Smudge 1How to smudge yourself and your space: To become centered, stabilized and cleared. 

Smudge sticks (Palo Santo or Sage), used by peoples in the West for millennia as a ceremonial and routine way to help them feel centered, healed, whole as well connected to the Universe.  It has properties to help inspire creativity, deepen the connection to ‘divine’, grounding, and aid in physical as well as emotional healing.   Some people have hesitation using smudge because it seems too esoteric, heretical, or just weird.   I have chosen to present it as a way to become clear on an intention you set for yourself or your home.  This way we can use more of the senses to get some concept going in our lives… This procedure we use sight, scent, movement, and sound to anchor our minds in the intention we set.  It is a symbolic way to use this very effective and powerful tool for emotional healing, spiritual development and intent to make the world a little better.

To smudge follow these steps, you can modify them as you please, but this was the traditional way I was taught by ‘senior healers’ I have chosen over my life.

You will need:  a candle, a lighter, a fire or heat proof dish or holder for the lit smudge, Sage or Palo Santo  (many herbs can be used.  Consider also using sweet-grass etc…)  Optionally, use a feather to waft the smoke.  I use my hand, as I find it not as mindful, useful or respectful of other life to use parts of another being… This is also why I do not advocate nor use an abalone shell… etc.

Light the candle and set it where you choose to begin.  Take a moment to be still.  Always use the breath, concentrate on the whole cycle of breathing with a special notice of the stillness of the top of the breath.

Light the end of the stick/bundle with a candle, leave the candle in the starting place.  let the smudge stick burn out to a smolder or waft it with the opposite hand you are holding it with, be mindful not to hit it, do not blow on it as it may spread embers.  Allow the smoke to rise.  It is best to have a fire proof tray or dish to hold it in or set it in.  You can hold it in your hand though.   Give a moment to silently watch the smoke rise.  Do this with an open contemplative mind.  Next, set your intention for why you are ‘smudging’.  Cleansing, clearing, centering, protecting, healing, etc…


IMG_20180602_122007Start anywhere in your house, go to each corner and waft the smoke in three clock-wise circles, then, move to the next corner (clockwise)… You can go to each room this way, ending in the same room you started in.  It helps to keep the intention when wafting the smoke, repeat it quietly or to yourself.  When you are done with the space smudging, grasp (with a cupped hand) the smoke and ‘wash’ your entire body, starting and ending with the area around your heart.  Continue repeating your intention, BE with that intention in your heart or mind.  Once done you can let the Sage or Palo Santo burn a little longer or tamp it out with sand…do not use water.

Keep the smudge stick dry, mindfully dispose of any ash left on the ground outside. (Returning the intention to source).   This is best done at the New Moon or Full Moon times of the month.

For more information, please see our blog or YouTube channel: Thenaturalbodyworks.


Precautions and Contraindications of Cupping Therapy:

Cupping is a therapy that can have great benefit and is relatively safe to do.  The following precautions should be followed to best avoid injury and undue pain.  This list also has contraindications for patients on whom  you should not do any cupping unless you really understand the pathology and physiology of the condition you are treating or trying to help.

  1. Hemophiliacs and those with thrombocytopenia: These people may have bleeding that will not stop, or undue bruising.  This can be more uncomfortable for them; it can possibly cause more problems, as well.


  1. Anyone who is dehydrated. You will likely find poor results, which can be frustrating.  Someone that is very dehydrated can have a good initial result.  However, cupping can cause trouble with the kidneys and make them feel temporarily worse.


  1. Skin allergies, Psoriasis, Vitiligo, eczema: You may make some of these conditions worse, at least in the short term.  Best advice is to avoid any skin that you would not consider ‘normal’.


  1. Any broken skin: Cuts, abrasions, holes, lacerations etc.  These just hurt and we never want to hurt people.  Infections or oozing areas are not a good idea either.


  1. Other skin changes: Raised moles, warts, local tumors, scabbed areas.  You can cause bleeding at these points.  When in doubt, cup elsewhere.


  1. Areas with large vessels, or lymph nodes: Arm pits (axillary), Cervical areas (the front of the neck), in the groin (inguinal), wrists, anterior of the forearm, back of the knee.  These places are usually considered too ‘Yin’ for cupping.  Some techniques can be used; we can discuss these later.  Cupping in these areas can cause severe pain and may damage the vessels or nodes.


  1. Deep vein thrombosis. Although there is little chance of causing more trouble, it is best to get a clearance from a primary provider before continuing.


  1. Genitals, nipples, lips: anywhere there is a mucous membrane. Mucous membranes are those places that open to the outside that have moisture.  Also the umbilicus (belly button).


  1. On the face. Use special technique… and really small cups…


  1. On or around the eye. This can cause exophthalmos, or an avulsion or prolapse of the tissues.  Avoid the eye area.  It would likely hurt a lot, too.


  1. On the tongue or mouth.  Although a part of a recent fad for young people, you can burst blood vessels as these are areas of very thin tissue.


  1. During the menstrual period as this can cause a disruption in the energy flow and increase discomfort, especially if many cups are used, or cupping is done near the uterus or pelvic area. This is a traditional statement really, and I have not found any significant difference in a person’s feelings after cupping.


  1. Women who are pregnant, ESPECIALLY no cupping on the pregnant belly. In fact there are areas on the ankle that are considered completely forbidden during pregnancy, as they can cause uterine contractions and therefore spontaneous abortion or delivery at the wrong time.  This point is generally not easily cupped anyway; it is located on the inner ankle about three thumb widths up from the ankle bone.  I know of no research or actual cases of this, but better to be safe than sorry.  Cupping on the shoulder and back should be fine as long as it is light and done with care.


