manual cupping deviceSize 1: external diameter 50, internal diameter 48.8, height 71.2Maximum negative pressure
Size 2: external diameter 44.5, internal diameter 43.7, height 68Dongbang Size 1: 323.2 ± 9.8
CupsSize 3: external diameter 39.7, internal diameter 39.1, height 68DE Medical Size 1: 318 ± 7.0
Wet cuppingSize 4: external diameter 32.7, internal diameter 32.3, height 68Hansol Size 1: 381.8 ± 13.4
Size 5: external diameter 30.3, internal diameter 25.5, height 66Daegun Size 1: 322.4 ± 9.8

Table 5 .. Constant Pressure Associated with Type, Diameter and Volume of Cups (Foreign)..

First author (y)Cupping device typeCup diameter (mm)Cup volume (cc)Cupping pressure (mmHg)
Teut [24] (2012)Electronic cupping deviceConstant negative pressure: 75-150
Silicone cups
Tham [21] (2006)Manual cupping device50Constant negative pressure: 75, 225 and 375
Cups
Teut [27] (2018)Electronic cupping deviceConstant negative pressure: 112.5-262.5
Silicone cups
Blunt [22] (2010)Cupping device40Constant negative pressure: 750
Cups

Table 6 .. Maximum Pressure Associated with Type, Diameter and Volume of Cups (Foreign)..

First author (y)Cupping device typeCup diameter (mm)Cup volume (cc)Cupping pressure (mmHg)
Huber [23] (2011)Electronic cupping device50168Maximum negative pressure:
LF1: 150 ± 22.5
Glass cupsLF2: 232.5 ± 22.5
AF: 420 ± 22.5
BA: 202.5 ± 12
Emerich [25] (2014)Electronic cupping device168Maximum negative pressure:
HV: 236.3 ± 48
Glass cupsNP: 212.3 ± 40.5
WC: 224.3 ± 44.3
Duh [26] (2015)Electronic cupping deviceMaximum negative pressure: 60
Vacuum chamber

