Why Cancer Happens and How It Can Be Treated an evolutionary prospective

In the public mind cancer is seen as aberrant cells growing by accident in a body. Actually, modern research has uncovered a much more instructive understanding of cancer. This understanding can allow us to make informed choices in treatment.

Firstly, they are not rogue or aberrant cells. If they were rogue cells it would mean that they come from random damage in cell replication and growth. Random damage would not show a repeatable pattern across many individuals and it would not give the sophistication in survival tactics that is observed across all cancer types. They are the body’s own cells only in a less individualised form.

If we look at why they are less differentiated or individualized and from what genetic material they come; we discover that the genetic material they come from is in a so called redundant or junk chromosome sequences. So, we ask what is a redundant or junk chromosome sequence. To understand this, we should know that our genetic make-up is built layer upon layer as we developed from simple multi-cell organisms to the complex creatures that we are now. Up until a certain point in our development all our cells could do all jobs, they were very adaptable so as to be able to survive. They could build a blood distribution when they got above a specific size. They may have been less differentiated than our cells now, but they were also more adaptable to harsh environments. This is what cancer cells are – less differentiated, adaptable, survivors. We do not, on the whole, die from cancer but rather it blocks the bodies complex functions so they fail and we die.

The last piece of the jigsaw to understand is that all cancers consist of two parts. On the one hand, we have the tumour cells, which we all know about, which are our fast-growing cells that can be attacked with chemo agents, zapped with radiation or cut out. The other part of cancer that is not generally talked about is the slow-growing stem cells. These are the cells that seed the tumour cells, they are hard to find and able to hide from the immune system – they are not seen as a problem by the immune system because they are the person’s own cells, they are able to create adaptations to chemo and radiation therapies; in short, they are what keeps cancer alive. The other thing we know about stem cells is that if you treat cancer with chemotherapy as the tumour cells die the cancer will create many more stem cells; rather like a stressed plant with flower and seed to survive. This is how tumours when they come back are mostly resistant to the treatments used before – they have adapted intelligently.

To summarise: cancer is a survival mechanism formed when we were more undifferentiated in our evolution. They consist of two parts: the fast-growing tumour cell and the slow resilient stem cell. They spread – metastases when they get too big or the oxygen supply is not adequate (this is why aerobic exercise lessens spread). They also spread by adapting when the stem cells have seeded to new areas because they have been forced out of old areas or disturbed in those areas.

We can easily see from the above that cancer is a primitive extreme survival mechanism that can be turned on when the person’s existence is threatened in a fundamental way. These threats are easy to see in viruses, inflammation, chemical pollution, stress, other pollutants (including smoking) and all the other factors which we know are carcinogenic. Interestingly, we know from work done at the Sanger Institute in their “Catalogue of Somatic Mutations in Cancer” that all cancers are multi-factorial, so it takes a lot to turn on cancer and unfortunately it also takes a lot to turn it off.

Given this information, how can we treat it? Firstly, if it is about to block or endanger the person or their vital functions the tumour may need cutting out or otherwise removing. If it is not endangering the person then maybe it is better to leave it because if it is removed it is very unlikely that you will get all the stem cells, especially if chemo is used as the removal agent. In fact, if chemo is used you can be pretty sure that you will have spread and strengthened the stem cells. This leaves us with three parts of the treatment:

  1. Get out of extreme survival mode, lessen pollutants (so organic food, no alcohol, natural drinks, no “products” in the house, etc.), lessen stress and take exercise; in short enjoy a fulfilling and natural life. This is seen in the number of people who experience “spontaneous remission” when they radically change their life. Unfortunately, there is no sure-fire formula of what this change needs to be. It is individual but it can still be part of the overall plan.
  2. Treat the tumour and stem cells. This can be done with various natural ingredients that: encourage apoptosis (natural cell death); make the stem cells visible to the immune system so that they can be mopped up if the system agrees the extreme survival is no longer needed. Lower the level of the interleukin signalling pathways – this is part and parcel of lowering the survival levels but the signalling can also be blocked naturally to slow the development and spread of the cancer. There are a host of other signalling pathways which can get out of balance. All of these actions can be achieved with high enough plasma concentrations of either turmeric, THC/CBD oil or Aloe Arborescens among other ingredients.
  3. Take measures to optimise the immune system, exercise, good food, fresh air, no stress, and various foods or herbal and other treatments that return the whole organism to health, etc. This can be helped with acupuncture, herbal medicine, ayurvedic detoxes , etc. All of these therapies must be individually designed to be effective. Because cancer is multi-factorial and because they are the person’s own response there is never going to be a “magic bullet” or ”one size fits all” treatment.

