Dear Editor,

With great interest, we read the article of Aboushanab et al. [1] entitled “Cupping Therapy: An Overview from a Modern Medicine Perspective” in the journal of Acupuncture and Meridian Studies 11 (3), 2018. In this article, cupping is classified with a different aspect. In a part of this article, the adverse effects of cupping are mentioned and divided into two categories: preventable and non-preventable. Kubner’s phenomenon, vasovagal attack, headache, dizziness, and nausea are classified in the non-preventable group, while according to the sources of Persian medicine, these complications can be prevented.

In the Persian medicine, it is believed that digestion of food and its transformation into body tissues occurs during four digestive stages: The first digestion is in the stomach; the second digestion is in the liver, the third digestion is in the vessels, and the fourth digestion is in the tissues [2,3]. Persian medicine scholars believed that cupping in the interscapular area weakens the stomach. It is stated in Kholasat-al-Hekmah (Summary of wisdom) that if cupping is done immediately after eating, it will disrupt the first and second digestion stages so inappropriate humors will move towards the place of cupping and cause vitiligo (Baras) [4]. Also, in those who have a history of gastrointestinal diseases due to bile dominance, cupping causes more weakness of the stomach and bile movement, so nausea, dizziness, headache, and symptoms of vasovagal attack may occur [5]. Of course, this problem does not occur in healthy people without digestive problems. Persian scholars believed that if bile prevails in the stomach, the resulting vapors will rise to the brain and cause the mentioned complications. To solve this complication, the scholars advise such people not to do cupping when they are hungry and to eat some light food such as quince or apple jam with bread half an hour before cupping, and to drink some pomegranate juice or lettuce and some vinegar after cupping. This suppresses the bile vapors and prevents these side effects [3,4].

The authors of this letter also agree with Aboushanab that these adverse effects of cupping are infrequent but would be rare if the points mentioned by Persian scholars are considered. In our clinical experience, we have concluded that if the indications of cupping are correctly diagnosed and done according to the opinion of Persian medical scholars, cupping will not cause serious complications [5].

Preventable complications of cupping are also based on the performance of the practitioner, which will not occur if the correct principles and rules are observed. El Sayed et al. [6] in his article, declares that cupping itself does not cause any side effects and all its complications are preventable.

The author declares no conflict of interest.