Health Traditions with Bruce Bentley, The Subtle Cup

The Subtle Cup

Bruce Bentley and Steven clavey

There is no doubt that Bruce Bentley is the foremost international expert on the history and practice of cupping in different cultures around the world, having spent 30 years in a dozen countries studying the range of techniques subsumed under the simple title. He makes a passionate case for a deeper look at a treatment modality all too often ignored or dismissed. STEVEN CLAVEY is asking the questions.

November 2006

Steve: Ever since I have known you – and that goes back to when we were students together in Taiwan too long ago to mention – you have been fascinated by cupping. What sparked this off?
Bruce: When I first arrived in Taiwan to study acupuncture in the '70s, it was like old China: practitioners who specialised in tuina, anmo, bone-setting, cupping, gua sha and herbal plasters for injuries would set up little practices open to the bustle of the street. You could always tell these places: hanging out front they would have a large red diamond-shaped sign with a big black circle in the middle advertising "gao yao" or plaster medicine, for applying herbs to the skin. The black circle shows the herbs dried hard into a resinous mass, while the red back-drop was the sticky backing material that would adhere to the skin. You remember the famous Gou Pi Gao Yao?

Steve: The Dog Skin Plaster? Was that for real?
Bruce: Yes, and it is still being sold, but the dog skin is now replaced with a leather backing. Anyway, I had just been in Taiwan a few weeks, when I saw this red diamond sign in the street, at a place with huge glass jars of herbs soaking in wine on the front counter. I wandered into the shop and saw a small group of people gathered around someone sitting being cupped. The group was friendly, so I stayed, intrigued. Besides the "gee whiz" factor of glass globes adhered to flesh, once the cups were removed the patient said his tight shoulders and headache had gone.

Steve: So did you learn from them?
Bruce: Well I was already set up studying at an acupuncture hospital, so I thought I would learn from my teachers there. I was surprised to find that most of them gave a flick of the hand and dismissed cupping as something not worth learning. One doctor explained to me patiently that cupping (and gua sha) were "merely" folk traditions that did not warrant serious study. Well, that hit me like a ton of bricks – it certainly was not what I had expected to hear! A pecking order and professional snobbery was alive and well in the Chinese medicine scene. After that I kept my own counsel and didn’t bring it up. But whenever I needed to have a treatment – and that was pretty often because I was doing lots of training in gung fu – whenever I was injured during training or sparring, I would get along to the practitioners who specialised in external injuries. I was really impressed with their skill at pain relief and fixing me up far quicker than if I had just left it to my own natural recovery rate. This encouraged me to spend as much time as I could learning these methods with different practitioners in Taipei.

Cupping requires a real finesse of application and a good degree of understanding... sorry to say it's often in short supply ...

Steve: You have travelled around the world investigating the practice of cupping, with an extended sojourn at the Wellcome Institute in London. When you first told me, I was surprised to find just how widespread the practice is.
Bruce: You can find it on every continent -- cupping is universal. I have not discovered any cultural group that has not done it in some form or other. Its appeal probably began as far back as when people sucked at the skin to relieve stings and injuries. Remember as a kid when you jammed your finger in a door and sucked at it to soothe the pain. That’s cupping too. It’s about the therapeutic action of vacuum. The North and South American natives performed cupping, as well as throughout Africa; in Black Africa and the Islamic countries cupping is still a popular practice. In fact a wellattested hadith (saying) of the Prophet includes cupping as one of three recommended medical procedures. In Australian aboriginal medicine it was, and continues to be, one of the major functions of the shaman to employ oral suction for the sick person who has been penetrated by malevolent spirits. Medical anthropologists have also described how oral suction is used in Siberian Inuit and Tibetan healing ceremonies. In Europe, cupping remains very popular in many countries. In Greece, Southern Italy and Poland people love it, and I’ve been told every Lithuanian family has a cupping set in the home. One Russian friend told me he knows a woman who was so keen on cupping that she emigrated from Russia with not much more than two suitcases full of cups ... for fear she couldn’t get any here. A Greek and a Pole, in separate discussions, both used almost identical wording when they said that during World War II, with the harsh wintry winds and many homes destroyed: "We all would have died if not for cupping."

