Significant and sustaining elevation of blood oxygen induced by Chinese cupping therapy as assessed by near-infrared spectroscopy

Noninvasive Assessing Low Back Pain by a Novel Near-Infrared Spectroscopy Flexible Probe With the Aid of Cupping Protocol

Low back pain (LBP) is the leading cause of disability worldwide, yet its quantitative and noninvasive assessment remains challenging. Considering that near-infrared spectroscopy (NIRS) became a promising noninvasive tool for monitoring muscle and cupping therapy could regulate muscle blood flow to relieve LBP, we attempted to incorporate cupping and hemodynamics monitoring in muscle tissue by NIRS to assess LBP. We collected 3-min NIRS recordings on 12 LBP patients and 12 healthy subjects before and after 20-min cupping. Initially, no significant hemodynamic differences were observed between the groups. After cupping, the concentration changes of oxy-hemoglobin (Δ[HbO2]) in the emitter-detector channel parallel to spine unexpectedly exhibited that LBP was remarkably lower by approximately 67% compared with the controls. This study highlighted the potential of combining NIRS and cupping protocol as a quantitative assessment technique for LBP, also providing a new idea for clinical integration of novel optical assessment technologies.

Application of near-infrared spectroscopy to assess the effect of the cupping size on the spatial hemodynamic response from the area inside and outside the cup of the biceps

Cupping therapy is a popular intervention for improving muscle recovery after exercise although clinical evidence is weak. Previous studies demonstrated that cupping therapy may improve microcirculation of the soft tissue to accelerate tissue healing. However, it is unclear whether the cupping size could affect the spatial hemodynamic response of the treated muscle. The objective of this study was to use 8-channel near-infrared spectroscopy to assess this clinical question by assessing the effect of 3 cupping sizes (35, 40, and 45 mm in inner diameter of the circular cup) under -300 mmHg for 5 min on the muscle hemodynamic response from the area inside and outside the cup, including oxyhemoglobin and deoxy-hemoglobin in 18 healthy adults. Two-way factorial design was used to assess the interaction between the cupping size (35, 40, and 45 mm) and the location (inside and outside the cup) and the main effects of the cupping size and the location. The two-way repeated measures ANOVA demonstrated an interaction between the cupping size and the location in deoxy-hemoglobin (P = 0.039) but no interaction in oxyhemoglobin (P = 0.100), and a main effect of the cup size (P = 0.001) and location (P = 0.023) factors in oxyhemoglobin. For the cupping size factor, the 45-mm cup resulted in a significant increase in oxyhemoglobin (5.738±0.760 μM) compared to the 40-mm (2.095±0.312 μM, P<0.001) and 35-mm (3.134±0.515 μM, P<0.01) cup. Our findings demonstrate that the cupping size and location factors affect the muscle hemodynamic response, and the use of multi-channel near-infrared spectroscopy may help understand benefits of cupping therapy on managing musculoskeletal impairment.

The impact of massage and dry cupping on dysrhythmia in cardiac patients: A randomized parallel controlled trial

BACKGROUND

Heart disease is the leading cause of death in many countries around the world and is linked to numerous complications. In addition to conventional pharmacological treatments, complementary and alternative medicines like massage and dry cupping are employed to help manage the disease and its symptoms. This study aimed to compare the effects of massage and dry cupping on dysrhythmia in patients with heart diseases.

METHODS

This randomized parallel controlled clinical trial study was conducted in two critical care units of Shafa hospital in Kerman, southeastern Iran, in 2019-2020. A total of 90 eligible patients were allocated into three groups: massage (n = 30), dry cupping (n = 30), and control (n = 30) using a stratified block randomization method. In the massage group, the head and face were massaged for three consecutive nights, while the dry cupping group received dry cupping between the fifth cervical vertebra and the second thoracic vertebra for the same duration. Each intervention session lasted 15 min. Data collection tools included a socio-demographic and clinical characteristics questionnaire, a form for hemodynamic parameters (systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation), and a form for assessing dysrhythmia using electrocardiogram readings. Dysrhythmia in the participants was evaluated after each session.

RESULTS

The results within each group indicated a statistically significant difference in the prevalence of dysrhythmia in the dry cupping group after the intervention (P < 0.05), but this difference was not statistically significant in the massage and control groups. However, when comparing between the groups, no significant difference was found among the three groups. Additionally, there was no significant difference in the type of dysrhythmia between the groups (P > 0.05).

CONCLUSION

While there was no difference in the type of dysrhythmia between the three groups, the additional reduction of dysrhythmia in the dry cupping group could hold clinical significance. Further studies are recommended to validate or refute the findings of the present study.

