Cupping puts suction cups on the skin to draw up the tissue underneath, and its clearest use is short-term pain relief, most studied for the neck and lower back. The trials point one way: cupping reliably beats doing nothing, but against a dummy version built to mimic the pull it holds no clear edge, and the independent evidence map rated none of the cupping-for-pain evidence high quality.
It is low-risk, you can learn the dry form yourself, and the round marks it leaves are ordinary bruising, not toxins.
Findings & Outcomes
What It Is
Cupping places cups on the skin and creates suction inside them, so the skin and the tissue just below are drawn up into the cup. It is one of the older tools of Chinese medicine, used mainly over the back, shoulders, and neck. It became far more visible in recent years after the circular marks on Olympic swimmers put it in front of a global audience, though its evidence stayed modest. The suction is made two ways. Fire cupping heats the air inside a glass cup with a brief flame; the modern way uses a rubber or silicone cup, or a cup with a hand pump, which needs no flame and is the form most people can use at home.
Dry cupping and wet cupping differ in both their evidence and their risk. Dry cupping is suction only, and it leaves the skin intact. Wet cupping, called hijama, makes tiny shallow cuts and then applies suction to draw out a small amount of blood, so it breaks the skin. Most of the research, and almost all of the safe at-home practice, is dry cupping.
Anatomy of the Practice
1What a cup does to the skin
The suction lifts the skin and the layer beneath it up into the cup and holds it there, usually for five to fifteen minutes, or the cup is oiled and slid along the muscle in what is called moving cupping. You feel a firm, tight pull rather than a pinch. The pull draws a little blood out of the smallest vessels into the surrounding tissue, which is what colors the skin.
2Dry, wet and fire cupping
Dry cupping is suction alone and leaves the skin unbroken. Fire cupping uses a brief flame to create the suction, so the cup goes on warm; the flame never touches you. Wet cupping makes small shallow scratches first and then draws a little blood into the cup. Dry cupping is the everyday form and the one to learn at home; wet and fire cupping belong with a trained practitioner.
3The marks, and how long they last
Where the cup sat you are left with a round mark, pink to dark purple depending on how much blood was drawn into the skin. It is a bruise, and it fades over several days to about two weeks, the same way any bruise does. The color reflects local bruising at that spot, and it is not a measure of toxins or of how well the session worked.
What It Does
The trials cluster around musculoskeletal pain, and they run from a few reasonably consistent uses down to thin, provisional ones. The neck and lower back sit at the top: pooling 18 trials, cupping lowered neck pain by about 2.42 points on a roughly 10-point scale against no treatment, and a separate review of 21 dry-cupping trials found similar short-term relief for the neck and lower back. The relief tends to arrive the same day and does not last, showing at two to eight weeks in the low back trials and gone by three to six months.
Knee arthritis and chronic hives sit lower, on thinner trials. Adding cupping to usual medicine improved a standard knee-arthritis score, and for long-lasting hives wet cupping performed about as well as antihistamine tablets and added benefit on top of them. All of these trials are low to moderate quality.
The sham comparison shows how much of this is the suction itself, and the answer is not much. Cupping easily beats doing nothing, but tested against a dummy version built to mimic the pull and the marks, the advantage shrinks to small and not statistically significant. A convincing sham for suction is hard to build, so even that comparison is imperfect. Much of the benefit for a sore, tight neck or back may come from the touch, the attention, and your own expectation, which is an active mechanism in its own right.
The independent evidence map rated none of the cupping-for-pain evidence high quality, and the best reached only moderate.
That makes cupping a low-risk thing to try for short-term relief, on its own or alongside care that works over the longer run, understanding what the marks are.
The Research & Studies
Everything here is based on the research we have collected and checked, sorted into groups and ordered with the strongest evidence first. Click any claim to open the studies behind it.
Pain
Against a sham cupping, no clear pain advantage (SMD -0.27), though cupping easily beat doing nothing
When cupping was tested against a fake version designed to mimic the sensation, it was no clearly better than the fake, even though it easily beat doing nothing. That gap is where the strongest part of the evidence sits, and it is the reason the effect is graded cautiously.
