Michael Phelps walks out at the Rio Olympics, August two thousand sixteen, wins his nineteenth gold, and the world goes collectively insane over the purple circles on his shoulders.
That one image did more for cupping than three thousand years of medical texts.
Hannah sent us something this week that starts exactly there. She remembers the Phelps moment, the eye-rolling, the whole "what is that" reaction. But then she tells a different story. She had this lingering breathing trouble after being sick, weeks of it, felt like the old childhood asthma coming back. Her Chinese medicine practitioner put cups on her back, and the relief was immediate. A couple more sessions and it was basically gone.
That's a strong personal report.
It gets better. She told her dad, and he said his grandmother used to do the same thing. He'd always thought it was just some strange Yiddish grandmother remedy. Bankes, they called it. And she later found out cupping isn't uniquely Chinese at all. It shows up in Egyptian, Greek, Islamic, Jewish traditions, all independently. So what she wants to know is the history across cultures, what each tradition thought it was doing, what modern research actually says, and where the mechanisms stop making sense.
That's a genuine question. Not "does cupping work" as a yes or no, but what is actually going on here.
That's where we should spend our time. Not deciding a verdict, but understanding why a practice that old, that widespread, with that many people reporting benefit, sits in such an awkward place in modern medicine.
The technique itself is straightforward. You take a cup, you create suction inside it, and you put it on the skin. Two ways to do that. The old way is fire. You put a flame inside the cup for a moment, it burns up the oxygen, you pull the flame out and slap the cup on the skin while the air inside is still cooling. The cooling creates a partial vacuum, and the skin gets drawn up into the cup. The modern way is mechanical. A pump pulls the air out through a valve in the top. Same effect, no open flame.
The skin comes up, the capillaries near the surface rupture, and you get those circular red or purple marks. They last about three or four days.
Phelps won that four by one hundred freestyle relay on August eighth, and when he came out, the marks were just sitting there on his shoulders for every camera in the world. He told Time magazine he'd been doing cupping for a while before meets. His exact words were "I asked for a little help yesterday because I was a little sore and I was training hard."
He asked for a little help and got a bruise the size of a tennis ball.
The American gymnast Alex Naddour told USA Today it was "better than any money I've spent on anything else." Called it "the secret that I have had through this year that keeps me healthy." His teammate Chris Brooks was doing DIY cupping with pump cups in his room.
A financial endorsement from a man whose sport involves launching himself off a springboard.
It wasn't even new in celebrity culture. Gwyneth Paltrow was photographed with cupping marks back in two thousand four. Justin Bieber, Victoria Beckham, Jennifer Aniston, all spotted with them before Phelps. But Phelps was different, because he wasn't a celebrity getting a wellness treatment. He was the most decorated Olympian in history, and he was doing it for performance.
And the reaction split right down the middle. Half the world thought it was brilliant, half thought it was medieval nonsense. Wikipedia currently describes cupping as a pseudoscientific treatment method. Edzard Ernst, the professor who's been the most prominent critic of complementary medicine in the UK, said on the BBC there's no evidence for its efficacy. David Colquhoun at UCL called it "hocus pocus" and "a voluntary tax on the gullible."
Meanwhile it appears independently in Chinese, Egyptian, Greek, Islamic, and Ashkenazi Jewish traditions. And millions of people report getting results. Those two facts have to sit in the same room.
Let's start with the room.
The history is older than most people think. The Ebers Papyrus, from Egypt, around fifteen fifty BC, is one of the oldest medical texts in existence, and it mentions cupping. We're talking three and a half thousand years.
The same Ebers Papyrus that has the first written references to heart disease?
Same document. Cupping is sitting right there next to some of the earliest medical descriptions we have. Then Hippocrates, fifth century BC, the father of Western medicine, he compiled extensive descriptions of cupping. He described two different cup types. One had a narrow opening and a long handle, and he used that for what he called "deep accumulation of fluids." The other had a wider opening, and that was for "the spread of pain."
Two cup designs for two different problems. That's not a ritual, that's clinical reasoning.