Using multi-channel near-infrared spectroscopy to assess the effect of cupping therapy on the spatial hemodynamic response of the biceps muscle: A preliminary study

BACKGROUND

The local hemodynamic response after cupping therapy has been considered as a contributing factor for improving muscle tissue health; however, the effects of cupping pressure and duration on the spatial hemodynamic response have not been investigated.

OBJECTIVE

The objective of this study was to investigate the hemodynamic response inside and outside the cupping cup under various pressures and durations of cupping therapy.

METHODS

A 3-way factorial design with repeated measures was used to investigate the main and interaction effects of the location (areas inside and outside the cup), pressure (-225 and -300 mmHg) and duration (5 and 10 min) on the hemodynamic response of the biceps muscle. A functional near-infrared spectroscopy was used to assess hemodynamic changes in 18 participants.

RESULTS

A significant three-way interaction of the location, pressure, and duration factors was observed in oxyhemoglobin (p= 0.023), deoxy-hemoglobin (p= 0.013), and blood volume (p= 0.013). A significant increase was observed in oxyhemoglobin, blood volume, and oxygenation compared to pre-cupping (p< 0.05) in the area outside the cup.

CONCLUSION

Our findings indicate that an appropriate combination of cupping pressure and duration can effectively affect the spatial hemodynamic response of the biceps.

Hemodynamic alterations response to Chinese acupuncture therapy monitored by a custom near-infrared spectroscopy probe with an open hole

Traditional acupuncture, a popular traditional Chinese medicine (TCM) technique, has demonstrated potential in relieving various ailments' symptoms. However, its black-box feedback loop model has limited proper evaluation and use by unskilled practitioners. This study aimed to analyze hemodynamic signals around acupoints during acupuncture to identify significant parameter changes. We designed hollow near-infrared spectroscopy (NIRS) probes for real-time measurements during acupuncture at acupoints, monitoring oxy-hemoglobin (HbO), deoxy-hemoglobin (Hb), and blood volume (HbT) changes. Acupuncture was performed on the "Xuehai" acupoint in 17 healthy subjects, with NIRS measuring hemodynamic alterations. Results showed significant and consistent increases in Hb and HbT around the acupoint, returning to baseline values after needle removal. One case of fainting revealed a significant Hb increase and HbO decrease. Acupuncture may induce tissue vasodilation and enhance oxygen consumption. This research provides a potential explanation for acupuncture's mechanism and emphasizes NIRS's potential in TCM.

Using cross-correlation analysis of multi-channel near infrared spectroscopy to assess the hemodynamic response to cupping therapy

Cupping therapy is a common intervention for the management of musculoskeletal impairment. Previous studies have demonstrated that cupping therapy can improve muscle hemodynamic responses using single-channel near-infrared spectroscopy (NIRS). However, the effects of cupping therapy on spatial hemodynamic responses as well as the correlation between oxyhemoglobin and deoxy-hemoglobin are largely unknown. The cross-correlation function (CCF) algorithm was used to determine the correlation between time-series NIRS signals from inside and outside the cup as well as time-series oxyhemoglobin and deoxy-hemoglobin under 4 cupping intensities, including -225 and -300 mmHg for 5 and 10 min. The main finding was that the maximum CCF values of oxyhemoglobin was significantly higher than those in deoxy-hemoglobin (p < 0.05). Furthermore, it was found that there was a correlation between deoxy-hemoglobin with a longer duration and a larger magnitude of negative pressure. This is the first study investigating time-series hemodynamic responses after cupping therapy using cross-correlation function analysis of multi-channel NIRS signals.

Using near-infrared spectroscopy to investigate the effects of pressures and durations of cupping therapy on muscle blood volume and oxygenation

Cupping therapy has been widely used to manage musculoskeletal impairment. However, the effects of pressure and duration of cupping therapy on the hemodynamic activity of the muscle have not been investigated. A 2 × 2 repeated measures factorial design was used to examine the main effect and interaction of pressure (-225 and -300 mmHg) and duration (5 and 10 min) on biceps muscle blood flow using near-infrared spectroscopy in 18 participants. The results showed that a significant interaction is between pressure and duration on deoxy-hemoglobin (p = 0.045). A significant main effect of pressure is on oxyhemoglobin (p = 0.005) and a significant main effect of duration is on oxyhemoglobin (p = 0.005). Cupping therapy at -300 mmHg for 10 min results in a higher oxyhemoglobin (6.75 ± 2.08 μM) and deoxy-hemoglobin (1.71 ± 0.78 μM) compared to other three combinations. Our study provides first evidence that the pressure and duration factors of cupping therapy can significantly affect muscle blood volume and oxygenation.

