Analytical Approach to the Literature of Cupping Therapy

This comprehensive meta-analysis, published in the Journal of Korean Society of Physical Medicine in 2021, represents a milestone in the evaluation of global scientific evidence on cupping therapy. The study, conducted by Koran and Irban, systematically analyzed 381 scientific studies published between 1950 and 2019, representing seven decades of research on this ancient therapeutic modality. The methodology involved a systematic search of the PubMed database using the term "cupping therapy," including studies that combined cupping with other complementary therapies such as acupuncture, moxibustion, and hirudotherapy. The results reveal a diverse distribution of study types: 127 randomized clinical trials (33%), 135 non-randomized studies (35%), 30 reviews (8%), 64 case reports (17%), 15 questionnaire studies (4%), and 3 meta-analyses (1%).

The temporal analysis shows significant growth in the number of publications, especially randomized clinical trials, in the past 10 years, with a notable geographic shift from Far Eastern countries toward Europe and the Americas. The most robust findings demonstrate consistent efficacy of cupping therapy in painful conditions, with all 22 randomized clinical trials on pain (including herpes zoster pain, fibromyalgia, low back pain, neck pain, headache, and acute injuries) showing positive results. The technique also demonstrated efficacy in 34 studies on musculoskeletal disorders (osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout, carpal tunnel syndrome), 16 studies on dermatologic conditions (dermatitis, herpes simplex, chronic urticaria, acne vulgaris, acute eczema), and 15 studies on neurological disorders (facial palsy, peroneal nerve palsy, cerebral palsy, brachial paresthesia, postherpetic neuralgia, migraine). The proposed mechanisms of action include local effects, the gate control theory, effects on the neural, hematological, and immune systems, cutaneo-visceral reflex mechanisms, and the placebo effect.

Wet cupping (with bleeding) was shown to be more effective than dry cupping in most studies, especially for pain and inflammatory conditions. The authors identified that the application generally follows traditional acupuncture points or specific areas related to the symptom location. In terms of safety, the analysis of 44 case reports on adverse events revealed that most complications (burns, blisters, keloids, hyperpigmentation, infections, abscesses) occurred after procedures performed by unqualified providers. Limitations include methodological heterogeneity between studies, lack of adequate placebo control in many trials (due to the visible nature of the intervention), and variability in treatment protocols.

The study concludes that there is growing and promising evidence for cupping therapy, especially in painful and musculoskeletal conditions, but emphasizes the need for more high-quality trials and standardization of protocols. The research suggests that cupping therapy is gaining international scientific recognition and may become more widely accepted in Western medicine with the continued accumulation of quality evidence.