NURSING INTERVENTIONS JOURNAL

Journal 1

Tittle Cupping therapy for acute and chronic pain management: a systematic
review of randomized clinical trials.
Author Huijuan Cao, Xun Li, Xue Yan, Nissi S. Wang, Alan Bensoussan,
Jianping Liu
Journal Journal of Traditional Chinese Medical Sciences
Year 2014
Nomor/Volum 1
e
Page 49-61
Reviewer Ni’mah Vicky Priyani

Background Cupping therapy is a traditional therapy that used for reduce pain.
There was only one systematic review of seven studies assessed the
effect of cupping for different types of pain.
Aim The goal of this paper is to present the research detailing what is known
concerning the effectiveness and safety of cupping for different types of
pain.
Methods This article had been review about thirteen research and four trial
registries were searched for randomized clinical trials. Trials used
combined therapy employing cupping therapy with other conventional
medications. Assessment of risk of bias provided by the Cochrane
Handbook for Systematic Reviews of Interventions.
Results Only 16 studies met according inclusion criteria. Sixteen trials with a
total 921 participants. About 6 trials with low risk of bias, another 6
trials were of unclear risk of bias and about four trials reported that had
high risk of bias. Cupping therapy was combined with other
conventional medications also showed better effect than conventional
medication alone. Cupping therapy was effective combined with heat
therapy and acupuncture therapy. Adverse events from mild to
moderate were reported in 6 trials. About 10.3% of participants
 reporting hematoma, 10.3% participants reporting increased pain and
7.5% participants reporting muscle soreness or tingling in the original
site
Conclusions Only 4 meta-analyses (with two trials in each) could be conducted.
There were potential benefit that cupping therapy compared with
conventional medications and usual care. Limitations of the review are
one half of the literature have introduced potential selection bias and
have heterogeneity among trials.
Journal 2

Title An Updated Review of the Efficacy of Cupping Therapy

Journal Plos One
Volume & pages Vol. 7, Hal. 1-14
Year 2012
Autor Huijuan Cao, Xun Li & Jianping Liu
Reviewer Hesti Kusumastuty
Date 14 April 2019

Background Cupping is a traditional Chinese medicine (TCM) therapy dating

back at least 2,000 years. Types of cupping include retained
cupping, flash cupping, moving cupping, wet cupping, medicinal
cupping, and needling cupping. The actual cup can be made of
materials such as bamboo, glass, or earthenware. The
mechanism of cupping therapy is not clear, but some researchers
suggest that placement of cups on selected acupoints on the skin
produces hyperemia or hemostasis, which results in a therapeutic
effect.
Aim Based on a previous systematic literature review of clinical
studies on cupping therapy, this study presents a thorough
review of randomized controlled trials (RCTs) to evaluate the
therapeutic effect of cupping therapy.
Method Six databases were searched for articles published through 2010.
RCTs on cupping therapy for various diseases were included.
Studies on cupping therapy combined with other TCM
treatments versus non-TCM therapies were excluded.
Result 135 RCTs published from 1992 through 2010 were identified.
The studies were generally of low methodological quality.
Diseases for which cupping therapy was commonly applied were
herpes zoster, facial paralysis (Bell palsy), cough and dyspnea,
acne, lumbar disc herniation, and cervical spondylosis. Wet
cupping was used in most trials, followed by retained cupping,
 moving cupping, and flash cupping. Meta-analysis showed
cupping therapy combined with other TCM treatments was
significantly superior to other treatments alone in increasing the
number of cured patients with herpes zoster, facial paralysis,
acne, and cervical spondylosis. No serious adverse effects were
reported in the trials.
Conclusion The results of this systematic review suggest that cupping
therapy appears to be effective for various diseases/conditions,
in particular herpes zoster, acne, facial paralysis, and cervical
spondylosis. However, the main limitation of our analysis was
that nearly all included trials were evaluated as high risk of bias.
As such, it is necessary to conduct further RCTs that are of high
quality and larger sample sizes in order to draw a definitive
conclusion.
Journal 3