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 efficacy and safety of dry cupping in cervical spondylosis with optimization of cup application time - a randomized clinical trial

OBJECTIVES

Dry cupping therapy (DCT) is considered beneficial in the amelioration of cervical spondylosis (CS) symptoms in Unani medicine. Therefore, the focus of this study was to ascertain the efficacy of DCT and optimal cup application time duration for CS.

METHODS

It was a randomized clinical trial involving 45 participants with clinically diagnosed CS. The eligible subjects were randomly categorized into three groups, each having 15 participants. Each of the three groups, i.e., A, B, and C, received DCT daily for 15 days for 8 min, 10 min, and 12 min, respectively. All the participants were evaluated at the baseline, 7th, and 15th days of the trial using the neck disability index (NDI) as well as the visual analogue scale (VAS).

RESULTS

The baseline mean ± SD of NDI and VAS scores were significantly reduced in all the three groups at the end of the trial. Although all three groups were statistically equal in terms of NDI, group-C demonstrated greater efficacy in terms of VAS.

CONCLUSIONS

The per-protocol analysis showed that dry cupping effectively alleviated neck pain across all treatment groups. Although, this effect on neck disability index was statistically equal in all three groups, the 12-min protocol was more successful in reducing pain.

Evidence-based and adverse-effects analyses of cupping therapy in musculoskeletal and sports rehabilitation: A systematic and evidence-based review

BACKGROUND

Cupping therapy has been used to treat musculoskeletal impairments for about 4000 years. Recently, world athletes have provoked an interest in it, however, the evidence to support its use in managing musculoskeletal and sports conditions remains unknown.

OBJECTIVE

To evaluate the evidence level of the effect of cupping therapy in managing common musculoskeletal and sports conditions.

METHODS

2214 studies were identified through a computerized search, of which 22 met the inclusion criteria. The search involved randomized and case series studies published between 1990 and 2019. The search involved five databases (Scopus, MEDLINE (PubMed), Web of Science, Academic Search Complete PLUS (EBSCO), and CrossRef) and contained studies written in the English language. Three analyses were included: the quality assessment using the PEDro scale, physical characteristic analysis, and evidence-based analysis.

RESULTS

The results showed that most studies used dry cupping, except five which used wet cupping. Most studies compared cupping therapy to non-intervention, the remaining studies compared cupping to standard medical care, heat, routine physiotherapy, electrical stimulation, active range of motion and stretching, passive stretching, or acetaminophen. Treatment duration ranged from 1 day to 12 weeks. The evidence of cupping on increasing soft tissue flexibility is moderate, decreasing low back pain or cervical pain is low to moderate, and treating other musculoskeletal conditions is very low to low. The incidence of adverse events is very low.

CONCLUSION

This study provides the first attempt to analyze the evidence level of cupping therapy in musculoskeletal and sports rehabilitation. However, cupping therapy has low to moderate evidence in musculoskeletal and sports rehabilitation and might be used as a useful intervention because it decreases the pain level and improves blood flow to the affected area with low adverse effects.

Anatomical Points of Cupping Therapy for Musculoskeletal Pain: A Systematic Review

Background: The prevalence of musculoskeletal pain is rising and plays a substantial role in disease and disability worldwide. There have been several previous studies on cupping therapy’s effectiveness in reducing musculoskeletal pain. However, studies that specifically review the literature on cupping points to reduce musculoskeletal pain are lacking.Purpose: This study aimed to identify the anatomical points of cupping therapy for musculoskeletal pain.Methods: A systematic review was employed. PubMed, ScienceDirect, and Google Scholar were used for the search process. The screening was performed based on inclusion and exclusion criteria. Crowe Critical Appraisal Tool (CCAT) was used to measure the quality of the articles. Standardized forms were used to extract essential characteristics from articles, including study design, participant and sample, and results. Data were narratively analyzed for thematic synthesis.Results: From a total of 1,045 articles acquired, eight articles were included in data synthesis. All articles were randomized control trials (RCT) design. Seven regions of cupping points were identified, including upper-middle-lower fibres of the trapezius muscles, the inter-scapular area around the 2-4th vertebrae torachalis, the sacrum area, between the lower vertebrae and the coccyx bone, the 1-5th vertebrae lumbalis, the 3-5th vertebrae lumbalis, knee joint, and lower border of the spinous process of the second lumbar vertebra (L2).Conclusion: Seven anatomical points of cupping therapy for musculoskeletal pain were identified by this systematic review based on studies. Single research could not define the whole range of advantages of each point. To support the previously described theories regarding cupping and develop new ones, future novel scientific studies are also required.

Acupuncture or cupping plus standard care versus standard care in moderate to severe COVID-19 patients: An assessor-blinded, randomized, controlled trial

Background

Non-pharmacological strategies that have been proposed by complementary medical systems, can be effective in management of COVID-19.

