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Cupping therapy: the evidence versus the language

The language we use every day holds a lot of power. Language has the power to make us look like we know what we are talking about or...make us look the fool. Our words have the power to uplift our patients on their health journey, or to defeat them.

September 17, 2018 By Paul Kohlmeier BPE RMT R.Ac.

Cupping has a long history – it’s been practiced within many cultures, written about and taught in many languages with explanations on the effects mirroring the various ideas of how the human body worked. The Egyptians practiced it first (according to written records), it was then passed to the Greeks, then it appeared in China, Persia and in other parts of Europe. Cupping was explained by the Greeks in relation to how they believed human physiology behaved. They were one of the first written accounts of medicine based on simple principles of biology – cause and effect – though they also included the four humors, geographic location, social class, diet, trauma, beliefs, and mindset in diagnosing a patient’s illness. In China, cupping was practiced alongside and within the traditional medicine framework. The Chinese explained cupping within the ideas of five element theory, and the zang-fu theory, among others.

As with anything old, it carries with it the weight of the years and some of the language of the past. As RMTs in a western-science, evidence-informed environment, we must explain what is being done to patients because what we say matters. We are seen as the experts and our patients are entrusting us as part of their healthcare team and our first responsibility is to do no harm.

Words can harm our patients. The concept called nocebo (or the nocebo effect) is the thought that negative thoughts about a treatment itself or the patient’s condition can influence a treatment to not have the effect it should. While the nocebo effect is something our patients experience (not a side effect of an intervention), what we say to them as health-care providers influences their experience. Think about the patient that is injured and goes to see a doctor, and they come in sullen because their doctor told them that the injury may end their career or sport involvement. While the prognostication may be true, the patient is more likely to have a negative response to intervention because they were told they probably won’t get back to what they love doing.

Using the right language

What has this got to do with cupping therapy? Lots! Read social media posts, blogs, or websites about Cupping, and you are faced with language that has very little to do with western medicine physiology. There is talk about toxins, qi, blood stagnation, and all sorts of pseudo-scientific talk describing different aspects of the modality. This is a problem. If any of these things were important, or real, I think they would have been covered somewhere in my three years of training in physiology at the University of Manitoba, or in the curriculum in my massage therapy program, but they were not.

Some of these things, however, were taught in my Chinese medicine training, but these ideas are much bigger and more complex than normally presented in short social media posts. Also, the language and concepts of Chinese medicine are not analogous to western physiology in that they represent a completely different view on how the body works, so importing ideas straight in without the theoretical framework creates problems. Toxins, for instance, in the Chinese medicine framework are a technical term and quite narrowly defined. They refer to the physiology that creates red, pustulating or swelling sores – conditions such as cystic acne, skin boils, mastitis and the red and swollen areas after a serious injury. They do not refer to anything else. But in the common English vernacular, they can mean a whole lot of other things, so telling a patient that the modality you use removes toxins (in Chinese medicine) describes something much different to the person not trained in the technicalities. They will jump to thinking that they have been exposed to environmental hazards or even to the idea that their body is poisoning itself, which is not what a Chinese medicine practitioner would be talking about. This language is potentially harmful to their recovery.

Qi is a very concrete idea in Chinese medicine and to put it plainly, has nothing to do with energy. It is only recently that the word qi (气) came to be equated with the word energy. It is an English-ism that probably started when English speakers were translating Buddhist (spiritual/religious) texts from the 1950s and was used in the later translations of Chinese medical texts in the 1970s and ’80s. Telling a patient that their qi is stagnant is not helpful to their recovery, and certainly telling them that their energy is stagnant is just wrong.

Blood stagnation is one of my favourite ones. Again, this technical term in Chinese medicine has no allegory in current ideas of science. First, it should be translated as blood stasis 瘀 (yù), not stagnation 滞 (zhi). The Chinese is quite clear on this – they are two separate words. The idea of the circulatory system is pretty well understood in our culture today, but if a therapist tells a patient their blood is stagnant or static, what conclusion is the patient going to jump to? They are going to think that they are broken, and then they will fill in the blanks on their own as to why cupping is going to re-start their circulation. This, again, is potentially harmful in creating a fracture in the patient’s concept of how their body works.

It is easiest to stick to what we know or think we know about cupping from looking at the research. We can say that there is evidence that cupping can influence the nervous system. It has been shown to influence research subjects’ perception of pain and VAS and ODI scores. It has been shown to stretch tissue and certainly influence local blood flow. Also, it has been shown to have some effect on reducing creatine kinase (a marker of tissue damage) and increasing the action of the HO-1 system, which seems to be protective against oxidative stress. Just telling a patient that Cupping can reduce their experience of pain is a win for their experience of pain is their pain. The rest can be left if they ask how it reduces the pain.

Which is easier to obtain consent for? Cupping could decrease the patient’s pain; or that cupping could get rid of nameless toxins or a qi stagnation or blood stasis that the patient didn’t know they had (thus compounding how they feel about their problem) and doesn’t fit into their health paradigm?

Let’s make access to cupping easy and less harmful, and see what the science shows us in the next 20 years.