The Science of Cupping Therapy: Mechanisms, Effects, and Evidence

Cupping therapy uses negative pressure on the skin to influence blood flow, nerves, and immune responses. Modern studies explore how this mechanical stimulus might translate into pain relief and other health effects, but mechanisms and clinical value are still only partly understood.

Mechanisms of Action

Local tissue and blood changes

Suction stretches skin and tissue, dilates capillaries, increases local blood flow, and can cause capillary rupture and bruising (Zhang et al., 2024; Mehta & Dhapte, 2015; Tao et al., 2020).
Breakdown of leaked blood activates heme oxygenase‑1 (HO‑1) and generates molecules with antioxidant, anti‑inflammatory and neuromodulatory effects; these may act locally and systemically (Zhang et al., 2024).
Negative pressure and temperature are key technical drivers, altering hemodynamics, metabolism, immune regulation, and pain signaling (Al-Bedah et al., 2018; Mehta & Dhapte, 2015; Tao et al., 2020).

Proposed physiological theories

Reviews summarize overlapping theories: blood‑circulation promotion, pain‑gate and diffuse noxious inhibitory controls, neurological reflex zones, inflammation–immune reaction, nitric‑oxide–mediated vasodilation, and “blood detoxification” via removal of blood and solutes in wet cupping (Lowe, 2017; Alam, 2021; Jia et al., 2025; Wang et al., 2020; Tao et al., 2020).
Animal and imaging work shows low‑pressure cupping can enhance blood and lymphatic flow and modulate inflammatory responses (e.g., improved sepsis outcomes in mice) (Mehta & Dhapte, 2015).

Different Pressures in Cupping

Parameter: Low pressure (~‑20 kPa); Higher pressure (~‑30 kPa)

Blood flow↑, reversible in ~2 h↑ with capillary rupture(Mehta & Dhapte, 2015)

Tissue effect: Minimal damage, bruising, oedema(Mehta & Dhapte, 2015)

Lymphatic drainage: Enhanced dye clearance; not highlighted(Mehta & Dhapte, 2015)

Clinical Effectiveness and Safety

Systematic reviews and meta‑analyses report short‑term pain reduction in chronic musculoskeletal pain and low back pain, with moderate evidence but high study heterogeneity and frequent risk of bias (Mohamed et al., 2022; Al-Bedah et al., 2018; Mohandes et al., 2024; Khudair et al., 2024; Santoso et al., 2025).
Cupping shows benefits for conditions like herpes zoster, neck pain, and some arthritis forms, mainly when added to other treatments; long‑term outcomes and optimal protocols remain unclear (Mohamed et al., 2022; Hou et al., 2021; Cao et al., 2012; Aboushanab & Alsanad, 2018).
For migraine and chronic musculoskeletal pain, cupping reduces pain intensity but has limited evidence for improving disability, mental health, or overall quality of life (Koran & Irban, 2021; Khudair et al., 2024).
Adverse events are usually mild and local (e.g., skin marks, discomfort), with serious complications rarely reported in these summaries (Mohamed et al., 2022; Al-Bedah et al., 2018; Hou et al., 2021; Santoso et al., 2025).

Conclusion

Modern research suggests cupping modifies local microcirculation, metabolism, and immune and neural signalling, with several plausible but unproven mechanisms. Clinically, evidence supports short‑term pain relief and symptom improvement for some conditions, but trial quality is variable and long‑term benefits are uncertain. Cupping appears relatively low‑risk when properly performed, yet more rigorous, standardised studies are needed to firmly define how, for whom, and how well it works.

References

Aboushanab, T. S., & Alsanad, S. M. (2018). Cupping Therapy: An Overview from a Modern Medicine Perspective. Innovations in Acupuncture and Medicine, 11, 83 - 87. https://doi.org/10.1016/j.jams.2018.02.001

Al-Bedah, A., Elsubai, I. S., Qureshi, N., Aboushanab, T. S., Ali, G. I. M., El-Olemy, A., Khalil, A. A., Khalil, M., & Alqaed, M. (2018). The medical perspective of cupping therapy: Effects and mechanisms of action. Journal of Traditional and Complementary Medicine, 9, 90 - 97. https://doi.org/10.1016/j.jtcme.2018.03.003

Alam, M. (2021). The Role of Cupping Therapy (CT) In Pain Tackling, an Insight into Mechanism Therapeutic Effects and its Relevance in Current Medical Scenario. International Journal of Current Science Research and Review. https://doi.org/10.47191/ijcsrr/v4-i7-16

Cao, H., Li, X., & Liu, J. (2012). An Updated Review of the Efficacy of Cupping Therapy. PLoS ONE, 7. https://doi.org/10.1371/journal.pone.0031793