Methods

This study was designed as a three-arm, assessor-blinded, randomized controlled trial. A total of 139 hospitalized COVID-19 patients were randomly assigned into three groups: (1) acupuncture (ACUG), (2) cupping (CUPG), and (3) control (CTRG). All participants received conventional treatment. The primary study endpoint included changes in respiratory signs including oxygen saturation (SpO2) and respiratory rate (RR). The secondary endpoints were COVID-19-related hospitalization duration and serious adverse events such as intensive care unit (ICU) admission, intubation or death, all up to day 30. Also, improvements in cough, dyspnea, chest tightness, oxygen demand, anorexia, headache, weakness, sore throat, and myalgia were evaluated.

Results

Forty-two patients in ACUG, 44 patients in CUPG, and 42 patients in CTRG completed the trial. After 3 days, SpO2 and RR improved significantly in CUPG and ACUG compared with CTRG (effect size: 8.49 (6.4 to 10.57) and 8.51 (6.67 to 10.34), respectively: p<0.001). Compared with CTRG, patients in CUPG and ACUG recovered faster (mean difference: 6.58 (4.8 to 8.35) and 9.16 (7.16 to 11.15), respectively) and except for two patients in ACUG who were admitted to ICU, none of patients in ACUG or CUPG needed ICU or intubation (p<0.001 in comparison to CTRG). Amelioration of clinical COVID-19 related symptoms reached a high level of statistical significance in CUPG and ACUG in comparison with CTRG (p<0.01).

Conclusion

Cupping and acupuncture are promising safe and effective therapies in management of COVID-19. Trial registration: This study was registered at Iranian Registry of Clinical Trials: IRCT20201127049504N1 (https://en.irct.ir/trial/52621).

Infrared thermal imaging-based skin temperature response during cupping at two different negative pressures

Cupping therapy can relieve muscle fatigue and pain after exercise by increasing blood flow at the treatment site, which may lead to dynamic changes of the local skin temperature. This study aimed to analyze the effect of cupping on local skin temperature under two different negative pressures using infrared thermography (IRT). Cupping therapy was performed on the forearms of 22 healthy subjects using the negative pressures of − 0.03 and − 0.04 MPa. IRT was used to record the dynamic changes in skin temperature before, during, and after cupping. Both cupping pressures induced a non-linear skin temperature response: temperature decreased first and then increased during cupping, while it first increased and then decreased after cupping. A significant difference was noted between the two negative pressure groups in the maximum temperature increment after cupping (P < 0.001). Compared with the basal temperature before cupping, the maximum increase in skin temperature after cupping in the − 0.03 and − 0.04 MPa groups was 0.92 and 1.42 °C, respectively. The findings of this study can lay the foundation evaluating the curative effect of cupping based on IRT and provide an objective reference for selecting the cupping negative pressure.

The efficacy and safety of cupping therapy for treating of intractable peripheral facial paralysis: A protocol for systematic review and meta-analysis

BACKGROUND

Peripheral facial paralysis (PFP) is a common clinical neurological disease and the incidence of intractable peripheral facial paralysis is on the rise. Symptoms include crooked mouth and eyes, tearing and shallow nasolabial folds. The disease seriously affects the physical and mental health of patients. At present, a large number of clinical studies have shown that cupping is effective in treating intractable peripheral facial paralysis (IPFP). Therefore, the purpose of this review is to evaluate the effectiveness and safety of cupping in the treatment of refractory peripheral facial paralysis.

METHODS

We will conduct a comprehensive and systematic search of relevant documents in the following databases: Medline, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Chinese Biomedical Literatures Database, China National Knowledge Infrastructure (CNKI), Wang Fang Database, Chinese Scientific Journal Database from inception to February 2021 without any language restriction. The 2 reviewers will be independently completed select research, extract data, evaluate research quality and use the Cochrane risk of bias tool to assess methodological quality. Using revman5.4 software for statistical analysis. The degree of heterogeneity will be Determined through heterogeneity test, to definite whether to adopt a random effects model or a fixed-effects model.

RESULTS

The protocol for the meta-analysis will systematically evaluate the efficacy and safety of cupping therapy for intractable peripheral facial paralysis patients.

CONCLUSION

This study will explore whether or not cupping therapy can be used as one of the non-drug therapies to prevent or treat intractable peripheral facial paralysis.

