Moxibustion and Cupping Risks: Burns, Smoke and Skin Injury

Urgent first

Call emergency services (US: 911) for trouble breathing, collapse, a severe headache after scalp cupping, or a burn on the face, hands or genitals that is large or deep. For smaller burns or blisters that look infected (spreading redness, pus, fever), see a doctor promptly.

Why look at risks first

Moxibustion and cupping are both used within traditional Chinese medicine (TCM). A Cochrane review describes moxibustion as "burning a herb close to the skin". [1] Cupping creates suction on the skin with a cup of glass, ceramic, bamboo or plastic, by applying a flame to the cup or attaching a suction device. In "wet cupping" the skin is pierced and blood flows into the cup; "dry cupping" does not pierce the skin. [2] Both involve heat or suction on the skin, so skin injury is the main concern. Each has its own page: Moxibustion and Cupping Therapy. This page does not give home instructions, and we advise against trying either without training; see TCM Practices That Should Not Be Tried at Home.

Moxibustion burns and allergy

A systematic review of adverse events of moxibustion (14 databases searched) found reports in 4 randomized trials, 1 controlled trial, 2 observational studies, 13 case reports and 1 prospective study. The authors concluded that moxibustion is not entirely risk free, with allergy, burn and infection the main potential events. [3] Events reported in trials included redness, blistering, itching, discomfort due to smoke, fatigue, stomach upsets, flare-ups, headaches and burns, and the incidence is not known because large prospective studies are missing. [3] Case reports included dry eye, dry skin, patches of darker skin and eyelid changes. [3]

Moxa smoke

Burning moxa produces smoke, and two laboratory studies reached different conclusions. A Korean chamber study burned commercial indirect moxa in an unventilated 2.5 m room and found increased carbon monoxide, nitrogen oxides and volatile organic compounds, but overall levels stayed within the safe limits of Korean environmental law; the authors estimated 20 units would need to burn to exceed them, a limit likely higher with ventilation. [4] A Chinese study of moxibustion rooms and test chambers reported notable health risks from indoor air pollution, with emissions from smoky and mild moxa close to tobacco and higher than other typical indoor sources, while smoke-free moxa differed. [5] The studies used different moxa, rooms and measures, so they do not settle the question. We found no study of long-term lung effects in practitioners or patients. If you have asthma or another lung condition, tell the practitioner, ask about smokeless forms and ventilation, and ask to stop if you cough or feel breathless.

Pregnancy

In pregnant women, reports included premature birth, premature rupture of membranes and bleeding associated with pressure over the placenta. [3] A Cochrane review of moxibustion for breech presentation found adverse events (such as nausea, unpleasant odor, abdominal pain and uterine contractions) but said the evidence about their frequency is very uncertain and that adverse events were inadequately reported in most trials. [1] Discuss moxibustion in pregnancy only with an obstetric clinician; see Moxibustion for Breech Presentation.

Cupping risks

NCCIH lists these effects of cupping:

• Temporary marks on the skin, which can be mistaken for signs of physical abuse, so NCCIH advises explaining their origin to health care providers. [2] See Cupping Marks.
• Persistent skin discoloration, scars, burns and infections, and cupping may worsen eczema or psoriasis. [2]
• Rare severe effects, such as bleeding inside the skull after cupping on the scalp and anemia from blood loss after repeated wet cupping. [2]
• Spread of bloodborne diseases such as hepatitis B and C if equipment is used on more than one person without sterilization. [2]

A 2026 meta-analysis of cupping for chronic neck pain (9 trials, 401 people) reported no serious adverse events but noted methodological limits. [6] Trials are usually short and small, which makes rare events hard to detect. Methods are compared on Dry, Fire, Wet Cupping and Hijama.

Who should take extra care

Ask a doctor first and tell the practitioner if any apply. See also Who Should Avoid Moxibustion, Cupping and Gua Sha.

• Skin conditions such as eczema or psoriasis (cupping), or allergy to smoke or herbs (moxibustion). [2][3]
• Pregnancy (moxibustion). [3]
• Anemia or bleeding problems, because repeated wet cupping has caused anemia from blood loss. [2]
• Infection risk: ask how equipment is cleaned or discarded; look for single-use or sterilized items, especially for wet cupping. [2]
• Lung conditions, for moxa smoke (see above).

Stop signs

Say "stop" right away for burning, sharp pain or difficulty breathing. Afterward, get medical care for large or infected-looking blisters, a burn on the face or genitals, severe headache after scalp cupping, or a skin reaction that does not settle.

Quality and training

Practitioner rules differ by place; see TCM Qualifications, Licensing and Medical Care. We did not find a source that gives safe home-use instructions for moxibustion or fire cupping, so this page gives none. For benefit, see TCM Evidence by Use.

Evidence label: evidence of harm (burns, infection, skin injury); smoke exposure mixed; serious events insufficient evidence on frequency.