From today to the past: the cupping therapy as a form of alternative medicine

INTRODUCTION

The cupping therapy is a form of alternative medicine that is already more than 2000 year old in China and in Egypt.¹ It uses glasses or cups, in general made of glass, pottery or, in some cases, bamboo. The suction force created in this technique may be achieved either by fire action or mechanically, being the mechanical devices nowadays used as a mechanism of a suction pump which is pulled by the operator in order to create the necessary vacuum (yet a more rudimentary method can be used, which consists in putting cotton or alcohol inside the glasses and the use of fire to create vacuum).^2,3 In any of these techniques, by making the skin and the subcutaneous tissue being pulled by the suction force will cause a cutaneous erythema, petechiae, purpura, ecchymoses and even burns.^3,4

In the common belief, the most widespread indications for this sort of treatment are lower-back pain, slipped disc, herpes zoster infection, cough and dyspnea.5

CASE REPORT

76-year-old male patient, with a history of high blood pressure, pulmonary emphysema and benign prostatic hyperplasia, complained of cough with sputum, characteristic pleuritic pain in the lower part of the right hemithorax and a six-day lasting fever. He presented himself at the emergency room after failing the attempt of home treatment without any prior medical assessment. At the physical examination he was hemodynamically stable, feverish (38,6 degree C of tympanic temperature) and with 28-cycle-per-minute of breathing, showing clearly a crackling on pulmonary auscultation in the lower third of the right lung. At the thoracic examination an almost perfect 7-cm diameter circumferential injury could be seen near the right nipple (Figure 1); it was red with a little blister inside very much suggesting a second-degree burning which was immediately treated. When asked about the etiology of the injury, he referred it was a consequence of the treatment he had made at home and explained it was a therapeutic method taught by his parents of “extracting the pain and the illness” from the body, which consisted of applying a big size glass on the skin of the affected area. That glass contained some cotton in alcohol-soaked which inflamed would be burnt and provokes suction-kind force that the common culture believes that it “sucked” the illness from the body.

The additional study made later at the emergency room highlighted: hemogram with leukocytosis (26.0×10^9/L), neutrophilia (2.2×10^9/L) and a high value of C reactive protein (28.7 mg/dL); arterial blood sample without respiratory insuffiency; chest X-ray with pulmonary consolidation in the right lower lobe; urine antigen positive for Streptococcus pneumoniae. Therefore, he was found to have pneumococcic pneumonia; he was medicated with antibiotherapy and reassessed five days later in a medical consultation, showing a clear improvement.

DISCUSSION

When a characteristic and suspicious skin lesion is seen the clinic, despite the cupping therapy dates back thousands of years, this form of alternative medicine should be considered. Even though the absence of drug therapy, described side effects are many, as examples the epidural abscess, iron-deficiency anemia and prothrombotic scenarios.^1,6,7 Other less serious effects but not negligible are erythema, itching, abrasions, vesicle formation, skin hyper-pigmentation and pain.⁷

Thus, the recognition of injuries produced by the cupping therapy is highly important in routine clinical practice, especially in the emergency room. If, on one hand as already stated, these injuries may develop serious complications which should be identified and treated in time, on the other hand, they may lead to a misdiagnosis of physical abuse and neglect, in particular when before more vulnerable patients (children and the elderly).⁸ This case highlights the importance of a good anamnesis near the patient, being able to more the right diagnosis when facing a skin injury, which could lead to thousands of other different diagnosis.

CONCLUSION

Nowadays, the cupping therapy should not be used in order to replace the physician evaluation. Despite, potentially delaying a correct diagnosis, as described, may result in side effects of an alternative treatment.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

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