Tittle The Medical Perspective of Cupping Therapy: Effects and Mechanisms of Action
Author Abdullah M.N. Al-Bedah, Ibrahim S.E, Naseem Akhtar Q, Tamer Shaban A.,
Gazzaffi I.M, Ahmed Tawfik E., Asim A.H., Mohamed K.M., Mesahri Saleh a.
Journal Journal of Traditional and Complementary Medicine
Year 2019
Volume 9
Page 90-97
Reviewer Melinda Kumala S

Background Cupping therapy is an ancient method of treatment that has been used in the
treatment of a broad range of conditions. There are two main types of cupping
therapy is dry and wet cupping. Cupping therapy possibly produces numerous
effects through a plethora of mechanisms. This review focused on theories and
hypotheses that explain mechanisms of cupping therapy from modern medicine
perspective.
Aim This review aimed to identify possible mechanisms of action of cupping therapy
from modern medicine perspective and offer possible explanations of its effects.
Methods The relevant literature published in English was searched in PubMed, Cochrane
Library and Google Scholar databases. The search strategy and the keywords were
modified as appropriate according to the database search. Articles retrieved were
223 which were reviewed by two independent assessors and finally both agreed to
include 64 studies in this narrative review.
Results The revealed results signified that certain effects and outcomes related to cupping
therapy might be linked to its possible theoretical and hypothenical mechanisms of
action. Many studies provided some evidence about the effectiveness of cupping in
certain medical and health conditions.
1. Cupping therapy effect
Cupping can induce comfort and relaxation on a systemic level and the
resulting increase in endogenous opioid production in the brain leads to
improved pain controls. Moreover, cupping therapy can enhance the circulation
of blood and remove toxins and waste from the body, reduce LDL in men and
consequently may have a preventive effect against atherosclerosis and
 cardiovascular disease. Cupping therapy tends to drain excess fluids and toxins,
loosen adhesions and revitalizes connective tissue, increase blood flow to skin
and muscles, stimulates the peripheral nervous system, reduces pain, controls
high blood pressure and modulates the immune system, and reduces blood
sugar in diabetic patients.
2. Cupping therapy outcomes in certain medical conditions
Cupping therapy appears to be effective for various medical conditions, in
particular herpes zoster and associated pain and acne, facial paralysis, and
cervical spondylosis, lowering blood pressure and prevents the development of
cardio vascular diseases CVDs in healthy people. Cupping is effective in
dealing with various pain complaints, headache, migraine, reduce systolic blood
pressure in hypertensive patients, treatment of cellulitis, cough, asthma,
arthritis, etc.
3. The most likely mechanisms of cupping and effects: bridging the gap
Many theories have been suggested to explain numerous effects of cupping
therapy and its mechanisms of action. These theories may have been interacting
harmoniously to produce the beneficial effects of cupping in treating patients
with various diseases and promoting well-being in healthy people.
4. Linking cupping therapy effects with mechanisms of actions
Understanding of the whole cupping procedure could be achieved by linking
cupping therapy effects with its mechanisms based on theories.

5. Effects and four main mechanisms of action

 Although the exact mode of action of cupping to reduce pain is not well
understood, three main possible hypotheses and theories might explain
mechanisms of pain reduction. These include “Pain-Gate Theory” (PGT),
“Diffuse Noxious Inhibitory Controls (DNICs)”and “Reflex Zone Theory”
(RZT).
Conclusion This review identified some possible mechanisms of cupping therapy based on
s certain theories that explain its diverse effects. No single theory could explain its
full spectrum of effects. The beneficial effects of cupping therapy need to be
substantiated by large randomized clinical trials, systematic reviews and meta-
analyses in future. Basic scientific innovative research is also needed to verify the
discussed theories about cupping along with inventing new theories. Prevailing
theories on cupping therapy mechanism of action that are related to Traditional
Chinese Medicine, Unani Medicine or other traditional healing practices need to
be addressed in a new innovative study.
Journal 4

Tittle Cupping therapy for Treating Knee Osteoarthritis: A protocol for

systematic review and meta-analysis of randomized controlled trials1

Author Mei-ying Guo , Ying-ji Tang , Zhi-ping He , Qiu-xiang Zhang

Journal European Journal of Integrative Medicine

Year 2017

Nomor/Volume 12

Page 131-134

Reviewer Risky Setyo P

Background Cupping therapy is widely used in East Asia, the Middle East, or Central
and North Europe to manage the symptom of knee osteoarthritis (KOA).