  1. Any active disease process that weakens the person. Here, refer to comfort and get advice from an advanced provider who understands what cupping is and does.  This would include:  tuberculosis, anemia, respiratory conditions (COPD, Emphysema, Asthma), cardiovascular issues that are not under control, including hypertension and congestive heart failure.  People who suffer from these ailments may not like or do as well with stronger cupping, so use flash or light cupping.  Remember, healing is a timed process.


  1. Anyone under the age of five, (traditionally it is three years old) I have found it impossible to get one so young to sit still long enough…


  1. Bug bites, animal bites; even though you can remove the toxins or poisons, it’s best to let the body do its own work and not irritate it any more.



  1. Anywhere there are sutures or stitches. Any place there has been recent surgery.  Sometimes glue is used to close wounds.  It’s best to wait until healing is complete; a good rule of thumb is six weeks or so after the sutures have been removed.  A good idea is to check with the surgeon first.



  1. Fresh scar tissue. There are some good techniques to get scar tissue to change, but that is a bit advanced.  Using different sized cups is useful here.  Along with herbs and other salves, it can show good results.


  1. Any burn areas, new or old. A sunburn is a terrible place to have cupping.  It will aggravate the issue and the patient can have massive problems with energy flow.  This can cause fever and chills and make them susceptible to other problems.  Wait until the skin has properly healed and no sloughing of skin is occurring. With sunburn, especially sunburn that covers a large area, avoid cupping it.


  1. Other burns, if someone has scar tissue from a burn, it is best not to do cupping on those areas. The skin is no longer normal. There  are significant challenges to the way cupping would have to be applied and how the scarred skin may react.  Get an OK from the primary if possible.


  1. Someone that does not want cupping. This would include someone that is not feeling up to it or is overly skeptical.  They will tend to focus on the discomfort.  As luck would have it, that is when injury is likely to occur.  Best to wait or offer some other treatment.


  1. Someone who has over eaten, is drunk, or drank a lot the night before. You can re-distribute the toxins and make them feel more ill.  Their energy and fluids are needed to transport and help in the digestion or metabolism process.


  1. Severe fatigue:  This is an option really.  Flash cupping can help them actually feel better.  More ‘fresh’ or effervescent…   This of course depends on the type of fatigue and how much time they have for recovery.  As long as they have the proper follow up, there should not be a  real problem.


  1. The palms or soles of the feet. These areas have different skin and it can be overly irritating.   It is also difficult to get the cups to stay.


  1. After strenuous exercise. The release of that reserve energy can cause the patient  to feel even more tired and fatigued.


  1. Be cautious with people who are overly nervous or restless. Some people with severe emotional disturbance cannot tolerate the therapy and should wait until they are feeling more stable. Occasionally, people can experience sudden and sometimes disturbing emotional releases.


  1. A chronic disease process you do not understand well, including complex disorders that you should first discuss with a practitioner who understands cupping, as well as the condition of the person receiving cupping.


  1. Thin skin, very papery skin. This is common in the very old or frail and you should be cautious with this.  Ok to do lighter technique but be gentle and take time.  It may take many visits to see the desired results.


  1. People on certain medications such as Warfarin, Coumadin, have taken a lot of Aspirin, or blood thinners. People that are taking large amounts of fish oils (omegas), DHEA, Vitamin E, or Gingko Biloba.  They may have markings from cupping that will last a very long time.


  1. People that are under treatment for cancer or diabetes. Make sure you get authorization from their primary care provider.  Although there are no research articles or studies that show cupping doing any harm other than the skin discolorations in people with diabetes or cancer, most Western medical practitioners caution that somehow it can help spread the disease.  There is no basis in fact with this as people have had all sorts of other treatments that were once forbidden for cancer patients, massage being one of them.  Remember, cupping is moving fluids within the tissues.  The body’s natural response is to clean and maintain homeostasis.  The cupping treatment stimulates that to continue more vigorously, thereby removing toxins that would otherwise have a harder time being released and properly dealt with.


  1. Other areas as diagramed below. Elbows, knees, ears, feet and hands are not a real contraindication, it is just too difficult to get any cups to stay and there is little benefit from using them there.

How cupping works:

An easy way to think of the big picture with cupping as a therapy is to think of it as a re-awakening of tissues.  If you have kids, the following example may help.  When you tell your kid to clean their room, they go upstairs for a while. You THINK they are doing exactly what you told them to do.  Later, you ask them if they cleaned their room..  They say, ‘Of course I did, just like you said’… So you believe them and let it go.  Sometime later you go up and see there is still a mess…  So this is pretty much how the body works.  The nervous system (brain), or ‘mom’ or ‘dad’ tells the kid (the distant tissues) to clean up.  The brain has lots to do, just like mom and dad, and cannot constantly check everything, so it  assumes all is well… Now, as cupping is concerned,  let’s go back to mom, dad, and the kid for a moment.  Say the light goes out in the room.  Mom  goes in to change the bulb and see the room is a mess, and tells  the kid to get back in there and clean up.  This is what the cup does on one level. It notifies the nervous system that attention is needed in the tissues.  The nervous system responds with a cleanup action.  This is how detoxification occurs.  Things build up in tissues just like they do in a child’s room.  If ignored, eventually dis-ease (lack of ease) occurs in the household (arguments, rolling of eyes, slamming of doors, etc.…) Cupping helps the tissues run at-ease as well as maintain homeostasis and balance in a ‘forgotten’ area.


Cupping changes the pH of tissues.  The pH means the amount or ‘potential’ of Hydrogen ions in a given solution.  Those with many Hydrogen ions bound to them are generally alkaline or ‘high’ pH.  Those with few or are giving off Hydrogen ions are considered acidic or ‘low’ pH.

The pH scale is on a 0 to 14 scale, with 14 being very alkaline and 0 being very acidic.  Distilled water is at 7 or neutral.  That basically means it does not give Hydrogen ions (acid) or receive Hydrogen ions (basic).

