Cupping Therapy has been practiced in many cultures throughout history, and both cupping and hijama have a particularly long history in the Middle East, where they have been used as traditional therapeutic practices for thousands of years. At ACPFOOD, we explore the historical role of Cupping Therapy in Persian Traditional Medicine and its place among traditional approaches to health and well-being.

Ancient Egyptian medical texts written on papyrus, including the Ebers Papyrus dating to around 1550 BC, contain references to cupping. Cupping is also commonly described as dry hijama and has long been regarded as an important therapeutic method in various traditional medical systems, including Traditional Chinese Medicine. For centuries, physicians and traditional healers in the East have recognized the potential therapeutic value of cupping and have used it as part of traditional approaches to managing various ailments and types of pain.

In Traditional Chinese Medicine, Cupping Therapy and acupuncture are sometimes used together as complementary practices. Practitioners may combine the two approaches as part of a broader traditional treatment plan, with the intention of enhancing the overall therapeutic effect.

In Persian Traditional Medicine, Cupping Therapy also has a long-established history. Prominent physicians such as Avicenna, Zkariya Al Razi, and Jorjani discussed and prescribed cupping as part of traditional approaches to various diseases, health complaints, and types of pain. Their writings helped establish cupping as an important therapeutic practice within the historical tradition of Persian medicine.

Table of Contents

The Difference Between Wet Hijama (Wet Cupping) and Dry Hijama (Dry Cupping)

The main difference between dry hijama (dry cupping) and wet hijama (wet cupping) is that wet cupping involves a controlled skin-pricking or superficial incision after the cup is removed, whereas dry cupping does not involve breaking the skin. In dry cupping, cups are placed on the skin and suction is created, usually keeping them in place for a period ranging from several seconds to several minutes before they are removed. The procedure is then complete, leaving temporary circular marks on the skin in many cases.

In wet hijama, the cup is initially placed on the skin to create suction and is typically removed after a few minutes. The practitioner then makes small, superficial scratches or punctures on the skin using a sterile instrument before applying the cup again to create suction. This allows a small amount of blood to be drawn through the superficial skin openings. Thus, while both methods use suction, dry cupping does not break the skin, whereas wet cupping involves superficial skin punctures or incisions and controlled blood removal.

What Is Cupping Therapy?

Cupping Therapy, also known as dry hijama, is a traditional therapeutic method that uses specially designed cups to create suction on the skin. These cups may be made from different materials, including glass, bamboo, or clay. Waist cupping with glass or other types of cups is one example of how this traditional method may be applied to specific areas of the body.

The suction created by the cups is traditionally believed to draw blood toward the treated area, help relieve muscle tension, and stimulate local circulation. In traditional medical systems, this process has been associated with supporting the body’s natural healing processes and promoting the recovery of tissues in the treated area.

Types of Cupping Therapy

Based on the method used to create a vacuum inside the cup, Cupping Therapy can traditionally be performed in two main ways:

Warm cupping: This is the traditional method of creating suction using a flame and a clear glass cup. The flame briefly heats the air inside the cup, and when the cup is placed on the skin, the cooling air creates a vacuum that holds the cup in place.

Cold cupping: In traditional practice, suction was sometimes created using animal horns. Today, cold cupping is generally performed using plastic cups together with a manual or mechanical suction device to create the vacuum inside the cup. Unlike warm cupping, this method does not require the use of a flame.

The Difference Between Warm and Cold Cupping

In traditional practice, both warm and cold cupping are believed to produce local warming of the treated area by drawing blood toward the skin where the cups are applied. The main difference between the two methods is how the vacuum is created. In cold cupping, no artificial heat is applied to the cup, while warm cupping uses a flame to heat the air inside a glass cup before it is placed on the skin. As a result, the treated area may feel warmer during warm cupping.

Therefore, the term “cold” cupping does not mean that the procedure necessarily cools the body. Rather, it refers to the method used to create suction. According to traditional explanations, however, the effect of Cupping Therapy may also vary depending on the area being treated. Cupping on certain areas is traditionally believed to redirect blood toward a location farther from the body’s central circulation, which may produce a sensation of coldness elsewhere. This is considered a result of the treatment mechanism and not necessarily a characteristic of cold cupping itself.

According to Persian Traditional Medicine, warm cupping may be particularly suitable when local warmth is traditionally considered desirable, such as in people with a cold temperament or in cases of muscle stiffness or spasms that are traditionally associated with exposure to cold environments. It has also historically been used as a warming method for areas affected by cold exposure. These applications reflect traditional medical concepts rather than established modern medical indications.