The 2020 meta-analysis (Cramer et al., Journal of Pain) pooled 18 RCTs and 1,172 people with chronic pain. Compared with no treatment, cupping showed a large short-term reduction in pain intensity (SMD -1.03, 95% CI -1.41 to -0.65) and a medium reduction in disability (SMD -0.66, 95% CI -0.99 to -0.34). Against sham cupping the pain effect was not significant (SMD -0.27, 95% CI -0.58 to 0.05), and against other active treatments it was also not significant (SMD -0.24). The split between the large no-treatment effect and the absent sham effect is the pattern of a therapy whose benefit is hard to separate from expectation and attention, which is compounded because a convincing sham for suction is difficult to build. The authors concluded cupping might be an option but the evidence remains limited by heterogeneity and risk of bias.
The study · 1
Cramer et al., Cupping for patients with chronic pain: a systematic review and meta-analysis · J Pain 2020;21(9-10):943-956
Across 14 reviews, none of the cupping-for-pain evidence rated high quality; the best was moderate
When someone looked across all the review-level evidence on cupping for pain, the reviews themselves were mostly weak, and none of the findings reached high quality. A handful reached moderate quality; the rest were low or very low.
The 2023 evidence-mapping study (Wang et al., Front Neurol) collected 14 meta-analyzes of cupping for pain-related outcomes and rated them with AMSTAR 2: 36% critically low, 50% low, 7% moderate and 7% high. Applying GRADE to the significant outcomes, the authors found no high-quality evidence for any pain outcome. The strongest available was moderate-quality evidence for a few conditions, including two moderate-quality bodies of evidence for low back pain, two for neck pain, and three for knee osteoarthritis, with the remainder low or very low. This sets the ceiling for how confident any single cupping-for-pain claim can be: a short-term signal on evidence that has not yet reached high quality.
The study · 1
Wang et al., Efficacy of cupping therapy on pain outcomes: an evidence-mapping study · Front Neurol 2023;14:1266712
Cupping cut neck pain about 2.42 points versus no treatment across 18 trials, on low-quality evidence
Pooling 18 trials, cupping lowered neck pain compared with no treatment and improved how the neck functioned, but the trials were low quality and hard to blind, so the size of the real effect is uncertain.
The 2018 systematic review and meta-analysis (Kim et al., BMJ Open) searched nine databases and pooled 18 RCTs of cupping for neck pain. Against a no-intervention group, cupping cut pain (MD -2.42, 95% CI -3.98 to -0.86) and improved function (MD -4.34, 95% CI -6.77 to -1.19); against active controls it reduced pain (p=0.0009) and improved quality of life (p=0.001); and as an add-on to control treatment it reduced pain versus the active control alone (p=0.001). Only 8 of 18 studies reported adverse events, which were mild and temporary. Because of the low quality of the included trials, the authors stated a definitive conclusion could not be drawn.
The study · 1
Kim et al., Is cupping therapy effective in patients with neck pain? A systematic review and meta-analysis · BMJ Open 2018;8(11):e021070
Cupping eased low back pain at 2 to 8 weeks but the gain was gone by 3 to 6 months, across 11 trials
Cupping eased low back pain in the first two to eight weeks and did better than painkillers or usual care over that window, but the benefit faded, with no clear effect left by one to six months.
The 2024 systematic review and meta-analysis (Zhang et al., Complement Ther Med) pooled 11 RCTs and 921 participants. Cupping improved pain at the 2 to 8 week endpoint (d=1.09, 95% CI 0.35 to 1.83, p=0.004), with larger effects versus medication (d=1.8, 95% CI 1.22 to 2.39) and usual care (d=1.07, 95% CI 0.21 to 1.93). No continuous improvement remained at one month (d=0.11, 95% CI -1.02 to 1.23) or 3 to 6 months (d=0.39, 95% CI -0.09 to 0.87). Cupping on acupoints outperformed cupping over the lower back area, and wet cupping outperformed dry, though the difference between types was not significant. Heterogeneity was high throughout (I2 above 50%), which the authors flagged as a real limit on the certainty of these estimates.
Treat cupping for the back as short-term relief within a few weeks, repeated as needed, and pair it with the approaches that hold up over months for back pain, above all staying active and progressive strengthening.