Our bodies have a multitude of ways to maintain a proper pH.  But, what is normal???


The ‘normal’ or most efficient pH of blood it 7.4.  To understand this, too low of a pH in blood could be from poor oxygen exchange in the cases of hypo ventilation, asthma, bronchitis, pneumonia, near drowning, loss of consciousness etc.  This would require the use of oxygen and a bicarbonate to ‘buffer’ the acid.


On the other hand, hyperventilation or too much O2 can cause the blood to be more alkaline and will reduce the breathing.  A pH of blood that is too high or too low would result in coma and eventual death.

The body is designed to deal with this in many ways.  You can change the breathing pattern and change the pH easily, next is to urinate out acids and the excess Hydrogen ions, then we can sweat, defecate or even take some of the calcium from bone to buffer the acids in the plasma.   Foods also make a significant difference in pH.


Urinary pH should be around 6.5 (slightly acid) to 8.0 (slightly alkaline) but then can become more alkaline in the evening as you have eaten and are releasing electrolytes (7.5 to 8.0).  Too much acid in the body would make the pH of the urine drop below 6.5.


Salivary pH should be between about 6.5 and 7.5.  So also, a rather narrow range.  This can change with foods eaten, amount of hydration, stress, and other biome factors. (Biome is the natural bacteria and other critters living on and in us.)



Cupping: the real deal.

  1. When the cup is placed on the skin, the practitioner will pump air from the bell shaped cup and cause a vacuum. This vacuum will, because of negative pressure in the cup, cause the skin to be pulled upward, making a bulge.


  1. As the skin is pulled up, a deep suction is created in the underlying tissues, which moves fluid (interstitial fluid, intercellular fluid, Lymph, (blood) and plasma). The fluid will change its place, thereby causing a further void that will be filled with other fluids nearby.  This new imbalance causes the vessels to open and bring more water and fluid into the area and help to wash out any toxins that were stuck due to poor circulation.   Not to get too technical, but it is this  action of hydrostatic pressure that moves the fluid.  Then as the fluid has moved to a new area, changing the concentration of fluid proteins, electrolytes and other solutes, they are further moved with osmotic pressure of water, depending on where and how concentrated the ‘stuff’ is in the fluid.


  1. Basically this is what is called Sterling’s Law of Capillaries. Hydrostatic pressure, also called fluid pressure, pushes more at the arteriole areas and pushes water out of the vessel into the interstitial space (space between cells, but outside the vascular system); then the water may travel into a cell (intercellular fluid) or eventually to the lymph capillary to be taken back up to the vascular system at the subclavian veins.  Then osmotic pressure, because of plasma proteins ‘sucks’ the water at the venuoles side… (See the diagram)
  2. Cupping causes a total, yet temporary, disruption of this process. Think of it as the opposite of massage pressure.  Instead of pushing, you are pulling.  This allows fluids to flow in directions they usually do not.  The body’s natural response is to re-regulate the fluid composition and redistribute the fluids back to a more ‘normal’ area.


  1. Stimulation of new blood, lymph, plasma, and intercellular fluid or interstitial fluid flow to areas where it has been removed by the vacuum or negative pressure.
  2. Toxins are generally cellular debris, lactic acids from anaerobic burning of glucose, Carbonic acid from respiration, acidic ketone bodies, and sulfuric acids from other metabolic processes.


  1. Once the fluids have been taken out of their regular environment, the histamines, heparins and other chemicals released by the stimulation of the cupping open the surrounding tissues and allows ‘flushing’ of the fluids back into lymph and blood capillaries. Also, because of the forced imbalance of the cells, spaces between the cells and fat cells, more actions are required by the cells, tissues and surrounding areas to regain their harmony (homeostasis) in the cupped area.


When the kidneys, liver and lungs cannot process these issues and become over worked, the body will naturally put the toxins ‘in storage’ so they can get to them later.  This usually will be in the underlying fat of the skin.   The cupping action is that of a vacuum.  It pulls the tissue and therefore the fluids through the different compartments and, over time, will stimulate the body to clear it out.

Cupping is quicker than acupuncture, massage or even chiropractic at getting toxins to release and be processed.

Cupping can also help you determine the extent of an issue…

-Demonstrates the severity of the congestion (see below)

-Demonstrates the location of the most congestion and stagnation.

-Can stimulate the liver, kidney, lungs and skin to work more efficiently.

A body in motion moves fluids through pressure changes both from within and on the outside.  The gentle bellows action of the normal breathing process, movement of muscles when walking or doing exercise help fluids change places.  Other ways you can get this is with massage, stretching, and other normal activities.  Many times people are rather sedentary; they work at jobs that require sitting, then go to a vehicle that offers the same.  Since they are tired, they simply go home and sit on the couch, then go to bed.  This is far too little movement of the body and will inevitably lead to stagnation and eventual breakdown.

Take the example of bed sores, called stasis ulcers.  When people are bed ridden and cannot move, the fluids in the body begin to settle and ooze through their normal position toward the ground.  The first signs are redness, then an oily sheen on that part of the skin as the plasma and lymph are oozing through.  Soon the tissue will become irritated and not be able to transfer out carbon dioxide or get oxygen, thereby becoming acidic. It  starts to break down.  That leads to an ulcer (an open lesion of the skin). The ulcer is susceptible to dis-ease from bacteria, becomes  active in the acidic environment and does  not have  good blood flow, which impedes the natural cleaning process by the blood (do you mean red?) and white blood cells.  Once bacteria get going, they can be difficult to stop.  Most people who are bed ridden do not have a great immune system to begin with. That can begin a cascade of trouble, leading to sepsis and eventual death.