Some traditional sources have also attributed a role to warm cupping in reducing localized fat. However, claims that the heat itself evaporates local moisture, dilutes fat, or prepares it for removal should be understood as traditional explanations rather than established physiological mechanisms.

In situations where a flame cannot safely be used, or when the practitioner does not have sufficient experience with warm cupping, cold cupping may be considered a practical alternative for creating suction without an open flame. It can provide the same basic cupping mechanism while avoiding the additional burn risk associated with heating the cup.

Cupping Therapy Can Be Done in 3 Ways

According to Persian Traditional Medicine, Cupping Therapy can be performed using three main techniques: fixed cupping, intermittent cupping, and moving or slippery cupping. Each method differs in how the cup is applied and moved and is traditionally believed to produce different effects.

Fixed cupping: In this method, the cup is placed on the desired area of the body and left in position for approximately 15 seconds to 20 minutes before being removed. According to traditional Persian medicine, fixed cupping causes substances and humors to become concentrated in the treated area rather than being dispersed. This method has traditionally been used for areas such as the shoulders, waist, and back, as well as for complaints associated with chronic fatigue.

Intermittent cupping: In this technique, the cup is repeatedly placed on the body and briefly removed before being applied again. According to traditional explanations, repeatedly creating and releasing suction promotes local blood flow and draws lighter and finer humors toward the treated area, making it feel warmer than with other cupping techniques. The cup may be applied and removed many times, sometimes 40 times or more, with each application lasting only a few seconds, generally less than 3 to 5 seconds.

Moving or slippery cupping: In this method, the skin is first lubricated with an appropriate oil or embrocation. The cup is then gently suctioned onto the skin and slowly moved across the treated area by hand. In traditional practice, this technique is considered particularly useful for relieving muscle stiffness, spasms, and excessive fatigue. Traditional Persian medicine also describes it as a method for directing substances or humors toward a desired area. For this reason, the direction in which the cup is moved is considered important in this traditional approach, with the cup traditionally moved toward the area where the practitioner intends the materials to be directed.

How to Do Cupping?

Before Cupping Therapy, the skin is traditionally lubricated with a natural oil such as sweet almond oil, chamomile, sesame, or olive oil. According to Persian Traditional Medicine, oils with a warm temperament are traditionally considered more suitable for this purpose. The oil may also be gently warmed before application, which can make the procedure more comfortable. If warming the oil, it is safer to place the container in warm water for a short time rather than heating it directly or placing it on a radiator.

In cold cupping therapy, when a suction device is used, it is traditionally recommended to begin by creating one or two gentle suctions so that the cup attaches securely to the skin. After approximately 20 seconds, additional suction can be applied gradually, allowing the negative pressure inside the cup to increase progressively.

Depending on the purpose of the treatment and the area of the body being treated, the cup may traditionally be left in place for approximately 5 to 20 minutes.

To release the cup, the suction should first be broken rather than pulling the cup away from the skin. If the cup has a valve, the valve can be opened slightly to allow air to enter and release the vacuum. Alternatively, a finger can be gently placed against the skin near the edge of the cup and pressed inward to allow air to enter underneath the rim. Once the vacuum is released, the cup can be removed easily.

The cup should never be pulled away from the skin by force while the suction is still active. Breaking the vacuum first helps prevent unnecessary skin irritation and injury and allows the cup to be removed safely.

In warm cupping therapy, traditional practice uses a brief flame to create a vacuum inside a glass cup. A small piece of cotton moistened with alcohol is ignited and carefully held inside the cup with metal tweezers while the cup is positioned with its opening facing downward. The flame should remain away from the rim and should not be allowed to heat the edges of the cup. The burning cotton is then quickly removed, and the cup is immediately placed against the skin to create suction as the air inside the cup cools.

Safety is particularly important when performing warm cupping because the use of an open flame introduces an additional risk of burns. An overheated cup or excessive suction may cause skin irritation, blistering, or burns. For this reason, warm cupping should be performed only by someone with appropriate training and experience, using suitable equipment and proper safety precautions.

Several factors can influence the traditional application of cupping, including whether the skin is lubricated beforehand, the strength of the suction, and the length of time the cups remain on the body. According to traditional practice, these factors may be adjusted according to the individual, the area being treated, and environmental or geographical conditions.

Cupping Therapy Benefits

According to Persian Traditional Medicine and other traditional medical systems, cupping has been used for a wide range of health complaints. Traditional practitioners have proposed several mechanisms for its effects, including local stimulation, changes in blood flow, muscle relaxation, and the traditional concept of regulating the movement of humors. Some of the traditionally described benefits and applications of Cupping Therapy are outlined below.