Cancer is not unfair or unnatural it is a primitive natural response to an impossible combination of threats. Normally these threats include physical, emotional and mental/spiritual threats coming together at the same time in a way that the person cannot resolve leading to the extreme survival response. For instance, a person has petrochemical or heavy metal residues in their colon, they then are coping with a parent with senile dementia and then get a real flu this then tips the body into survival mode and the stress focuses in the colon and manifests as colon cancer. In this instance, it can be cut out because it is around the petrochemical residue but you still have the original emotional overload, that was unsupportable, to heal. Cancer is always a wake-up call but it can be responded to if you realise the depth of the problem. Without an appreciation of the depth the work on realising and reaffirming your health is unlikely to be strong enough to re-establish health in a complex organism.

This is not written as a scientific paper, so I have not included references backing up all the statements, but I have done my best to base all my observations on solid science. It is though, only my understanding and opinion. If you want to review the evidence that let me to these conclusions I encourage you to look at these two main papers:

  • PCW Davies & CH Lineweaver, 2011, Cancer tumors as Metazoa 1.0: tapping genes of ancient ancestors, Phys Biol. 2011 February ; 8(1): 015001. Doi:10.1088/1478-3975/8/1/015001
  • PP Sordillo & L Helson, 2015, Curcumin and Cancer Stem Cells: Curcumin Has Asymmetrical Effects on Cancer and Normal Stem Cells, SignPath Pharma Inc, Quakertown, PA, USA

Both papers also list numerous citations some of which have also been reviewed and contribute to this analysis.

I hope this helps inform your understanding of cancer and its treatment. Do remember that cancer is not an invader but a natural response in an extreme situation.

Michael Pringle, South Devon, 2017

Cupping As a Tool For Health

I was recently asked for a short article on cupping as a part of Chinese Medicine, it has appeared in Acu, the magazine of the British Acupuncture Council. My thanks to them for asking for it and publishing my thoughts. Here is a copy of the article:

There are many stages to helping a person to heal, but the overall strategy must be to get the person to trust and respect themselves again. So often the disease causes a breakdown of this trust and is itself often a product of this erosion of trust. No healing can succeed if this trust is not re-established; without this return of trust there will only be the obscenity of “managing disease”.

To re-establish trust there needs to be respect in all our dealings with the whole person. As practitioners we are not only courteous to the outer person but to their life-force and their life processes, including disease processes; for all disease processes have a purpose and a journey in themselves. If we do not understand this purpose and direction, how can we work with the person to further their own connection with themselves and so help them to “health”? If we think disease is meaningless and stupid, how can we help the person to reconnect and to enhance their experience and trust of their own precious life process?

One expression of this courtesy is in the tools we use to “touch” their lives. At first glance, needles might seem an odd way of respecting and touching a person. But it is all in the way they are wielded. A number of years ago I was honoured to treat some people who had been physically tortured. The perceived wisdom was that using needles would only reinforce the trauma (this misconception later stopped the project), but my and the peoples’ experience was that the body having a health-giving response to physical stimulation was a wonderfully healing and liberating, even redeeming experience.

Even more than needles, cupping is often seen as a blunt instrument. I think this is missing the point. The body (and by body I mean the whole manifest experience of life) is accustomed, in this modern society, to only experiencing a few strong sensations. This might be loving, or adventure, but by and large the strongest sensation for most people is pain and illness. This seems to have had a negative effect on our perception of strong sensation. We need to reclaim strong sensation as part of being alive; strong sensation is transformative and has the power to re-set redundant patterns. Used strongly on a patient with a body-memory of trauma, cups can be unbearable, but when used softly that trauma can dissolve. I have also seen this with guasha or massage but cupping is quicker and gentle than both.

In Chinese medicine pain is always dispersed, the experience is not wasted. Pain is caused by the accumulation of blood (stabbing pain), qi (moving pain) or fluids – causing dryness or oedema (ache). When we move or clear this we can expect to body to bring the experience of pain into balance and it becomes a stimulus for, and part of, the healing (though, in my view, the pain from cancer may be an exception to this). We can achieve this in many ways – gently touching the cause so the body moves again, or through stronger stimulus like a strong needling technique. guasha, tuina, herbal formulae or cupping.

In my experience cupping is endlessly versatile. For instance, over the years I have notice a correlation between old blocks from fear that are reported in the case history and the appearance of a layer of internal cold showing on the pulse – using cupping to disperse the internal cold and we see the old trauma no longer blocking the persons experience. Here as in all things in energy medicine, we can only treat it when it is showing itself to the practitioner.

We have the techniques of static cupping, moving cupping, flash cupping, and other variations all of which can be applied to fit the situation. For appropriately moving qi, blood and fluids there is no better way. But these are only words the real magic is in our interaction with the life of the person in a meaningful way.