Pressure-driven accumulation of Mn-doped mesoporous silica nanoparticles containing 5-aza-2-deoxycytidine and docetaxel at tumours with a dry cupping device

Drug delivery with the help of nanoparticles could transport more payloads to tumour site. Owing to their limited accumulation and penetration in the tumour tissues, to increase delivery efficiency is currently still required for applying nanomedicine to treat tumour. Here, we initially report a pressure-driven accumulation of drug-loaded nanoparticles to tumours for efficient tumour therapy with a dry cupping device. The mesoporous Mn-doped silica based nanoparticles delivering 5-aza-2-deoxycytidine and docetaxel were prepared, characterised and used as a model nanomedicine to investigate the potential of dry cupping treatment. For this system, the Mn doping not only endowed the mesoporous silica nanoparticles biodegradability, but also made it much easier to bind a tumour targeting group, which is a G-quadruplex-forming aptamer AS1411. On tumour-bearing mice, the in vivo results demonstrated that the dry cupping treatment could substantially improve the distribution of nanomedicines at tumour site, resulting in enhanced treatment efficacy. Overall, this method enables the therapeutical nanoparticles accumulate to tumour through increasing the blood perfusion as well as altering the biological barrier, which opened up possibilities for the development of pressure-driven nanomedicine accumulation at tumour site.

Online Assessment of Hemodynamics in the Suctioned Volume of Biological Tissue by an Embedded Near-Infrared Spectroscopy Sensor

Cupping therapy is a promising method to cure or reduce symptoms of some diseases including muscle pain/tenderness/fatigue. Although the applications of cupping therapy have a thousand-year history in traditional Chinese medicine and have been spread to other countries in recent years, cupping therapy is something like a black box, and the unskilled user can hardly control it due to the absence of physiological observations. In this study, we developed a NIRS instrument with three probes to detect the blood-oxygen level of the skin tissue where the cupping therapy is being carried out. Each probe includes two detection channels. One of the probes is embedded in the cup to monitor the hemodynamic parameters in the cupping site, and the other two probes are placed outside, surrounding the cupping site. Using this monitor, we can observe the changes in oxy-hemoglobin ([HbO2]), deoxy-hemoglobin ([Hb]), and total hemoglobin ([tHb]), as well as the heart rate, calculated from the change curves of [HbO2] during cupping therapy in real time. Therefore, the doctor or other users can see the impact of cupping on the tissues to which it is applied which should facilitate the development and understanding of the application of cupping.

Online Noninvasive Assessment of Human Brain Death by Near-Infrared Spectroscopy with Protocol of O2 Inspiration

Brain death is the irreversible loss of all the functions of the brain and brainstem. Compared to traditional diagnostic methods of brain death, near-infrared spectroscopy (NIRS) is a noninvasive, objective, cost-effective, and safe way of assessment of brain death. Eighteen brain dead patients and 20 healthy subjects were studied by NIRS, with a multiple-phase protocol at varied fractions of inspired O₂ (FIO₂). We found that the changes in the concentration ratios of oxyhemoglobin to deoxyhemoglobin (Δ[HbO₂]/Δ[Hb]) in the cerebral cortex of brain dead patients were significantly higher than those of healthy subjects, and its low-to-high FIO₂ phase was most sensitive, with a recommended threshold in the range 1.40-1.50. Our study indicated that NIRS is a promising technology for assessing brain death. The success of this application potentially offers a supplementary technique for the assessment of brain death in real time in order to be able to promptly offer quality-assured donor organs.

Influence of quantified dry cupping on soft tissue compliance in athletes with myofascial pain syndrome

PURPOSE

This study aimed to develop a quantitative dry cupping system that can monitor negative pressure attenuation and soft tissue pull-up during cupping to quantify soft tissue compliance.

METHODS

Baseball players with myofascial pain syndrome were recruited to validate the benefits of cupping therapy. Nine of 40 baseball players on the same team were diagnosed with trapezius myofascial pain syndrome; another nine players from the same team were recruited as controls. All participants received cupping with a negative pressure of 400 mmHg for 15 minutes each time, twice a week, for 4 weeks. Subjective perception was investigated using upper extremity function questionnaires, and soft tissue compliance was quantified objectively by the system.

RESULTS

During the 15-minute cupping procedure, pressure attenuation in the normal group was significantly greater than that in the myofascial group (p = 0.017). The soft tissue compliance in the normal group was significantly higher than that in the myofascial group (p = 0.050). Moreover, a 4-week cupping intervention resulted in an obvious increase in soft tissue lift in the myofascial pain group (p = 0.027), although there was no statistical difference in the improvement of soft tissue compliance. Shoulder (p = 0.023) and upper extremity function (p = 0.008) were significantly improved in both groups, but there was no significant difference between the two groups.

CONCLUSION

This quantitative cupping monitoring system could immediately assess tissue compliance and facilitate the improvement of soft tissues after cupping therapy. Hence, it can be used in athletes to improve their functional recovery and maintain soft tissues health during the off-season period.

