Wet cupping for hypertension: a systematic review and meta-analysis

The efficacy and safety of cupping as complementary and alternative therapy for metabolic syndrome: A systematic review and meta-analysis

INTRODUCTION

This systematic review and meta-analysis aimed to assess the efficacy and safety of cupping therapy in patients with metabolic syndrome (MetS).

METHODS

This systematic review focused on patients with MetS and included randomized controlled trials (RCTs) that compared the effects of cupping therapy with control groups. A total of 12 electronic databases were searched from inception until February 03, 2023. The main outcome after the meta-analysis was waist circumference; the others included anthropometric variables, blood pressure, lipid profile, fasting blood glucose level, and high-sensitivity C-reactive protein level. The incidence of adverse events and the follow-up courses were also evaluated. Risk of bias (ROB) was evaluated using ROB 2.0 from the Cochrane Handbook.

RESULTS

This systematic review included five studies involving 489 patients. Some risks of bias were also identified. The meta-analysis revealed a statistically significance in waist circumference (MD = -6.07, 95% CI: -8.44 to -3.71, P < .001, I2 = 61%, τ2 = 3.4), body weight (MD = -2.46, 95% CI: -4.25 to -0.68, P = .007, I2 = 0%, τ2 = 0) and body mass index (MD = -1.26, 95% CI: -2.11 to -0.40, P = .004, I2 = 0%, τ2 = 0) between the cupping therapy and control groups. However, there were no significant results in total fat percentage and blood pressure values. Regarding biochemical markers, cupping significantly lowered the concentration of low-density lipoprotein cholesterol (MD = -3.98, 95% CI: -6.99 to -0.96, P = .010, I2 = 0%, τ2 = 0) but had no significant effect on total cholesterol, triglyceride, high-density lipoprotein cholesterol, fasting blood glucose, and high-sensitivity C-reactive protein. 3 RCTs reported no adverse events.

CONCLUSIONS

Despite some ROB and low to substantial heterogeneity of the included studies, cupping therapy can be considered a safe and effective complementary intervention for reducing waist circumference, body weight, body mass index, and low-density lipoprotein cholesterol in patients with MetS. In the future, well-designed, high-quality, rigorous methodology, and long-term RCTs in this population are required to assess the efficacy and safety of cupping therapy.

Effect of Massage and Dry Cupping on Hemodynamic Parameters of Cardiac Patients: A Randomized Controlled Trial

Objective

The aim of this study was to compare the effects of massage versus dry cupping in addition to routine care on hemodynamic parameters of cardiac patients in critical care units.

Methods

The present study was a parallel randomized controlled clinical trial that was conducted in the critical care units of Shafa Hospital in Kerman, Iran, from 2019 to 2020. Ninety eligible patients)aged 18-75 years, no cardiac arrest in the past 72 hours, no severe dyspnea, no fever, and no cardiac pacemaker) were divided into massage (n = 30), dry cupping (n = 30), and control (n = 30) groups using the stratified block randomization method. The massage group received routine care and a head and face massage for 3 consecutive nights from the second day of admission. The dry cupping group received routine care and dry cupping between the third cervical vertebra and the fourth thoracic vertebra for 3 consecutive nights. The control group received only routine care, which included daily visits by the attending physician, nursing care, and medication. Each intervention session was performed for 15 minutes. The data collection tools included the sociodemographic and clinical characteristics questionnaire and the hemodynamic parameters form (systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and saturation of peripheral oxygen). The hemodynamic parameters were measured each night before and after the intervention.

Results

The mean systolic blood pressure, heart rate, respiratory rate, and oxygen saturation level showed no significant difference among the 3 groups. The mean diastolic blood pressure of the 3 groups varied significantly over time. The mean diastolic blood pressure of the massage group decreased significantly on the third day of intervention, while it did not change significantly in the 2 groups of dry cupping or control (P < .05).

Conclusion

According to the results of this study, dry cupping had no effect on regulating hemodynamic parameters, while only diastolic blood pressure was reduced significantly after massage on the third day of intervention. Therefore, our study did not show effects of massage and dry cupping on regulating hemodynamic parameters.

