Dry, Fire, Wet Cupping and Hijama: Methods and Risks

What cupping is, and what the names mean

Cupping is a practice used in traditional medicine in several parts of the world, including China and the Middle East. A cup made of glass, ceramic, bamboo or plastic is placed on the skin and suction is created inside it. [1] In Arabic the practice is called hijama. One narrative review says its use is documented in early Egyptian and Chinese medical practices, and that the data on its exact origin are inconsistent. [2]

This page explains the methods and their risks. It is information only, and it gives no instructions for doing any of them yourself. For the wider picture see Cupping Therapy, and for what the research found by health problem see Cupping Therapy Evidence by Use.

The main methods

The names describe how suction is made and whether the skin is cut.

• Dry cupping. The skin is not pierced. [1] Suction can also be made by attaching a suction device to the cup. [1]
• Fire cupping. A flame is used on the cup to remove oxygen before it goes on the skin. [1] The flame is why burns are a named risk (see below).
• Wet cupping (hijama). The skin is pierced and blood flows into the cup. [1]

What the tradition says, and what it does not show

Practitioners in different traditions give their own explanations of why cupping is used, and some use words such as "blood stasis" or "toxins." These are traditional frameworks, not measured biology. Our reading found no source showing that cupping removes toxins from the body. The skin marks that follow are bruise-like, and they do not by themselves show that anything has been "drawn out." See Cupping Marks: What They Are and What They Do Not Show.

What research found (short version)

The US National Center for Complementary and Integrative Health (NCCIH) says there has been some research on cupping but most of it is of low quality. Cupping may help reduce pain, but the evidence for this is not very strong, and there is not enough high-quality research to reach conclusions about other conditions. [1]

Wet cupping has been tested for itchy skin conditions. A review of 19 studies on neurodermatitis found low-grade evidence and poor methods, and the authors advised caution in applying the findings. [3] A review of rheumatic diseases said cupping still needs more evidence before it can be called a treatment for those conditions. [4] Label: insufficient evidence for most uses; promising but limited for some pain problems (see the evidence page).

Risks that apply to every type

• Skin effects. NCCIH lists persistent skin discoloration, scars, burns and infections, and says cupping may worsen eczema or psoriasis. [1]
• Rare severe harm. Bleeding inside the skull has been reported after cupping on the scalp, and anemia from blood loss after repeated wet cupping. [1] A review of case reports found 14 patients with neurological complications, most commonly bleeding between the brain and its covering, and called these complications rare but potentially life-threatening. [5]
• Infection spread. Cupping equipment can become contaminated with blood, on purpose in wet cupping or by accident in dry cupping. Using the same equipment on more than one person without sterilization can spread bloodborne diseases such as hepatitis B and C. [1]
• Marks look like injury. The origin of cupping marks should be explained to health care providers so they are not mistaken for signs of physical abuse. [1]

Infection control: what good practice looks like

Safety authors writing on cupping and gua sha say reusable instruments need high-level disinfection and, for wet cupping, sterilization. [6] In practice, ask any practitioner how they handle equipment between people, whether blood-contact items are single-use or sterilized, and what they do with used items. If the answers are vague, or if the same cup touches broken skin on more than one person, do not go ahead. Because fire cupping uses a flame, burns are a listed risk, which is another reason not to try it without training. [1]

Who should take extra care

Talk to your own doctor first if you take blood thinners, have a bleeding disorder, anemia, an active skin condition, diabetes with slow healing, are pregnant, or are caring for a child. We did not find a source we could read that gives pregnancy-specific rules for cupping, so we do not state any; see TCM in Pregnancy. Do not delay care for serious symptoms to try cupping.

When to get urgent help

In the US, call 911 for a sudden severe headache, confusion, weakness, trouble speaking or heavy bleeding after any cupping, especially on the scalp or neck. For spreading redness, pus, fever or a wound that does not heal, contact a doctor soon. Tell them cupping was done.

Choosing a practitioner

Training and regulation vary by country and by state. Read How to Choose a TCM Practitioner and Moxibustion and Cupping Risks. We do not list or recommend practitioners.