Cupping Therapy: Those Circles Explained
Why athletes, celebrities, and millions of Chinese have been leaving circular marks on their skin for 2,000 years.
⚡ Quick Take
- Cupping creates suction on the skin, drawing blood to the surface and promoting circulation.
- The circular marks are not bruises —they are pooled blood that typically fades in 3–5 days.
- Evidence supports cupping for chronic neck and back pain, though the mechanism remains debated.
Table of Contents
In 2016, Michael Phelps walked onto the Olympic pool deck with dark purple circles on his shoulders and back. Within 48 hours, cupping therapy went from an obscure TCM practice to a global wellness trend. Gwyneth Paltrow did it. Jennifer Aniston did it. Your neighbor probably did it.
But cupping is not new. It is at least 2,000 years old, documented in the Han Dynasty medical text Prescriptions for Fifty-Two Diseases. This guide explains what cupping actually does, what those marks mean, and whether it works.
How Cupping Works
Cupping involves placing a heated glass or plastic cup on the skin, creating a vacuum that pulls the skin and superficial muscle layer upward into the cup. The suction:
- Dilates blood vessels in the treated area
- Increases local blood flow, bringing oxygen and nutrients to tissues
- Stimulates the immune system through mild trauma to the skin
- Releases fascial tension between muscle layers
Types of Cupping
| Type | Method | Marks | Intensity |
|---|---|---|---|
| Dry cupping | Suction only; cups left in place 5–15 min | Dark circles | Moderate |
| Moving cupping | Oil applied; cups slid across muscle | Streaks, lighter | Mild |
| Wet cupping (Hijama) | Small skin incisions before suction | Blood drawn | Strong |
| Flash cupping | Cups applied and removed repeatedly | Minimal | Very mild |
Wet cupping is common in Middle Eastern medicine but rare in modern Chinese clinics. The Olympic athletes used dry cupping.
What the Marks Mean
The circular marks are the most visible (and most misunderstood) aspect of cupping. They are not bruises in the traditional sense.
| Mark Color | Interpretation |
|---|---|
| Light pink | Healthy circulation; minimal stagnation |
| Dark red | Moderate stagnation; common in sedentary people |
| Purple/black | Significant stagnation; often seen in chronic pain patients |
| No mark | Either very healthy circulation or insufficient suction |
In TCM theory, dark marks indicate “stagnant blood” —poor circulation and accumulated metabolic waste in the tissues. The cupping draws this stagnation to the surface, where the body can clear it.
Western medicine offers a different explanation: the suction causes capillaries to rupture, creating localized petechiae (small hemorrhages). The body then initiates a healing response, increasing blood flow and immune activity in the area.
Both explanations may describe the same phenomenon from different angles.
The Evidence
Cupping has been studied more extensively than many TCM modalities, though the overall quality of research remains mixed.
| Condition | Evidence Level | Key Finding |
|---|---|---|
| Chronic neck pain | Moderate | Significant pain reduction vs. no treatment |
| Chronic back pain | Moderate | Comparable to standard care |
| Knee osteoarthritis | Low-moderate | May reduce pain and stiffness |
| Herpes zoster (shingles) | Moderate | May reduce pain and healing time |
| Facial paralysis | Low | Some benefit when combined with acupuncture |
| General wellness | Insufficient | No high-quality evidence for non-specific benefits |
A 2015 systematic review in the Journal of Traditional Chinese Medical Sciences concluded that cupping shows promise for pain conditions but called for larger, better-designed trials.
What to Expect in a Session
- Assessment —The practitioner identifies areas of tension or pain
- Preparation —Skin is cleaned; oil may be applied for moving cupping
- Application —Cups are heated (glass) or pumped (plastic) and placed on the skin
- Duration —5–15 minutes, depending on the condition and the patient’s tolerance
- Removal —The suction is released; the practitioner may massage the area
- Aftercare —The patient is advised to keep the area warm and avoid cold exposure for 24 hours
The sensation is unusual but not painful —a tight pulling feeling that becomes more comfortable as the muscles relax.
Risks and Contraindications
Safe for most people, but avoid if:
- Pregnant (especially on the abdomen and lower back)
- Taking blood-thinning medication
- Have bleeding disorders
- Have skin conditions (eczema, psoriasis) in the treatment area
- Have open wounds or recent surgical scars
Common side effects:
- Circular marks (3–5 days)
- Mild soreness (1–2 days)
- Rare: blistering if cups are left too long
DIY Cupping: Should You?
Silicone cupping sets are widely available online for $10–30. They are safe for basic use if you follow guidelines:
- Never cup over spine, neck front, or major joints
- Start with 5 minutes —do not leave cups for extended periods
- Use moving cupping on large muscle groups (thighs, back)
- Stop if you feel sharp pain —suction should feel like pressure, not pain
That said, professional assessment adds value. A trained practitioner can identify the precise points and muscle groups that will benefit most from treatment.
Related Questions
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