*4.4.4 Laser cupping*

*Pain Management - Practices, Novel Therapies and Bioactives*

associated with a risk of burn [1, 22].

*4.3.2 Manual vacuum cupping*

*4.3.3 Electrical vacuum cupping*

generate pressure pulses [27].

*4.4.2 Hot cupping or Moxa cupping*

with the cups. It includes the following types [22, 23]:

**4.4 Added therapy types:**

*4.4.1 Needle cupping*

*Fire cupping* is used with glass, ceramic, and bamboo cups that have no valves as the valve is used to control the air flow through the cup. Traditionally in China, a piece of paper or cotton is used either alighted and inserted into the cup directly, or soaked with 95% alcohol and attached to the end of a stick and then burned. The burning stick is used to make the cup hot and is removed later. This method is

*Manual vacuum cupping* is also known as vacuum cupping and opening cupping. The pressure is created by using a manual suction pump which is either self-suction cups or squeeze rubber top [1, 27]. Studies showed that manual vacuum cupping is superior to fire cupping in terms of causing greater blood flow to the treated

*Electrical vacuum cupping* is an electrical suction pump. It is used where the negative pressure can be easily adjusted and can be connected to several cups at the same time. Moreover, it is also used with pulsatile cupping because of its ability to

This classification is done according to the additional material used in combination

*Needle cupping* involves the combined use of acupuncture and cupping. Therapists usually apply acupuncture needles first followed by cupping therapy [27]. In this type, it is crucial to use small short needles and avoid specific body areas such as the abdomen and the chest to avoid any risk of organ penetration [22].

*Hot cupping or Moxa cupping* is cupping combined with heat and a herb called Moxa [28]. Moxa is made up of dried Mugwort leaves. During the cupping process, the therapist will initially warm a needle with Moxa and applies a cup over it. A thin aluminum layer is used as a barrier before putting the hot Moxa to prevent skin

*Herbal cupping* is also known as medicinal cupping. In this type, the therapist will boil a herbal solution for about 30 minutes and then bamboo cups will be soaked in the solution for five minutes before applying the cups to the skin [29]. To avoid skin burns, the cups will be left for one minute to cool down before applying

*Magnetic cupping* is done by using magnetic cupping sets which have magnets inside. It is commonly used to treat joint-related diseases affecting big joints such as

*4.3.1 Fire cupping*

area [1].

**222**

burns [22].

*4.4.3 Herbal cupping*

them to the treated area [22].

*Laser cupping* is a new cupping device which is used in combination with cupping therapy. An acupuncture laser probe is inserted inside the cups in order to stimulate specific acupuncture points as an additive effect to the cupping. The advantage of this method is that it provides the 'double effect' of both cupping therapy and laser acupuncture [31].
