CHAPTER 8 Ancillary therapies

The ancillary therapies of cupping, gua sha and moxibustion are powerful and potent therapeutic methods that can be applied in conjunction with Tui na treatment to produce excellent results. In this chapter I will give a brief description of each of the three therapies, how to apply them, their therapeutic effects and some suggestions for when to use them. As with Tui na, these therapies are practical and need to be taught by an experienced practitioner.

You can refer to the recommended reading section at the end of this book for more detailed information.

Cupping

Cupping is an ancient therapy that has been used as part of folk medicine all over the world. The earliest recorded use of cupping is found in A Handbook of Prescriptions for Emergencies written by the famous Taoist alchemist and herbalist, Ge Hong (AD281–341). Cupping was used in English hospitals in the 1830s to treat contagious diseases; it was so popular at the time that there were paid ‘cuppers’ working in the hospitals. Originally, cups were made from animal horns, then pottery and bamboo. Today they are made out of thick glass.

Cupping is used to release the Exterior, and draw external pathogens up to the surface and out through the open pores. It stimulates and regulates the flow of Qi and Blood and can be used to relax the muscles, move stagnant Qi and Blood and ease pain.

How to apply cupping

To create the suction, which enables the cups to stick to the skin, you have to remove the oxygen from the cup by briefly putting a flame into it (Fig. 8.1).

To apply cupping:

1. Lubricate the patient’s skin at the area you want to cup with a little base oil such as grapeseed oil.

2. Bring the cups that you want to use close to the patient.

3. Soak a small ball of cotton wool in surgical spirits and squeeze out any excess.

4. Hold the soaked ball of cotton wool with a pair of long-handled forceps in your dominant hand and light it.

5. Warm the rim of the glass cup with the flame so that it is not cold when you put it onto your patient’s skin. Test the temperature of the cup rim on the back of your hand.

6. Holding the cup close to the area you want to apply it to, put the flame into the cup very briefly, then withdraw the flame and immediately apply the cup to the skin. If you hold the cup too far away from the skin, by the time you apply it, oxygen will have returned to the cup and there will be very little or no suction.

7. Keep the flame away from the patient. When you have finished cupping, either blow out the flame or put it in water to extinguish it.

8. To remove the cups, press the skin by the edge of the cup firmly with the fingers of one hand to allow air in and gently lift the cup off with the other hand. If your cupping is too strong you can loosen the suction by using this pressing method to allow a little air into the cup.

9. Remove any oil with a clean piece of couch roll.

10. Wash the cups after use with Milton’s solution.

Apply cupping before Tui na treatment. Once the cups have been removed, work gently to soothe the area and to help to disperse local stagnation, then continue with the rest of your Tui na treatment.

Cupping marks

Cupping will often leave a reddish-purple, circular, bruise-like mark the first time it is applied, unless a weak method is being used or there is no stagnation or pathogen present. It is important that you warn your patient about this and reassure them that the marks will fade after a few days. The color of the mark depends partly on the strength of cupping applied and also on the amount of stagnation present. Usually after cupping has been applied three or four times the marks become gradually less apparent, and eventually, when the stagnation moves or the pathogen clears, there will be no marks at all.

Once I had a patient with a frozen shoulder who had so much stagnation of Qi and Blood that his cup marks were black at first. As treatment progressed, these went from black to purple to red and, eventually one day, there was nothing. The marks in themselves are very useful diagnostically.

The strength of the suction is altered by the size of the flame and the time you leave the flame in the cup. The bigger the flame, the stronger the suction.

There are several cupping methods and the ones that are relevant to Tui na are described below.

Weak cupping

A gentle suction is applied – just enough to hold the cups in place. This is used for patients who are very Deficient, frail or old. This method should not create any redness or bruising to the patient’s skin.

Medium cupping

This is the most commonly used form. A moderate suction is applied so you can see that the skin is raised up a little inside the cup. This method is suitable for most patients. It will generally produce some red cupping marks. It can also be applied to the abdomen for digestive problems such as Middle Jiao disharmony.

Strong cupping

This is only applied to patients with strong constitutions and purely Excess conditions and is therefore rarely used. It is applied for only 3–5 minutes. Never apply strong cupping the first time you cup a patient; it can be very draining and will generally produce a lot of red and purple cupping marks.

Empty or walking cupping

This is a very useful method if you have a patient who is both Deficient and has a lot of Qi stagnation. It invigorates the Qi but does not drain it. It is commonly applied to the back along the Bladder channel and Governing Vessel. Several cups, usually between five and 10, are applied one after another in quick succession. Each cup only remains in place for a few seconds before it is removed and replaced at a different site. The cups are kept continually moving on and off the body for about 5 minutes (Fig. 8.2).

Moving or sliding cupping

This is a strong method of cupping and can be painful if the suction applied is too strong. It is generally used for Excess Heat conditions and can create some quite dramatic looking purple red marks. The cups are applied and then slid up and down the area to be treated. It is usually applied to the back (Fig. 8.3).

Fig. 8.1 Application of cupping.

Fig. 8.2 Empty cupping.

Fig. 8.3 Cupping–sliding.

Therapeutic effects of cupping

• Regulates and invigorates the flow of Qi and Blood

• Moves stagnant Qi and Blood

• Eases pain

• Relaxes the muscles

• Draws out and releases pathogenic Wind, Cold, Damp and Heat

Suggestions for use

• Common colds, coughs and flu

• Chronic bronchitis and asthma

• Muscular pain and tension

• Bi syndrome

• Lower backache

• Frozen shoulder

• Tennis elbow

• Digestive weakness

• Irregular menstruation and dysmenorrhea

Contraindications

Do not apply cupping:

• To areas of skin where there is a skin disease such as psoriasis or eczema or if the skin is burnt

• To the abdomen or lower back during pregnancy

• If the patient is very weak

Note on safety

Remember you are dealing with fire. Take your time and pay attention to what you are doing. Make sure the cotton wool ball is not dripping with surgical spirits – squeeze out any excess before you begin.

Gua sha

Gua sha is a similar therapy to cupping in that it is used to release the Exterior, expel pathogens and move stagnant Qi and Blood. I use it a great deal in my practice and have found it extremely effective in the treatment of migraine and hypertension as well as for a variety of muscular skeletal problems. It is a very flexible and highly effective therapy to use in conjunction with Tui na.

‘Gua’ means to scrape or scratch and ‘sha’ is ‘a red, elevated, hot skin rash’. The rash or petechia is intentionally brought to the surface by scraping the patient’s skin with a rounded tool. This sounds worse than it actually is; it is in fact painless when done correctly and patients often find it very relieving, as it is so effective for easing pain and stiffness.

Gua sha affects the Exterior of the body, the Wei Qi level and channel sinews. It has been used in many countries as part of folk medicine for treating common ailments such as fever, common colds, aches and pains. Towards the end of the last century, Jingluo gua sha was developed and used by practitioners of Chinese medicine both as a diagnostic method and for the treatment of painful conditions such as Bi syndrome.

The ‘sha’ or rash

Gua sha marks can look quite dramatic. The red or purple rash is a sign that Qi and Blood are obstructed and not circulating properly. As with cupping it is important to warn your patient about the marks and explain the purpose of what you are doing. The sha should fade in 3–4 days unless there is pronounced Blood stasis. Do not apply gua sha again to the treated area until the marks have completely gone.

The color of the sha is a useful diagnostic tool:

• Very light sha indicates Blood Deficiency

• Red sha indicates a recent invasion of a pathogenic factor

• Dark red sha usually indicates Heat

• Purple or very dark sha indicates long-standing Blood stasis

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