Michael Pringle initially qualified in 1982 in Chinese medicine and has been learning, treating and teaching ever since. He lives in South Devon with his partner and two children. A full article “Some Thoughts on Fire Cupping” Michael Pringle is available from JCM article archive JCM 83/46. Contact details at www.acupunturesouthhams.co.uk

Year of the Goat

Chinese astrology outlook for the year of the Yin Wood Goat 2015

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19 February 2015 – 7 February 2016

The Goat relationship is important. This year is a time to relate to others and the world in which we live.
This is a wood Goat year. The Goat is an earth animal, in a male world the wood over-controls the earth so the energy gets consumed but in a female world the earth softens the wood making it more gently creative. This means that there should be less energy for conflict and more energy for creative and nourishing forms of existence. There is practically no metal or water in this year so it could be a bit volatile, as in flash fires emotionally or physically.

Another way of seeing the same thing is that the Goat has a fine head of horns but soon realises that if you keep butting against things you just give yourself a headache. Therefore you have two options; you either look for better ways of resolving conflict or you become a mean goat that looks for ways to hit from behind or give a sly butt.
On the other hand it should be a good year for genuine solutions in diplomacy, business, medicine, including natural medicine and for the arts.


Goat children need gentle loving, they will want to stay connected and nourished by their home. Standing on their own is not their thing. They are good at affection but need encouragement and a secure environment to bring their creativity out. No criticism.


How different people fare in the year of the Yin Wood Goat


Goat – earth 1919, 1931, 1943, 1955, 1967, 1979, 1991, 2003, 2015

The Goat in a wood year needs to find the gentle side of life, then they will feel nourished. If you are in a stressful situation it will feel more difficult than usual. It should be easier to choose this year than last.
Look after your home and let things come to you. Let your creativity and love of beauty guide you and try not to worry or hustle.


Monkey – metal 1920, 1932, 1944, 1956, 1968, 1980, 1992, 2004

It may feel like trouble is chasing you this year but being a Monkey you should keep ahead of it and in your year – next year – you will realise that you have been pushed to a new place where you want to be and would never have got to if you hadn’t had to run.
Sincerity in play can seem like a new one to you, but if you can you will find a place to be creative without leaving others confused.
Look after your lungs, with gentle and deep breathing.


Rooster – metal 1921, 1933, 1945, 1957, 1969, 1981, 1993, 2005

This is a year where you need to gently let things come to you. After the year of the horse this is a year to finally relax and be. You can travel, you can have good times, but they will come and go don’t try to control things. Eat a little good food, breath good air listen to good music and you may find that there is happiness inside.


Dog – earth 1910, 1922, 1934, 1946, 1958, 1970, 1982, 1994, 2006

This year is about relationships and family so it should suite Dogs down to the ground. But, as for this year in general, remember that it is a wood year so if you try to control things you will get into conflict. Let life come to you, have modest ambitions and enjoy your friends and family. If you are worried about your house, make small alterations and keep the expense down or it could get out of hand.


Pig – water 1911, 1923, 1935, 1947, 1959, 1971, 1983, 1995, 2007

This should be a good year for Pigs. The water of your sign nourishes the year so you will find that what you do seems to make things better. Or rather how you are is appreciated and seems to connect you to family and friends. As a Pig you will only be really happy if you feel happy at home, so be there, make it nice and have a few friends around.
Make sure you stay hydrated with juice and fruit.


Rat – water 1912, 1924, 1936, 1948, 1960, 1972, 1984, 1996, 2008

Rats need to be working towards a secure future and as such this year can be good. Remember that this is a gentle year, not one to push and you will find that problems from previous years will now move, people will help and allow more security to come to you. In the past it may have looked like people resented you getting what you needed, but now in this gentle year there is room for all to thrive.
Work gently for the good of your family and you should not get any resistance.
Once again as this is a year with little water and you are a water sign don’t let your reserves get low – nervous or physical.


Ox – earth 1913, 1925, 1937, 1949, 1961, 1973, 1985, 1997, 2009

Travel, love and family will be good but as an Ox you are used to pushing forward. This is not a year for pushing, so if you push in work or play you will not be appreciated. You may even find that if you push you are put out to grass, don’t risk it, be a patient Ox that waits in the shade and enjoys the rest.
This is not a year to have secrets. The year is about sustainability not short term gain. To the Ox this should be a relief but it may mean changing work practices or letting go of secret income streams before they are deemed immoral. What was once considered good business practice is now coming to be seen as exploitative. So what was okay is now not and so the systematic and moral Ox can be seen as immoral when morality changes.


