Dry cupping vs wet cupping (hijama): what's the difference?

Ask three people what cupping is and you may get three different answers. A sports therapist will describe silicone or pump cups gliding over a tight calf. A traditional Chinese medicine practitioner may talk about glass cups and a flame. Someone from a Muslim background may picture hijama: cups applied, the skin scratched, and a small amount of blood drawn. These are not the same treatment, and the differences matter for safety, regulation and what you can sensibly do at home.

This article explains how dry cupping and wet cupping (hijama) differ, where hijama sits in the UK, what the rules and hygiene expectations are for anyone breaking the skin, and which kind of cupping the sets we sell are designed for. For the broader picture, including how suction works and what the research says overall, start with our complete guide to cupping therapy.

The short version

What dry cupping is

Dry cupping is cupping with the skin left intact. A cup is placed on the skin and the air inside is reduced, either by a hand pump, a squeezed silicone cup, an electric vacuum unit or (in traditional practice) a flame that heats the air before the cup is applied. The resulting suction lifts the skin and the tissue beneath it into the cup.

Cups can be left in place for several minutes (static or retained cupping), lifted and re-applied repeatedly (flash cupping), or moved across oiled skin (gliding or moving cupping). A 2018 overview in the Journal of Acupuncture and Meridian Studies grouped cupping by technique, suction strength, method of suction, any added therapy, and the area treated, which is a useful reminder that "cupping" covers a wide family of methods [1].

Dry cupping is what most UK physiotherapists, sports therapists and massage therapists mean when they offer cupping, and it is the only form that is realistic to do at home. Our step-by-step guide to using a cupping set at home covers the practical side.

What wet cupping (hijama) is

Wet cupping adds a second stage. After a few minutes of suction, the cup is removed and the practitioner makes small, shallow scratches or punctures in the raised skin with a sterile blade or lancet. The cup is then re-applied, and the suction draws a small amount of blood into it. The cups and blades are disposed of afterwards and the area is cleaned and dressed.

Hijama is the Arabic term for this procedure. It is practised across the Middle East, North Africa and South Asia and is well established in the UK's Muslim communities, where it is understood as part of prophetic medicine. A 2019 article in the Journal of the British Islamic Medical Association notes that the practice is supported by a hadith in Bukhari describing healing in cupping, and that it is promoted in the UK as a revived sunnah (a practice of the Prophet) [2]. For many clients, the religious and cultural meaning is as important as any physical effect, and a good practitioner will respect that.

Wet cupping is also used in traditional Chinese medicine, where it is sometimes called blood-letting cupping or pricking and cupping. A 2012 review of 135 Chinese randomised trials found that wet cupping was the most frequently studied form in that literature, although the trials were generally of low methodological quality [3].

Wet cupping versus dry cupping: what the evidence shows

The evidence cannot yet say whether one works better than the other. A 2024 meta-analysis of 11 randomised trials in low back pain, led from the University of Nottingham, found that wet cupping produced a statistically significant short-term reduction in pain while dry cupping did not, but the difference between the two types was not itself statistically significant, and the trials varied so much in method that the authors flagged high heterogeneity as a limit on confidence [4]. We look at this and other back pain studies in more detail in cupping therapy for back pain and sciatica.

Claims that hijama "removes toxins" or "cleanses the blood" are common in marketing but have no robust support. A 2019 review of proposed mechanisms listed a blood detoxification theory alongside pain-gate, nitric oxide and immune theories, and concluded that no single theory explains cupping's effects and all need further testing [5]. In 2014 the UK Advertising Standards Authority upheld a complaint against a Luton spa whose hijama advertising claimed the treatment removed toxins, boosted the immune system and prevented illness; the ASA found the claims unsubstantiated and ruled the advert misleading [6]. If a practitioner's website makes those claims, treat it as a warning sign.

Regulation and hygiene: wet cupping is an invasive procedure

This is the part that matters most. The moment the skin is broken, cupping becomes a procedure with the same blood-borne virus and bacterial infection risks as tattooing, body piercing or acupuncture.

How it is regulated in the UK

There is no national register of cupping practitioners. In England and Wales, local councils can require anyone carrying out acupuncture, tattooing, cosmetic piercing, semi-permanent skin colouring or electrolysis to register their premises and themselves under Part VIII of the Local Government (Miscellaneous Provisions) Act 1982, with local byelaws setting hygiene standards [7]. Cupping and hijama are not named in that legislation, and council pages we reviewed (including Birmingham, Bury, Coventry, Ipswich and Hartlepool) do not list them. In London, the London Local Authorities Act 1991 lets boroughs license "special treatments", defined to include skin piercing and treatments of a like kind, with detailed conditions on sterile instruments, sharps disposal and hepatitis B records [8]. Whether a given council treats wet cupping as falling within these schemes varies, so practitioners should ask their local environmental health team rather than assume.

The 2019 BIMA article described hijama as effectively unregulated, noted that it is often practised by people with little clinical training, and called for statutory regulation, careful consent and record-keeping, and proper supervision [2]. The British Cupping Society, founded in 2008 by medical and healthcare professionals, offers training for clinicians and is a member of the General Regulatory Council for Complementary Therapies, but membership is voluntary [9].