And it continues. The Arabic and Islamic medical tradition picked it up and ran with it. Al-Razi, born eight fifty-four. Al-Zahrawi, born nine thirty-six, he described specific cupping sites and drew diagrams of the instruments. Ibn Sina, born nine eighty, included cupping in his medical writings. These are not marginal figures. These are the foundational physicians of medieval medicine. Al-Zahrawi's illustrated surgical textbook was a standard reference in Europe for centuries.
Then it spreads to Renaissance Europe.
Fourteenth through seventeenth centuries, cupping is popular in Italy and across Europe, especially for gout and arthritis. Every medical tradition that had access to cups and fire seems to have arrived at this technique.
And that gets us to the piece that makes this personal.
The Yiddish connection. Cupping was known in Yiddish as bankes. Also spelled bonkes or bahnkes, depending on the region. It was a popular form of respiratory healing practiced by folk healers across Eastern Europe. Feldshers, the local medics, carried cupping sets on house calls. The Bielsk-Podlaski yizkor book, the memorial book for that town, describes townspeople doing "bankes, putting on cupping glasses" for the sick.
Hannah's great-grandmother and the Chinese medicine practitioner in Jerusalem were doing the same thing.
Same technique. Independently arrived at. Marek Tuszewicki wrote the landmark work on this, a book called "A Frog under the Tongue," about Jewish folk medicine in Eastern Europe. Bankes is right there in it. There's even a column by Philologos in Mosaic confirming that cupping has a long history in Judaism.
I want to stay with this for a second. When I first encountered leaf medicine, which I maintain is ancestral and not, as Herman would say, debunked, the thing that struck me was how much of folk medicine is not random. It's people observing a physical effect and building a practice around it.
I'll grant you that, with the caveat that observation without controls can lead you very far astray.
Noted and filed.
Here's the part that I think is important. These traditions didn't just independently discover the same technique. They arrived at different explanations for why it works. Traditional Chinese Medicine says cupping helps the flow of qi and rebalances yin and yang. A practitioner named Jackie Long told the BBC in twenty sixteen that "the darker the mark left by the cup, the poorer the blood circulation is in that part of the body." So the mark is diagnostic, not just a side effect.
That's a completely different framework than saying "it relaxes the muscle."
Completely different. Islamic tradition has hijama, which is wet cupping. You make a small cut in the skin before applying the cup, and the suction draws out blood. In Chinese medicine that's seen as a type of detox. In Islamic tradition it's classified as Prophetic medicine, al-Tibb al-Nabawi, tied to reported guidance from the Prophet Muhammad. So you have the same physical technique being explained through qi, through detox, through Prophetic tradition, through Hippocratic humors.
And the explanation is always local.
Always local. The technique travels, or rather, it gets reinvented, and each culture wraps it in its own medical cosmology. That's not a weakness of the practice, exactly. It's a clue about how folk medicine works. The physical thing is real. You put a cup on skin, you create suction, something happens. But the why of it, that's a story each culture tells itself.
Here's the question that sits underneath Hannah's prompt, then. If you've got a technique that's been reinvented five times, that's cheap, that's safe in its basic form, and that people consistently say helps them, at what point does dismissing it without examining why people report benefit become its own kind of closed-mindedness?
I think it does, if you dismiss it without curiosity. The "survived for thousands of years" argument has a real flaw, though. Longevity can reflect that something is cheap, safe, and feels like something is happening. That's not the same as efficacy. A practice can persist for millennia because it's tolerable and affordable, not because it works.
Better than surviving because it's expensive and dangerous.
Fair. But the counterpoint is also real. If you say "people report benefit," and you leave it there, you've explained nothing. The question is what people are actually experiencing, and whether that experience tells you something about the body.
Daniel's family is full of scientists, and Hannah's clearly inherited that skeptical instinct. But she's also telling you: I had breathing trouble, I got cupping, and it went away. That's not nothing.
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I'm going to guess that was you.
I had nothing to do with that.
You knew three specific details about it before I finished the sentence.
I'm familiar with the subscription box space generally. That's market awareness, Corn. That's a different thing.
You have a velvet case problem, Herman.
Let's move on. The modern evidence, which is where this gets interesting, because the studies do not agree with each other.
In what way?
The split is remarkably clean. On one side you have meta-analyses that pool a bunch of trials and find real benefit. Zhang et al, twenty twenty-four, eleven trials, over nine hundred participants, found what they called high-quality evidence that cupping significantly improves pain at two to eight weeks. Effect size of about one point zero nine, which is large.