Aim The aim of this systematic review was to evaluate the available evidence
from randomized controlled trials (RCTs) of cupping therapy for treating
patients with KOA.

Methods The following databases will be searched from their inception until January
2017: PubMed, Embase, the Cochrane Central Register of Controlled
Trials, AMED, CINAHL, four Chinese databases [WanFang Med
Database, Chinese BioMedical Database, Chinese WeiPu Database, and
China National Knowledge Infrastructure (CNKI)], and six Korean medical
datebases (Korean Studies Information, DBPIA, the Korean Institute of
Science and Technology Information, KERIS, KoreaMed and the Korean
National Assembly Library). Only the RCTs related to the effects of
cupping therapy on KOA will be included in this systematic review. A
quantitative synthesis of RCTs will be conducted using RevMan 5.3
software. Study selection, data extraction, and validation will be performed
independently by two reviewers. Cochrane criteria for risk-of-bias will be
 used to assess the methodological quality of the trials.

Results The author only included two RCTs to test the effect of cupping therapy on
the pain intensity and physical function of KOA patients. The meta-
analysis will be repeated after omitting the low-quality studies. The test for
heterogeneity p value is less than 0.1 after performing the subgroup
analysis meaning is Less powerful.

Conclusions Only weak evidence can support the hypothesis that cupping therapy can
effectively improve the treatment efficacy and physical function in patients
with KOA.
X
Journal 5

Tittle The Effects of Wet Cupping Therapy on the Blood Levels of Some
Heavy Metals: A Pilot Study
Author Nafisa K. Umar, Sherali Tursunbadalov, Serdar Surgun
Journal Journal of Acupuncture and Meridian Studies
www.jams-kpi.com
Year 2018
Nomor/Volum 11 (6)
e
Page 375 – 379
Reviewer Irmaya Nur S

Background Heavy metals have been recognized as toxins for centuries.

Accumulating evidence indicates that heavy metals can cause illness
and somechronic illnesses, including birth defects, decrease in
intelligence intelligence quotient, memory loss, infertility, seizures,
and many idiopathic illnesses. The first measure against heavy
metals toxicity is to prevent preventive measures. Cupping therapy
has been shown to aid in the excretion of accumulated fluids and
toxins from the intersti-tial fluid.

Aim The aim of this study was to investigate the effects of wet cupping
therapy on blood levels of heavy metals

Methods Thirteen healthy male individuals [mean age + standard deviation,

28.47 + 6.18] participated in this study.
Procedure :
 All participants gave written informed consent to participate in
the study.
 Venous blood samples were collected twice (before and after
therapy) for determination of the level ofheavy metals.
 Wet cupping therapy was performed by one ofthe authors.
Blood collection :
Venous blood samples were collected 5 min before and 30 days after
 the wet cupping therapy.
Wet cupping therapy :
To perform the therapy, steriledisposable cups measuring about 5
cm in diameter wereused.
1. Five points of the posterior torsoebilateralperispinal areas of
the neck and thoracic spine, selected forthe procedure, were
cleaned with antiseptics.

2. Disposable cups were gently placed and negative pressure

was applied using a cupping (vacuum) pump.
3. The cups were removed after about 2 - 3 minutes.
4. Twenty-sixegauge disposable lancets were used to punc-ture
to a depth of 2 mm on the areas of the skin to which cupping
pressure was applied
5. Thereafter, vacuum pumping was applied for the second
time, draining about 3-5cm of blood per cupping site.
6. The application sites were coveredwith sterile pads
The levels of aluminium (Al), zinc (Zn), and cadmium (Cd) were
measured using an atomic absorption spectrophotometer.