Cupping Therapy for Diseases: An Overview of Scientific Evidence from 2009 to 2019

Cupping therapy has been accepted worldwide, and many studies have been conducted to reveal its curative effects and mechanisms. To comprehensively evaluate the effect of cupping therapy, database including China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database VIP, Wan Fang Database, Chinese Biomedicine (CBM), PubMed and Web of Science were searched from 2009-2019. We summarized all the meta-analyses, randomized controlled trials, clinical trials and the mechanisms studies of cupping therapy in the previous 10 years, hoping to provide a reference for the clinical applications and studies.

Photoacoustic imaging of microenvironmental changes in facial cupping therapy

As a traditional medicine practice, cupping therapy has been widely used to relieve symptoms like fatigue, tension, and muscle pain. During the therapy, negative pressure is applied to the skin for a while with an intention to enhance blood circulation or induce micro-bleeding. The therapeutic effect, however, is not clear due to the lack of direct quantification. Aiming at a quantitative assessment of the treatment effect, we explore optical-resolution photoacoustic microscopy (OR-PAM) in monitoring the structural and functional changes after cupping. We find that, after 5-minutes of ∼ 20 kPa negative pressure cupping, more capillaries appear in the focus, and micro-blooding is observed from the capillaries. We quantify the images and find the blood vessel density is increased by 64%, and the total hemoglobin concentration in both the veins and the arteries exhibits 62% and 40% elevation, respectively. Oxygen saturation in the vein and artery decreased by 17% and 3% right after cupping, respectively. After two hours of recovery, the three blood-related parameters return to their original levels, indicating that the effects in the tissue last only a short period after cupping at the given pressure and time duration. Note that no significant cupping marks are induced with the treatment parameters in this study. This work proposes OR-PAM to quantitatively monitor and evaluate the effect of cupping therapy from the perspective of imaging. The method is also useful for accurate control of the therapeutic outcome.

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.

Integrating Cupping Therapy in the Management of Sudden Sensorineural Hearing Loss: A Case Report

Sudden sensorineural hearing loss (SSNHL) is most often defined as a rapid hearing loss of ≥ 30 decibels across at least three contiguous audiometric frequencies over a time of ≤ 72 hours. Cupping therapy has been practiced across the world for thousands of years. Cupping therapy is practiced by creating suction inside cups that are placed on predefined skin areas. Our case is a 48-year-old female with a four-year history of Meniere’s disease, recurrent tinnitus, episodes of dizziness attacks, and fullness of the right ear. The patient developed sudden sensorineural hearing loss. She received conventional treatment and wet cupping therapy as a complementary integrative treatment. After the integrative management protocol was completed, pure tone audiometry tests revealed significant hearing improvement across almost all frequencies. To the best of our knowledge, this case presentation is the first reported case of this type. A positive effect of cupping was reported in our case as an integrative complementary treatment. Large, well-designed quality clinical trials to evaluate the efficacy and safety of wet cupping therapy (WCT) as a complementary treatment of SSNHL is highly recommended.

The hemodynamic changes during cupping therapy monitored by using an optical sensor embedded cup

Cupping therapy is one form of alternative medicine that is used widely across the world. Although the applications of cupping therapy including pain relief have a 1000-year history, the therapeutic effect of cupping is still questionable due to a lack of scientific evidence. Therefore, in the present study, we embedded a near-infrared spectroscopic sensor into a suction cup to monitor the hemodynamic changes on the treated site while the hemodynamics at the surrounding tissue of the cup was also simultaneously monitored by another near-infrared spectroscopic sensor. The results from 10 healthy male subjects show a dramatic increase of the oxy-hemoglobin (OHb) and deoxy-hemoglobin (RHb) concentrations at the treatment site while the OHb and RHb levels were decreased at the surrounding tissue. Moreover, after the treatment, we observed that the OHb concentrations were maintained at a higher level than before treatment at both sites, which may demonstrate how cupping therapy works for treatment. In summary, the results showed that cupping therapy increases blood volume and tissue oxygenation at the treatment site while those were slightly decreased at the surrounding tissue. This study showed that the embedding of near-infrared spectroscopy in a cupping system could offer a better understanding of the mechanism of cupping therapy.

