If you watched the 2016 Rio Olympics, you probably noticed something unusual. Several athletes, most notably swimmer Michael Phelps, stepped onto the world stage covered in perfectly circular dark marks. The internet lit up with questions. Were they bruises? Burns? Some new performance-enhancing treatment?
They were cupping marks. And in Traditional Chinese Medicine, those marks are far more than side effects — they are diagnostic tools that reveal what is happening inside your body.
Cupping therapy has been practiced in China for over two thousand years. The earliest written record appears in the Huangdi Neijing, or Yellow Emperor’s Inner Canon, compiled around 200 BCE. Ancient practitioners used animal horns, bamboo cups, and pottery to create suction on the skin. The technique was originally called jiao fa, or “horn method,” because animal horns were the first tools used.
Over centuries, the method evolved. Glass cups replaced horns. Fire became the standard way to create suction — a cotton ball soaked in alcohol is lit, held inside the cup briefly to heat the air, and then the cup is placed on the skin. As the air cools, it contracts, pulling the skin and superficial tissue upward into the cup.
Today, modern practitioners also use vacuum pump cups, silicone cups, and even electric cupping devices. But the underlying principle remains the same: suction creates localized pressure changes that draw blood to the surface and influence the body’s internal dynamics.
In Traditional Chinese Medicine, pain and illness often result from stagnation. Qi (vital energy) and blood must flow freely through the body’s meridian channels. When that flow is blocked — by cold, dampness, emotional stress, or physical injury — symptoms appear. Pain, stiffness, fatigue, and even internal organ dysfunction can all trace back to stagnation.
Cupping works by drawing stagnant blood and qi to the surface. Think of it like clearing a clogged pipe. The suction pulls trapped metabolic waste, old blood cells, and stagnant fluids from deep tissue layers toward the skin, where the body’s lymphatic and circulatory systems can process and eliminate them more efficiently.
The key concept here is xing qi huo xue — “moving qi and invigorating blood.” Cupping does exactly that. By creating localized negative pressure, it mechanically lifts tissue, opens capillaries, and encourages circulation in areas that have become stagnant.
This is where cupping becomes genuinely fascinating. The color, texture, and appearance of the marks left behind are not random. They tell a story about the patient’s internal condition. Experienced TCM practitioners can read these marks the way a Western doctor reads lab results.
This is the most common color people associate with cupping, and it indicates one thing clearly: yu xue, or blood stasis. Dark purple marks suggest that blood has been stagnant in the area for some time. This often corresponds with chronic pain, old injuries that never fully healed, or long-term meridian blockages.
The darker the purple, the more severe the stagnation. Practitioners often see this on patients with chronic lower back pain, frozen shoulder, or areas of long-standing muscle tension. When very dark marks appear, it usually means the problem has been building up over weeks or months, not just days.
Bright red marks indicate re, or heat, in the area. This is common in acute conditions — recent injuries, inflammatory responses, or conditions where the body is actively fighting something. Red marks can also suggest that qi stagnation is present but has not yet progressed to blood stasis.
In clinical practice, bright red marks often appear on patients with recent sprains, acute muscle spasms, or flare-ups of inflammatory conditions. The heat aspect suggests the body’s defensive mechanisms are actively engaged.
When cupping produces pale, almost colorless marks, it tells a different story. This indicates xu han, or deficiency-cold. The patient’s qi and blood are insufficient to mount a strong response. The area lacks adequate circulation not because something is blocking it, but because there simply is not enough energy to drive it.
This pattern appears frequently in patients with chronic fatigue, poor digestion, cold extremities, or general weakness. These patients often need nourishing treatments — warming herbs, moxibustion, or tonifying acupuncture — rather than aggressive cupping.
When cupping draws fluid to the surface, producing small blisters or a watery discharge, it indicates significant shi, or dampness, in the body. Dampness in TCM is a pathological concept that describes sluggish, heavy, stagnant fluid metabolism. It often manifests as water retention, a feeling of heaviness in the limbs, joint swelling, or digestive sluggishness.