The study · 1
Zhang et al., The effectiveness of cupping therapy on low back pain: a systematic review and meta-analysis of randomized control trials · Complement Ther Med 2024;80:103013
Dry cupping cut chronic neck pain 21.67 and low back pain 19.38 points on 100-point scales, on low-to-moderate evidence
Dry cupping, which uses suction alone with no cutting of the skin, took a meaningful amount off chronic neck and low back pain and loosened stiff joints in the short term, though the underlying trials were only low to moderate quality.
The 2020 systematic review and meta-analysis (Wood et al., J Bodyw Mov Ther) assessed 21 RCTs and 1,049 participants treated with western dry cupping, grading quality with the Downs and Black checklist and GRADE. Low-quality evidence showed dry cupping reduced pain in chronic neck pain (MD -21.67, 95% CI -36.55 to -6.80) and non-specific low back pain (MD -19.38, 95% CI -28.09 to -10.66); moderate-quality evidence showed improved neck function (MD -4.65, 95% CI -6.44 to -2.85); and low-quality evidence showed improved range of motion versus no treatment (SMD -0.75). The authors could draw no definitive conclusion because of the low to moderate quality and called for larger trials with long-term follow-up and full adverse-event reporting.
The study · 1
Wood et al., Dry cupping for musculoskeletal pain and range of motion: a systematic review and meta-analysis · J Bodyw Mov Ther 2020;24(4):503-518
Head to head, cupping matched acupuncture for pain across 23 poor-quality trials, with no reliable winner
Head to head, cupping and acupuncture worked about equally well for several painful conditions, with no reliable winner, but all the trials were poor quality and there were not enough data to be sure.
The 2017 systematic review with trial sequential analysis (Zhang et al., Chinese Medicine) included 23 RCTs and 2,845 participants across 12 pain-related conditions. Meta-analyzes found similar rates of symptom improvement for cupping and acupuncture in cervical spondylosis (RR 1.13, 95% CI 1.01 to 1.26), lateral femoral cutaneous neuritis (RR 1.10, 95% CI 1.00 to 1.22) and scapulohumeral periarthritis (RR 1.31, 95% CI 1.15 to 1.51), and no significant difference on visual analog or numerical rating scales for any condition. All studies were poor quality, and trial sequential analysis for cervical spondylosis showed the available data had not reached a firm conclusion. No serious adverse events from either therapy were reported.
The study · 1
Zhang et al., Cupping therapy versus acupuncture for pain-related conditions: a systematic review of randomized controlled trials and trial sequential analysis · Chin Med 2017;12:21
In 80 adults, six wet-cupping sessions lowered persistent back pain (29.2 versus 57.9) more than no treatment
In one trial, drawing a small amount of blood with wet cupping lowered persistent back pain and disability more than doing nothing, and the improvement lasted about two weeks past the treatment.
The 2015 randomized controlled trial (AlBedah et al., J Altern Complement Med) allocated 80 adults with persistent non-specific low back pain to wet cupping (six sessions in two weeks at bladder-meridian points BL23 to BL25) or no treatment, with acetaminophen allowed as rescue in both arms. At the end of treatment the wet-cupping group had lower numeric pain (29.2, 95% CI 24.6 to 33.8 versus 57.9, 95% CI 53.3 to 62.6), lower present pain intensity (1.17 versus 2.3) and lower Oswestry disability (19.6 versus 35.4), all p=0.0001, with benefit persisting two weeks after the last session. Rescue acetaminophen was used less with cupping but not significantly so. No adverse events were reported. The authors noted the trial had no sham arm and called for placebo-controlled studies.
Wet cupping breaks the skin, so it belongs with a trained practitioner using sterile single-use equipment; the at-home version of cupping is dry cupping, which uses suction only.
The study · 1
AlBedah et al., The use of wet cupping for persistent nonspecific low back pain: randomized controlled clinical trial · J Altern Complement Med 2015;21(8):504-508
Joint And Arthritis Pain
Added to usual medicine, cupping improved the WOMAC knee score (pain -1.01) but not a simple pain rating, on weak evidence
For knee arthritis, adding cupping to usual medicine improved a standard arthritis score, but it did not move a simpler pain rating, and the trials were weak, so the case is thin.