Tiger – wood 1914, 1926, 1938, 1950, 1962, 1974, 1986, 1998, 2010

This year will seem to boring and slow for most Tigers, but what they don’t realises is that the Goat is looking closely at what is good and can it be trusted. It is not a year for rash schemes and it is not a year where the Tiger can get away with making his own rules as he is used to.
It is not that anyone minds the energetic and dominate Tiger. Everyone knows that it is their nature and the world would be poorer without them; it is just that this year people don’t want to suffer for others excesses and they will say so. Curb you enthusiasms and don’t behave like you are top of the food chain and the food chain won’t cut you off.


Rabbit – wood 1915, 1927, 1939, 1951, 1963, 1975, 1987, 1999, 2011

A wood year for a wood Rabbit it has to be good. In fact this year will suite your nature far more than last year. Gentle and social are the ways to be. At last your creativity and sense of what is right will be appreciated.
There is not a lot you need to be scared of this year as your gentle way of working is just what we all need. Don’t hold back, show people what they are looking for – truth and beauty, love and caring.
It is about playing in a safe way on a beautiful planet and you above all know this.


Dragon – earth 1916, 1928, 1940, 1952, 1964, 1976, 1988, 2000, 2012

As with all earth signs Dragons need to take the female path this year. This is a year for sitting back taking stock and deciding what you really want from your life. It is a time for reassessment and change.
All Dragons can feel themselves above the law and that laws are good for others but don’t apply to them. Well now they do, so be careful that you move with the times and find a new morality. If you think you are above the law that is exactly the people the Goats will butt.
The way forward is to gently envision a world where all are cared for none are exploited and all are appreciated for what they bring to life. Don’t worry you will always be a Dragon with your natural charisma.


Snake – fire 1917, 1929, 1941, 1953, 1965, 1977, 1989, 2001, 2013

This is definitely not a year to be ruthless. You may get away with it now but it will be held against you for a long time, even until it has caused your ruin.
That warning aside, if you find your gentle beauty loving nature and act from there, you will be appreciated and asked to help and guide others in finding a way forward for the world’s problems.
It is your choice: if you can take a wider view of true wealth and the larger family it can be a fantastic year for you and so us all.


Horse – fire 1918, 1930, 1942, 1954, 1966, 1978, 1990, 2002, 2014

Most horses will find this year outwardly boring because they cannot run off and canter over the planes. This is a year for standing in your field and letting things come to you. They will come to you, because of your sense of fairness and your creativity you will be asked to come forward. But you do need to wait to be asked.
Appreciate your friends family and companions.
This is a great year because though this gentle resting in your being, your health will regenerate and your standing in the world will return.


I hope you have a gentle, creative and health filled year.


Disclaimer: I hope you find this booklet informative but it is not a substitute for individual professional advice or treatment either medical nor legal and it carries no guarantees.
We must all find our own truths and what works for us.

©2015 Michael Pringle

happiness

 

Some thoughts on fire cupping

This article was originally published in The Journal of Chinese Medicine, from whom reprints can can be obtained:

 

Some Thoughts on Fire Cupping By Michael Pringle

Keywords: Cupping therapy, qi stagnation, blood stasis, external pathogenic factors, pain syndromes.

Abstract

This article discusses the techniques for safe and effective fire cupping as an important adjunct to acupuncture treatment, including the different applications of cups to suit the individual patient’s condition. It also covers moving cups, walking cups, water cups and emergency cupping.

Introduction

Fire cupping has a great deal to offer as an adjunct to acupuncture. It is easy, safe and normally well received by patients (as long as the practitioner is confident and explains the procedure adequately). It also offers benefits that are hard to achieve in other modalities of Chinese medicine, such as the ability to clear the channels and collaterals after long-term illness.
While in China fire cupping, the most common method of cupping, is used on probably two thirds of all patients, cupping generally appears to be underused in the West, possibly because its technicalities are not well understood.
In this article I intend to present what I feel are the important considerations for safe and effective cupping, to review the indications for cupping and to present different ways of applying cups for different situations, including emergency cupping.
I was fortunate to be rigorously schooled in cupping as an intern in the Nanjing clinic of Dr. Wang Ning Sheng who is known locally for his gentle and effective technique. Nearly every day that I was with him he would push me to use different cupping techniques on his patients.
I will limit my discussion here to fire cupping as this is the traditional method and I feel that the fire is an important transformative ingredient in cupping. I have only limited experience of cupping using mechanical suction, but for me it is just that: a mechanical procedure, which does not move the qi in the same way as fire cupping.
I hope that my experience of and enthusiasm for fire cupping will inspire more practitioners to use it.