For context, that's not a marginal effect. That's a "you can feel it" effect.
Jia et al, twenty twenty-five, in BMJ Open, found a significant reduction in chronic musculoskeletal pain, moderate quality. Moura et al, twenty eighteen, sixteen studies on chronic back pain, significant reduction in pain intensity. So the -analyses are positive.
But.
But. When you look at the best-designed individual trials, the ones with proper sham controls, the picture flips. Almeida Silva, twenty twenty-one, ninety participants, eight weekly sessions, found dry cupping was "not superior to sham cupping" for chronic low back pain. The between-group difference was zero to zero point six on a zero to ten scale. That's a nothing difference.
The sham cupping worked as well as the real cupping.
Essentially. Cavalcanti, twenty twenty-six, sixty-two women with knee osteoarthritis, same finding, not superior to sham. Jenkins, also twenty twenty-six, a systematic review in JOSPT Open, five trials, under three hundred participants, found what they called "very-low-certainty evidence" for dry cupping versus placebo. The short-term improvement was about ten points on a hundred-point scale, and the threshold for a meaningful clinical difference is fifteen.
So the good trials say it doesn't beat placebo, and the -analyses, which include a lot of weaker trials, say it does.
That's the crux. And it's a pattern you see in complementary medicine research all the time. The positive -analyses tend to be dominated by lower-quality trials, smaller studies, often from Chinese databases where publication bias is a documented problem. The negative results come from tighter designs with better blinding.
There's something nagging me about the sham, though. How do you sham cupping?
This is the methodological problem I actually think is interesting. Sham cupping usually involves a cup with a hidden vent, so it looks like real cupping but doesn't create full suction. Or it creates very weak suction. But here's the issue. Even sham cupping involves putting a cup on the skin, creating some sensation, and the whole theatrical experience of the treatment.
The patient knows something happened.
They know something happened, and more importantly, they feel something. Cupping produces a dramatic, visible, slightly painful physical sensation. That is exactly the profile that generates strong expectancy effects. You see the marks, you feel the pull, you walk away knowing you had a treatment. That's not a subtle intervention where the placebo effect would be small.
So the sham isn't inert.
It may not be. And that cuts both ways. It means the sham trials might underestimate any real effect, because the sham itself is doing something. But it also means the positive trials might be inflated, because the dramatic nature of the treatment amplifies expectancy in both arms.
The one thing the studies agree on is that it's hard to study.
You cannot blind a practitioner to whether they're doing real cupping, the marks are visible, and the patient can usually tell the difference between strong and weak suction. The double-blind model, which is the gold standard for drug trials, is almost impossible to implement properly here.
What about Hannah's specific experience, the respiratory thing? Because that's not muscle pain, that's a different claim entirely.
The respiratory evidence is essentially absent. There's no rigorous sham-controlled trial of cupping alone for respiratory conditions that I can find. The closest thing is a twenty twenty-three Chinese trial by Tao and Zou that tested blistering cupping plus moxibustion, which is burning herbs near the skin, plus standard inhalers, in bronchial asthma. It improved lung function and airway remodeling markers. But it was an add-on to standard budesonide-formoterol therapy. Cupping wasn't tested alone.
So nobody's actually tested the thing she's describing.
Nobody's isolated it. Her experience of immediate relief after cupping on her back for breathing trouble, that's real as an experience. But there's no trial that says "cupping alone improves respiratory function in a controlled setting."
What about the mechanisms? Is there any plausible story for what the suction could be doing?
Aboushanab and AlSanad published a review in twenty eighteen, and they state it plainly. "The mechanism of action of cupping therapy was not clear until now." And then, "In summary, there is no clear identified mechanism of action of cupping therapy." That's the honest starting point.
That's refreshingly blunt.
Proposed mechanisms include the subatmospheric pressure suction promoting peripheral blood circulation, changes in skin biomechanical properties, increased pain thresholds, improved local anaerobic metabolism, reduced inflammation, modulation of the cellular immune system. There are two named theories. The immunomodulation theory from Guo and colleagues suggests that skin stimulation gets transformed into biological signals that activate the neuroendocrine immune system. Basically, you irritate the skin and the immune system responds.
