What is cupping therapy? The marks, claims and evidence

It takes 10 minutes at W Spa, where cupping is an add-on attached to a booked massage and not a session of its own.

A steady upward tug, strongest in the first minute and duller after that. It tends to feel strange rather than painful, closer to a vacuum than to pressure. If a cup draws hard enough to sting, say so while it is happening — a practitioner can release the seal and reseat the cup somewhere with more give.

Dry cupping leaves the skin intact and marks it like a bruise; wet cupping pierces the skin so blood flows into the cup, which adds the risks of an open wound and bloodborne infection. If a practitioner cannot tell you plainly which one they do, settle that before anything touches your back.

The circles themselves have nothing to do with impact, and nothing to do with toxins being pulled to the surface, whatever the marketing says. Suction ruptures tiny blood vessels under the skin, and blood leaks into the tissue around them. What you see afterwards is a flat round patch tracing the rim of the cup, red to purple and sometimes nearly black.

The marks fade. NCCIH adds a practical point: tell your health care providers where they came from, so the round patches are not mistaken for signs of physical abuse. A clinician who sees symmetrical circular marks on someone's back with no context has reason to ask hard questions.

Possibly for pain, but weakly. NCCIH's bottom line is that cupping may help reduce pain, but the evidence for this isn't very strong: most cupping research is of low quality, and there is not enough good research to judge it for other conditions.

On acupuncture, a far more heavily studied practice than cupping, the picture runs genuinely both ways. Some trials find real acupuncture and sham acupuncture equally effective, which points to a placebo effect. Other studies suggest real acupuncture may help with often-chronic pain: low-back pain, neck pain, osteoarthritis and knee pain, and carpal tunnel syndrome. It may also reduce tension headaches and help prevent migraines.

Studies point to two effects: acupuncture stimulates the release of the body's natural painkillers, and it affects brain areas involved in processing pain. Cupping's pull-the-blood-to-the-surface story has no comparable mechanism findings in the agency's fact sheet.

Whatever relief a session brings may owe a good deal to expectation, attention, and the plain comfort of lying still while someone tends to your back. That is a real effect for the person feeling it, and as a short add-on to a massage it costs little to try.

Five documented side effects, plus two rare severe ones. NCCIH lists persistent skin discoloration, scars, burns and infections, and notes that cupping can make eczema or psoriasis worse. Burns trace straight back to the fire method, since an open flame near skin to create suction carries an obvious hazard.

The rare severe cases NCCIH flags are bleeding inside the skull, reported after cupping on the scalp, and anemia from blood loss, reported after repeated wet cupping.

Cupping equipment can pick up blood, intentionally in wet cupping and inadvertently in dry. Reusing it without sterilizing it between clients can spread bloodborne diseases such as hepatitis B and C.

Skip cupping therapy if you bruise or bleed easily, take a blood thinner, or have eczema or psoriasis over the area being worked, and ask your own clinician first if you are pregnant.

Usually a few days, fading the way a bruise does, from purple through green to yellow. They sit where the rim of each cup sealed, which makes them round and evenly spaced rather than blotchy. Plan around them if you have a wedding, a photo shoot or a swim meet in the coming week.

No, and the tradition's own record is the clearest argument against it. Cupping is usually presented inside traditional Chinese medicine. NCCIH describes that as a system evolved over thousands of years, using psychological and physical approaches such as acupuncture and tai chi alongside herbal products. Line up four practices from that one tradition and they have fared very differently under modern testing.

Treat it as low-evidence comfort care rather than a medical treatment. At W Spa cupping is a 10 minute add-on at $20, placed along the back during a massage. A 60 minute Swedish massage is $80, or $100 with cupping; a 60 minute deep tissue massage is $90, or $110 with cupping.

Questions before you book? Call W Spa at (650) 272-6881. The spa is at 441 Waverley Street, Palo Alto, CA 94301, open every day from 9:30 AM to 10 PM.

One boundary NCCIH attaches to traditional Chinese medicine broadly applies here in full: do not let cupping replace or delay conventional care for a real condition.