Fire Cupping Therapy: What It Is, How It Works, and What the Research Shows

What it is A session History Evidence How it may work Marks and safety Who should skip it Who can perform it FAQ Sources

Fire cupping is a Traditional Chinese Medicine technique in which a practitioner warms the air inside a glass cup with a brief flame and sets the cup on the skin, where the cooling air contracts and draws the skin and the tissue beneath it up into the cup. The cups stay on for several minutes, and the round marks they leave behind generally fade within about a week.

I am a certified clinical herbalist and completed formal training in fire cupping in 2020, so I know the technique from the practitioner's side of the table as well as from the literature. I do not offer it to clients, because in Montana and most other states cupping falls under the acupuncture or massage therapy license, neither of which I hold, and that is covered in its own section below. In this article I walk through what happens during a session, where the technique comes from, and what the controlled trials and meta-analyses published so far have found. The research is thinner than most practitioners let on, so I have labeled each section by how strong the supporting evidence is.

Key takeaways

• Fire cupping creates suction by cooling heated air inside a glass cup, and because nothing breaks the skin it counts as a form of dry cupping.
• Meta-analyses of randomized trials report lower pain scores for chronic neck pain and low back pain, mostly in trials that compared cupping against no treatment or usual care.
• When cupping is measured against a sham procedure the difference narrows, and in at least one well-designed trial it disappeared entirely.
• Reviewers rate the overall evidence as low to moderate quality, with no high-quality evidence for any pain outcome yet.
• The marks are an expected part of the treatment rather than bruises from impact, and the most common preventable injury from the fire method is a burn caused by poor technique.
• Wet cupping, which breaks the skin, carries an infection risk that properly performed dry and fire cupping do not, and it is rarely offered in Western acupuncture or TCM clinics.
• In the US there is no cupping license. The technique is legally performed under an existing license, most often acupuncture or massage therapy, and the rules vary by state.

This article is for education only and is not medical or legal advice. Cupping should be performed by a practitioner licensed to do so in your state. Talk with a qualified healthcare provider before trying cupping, especially if you take blood thinners, have a bleeding disorder, are pregnant, or have a skin condition in the area you want treated.

What is fire cupping?

Evidence: descriptive. Definitions from published clinical reviews.

Cupping is any therapy that applies suction to the skin through a cup, and the suction can come from a hand pump, a mechanical device, or heat. With the fire method, the practitioner holds a flame inside a glass cup for a moment, pulls it out, and immediately places the cup on the skin, where the warmed air cools and contracts and lifts the skin into the cup. The flame itself never comes near the body, which surprises people who have only seen the name.⁸

Published reviews divide cupping into two broad families. Dry cupping relies on suction alone, while wet cupping adds a few shallow cuts to the skin before the cup goes on so that a small amount of blood is drawn out with it.⁶ Wet cupping is still common in the Middle East and parts of East Asia, where it goes by names like hijama, but in the West it is rarely offered outside of clinics that specialize in it, partly because breaking the skin brings infection risk and liability that most licensed acupuncturists and bodyworkers would rather avoid. Fire cupping belongs to the dry family, which is what you will encounter in nearly every Western clinic, and within it the cups can be left in one place for a set time, slid across oiled skin, or applied and lifted in quick succession depending on what the practitioner is trying to do.

The change in the skin is visible within seconds. The area inside the cup reddens and may deepen to purple as the small vessels near the surface expand and, in some spots, leak into the surrounding tissue, which researchers describe simply as an increase in local blood flow.⁸

What happens in a fire cupping session

Evidence: practitioner description. Reflects standard training rather than a clinical trial protocol.

A session starts with a conversation about why you have come in and whether anything in your history would make cupping a poor choice that day. From there the practitioner picks the locations, which are most often along the back, across the shoulders, or down the thighs, and may apply a light oil if the cups are going to be moved rather than left in place.

Placing each cup takes only a few seconds. The heat comes from a cotton ball soaked in alcohol, gripped in forceps, lit, swept through the inside of the cup, and withdrawn before the cup touches you. What you feel is a firm pull as the tissue rises, and most people describe it as pressure rather than pain, so if a cup does hurt you should say so right away rather than waiting it out.

