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Cupping therapy was an ancient healing method used to treat sick people. A procedure that involved placement of suction cups on specific surfaces on the back. Ancient Chinese and Arabic text mentioned the use of cupping proved that the therapy was used in the past. There are still modern-day cupping practitioners that use this therapy to treat sick people. Also, athletes use this therapy in hopes of benefiting from its possible therapeutic effect ; however, cupping can be viewed as an alternative therapy due to the lack of scientific support. Revision of cupping therapy studies showed that many studies are procedurally flawed and have a high risk of bias. These flaws render many conclusive study results weak but Olympian athletes from the 2016 Rio Olympics asserted that cupping helped with their recovery, thus leads to advancements in mainstream knowledge of cupping therapy. The rising popularity and awareness of cupping in recent years could promote further research on cupping.

History
Cupping wasn’t only used in Chinese or Arabic countries. Ancient text from other parts of the world showed different forms of cupping being used, thus the exact origins of cupping are unclear. Text from ancient Greek historian, Herodotus, showed that cupping therapy was done to treat ailments, such as headaches, indigestion, or fainting. Arabic countries developed a variant of cupping therapy called ʻAl-Hijamaʼ or wet cupping, which was used for medical purposes. In the late 19th century, medicinal use of cupping therapy was documented in medical journals. In his 1888 autobiography, Sir Arthur Keith documented a cupping therapy practitioner treat a farmer with low back pain using the therapy when he was a medical student. Modern-day cupping therapy usage is popular amongst athletes due to its potential therapeutic effects

Fire cupping


Fire cupping was a variation of cupping therapy that was used in ancient China to treat sick people. This type of treatment was based on the idea of qi, the vital energy of life. Qi flows through everything that is living and illnesses originate from the blockage of qi flow. Cupping practitioners view the therapy as a method for promoting blood flow and restoring proper qi flow which results in healthier individual. Practitioners would have their patient lies on their stomach on top of a table. Cup placement would be pre-identified on the back. Then, the practitioner will ignite a cotton ball to create a flame and move the flame inside of circular glass cups. After a short period of heating, the flame is quickly removed, creating a vacuum inside the cup due to the flame removing any oxygen within the cup. Quickly, the cups are placed on top of the pre-identified areas and the skin will be dragged in towards the cup.

Wet cupping
Wet cupping is another variation of cupping therapy that was widely used in Arabic countries and Chinese countries. Similar to fire cupping, wet cupping was used for medicinal purposes as well. Practitioners would create small, shallow cut on areas that the suction cup will be placed. Once the suction cups are applied, blood will gradually flow from these shallow cuts and be collected in the cup. It was believed that the therapy could remove potential disease-causing substances from the body in the form of capillary blood that cupping draws from. Furthermore, capillary blood contains lymphatic fluid that primarily functions to remove toxin and waste from the body; so its believed that wet cupping can aid in body toxin.

Research
Scientific speculation on the effectiveness of cupping therapy to treat disease showed questionable results. Randomized controlled trials of cupping studies were analyzed in a systematic review done by Cao Huijuan and his group from the Centre for Evidence-Based Chinese Medicine, Beijing University. Published on February 28, 2012, they looked at any cupping therapy studies that were published from 1992 to 2010. Databases were used to gather studies were China Network Knowledge Infrastructure, Chinee Scientific Journal Database, Chinese Biomedical Database, Cochrane Central Register of Controlled Trials, Wangfang Database, and Pubmed. The study team used a few criteria to determine eligibility for studies to be included for the review. Studies had to include a variation of cupping as the intervention for the study, adding other therapies within the study, such as acupuncture was deemed ineligible. Using these criteria, the group compiled 135 cupping therapy studies. Majority of these studies used wet cupping as the intervention and the most common investigated diseases from these studies were cervical spondylosis, acne, herpes zoster and facial paralysis. Using the data compiled from the 135 studies that looked into these diseases, a meta-analysis was conducted for each.

Herpes zoster
From the meta-analysis, the study team looked at the results of cupping studies that investigated the effects of wet cupping on subjects with herpes zoster. Cupping therapy subjects experienced significant improvement than subjects that received pharmaceutical medicine. Furthermore, the combination of medication and cupping therapy showed greater significant improvement in condition compared to subjects that only received medication as an intervention.

Facial paralysis
Similar results were found for studies that looked at facial paralysis and cupping therapy. Studies that investigated this disease didn’t purely use wet cupping but included fire cupping as well. The result of the meta-analysis showed that subjects that received a combination of medication and cupping therapy showed greater improvement in condition compared to a subject that only received medication.

Acne
Six trials were used for the meta-analysis of cupping therapy effects on acne. The results showed that wet cupping subjects experienced significant improvement than a subject that purely had medication. Furthermore, a combination of cupping and medication showed greater improvement than medication.