Application

Cupping is reducing
It must first be stated that however it is applied, cupping has a reducing effect. Nevertheless there are many degrees of, and ways to apply, reduction. The main use of cupping is to reduce stagnation, either of qi or blood. If a patient has deficiency that has led to stagnation it is often difficult to tonify without first clearing the stasis. Cupping is an ideal way to clear this stasis in the midst of deficiency and make room for more qi or blood. I find moving cups or cupping of very short duration most effective in this situation.
The variables in cupping
• Number of cups.
• Degree of suction.
• Duration.
• Size of cups.
• Movement of the cups.
• Speed at which the cups are removed.

Materials

For reasons of hygiene I only use glass cups and will discuss how their effects can resemble those of bamboo cups. Bamboo is generally softer than glass and has a potentially stronger effect in facilitating the movement of blood and clearing phlegm. Chinese Herbal Medicine: Materia Medica1 states of the nature of bamboo shavings that “Its lightness can expel excess, its coolness can expel heat and its bitterness can direct downward – an admirable herb for calming the spirit and relieving constraint”. These are useful attributes for the material from which cupping tools are made.
Under the UK Code of Conduct, bamboo cups must be boiled between uses and I don’t think they will stand this treatment for long. I have gone into the attributes of bamboo because by seeing what we are missing, we can use glass cups in a particular way to achieve a similar result. I will describe this under ‘Basic Application of a Cup’.
Strength of suction – from heavy to light-heavy
The use of many cups, with a strong suction, will produce a strongly reducing effect, especially if they are left in place for a long time (e.g. 30 minutes). Heavy cupping is indicated only for those with strong and heavy bodies. For example for manual workers with serious blood and qi stagnation in their lower backs (back sprain), this type of cupping can get them back to work rapidly. Cupping may be applied while the patient is standing, with the addition of Weizhong BL-40, which is needled or bled.
However, even a single cup applied with strong suction for a long time can strongly reduce stagnation and in my experience may be used for frozen shoulder and other local bi zheng (painful obstruction) on quite frail people. One example would be the use of a single, small cup, very precisely placed on a knot of tension, to release the knot without depleting the patient. This level of precision is unnecessary on a robust person. I frequently use two or three smaller cups, as this makes it easier to tailor the strength of the effect to the patient’s needs. These cups can be applied with varying suction and removed at different times as the stagnation disperses, or in cases where the cups become uncomfortable on delicate patients.
I also use one or two cups over Zhangmen LIV-13 to release a tight diaphragm and help disperse damp-heat from the Gall Bladder and heat from the Liver.
Strong suction for a shorter period of time, 30 seconds to ten minutes, expels exterior pathogens such as wind or heat, and may have the effect of strengthening the ying (nutritive qi) and the wei (defensive qi) as long as the person’s zheng (correct) qi is already relatively strong. This is useful in averting colds and ‘flu in the early stages, and when the channels and collaterals are blocked after prolonged qi or blood stagnation due to traumatic injury, Liver qi stagnation or long-term deficiency. The ying and wei are strengthened because they are no longer obstructed by either the external pathogens (which have now been released to the exterior) or the long term stagnation and stasis (which have now been removed), so the zheng qi is then able to differentiate and propagate.
External pathogenic factors can also be successfully expelled with ‘walking cupping’ (see below). The main application of this technique is for acute wind or cold invasion with pain in the back, and it may be used even in cases of internal deficiency, because walking cups invigorate the surface. This method really comes into its own when the invasion causing the pain is relatively new and quite extreme.
Strong reduction of stagnation of qi, blood or damp, again with minimal negative impact on internal deficiency can be achieved with ‘moving cupping’ (see below).
Strength of suction – moderate
In the middle of the range is moderate suction, for example using approximately five cups on the shoulders for about five minutes. This is effective in relaxing muscle tension due to emotional stress, when the shoulders are often too tender for massage. A similar muscular tenderness may also manifest due to damp-heat or phlegm stagnation in cases of chronic fatigue syndrome. In these cases three or more treatments with cups may be needed before the stagnation begins to move.
Strength of suction – light
The lightest application would use approximately two cups on the shoulders or lower back to assist in the movement of qi while at the same time tonifying the patient with needles. This is useful in a situation where the patient is so weak that they have difficulty responding to tonification because the qi is too deficient to move and the effects of treatment cannot be maintained. Incidentally, this technique is the only one I think is overused. I have observed in China, and amongst those trained in China, that cups are habitually used on back-shu points and while this is not without merit, the standardisation of this protocol on nearly all patients should be questioned because of the variable individual response of each patient to treatment.