The 2017 systematic review and meta-analysis (Li et al., Complement Ther Clin Pract) pooled 7 RCTs of cupping for knee osteoarthritis, most of low methodological quality. Dry cupping plus western medicine beat western medicine alone on WOMAC pain (MD -1.01, 95% CI -1.61 to -0.41), stiffness (MD -0.81, 95% CI -1.14 to -0.48) and physical function (MD -5.53, 95% CI -8.58 to -2.47), all with low heterogeneity, but showed no significant effect on a visual analog scale (MD -0.32, 95% CI -0.70 to 0.05, p=0.09). Wet cupping plus medicine improved response rate and a functional index. The authors concluded only weak evidence supports cupping improving efficacy and function in knee osteoarthritis.
The study · 1
Li et al., Cupping therapy for treating knee osteoarthritis: the evidence from systematic review and meta-analysis · Complement Ther Clin Pract 2017;28:152-160
Skin And Hair
For chronic hives, wet cupping roughly matched antihistamines and helped as an add-on (RR 1.18), on poor-quality trials
For long-lasting hives, wet cupping worked about as well as antihistamine tablets, and adding it on top of antihistamines helped more people and reduced relapse, but the trials were poor quality so this is an early signal.
The 2020 systematic review and meta-analysis (Xiao et al., J Integr Med) pooled 13 comparisons from 12 RCTs and 842 participants with chronic urticaria. Wet cupping did not differ significantly from medication on total effective rate (RR 1.10, 95% CI 0.97 to 1.25) or recurrence (RR 0.56, 95% CI 0.23 to 1.36). Cupping added to antihistamines beat antihistamines alone on effective rate (RR 1.18, 95% CI 1.01 to 1.39) and recurrence (RR 0.52, 95% CI 0.32 to 0.84), and cupping added to acupuncture beat acupuncture alone (RR 1.25, 95% CI 1.07 to 1.46). No serious adverse events were reported. The authors stressed the results should be applied with care because of the poor quality of the included studies.
The study · 1
Xiao et al., Cupping therapy for patients with chronic urticaria: a systematic review and meta-analysis · J Integr Med 2020;18(4):303-312
How it works
A review of 64 studies proposed six ways cupping might ease pain, none of them confirmed
The best current thinking is that the suction relieves pain the way rubbing a sore spot does, by firing touch nerves that dampen pain signals, and that it raises blood flow in the skin and muscle underneath. These are working ideas, not settled facts, and no single one has been proven.
The 2019 mechanistic review (Al-Bedah et al., J Tradit Complement Med) assessed 64 studies and set out six proposed mechanisms of action. Pain reduction and changes in the skin are attributed to the pain-gate theory, diffuse noxious inhibitory controls and a reflex-zone effect; muscle relaxation and increased local circulation to a nitric-oxide effect; and immunological and hormonal changes to activation of the immune system. A blood-detoxification theory is listed as one of the six but is not established. The authors state that no single theory explains the whole of cupping and that the mechanisms may overlap, and they call for further research to support or refute each one. This is proposed physiology, not evidence that cupping treats any given condition.
The study · 1
Al-Bedah et al., The medical perspective of cupping therapy: effects and mechanisms of action · J Tradit Complement Med 2019;9(2):90-97
How It Works
For pain there is a plausible mechanism that needs nothing exotic. The firm, sustained pull fires the large touch and pressure nerves in the skin and muscle, and that signal dampens the slower pain signals traveling to the spinal cord and brain, the same pain-gate effect that makes you rub a sore spot. A review of 64 studies sets out six overlapping candidates:
- the pain-gate effect
- a diffuse pain-dampening reflex
- a reflex-zone effect
- a nitric-oxide rise that opens small vessels and lifts local blood flow
- immune activation
None has been confirmed on its own, and the classical idea that suction draws out toxins is the sixth hypothesis on that list, not a settled fact.
The numbers are graded cautiously because of a problem in the study design. A cup that pulls the skin and leaves a mark is obvious to the person receiving it, so a cupping trial is hard to blind, and a dummy that mimics the pull without treating anything is hard to build. That is why cupping beats no treatment by a wide margin while showing almost no advantage over a sham. Until a better sham exists, the size of the specific effect stays uncertain.