Steve: Do they all cup in the same way we do in TCM
Bruce: There are lots of really interesting techniques in cupping. Different cultures, as you would expect, have over the millennia developed a wide range of applications and methods. For just a couple of examples, the inaugural head of the Department of Folk Medicine at Moscow University taught me what I now call the “Russian cupping massage”. This practice features sliding multiple cups in a sequence throughout the back for pain and stress relief. It works wonderfully well, and because it is essentially a sedating method has a really rejuvenating effect. In Morocco, a Berber woman showed me where and how to place cups for infertility – she said that if colour came to the cups it showed that there was cold in the womb. The cupping in Chinese medicine is based on point location and medical theory, and this has its advantages. One thing that all good cuppers know is to judge the strength at which the cups should be applied to the body, that is, the right amount of suction for the condition of the patient. An abbot of a Vietnamese Buddhist temple in Melbourne put it nicely: “Our method is based on the strength of the patient – not on the strength of the pathogen”. These are considerations in cupping that need to be taught, but often are not.

Steve: What do you mean?
Bruce: Too many times I have seen patients who have received cupping that has been way too strong. A good example is for the treatment of low back pain due to Kidney yang deficiency. In this case you need to warm the cups and place them softly and repeatedly on Shen Shu (UB 23) points. Deficiencies need the qi to be nurtured back instead of a crash/bang strong application that is a sedating technique (just the same applies in acupuncture or gua sha or tuina). Imagine how someone is going to feel if they suffer a deficiency and a strong sedating method is applied. The cups also literally suck out the qi and they are left worse off! Cupping requires a real finesse of application and a good degree of understanding ... sorry to say it’s often in short supply and so cupping gets a bad rap. The record needs to be seriously readdressed on many levels as far as the practice is concerned.

Steve: That is really interesting about the deficiencies. Any other hints?
Bruce: In TCM there is an important understanding that to tonify you have to make the treatment very comfortable for the patient to receive. The consciousness needs to respond favourably to treatment. In that same lower back scenario, for example, if you were to needle those points and produce a painful response, the consciousness of the patient will move out of the body to avoid pain. This then becomes a sedating method, which is the opposite of what you want. Instead the treatment needs to soothe the person so that in turn the breath then travels to the area, which is then followed by the qi. Try placing a warm light palm across the Shen Shu points. After a short time, without any prompting, the patient’s breath begins meeting the area. In contrast, the opposite can be said for sedating. Just as strong pressure with tuina is satisfying to relieve tight strong muscles, so too more robust cupping is effective. In a nutshell, whether you are tonifying or sedating, if it feels good then you have done the right thing.

Cupping Implements

From Bruce’s collection:

  1. Rubber pump cup (Hong Kong 1990s)
  2. Yak horn cup (Tibet 1980s)
  3. Screw top vacuum pump (Hong Kong 1990s)
  4. Bronze cup (Tibet 1980s)
  5. Tin cups (Tunisia 1990s)
  6. Vacuum pump cups (France 1800s).
  7. Bamboo cups (Vietnam 1990s)
  8. Glass cup (France 1850 – very delicate)
  9. Glass cup (Bulgaria 1990s)
  10. Glass cup (United States Civil War period 1861 – 1865)
  11. Glass cup (UK 1800s)
  12. Tin cup (France 1800s)

Steve: Do you think people may be unwilling to go out of their way to study cupping?
Bruce: Yes, I think cupping has often been sold short in courses. A few hours of simple instruction leaves students with the belief that there’s not much to it. This is a real pity because there is so much in this art. A student in one of my cupping workshops told me he had lost interest in cupping after getting only three hours of instruction at his acupuncture school, and that his classmates walked out of the class saying "if cupping is only good for stagnation why not just do acupuncture instead and avoid leaving bruises!" That sort of thing gets me fired up because it does the practice a grave injustice. Proper teaching is crucial, too, for safety reasons. Where alcohol or methylated spirits are used in conjunction with a naked flame it is a dangerous mix and always a cause for concern and diligence.

