Broadly speaking there are two types of cupping: dry cupping and bleeding and/or wet cupping (controlled bleeding), with wet cupping being more common. The British Cupping Society (BCS), an organization promoting the practice, teaches both. As a general rule, wet cupping provides a more “curative-treatment approach” to patient management whereas dry cupping appeals more to a “therapeutic and relaxation approach”. Preference varies with practitioners and cultures.
Dry cupping. The cupping procedure commonly involves creating a small area of low air pressure next to the skin. However, there are varieties in the tools used, the methods of creating the low pressure, and the procedures followed during the treatment.
The cups can be various shapes including balls or bells, and may range in size from 1 to 3 inches (25 to 76 mm) across the opening. Plastic and glass are the most common materials used today, replacing the horn, pottery, bronze and bamboo cups used in earlier times. The low air pressure required may be created by heating the cup or the air inside it with an open flame or a bath in hot scented oils, then placing it against the skin. As the air inside the cup cools, it contracts and draws the skin slightly inside. More recently, vacuum can be created with a mechanical suction pump acting through a valve located at the top of the cup. Rubber cups are also available that squeeze the air out and adapt to uneven or bony surfaces.
In practice, cups are normally used only on softer tissue that can form a good seal with the edge of the cup. They may be used singly or with many to cover a larger area. They may be used by themselves or placed over an acupuncture needle. Skin may be lubricated, allowing the cup to move across the skin slowly.
Depending on the specific treatment, skin marking is common after the cups are removed. This may be a simple red ring that disappears quickly, the discolouration left by the cups is normally from bruising especially if dragging the cups while suctioned from one place to another to break down muscle fiber. Usually treatments are not painful.
Fire cupping. Fire cupping involves soaking a cotton ball in 99% alcohol. The cotton is then clamped by a pair of forceps and lit via match or lighter. The flaming cotton ball is then, in one fluid motion, placed into the cup, quickly removed, and the cup is placed on the skin. By adding fire to the inside of the cup, oxygen is removed (which is replaced with an equal volume of carbon dioxide) and a small amount of suction is created by the air cooling down again and contracting. Massage oil may be applied to create a better seal as well as allow the cups to glide over muscle groups (e.g. trapezius, erectors, latisimus dorsi, etc.) in an act called “moving cupping”. Dark circles may appear where the cups were placed because of rupture of the capillaries just under the skin, but are not the same as a bruise caused by blunt-force trauma.