Hou, X., Bai, Z.-M., & Liu, J. (2021). [Physiological mechanisms and clinical research progress of cupping therapy].. Zhen ci yan jiu = Acupuncture research, 46 3, 254-8. https://doi.org/10.13702/j.1000-0607.200334

Jia, Y., Dong, X., Chai, Y., Bai, Z., Sun, T., & Hou, X. (2025). Effects of cupping therapy on chronic musculoskeletal pain and collateral problems: a systematic review and meta-analysis. BMJ Open, 15. https://doi.org/10.1136/bmjopen-2024-087340

Khudair, S., Hussein, L., Hameed, S. I., & Hussein, S. A. M. (2024). Review Article: Cupping Therapy in Treatment of Certain Diseases. International Journal of Health & Medical Research. https://doi.org/10.58806/ijhmr.2024.v3i07n19

Koran, S., & Irban, A. (2021). Analytical Approach to the Literature of Cupping Therapy. Journal of The Korean Society of Physical Medicine. https://doi.org/10.13066/kspm.2021.16.3.1

Lowe, D. T. (2017). Cupping therapy: An analysis of the effects of suction on skin and the possible influence on human health.. Complementary therapies in clinical practice, 29, 162-168. https://doi.org/10.1016/j.ctcp.2017.09.008

Mehta, P., & Dhapte, V. (2015). Cupping therapy: A prudent remedy for a plethora of medical ailments. Journal of Traditional and Complementary Medicine, 5, 127 - 134. https://doi.org/10.1016/j.jtcme.2014.11.036

Mohamed, A., Zhang, X., & Jan, Y.-K. (2022). Evidence-based and adverse-effects analyses of cupping therapy in musculoskeletal and sports rehabilitation: A systematic and evidence-based review. Journal of Back and Musculoskeletal Rehabilitation, 36, 3 - 19. https://doi.org/10.3233/bmr-210242

Mohandes, B., Bayoumi, F., AllahDiwaya, A. A., Falah, M., Alhamd, L., Alsawadi, R., Sun, Y., A.-J., Sula, I., & Jihwaprani, M. C. (2024). Cupping Therapy for the Treatment of Migraine Headache: a systematic review and meta-analysis of clinical trials. Journal of Pharmacopuncture, 27, 177 - 189. https://doi.org/10.3831/kpi.2024.27.3.177

Santoso, A. B., Yuantari, M. C., & Asfawi, S. (2025). Mapping the Effect of Cupping Therapy on Body Health: A Bibliometric Analysis. Jurnal Ners. https://doi.org/10.31004/jn.v9i2.43614

Tao, J., Zhao, P., Mo, T., Zhao, R., Yang, N., Lee, M. S., Liu, J., & Cao, H. (2020). Key elements that determine the efficacy of cupping therapy: A bibliometric analysis and review of clinical studies. Journal of Traditional Chinese Medical Sciences. https://doi.org/10.1016/j.jtcms.2020.11.001

Wang, S.-Z., Lu, Y.-H., Wu, M., Chen, K., Liu, Y., & Liu, L. (2020). Cupping Therapy for Diseases: An Overview of Scientific Evidence from 2009 to 2019. Chinese Journal of Integrative Medicine, 27, 394-400. https://doi.org/10.1007/s11655-020-3060-y

Zhang, P., Lv, J., Ge, C., Yu, B., Qiu, Y., Qin, A., Ai, Z., Wu, Z., Nie, L., & Xiang, Z. (2024). Quantitative evaluation of microenvironmental changes and efficacy of cupping therapy under different pressures based on photoacoustic imaging. Photoacoustics, 40. https://doi.org/10.1016/j.pacs.2024.100661

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The Science of Cupping Therapy: Mechanisms, Effects, and Evidence

Cupping therapy uses negative pressure on the skin to influence blood flow, nerves, and immune responses. Modern studies explore how this mechanical stimulus might translate into pain relief and other health effects, but mechanisms and clinical value are still only partly understood.

Mechanisms of Action

Local tissue and blood changes

Suction stretches skin and tissue, dilates capillaries, increases local blood flow, and can cause capillary rupture and bruising (Zhang et al., 2024; Mehta & Dhapte, 2015; Tao et al., 2020).

Breakdown of leaked blood activates heme oxygenase‑1 (HO‑1) and generates molecules with antioxidant, anti‑inflammatory and neuromodulatory effects; these may act locally and systemically (Zhang et al., 2024).

Negative pressure and temperature are key technical drivers, altering hemodynamics, metabolism, immune regulation, and pain signaling (Al-Bedah et al., 2018; Mehta & Dhapte, 2015; Tao et al., 2020).

Proposed physiological theories

Animal and imaging work shows low‑pressure cupping can enhance blood and lymphatic flow and modulate inflammatory responses (e.g., improved sepsis outcomes in mice) (Mehta & Dhapte, 2015).