Cupping is not the only answer, of course.  It is one tool.  The first and foremost way to ensure there is good flow is to move.  Exercise, get massage, do some stretches!  Let us imagine you have had a back injury. To help your body through this injury, your  muscles tighten,  the blood flow decreases and then your blood can become still and stagnant, making it difficult to clean out.  I suggest only a few sessions to get things going, and you can get the whole process in motion and find quicker relief. (? Did not understand last sentence.)

An occasional ‘tune up’ is a good idea and I suggest once a month or so, with a follow up visit. ).The chart below will show you what to look for.   As areas go from congested through to good healthy blood flow, you will find more relief.  Someone with spots after cupping that are on the left side (healthy Blood Circulation) will have a pink-ness that will go away in a day or so.  They only need maintenance, for example, once every few weeks depending on their activity levels.

Cupping Therapy Mishaps, When things go wrong:

What to do if…

In cupping as a practice, like any type of health care procedure, things can go not as planned.  In fact, you can hurt yourself or others with most health maintenance products.  One can cut a gum with dental floss; rupture an ear drum with a ‘Q-Tip’, or cut yourself with a simple razor.  You can also overdose on the myriad of over the counter medications available at any local store, many with fatal results.  Did you know, for example, that over 1,000 people a year die from taking Tylenol as it is suggested ON the label?!  Most of the issues we will see with cupping are very minor indeed; however, knowing how to handle an unexpected problem can make all the difference, if you are prepared.  Here is a list of the most common and what to do about them.  While we are using a cupping system and technique that avoids fire, we generally do not have to worry about the most common injury in fire cupping, that is, burns.  Please refer to the section on contraindications and precautions to keep these from happening….


  1. Bleeding mole or mark: If you placed the cup near a mole that is raised or at all different from the surrounding skin, it can tear or open and bleed.  This is a simple fix.  First, stop the cupping on that area and remove the cup.  Use a cotton ball or gauze swab to clean any blood off the skin.  Make  sure you stop the bleeding with direct pressure.  Clean the area well and place a Band-Aid on the open skin.  You may choose to tell the person having cupping to use some Neosporin and to watch the area for proper healing.  Make sure and follow up over the next few days to see how it is going.  Reassure the ‘client’ that it can happen in rare occasions and is largely inconsequential.  Any infection should be followed up with a more qualified practitioner.


  1. Severe bruise: In this case we see a bruise that seems to last too long.  Remember the lesion you created is not a true bruise.  A bruise is a breaking of blood vessels and ‘frank blood’ leaking into the surrounding tissues.  Reassure the client and have them use a cold pack for pain if they experience this.



  1. Skin irritation: Stop the cupping if you see increased redness around the cup, or if the client complains that the cupping itches.  It is simply too much pressure.  Release some of the pressure in the cup but keep it in place for the duration of the treatment.  If irritation occurs after the cupping session, it may also be a sign that the tissues were very closed off, and the new flow of fluids are stimulating new flow of nutrients and toxins out of the system.  If this is too irritating or they notice swelling that lasts more than a day or two, this means they are VERY toxic and will need much more treatment.  Heat then, would be the choice of treatment.  A good Epsom salts bath can help.


  1. Health Care Crisis’ i.e. feeling worse after a session: This is common when there is  poor energy in the body to handle the toxins that were stirred up by treatment.  Here, the best treatment is lots of good fluids and get some rest.  The client should be reassured that this can be expected only once or twice ever and that future treatments will be more invigorating for sure.  If the feeling of cruddiness lasts more than two days, it is best to get to a more qualified practitioner for an evaluation. There  may be something else going on not really related to the cupping.



  1. Prolapsed or bulging vessel: This can happen when cupping is done on one of the areas you should not be doing it on… so make sure you follow the precautions.  If this does happen because of too brazen cupping, press the area with a finger and place a cold pack on it as soon as possible.  If the vessel ruptures you will see lots of bruising.  Best not to do any more cupping on that area until completely healed, and then consider other areas.


  1. Blisters filled with water: This happens when the tissues of the patient are too tight, acting like wood.  There is no good capillary flow and the lymph is sluggish at best.  The blisters may pop.  If not, it is best to pop them on the most inferior aspect and let them drain.  Make sure they stay covered as this is open skin.  It is very common that they leave red marks ‘lesions’ for up to a couple weeks.    In the future consider massage or ‘moving’ cupping technique.





  1. Infection: In the very exceptionally rare event of any type of infection:  That is, heat, redness, pain, and swelling in the area. Stop cupping until the infection is cleared and get to the real cause of their illness.  Refer to another provider as soon as possible.  Any area that may have broken skin or that you might think has infection, cover with Neosporin and watch it closely for a few days for signs of healing.   Treat it as you would any injury to the skin.


  1. Broken skin, tearing: This is most common in older people that have paper thin skin and are generally poorly hydrated. The skin can tear like wet paper.  Avoid further cupping and make sure the area is covered and let to heal properly.  Maintain communication with the client about this, and that they need much more integumentary hydration and collagen.  They should consider strong doses of Vitamin C to help with skin repair.  Other nutritionals should also be considered.   Make sure that they are hydrated and keep that up as well as something to hydrate and help the skin.



  1. Pain during cupping: This is common in first timers as well as when you get a little too aggressive with the cupping.  Check in with the client every few minutes.  This therapy can be uncomfortable, but too much pain just stresses the client.  Release some of the pressure by pulling the tab at the top of the cup.  Then you can add more pressure by using the pump gun for another light pump or two.


  1. Emotional releases: This is left for last because it is the least expected and can be one of the most disturbing for both the client and practitioner.  Often the client is too stressed to receive cupping for this session; however, you both choose to do it at this time.  There is no lasting trouble here, so be confident and compassionate.