Cups usually stay on somewhere between five and fifteen minutes depending on the goal, the location, and how your skin is responding, which is in line with the session lengths used in the trials reviewed below.¹ When it is time to take a cup off, the practitioner presses the skin next to the rim to let air in and break the seal, since pulling straight up would be uncomfortable and unnecessary.

You will leave with round marks where the cups sat, and the area may feel warm and a little tender for the rest of the day. The usual advice is to keep the treated area covered and warm, and to hold off on hot baths, cold exposure, and hard exercise for a few hours afterward.

Where fire cupping comes from

Evidence: historical record. Based on a published narrative review of primary texts.

Cupping is older than Traditional Chinese Medicine as an organized system. A 2017 narrative review of the historical literature traces documented use back to the Egyptian Ebers Papyrus, dated to around 1550 BCE, and finds independent traditions in ancient Greek, Persian, Arabic, and Chinese medicine.⁹ The earliest cups were made of animal horn and bamboo, and glass arrived much later, which is what made the fire method practical, because glass tolerates the heat and lets the practitioner watch what the skin is doing.

In the Chinese tradition, cupping is understood to move what practitioners call stagnant Qi and blood, to draw cold and dampness out of the body, and to release tension held in the muscles. Those are explanatory terms from a traditional framework rather than quantities anyone has measured, and the reviews cited in this article treat them that way.⁹ The practice is still in routine clinical use across East Asia, the Middle East, and parts of Europe, and it reached a much wider Western audience after Olympic athletes showed up with cupping marks at the 2016 games in Rio.¹⁰

What the research shows

Evidence: low to moderate. Multiple meta-analyses of randomized trials, most with a high risk of bias.

The clinical literature on cupping has grown considerably since I first wrote this article. In 2011 a systematic review could find only seven randomized trials of cupping for pain, but by 2020 a meta-analysis in the Journal of Pain was able to pool trials across several chronic pain conditions, and by 2023 an evidence-mapping study had fourteen separate meta-analyses to grade.⁴⁷ The amount of evidence has improved a great deal more than its quality has, which is the theme of everything that follows.

Low back pain

The two trials I cited in the original version of this article are still worth knowing. In the first, researchers at Shiraz University of Medical Sciences in Iran randomized 100 first-time mothers with postpartum low back pain to either dry cupping at the acupuncture point BL23 or no treatment at all, with cupping applied for 15 to 20 minutes across four sessions. On a 0 to 10 scale, average pain in the cupping group fell from 7.8 before treatment to a lower score at every follow-up through two weeks, and the authors concluded that cupping was effective for this kind of pain.¹ Because the control group received nothing, though, the trial cannot tell us how much of that improvement came from the cups and how much came from being treated at all.

The second trial, run out of a medical clinic in Kermanshah, Iran, randomized 98 adults with nonspecific low back pain to three sessions of wet cupping or to usual care from their family doctor. Three months later the wet cupping group reported lower pain intensity, less pain-related disability, and lower medication use than the usual care group.² Two caveats apply here as well: this trial used wet cupping rather than the fire method, and once again the comparison was usual care rather than a sham procedure.

A 2020 meta-analysis that looked only at dry cupping, the family fire cupping belongs to, pooled 21 randomized trials with 1,049 participants across a range of musculoskeletal conditions. The authors found low-quality evidence that dry cupping reduced pain in both chronic neck pain and low back pain, by roughly 20 points on a 100-point scale in each case, along with moderate-quality evidence that it improved function in chronic neck pain, and they were direct in saying that no definitive conclusion about effectiveness or safety could be drawn from what exists.⁵

Neck pain

Neck pain has more trial data behind it than any other single condition. A 2018 meta-analysis in BMJ Open pooled 18 randomized trials and reported that cupping reduced pain and improved function compared with the control conditions, while acknowledging that the included studies were small and methodologically weak.⁶ When the 2023 evidence map graded the neck pain literature, it came out as two moderate-quality findings, four low-quality findings, and two very low-quality ones.⁷

What the sham comparisons show

The most useful trial on this question comes from the University of Duisburg-Essen in Germany, where researchers randomized 141 patients with fibromyalgia to five sessions of cupping on the back, five sessions of sham cupping using a device that produced only weak suction, or usual care. At day 18, the patients who received real cupping reported meaningfully less pain than those on usual care, but they did not report less pain than the sham group, and the authors concluded that no recommendation for cupping in fibromyalgia could be made on that basis.³

