Why Cupping Marks are Not Bruises?

Why Cupping Marks are Not Bruises?

Dr. Ahmed H Saleh.

Al Hijama ( Cupping Therapy ) is an important and integral part of non - drug folk therapy on Traditional Arabic Medicine (TAM)  and Traditional Chinese Medicine (TCM), there were also many other names for cupping therapy, such as "الحجامة" , " كؤوس الهواء" , "horning", "needlehorn", "sucking method", "fire - cupping", "boiling bamboo cylinder". By textual investigation, considerable clear recognition can be reached on the names, cupping instruments, cupping measure, indications and contradictions in different historical stages. Presently, cupping therapy is combined with other measures, such as drug therapy, acumoxibustions etc. In recent years, multi - functional vacuum cupping devices made of high - technical materials mark a great leap forward of the features of cupping devices and sucking measures. (Yang 1999)

The most common misunderstanding regarding one of the most powerful and beneficial after effects of Cupping, is the marks that sometimes result. Those unfamiliar to Cupping Therapy, believe the Cupping marks to be bruises. In North American society bruising is considered an injury.Bruising is caused by impact trauma with compressed breakage of capillaries and a reactionary rush of fluids to the damaged location from the tissue injury. There is no compression in correctly performed suction cup therapy. Although it is quite common during Stationary Dry Cupping (left static for 5 - 20 minutes - see below) to achieve dramatic 'marks' or 'discolorations', the less aggressive action of moving the cups, minimizes the intensity and duration of the discolorations.

Why Cupping Marks are Not Bruises? Cupping marks cannot be called bruises simply because of the way bruises are caused. Bruises appear when the body experiences some kind of blunt injury or trauma. The impact can break the blood capillaries present under the skin, which is why you see the redness. The body responds to the injuries with a rush of healing fluids to the area that also contribute to the bruising or redness. When the proteins at the injury site begin to coagulate, blood circulation reduces and the patient feels pain.

Cupping marks are caused by suction instead of the pressure in case of trauma, and works to bring toxins to the surface. The most important differentiating factor is the cupping marks do not cause pain and if there is any discomfort, it is minimal and goes away quickly.

IS THE CUPPING MARKING A BRUISE OR AN ECCHYMOSIS?

There is an ongoing debate among cupping practitioners over whether we should call the subsequent cupping marks as such, or a ‘bruise’? The English Medical Dictionary by Peter Collin (Collin, 1987) describes a bruise as: ‘contusion or dark painful area on the skin, where blood has escaped under the skin following a blow’. The online MedicineNet.com dictionary gives the following description of bruising: ‘a bruise is a traumatic injury of the soft tissues which results in breakage of the local capillaries and leakage of red blood cells. In the skin it can be seen as a reddish-purple discolouration that does not blanch when pressed upon.’ A different explanation from the latter source is: ‘a bruise is called a contusion and is typically a result of some degree of injury to the blood vessels in the skin. Local leakage of blood into the skin from the capillaries that occurs spontaneously and is flat is referred as ecchymosis.’ When we look at the various explanations above, it is clear that a bruise should have at least two characteristics: (1) contain a dark and painful area; and (2) be the result of a blow, injury or trauma. The noun ‘ecchymosis’, however, is explained as ‘local leakage of blood into the skin from the capillaries that occurs spontaneously and is also painless’. Almost all blood thinning medications and treatments cause ecchymosis that is not painful but causes discoloration of the skin. 

All skin marks that are the result of cupping therapy, however dark they may appear, are not painful. There is no external or internal damage inflicted to the skin. Capillaries do not leak as result of ‘injury or blow to blood vessels’. Also, all bruises will turn yellowy-green before totally fading away. With the exception of Strong cupping on the frst two visits, all cupping marks will fade away without turning a yellowy-green colour. Even following the Strong cupping method, local pain will not accompany the cupping mark! Slight local sensitivity is the expected reaction immediately following the cupping application, and is usually much less tender over the next day or two. I personally prefer to call these effects ‘cupping marks’ as I fnd ecchymosis a rather technical term and too ‘trendy’ a word to use! (ilkay zihni chiral 2014)

Cupping is one of the various treatment methods used in traditional oriental medicine. Cupping is also used as a diagnostic method and it may cause skin hyperpigmentation. We propose that this method can be useful for visual identification and as a way to improve the identification of skin color changes. Quantitative measurements and analysis of changes in skin color due to cupping are critical. The purpose of this study is to suggest an optical technique to visualize and identify changes in skin color due to cupping (kim 2014)

It was discovered that the property of syndromes should be recognized by the palpation on skin and muscle in the moving cupping therapy so that the pathogenesis and treating principle could be carefully determined. The moving cupping therapy is the important component of body surface therapy. Skin reaction observation and syndrome differentiation is the essential guidance of the moving cupping therapy.( Deng 2014)

the effects of time and pressure factors during cupping treatment on the cupping mark color was investigate, so as to provide scientific data and evidence for study on parameters and effect of cupping treatment. the researcher found that The time and pressure  factor had statistically significant effect on cupping mark color (Zhao 2009) 

Wrong cupping may result in circular erythema, petechiae, purpura, ecchymosis, burns and may be mistaken for trauma-related ecchymosis or livor mortis, The stimulation of 10 minutes and the pressure of -0.04 MPa produces a marked ecchymosis on the cupping site (Cavlak, Özkök et al 2015)( Zhao 2009)