Using It Well
Ways to Do It
Start with dry cupping, the suction-only form that leaves the skin intact, and keep wet and fire cupping with a trained practitioner. It suits short-term relief for a tight, sore neck, shoulders or lower back, repeated as needed.
A set of silicone or hand-pump cups is inexpensive and needs no flame. Place a cup on a fleshy, muscular area such as the upper back or shoulders, draw the suction to a firm but comfortable pull, and leave it five to ten minutes, or oil the skin and glide the cup slowly along the muscle. Cups seal on flesh, not on bone, so work the muscular areas and stay off the front of the neck. This is the form with the most behind it and the lowest risk.
A practitioner reads your area, places several cups, and leaves them for five to fifteen minutes while you rest, sometimes gliding them along the muscle. The pull is firm and usually eases within a minute. You leave with round marks and often a loose, worked feeling in the area. Relief, when it comes, tends to arrive the same day.
For wet or fire cupping, the practitioner is the safeguard. Look for a licensed acupuncturist or Chinese medicine practitioner who uses single-use, sterile equipment for any wet cupping, keeps the flame well away from skin for fire cupping, and explains what the marks are and how long they last. A practitioner who cannot say why they are cupping a given area is one to pass on.
The round marks are bruises and fade over days to about two weeks. A darker mark means more blood was drawn into the skin at that spot, and that is all it means; it is not a readout of toxins or of how much good the session did. Let them fade on their own, and space repeat sessions so an area is not re-cupped while it is still marked.
Go Deeper
- Acupressure and self-massage: the hands-on branch of the same tradition, worked without cups or needles.
- Low back pain: the condition worked from both sides, where cupping is one of several short-term options.
- Neck and shoulder pain: the fuller picture, of which cupping is one part with trial support.
- Tai chi and qi gong: the movement side of the same tradition, with the most randomized evidence behind it.
The Chinese Medicine View
This is our own tradition, told on its own terms. Cupping works on the same channels and points that acupuncture uses, and its classical job is to move what has become stuck. Where Qi and Blood stop moving freely, the tradition holds, there is pain and stiffness, and the suction is understood to draw stagnant Qi and Blood to the surface and get them moving again. That is the frame behind its long use for a tight, aching neck, shoulders and back.
Cupping is also a classical way to dispel external pathogenic factors, above all Wind, Cold and Damp, the influences held to lodge in the muscles and channels and cause heavy, stiff, weather-sensitive aches. Cupping over the upper back is a traditional response to an invasion of Wind-Cold at the very start of a common cold, and over the low back for the cold-damp pattern of back pain. This whole approach of working the channels from the surface to keep Qi and Blood moving belongs to Yang Sheng, nourishing life, the preventive half of Chinese medicine.
The tradition does not hold that cupping suits everyone at every moment. Strong suction is a moving, draining technique, well suited to a robust person with an acute blockage and capable of leaving someone already depleted more tired. Classical practice is lighter over the weak, the elderly and the very thin, avoids cupping over the abdomen and low back in pregnancy, and keeps cups off areas where the skin is fragile. If you work with a practitioner, your pattern is a good thing to ask about, since the classical answer depends on your constitution and current state.
Cautions For This Practice
Extra restraintEverything to be aware of is here, in one place. This practice suits most healthy people; a few situations call for real care.
Across 22 studies the side-effect rate was very low; the round marks are ordinary bruising, serious events rare
The 2023 evidence-based review (Mohamed et al., J Back Musculoskelet Rehabil) analyzed 22 studies of cupping in musculoskeletal and sports rehabilitation and reported that the incidence of adverse events is very low. The expected local effect is the circular mark: suction pulls blood out of small vessels into the surrounding tissue, so the mark is a bruise rather than a sign of toxins leaving the body, and it resolves over days to about two weeks. The higher-risk variants are wet cupping, which deliberately breaks the skin and so carries an infection risk if equipment is not sterile, and fire cupping, where the flame used to create suction can burn the skin. Serious complications are rare in the trial literature.Mohamed et al., Evidence-based and adverse-effects analyzes of cupping therapy in musculoskeletal and sports rehabilitation: a systematic and evidence-based review
Wet cupping breaks the skin, so it carries an infection risk
Wet cupping deliberately makes small cuts before applying suction, which opens a route for infection if the equipment or skin is not clean. Have it done only by a trained practitioner using sterile, single-use blades and cups, never shared or reused. The at-home version of cupping is dry cupping, which uses suction only and leaves the skin intact.