Here is what to do.  First, have the client stay still if they can, and loosen the cups but do not remove them… Then have the client breath out longer than they breathe in.  When they exhale do it as if they are fogging their glasses to clean them. This enhances the tone of the Vagus nerve and they will soon relax.  Offer simple ‘holding of a space’ support.  There is no need to talk it out unless they are willing and ready.


In fact, let them initiate.  Explain to them that occasionally, emotional energies get caught up in tissues and can be released with such therapies.  It is really a great sign that healing or detoxification is occurring on multiple levels is possible, and the release is a great sign.  Comfort and rest are the best treatment now.  Future treatments may or may not have the same response.  Just go with it.    Catharsis is a good thing.  The safe space you have created allowed this to blossom forth.

Types of cupping

  1. Weak or light cupping: This is just as it says, light and easy.  One pump or so, left for a short time, to begin the stimulation of the movement of the fluids.  This is great for first timers, children, the skeptical, and frail.


  1. Medium or strong cupping: As you work up to this level, you will see more stagnation and more movement of the fluids.  This is, in my opinion, the best technique.  You can work up to it either over multiple visits/treatments or during a treatment.  Basically an extension of weak cupping.


  1. Moving cupping: (Negative Pressure Massage) this is a great technique for muscle pain, and for stress care (Emotional, mental, spiritual or energetic).  Use the meridian charts to move the energy and stagnation out, as well as to enhance or reduce the flow of Qi energy.  You can use oils to help the cups slide across the skin.  It is difficult on bony areas and areas that are in corners etc… Finnish cups are either silicone or a form of latex that are flexible and work really well for muscle tightness.   You can also affect the myofascial system greatly with this technique.  Similar is a technique of pulling or moving the skin that is held under the cup.


  1. Needle or puncture cupping: Also called wet cupping.  In this technique, though, we are using cupping along with acupuncture and are only attempting to get one drop of blood.  This causes a healing event and can help the body with swelling and with chronic issues.  Proper technique requires good cleaning and sterile equipment.


  1. Moxa or hot cupping: Sometimes a piece of paper is set alight and placed in the cup.  Usually when the cup is placed on the body the paper burns away and sticks to the top of the cup.  It can burn the patient.  It can be infused paper with certain herbs, or have certain prayers of sayings written upon them to enhance more subtle healing.  I do not prefer this, as again we are playing with fire… on many levels.


  1. Empty or flash cupping: This is a misnomer really; it is very quick and repetitive to get some redness.  We are not leaving the cups on more than a couple moments.  Good for use on the face, and some areas that have lots of vascularity or lymph tissue.   This is also good for the very fatigued as it can increase Qi energy movement.


  1. Wet or bleeding cupping: Found typically in western medicine and Middle Eastern medicine.  Here, cuts are placed in the skin then the cups pull out the stagnant blood or morbid humors[1]… This is a big hazard for infection, but even so,  it is quite popular.  The blood needs to be properly discarded and cleaned.  I find it disagreeable and rather advanced.  I do not think I would have it done to me unless I was in a dire condition.


  1. Herbal cupping: Placing herbal liquids or tinctures in the cup can help deliver them into the tissues directly.  Works great with tinctures made with alcohol.  No burning is necessary.  We can do this one with the vacuum cups.  It can be messy and may cause some irritation on the skin.


  1. Water cupping: The cups are placed in very hot water and then placed on the body; this heat transfer causes the vacuum phenomenon.  It is primarily used with either horn or bamboo cups.  We do not use it because it can also burn the person as well as create a wet mess.


  1. Fire cupping: This involves the use of spirits such as rubbing alcohol as the fuel.  The fuel is rubbed inside the cup and set alight, then the cup is placed on the body.  The fire depletes the oxygen in the cup and creates a vacuum and suction.  We do not do this type of cupping for a few reasons.  First of all, fire burns stuff.  The cup can become hot and can burn the skin or scorch the skin.  It only allows for a single application per cup at a time.  You cannot easily adjust the suction.  This is perhaps one of the oldest ways to cup.

Video: difference between acupuncture and dryneedling

The difference between acupuncture and dry needling.

A historical and practical application.

Key words:  Dry Needle, Acupuncture, Motor point needling, Ashi acupuncture, Tsubo acupuncture, Trigger point, Deqi, Meridian, Spasm, Fasciculation, adverse reaction, myofascial pain,

Acupuncture:  “Technique for treating certain painful conditions and for producing regional anesthesia by passing long thin needles through the skin to specific points.  The free ends of the needles are twirled or in some cases used to conduct a weak electric current.  Anesthesia sufficient to permit abdominal, Thoracic, and head and neck surgery has been produced by the use of acupuncture alone.  The patient is fully conscious during the surgery.  Acupuncture as a method of medical investigation (but not for anesthesia) has been known in the Far East for centuries. But received little attention in Western cultures until the 1970’s.”  (Taber’s Cyclopedic Medical Dictionary, 16th Edition, 1989)

The online Miriam-Webster dictionary lists acupuncture as:  “An originally ancient Chinese practice of inserting fine needles through the skin at specific points especially to cure or relieve pain (as in surgery).”

To understand it, let’s take the word acupuncture and dissect that; Acus, in Latin means ‘needle’, and puncture (common English) is to pierce. This term was coined in the 1700s and continues to be used today.

Acupuncture as we know it now is the application of filiform needles (without any tube to deliver liquid). These needles are sterile, generally blister packed and designed to be disposed of.  The points that they are inserted in are very specific and have been largely agreed upon for thousands of years.  Each of these points has been organized into meridian lines which correspond with a functional organ of the body.  Basically, there are, in some cases over 1,000 points, but it is common to study about 365 points along 12 meridians.  There are also special points that are not on those meridians but generally align with nerves.