Results The results of this study indicate that wet cupping can be effective in
excretion of excess metal from the blood. The levels of heavy metals
(Al, Zn, and Cd) after cupping therapy were significantly lower than
the levels before therapy

Conclusions These results suggest that wet cupping therapy has an excretory
effect on the kidney. Wet cupping therapy may clear blood from
 excess heavy metals. Wetcupping therapy may be recommended as
an effective complementary medicine treatment option in diseases
tha tare characterized by accumulation of toxic metals in thebody.

Irmaya Nur Solikah

2202011513080
Journal 6

Tittle Cupping therapy: An analysis of the effects of suction on skin and

the possible influence on human health.
Author Duane T. Lowe
Journal Complementary Therapies in Clinical Practice
Year 2017
Nomor/Volum 29
e
Page 162–168
Reviewer Afriana Dwi Saputri

Background Cupping therapy is a traditional therapy that has been employed

worldwide for thousands of years. Despite a lack of quality clinical
studies evaluating the efficacy of cupping therapy, its long history
and widespread use throughout the world suggests the commonly
claimed health benefits should not be completely discounted as
without merit.
Aim The goal of this paper is to present the research detailing what is
known concerning the effects of suction on skin and underlying
tissue, and the reaction of the body to that stimulus.
Methods Understanding the literature on the physiological effects of this
mechanical force may help elaborate an explanation for the
advertised local and systemic effects of cupping therapy.
Results Negative pressure causes stretching of the skin and underlying tissue
and dilation of the capillaries. This stimulates an increase in tissue
blood flow, eventually leading to capillary rupture and ecchymosis.
Macrophages phagocytize the erythrocytes in the extravascular
space which stimulates the production of Heme Oxygenase-1 (HO-
1) to metabolize the heme. Heme catalysis results in the production
of carbon monoxide (CO), biliverdin(BV)/bilirubin(BR) and iron.
HO-1, BV, BR, and CO has been shown to have antioxidant, anti-
inflammatory, antiproliferative, and neuromodulatory effects in
animal and human systems. These substances also stimulate a shift
of macrophages to the anti-inflammatory M2 phenotype. There is
evidence that the effects are both local and systemic.
Conclusions Besides the mechanical effect of cupping increasing the local blood
flow and stretching underlying tissue, activation of the HO-1 system
could account for many of cupping therapy's claimed local and
systemic health benefits.

Afriana Dwi Saputri

220201151308
 REFERENCES

Cao, H., Li, X., & Liu, J. (2012). An Updated Review of the Efficacy of Cupping
Therapy. Plos One Volume 7 Issue 2 page. 1-14.

Cao, H., Li, X., Yan, X., Wang, S. M., Bensoussan, A., & Liu, J. (2014). Cupping
therapy for acute and chronic pain management: a systematic review of
randomized clinical trials. Journal of Traditional Chinese Medical Science, 1, 49-
61.

Guo M, Tang Y, He Z, Zhang Q. European Journal of Integrative Medicine Cupping

therapy for Treating Knee Osteoarthritis : A protocol for systematic review and
meta-analysis of randomized controlled trials. Eur J Integr Med [Internet].
2017;12:131–4. Available from: https://doi.org/10.1016/j.eujim.2017.05.006

Lowe, D. T. (2017). Cupping therapy: An analysis of the effects of suction on skin and
the possible influence on human health. Complementary Therapies in Clinical
Practice, 29, 162–168.

Nafisa K. Umar, Sherali Tursunbadalov, Serdar Surgun. 2018. The Effects of Wet
Cupping Therapy on the Blood Levels of Some Heavy Metals: A Pilot Study.
Journal of Acupuncture and Meridian Studies. 11 (6) : 375-379