Skin Color Changes During Cupping Therapy : Explanations and Applications. This presentation highlighted the theories which explained skin changes after cupping. It gives an overview of knowledge and information about this phenomenon through extensive search in medical literature.

1. Skin Color Changes During Cupping
Therapy : Explanations and
Applications
Dr. Tamer Shaban
Dr. Tamer Shaban

2.  Cupping is commonly leaving skin
marks or spots
 Skin changes are Red, bluish, or
purple or mixed in color.
 Cupping spots take the shape of
the cup (Round is common,
square, or heart according to the
cup shape).
Cupping skin marks
Dr. Tamer Shaban

3. There are two common explanations
 Bruises as a result of the suction pressure
 Chinese medicine explanations
Explanations
Dr. Tamer Shaban

4. Chinese Medicine explanation
Red cupping-mark
• Severe heat
Cupping-mark ( dark colour )
• Exuberance of the
pathogenic (Qi)
Cupping-mark ( light colour )
• Mild pathogenic (Qi)
Purplish red
Bluish purple
• Severe cold-dampness
No cupping mark
• Absence of pathogenic (Qi)
Reference: ZHONG, Lan. "Joint Reinforcing-Reducing Effect of
Acupuncture, Moxibustion and Cupping Therapies." Journal of
Traditional Chinese Medicine 29.2 (2009): 101-103.
• In Chinese and oriental medicine,
cupping therapy may considered
both a diagnostic and therapeutic
tool
• The color of the skin (cupping mark)
according to their theory may be a
diagnostic tool
• According to (Lan Zhong,2009), The
colour changes and explanations
were presents in the figure (1), (2)
Dr. Tamer Shaban
Figure (1) skin color changes after cupping
according to TCM.
Design: Dr. Tamer Shaban

5. Chinese Medicine explanation
Red cupping-mark
• Severe heat
Cupping-mark ( dark color )
• Exuberance of the pathogenic (Qi)
Cupping-mark ( light color )
• Mild pathogenic (Qi)
Purplish red
.Severe damp-heat
Bluish purple
• Severe cold-dampness
No cupping mark
• Absence of pathogenic (Qi)
Reference: ZHONG, Lan. "Joint Reinforcing-Reducing Effect of Acupuncture, Moxibustion
and Cupping Therapies." Journal of Traditional Chinese Medicine 29.2 (2009): 101-103.Dr. Tamer Shaban
Figure (2) Explanation of skin color changes after cupping according to TCM. Design: Dr. Tamer Shaban

6. Effect of suction explanation
According to (Tham et al,
2005):
• Suction pressure led to skin
stresses, ecchymosis and
bleeding under the skin
which led to cupping marks.
• The stress and color is deep
around the cup rim and in
the middle.
Reference: Tham, L. M., H. P. Lee, and C. Lu. "Cupping: from a biomechanical perspective."
Journal of biomechanics 39.12 (2006): 2183-2193.
Dr. Tamer Shaban
Design: Dr. Tamer Shaban

7.  According to (Al-Rubaye, 2012), histological
smears after wet cupping, presented these
changes in skin layers:
Histological smears
ChangesSkin Layer
longitudinal fissure
due to the use of the
scarification tool
Epidermis
Edema, bleedingDermis
No cellular infiltrationHypodermis
Al-Rubaye, Kadhim Qasim Ali. "The clinical and histological skin changes after the cupping therapy (Al-
Hijamah)." J Turk Acad Dermatol 6.1 (2012): 1261a1.
Dr. Tamer Shaban
Design: Dr. Tamer Shaban

8. Light cupping markDark cupping mark
higher levels of
1. lymphocytes
2. Monocytes
3. mean corpuscular
volume
4. Platelets
compared with the
dark-skin
higher levels of :
1. white blood cells
2. polymorph nuclear
neutrophil
leukocytes
3. red blood cells
4. Haemoglobin
5. mean corpuscular
haemoglobin
6. haematocrit
compared with the
light-skin
The comparison between light and
dark cupping marks
Reference: Kim, Soo-Byeong, and Yong-Heum
Lee. "Numerical analysis of the change in skin
color due to ecchymosis and petechiae generated
by cupping: a pilot study." Journal of acupuncture
and meridian studies 7.6 (2014): 306-317.
Dr. Tamer Shaban
(Kim, and Lee, 2014) were
studied the changes in skin
color due to cupping. The
difference between dark and
light cupping mark was
summarized in this table.

9. Two factors are evaluated by (Zhao et al, 2009) for
their effects on cupping therapy spots which are:
1. Pressure
2. Time
Factors affecting Cupping marks
Reference: Zhao, X. X., et al. "Effect of time and pressure factors on the cupping mark
color." Zhongguo zhen jiu= Chinese acupuncture & moxibustion 29.5 (2009): 385-388.
Dr. Tamer Shaban

10. According to (Zhao et al, 2009), The pressure effect has the
following criteria:
 Increase pressure intensity = increase skin darkness
 10 minutes of - 0.04 mega pascal pressure produced marked
ecchymosis
 There is a linear relationship between pressure and skin color
 (cupping skin color) = 2.025 + 0.902 x 100 x negative pressure
absolute value (-MPa)
Pressure effect
Zhao, X. X., et al. "Effect of time and pressure factors on the cupping mark color." Zhongguo zhen
jiu= Chinese acupuncture & moxibustion 29.5 (2009): 385-388.
Dr. Tamer Shaban

11. According to (Zhao et al, 2009), The effect of time is
complicated and has the following criteria:
 10 min >30 min >20 min. (begin with darkest color)
 It may be according to cupping site.
Time effect
Zhao, X. X., et al. "Effect of time and pressure factors on the cupping mark color." Zhongguo zhen jiu= Chinese
acupuncture & moxibustion 29.5 (2009): 385-388.
Dr. Tamer Shaban

12. Healing of cupping spots (complete recovery) has the
following criteria according to published researches:
 Healing is usually completed within 3 weeks [1].
 laser therapy (energy density: 8 J/cm2) may have a
significant recovery of skin spots after cupping as reported
by (Kim, 2017) [2].
Healing
1-Al-Rubaye, Kadhim Qasim Ali. "The clinical and histological skin changes after the cupping therapy (Al-Hijamah)."
J Turk Acad Dermatol 6.1 (2012): 1261a1.
2-Kim, Soo-Byeong. "Laser acupuncture improves skin color deformation by cupping: A pilot study." Acupuncture
& Electro-Therapeutics Research 41.3-4 (2017): 155-169.
Dr. Tamer Shaban

13. Applications of the researches and knowledge regarding skin
changes during and after cupping :
 A tool that may led to discover the mechanism of action of cupping
therapy by studying the physiological body response to the
phenomenon.
 Developing a digital numerical analysis for color changes as studied
by (Kim, and Lee, 2014).
 Discover a new ways of treatment that accelerate complete
recovery and healing of these cupping spots as studied by ( Kim,
2017).
Application
Dr. Tamer Shaban
1- Kim, Soo-Byeong, and Yong-Heum Lee. "Numerical analysis of the change in skin color due to ecchymosis and
petechiae generated by cupping: a pilot study." Journal of acupuncture and meridian studies 7.6 (2014): 306-317.
2-Kim, Soo-Byeong. "Laser acupuncture improves skin color deformation by cupping: A pilot study." Acupuncture &
Electro-Therapeutics Research 41.3-4 (2017): 155-169.

14. Dr. Tamer Shaban
Thank You
Dr. Tamer Shaban