Different Pressures in Cupping

Parameter: Low pressure (~‑20 kPa); Higher pressure (~‑30 kPa)

Blood flow↑, reversible in ~2 h↑ with capillary rupture(Mehta & Dhapte, 2015)

Tissue effect: Minimal damage, bruising, oedema(Mehta & Dhapte, 2015)

Lymphatic drainage: Enhanced dye clearance; not highlighted(Mehta & Dhapte, 2015)

Clinical Effectiveness and Safety

Cupping shows benefits for conditions like herpes zoster, neck pain, and some arthritis forms, mainly when added to other treatments; long‑term outcomes and optimal protocols remain unclear (Mohamed et al., 2022; Hou et al., 2021; Cao et al., 2012; Aboushanab & Alsanad, 2018).

For migraine and chronic musculoskeletal pain, cupping reduces pain intensity but has limited evidence for improving disability, mental health, or overall quality of life (Koran & Irban, 2021; Khudair et al., 2024).

Adverse events are usually mild and local (e.g., skin marks, discomfort), with serious complications rarely reported in these summaries (Mohamed et al., 2022; Al-Bedah et al., 2018; Hou et al., 2021; Santoso et al., 2025).

Conclusion

References

Aboushanab, T. S., & Alsanad, S. M. (2018). Cupping Therapy: An Overview from a Modern Medicine Perspective. Innovations in Acupuncture and Medicine, 11, 83 - 87. https://doi.org/10.1016/j.jams.2018.02.001

Alam, M. (2021). The Role of Cupping Therapy (CT) In Pain Tackling, an Insight into Mechanism Therapeutic Effects and its Relevance in Current Medical Scenario. International Journal of Current Science Research and Review. https://doi.org/10.47191/ijcsrr/v4-i7-16

Cao, H., Li, X., & Liu, J. (2012). An Updated Review of the Efficacy of Cupping Therapy. PLoS ONE, 7. https://doi.org/10.1371/journal.pone.0031793

Hou, X., Bai, Z.-M., & Liu, J. (2021). [Physiological mechanisms and clinical research progress of cupping therapy].. Zhen ci yan jiu = Acupuncture research, 46 3, 254-8. https://doi.org/10.13702/j.1000-0607.200334

Jia, Y., Dong, X., Chai, Y., Bai, Z., Sun, T., & Hou, X. (2025). Effects of cupping therapy on chronic musculoskeletal pain and collateral problems: a systematic review and meta-analysis. BMJ Open, 15. https://doi.org/10.1136/bmjopen-2024-087340

Khudair, S., Hussein, L., Hameed, S. I., & Hussein, S. A. M. (2024). Review Article: Cupping Therapy in Treatment of Certain Diseases. International Journal of Health & Medical Research. https://doi.org/10.58806/ijhmr.2024.v3i07n19

Koran, S., & Irban, A. (2021). Analytical Approach to the Literature of Cupping Therapy. Journal of The Korean Society of Physical Medicine. https://doi.org/10.13066/kspm.2021.16.3.1

Lowe, D. T. (2017). Cupping therapy: An analysis of the effects of suction on skin and the possible influence on human health.. Complementary therapies in clinical practice, 29, 162-168. https://doi.org/10.1016/j.ctcp.2017.09.008

Mehta, P., & Dhapte, V. (2015). Cupping therapy: A prudent remedy for a plethora of medical ailments. Journal of Traditional and Complementary Medicine, 5, 127 - 134. https://doi.org/10.1016/j.jtcme.2014.11.036

Mohamed, A., Zhang, X., & Jan, Y.-K. (2022). Evidence-based and adverse-effects analyses of cupping therapy in musculoskeletal and sports rehabilitation: A systematic and evidence-based review. Journal of Back and Musculoskeletal Rehabilitation, 36, 3 - 19. https://doi.org/10.3233/bmr-210242

Santoso, A. B., Yuantari, M. C., & Asfawi, S. (2025). Mapping the Effect of Cupping Therapy on Body Health: A Bibliometric Analysis. Jurnal Ners. https://doi.org/10.31004/jn.v9i2.43614

Tao, J., Zhao, P., Mo, T., Zhao, R., Yang, N., Lee, M. S., Liu, J., & Cao, H. (2020). Key elements that determine the efficacy of cupping therapy: A bibliometric analysis and review of clinical studies. Journal of Traditional Chinese Medical Sciences. https://doi.org/10.1016/j.jtcms.2020.11.001

Wang, S.-Z., Lu, Y.-H., Wu, M., Chen, K., Liu, Y., & Liu, L. (2020). Cupping Therapy for Diseases: An Overview of Scientific Evidence from 2009 to 2019. Chinese Journal of Integrative Medicine, 27, 394-400. https://doi.org/10.1007/s11655-020-3060-y

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