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CONTRAINDICATIONS AND INDICATIONS As with all therapies, it's important to understand the circumstances under which cupping should be avoided. Cupping therapy is not advised for persons with a bleeding tendency, cancer, edema, high fever, infection, sensitive skin, spasms, twitching, or ulcers. It should also not be applied over the abdominal or sacral regions of pregnant women. Cupping therapy is effective for shoulder and back pains, joint pains, soft-tissue injuries, and several internal conditions. The typical sites for treatment of shoulder and back pains include points on the bladder, conception (ren), gall bladder, governing (du), large intestine, small intestine, sanjiao, spleen, and "extraordinary head-neck" meridians. These specific points are dazhu (BL11), fengmen (BL12), geshu (BL17), ganshu (BL18), shenshu (BL23), ciliao (BL32), weizhong (BL40), qihai (CV6), fengchi (GB20), jianjing (GB21), yaoyangguan (GV3), dazhui (GV14), quchi (LI11), binao (LI14), jianyu (LI15), jianzhen (SI9), tianzong (SI11), jianwaishu (SI14), waiguan (SJ5), sanyinjiao (SP6), and bailao (Ex-HN15). The courses of these meridians are in the posterior body and anterior arms, so cups should be applied on these areas of the body. The typical sites for treatment of internal conditions such as constipation or abdominal bloating include points on the bladder, conception (ren), governing (du), kidney, spleen, stomach, and "extraordinary back" meridians. These specific points are geshu (BL17), pishu (BL20), weishu (BL21), zhonglushu (BL29), ciliao (BL32), guanyuan (CV4), qihai (CV6), dazhui (GV14), dahe (KI12), sanyinjiao (SP6), diji (SP8), C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 59 Resources "Bahuoguan." Accessed June 2016. www.baike.com. Chirali, Ilkay Zihni. Traditional Chinese Medicine: Cupping Therapy, 3rd ed. (Churchill Livingstone, 2007). Wong, Samuel. Becoming a Massage Therapist at Age 70 (XLIBRIS, 2015): 190–91. Client Take-Home Instructions When sending your cupping client home after a session, be sure to offer these home-care tips: • Keep yourself warm. Don't be exposed to cold air. • Don't take a bath or shower immediately after treatment. • Don't vigorously rub the treatment area. • If the skin marking is colored dark red or purple-black, but there are no spotted bruises and it's not warm to the touch, the client's internal condition has stagnated blood. • If the skin marking has no change of color and is not warm to touch, the client's internal condition is "cold" and yang-deficient. • If the skin marking is itchy or wrinkled, the client's internal condition is cold and gaseous. CONCLUSION The mechanics of cupping are relatively simple. Although the theoretical basis of cupping therapy revolves around meridians and pressure points, its application can be adapted according to Western understanding of human anatomy and physiology— knowledge that therapists have acquired in their initial training and refined in their clinical practices. Cupping therapy, especially using vacuum cups, can be an invaluable tool for massage and bodywork therapists, and it can be learned in a short time, ideally in a workshop under the supervision of a cupping expert. Samuel Wong is a research massage therapist based in Northern Virginia. Trained in Western massage, Wong is also a practitioner of tui na and trained in China. His research focus is using massage to treat fibromyalgia. Reach him at drsamwong39@gmail.com. guilai (ST29), zusanli (ST36), and shiqizhui (Ex-B7). The courses of these meridians are in the anterior lower abdomen, posterior lower- and mid-back, and medial legs. CUPPING AT WORK Cupping is a technique that can be easily combined with other hands-on modalities. Here is a brief overview of what cupping looks like to the practitioner. To begin, lightly lubricate your hands and glide over the areas of pain or discomfort on your client to feel for muscular adhesion and tightness (stagnated blood or fluid). Then, lubricate the problem area liberally. Place a vacuum cup over the area and extract air pressure from the cup with a suction gun. Adjust suction according to the client's condition and reaction. Use two or three cups along the same meridian, as needed. Remove the cups after 10–15 minutes. Apply effleurage or petrissage strokes to the distal segment of the meridian while the cups are on the skin. Wipe off lubrication after the cups are removed, and sanitize the cups using Standard Universal Precautions. INTERPRETING THE RESULTS After removing the cups, you can further discern the client's condition by evaluating what you see. • If the skin marking appears moist and water-filled, the client's internal condition is "damp" and yang-deficient. • If the skin marking is colored dark red or purple-black, is filled with spotted bruises, and is warm to the touch, the client's internal condition is "overheated" and yang-excessive.