Fire cupping can burn
Fire cupping uses a brief flame to create the suction, and the reported injury is a burn to the skin when the cup or the flame is mishandled. A skilled practitioner keeps the flame away from the skin and tests the cup temperature. If you are new to it, the flameless silicone or pump cups avoid this risk entirely.
Blood thinners, bleeding disorders and fragile skin
Cupping raises its marks by drawing blood into the skin, so anything that makes you bruise or bleed more easily makes the marks larger and slower to clear. If you take a blood thinner, have a bleeding disorder, or have thin or fragile skin from age, long-term steroids or poorly controlled diabetes, keep the suction light, and treat wet cupping as higher risk and one for a practitioner to judge.
The marks are bruising, and where not to cup
The round marks are expected and fade over days to about two weeks; they are bruises, not toxins, and their color is not a measure of anything. Keep cups off broken or inflamed skin, active eczema, psoriasis or sunburn, over varicose veins, and over areas of reduced sensation where you cannot judge the pull. Do not use cupping to push through pain that is new, severe or unexplained, since that kind of pain needs a diagnosis first.
Start slow, be smart, read the research, and consult a professional if you have any concerns. This is here to inform your choice, not make it for you.
Common Questions
Does cupping actually work?
For short-term pain the signal is modest but consistent. Pooled trials show cupping easing neck and low back pain compared with no treatment, with relief often arriving the same day and fading over the following weeks. The limit is what happens when it is tested against a dummy cupping built to mimic the pull: in the largest review the advantage over sham was small and not statistically significant, and the independent evidence map rated none of the cupping-for-pain evidence high quality. So it is reasonable to try for short-term relief, understanding that part of the benefit may come from the touch, the attention and your own expectation as much as from the suction itself.
What are the round marks, and are they toxins being pulled out?
They are bruises. The suction pulls a little blood out of the smallest vessels into the surrounding skin, and that is what you see, pink to dark purple depending on how much came out at that spot. It fades over several days to about two weeks, exactly as a bruise does. A darker mark means more local bruising there, and nothing more; it is not a gauge of toxins leaving the body or of how much the session helped. The toxin idea is a traditional interpretation, and modern reviews list it as one hypothesis among several, none of them established.
What is the difference between dry and wet cupping?
Dry cupping is suction only and leaves the skin intact, which is the everyday form and the one safe to do at home. Wet cupping, called hijama, makes tiny shallow cuts first and then applies suction to draw out a small amount of blood, so it breaks the skin. Because it breaks the skin, wet cupping is the form to have done by a trained practitioner rather than at home, for the reasons set out in the Cautions section. Fire cupping is a separate distinction, about how the suction is made, a brief flame rather than a pump, and it can be either dry or wet.
Is cupping the reason the Olympic swimmers had those circles, and does it really help?
Yes, those circles were cupping marks, and they drew more attention to cupping than its evidence justified. The marks themselves are just bruises. The trial record behind cupping is low to moderate quality and points to a short-term easing of pain, not a performance boost, so expect a low-risk way to take the edge off a sore, tight area for a while.
How often would I need it, and does the relief last?
The benefit is short-term. In the low back pain trials the improvement showed at two to eight weeks and had faded by three to six months, so the relief has to be repeated. A practical pattern is to use it when an area is tight or sore, space sessions so the skin is not re-cupped while still marked, and lean on the approaches that hold up over months, staying active and progressive strengthening, for the durable part.
Explore Related
Other pages this one connects to, by the evidence they share, the outcomes they touch, and the ground they cover.
All 11 sources on this page independently checked and cross-referenced.
Thomas Dehli, Founder & Editor, Sacred Lotus
Sacred Lotus has published Chinese medicine reference material since 2001. Integrative pages are held to the same standard as the herb and formula library: cite the source, grade the claim at its real strength, and say where the research has not looked. This page is educational and it is not medical advice. Last reviewed and updated August 9, 2026.
Evidence strength
How confidently the research supports a claim. Strength describes the evidence, not our endorsement.