Steve: Bruce, I remember a Greek patient who said to me “Hey! I’ve seen them cupping for high blood pressure in Greece: they make two slices with a razor blade at the big vertebra there on the shoulders, then put a cup over the slices to pull out the blood. Works great!” He meant Da Zhui (DU 14), of course.
Bruce: Yes, this is what is called “wet cupping” in the West – that is when cups are used to pull out more than the regular flow of blood after an incision to the skin has been made. While it’s called wet cupping, I look at it more as an auxiliary form of blood-letting that happens to make use of cups to draw more blood out. Around the 17th to 19th centuries in England, cups used like this were called "artificial leeches." When you read a lot of old texts that refer to cupping, it’s often hard to figure out whether they mean wet cupping or the cupping that we do most, which is known as “dry cupping”. I regard them as two quite distinct categories. Going back to your Greek story, Steve, some Greeks have also told me about bloodletting and cupping for high blood pressure. One man told me his mother got it done once a month – a series of cups placed over a set of fine incisions made between the shoulder blades. It all started when her GP told her she had high blood pressure and she allowed a friend to do the traditional treatment on her. She was reluctant at first, but when she returned to her doctor the next day her blood pressure was normal. A month later her doctor took her blood pressure again, and again found it was elevated. So she had the traditional treatment, and the next day it had fallen to normal. Since that time she gets the treatment done one time a month, takes no medication for it and has no problem.

Steve: I remember in the clinic in China in the early ‘80s, just before we closed for the day, the porters would come in. These were the ones who carried large loads – stone slabs, barrels of oil, and things like that – on yokes stretched over their shoulders. When they got off work, they came in to get cupped, every day. We would use a plum-blossom needle on their shoulders, and we would have to hit hard because the skin was thickened like leather. Then we would use lots of cups all over the shoulders – the blood that came out was black and thick, like pitch. This was the only thing, the one thing – the cups – that gave them any relief from the pain.
Bruce: Yes, for that kind of painful blood stagnation, letting blood is very effective. The last time I did so was for a woman who had terrible pain in her toe. It was very dark coloured, so I made small incisions around the area and squeezed the black ooze out. I had to get some very small cups and made a mix of flour and water to the consistency of unfired pizza base, and pasted it around the lip of the cup. That makes it stick better when you’d otherwise struggle to fix the cup on an area that curves at the sides. After two treatments she had no more pain.

Steve: The marks the cups leave: do they have a meaning, or are they just a fashion statement? Is there a way to interpret the various things pulled up (wetness, colours, etc.) with treatment?
Bruce: Steve, mate, you’d need a lot more than cupping to make you fashionable. But it’s a good question. All the changes that arise are pathogenic factors brought to the body surface. And they are certainly not “bruises” as far too many people believe. This is a big question so let’s just cover some issues in brief. Different colours are explicit indicators of the conditions within the body. A dark purple or even black marking always shows that there is deep-seated blood stasis. This will occur over an area with an unresolved longterm injury. Qi deficiency is indicated by the area remaining neutral or paler than the surrounding skin surface, after cupping. Coldness is a light mauve discolouration. Sha also frequently shows up at the skin surface after cupping, though not as much as after gua sha, because it is more thoroughly drawn out and released by the process of scraping. Cups can also draw up dense knotty purple masses, like varicosed lumps, from the body. One case where these turned up was on a woman’s scapula. After treatment she had great relief and said that since childhood she’d always had a problem in the area, ever since her mother had yanked her arm very hard and dislocated her shoulder. The cups drew out this old trauma and she has been fine since.

Steve: So it pulled out this deep stagnation lurking there for years.
Bruce: Just a good example of cupping doing it better than any other treatment. Here is another one: a friend of mine knew someone who was a spy during the cold war days in Germany. This fellow somehow had been exposed to radiation, and radiation poisoning was making him sick — until he had cupping, that is. The results were so good he continues to have the treatment religiously every few weeks. The cupping in this case reduces the build-up of toxins and successfully removes them from the body. This inspired me to put together a sequence of methods based on the Chinese medical model which I call the cupping detox program. I do this on people especially during spring time, and the results have been remarkable.