Cervical spondylosis
Lastly, six studies that looked at cervical spondylosis and cupping therapy were used for the meta-analysis. Wetting cupping was used for the trials and showed that that cupping therapy combined with other treatments resulted in subjects experiencing better symptom improvement than subjects that only received other treatments alone. One study used in the analysis compared the effectiveness of wet cupping therapy to a treatment medication, flunarizine. The results showed that subjects from both groups experienced the same amount of improvement in condition.

Conclusion
Cao Huijuan’s review suggested that the effectiveness of cupping therapy for treatment of diseases was high when combined with other treatments; however, further testing is needed. The results of analyzed data showed possible significant findings; however, due to the weak design of the analyzed studies, a definitive answer can’t be made from their data. The study group reported that 84.44% of the studies used had a high level of bias. This bias could have impacted the data from the individual studies and in turn affect the overall analysis. The review pointed out that many of the reviewed studies didn’t report their procedures according to Consolidating Standards of Reporting Trials (CONSORT), thus creating discrepancy on study procedures across cupping therapy studies. Other problems that reviewed studies had was lack of blinding within the study. Due to the nature of the intervention, cupping therapy, blinding is difficult to incorporate into the study. Similar problems are encountered in studies that look at acupuncture or massage, both subject and experimenter will always know if the intervention is being applied or not. One possible solution developed is a sham cup. This cup uses a small opening to relieve the suction regular cups have on the skin. The result is a cup that has reduced suction on the skin. The study that used sham cups showed it could possibly be a control for real cupping; however, further studying would need to reach a conclusive answer.

Future studies
Currently, randomized controlled trials of cupping studies face the inability of being blinded. Typically, the gold standard way of proving a medication or therapy is effective in treating by conduct a double-blind placebo control trial. This type of trial has both groups, experimenters and subject, blinded to which intervention the subject group is receiving, therefore, there is less chance for bias to be a part of the results. The final results from the two groups of the double-blinded studies are then compared and if the intervention showed a significant difference compared to the placebo group, then the intervention is proven effective.

Placebo Development
In December 2010, Myeong Soo Lee and his team from Korea Institute of Oriental Medicine, South Korea developed a potential placebo for cupping therapy called sham cupping device. The team investigated if subjects could notice a difference between real cupping or placebo. The sham cup is able to function like a regular suction cup; however, there is a small 0.2 mm hole present on the side of the cup that eliminates negative pressure within the cup. Thirty-four subjects were recruited for this study, seventeen subjects received the real cupping and seventeen subjects received sham cupping. The results showed that 41% of the subjects from the real cupping group and 59% of the subjects from the sham cupping group didn’t know which group they were in. The results of this study showed that the device could potentially blind subjects in cupping therapy studies; however, further investigation is needed to address the weaknesses of this study for a conclusive answer.

Athletic Use
In December 10, 2016, a systematic review of cupping studies that used the therapy for athletes was published by Rhianna Bridgett and her team from Endeavour College of Natural Health, Australia. The review looked at studies from databases, such as Pubmed, AMED, CNKI, Cochrane Library, and SCOPUS. Studies that were included in the review had to be looking into the effects cupping therapy, by itself or combined with other treatment, on athletic performance and health. Eleven trials were used for this analysis with a total of 498 subjects across all studies. The term athletes in this review covered athletes from various sports, such as soccer, handball, swimmers, soccer, gymnast, and track and field. Reviewed studies applied cupping therapy to athletes between one to twenty times daily or weekly, other supplementary treatments were applied as well, such as acupuncture. To determine effectiveness, the studies looked at these outcomes: symptom intensity, recovery measures, functional measures, serum markers, and experimental outcomes. Subjects from the experimental group reported feeling less pain and increased range of motion after cupping intervention. Testing showed that subjects that underwent cupping had reduced creatine kinase than subjects in the control group. From the revision, the study team noted that there wasn’t a definitive answer based on the measured outcomes due to great variation. Furthermore, the majority of the reviewed studies had a high risk of bias. For these reasons, the study couldn’t determine if cupping therapy is effective in improving an athlete's performance, more studies are needed to draw a conclusive answer.

Placebo Effect
A placebo effect is when factors from our surrounding and situation affect our mental state of mind which result in a biological change. People that have experienced positive benefits from cupping could be under the influence of the placebo effect. On July 7th, 2017, Brian Resnick published an article about the effects of placebo and the potential benefits of it. From 1996 to 2013, the chances of a drug showing a significant effect over the study placebo has dropped from 23% to 9%, meaning that people are failing to separate a placebo drug from an actual drug.

Studies
Placebo effect studies showed that a positive effect can be conditioned into an individual. Parkinson’s disease patients were given medication to alleviate the symptoms and pain caused by the disease. A few days later, the medication was switched to a placebo medication. Patient brain scans revealed that the same areas of the brain were activated when the placebo was taken as when the actual medication was taken. Other placebo effect studies showed that the strength of a placebo depended on the environment in which it is done, the person that is giving the placebo, and the complexity of the placebo.