The Effect of Wet Cupping on Baroreceptor Sensitivity in Hypertensive Patients in Sidenreng Rappang Regency, South Sulawesi

Wet cupping therapy  removes toxins  thereby increasing blood flow and  stimulating baroreceptors sensitivity which provides a stimulus to the autonomic nerves. This stimulus reduces the sympathetic nerves’ work and inhibits  the vasomotor center, leading to vasodilation, therefore decreasing blood pressure and pulse frequency. This research aims to determine the effect of wet cupping therapy on baroreceptors sensitivity with blood pressure and pulse frequency indicators. It was conducted in Sidenreng Rappang Regency, South Sulawesi, eastern Indonesia from February to May 2021. Randomized Controlled Trial (RCT) method was used including two groups of 31 respondents each. The intervention group used wet cupping therapy to regulate anti-hypertensive drugs and the control group used anti-hypertensive drugs with blood pressure and pulse frequency measurements until 6 weeks after the therapy. Wet cupping affects baroreceptor sensitivity by reducing the indicators. The result showed a significant difference in blood pressure measurement (systolic; diastolic) before and after the 2-week follow-up period (P = 0.000; P = 0.001), and between 2 and 4 weeks (P = 0.000; P = 0.000), but between 4 and 6 weeks there was no significant difference in the intervention group (P = 0.248; P = 0.583). There was a significant difference in pulse frequency at 2 and 4 weeks after the intervention (P = 0.016). In conclusion, wet cupping therapy effectively increases baroreceptor sensitivity by reducing blood pressure and pulse frequency indicators in hypertensive patients up to 4 weeks limit after the therapy, without any serious side effects experienced by respondents.

Evidence Map of Cupping Therapy

This study aimed to describe and assess the current evidence in systematic reviews on cupping therapy for various conditions. We searched PubMed, EMBASE, Cochrane Database of Systematic Reviews, China National Knowledge Infrastructure, and six Korean databases for systematic reviews of trials on cupping treatments for any condition published prior to March 2021. We used a bubble plot to graphically display the clinical topics, the number of articles, the number of participants in the total population, confidence, and effectiveness. Thirteen systematic reviews that met the inclusion criteria were included in the evidence map, and 16 bubbles were created. The findings from six reviews showed potential benefits of cupping for conditions such as low back pain, ankylosing spondylitis, knee osteoarthritis, neck pain, herpes zoster, migraine, plaque psoriasis, and chronic urticaria. Cupping has been applied in a variety of clinical areas, and systematic reviews in a few of these areas have demonstrated statistically significant benefits. The evidence map provides a visual overview of cupping research volume and findings. Evidence mapping can facilitate the transfer of knowledge from researchers to policymakers and promote research on musculoskeletal pain (such as low back pain, neck pain, and knee osteoarthritis) and skin disease (plaque psoriasis).

The Effect of Wet Cupping Therapy on Blood Pressure and Total Cholesterol on Healthy Young Male Adults

BACKGROUND: Hypertension and hypercholesterolemia are most predisposition factors and show a significant impact in causing cardiovascular disease. Therefore, it is recommended to conduct dietary modifications, physical activity, and alternative therapies. One such option for alternative therapies is wet cupping therapy. AIM: This study aims to investigate the effect of wet cupping on blood pressure (BP) and total cholesterol (TC) on healthy young male adults. METHODS: This study design was quasi-experimental with a control and intervention group. It was conducted between January and February 2020 at Mini Hospital, School of Nursing, Universitas Muhammadiyah Yogyakarta. There were 44 healthy young male adults divided into control (n = 22) and intervention (n = 22) groups. This study’s outcomes were BP (systolic BP [SBP] and diastolic BP [DBP]) and TC. RESULTS: In the intervention group’s post-test, the mean SBP and DBP were substantially different from the pretest (p = 0.01 and 0.03). Although there was no statistically significant difference in TC outcome, overall cholesterol decreased following an intervention. There was no statistically significant difference in the outcome between the control and intervention groups, except for TC, which was significantly lower in the post-test than in the pre-test. CONCLUSION: This study’s results indicated that wet cupping could be useful in decreasing BP and total cholesterol.

Effects of moving cupping therapy for plaque psoriasis: study protocol for a randomized multicenter clinical trial

BACKGROUND

It is difficult to achieve a balance among safety, efficacy, and cost for the clinical treatment of plaque psoriasis. The current treatment of psoriasis often involves comprehensive therapy such as topical plasters, internal medicine, and phototherapy, which are expensive, and some of the drugs have serious side effects. Moving cupping is a type of cupping that has been used clinically for thousands of years in China. It has the advantage of being inexpensive and easy to perform. Therefore, it is widely used in public hospitals in China for psoriasis treatment. However, a comprehensive evaluation of the current clinical evidence of its efficacy is lacking. In this study, we aimed to evaluate the efficacy and safety of moving cupping to treat plaque psoriasis.