Blisters after cupping suggest the body is actively trying to expel this dampness through the skin. Practitioners take this as a sign to focus treatment on resolving dampness — using herbs like Cang Zhu (Atractylodes lancea) or Fu Ling (Poria), adjusting diet, and possibly using wet cupping techniques to draw out the excess fluid.
How long marks persist also carries meaning. Marks that fade within a day or two suggest the stagnation is relatively mild and superficial. Marks that last five to seven days or longer indicate deeper, more chronic stagnation that may require multiple treatment sessions to resolve.
Western researchers have started investigating cupping with growing interest, and their findings align surprisingly well with TCM theory, even if they use different language.
The suction from cupping causes capillaries beneath the skin to dilate and, in some cases, rupture. This produces the characteristic circular marks — essentially controlled micro-trauma. The body responds by increasing local blood flow, activating the lymphatic system, and triggering an inflammatory healing response.
A 2015 meta-analysis published in the Journal of Traditional Chinese Medicine reviewed 135 studies on cupping and found evidence supporting its effectiveness for conditions including chronic neck and shoulder pain, lower back pain, and osteoarthritis. The researchers noted that cupping appeared to work through multiple mechanisms: improving local circulation, reducing inflammation markers, modulating the immune response, and stimulating the nervous system.
Another study published in PLOS ONE found that cupping therapy significantly increased skin surface temperature and blood perfusion in treated areas, effects that persisted for up to 30 minutes after the cups were removed. This supports the TCM concept of “invigorating blood” — cupping genuinely does increase local circulation.
The marks themselves appear to result from a combination of extravasated red blood cells, increased interstitial fluid, and localized inflammatory mediators. In other words, the body is indeed moving stagnant material to the surface, much as TCM practitioners have described for centuries.
Cupping is particularly effective for musculoskeletal pain conditions. Chronic back pain, neck and shoulder tension, sports injuries, and tension headaches all respond well. Patients with respiratory conditions like chronic cough, asthma, or recurrent colds may also benefit — in TCM, cupping the upper back helps “release the exterior” and expel pathogenic factors from the lung meridian.
Athletes increasingly use cupping as part of recovery protocols. The improved circulation and accelerated clearing of metabolic waste products from muscle tissue can speed recovery after intense training. This explains why so many Olympic and professional athletes have adopted the practice.
Cupping is not for everyone. Patients with bleeding disorders or those taking blood-thinning medications should avoid it, as the suction can cause excessive bruising. Pregnant women should not receive cupping on the abdomen or lower back. People with skin conditions like eczema, psoriasis, or open wounds in the treatment area should wait until the skin has healed.
Elderly patients with very thin skin, individuals with severe anemia, and those who are extremely fatigued or weakened should also use caution. The principle of bu xie in TCM — tonify where there is deficiency, drain where there is excess — applies directly here. Cupping is primarily a draining technique. Using it on someone who is already deficient can worsen their condition.
Those circular marks that caught the world’s attention in Rio are not simply bruises. They are a visual record of what is happening beneath the surface — a diagnostic map written on the skin by the body itself. Purple speaks of old stagnation. Red signals active heat. Pale marks whisper of deficiency. Blisters reveal hidden dampness.
This is one of the most remarkable aspects of Traditional Chinese Medicine: the body is understood as a system that constantly communicates its condition. The skilled practitioner knows how to listen — not just to the pulse and the tongue, but to the marks left by a simple glass cup.
Cupping therapy reminds us that sometimes the most powerful diagnostic tools are also the simplest. A bit of fire, a glass cup, and two thousand years of accumulated observation. That is enough to read what the body has been trying to tell us all along.
Professor Zhao Hanqing is a senior TCM practitioner at Beijing Heniantang, specializing in traditional Chinese medicine theory, classical formula research, and TCM informatics. With years of clinical experience and academic dedication, Professor Zhao bridges the wisdom of ancient Chinese medical classics with modern computational approaches to advance the field of TCM knowledge systems.
Disclaimer: This article is presented for educational and informational purposes. Individual results may vary. Always consult qualified healthcare providers before beginning any treatment.
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