Relief of muscle pain and fatigue: Traditional explanations associate some localized pain and fatigue with impaired circulation and the accumulation of metabolic waste products in tissues. Cupping creates negative pressure on the skin and is traditionally believed to increase local blood flow, which may contribute to relaxation and relief of discomfort in the treated area.
Supporting local tissue recovery: Increased local circulation and mechanical stimulation are traditionally considered helpful for supporting tissue recovery. Cupping has therefore been used traditionally around some areas of localized tissue damage and skin problems.
Local cleansing and traditional detoxification: Traditional practitioners have sometimes used cupping with the intention of removing unwanted substances from a particular area. Historical sources have even described its use in conditions such as insect, snake, and scorpion bites. These are traditional applications and should not replace urgent medical treatment for poisoning or envenomation.
Relieving muscle tension and spasms: The negative pressure created by cupping mechanically stretches the superficial tissues and may help relax tense muscles. Traditional practitioners have therefore used cupping for muscle stiffness, spasms, and associated localized pain.
Supporting digestive function: Cupping has traditionally been used alongside other treatments for certain digestive complaints, including constipation and what traditional medicine describes as sluggish bowel function. Such applications are based on traditional medical concepts and should not be considered a treatment for conditions such as stomach ulcers without appropriate medical care.
Supporting muscle development and recovery: Intermittent cupping is traditionally believed to increase local circulation around the muscles and has been used with the intention of supporting muscle nourishment and recovery in people experiencing weakness or emaciation.
Localized body-fat concerns: Some traditional sources have attributed a role to cupping in reducing localized fat deposits. However, the idea that cupping directly burns or removes body fat is a traditional claim rather than an established physiological effect.
Traditional applications related to menstrual bleeding: Some traditional practitioners have used different cupping techniques and locations according to traditional theories concerning the distribution and movement of blood. These historical practices have included applications intended to influence excessive or insufficient menstrual bleeding. However, abnormal menstrual bleeding can have important medical causes and should be properly evaluated by a healthcare professional rather than treated with cupping alone.
Relief of localized muscle-related pain: Traditional practitioners have suggested that some muscle pain may result from pressure or tension affecting sensory nerves or surrounding connective tissues. By mechanically stretching the superficial tissues, cupping may help reduce local muscle tension and associated discomfort.
Paresthesia and numbness: Cupping has traditionally been used for some complaints involving numbness, tingling, or altered sensation, with traditional explanations emphasizing improved local circulation and stimulation of the treated tissues. Persistent or unexplained paresthesia requires proper medical evaluation.
Kidney and urinary complaints: Some traditional physicians have used moving or slippery cupping over the kidney and urinary tract areas as part of traditional approaches to kidney stones and related pain. These historical applications should not replace medical evaluation or treatment of kidney stones.
Cold and moist temperaments: In Persian Traditional Medicine, warm cupping has traditionally been considered particularly suitable for people with a cold and moist, or phlegmatic temperament. It has also historically been considered an alternative to wet hijama in certain situations.
Pain associated with coldness: According to Persian Traditional Medicine, some types of pain are traditionally attributed to excessive coldness affecting a tissue or organ. Warm cupping is therefore traditionally used in such cases to provide local warmth and relieve discomfort.
Skin conditions: Because cupping produces local changes in blood flow and mechanical stimulation of the skin, it has traditionally been used for various skin complaints. Its traditional applications vary according to the condition and the area being treated.
Swelling and fluid accumulation around the knee: Traditional practitioners have used repeated intermittent cupping around swollen or painful joints, including knees with what traditional medicine describes as local accumulation of phlegm or fluid. Such joint swelling can have many different causes, however, and should be medically assessed before repeated treatment.
Cough and shortness of breath: Cupping has been used traditionally as a complementary practice for certain respiratory complaints, including cough and breathing discomfort. Shortness of breath, particularly when severe or sudden, requires medical evaluation.
Lumbar disc problems: Cupping has traditionally been used as a complementary method for some forms of lower-back pain associated with lumbar disc problems.
Cervical spondylosis: Traditional practitioners have used cupping as a complementary approach for neck stiffness and pain associated with cervical spondylosis.
Acne and other skin complaints: Cupping has been used traditionally for some skin conditions, including acne, although it should not be considered a substitute for appropriate dermatological treatment.
Facial paralysis: Some traditional practitioners have used cupping as a complementary treatment for facial paralysis. Because facial paralysis can have serious underlying causes, prompt medical assessment is important.
Shingles: Cupping has historically been used in some traditional practices for skin complaints such as shingles. However, shingles requires appropriate medical evaluation and treatment, particularly when it affects the face or eyes.
Traditional detoxification: Detoxification is one of the traditional concepts associated with cupping. Traditional practitioners have believed that cupping can help remove certain unwanted substances from the body or treated area. This concept should be understood within the framework of traditional medicine.
Disease prevention: Some traditional medical systems have used cupping as a preventive practice for maintaining balance and supporting general well-being, rather than only for treating existing complaints.
Supporting muscle strength: Cupping has traditionally been used with the intention of supporting muscle nourishment, recovery, and strength.
Thyroid disorders: Some traditional practitioners have historically used cupping in approaches to thyroid-related complaints, including both hyperthyroidism and hypothyroidism. These conditions require medical diagnosis and monitoring and should not be treated with cupping alone.
Infertility: Cupping has been used in some traditional medical practices as a complementary approach for infertility. Because infertility can have many underlying causes, appropriate medical investigation is essential.
Kidney function: Some traditional practitioners have used cupping as part of approaches intended to support kidney health and function. This should be understood as a traditional application rather than an established treatment for kidney disease.
Diabetes prevention: Traditional sources have sometimes included cupping among preventive practices for metabolic disorders such as diabetes. There is not sufficient basis to consider cupping a replacement for established diabetes prevention or treatment.
Maintaining general health: Cupping has historically been used as part of traditional health-maintenance practices intended to support overall balance and well-being.
Knee arthritis: Cupping has traditionally been used as a complementary method for knee pain and discomfort associated with arthritis.
Abnormal spinal curvature: Some traditional practitioners have used cupping as a complementary approach for back discomfort associated with spinal curvature. It does not correct structural spinal deformities.
Depression and emotional complaints: Cupping has been used traditionally for certain emotional and psychological complaints, including low mood. Persistent depression requires appropriate professional evaluation and treatment.
Headache: Traditional practitioners have used cupping for different types of headache. Because headaches can have many causes, the appropriate approach depends on identifying the underlying cause.
Kidney stones and kidney pain: Cupping has historically been used as a complementary practice for kidney stones and related pain, particularly through moving cupping in traditional approaches. Kidney stones can require medical treatment, especially when accompanied by severe pain, fever, vomiting, or difficulty urinating.
Sexual weakness: Some traditional medical practitioners have used cupping as part of traditional approaches to sexual weakness and related complaints.
Weakness and numbness of the legs: Cupping has traditionally been used for certain complaints involving weakness, numbness, or altered sensation in the legs. Persistent symptoms should be medically evaluated to identify their underlying cause.
Supporting metabolism: Some traditional sources associate cupping with supporting the body’s metabolic processes. This remains a traditional claim and should not be interpreted as evidence that cupping directly increases metabolic rate.