Bruising

The patient should be warned that cupping therapy may cause bruising for up to seven days and their consent should be obtained before beginning. Unlike normal bruising, this is not usually tender to the touch. It is rather the stagnation becoming visible on the surface. The nature of the colouration and its duration is therapeutically meaningful and this will be discussed later. If there are blisters or blood spots, the cupping has probably been too hard. It should be noted, however, that bruising may not manifest until after the first or second cupping treatment. Although one might doubt one’s diagnosis in this situation, with perseverance on the practitioner’s part the stagnation will manifest itself. It is probably a good idea not to reapply cups to the same area until the bruising has dispersed, to allow the treatment time to work.
The colour of the bruising gives a good indication of the nature of the stagnation:
• Qi stagnation bruising is generally quite a light red, or even orange if there is blood deficiency.
• Bruising in cases of long-term qi stagnation is generally brown. (This is the colour that was shown in public recently by Gwyneth Paltrow and which appeared in many newspaper photos).
• Blood stagnation bruising is generally from mid-red through to purple.
• Cold bruising is generally very blue.
As the cupping becomes effective there will be progressively less bruising which will also clear more quickly.
Additional uses of cupping
Cupping may be used to assist bleeding treatments and is applied either after needling with a bleeding needle or after seven star hammer treatments. Water cups may be used to reduce inflammation and swelling. These applications will be discussed in more detail below.
Contraindications to cupping
The British Acupuncture Council Guide to Safe Practice lists the following areas on which cupping should not be used
• On the lower back or abdomen during pregnancy.
• Directly over a recently traumatised area. (The key word here is ‘recent’. Sometimes if the bruising is not coming out and the trauma is not healing, cupping is a safe way to move the stagnation and initiate the healing process).
• Over broken or ulcerated skin (including eczema).
• Over oedematous areas. (I use ‘water cups’ over extra point Heding (M-LE-27) in cases of ‘cranes knee wind’ (swelling of the knee due to damp-heat or sometimes to cold transforming to heat). This is the only time I would cup an oedematous area, and it is adjacent to, rather than actually over the oedema).
• Over enlarged blood vessels, varicose veins, thromboses, aneurysms or advanced arteriosclerosis.
• Over needles on the thorax, although it is possible to use cups close to the spine where the musculature is thicker.
• Over the throat area.
• In cases of cardiac disease.
• Over inflamed or perforated organs.
• In cases of severe weakness or anaemia.
• In cases of susceptibility to profuse bleeding (e.g. haemophilia).
• When the patient is taking anti-coagulant medication.
• When there is very thin skin, as in some elderly patients and those on steroid medication.
• In cases of hypertension.

Practicalities and equipment

The following considerations may seem overly detailed, but in order to use cupping at different strengths and in different ways, good control over the tools is needed.

Alcohol

When I was in China there were two large jars in the store. One was marked Alcohol 60% and was used for swabbing, and the other was marked Alcohol 90% and was only used for cupping. Alcohol at a strength that allows it to burn fast and furiously is necessary for cupping. In the UK most practitioners use surgical spirit which has the disadvantage that it contains substances to discourage people from drinking it, to make it less flammable for safety reasons and to stop it being so drying to the skin (often castor oil). These not only change the way that the cupping works, but the chemical additives and resulting odours may also have a medical effect. From experimenting with several forms of alcohol I use one containing castor oil since it has the lightest and most innocuous smell.

The alcohol container

The ideal container:
• Will not break when dropped.
• Must not contain too much at a time in case it is knocked over.
• Must not deteriorate in contact with alcohol.
• Should have a wide enough mouth that the swab is not squashed on its way in or out. It also needs to have sides that slope upwards, making it easier for excess alcohol to be be squeezed off.
• I find the ideal container to be Chinese patent pill bottles.

The swab

Locking forceps should always be used (Halsted Mosquito Hemostat or Foester Sponge Forceps) in preference to normal forceps. This ensures there is no danger of dropping the swab and burning furniture or the patient. A number of practitioners seem to have been put off cupping because they were taught to hold the swab in normal forceps and had feared dropping the flaming swab ever since.
Swabs need to be wrapped tightly otherwise they can drip or squeeze alcohol out if they are accidentally knocked against the cup, which carries obvious hazards if they are alight. If traces of alcohol remain on the inside of the cup, these can run downwards when the cup is placed and burn the patient. With a tightly wrapped swab there is less likelihood of squeezing any alcohol out even if the side or the bottom of the cup is touched.
There are two ways to tightly wrap a swab. Either square or round cotton wool pads are rolled and folded in half with the cut edge in the middle of the fold. The ends are then clamped in the locking forceps with the fold about a centimetre clear. The other method is to unroll a cotton wool ball, spread it to about four centimetres in length, and then re-roll it as tightly as possible and fold and clamp as before.

Some-thoughts-on-fire-cupping-jcm-3swab

 

 

 

 

 

These methods will produce a swab that holds enough alcohol for five or six cups and can be quickly re-loaded.