That pattern, in which cupping beats doing nothing but cannot clearly beat a convincing placebo, shows up across the literature. The 2020 Journal of Pain meta-analysis found that dry, wet, and pulsating cupping were each better than no treatment for pain and disability, yet described the evidence as limited by clinical heterogeneity and risk of bias and asked for high-quality trials before anyone draws firm conclusions.⁴ The 2023 evidence map, after grading fourteen meta-analyses, found no high-quality evidence for any pain outcome at all.⁷

My reading of all this is that cupping reliably produces reported pain relief in trials, that a portion of that relief is likely coming from expectation and attention, and that whether the suction adds something on top of that is a question the research has not yet answered.

How cupping may work

Evidence: theoretical. Proposed mechanisms from a literature review, not confirmed by controlled studies.

A 2019 review in the Journal of Traditional and Complementary Medicine went through 64 studies and pulled out six proposed explanations for what cupping does.⁸ The pain-gate theory suggests that the strong sensory input from suction competes with pain signals on their way to the brain, and a related idea called diffuse noxious inhibitory control rests on the observation that one uncomfortable stimulus can reduce the perception of another. A third theory proposes that cupping stimulates reflex zones connected to the internal organs, and the remaining three involve nitric oxide release and local blood flow, changes in immune signaling, and, for wet cupping only, the removal of substances from the blood.

None of the six has been tested in a way that would confirm it, and the reviewers said as much, writing that the benefits of cupping need to be substantiated by large randomized trials and that basic research is needed to check the theories themselves. What is well documented is the local effect, which is that suction increases blood flow in the treated skin and tissue in a way you can see as reddening within seconds.⁸ Whether that surface change does anything for the deeper tissue people are usually hoping to reach is still an open question.

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Cupping marks and safety

Evidence: moderate for common side effects (systematic reviews of adverse events); case reports for rare serious events.

The marks are the most visible part of cupping and the part people misunderstand most often. They are not bruises in the sense of an injury from impact. The suction pulls blood into the small vessels near the surface, some of it leaks into the surrounding tissue, and that shows through the skin as a pink, red, or purple circle, with a darker color reflecting more leakage rather than more damage. Reviews of adverse events list the marks, along with short-lived redness and swelling, as expected effects of the treatment rather than complications of it, and they fade on their own over roughly a week.¹¹

Two adverse-event reviews fill in the rest of the picture. A systematic review of Korean studies found that most reported events were mild to moderate, with scarring the most common and burns close behind.¹¹ A 2023 review of cupping in musculoskeletal and sports rehabilitation went through 22 trials and listed what those trials reported: hematoma at the cup site, muscle soreness lasting a day or two, temporary increases in pain, brief headaches, tingling, dizziness, and minor burns.¹⁰

Burns deserve their own paragraph because they are the one risk that belongs to the fire method specifically. They happen when alcohol drips from the swab onto the skin, when the rim of the cup gets overheated, or when a cup goes on too soon after the flame, and every one of those is a technique error rather than an inherent risk of the therapy. A properly trained practitioner heats the air inside the cup rather than the glass itself and never lets the swab drip, so if you notice someone heating the rim or working over your body with an open flame, you have a good reason to end the session there.

Wet cupping is a different matter, because breaking the skin gives bacteria a way in. You are unlikely to be offered it in a Western acupuncture or TCM clinic, where the infection risk and the liability that comes with it have pushed most licensed practitioners toward dry methods only, but it remains in routine use in the Middle East and East Asia and is available in the West through clinics that specialize in it. A 2023 case report from Peking Union Medical College Hospital described a 33-year-old woman with a healthy immune system who developed a disseminated Staphylococcus aureus infection after wet cupping, complete with an abscess, liver and kidney injury, and internal bleeding, and who recovered only after a course of targeted antibiotics. The authors reviewed the other published infections following cupping and recommended strict hygiene standards for anyone who performs the wet version.¹² Fire cupping done correctly leaves the skin intact and does not carry this risk.

Who should skip cupping

Evidence: clinical consensus. Standard exclusions used across the trials and reviews cited here.

