A customer-slash-victim undergoing dry cupping. I know, super gross, right?

A customer-slash-victim undergoing dry cupping. I know, super gross, right?

Always start with an excuse. I have been ill for the last 10 days. I suspect I picked up an infection from the woman I slept with in Vegas.* I normally go through the day at warp 5 (I do not want to destroy space-time), but this illness has reduced my mental functioning in the evening to one-half impulse at best, with thoughts moving at the speed of a cold Oregon slug. So bear with me.

There can be an odd popularity to medicine. I see this in antibiotics usage. When a patient is admitted to the ICU with sepsis, while awaiting cultures you try and kill all the likely bacteria that may be trying to kill the patient. At any given time most doctors can only remember two antibiotics and the current popular duo is vancomycin and pipericillin/tazobactam. It is a reasonable choice, one of many combinations that would treat most patients with sepsis. I am not certain how this combination became so popular, although I have been told that the pipericillin/tazobactam reps have been very active at the Universities with medical students and residents. As the adage goes, “Give me a student until he is seven and I will give you the doctor.”

There are also popular trends in alternative medicine as well. Every now and then there is a flurry of mentions on the interwebs suggesting that a pseudo-medicine has become all the rage. Or maybe it is just the echo chamber that is the interwebs.

This week it is “Oil Pulling Might Be The Next Big Thing — Or Not” and “What is cupping? Lena Dunham the latest celeb to try the ancient Chinese remedy for pain relief.”

If oil pulling appears on the Huffington Post it must popular, although Dr. Novella is skeptical as to its efficacy. And just thinking of swishing oil in my mouth for 20 minutes or so gives me that gaggy feeling.

Cupping is not the protection I used for karate as a kid. Cupping is a technique where a vacuum is made in container and applied to the skin, and the vacuum sucks on the skin creating a welt. Basically cupping gives the patient a hickey without, usually, the mess and aggravation of making out.

Medicine has, for the most part, toughened me. I have learned not to scream or vomit when faced with the occasional surprise such as an unexpected squirt of pus up a tie or a jar filled to the brim with dried boogers. But the photos of cupping on the interwebs give me the wiggins. It doesn’t make me gaggy like oil pulling, but ick.

Cupping is one of the ancient therapies, used in Egypt, China, and Greece. Antiquity is always a reliable guide for health and life-style choices. I live in a pyramid with my terracotta army, tended by my slaves and planning the conquest of a city-state based on the entrails of a sacrificed goat. What was good enough for the ancients is good enough for me. Except for that whole “short life expectancy from infections” thing. It is an oddity of the appeal to antiquity in that it is mostly used to justify pseudo-medicines, but little else in life if you are not Amish. I can’t see anything in my personal or professional life that uses the methods of the ancients. I am certainly glad it is not used in the brewing of beer.

Cupping is like acupuncture in that at different times and places variations on the technique have evolved. There are a many forms of forms of cupping: dry, fire, retained, moving, flash, needles, medicinal and wet among others. In wet cupping they make a small incision in the area of suction to make sure that blood is drawn out to:

remove harmful substances and toxins from the body to promote healing.

That is like cleaning a swimming pool by taking out a cup of water.

Like acupuncture, there is no process for which it cannot be used. Except birth control. As best as can be determined, prevention of conception is not the strong suit of TCM. But it has been suggested that there are 1,001 diseases for which cupping can be of benefit (although they mention only 120).

Our results suggest that CT is currently prescribed for up to 120 diseases and disorders that are difficult to treat, including cutaneous (21.7%), musculoskeletal (15%), and central nervous system (13.3%) disorders.

There is no reason cupping should have any effect on any disease beyond the usual placebo effect and it would be difficult to do placebo controlled trials given the large hickeys induced by the procedure, although someone has devised a form of sham cupping. Given the dramatic changes to the skin from cupping, I would expect the technique to be a particularly powerful set of beer goggles. The more impressive the placebo, the more it will alter perception. And, like a good set of beer goggles:

majority of studies show potential benefit on pain conditions…that there is insufficient high-quality evidence to support the use of cupping therapy on relevant diseases….Existing trials are of small size and low methodological quality. Further high quality studies of larger sample size are needed to assess the effectiveness of cupping therapy.

More studies needed. They always say that, no matter how ridiculous the intervention. I would beg to differ. There is no reason to waste time and money on interventions with no reason to work. I would also expect, since cupping has no reality-based reason for efficacy, that it would have no significant effect on a process with a hard endpoint like hypertension. And it doesn’t.

Like most pseudo-medicine, cupping only shows efficacy in poorly-controlled trials and usually only for subjective endpoints.

Despite the large number of studies on cupping therapy, including the 62 new ones, there remains a lack of well-designed investigations [Shocking – Ed.]. Of the 135 RCTs included in this review, 84.44% were high risk of bias [What ! Ed.] . One issue is adherence to the Consolidated Standards of Reporting Trials (CONSORT) in which randomization methods should be clearly described and fully reported. Another issue is blinding, which continues to be a challenge for studies involving manual healing therapies, such as acupuncture, massage, and cupping therapy.

Reality also remains a challenge, but that is almost never considered in the discussion:

our study is based on a process that has no basis in anatomy and physiology and as such any likely efficacy can be accounted for by bias and poor study design. More research needs to be done.

I love the purported mechanism:

The mechanism of cupping therapy is not clear, but some researchers suggest that placement of cups on selected acupoints on the skin produces hyperemia or hemostasis, which results in a therapeutic effect.

Exactly how skin hypermia or hemostasis would have any effect beyond the local hickey is never explained, except in the context of mystical fiction:

Like acupuncture, cupping follows the lines of the meridians. There are five meridian lines on the back, and these are where the cups are usually placed. Using these points, cupping can help to align and relax qi, as well as target more specific maladies. By targeting the meridian channels, cupping strives to ‘open’ these channels – the paths through which life energy flows freely throughout the body, through all tissues and organs, thus providing a smoother and more free-flowing qi (life force).

When you look at the ginormous welts (not for the squeamish) on cupping patients you have to wonder just how select these points are. They must activate half a dozen acupoints with each cupping. Shouldn’t it set off a qi storm with so many acupoints being activated at once? Oh, wait, I’m sorry. For a moment I was considering the process as if it actually corresponded with reality.

I can see how cupping would be popular since it leaves a tell-tale mark that lets those around you know that you are one of the cognoscenti without the permanence of a tattoo. No one knows if you are getting acupuncture or reiki, but the hickey on the back is an instant attention-getter, the perfect pseudo-medical ‘look at me’ sign that advertises your subtle understanding of ancient Chinese wisdom. Seems perfect for Hollywood.

Or it might suggest you would be interested in helping move some money from Nigeria to the US to help out a poor widow whose husband left her a fortune.

And if you have been cupped perhaps there is a way to remove the embarrassing bruise.

Two notes.

April 12/13 I will be in Manchester at QED ostensibly to give a talk and participate in panel discussion. I am really there to see if there are any English beers better than those here in Beervana. I doubt it.

I have had issues with the Quackcast and iTunes RSS feeds. I think it is fixed. If you have been a listener but wonder where the podcast has gone, delete the feed and resubscribe.

*My wife was ill first and I suspect I got it from her. Get your mind out of the gutter.



  • Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, from 1990 to 2023. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His multi-media empire can be found at

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, from 1990 to 2023. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His multi-media empire can be found at