Social learning
The social learning principle of placebo effects is when a subject sees a placebo is producing a positive effect on another subject. Subsequently, when they are given the placebo, they will experience the positive effect to a great extent. The social learning could possibly explain why alternative therapies have a positive effect on users. If high-level performing athletes like Olympians report that cupping therapy aids in their recovery and performance, this can give the impression to other athletes that the therapy will produce the same beneficial effects. Once given the cupping therapy, they could possibly feel better based on the social learning idea of placebos.

Criticism
The NIH reported that cupping therapy’s effectiveness is not fully understood. They understood that the basis of cupping is that suction cups promote healing by pulling more blood to the treated areas; however, due to the lack of supporting evidence, this therapeutic effect cannot be proven. Furthermore, a review published in 2015 by Dr. Qi-ling Yuan from Xi'an Jiaotong University showed that cupping therapy studies still lack sufficient evidence to prove that cupping therapy is effective. The NIH also warned users of the potential risks that they will be exposed to. For example, cupping therapy can result in bruises, burns, discomfort, or skin infection.

Wikipedia Reflection
It was difficult to start the Wikipedia project because the word requirement of the assignment made me feel intimidated and anxious. I had many moments of writer's block because of the requirements and restricts that Wikipedia wants from writers. For example, maintaining a neutral tone and point of view throughout the article was difficult because explaining studies of my topic generally made my article lose neutrality in a topic. This difficulty from creating the Wikipedia page relates to my course reflection of audience because this project definitely showed that the reading audience will determine the structure of your writing. These feelings slowly went away as I started to write and ideas for the Wikipedia page started to come together. When we had to upload our Wikipedia article drafts into our sandbox, creating citations for Wikipedia article caused me a headache. I understand that we have training modules that went over the basics of how to use Wikipedia, but any advance use of would be left for users to figure out. For example, finding the proper formula to create in-text citations that had the citation appear from hovering over it took a good amount of time to figure. Eventually, I gave up on looking into the Wikipedia manuals and went to other Wikipedia pages to find the proper formula. Although I didn’t mind figuring out how to configure Wikipedia because it felt rewarding when I did figure it out, I think it would be extremely helpful for students to receive a hand out for typical formulas structure. The options on the Wikipedia menu weren’t always working for me so I had to manually enter formulas for headers or citations. I think by provide a handout that told me how to create with a ref name and using would cite the same source would have been helpful to future students. Moving to the last week of our Wikipedia assignment, I listened to the announcement advise and posted in the Wiki Teahouse as well as the Talk page of my current article. I asked editors to review my draft and post feedback any feedback they had. The feedback I received from editors varied because some advices were great from editors that listed what I need to fix and how to fix them, but I received some comments that were less productive. A couple of hours after I posted my sandbox in the Teahouse chat, an editor comments that “on their experience editing Wikipedia are not appropriate for an encyclopedia article.” Other editors commented that the quality of english wasn’t strong in my Wiki article. To a degree, I felt offended from these comments because by that point, I spent a great deal time research, writing, and designing my wiki article and their comments made it seem that my draft was thrown together in 5 minutes ; however, one way that I look at these editor’s comments is that I will have to go through stricter and more important critics in the futures, such as defending a thesis if I want to pursue a PhD. After thinking of the feedback from this point of view,  I realized that Project Two did a great job in providing students with a sample of academic writing in scientific fields because publishing an article on Wikipedia required the student to product and publish scientific information. Similar to academic writing, creating an Wikipedia article required students to follow strict guidelines and receive criticism that will judge your work.

Articles of Interest
Cupping Therapy Ginseng.

My thoughts on the ginseng article are written out below.

The talk page for the Cupping Therapy article showed many aspects that could be improved. 1. Use of primary research rather than secondary. I think referencing systematic reviews or meta-analyses on cupping therapy research can improve the reliability of this page. 2. Use of biased statements. The talk room spoke of changing sentence structure/ wording. 3. Adding more headings to better organize information.

Article Evaluation
Reading the Talk section of my chosen Wikipedia article was intense. Although the article was not mine, I felt as if I was on stage and the audience was hammering away at the flaws of my article. From my initial read of the article, I didn’t see any problems with information. I checked the sources on the reference page and most of the researched information came from credited databases, such as Pubmed. One problem with the article that the Talk page pointed out was the use of the word “ginseng” because critics weren’t sure which species of ginseng the author was speaking of throughout the article. They suggested having the page provide links to specific species of ginseng to eliminate any confusion. This message exchange went on for a couple of lines and concluded with article needing reorganization and formatting of information and ginseng naming. After reading the “Talk” chat I believe this article can improve in many areas and it goes to show the benefits of constructive criticism. I hope to cover a specific Chinese herbal medicine for my wiki project, so looking into ginseng is a good start to my project. I commented on my suggestions on the article’s Talk page.