The trials in this article excluded certain groups of people, and those exclusions make a sensible guide for anyone deciding whether to try it. Cupping is generally avoided by people on anticoagulant medication or with a bleeding disorder, since the suction is drawing blood into the tissue by design, and it is not applied over broken skin, active rashes, sunburn, open wounds, varicose veins, or areas of recent injury or surgery. Pregnant women are typically not cupped on the abdomen or lower back, and anyone with a fever, an active infection, or a history of deep vein thrombosis is usually told to wait.¹³

None of that makes cupping dangerous for the average healthy adult, and the evidence reviewed above points the other way. What it does mean is that a practitioner who skips the questions about medications, bleeding history, and pregnancy before placing the first cup is leaving out a step that every clinical trial cited here treated as mandatory.

Who is allowed to perform fire cupping in the US

Evidence: statutory. Based on state practice acts; rules differ by state and this is not legal advice.

There is no such thing as a cupping license in the United States. No state issues one, and no federal body regulates the practice. Instead, cupping is treated as a technique that belongs inside an existing license, and the question of who may do it comes down to whose practice act covers it in your state.¹⁶

Licensed acupuncturists are the clearest case. California's acupuncture statute defines the practice to include cupping by name, and Massachusetts lists it among the methods an acupuncturist may use.¹³ Montana's act does not use the word, but it defines acupuncture to include thermal stimulation of points on the body along with adjunctive therapies based on traditional oriental medical theory as taught in accredited acupuncture programs, which is where cupping sits in every accredited curriculum, and it prohibits anyone without an acupuncture license from practicing under that definition.¹⁴ If you want fire cupping specifically, with the glass cups and the flame, a licensed acupuncturist is the practitioner most likely to have been trained in it.

Licensed massage therapists are the second group, and here the rules vary more. Montana's massage therapy act covers structured touch and pressure applied to soft tissue, including through hand-held tools that mimic or support the action of the hands, and it requires a license to practice under that definition.¹⁵ Suction cups fit the hand-held tool language, and many state massage boards treat dry cupping with pump or silicone cups as within scope, though some require documented training first and the fire method in particular is less common in massage settings. Physical therapists and chiropractors perform dry cupping in a number of states under their own practice acts, again with state-by-state differences.

Where that leaves someone like me is the honest part of this section. I am a certified clinical herbalist, and I completed a fire cupping training program, but certification in herbalism is not a state license and no herbalist license exists in the US. Putting cups on another person for pain relief in Montana falls under either the acupuncture act or the massage therapy act, so I do not offer cupping to clients, and I would be wary of anyone without one of those licenses who does. Training tells you a practitioner knows the technique. A license tells you the state has a board that can act if something goes wrong. Before you book, ask which license the practitioner holds and confirm it with your state's licensing board, most of which have a public lookup tool.

Frequently asked questions

Does fire cupping hurt?

Most people feel a firm pulling or pressure rather than pain, with some tightness while the cups are on and tenderness afterward. Sharp or burning pain during a session is not normal and is worth telling the practitioner about immediately.

How long do cupping marks last?

The marks usually fade within about a week, though darker ones can take somewhat longer. They come from blood drawn into the tissue near the surface rather than from bruising caused by impact.¹¹

Does cupping work for back pain?

Randomized trials report lower pain scores compared with no treatment or usual care, and meta-analyses pool those findings into low to moderate quality evidence of benefit.⁵ When cupping is compared with a sham procedure the advantage shrinks, and reviewers have yet to find high-quality evidence for any pain outcome.⁷

What is the difference between fire cupping and dry cupping?

Fire cupping is one kind of dry cupping. Dry cupping covers any method that creates suction without breaking the skin, whether the suction comes from heat, a hand pump, or a machine, and fire cupping is the version that uses heated air inside a glass cup.⁶

Is fire cupping safe?

Reviews of adverse events find that most side effects are mild, mainly marks, soreness, brief headaches, and occasional minor burns that trace back to technique errors with the flame.¹⁰ Serious infections have been reported after wet cupping, which breaks the skin, but not after properly performed dry cupping.¹²

Can anyone do cupping, or does it require a license?

In the US, cupping on another person is performed under an existing license, most often acupuncture or massage therapy, and the specifics depend on your state's practice acts.¹⁴ There is no separate cupping license, and a certificate from a cupping course is not a license on its own.

