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Cupping and moxibustion

Cupping (suction cups on the skin) and moxibustion (burning the herb moxa on or near the skin) are practices from traditional Chinese medicine, which explains them in terms of qi flow and the meridian system. In trials, cupping was followed by short-term lower pain scores in adults with chronic pain compared with no treatment, but not clearly compared with sham cupping, and the trials carry a high risk of bias. A Cochrane review found moderate-certainty evidence that adding moxibustion to usual care probably reduces the chance of a baby being in non-cephalic presentation at birth for women with a breech-presenting pregnancy. Both practices have documented adverse effects, including burns, skin injury and infection.

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Evidence retrieved up to

What the research shows

In randomised trials of adults with chronic pain, cupping was followed by lower short-term pain scores than no treatment, but the difference compared with sham cupping was small and not statistically significant; cupping may help people living well with chronic pain, though the trials are at high risk of bias.

Low certaintyFurther research is likely to change this.
Take care: see the safety noteBenefit

Who this is about

adults with chronic pain, mainly chronic musculoskeletal pain

Practical note

Graded low: the 2020 meta-analysis pooled 18 trials with 1172 participants, most limited by risk of bias and clinical heterogeneity, and the 2025 meta-analysis found very high heterogeneity (I2 94%); patients cannot easily be blinded, and the sham comparison did not reach significance. The 2025 review found no clear improvement in functional disability.

Safety note

Adverse events were more frequent with cupping than with no treatment. Reported side effects include persistent skin discoloration, scars, burns and infections. People living with chronic pain may wish to discuss cupping with their health care provider.

Sources

In randomised trials of pregnant women whose baby was in breech presentation, adding moxibustion at the acupoint BL67 to usual care probably reduced the chance of the baby being in a non-cephalic presentation at birth, with little to no difference in the rate of caesarean section.

Moderate certaintyFurther research may change the size of the effect.
Take care: see the safety noteBenefit

Who this is about

pregnant women with a singleton breech presentation

Practical note

The Cochrane review included 13 trials with 2181 women; the presentation-at-birth result came from 7 trials and 1152 women (risk ratio 0.87, 95% CI 0.78 to 0.99). Moxibustion was applied at BL67, at the tip of the fifth toe.

Safety note

Adverse events were inadequately reported in most trials; one trial reported nausea, unpleasant odour, abdominal pain and uterine contractions with moxibustion. Case reports of moxibustion in pregnancy include premature birth and fetal distress. Moxibustion in pregnancy is something to discuss with the maternity care team.

Sources

Cupping and moxibustion have documented adverse effects, most often burns, skin discoloration or scarring, allergic reactions and infections, including bloodborne infections spread by unsterilised cupping equipment; how often these occur is not known.

Low certaintyFurther research is likely to change this.
Take care: see the safety noteRisk

Who this is about

adults receiving cupping or moxibustion

Practical note

Graded low: the evidence comes mainly from case reports, observational studies and trial adverse-event reports, which show that these harms occur but not how often; in a 2020 meta-analysis of chronic-pain trials, adverse events were more frequent with cupping than with no treatment.

Safety note

Reported risks depend on technique: the position, duration and distance between moxa and skin, the practitioner's skill, the smoke, and whether cupping equipment is sterilised between people. Rare severe events after cupping include bleeding inside the skull and anaemia from repeated wet cupping. Choosing a trained practitioner who uses sterile or single-use equipment reduces these risks.

Sources

What the tradition holds

Traditional Chinese medicine uses cupping, in which suction is created in glass, ceramic, bamboo or plastic cups placed on the skin, and holds that it works by restoring the flow of qi; the practice is also used in Middle Eastern traditional medicine.

Take care: see the safety noteUnclear

Who this is about

adults using traditional Chinese or Middle Eastern medicine practices

The tradition's frame

TCM

In traditional Chinese medicine, cupping is held to correct imbalances in the body and restore the flow of qi; suction from a heated cup is said to mobilise blood flow.

Practical note

Dry cupping uses suction only; wet cupping pierces the skin so that blood flows into the cup.

Vegan note

Cupping uses no animal-derived materials in its usual glass, plastic or silicone forms.

Safety note

Cupping leaves temporary marks and can cause persistent skin discoloration, scars, burns and infections, and may worsen eczema or psoriasis; reused equipment that is not sterilised between people can spread bloodborne infections such as hepatitis B and C.

Sources

Traditional Chinese medicine uses moxibustion, the heat of burning moxa applied to acupoints either directly on the skin or at a distance, and holds that it acts through the meridian system.

Take care: see the safety noteUnclear

Who this is about

adults using traditional Chinese medicine practices

The tradition's frame

TCM

Traditional Chinese medicine theory holds that moxibustion has a dual effect, tonification and purgation, acting through the meridian system and through the moxa and the fire.

Practical note

In direct moxibustion a moxa cone is placed on the skin and lit; in indirect moxibustion the moxa is kept at a distance from the skin.

Vegan note

Moxa is burned plant material; some indirect methods place garlic, ginger or salt between the moxa and the skin.

Safety note

Reported adverse events of moxibustion include burns, allergic reactions and infections; the distance between the moxa and the skin, the duration, the practitioner's skill and the smoke all affect safety.

Sources