As for spasm treatment, acupuncture and dry needling are very similar, in fact nearly identical.  When I was in Japan, I did some training with a physiotherapist that happened to be an acupuncturist.  He showed me a technique he simply called ‘Ashi’ (basically means ‘ouch’).  The point of pain, as indicated by the patient and confirmed by the practitioner as a tight muscle with point tenderness (basically a trigger point) was used as the location of a larger diameter needle until it twitched or the patient felt what is called ‘De-qi’ or “Daychee”.  De-qi is the excitation of the point releasing or moving the energy.  It is a feeling by the patient of warmth, soreness, ache, distention, heaviness, dull pain and even a sensation of ‘energy’ by the patient.  This can be quite substantial and is always a good sign that the point was, in fact, located.    Occasionally the patient will feel sharp pain, usually described as a pinch or poke.  This is an obvious sign of being poked with a needle and I do not consider it a good indicator of anything except possibly anxiety or a basically functional nervous system in the area.

Dry Needling: A newer term (not found in my Taber’s Cyclopedic Dictionary, 1989) Has also been called trigger point needling, myofascial needling, medical acupuncture and others.   Initial research finds mention of it by Dr. Janet Travell.  She was the modern founder of the trigger point therapy techniques.

It is also commonly held by practitioners in the West that Dry Needling has no ties to acupuncture historically, this, however is only partly true.  Dr. Travel and others were using hypodermic needles to inject areas of muscle spasm as early as the 1940’s.  The common fluid (medicine) injected as either Lidocaine, Novocain, and more commonly corticosteroids, sometimes even saline may be used as a counter irritant.

Dry Needling according to the National Institute of Health is; ‘dry needling is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments’    Ref:

In the 1970s it had been discovered that stimulation of the trigger point or spasm occurred even without injection of the medication at times.  This stimulation and result came to be known as the ‘twitch response’.  It could be created without anything in the needle at all, thus, ‘dry needle’ was coined.

It was found that the results of dry needle and wet needle were actually comparable and acceptable to both the provider and patient.  There were no side effects nor problems with the medications.

Some of these side effects of using a medication for injection are; bleeding at the site of injection, increased pain, headaches, sleepiness, fever, high blood sugar, decrease in immunity because of suppressive effects of steroids, anxiety, stomach ulcers, avascular necrosis (death of the bone because the steroid interfered with blood flow), infection,  cataracts…

Side effects of dry needling are similar to those of acupuncture and include; bleeding, ache, or pain at the site after treatment. Infection is also possible although extremely rare as in wet needling.  As long as either practitioner uses good prep and disposal there is little concern for infection.

Notice that with the acupuncture and dry needling there are no ‘other’ symptoms related to an injectable substance because there is nothing injected and therefore no artificially provided biochemical change.

The attempt to separate:

Currently there is a turf war over this technique and its definition.  Physiotherapists, medical doctors, physical therapists, chiropractors and acupuncturists are all vying for reimbursement from insurance companies.  The reimbursement is always related to the specific definition of a condition and the treatment.

So each of the types of providers have a stake in the claim and do not want the others to have that patient base and ability to bill for a specific procedure.  Therefore we have the definition wars.  Each of the provider types have different, even if slightly, definitions of dry needing and acupuncture.  This ensures (according to each of them) professionalism, accuracy, and technique boundaries.  A simple web search will show this to be true.

In reality there is some difference in the practice but only in definition.  We see words like twisting vs. rotation of a needle or ‘pistoning’ as a way to explain a needle manipulation of pushing and pulling the needle.  Each of these are well defined and designed to be specific.  Some of the definitions, including that of dry needling itself have been because of research articles written in each of the prospective practitioners’ journals.  Once you start to really look and read the techniques, whether Eastern or Wester are, by and large the same.

The difference in practice:

So, the difference between acupuncture and dry needling is the topic here and that is what we need to focus on.  In acupuncture, as it is largely practiced, deals with subtle energy and the flow of that energy as perceived by the practitioner not the patient (objective finding).  Few patients will arrive complaining of a ‘slippery pulse’ in the spleen meridian.  This is a rather typical finding in acupuncture used by a well-trained and proficient acupuncturist.

Having a muscle spasm is something that is both subjective and objective inspection.  Having a spasm or ‘ashi’ point is in fact a part of acupuncture and is treatable with shallow needle work.  Acupuncture generally goes to a depth of less than 1” (cun=body inch as indicated by the width of the patient’s thumb on their body).   Since most spasms people complain of are on the back, it stands to reason that also the needling in those areas will be shallow (less than 1 cun).  Of course this is only if the needle is inserted perpendicular to the surface.  Angled insertion can go in much further.

There is no difference in the needles themselves.  Unless the practitioner is using ‘real’ dry needling and wasting an entire syringe to do the work of a regular filiform needle.  Acupuncture or dry needling needles come in various lengths.  In my practice I use needles that are between 5 mm. in length (usually for hand, fingers, toes and facial acupuncture up to 125 mm. (that is about 5”, used at an angle mostly or in people with significant subcutaneous fat.  This way I can get to the muscle tissue).  Somewhere in the middle of that range is the length for acupuncture needles by any given practitioner.  Some prefer shorter or longer depending on depth needed and technique.

Another measurement of the needles is the diameter.  In my office I use a very thin .18 mm (about 2-3x the thickness of a human hair from the head) (Ref.   to .60 of a mm.  This of course also is related to the length, a thin needle that is too long is flimsy and difficult to manage.  One that is too thick but short not only looks imposing but also unable to perform the needed manipulations in the muscle or deeper tissues it is designed for.   However, taking a hypodermic needle diameter, they are generally measured in gauge.  Typically from about 16 to 29 gauge.  That is about 1.6 mm to .30 mm (the larger the gauge the smaller the needle) this is at its largest size (.30mm or 16 gauge) is the size of needle I prefer for most muscular dry needling.  I often show people that I can put a few of my regular acupuncture needles inside a hypodermic needle.  Most patients also relate this to possible perceived pain and helps with anxiety about getting the procedure.   A smaller diameter needle will go in easier, a larger one will be more difficult to insert and will be felt by the patient more.


