{"id":37261,"date":"2016-08-19T11:57:27","date_gmt":"2016-08-19T10:57:27","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=37261"},"modified":"2016-08-26T13:56:23","modified_gmt":"2016-08-26T12:56:23","slug":"jeff-aronson-when-i-use-a-word-cupping","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2016\/08\/19\/jeff-aronson-when-i-use-a-word-cupping\/","title":{"rendered":"Jeffrey Aronson: When I use a word . . . Cupping"},"content":{"rendered":"

\"jeffrey_aronson\"<\/a>Many celebrities, including Olympic athletes, such as US swimmer\u00a0Michael Phelps<\/a>, and actors, such as Gwyneth Paltrow and Jennifer Aniston<\/a>, are fashionably subjecting themselves to cupping<\/a>. So, is \u201cthe silliest celebrity health fad ever<\/a>\u201d effective for treating anything? Well, despite all the attendant gobbledegook, or more likely reflected by it, the answer is clear: no.<\/p>\n

Today cupping is mostly associated with medical practices in the Far East, typically China and Korea, but it has a long pedigree in many other countries. Here, for instance, is a description<\/a> of an episode in the life of King Charles II in 1685:<\/p>\n

With a cry he fell. Dr. King, who, unfortunately, happened to be present, bled him with a pocket-knife. Fourteen physicians were quickly in attendance. They bled him more thoroughly; they scarified and cupped him; they shaved and blistered his head; they gave him an emetic, a clyster, and two pills. During the next eight days they \u201cthrew in\u201d fifty-seven separate drugs; and, towards the end, a cordial containing forty more. This availing nothing, they tried Goa stone, which was a calculus obtained from a species of Indian goat; and as a final remedy, the distillate of human skull.<\/p><\/blockquote>\n

The King graciously apologized for being \u201can unconscionable time a-dying\u201d but did at last.<\/p>\n

In Eastern medicine cupping is partly based on ideas about channelling the life force qi. The mechanistic theory that encouraged cupping in Western medicine was that of the four humours, blood, phlegm, [yellow] bile, and black bile. Imbalances in the humours could be remedied\u2014excess blood, for example, by bloodletting. Removal of blood, or of blister fluid produced by cupping or the application of blistering agents such as cantharides, was also a way of removing what Dryden called \u201cnoxious humours that infect the blood\u201d. Emetics and cathartics had supposedly similar effects. Some foods and medicines were supposed to counteract ill humours; wine, for example, was regarded as an antidote to excess phlegm. In An Essay on the Shaking Palsy<\/em> (1817) James Parkinson described treating a patient with \u201crheumatic affection of the deltoid muscle\u201d by cupping, hot fomentations, blistering, sweating with antimonials, and calomel to evacuate the bowels, all with the same purpose.<\/p>\n

Cupping (\u201cdry cupping\u201d) increases local blood flow, and so cupping can be used for bloodletting (\u201cwet cupping\u201d; picture). First scarify the skin, then apply a heated glass cup. The hot air in the cup cools and creates negative pressure, causing blood to flow. Alternatively, raise a blood-filled blister and pierce it. There are many different methods.<\/p>\n

Cupping has been recommended<\/a> for a myriad of indications, including pain relief, many types of infections, facial paralysis, Beh\u00e7et\u2019s disease, acute gout, chloasma, urticaria, and snakebite. Can anything that purports to treat so many problems be effective for any of them?<\/p>\n

Cupping is not entirely safe. Adverse reactions<\/a> have included anemia, panniculitis, herpesvirus infection, abscesses, post-inflammatory hyperpigmentation and keloid, burns<\/a>, and a Koebner effect<\/a>. Cupping may also exacerbate eczema<\/a>. Cupping of the cervical area has been associated with hemorrhagic stroke, attributed to an acute rise in blood pressure, and rupture of a dissecting vertebral artery<\/a>.<\/p>\n

The Indo-European root KEU meant a bend or a curve and hence a rise or a hollow. Add p and you get cup and cupola (Latin cupa, a tub or barrel). Add m and you get kymograph (Greek \u03ba\u1fe6\u03bc\u03b1, a swelling or wave). Add l and you get koilonychia (Greek \u03ba\u03bf\u1fd6\u03bb\u03bf\u03c2, a hollow). Add d and you get codeine (Greek \u03ba\u03ce\u03b4\u03b5\u03b9\u03b1, a poppy capsule). Well at least we know that codeine is a pain killer, even if cupping isn\u2019t, and codeine isn\u2019t on the World Anti-Doping Agency\u2019s 2016 list of prohibited drugs<\/a> in sports.<\/p>\n

Edzard Ernst, author of an umbrella systematic review of trials<\/a>, has said<\/a> that \u201cthere is no good evidence that cupping helps any condition\u2014except the dreaded condition of celebrities craving attention.\u201d Perhaps the Olympic athletes have forgotten that winners at the Games are awarded medals, not cups.<\/p>\n

\"jeff_aronson_cupping_pic\"<\/p>\n

A woman and her assistant cupping a patient. Oil painting on wood, after Cornelis Dusart, 17th C. Reproduced with permission from the Wellcome Library, London. No. 45021i . Creative Commons Licence CC BY 4.0.<\/em><\/p>\n

Thanks to Kamal Mahtani for the suggestion.<\/em><\/p>\n

Jeffrey Aronson<\/strong> is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford’s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n

Competing interests:<\/strong>\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"

Many celebrities, including Olympic athletes, such as US swimmer\u00a0Michael Phelps, and actors, such as Gwyneth Paltrow and Jennifer Aniston, are fashionably subjecting themselves to cupping. So, is \u201cthe silliest celebrity health fad ever\u201d effective for treating anything? Well, despite all the attendant gobbledegook, or more likely reflected by it, the answer is clear: no. Today […]<\/p>\n

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