Hijama / Cupping Therapy

What is Hijama / Cupping Therapy?

Cupping therapy is a traditional therapy in which special cups are placed on the skin to create suction. The suction draws the skin and underlying tissues upward into the cup. It has been practised for thousands of years in many medical traditions around the world — including Ayurveda, Unani (where wet cupping is known as Hijama), Traditional Chinese Medicine and ancient Greek and Egyptian medicine. Today, it is widely used for musculoskeletal pain, muscle tension and as a wellness therapy.

In Ayurveda, cupping is related to Raktamokshana — therapeutic bloodletting — one of the classical methods of removing vitiated blood described by Acharya Sushruta. Sushruta describes Shringa (horn) as an instrument for drawing blood through suction, particularly for conditions involving Vata and Rakta. The horn was applied over small superficial incisions, and suction was created by the practitioner. Modern cupping uses sterile glass, plastic or silicone cups with mechanical pumps or controlled heat to create suction.

There are two main types of cupping. Dry cupping uses suction alone, without drawing blood. Wet cupping (Hijama) combines suction with tiny, superficial skin scratches or pricks so that a small quantity of blood is drawn into the cup. Both forms must be performed by trained practitioners with strict hygiene and sterile, single-use materials. At Manojivan, the type of cupping is chosen by the physician after evaluation.

How cupping is understood to work

From the Ayurvedic perspective, cupping and Raktamokshana help relieve local congestion and obstruction, pacify aggravated Vata causing pain, and remove vitiated Rakta (blood) and Pitta in certain conditions. This is believed to relieve pain, stiffness, heaviness and certain inflammatory conditions at the local level.

From a modern viewpoint, suction lifts and stretches the skin, fascia and muscles, increasing local blood flow and potentially reducing muscle tension. Researchers have proposed several mechanisms — changes in local circulation, effects on pain signalling and relaxation of soft tissues — and some studies report short-term pain relief in conditions such as neck and back pain. However, the overall quality of research is mixed, and more rigorous studies are needed. We describe cupping as a traditional therapy that may help some patients with pain, without overstating its benefits.

Types of cupping

Dry cupping

Cups are applied to the skin with suction and left in place for a few minutes. No incision is made. Suitable for many patients with muscle tension and pain.

Wet cupping (Hijama)

After a short period of dry cupping, the cup is removed, small superficial scratches or pricks are made on the skin with a sterile blade or lancet, and the cup is reapplied to draw a small amount of blood. The cup is removed, the area cleaned and dressed.

Moving (gliding) cupping

Oil is applied to the skin, and a cup with gentle suction is moved along the muscles — similar to a deep massage.

Fire cupping

Heat is used to create a vacuum in glass cups. This requires careful technique and is used selectively; mechanical pumps are often preferred for safety and control.

Who may benefit?

• Chronic neck and shoulder tension
• Upper and lower back pain
• Muscle stiffness and spasm
• Selected joint pains, as part of a plan
• Frozen shoulder and periarthritis, alongside other therapies
• Sciatica and nerve-related pain at specific points, after evaluation
• Tension-type headaches related to neck muscles
• Certain skin conditions involving Rakta and Pitta (wet cupping, selected cases)
• Sports-related muscle tightness and fatigue

Cupping is a complementary therapy for selected conditions. It does not replace medical diagnosis or treatment, and results vary.

Who should avoid cupping?

• Pregnant women (particularly over the abdomen and lower back)
• People with bleeding disorders, very low platelets, or on blood thinners (especially for wet cupping)
• Patients with anaemia or significant weakness (wet cupping)
• People with uncontrolled diabetes (poor wound healing)
• Skin infections, wounds, ulcers, burns, eczema or psoriasis at the site
• Varicose veins, deep vein thrombosis or over arteries
• Fever, acute illness or acute inflammation
• Recent fractures or over bony prominences
• Children and very elderly people, unless specifically advised
• People with pacemakers or severe heart disease, depending on assessment

Before the therapy

1. Assessment — the physician confirms the diagnosis, identifies the treatment areas and rules out contraindications.
2. Investigations — haemoglobin, blood sugar and bleeding tests may be advised, especially before wet cupping.
3. Informed consent — the procedure, expected marks and aftercare are explained.
4. Light meal — avoid coming on an empty stomach or immediately after a heavy meal; a light meal two to three hours before is ideal.
5. Hydration — drink adequate water beforehand.
6. Skin preparation — the area is cleaned with antiseptic.

The procedure

The patient lies or sits comfortably. For dry cupping, sterile cups are placed on the selected points, and suction is created using a manual pump or controlled heat. The skin rises into the cup. Cups remain in place for about 5–15 minutes, depending on the area and the patient’s tolerance, and are then gently released by breaking the seal.