Patients ask me if the needles I use are sterile.  Today, the needles are manufactured at plants that may also make other medical grade instruments.  Mainly as I have seen needles are sterile when they are made and come in blister packs of one to ten needles.  Each needle is stainless steel and some are covered in silicone to make insertion easier.  All the needles are intended to be disposed of after a single use.  A single use is generally per patient but may also be single insertion depending on the technique and need of the situation.   In history, since metal is very difficult to come by and manufacture, a single needle was used and used again on other patients.  Boiling the needle to clean or with cleaners such as alcohol or fire have been used.  Previously to that the needle was rubbed on the hair of the practitioner to clean.  Sebum, the oil released by the sebaceous glands at each hair follicle is generally antiseptic and this was understood hundreds of years ago.  (Note, in the West and the world, penicillin was not discovered or used until the 1940s.)  So in brief, the needles are sterile, they are used once and disposed of.  This is true of syringe needles and acupuncture or dry needling needles.  This way, we can reduce the possibility of infection.

Dry needle theory:

Dry needling as explained using the filiform needles is as follows.  There are a couple different theories and I will try to combine and explain in as little space as possible.  First, there is the blood as an irritant theory.  When a needle is pushed into the muscle tissue there is bleeding.  This causes an inflammatory response including heparin, histamine and other chemical inflammation mediators.  This attracts white blood cells to start a repair process.  Many times, the chronic spasm has been ‘forgotten’ by the system.  Likely this is because it was a constant and consistent set of impulses to the central nervous system that eventually became ‘background noise’ or was eventually ignored as an alarm and became a ‘normal’ action of that set of muscle fibers.  The new injury from the needling caused a whole new alarm and set of steps to evaluate and fix the issue.  This is also why people generally can feel achy for a day or so after the treatment.  Not at the points of insertion necessarily but in the muscle treated overall.

Other theories go into inflammation response, the twitch response, muscle spindle or Golgi tendon organ stimulation etc.  I have only outlined the basic most accepted reasoning.

This of course is not to diminish the work of acupuncture as it is done on the meridian points.  Dry needling does not generally follow the specificity of the acupuncture points and may go far off a meridian line into a belly of a muscle elsewhere.   This is the real only difference in the technique unless you are doing the ‘ashi’ style.

Trigger points have to be understood as well in this discussion.  Dr. Travel and others found that there were two types of trigger points; latent and active.  Active ones had referral pain that not always followed the nerve path, but did stick to the general myotome or dermatome.  Latent ones were there when you palpated them but may not have symptoms otherwise.  Once a trigger point, also commonly called knots or tsubos (Tsubos are tight points along the meridians in Japanese techniques.  Ref: Tsubo, Vital Points for Oriental Therapy, by Katsusuke Serizawa, M.D.) are areas of increased tension in the set of muscle fibers.  This blocks off incoming blood flow including nutrients like glucose, oxygen and water to the cells so that they can run properly.  The tightness also reduces the release from the area of waste products such as lactic acid, carbonic acid, cellular debris and other products of cellular metabolism.  To better understand this, please read about the pain spasm cycle for more detail.

Once the needle pierces the proper point on the muscle belly a twitch can be observed.  This twitch is a good indicator that the muscle has held too much tension and is giving a release of physical, chemical and energetic tension.  Other good signs are the ‘red flash’, a redness around the needle indicating a proper inflammation response.  The duration and circumference of the red flash spot is an indicator of general function of the whole body and area being treated.  Another sign it is working is the feeling of a deep ache or cramp by the patient in the treated muscle.  This feeling will go away with some manipulation of the needle and will help the patient regain a communication with the area of treatment neurologically and consciously.  Of course much of that is speculative and subjective.  This is why acupuncture and dry needling do not react the same on every patient or even the same patient every time.  Thinking holistically we have to also consider physical, physiological, psychological, environmental, cultural and even social aspects of the stress response and how the treatment will work.   Many would simply write this all off to the placebo effect.  We must also keep in mind that the placebo effect is present in every procedure that the patient is conscious and can be molded by all the expectations and suggestions involving the topics as listed above.

This brings us to the real difference between dry needling and acupuncture.  Since traditionally performed acupuncture relies on insertion of needles into specific points called meridian points or acupuncture points and dry needling does not it stands that they are very different.  Dry needling concerns itself with muscular pain and tension and may have points used not on the meridian system.  However, taking into consideration the numerous ‘special points’ or exceptional points or whatever you would like to call them and that acupuncture does and has used needles to relieve spasm for over two millennia we are at an impasse.  The dry needling practitioner does not need to know the meridians.  Only knowledge of muscles, some physiology and general anatomy along with some palpation skill is needed by the dry needle practitioner.   The acupuncturist may have knowledge of the meridians and the points but lack the palpation skills or musculoskeletal knowledge of the physiotherapist or chiropractor.  Somewhere between the two we will find the answer.  A practitioner of either sort would benefit from study of the other to enhance their skills and service to the public.

So, in my opinion, the only difference is the desired outcome by the practitioner.  There is little to no real dry needling with a syringe done anymore.  So I would venture to say dry needling is a part of acupuncture that was renamed for convenience.  Call it what you will, the result is the goal.  Pain free patients that can go about their daily lives in comfort.




First of all, the marks are NOT bruises.  Bruises are areas where the blood has left the vessel because the vessel has been crushed or torn. The ‘frank’ blood has escaped into the surrounding tissues.  “Frank” blood is blood that is liquid red.  Nothing special.