Noninvasive and sensitive optical assessment of brain death

Brain death is an irreversible loss of all brain functions, and the assessment is crucial for organ supply for transplantation. The noninvasive, sensitive, universally available and timely ancillary method to assess brain death has not been established. Here, we attempted to explore a noninvasive way in brain death assessment. Eighteen brain-dead patients and 20 healthy subjects were measured by near-infrared spectroscopy (NIRS), with a multiple-phase protocol at varied fraction of inspired O₂ (FIO₂ ). We found that the concentration changes ratios of oxyhemoglobin to deoxyhemoglobin (Δ[HbO₂ ]/Δ[Hb]) in the cerebral cortex of brain-dead patients were significantly higher than those of healthy subjects. And, the Δ[HbO₂ ]/Δ[Hb] in low-to-high FIO₂ phase was most sensitive to distinguish brain-dead patients from healthy subjects, with a recommended threshold ranged in 1.40~1.50. The innovative incorporation of NIRS and a varied FIO₂ protocol was shown to be a noninvasive and reliable way in assessing brain death. This successful attempt of NIRS application is a help for fast and accurate evaluation of brain death, promptly offering quality-assured donor organs and indicate us a protocol-aided way to expand the use of NIRS.

Alternations of hemodynamic parameters during Chinese cupping therapy assessed by an embedded near-infrared spectroscopy monitor

Cupping therapy is a promising method to cure or reduce the symptoms of some diseases including muscle pain/tendency/fatigue. Although the applications of cupping therapy have a thousand-year history in traditional Chinese medicine, the therapeutic effect of cupping is still questionable due to a lack of scientific evidence and the absence of physiological observations. In our previous study, we utilized near-infrared spectroscopy (NIRS) to assess the concentration change surrounding the cupping site and found a significant elevation in oxy-hemoglobin (HbO₂). To further investigate the therapeutic effect of dry cupping treatment, we embedded a NIRS sensor into a suction cup to monitor the hemodynamic changes including HbO₂, deoxy-hemoglobin ([Hb]) and blood volume on the cupping site in this study. Both a prominent elevation in [Hb] and a significant drop in [HbO₂] in the tissue of the cupping site were observed during cupping. We also observed similar hemodynamic changes during post-cupping, which may demonstrate how cupping therapy works for treatment. This study showed that the embedding of NIRS sensor in a cupping system could offer a better understanding of the mechanism of cupping therapy.

Effects of Pulsatile Cupping on Body Pain and Quality of Life in People with Suboptimal Health:A Randomized Controlled Exploratory Trial

Objective: The curative effect of pneumatic pulsatile cupping on pain has been shown. This study was conducted to investigate effects of the pulsating frequency of pneumatic pulsatile cupping, compared with traditional cupping (TC), on body pain and quality of life (QoL) in people with suboptimal health status (SHS). Materials and Methods: Ninety-six participants with SHS were randomized to low-frequency (LF; n = 24) or high-frequency (HF; n = 24) pulsating cupping, traditional cupping (TC; n = 24), or wait-list (WL; n = 24) groups. The LF, HF, and TC groups received 4 sessions of cupping over 2 weeks. Visual analogue scale (VAS; 0-100 mm) pain level and Short-Form-36 (SF-36) QoL measurements were taken before and after the intervention. Results: Both LF and HF reduced pain significantly (VAS: -28.26; 95% confidence interval [CI] -36.18 to -20.34; and -31.88, 95% CI -39.81 to -23.96; both P = 0.000) and improved QoL more than WL (SF-36, Bodily Pain dimension: 1.46, 95% CI: 0.85 to 2.07; and 1.75, 95% CI: 1.14 to 2.36, both P = 0.000). Compared to TC, LF and HF significantly reduced pain (VAS: -7.92, 95% CI: -15.75 to -0.08, P ^LT = 0.048; and -11.54, 95% CI: -19.38 to -3.70, P ^HT = 0.004) and improved QoL (SF-36, Bodily Pain dimension: 0.61, 95% CI: 0.01 to 1.21, P ^LT = 0.046; and 0.90, 95% CI: 0.30 to 1.50, P ^HT = 0.004). There was no significant difference between LF and HF. Conclusions: This study showed that, in patients with SHS, pulsatile cupping therapy could have a more-favorable effect to relieve body pain, compared to TC. LF and HF pulsation produced equivalent pain relief. Further studies investigating the underlying mechanism are needed. Trial registration: This trial was registered in the Chinese Clinical Trial Registry (ChiCTR-INR-16009345).

Is cupping therapy effective in patients with neck pain? A systematic review and meta-analysis

OBJECTIVES

Neck pain is a significant condition that is second only to depression as a cause of years lived with disability worldwide. Thus, identifying and understanding effective treatment modalities for neck pain is of heightened importance. This systematic review aimed to investigate the effects of cupping on neck pain from the current literature.

DESIGN

Systematic review and meta-analysis of randomised controlled trials (RCTs).

SETTING

Nine databases, including Chinese, Korean and Japanese databases, were searched for data up to January 2018 with no restrictions on publication language.

PARTICIPANTS

Patients with neck pain.