Steve: What other marks happen after cupping, and what do they mean?
Bruce: When cupping leaves a circular thickened hump that lingers after taking off the cup, this shows the presence of damp phlegm stuck in the channel. You can also get localised water and dampness swelling into clusters of small to large blisters during and after cupping. This is another example of beneficial release from the body -- removing the clogging effect of superficial dampness and generalised stagnation. In this last case, cutaneous needling is also recommended to drain these accumulations. What I am confident about is whatever gets drawn from within to the surface, provided the suction being applied is appropriate, is always a positive gain.

Steve: So cupping can tonify and sedate, but also can drain off all kinds of pathogens. How do pathogens actually leave the body?
Bruce: By two means, from a TCM perspective. First there is the active dispersing action of the wei qi. Secondly, once brought to the surface by cupping, a large amount of whatever the pathogen is gets released to float off into the ether. A good example is when coldness is pulled out to the surface and into the cup. As you release the seal of the cup, notice the escape of that cold at your finger tips – it feels like you have just opened the freezer door. Or how about when wetness collects at the upper interior of the cup or when the inner surface of a cup gets a thick creamy residue of phlegm. Because of this, it’s very important not to break the seal and open cups in your direction – otherwise these sorts of pathogenic xie qi are headed your way. An old TCM doctor in Taiwan instructed me on this 30 years ago. I have never heard it since and I think it’s very important for practitioners to know about.

Steve: What about the Western tradition of cupping?
Bruce: After spending such a lot of time learning and practising Eastern medicine the chance to trace back my own cultural roots with cupping’s practice in the West proved a real interest. If you are fortunate to meet up with practitioners from the Western tradition, you will find it unchanged from how it has been done for countless generations. Cupping in the West is one of the last links with how our ancestors made sense of their bodies and what made them ill. When we think how long cupping has been around … I suppose the hiatus of the past 100-odd years following the discrediting of cupping by the biomedical model since its emergence around the 1880s in countries like Australia, the UK, the US and Canada has been a fairly small gap in what otherwise has been a long and unbroken history.

Steve: You have really spent many years travelling and researching cupping. How have you been able to make these grassroots contacts in so many different societies?
Bruce: I have discovered that researching traditional practices like cupping has been an experience with the locals that otherwise would be very difficult to have. I cannot think of a better way to break the ice and become a guest. I get to a location and start chatting, and people are usually really pleased and eager to talk about their healing traditions. I get invited into their homes and discuss things that otherwise would be off limits for most tourists. I cannot imagine going anywhere now without doing a bit of research. It’s very interesting and satisfying. There is a line from the great anthropologist George Foster who wrote something like “traditional medical practices are an exquisite indicator of the way a community goes about living life”. I like that.

Bruce Bentley studied Chinese medicine in Taiwan from 1976 until 1981. He has a Masters Degree in Health Studies based on his thesis entitled Cupping as Therapeutic Technology. He has investigated the Eastern tradition of cupping in Vietnam, and studied at the Shanghai University of Traditional Chinese Medicine, the Tibetan Medicine Hospital in Lhasa, Tibet, and at the Uighur Traditional Medicine Hospital in Urumqi, Xinjiang Provence, China. To research the Western practice of cupping, Bruce visited the Australian Institute of Sport in Canberra where masseurs employ cupping to treat injuries and enhance performance, and in 1998 he went to Europe and North Africa, doing archival research on cupping at the Wellcome Institute for the History of Medicine, London, and the Department for the History of Medicine at Rome University, followed by field-work in Sicily, Greece, Bulgaria, Turkey, Morocco and Tunisia learning local cupping traditions. Bruce's most recent research trip investigating cupping was in Cambodia during July 2003. He is also a state registered acupuncturist and Chinese herbalist and director of Health Traditions:

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