References

  1. Korean Acupuncture and Moxibustion Medicine Society. Acupuncture Medicine. Seoul (Korea): Hanmi Medical Science; 2016. 119 p. [in Korean]
  2. Ilkay, ZC. Traditional Chinese Medicine Cupping Therapy, 3rd ed. Amsterdam (Netherlands): Churchill Livingstone; 2014. p. 1-4.
  3. Lee, B, Song, Y, and Lim, H. Literature Investigation Regarding Cupping Therapy and Analysis of Current Professional’s Cupping Treatment. J Orient Rehabil Med 2008;18:169-191. [in Korean]
  4. Shin, H. A Study on the Color Reaction of Stroke Patients with Cupping Therapy. East West Med 1979;4:55-58. [in Korean]
  5. Im, J, and Moon, J. A Clinical Study on Symptoms of Stroke in the Color Reaction of Cupping Therapy. J Korean Med 1980;16:79-82. [in Korean]
  6. Shin, W, Kim, S, and Song, H. Clinical Observation of Blood-stasis Spots in Cupping Therapy on 3700 Cases of Back-Neck-Shoulder Pain Patients. J Haehwa Med 1988;6:303-311. [in Korean]
  7. Park, J, and Lee, C. Effects of Cupping Therapy on the Variation of back Temperature measured by Blood and D.T. in Healthy Adult Men and Women. J Orient Physiol Ther 1995;5:101-114. [in Korean]
  8. Oh, J, and Kim, S. Effect of negative therapy at back meridian points on blood gas components and immune functions in male college students. J Korean Orient Med 1999;37:75-83. [in Korean]
  9. Kweon, O, Kim, E, Kim, J, and Bae, S. Analysis of Blood Components in Skin Color Reaction after Cupping Glass Therapy. J Korean Soc Phys Ther 2002;14:57-75. [in Korean]
  10. Lee, H, Jun, H, Hwang, U, Nam, S, and Kim, Y. Effects of moving cupping therapy on the edematous hands of three patients with flaccid hemiplegia. J Korean Acupoint Moxib Soc 2002;19:231-237. [in Korean]
  11. Ryu, G, Lee, J, Kim, G, Yang, H, Park, S, and Kim, M. Study on the BUDDEUMI Structural Character and Treatment. J Physiol Pathol Korean Med 2006;20:522-526. [in Korean]
  12. Sho, M, Song, Y, and Lim, H. Comparative Study on Cupping Apparatuses for Medical Use by Mechanical Stability and Functional Test. J Orient Rehabil Med 2008;18:157-167. [in Korean]
  13. Kim, Y, Kim, D, Yeon, S, Lim, B, Choi, Y, and Lee, G. Experimental Study on the Pressure Characteristics in the Cupping Therapy. J Korean Acupoint Moxib Soc 2008;25:121-130. [in Korean]
  14. Yi, S, Kim, E, Shin, K, Nam, D, Kang, J, and Lee, S. Study on Developing Assessment Guideline for Safety and Performance of Electric Cupping Apparatus. J Korean Acupoint Moxib Soc 2009;26:101-110. [in Korean]
  15. Kim, S, Lee, N, Joo, Y, Jung, B, and Lee, Y. Analysis of Moisture, Elasticity and EMG Change on Meridian Acupoints by Cupping (Negative Pressure) Stimulation. J Korea Inst Marit Inf Commun Sci 2010;14:2747-2754. [in Korean]
  16. Kim, S, Lee, N, Kim, Y, Lee, J, Song, G, and Jung, B. Analysis of Meridians Energy change by Cupping Stimulation. Korean J Acupunct 2010;27:49-57. [in Korean]
  17. Yi, S, Kim, E, Shin, K, Nam, D, Kang, J, and Lee, S. Study of Mechanical Characteristics of Electric Cupping Apparatus in Korea for Suggestion of its Assessment Guideline. J Korean Acupoint Moxib Soc 2010;27:1-10. [in Korean]
  18. Kim, S, Lee, N, Jung, B, and Lee, Y. Evaluation of Significance & Development of Quantitative Measurement System for Acupoint Pigmentation by Cupping Therapy. Korean J Acupunct 2011;28:63-71. [in Korean]
  19. Kim, S, Jung, B, Shin, T, and Lee, Y. A New Method for Measuring Acupoint Pigmentation After Cupping Using Cross Polarization. Korean J Acupunct 2013;30:252-263. [in Korean]
  20. Kim, D, Bae, E, Park, J, Kim, S, and Lee, S. Change in Risk of Dropout Due to Bleeding during Bloodletting-Cupping Therapy. Korean J Acupunct 2018;35:41-45. [in Korean]
  21. Tham, LM, Lee, HP, and Lu, C. Cupping: From a biomechanical perspective. J Biomech 2006;39:2183-2193.
  22. Blunt S, B, and Lee, H. P. Can traditional “cupping” treatment cause a stroke?. Med Hypotheses 2010;74:945-949.
  23. Huber, R, Emerich, M, and Braeunig, M. Cupping - Is it reproducible? Experiments about factors determining the vacuum. Complement Ther Med 2011;19:78-83.
  24. Teut, M, Kaiser, S, Ortiz, M, Roll, S, Binting, S, and Willich, SN. Pulsatile dry cupping in patients with osteoarthritis of the knee - A randomized controlled exploratory trial. BMC Complement Altern Med 2012;12:184.
  25. Emerich, M, Braeunig, M, Clement, HW, Lüdtke, R, and Huber, R. Mode of action of cupping - Local metabolism and pain thresholds in neck pain patients and healthy subjects. Complement Ther Med 2014;22:148-158.
  26. Duh, FC, and Chiu, YH. Vacuum Cupping Under Various Negative Pressures: An Experimental Investigation. J Multidiscip Eng Sci Tech 2015;2:1907-1911.
  27. Teut, M, Ullmann, A, Ortiz, M, Rotter, G, Binting, S, and Cree, M. Pulsatile dry cupping in chronic low back pain - a randomized three-armed controlled clinical trial. BMC Complement Altern Med 2018;18:115.
  28. Kim, Y, Song, B, Koo, S, Cho, N, Yoon, H, and Lee, E. Easy-to-know Cupping Therapy. Seoul (Korea): Uiseongdang; 2009. p. 15-18. [in Korean]
  29. Rozenfeld, E, and Kalichman, L. New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. J Bodyw Mov Ther 2016;20:173-178.
  30. Aboushanab, TS, and AlSanad, S. Cupping Therapy: An Overview from a Modern Medicine Perspective. J Acupunct Meridian Stud 2018;11:83-87.
  31. Yun, H, Kwon, S, Kim, S, Park, H, Hahm, D, and Lee, H. The Study of Blister Caused by Cupping Therapy. Korean J Acupunct 2011;28:141-150. [in Korean]
JAR
May 31, 2024 Vol.41 No.2, pp. 75~142

Stats or Metrics

Share this article on

  • line

Related articles in JAR

Journal of Acupuncture Research

pISSN 2586-288X
eISSN 2586-2898
qr-code Download