Which is not crazy. The skin is an immunological organ.
It's not crazy at all. The skin is the largest organ in the body, it's packed with immune cells, and mechanical stimulation of skin does produce measurable biological signals. The question is whether the specific amount of stimulation from cupping produces a clinically meaningful response. The other theory is from Shaban and Ravalia, and it's a genetic theory. Mechanical stress and local oxygen deprivation from the suction could activate or inhibit gene expression. In wet cupping, the scarification might trigger wound-healing gene programs.
So the theory is: you create minor tissue stress, the body mounts a repair response, and that response has systemic effects?
That's the shape of it. Whether that response is large enough to matter clinically is the question the trials haven't answered.
Because the sham trials say it doesn't and the open trials say it does.
You're stuck. The best-controlled trials say no difference from sham. The positive -analyses are dominated by weaker designs. The mechanism is plausible in outline but unproven in detail. And the sham control itself might not be inert.
Let me push this one step further. Hannah said the relief was immediate. She felt it right after the session. If the mechanism is immunomodulation or gene expression, those don't work in minutes. Those take hours or days. So what's the immediate effect?
My guess is that the immediate effect is a combination of things. You've got a strong sensory stimulus, which can modulate pain perception through gate control theory, the same mechanism where rubbing a sore spot reduces pain. You've got increased local blood flow from the suction, which might produce a transient warming or relaxation effect. And you've got the expectancy component, which is not fake, it's a real neurobiological response.
The placebo effect is a real biological event, not a trick.
It's a real biological event. When you expect relief, your brain releases endogenous opioids and dopamine, and those produce measurable changes in pain and mood. The fact that relief might be placebo-mediated does not mean nothing happened. It means the mechanism is expectancy and neurochemistry, not suction and tissue repair.
You can't double-blind a bruise.
No. You really can't.
So where does the honest skeptic actually land?
The honest skeptic says: cupping probably doesn't have specific effects beyond placebo and generic mechanical stimulation, based on the best sham-controlled trials. But the experience of relief is real. The mechanism is unknown. And dismissing it without examining why people report benefit is its own failure of curiosity. You can hold all of those at once.
That's where Hannah is, I think. Skeptic, but curious. Not "this is magic," not "this is nonsense," but "something happened to me and I want to understand what."
And the answer is: we don't fully know what. That's the honest answer. We have some leads, some plausible pathways, but no confirmed mechanism and no clean trial evidence. The respiratory claim is the weakest in terms of evidence and the strongest in terms of personal testimony, which is an uncomfortable position.
The kind of position where you either trust the trial data or you trust your lungs, and most people trust their lungs.
Can't blame them for that.
So you've got a practice that's been reinvented five times across three thousand five hundred years. Each culture found the same physical technique and explained it through its own cosmology. The modern evidence is a mess. The mechanism is unknown. The best trials don't beat sham, the sham might not be inert, and people keep reporting benefit. That's not a simple story.
It's not. And it's not a story that ends with "it works" or "it doesn't." It ends with "we don't know why people keep saying it helps, and that's worth investigating."
Schott Jena glass, set of six, nineteen seventy-three production run, forty-two deutschmarks from the pharmacy on Karl Liebknecht Strasse.
You've been listening.
I've been listening to you two explain cupping to each other for twenty minutes and you've been wrong about the glass the whole time. Nobody used borosilicate. It was soda-lime. Schott switched to borosilicate for labware, not for cups. The cups were always soda-lime, because they needed to take the thermal shock of the flame and not crack, and the soda-lime was cheaper and it worked.
You own cupping cups?
My grandfather's sister, Tante Erna. She was a feldsher in Zeitz, near Leipzig. She treated half the street. She had a case, velvet-lined, smelled of camphor. Six cups, one with a chip in the rim. She said the chip was from a night in February nineteen eighty-two when a man wouldn't sit still while she was working on his back. He kept twisting, and the cup caught the edge of the table. She told him if he moved again she'd do his chest instead and he wouldn't like that. He sat still.
Was the man anyone in particular?
A boxer. Local. Not famous. Called Der Hammer. Real name was Wolfgang. She treated him every two weeks from nineteen seventy-nine to nineteen eighty-six, when he moved to Düsseldorf.