INTERVENTIONS

Cupping therapy as the sole or add-on intervention compared with no treatment or active controls.

PRIMARY AND SECONDARY OUTCOME MEASURES

Pain severity, functional disability and quality of life.

RESULTS

Eighteen RCTs were selected. Compared with the no intervention group, the cupping group exhibited significant reduction in pain (mean difference (MD) -2.42(95% CI -3.98 to -0.86)) and improvement in function (MD -4.34(95% CI -6.77 to -1.19)). Compared with the active control, the cupping group reported significant reduction in pain (p=0.0009) and significantly improved quality of life (p=0.001). The group that received control treatment with cupping therapy (add-on group) displayed significant pain reduction compared with the active control group (p=0.001). Of the 18 studies, only 8 reported occurrence of adverse events, which were mostly mild and temporary.

CONCLUSIONS

Cupping was found to reduce neck pain in patients compared with no intervention or active control groups, or as an add-on treatment. Depending on the type of control group, cupping was also associated with significant improvement in terms of function and quality of life; however, due to the low quality of evidence of the included studies, definitive conclusions could not be drawn from this review. Future well-designed studies are needed to substantiate the effectiveness of cupping on neck pain.

PROSPERO REGISTRATION NUMBER

CRD42016047218.

Online Removal of Baseline Shift with a Polynomial Function for Hemodynamic Monitoring Using Near-Infrared Spectroscopy

Near-infrared spectroscopy (NIRS) has become widely accepted as a valuable tool for noninvasively monitoring hemodynamics for clinical and diagnostic purposes. Baseline shift has attracted great attention in the field, but there has been little quantitative study on baseline removal. Here, we aimed to study the baseline characteristics of an in-house-built portable medical NIRS device over a long time (>3.5 h). We found that the measured baselines all formed perfect polynomial functions on phantom tests mimicking human bodies, which were identified by recent NIRS studies. More importantly, our study shows that the fourth-order polynomial function acted to distinguish performance with stable and low-computation-burden fitting calibration (R-square >0.99 for all probes) among second- to sixth-order polynomials, evaluated by the parameters R-square, sum of squares due to error, and residual. This study provides a straightforward, efficient, and quantitatively evaluated solution for online baseline removal for hemodynamic monitoring using NIRS devices.

Optimal hemoglobin extinction coefficient data set for near-infrared spectroscopy

Extinction coefficient (ε) is a critical parameter for quantification of oxy-, deoxy-, and total-hemoglobin concentrations (Δ[HbO₂], Δ[Hb], Δ[tHb]) from optical measurements of Near-infrared spectroscopy (NIRS). There are several different ε data sets which were frequently used in NIRS quantification. A previous study reported that even a small variation in ε could cause a significant difference in hemodynamic measurements. Apparently the selection of an optimal ε data set is important for NIRS. We conducted oxygen-state-varied and blood-concentration-varied model experiments with 57 human blood samples to mimic tissue hemodynamic variations. Seven reported ε data sets were evaluated by comparisons between quantifications and assumed values. We found that the Moaveni et al (1970)' ε data set was the optimal one, the NIRS quantification varied significantly among different ε data sets and parameter Δ[tHb] was most sensitive to ε data sets selection.

Clinical Effects of Laser Acupuncture plus Chinese Cupping on the Pain and Plasma Cortisol Levels in Patients with Chronic Nonspecific Lower Back Pain: A Randomized Controlled Trial

Objectives

Chronic nonspecific lower back pain (LBP) is a common disease. Insufficient data is currently available to conclusively confirm the analgesic effects of laser acupuncture on LBP. This study evaluated the effectiveness of laser acupuncture plus Chinese cupping in LBP treatment.

Methods

Patients with chronic nonspecific LBP were enrolled for a randomized controlled trial and assigned to the laser acupuncture group (laser acupuncture plus Chinese cupping) and control group (sham laser plus Chinese cupping). Laser acupuncture (808 nm; 40 mW; 20 Hz; 15 J/cm²) and Chinese cupping were applied on the Weizhong (BL40) and Ashi acupoints for 5 consecutive days. Plasma cortisol levels were assessed before and after the 5-day treatment session. The visual analog scale (VAS) scores were recorded at baseline and throughout the 5-day treatment session.

Results

After the treatment session, the plasma cortisol levels and VAS scores decreased significantly in both groups. In the laser acupuncture group, the VAS scores decreased significantly on days 4 and 5, and an enhanced reduction in VAS scores was observed.

Conclusion

Laser acupuncture plus Chinese cupping at the Weizhong (BL40) and Ashi acupoints effectively reduced pain and inflammation in chronic nonspecific LBP. This therapy could be a suitable option for LBP treatment in clinical settings.