Important note: According to Persian Traditional Medicine, warm and dry cupping is traditionally considered more suitable than cold cupping when the intended purpose is to address what traditional medicine describes as excess coldness or moisture. Cupping is generally regarded within these traditions as a complementary practice rather than a replacement for diagnosis and appropriate medical treatment. Since pain and other health complaints can have many different causes, identifying the underlying cause is particularly important before using cupping. For example, headaches may be associated with conditions ranging from migraine and sinus problems to blood-pressure abnormalities or other neurological disorders. Therefore, persistent, severe, unusual, or unexplained symptoms should first be evaluated by a qualified healthcare professional.

What Are the Side Effects of Cupping?

Cupping Therapy is generally associated with temporary local effects, particularly when it is performed by a properly trained and experienced practitioner using appropriate equipment and hygienic techniques. Depending on the type of cupping and the individual’s skin sensitivity, temporary effects such as mild soreness, circular bruising or discoloration, skin irritation, or, in the case of warm cupping, burns may occur. Skin infection is also possible if proper hygiene and sterilization procedures are not followed. Most minor effects typically resolve within several days.

It is important to avoid applying cups over areas of active skin inflammation, burns, infections, or open wounds, as this may aggravate the affected area or increase the risk of complications. Cupping should also be performed with particular care in people who may be more susceptible to bleeding, skin injury, or other complications.

Conclusion

Cupping Therapy is a traditional therapeutic practice with a long history in Persian Traditional Medicine and other traditional medical systems. From warm and cold cupping to fixed, intermittent, and moving techniques, different methods have traditionally been used according to the individual’s condition, temperament, and the purpose of treatment.

Traditional Persian medicine attributes various benefits to cupping, including relieving certain types of pain and muscle tension and supporting local circulation. However, because many health conditions can have different underlying causes, cupping should be considered a complementary practice rather than a substitute for accurate diagnosis and appropriate medical treatment. When it is considered appropriate, having the procedure performed by a properly trained and experienced practitioner can help reduce the risk of unnecessary complications.

Medical Disclaimer