She treated him for seven years?
His back was finished. Too many fights, too much training. He said the cups were the only thing that let him sleep. Whether that's true, I can't tell you. I can tell you he came every two weeks for seven years and paid five marks a session, and when he left for Düsseldorf he gave her a box of cigars and a photograph of himself in the ring, which she kept on the mantelpiece until she died.
What happened to the cups?
My mother took them. They're in her hallway closet, in the same case. Still smells of camphor.
And the chipped one?
Still chipped. Tante Erna wouldn't let anyone fix it. She said it reminded her that some patients needed threatening before they'd hold still.
You said Der Hammer. Do you know his last name?
No. Tante Erna only ever called him Der Hammer. She had a letter he wrote her when he got to Düsseldorf, thanking her. Four lines. But it was in handwriting none of us could read, and my mother's cousin said it might be Plattdeutsch, low German, which none of us speak. My mother's cousin knows a man in Hamburg who can read Plattdeutsch, but the cousin and the man had a falling out in nineteen ninety-four over a parking space, and my mother didn't want to get involved.
So the letter's been sitting there for, what, over thirty years?
Thirty-two years. My mother says she'll deal with it when she has time. She's been saying that since nineteen ninety-four.
At this point the letter could say anything. It could be a thank-you note or it could be a grocery list.
That's what I told her. She said it didn't matter what it said, it mattered that he wrote it. Which I suppose is a position.
She's probably right about that.
She usually is. About most things. Not about the camphor, though. She thinks the camphor smell is from the lining. It's from the cups. Soda-lime glass absorbs camphor if you store them near it, which she did, because Tante Erna kept camphor tincture in the same case for the blister cupping.
Wait, Tante Erna did wet cupping?
On Der Hammer, yes. Every two weeks. Scarification, then the cup. He said it was the only thing that touched the pain. Five marks.
A voluntary tax on the gullible at five marks a session, twice a month, for seven years.
The man could sleep. That's all I know. Whether the cups did it or the threatening did it, I can't tell you. Tante Erna would have said it was the cups.
Five marks is cheap for seven years of sleep.
Corn, everything Tante Erna did was cheap. She patched the same kettle three times. She re-stitched the same coat for forty years. Five marks was her standard rate for everything, including the time she set a man's broken finger in the kitchen at midnight. He gave her ten and she gave five back and told him not to be extravagant.
That's quite a woman.
She was. She's been gone since two thousand three. The cups are still in the closet. The letter is still unread.
Thirty-two years. If you ever do get it translated, tell us what it says.
I'll tell my mother you're interested. She'll be pleased someone else cares about Wolfgang's letter.
Let's bring this together. The mechanism is unknown. The best sham-controlled trials don't show benefit beyond placebo, but the sham itself may not be a true inert control. The positive -analyses exist but are built mostly on weaker trials. The respiratory evidence is essentially absent. And yet the practice persists across thirty-five centuries and five independent traditions.
And people who experience it, including Hannah, report relief that is real as an experience even if we can't pin down the mechanism. The honest position is that we don't know why people report benefit, and that question is worth taking seriously. Not because ancient wisdom is automatically right, but because a consistent pattern of reported relief across cultures and millennia is a legitimate phenomenon to investigate, even if the answer turns out to be placebo and expectancy.
If there's one thing to take from this, it's that "we don't know why this helps" is a different statement from "this doesn't help." The first is honest science. The second is a verdict the evidence doesn't actually support.
And the methodological problem, that you can't build a truly inert sham for a treatment that involves suction, sensation, and visible marks, means the question may be hard to settle with the tools we have. That's not a failure of cupping or a failure of science. It's a recognition that some interventions don't fit neatly into the trial framework we've built.
More rigorous sham-controlled trials may clarify the picture, or the sham problem may prove intractable. Either way, the conversation is worth having. Thanks to Hilbert Flumingtop for producing the show. If this was your kind of episode, go back for episode thirty-five, The Privacy Gap; and episode ten, How ASR Went From Frustration To ... Whisper Magic. This has been My Weird Prompts. If you enjoyed this episode, please leave a review on your podcast platform of choice. It helps other listeners find the show. You can also find us at my weird prompts dot com. We'll see you soon.