In the more holistic forms of health care we have four examination points to consider to get a whole picture of the patient’s overall health.   In more focal techniques that are used in hospitals and ‘Western’ medical offices they usually rely of only the main complaint.   Most of these were developed thousands of years ago before x-ray or MRIs became even a dream.  The four diagnoses are; looking, listening, smelling/tasting, and touching (palpation).


The looking diagnosis is used here in the cupping technique because we need to see the marks left by the cups to determine how much stagnation there is.  Looking diagnosis takes into consideration the skin, eyes, hair, tongue, tone and color of the lips etc.  These can give a good indication of how healthy the person is generally.  However, people that use many products such as hair gels, conditioners, makeup, cover-ups and such can be more difficult to diagnose correctly.   To use looking diagnosis on a patient beforehand we hope to determine the following.  Skin tone and color, determine if the skin is too dry, or there are mottled portions (colored patterns) also look for moles, skin tags, scars and the like.  These can determine changes in the cupping technique, placement or time of treatment.


Listening diagnosis:  Not only listening to the patient as to why they are getting cupping it is important to know their expectations of what they think it will do for them.  Also the tone and volume of voice can indicate other issues such as weakness, nervousness, etc.  In traditional Chinese theory as well as Ayurveda certain sounds relate to specific organs or energy centers.


Smelling and tasting of a patient is rather weird, but having that knowledge can help you determine other factors of the health and dis-ease processes of the patient.  Here, with cupping we do not need to smell or taste anything.  The practitioners of old would smell breath, urine, taste skin etc to find core causes of disease.


Felling diagnosis is also called palpation.  We will use this to feel for very tight areas and how loose or tight the tissue is we are cupping on.   In traditional Chinese medicine and acupuncture practice we use the pulse to determine problems.  In cupping you can use touch to find where to put the cups, where to avoid putting them (like on boney areas) and the like.

So now that you have completed cupping on a person you see a variation of colors, textures and other ‘signs’ what do they mean?


The first spot.  Darkened purple to almost black spot.  This is a severe stagnation sign and there is good chance that the toxins have now been released for the body to process.  It is the most desirable sign in cupping.   It means you have gotten much of that dark, stagnant blood up to the surface. We will recheck each three or four days until there are not any more spots to do.  We try to give at least five days for each spot to completely ‘heal’, although some bilirubin signs may remain for up to two weeks.  This is also a sign that the overall system is challenged.


The second:  Moderate stagnation:  This is a more red than purple spot.  A good sign toxins have been released as well, but they were not as stagnant as long. You may notice this after a couple sessions on the same person.  It means you have gotten some of that deep dark stagnant blood to the surface.  It may mean you only have a few more treatments before you are ‘clear’. There may be blisters or clear fluid as well.  This level would require some visits to clear out. I usually suggest after the first visit to wait five days and then do another session.  The spots will generally turn a yellowish green as the bilirubin of that stagnant blood is processed.


The third: ‘Healthy’ do not be fooled by this.  Look carefully.  You may have not put the cups on strong enough or left them on for enough time,  although it can be seen on someone who  has a healthy system and who is  releasing toxins effectively.  Still this therapy can help them ‘stay on top’ of it.  Sometimes the client is too dehydrated to have cupping do anything. Sometimes they are too tight.



Massage and heat before cupping will help this open up.

The fourth:  Spotted with pink to lavender background.  Lots of congestion and toxins that are having a hard time moving.  This can be painful even.  Consider heat with or before cupping to help them release toxins.   The tissues are too tight to release the stagnant dark blood but you have managed to pull some of it forward.  The background may be a greenish lavender color. These people need lots of work.


The fifth: Lavender to yellow appearance.  This is the worst case as it usually means (traditionally) that there is a nerve or bone problem.  A sign of severe stagnation that cannot be released yet. This sign is not good and luckily not too common.  I have found it in people with very chronic diseases that are usually on significant amounts of prescription medication.   There are other treatments that will help these people become more comfortable and stable before more treatment.   Remember, cupping is no silver bullet; however   it is a great tool and will help the body regain homeostasis.



Sixth: Blisters, you may see water filled blisters and no other redness under the cup.  This is a different kind of stagnation bordering on outright dryness.  Think of a river bed.  It is not wet enough to be muddy, but if you pick up dirt and squeeze it, water may come out.  The patient needs  much more fluid and fluid movement.  Treat as much as you can, even daily.   Best to release the fluid if the blisters are big, and cover.  Continue treatment after the blisters have healed.  Make sure the patient does lots of hydration (in and out) before next treatment.  They  may benefit more from massage therapy.


Seventh:  Redness around the cups.   This is from a histamine response.  These people may have allergies or some form of autoimmune disorder.  Other than that, any of the above can occur.  They may have itchiness after treatment.  Itchiness is a histamine reaction and goes away quickly.  If the histamine reaction (a reddish halo) is large, it can be an indicator that the body is already in an inflammatory response somewhere (or everywhere).  If it does not show it could be normal for darker skin or show that the histamine reaction is too slow.  People that take antihistamines may show no halo.  Remember, the interior of the circle will be any of the above possibilities.


The ‘Halo’

Here we see a different pattern with a normal treatment time.   The inner area of the circle is somewhere between moderate to normal in appearance, it may even have some lavender look to it.  However, on the outer rim is a halo of moderate to severe stagnation.  This is mostly due to tightness of the tissue as when the patient is over stressed, poorly hydrated, or needs more treatments.   Occasionally the center will look lavender or dark only to disappear when the cups are removed.  This is a deeper set of toxins and will take longer to get the desired result.


Note:  People with very dark skin will show up differently.  Be observant and watch for the same signs but in darker colors.   Try not to be fooled by those of more olive skin, they can frequently show greenish or yellowing which is not Jaundice or anything to be concerned with.