METHODS

A multicenter, two-arm parallel group, single-blind, randomized, controlled trial will be conducted at six hospitals in China between August 1, 2019 and December 31, 2021. A total of 122 adult patients (aged 18-65 years) who meet the inclusion criteria are being recruited. Participants will receive either basic treatment combined with moving cupping therapy or basic treatment combined with moving cupping placebo. The treatment cycle will be 4 weeks, and the efficacy of treatment will be assessed weekly by the Psoriasis Area and Severity Index during the treatment period and follow-up visits at weeks 6 and 8. The body surface area, physician's global assessment, Dermatology Life Quality Index, patient-reported quality of life, visual analog scale, Traditional Chinese Medication syndrome scoring scale, combined medication, and adverse events will also be recorded and compared to the relative baseline values.

DISCUSSION

The findings of this trial may lead to better decisions regarding the treatment of plaque psoriasis. If the trial outcomes are considered favorable, this ancient Chinese medical therapy may be worthy of widespread use because of its convenience and low cost.

TRIAL REGISTRATION

This study was registered on May 15,2019 at ClinicalTrials.gov with the identifier number NCT03952676.

Should acupuncture, biofeedback, massage, Qi gong, relaxation therapy, device-guided breathing, yoga and tai chi be used to reduce blood pressure?: Recommendations based on high-quality systematic reviews

BACKGROUND

This review aims to rate the quality of evidence and the strength of recommendations in high-quality systematic reviews of non-drug therapies. Hypertensive patients who are resistant or non-adherent to antihypertensive drugs may be easier to manage if they choose alternative non-drug therapies for hypertension, based on this review.

METHODS

P: Adults (>18 years), except pregnant women, with essential hypertension. I: Cupping, moxibustion, acupuncture, acupoint stimulation, yoga, meditation, tai chi, Qi gong, Chinese massage, massage, spinal manipulation, biofeedback, device-guided breathing therapy, aromatherapy, music therapy, and relaxation approaches. C: 1. No treatment. 2. Sham therapy. 3. Conventional treatment, including antihypertensive drugs and lifestyle modification (e.g., exercise). O: 1. Change in the incidence of cardiovascular death. 2. Change in the incidence of myocardial infarction. 3. Change in the incidence of stroke. 4. Change in blood pressure (BP). 5. Efficacy rate of BP lowering. 6. Adverse effects (review specific). S: Systematic reviews of randomized controlled trials, including meta-analyses and assessments of the methodological quality/risk of bias.

INFORMATION SOURCES

Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane library, PubMed, Web of Science, China National Knowledge Infrastructure, and Chinese Scientific Journal Database were searched. The bibliographies of the included articles were also searched for relevant systematic reviews. GRADE criteria were used to rate the quality of evidence in systematic reviews considering 6 factors, including risk of bias.

RESULTS

This review ultimately included 13 systematic reviews of 14 non-drug therapies (acupuncture, wet cupping, Baduanjin, blood letting, auricular acupuncture, music, massage, Qi gong, moxibustion, relaxation therapies, biofeedback, device-guided breathing, yoga and tai chi) based on the inclusion criteria. The quality of evidence was generally low, and weak recommendations were given for most therapies except massage and acupuncture plus antihypertensive drug. Based on the analyzed evidence, massage and acupuncture plus antihypertensive drug could benefit people who want to lower their BP and do not have contraindications for massage and acupuncture plus antihypertensive drug.

DISCUSSION/STRENGTH

The GRADE approach makes this review a unique reference for people who are considering the grade of quality of evidence in systematic reviews, the balance of desirable and undesirable consequences and the strength of recommendations to decide which intervention should be used to reduce BP.

LIMITATIONS

Many non-drug therapies were excluded due to the low methodological quality of their systematic reviews, and only 14 therapies were evaluated in this review. As no patient-important outcomes were reviewed, surrogate outcomes were used to rate the strength of recommendations. This approach may cause a decrease in evidence quality according to GRADE, but we argue that this is appropriate in the context of this review.