What safe practice looks like

The clearest published UK standard for skin-breaking procedures is the Chartered Institute of Environmental Health's tattooing and body piercing guidance toolkit, endorsed by Public Health England in 2013. It sets out the principles any hijama practitioner should be following [10]:

• Sterile, single-use blades or lancets, opened in front of you and disposed of in a proper sharps bin.
• Single-use cups for wet cupping, or reusable cups cleaned and sterilised in an autoclave between clients.
• Hand washing with liquid soap and disposable towels, fresh gloves for every client, and a disposable apron.
• Skin cleaned with an appropriate antiseptic before and after, and a dressing applied.
• Clinical waste handled and collected correctly.
• Practitioners vaccinated against hepatitis B.
• A medical history and written consent before treatment.

The risks are not theoretical. A 2023 case report in BMC Complementary Medicine and Therapies described a previously healthy 33-year-old woman who developed a disseminated Staphylococcus aureus infection, with abscess and lung involvement, after wet cupping for a sprain. The authors' review found ten further published infections after cupping, most following wet cupping, and they recommended strict hygiene, single-use needles and sterilised equipment [11]. A 2014 letter in the American Journal of Infection Control likewise flagged hijama practice as a potential route for blood-borne infection [12].

Who should not have wet cupping

Anyone taking anticoagulant or antiplatelet medication, anyone with a bleeding disorder, anaemia, diabetes with poor wound healing, a compromised immune system, or skin infection in the area should not have wet cupping. Pregnant women and children should not have it. Our article on cupping therapy side effects and who should avoid it goes through the full list and the reasoning.

Our cupping sets are for dry cupping only

Every set in our cupping therapy collection is designed for dry cupping only. The Hansol pump sets and the Meifuly electric cupping machine create suction on intact skin, and their cups are reusable items meant to be cleaned between uses, not sterile disposables. Please do not use them, or any home kit, to attempt wet cupping. If hijama matters to you for religious or cultural reasons, seek out a practitioner who can show you their training, their insurance and their infection-control set-up, and who is happy to answer the questions above.

Dry cupping, done well, gives you most of what people value in cupping: the pull on the tissue, the sense of release, the circular marks that fade over a week or so (see our guide to cupping marks and what they mean), and a tool you can use on your own schedule. For the full picture of what cupping can and cannot do, go back to our complete guide to cupping therapy.

References

1. Aboushanab TS, AlSanad S. Cupping therapy: an overview from a modern medicine perspective. Journal of Acupuncture and Meridian Studies. 2018;11(3):83–87. https://doaj.org/article/6faa8ce56a0c4fc6a07b4ba58f88301c
2. Mayberry JF. Al-Hijama in the UK. Journal of the British Islamic Medical Association. 2019;1(1). https://www.jbima.com/wp-content/uploads/2019/04/E01_0409_al_hijama_in_the_uk.pdf
3. Cao H, Li X, Liu J. An updated review of the efficacy of cupping therapy. PLoS One. 2012;7(2):e31793. https://doi.org/10.1371/journal.pone.0031793
4. Zhang Z, Pasapula M, Wang Z, Edwards K, Norrish A. The effectiveness of cupping therapy on low back pain: a systematic review and meta-analysis of randomized control trials. Complementary Therapies in Medicine. 2024;80:103013. https://doi.org/10.1016/j.ctim.2024.103013
5. Al-Bedah AMN, Elsubai IS, Qureshi NA, et al. The medical perspective of cupping therapy: effects and mechanisms of action. Journal of Traditional and Complementary Medicine. 2019;9(2):90–97. https://doi.org/10.1016/j.jtcme.2018.03.003
6. Advertising Standards Authority. ASA Ruling on BodyToxing (A14-274451). 3 December 2014. https://www.asa.org.uk/rulings/bodytoxing-a14-274451.html
7. Hartlepool Borough Council. Skin piercing treatments: registration under the Local Government (Miscellaneous Provisions) Act 1982, Part VIII. https://www.hartlepool.gov.uk/info/20137/health_and_safety/277/skin_piercing_treatments
8. London Borough of Hammersmith and Fulham. Standard conditions for premises operating special treatments (London Local Authorities Act 1991, Part II). https://www.lbhf.gov.uk/sites/default/files/section_attachments/standard_conditions_for_premises_operating_special_treatments.pdf
9. British Cupping Society. About the BCS. https://bgi.uk/associated-groups/bcs/
10. Chartered Institute of Environmental Health. Tattooing and body piercing guidance toolkit. July 2013 (endorsed by Public Health England). https://www.hull.gov.uk/downloads/file/2138/cieh-tattooing-body-piercing-toolkit
11. Wang Y, Fan H, Huang X, Jiao Y. Disseminated Staphylococcus aureus infection after scarification wet cupping therapy: a case report and literature review. BMC Complementary Medicine and Therapies. 2023;23:94. https://doi.org/10.1186/s12906-023-03932-x
12. Rehman A, Ul-Ain Baloch N, Awais M. Practice of cupping (Hijama) and the risk of bloodborne infections. American Journal of Infection Control. 2014;42(10):1139. https://doi.org/10.1016/j.ajic.2014.06.031

This article is for general information only and is not medical advice. Always follow the instructions supplied with your equipment, and consult a qualified healthcare professional if you have a medical condition or are unsure whether a treatment is right for you.