For wet cupping (Hijama), after brief dry cupping, the cups are removed, the skin is cleaned again, and a few tiny, superficial scratches or pricks are made with a sterile, single-use blade or lancet. The cups are reapplied to draw a small quantity of blood. After a few minutes, the cups are removed, the area is cleaned, and a sterile dressing or soothing application is placed.

Throughout the procedure, the practitioner monitors the patient for dizziness, discomfort or excessive suction.

After the therapy

1. Rest — sit or lie down for a few minutes before getting up.
2. Hydration — drink warm water.
3. Keep the area clean and dry — avoid bathing the area for about 12–24 hours, or as advised, particularly after wet cupping.
4. Keep warm — avoid cold wind and cold water.
5. Light diet — eat light, warm food for the rest of the day.
6. Avoid — strenuous exercise, heavy lifting and alcohol on the day of therapy.
7. Watch for infection — redness, pus, increasing pain or fever need prompt attention.

About cupping marks

Cupping commonly leaves circular, red or purplish marks where the cups were applied. These are caused by suction drawing blood toward the skin surface and are usually painless. They typically fade within a few days to two weeks. They are not bruises from injury, though they may look similar. Wet cupping also leaves tiny scratch marks that heal within a few days.

Duration and number of sessions

A cupping session usually takes about 30–45 minutes, including preparation and aftercare. Dry cupping may be repeated weekly or as advised. Wet cupping sessions are usually spaced several weeks apart. The number of sessions depends on the condition and response.

What does it feel like?

During dry cupping, patients feel a tight, pulling sensation as the skin is drawn into the cup. Most find this tolerable and some find it relaxing. During wet cupping, the tiny scratches cause brief, mild stinging. Afterwards, the area may feel tender, warm or light. Some people feel relaxed or slightly tired. Dizziness is uncommon but possible, especially if the patient is anxious, hungry or dehydrated.

Cupping in specific conditions

Neck and shoulder pain

Cupping over the upper back and shoulder muscles may relieve tension, often combined with Greeva Basti, Abhyanga and posture correction.

Back pain

Cupping over the lower back muscles may complement Kati Basti, exercise and other therapies for chronic back pain.

Frozen shoulder

Cupping around the shoulder may support pain relief alongside Abhyanga, Swedana and shoulder exercises.

Sports-related muscle tightness

Moving cupping with oil may relieve muscle tightness after training, in combination with stretching and rest.

Hygiene and safety

Because wet cupping involves breaking the skin, infection control is essential. At Manojivan, we use sterile, single-use blades and lancets, disinfected or single-use cups, gloves and appropriate biomedical waste disposal. Practitioners follow strict hygiene protocols. Never undergo wet cupping in settings that do not follow sterile procedures.

Hijama at Manojivan

At Manojivan Ayurvedic Hospital, cupping therapy is performed by trained practitioners under physician supervision, after evaluation and informed consent. We choose dry or wet cupping based on the condition and the patient’s health, and provide clear aftercare guidance.

Cupping in Ayurveda: Shringa and Alabu

Sushruta describes two suction instruments for Raktamokshana: Shringa (animal horn) and Alabu (bottle gourd). Shringa was traditionally used for conditions with Vata predominance, while Alabu, in which a flame created suction, was used for Kapha predominance. These classical methods form the Ayurvedic background of modern cupping. Today’s sterile cups and pumps provide better control and hygiene.

Special considerations

• Diabetes: good control is essential, particularly for wet cupping.
• Older adults: gentle suction, fewer cups and careful skin assessment.
• Anaemia: wet cupping is avoided.
• Blood thinners: inform your doctor; wet cupping may be unsuitable.
• Sensitive skin: suction strength and duration are reduced.

What research says about cupping

Cupping has been studied more widely in recent years. Some reviews report short-term reductions in neck and back pain compared with no treatment, but many studies are small, of variable quality and difficult to blind, so firm conclusions are limited. Claims that cupping cures serious diseases or removes all toxins are not supported by evidence. We offer cupping as a complementary therapy for selected pain and muscle conditions, combined with exercise and other care.

Questions to ask before cupping

• Is dry or wet cupping more suitable for me?
• How many sessions are planned?
• Do I need any blood tests beforehand?
• How long will the marks last?
• What aftercare should I follow?

Common myths and facts

• Myth: Cupping marks are injuries. Fact: They result from suction and usually fade within days.
• Myth: Wet cupping removes “all toxins”. Fact: It is a traditional therapy for specific conditions; claims of removing all toxins are not supported.
• Myth: Cupping is suitable for everyone. Fact: There are important contraindications, especially for wet cupping.
• Myth: More cups and stronger suction work better. Fact: Suction and number of cups are adjusted to the person and condition.

Frequently asked questions

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