How often can you get cupping?

The trials in this article used schedules ranging from every other day for four sessions to twice a week for five sessions.¹³ In practice, most practitioners wait for the previous marks to fade before cupping the same area again.

Sources

1. Akbarzadeh M, Ghaemmaghami M, Yazdanpanahi Z, Zare N, Azizi A, Mohagheghzadeh A. The effect dry cupping therapy at acupoint BL23 on the intensity of postpartum low back pain in primiparous women based on two types of questionnaires, 2012; a randomized clinical trial. International Journal of Community Based Nursing and Midwifery. 2014;2(2):112-120. Conducted at Shiraz University of Medical Sciences, a public university; no industry funding reported. ↩
2. Farhadi K, Schwebel DC, Saeb M, Choubsaz M, Mohammadi R, Ahmadi A. The effectiveness of wet-cupping for nonspecific low back pain in Iran: a randomized controlled trial. Complementary Therapies in Medicine. 2009;17(1):9-15. ↩
3. Lauche R, Spitzer J, Schwahn B, et al. Efficacy of cupping therapy in patients with the fibromyalgia syndrome: a randomised placebo controlled trial. Scientific Reports. 2016;6:37316. Disclosure: cupping equipment and sham devices were provided by Pneumed GmbH, a cupping device manufacturer. ↩
4. Cramer H, Klose P, Teut M, et al. Cupping for patients with chronic pain: a systematic review and meta-analysis. The Journal of Pain. 2020;21(9-10):943-956. ↩
5. Wood S, Fryer G, Tan LLF, Cleary C. Dry cupping for musculoskeletal pain and range of motion: a systematic review and meta-analysis. Journal of Bodywork and Movement Therapies. 2020;24(4):503-518. ↩
6. Kim S, Lee SH, Kim MR, et al. Is cupping therapy effective in patients with neck pain? A systematic review and meta-analysis. BMJ Open. 2018;8(11):e021070. Authors are affiliated with Jaseng Hospital of Korean Medicine, a clinical provider of cupping. ↩
7. Wang L, Cai Z, Li X, Zhu A. Efficacy of cupping therapy on pain outcomes: an evidence-mapping study. Frontiers in Neurology. 2023;14:1266712. ↩
8. Al-Bedah AMN, Elsubai IS, Qureshi NA, et al. The medical perspective of cupping therapy: effects and mechanisms of action. Journal of Traditional and Complementary Medicine. 2019;9(2):90-97. Authors are staff of the National Center for Complementary and Alternative Medicine, Saudi Ministry of Health, which licenses cupping practitioners. ↩
9. Qureshi NA, Ali GI, Abushanab TS, et al. History of cupping (Hijama): a narrative review of literature. Journal of Integrative Medicine. 2017;15(3):172-181. Same institutional affiliation as source 8. ↩
10. Mohamed AA, Zhang X, Jan YK. Evidence-based and adverse-effects analyses of cupping therapy in musculoskeletal and sports rehabilitation: a systematic and evidence-based review. Journal of Back and Musculoskeletal Rehabilitation. 2023;36(1):3-19. ↩
11. Kim TH, Kim KH, Choi JY, Lee MS. Adverse events related to cupping therapy in studies conducted in Korea: a systematic review. European Journal of Integrative Medicine. 2014;6(4):434-440. ↩
12. Wang YY, Fan HW, Huang XM, Jiao Y. Disseminated Staphylococcus aureus infection after scarification wet cupping therapy: a case report and literature review. BMC Complementary Medicine and Therapies. 2023;23:94. ↩
13. California Acupuncture Board. Laws and regulations relating to the practice of acupuncture, Business and Professions Code section 4927 (definition of acupuncture includes cupping); Massachusetts 243 CMR 5.00, The practice of acupuncture (permitted methods include cupping). ↩
14. Montana Code Annotated 2025, 37-13-103, Acupuncture Practice Act, definitions. ↩
15. Montana Code Annotated 2025, 37-33-403, Massage Therapy, definitions, and 37-33-501, license required. ↩
16. Sheikh AA, et al. The need to develop a regulatory body for the practice of Al-Hijama. 2018. PubMed 30136772. Notes that wet cupping is subject to statutory regulation in no Western country. ↩