The Local and Systemic Effects of Cupping Therapy

Cupping therapy is an ancient yet recently trending treatment that has been used for thousands of years for musculoskeletal pain, arthritis, skin problems such as acne or eczema, migraines, anxiety, and even the common cold.

There are several well-studied mechanisms of cupping. Understanding the local and systemic effects may explain why it is used for such a variety of ailments.

In 2017, Duane T Lowe of Madigan Army Medical Center wrote a piece combining the insights of numerous studies to present a comprehensive and sequential explanation of the local and systemic effects of cupping therapy. Lowe’s paper is entitled Cupping Therapy: An Analysis of the effects of suction on skin and the possible influence on human health.

Lowe provides 5 “accepted statements supported by current literature”, which is further detailed below. He provides a great explanation on the development of cupping marks and the physiological processes that occur during and after cupping to induce healing.

“1.  Negative pressure on skin can elicit ecchymosis.”

When a cup is applied, the underlying skin, tissue and muscles are raised. This creates a  negative pressure that dilates the capillaries. The capillaries eventually rupture to cause petechiae, purpura or ecchymosis. The circular marks that resemble bruises (without the trauma associated) is due to the extravascular blood in the subcutaneous tissue.

“2.  Ecchymosis attracts macrophages which phagocytize the erythrocytes and stimulates them to produce HO-1 to metabolize the heme they contain.”

The release of erythrocytes into the extravascular tissue initiates the movement of enzyme heme oxygenase-1 (HO-1)  to the cupped area to remove hemoglobin from the tissue.

“3.  HO-1 breaks down heme into BV/BR, CO and iron. The iron is sequestered by ferritin.”

HO-1 removes the hemoglobin from the tissue by catalyzing it into biliverdin (BV), carbon monoxide (CO), and iron. BV is then reduced to bilirubin (BR).

Studies have shown that HO-1 levels can be elevated for 7 days post-cupping. Ever wondered why cupping mark colors change with time? Lowe explains that the “BV from heme gives a bruise a greenish color and the conversion of BV to BR is the source for the yellow color in a bruise as it ages.”

“4.  HO-1, BV/BR, CO, directly and indirectly have significant antioxidant, anti-inflammatory, anti-proliferative, and neuromodulatory activities.”


  • increases the inflammatory cytokine Interleukin 10 (IL-10)
  • decreases pro-inflammatory cytokines tumor necrosis factor (TNF) alpha and interleukin-6 (IL-6)
  • increases antioxidant enzymes Catalase and Superoxide Dismutase
  • involved in wound healing by increasing vascular endothelial growth factor (VEGF) and stimulating mitochondrial biogenesis


  • mildly elevated levels are correlated with antioxidant and anti-inflammatory effects


  • the small amounts produced by HO-1 activity  has anti-inflammatory effects
  • a vasodilator

“5.  HO-1 system activation can have both local and systemic effects.”

Local Effects:

Based on the discussion above, cupping increases blood and lymphatic blood flow and activates the HO/BR/CO system. Lowe argues this can “lead to shorter healing times for sprains, strains, or wounds” and “this may be the mechanism behind a diminished perception of (musculoskeletal) pain.”

Systemic Effects:

The anti-inflammatory, antioxidant and healing effects of cupping may not only be local, but seen in the general blood circulation as well. If cupping therapy indeed has systemic effects, it can explain why it is often used in the treatment of more systemic conditions such as eczema or anxiety.

Study Referenced: Cupping Therapy: An Analysis of the effects of suction on skin and the possible influence on human health.

Photo Credit: Freepik

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