The cups

To ensure that there are always enough cups, about 18 are needed in the West. Ten or 12 cups are conventionally given as sufficient, but then there is a risk of running out when treating more physically robust patients. Because the Chinese use guasha and tuina at home, their flesh tends to be softer, and in China I never saw the extreme hard stagnation that is evident here. A minimum set would be (internal diameter):
• 6 x 5cm (2”)
• 6 x 4cm (1.5”)
• 4 x 3cm (1.15”)
• 2 x 2.5cm (1”)
Quality is important in two ways. There should be no sharp mould lines and the cups must be strong enough not to shatter when they drop off (because they will).
It is important to check the quality of the cups. The round, thick, clear cups with a flattened top are good and have proved themselves by bouncing off concrete floors in China without breaking.

Oil for moving cups

Another important consideration is that that the oil used for moving cups needs to be therapeutically useful and slippery but at the same time not readily flammable. Bee Brand Massage Oil is a good example.
When testing an oil, it should be spread on good quality paper and a lighter held to it. If it lights more easily than the paper on its own then it should not be used.
The Chinese have little body hair, so they see the body hair of Europeans as a problem in cupping. Their solution is to suggest shaving. This is unacceptable to most patients, and also unnecessary. A thin smear of Aloe Vera gel creates a seal and moistens the skin without any evident changes to the therapeutic effect. It also works for dry skin without leaving a residue. Any spare gel should be wiped from around the cups so that the patient does not get cold while the cups are on.

Cleaning the cups

The British Acupuncture Council Guide to Safe Practice is clear that cups must be properly washed between use, not just wiped. This need not be onerous and should not put us off cupping. They may be removed straight into the sink and washed with Hibitane or household detergent, taken out, rinsed and dried. Then they must have the rims cleaned with an alcohol wipe, ready for reuse.

Basic Application of a Cup

Steps to successfully placing a cup:
Soak the swab and squeeze it out on the inside of the pot so that it will not drip. Holding the forceps in your dominant hand, light it with a lighter. Do not use matches, as they won’t necessarily go out when you drop them.
Hold the cup in your non-dominant hand and warm the rim with the flaming swab. Test the warmth on the inside of your other forearm to ensure the temperature is neither too hot nor too cold for your patient.
The warming of the rim is important to create the dispersing effect of bamboo. (Many books advise against this, seemingly out of fear of over heating or transferring alcohol to the rim and burning the patient. These are both legitimate worries which can be avoided if you test on your own arm).
Place the cup lightly on the place you want to apply it, then barely lift your arm and rotate your forearm. This is the secret of quick and effective application.
Waft the flame into the cup. This can be done with the cup horizontal. Remember not to touch the sides or the bottom. Patients only get burned with cups if some burning liquid is transferred to the cup and then to the person. A well squeezed and firm swab will not transfer fluid so easily if you do accidentally touch the cup.
Immediately rotate your wrist and place the cup. Then lift slightly to help the suction settle and simultaneously test the amount of suction. To achieve different degrees of suction I trained myself to always use the same speed of rotation: this way I can use different distances from the surface to alter the strength of suction. For instance, very close is strong but to get the degree of suction for ‘moving cups’ I hold the cup 7.5cm from the surface as I burn out the air.
Air is about 20% oxygen. As it is only the oxygen that burns, 20% is the most vacuum we can get. Strong cupping seems to pull most people’s flesh about one and a half centimetres into the cup, while ‘moving cups’ pull in the least amount of skin to maintain suction. Different areas and densities of flesh pull up different amounts.
Cover the patient or use a heat lamp while the cups are in place.

Removing the cups

For the greatest comfort and the best effect from the cupping, the cups should be removed as slowly as possible. The one exception to this is ‘walking cups’ when the cups are removed abruptly for a specific effect.
Slide your finger under the edge at the softest place on the skin while holding the cup down. As soon as the vacuum starts leaking out, take the cup off slowly, the slower the better.
Dr. Wang would give me a look if he heard a quick rush of air as I removed the cups. The most common complaint from patients seems to be that it is almost traumatic for them if the cups are removed too quickly, which makes them resistant to trying cups again.
After removal of the cups the patient will have slightly raised circular areas where the vacuum has pulled the skin up. It is more comfortable for the patient if this is soothed, and a good way to do this is to use gentle circular massage through a cloth.

Advanced techniques

Moving cups

Moving cups can be very gentle or strong and are a great treatment for aching lower backs or shoulders when the patient is deficient. As long as they are not left for too long, their zheng (correct) qi will not be reduced. This method is also effective for frozen or painful shoulder of recent onset.
Method: Smooth a relatively generous layer of massage oil over the area to be cupped. Apply a medium sized cup, lightly support the skin with one hand and move the cup while holding it down with the other hand. This should not hurt but it will raise an erythema.
It is very easy to lose the vacuum and the cup is then simply reapplied.

Walking cups (sometimes called flash cupping)

This technique gives strong but superficial reduction for external invasion. The first time I used it was with a computer operator who had been tense on his first day in a new job, had been placed in front of the air conditioning while only wearing a t-shirt and had ended the day in severe pain. He came for treatment early the next day and after ten minutes of moving cups was better. He wore a coat at work that day, had one more treatment that evening and then managed to move his desk.
Method: Using about four medium large cups (two each side of the spine or five, including one over the spine, if there is enough space) work over the whole back, placing the cups in very fast succession in a line across the lower back. Immediately go back to the first one, break the suction with a fast, popping wrist action, and replace it one diameter higher up the back. Break off the next one and replace, continuing until the top of the back is reached, and then work down again, the faster the better. Four or five passes is normally enough. It is useful to have a helper to hand the practitioner recharged swabs.
This is the one technique where the cup may get too hot but it will tend to be the bowl and not the rim, so the hand holding it will be able to assess the heat. Have spare cups handy and change as necessary.
Cover the patient and let them rest for fifteen minutes after cupping before they leave the clinic.

Water cups

As stated earlier, the primary application of this method is with ‘cranes knee wind’ swelling, but it can also be used to assist bleeding. In China I was taught to add a few drops of Dettol to the water. Water cupping is cooling and dispersing. I have seen this used with good effect on a patient’s gouty foot after needling.
Method: Fill a cup one third with water. Apply the flame and using a more exaggerated circular wrist action than usual, turn the cup over rapidly and place it on the patient with the water against them. To remove, pack sufficient couch paper around the cup to absorb all the water and gently release.

Cup-assisted bleeding

This is used either after a bleeding needle or after seven star hammering and is a favourite amongst a number of practitioners for frozen shoulder.
Method: Place strong cup/s over the point/s. Again pack around the cup with paper towel and use gloves while removing, as the cup can partially fill with blood.

Emergency cupping

Dr Wang insisted that I learned this so that I could cup anywhere. It has stood me in good stead with friends when they are doubled up with pain. Knowing this method means that I can always find the equipment to apply cupping in an emergency.
Method: Dr Wang’s method is safe and simple: all you need is some kind of cup. I have used mugs, jam jars, welded tube, brass ashtrays: in fact anything that is not flammable, is able to hold a vacuum and has a smooth edge can be used. It is best, however, if the item is deeper than it is wide.

Some-thoughts-on-fire-cupping-jcm-emerg

 

 

• Use a square of newspaper to provide the flame.
• This square should be slightly larger than the ‘cup’ is deep.
• Fold in an edge of the square so that the folded dimension is about 5mm shorter than the depth of the cup.
• Fold the paper lightly in half the other way, and in half again the same way.
• Do not flatten the folds.
• You now have a kind of concertina that will slip into the cup.
• Hold the cup slightly inverted above the point to be cupped.
• Hold the folded edge of the paper with two spare fingers of the hand holding the cup.
• Light the edge of the paper opposite the folded-in edge. Drop the lighter.
• Take the paper with your free hand. Tilt it to equalise the flame.
• Drop the paper into the cup, flaming end first, and immediately invert on the point. The folded-in edge is against the skin and holds the flames away from the skin by stiffening that edge. As long as there is a good seal the flame will soon asphyxiate inside the jar, creating the vacuum.
In my experience, this method is easier and quicker than wrapping coins in paper and lighting and if you don’t get a seal you can quickly remove the cup before it burns.

Afterword

For a more exhaustive discussion of cupping with many examples of suggested treatments, see Ilkay Chirali’s book on Cupping.
The principles of cupping treatment remain those of Chinese medicine. They must be based on a clear differentiation of syndromes to ensure success.
Emergency Cupping: Preparing the cup (from top to bottom)

Michael Pringle originally qualified in acupuncture at The College of Traditional Chinese Medicine in the UK in 1983. He later studied at The College of Integrated Chinese Medicine (CICM) in Reading and also went to China to consolidate his diagnostic skills. In Nanjing, Michael had tuition from Dr. Wang Ning Shen in advanced cupping techniques. He lives and works in South Devon where he also teaches cupping Contact: michael@acupuncturesouthhams.co.uk.

References
1 Bensky , D, Clavey, S, Stöger, E with Gamble, A, (2004). Chinese Herbal Medicine – Materia Medica, 3rd Edition. Eastland Press, Seattle, USA.
2 Chirali, I (1999). Traditional Chinese Medicine – Cupping Therapy. Churchill Livingstone, Edinburgh, UK.