Parallels Between Cupping in Traditional Chinese Medicine and Ventosas in Native American Cultures

INTRODUCTION

Folk medicine has been practiced for thousands of years. Although much is known about traditional Chinese medicine (TCM), less is known about the Native American (NA) healers known as curanderos and sobadores. Folk medicine often relies on “high touch” interactions, a term used to describe healing through the massaging and rubbing of the skin, as opposed to the increasing use of “high tech” technologies in modern medicine. ¹ The hands-on approach of TCM is paralleled by the sobadores of Hispanic communities including in traditional Mexican medicine (TMM).

Multiple healing traditions use networks of anatomical lines to base their treatments, such as acupuncture and its use of meridians. ² Cupping is practiced as part of TCM, whereas sobadores in Latin America perform ventosas, which is also based on the use of cups to create negative pressure and cause suction to extract “bad air” through the pores. ³ Recognition of the similarities and their independent development across separate cultures highlights the importance of these traditional practices. Although these traditional practices may be perceived as opposing modern medicine, studies continue to demonstrate their benefits and the importance of addressing cultural values in “whole person care.” To address patients holistically, more cultural understanding is necessary regarding the history of TMM, sobada, and folk healers of various Indigenous cultures.

ORIGIN OF CUPPING IN EUROPE

Both cupping and acupuncture are part of TCM but have also been found in other ancient cultures. Cupping, a part of TCM, has been traced back 5000 years in Asia. ⁴ Acupuncture originated in China, and evidence suggests that it may have also developed in other parts of the world separate from Chinese influence. The preserved “Ice Man” from 5000 years ago in the Alps had evidence of acupuncture, indicating that this practice may have developed and then “disappeared” in Europe before the arrival of TCM.^5–8 The Ebers Papyrus, medical records from 1550 BCE, indicates that cupping was used in ancient Egypt. ⁹ Hippocrates described both dry and wet cupping, and Galen practiced cupping.^4,10 The first English-written documentation of TCM and moxibustion in England was in the 17th century. ¹¹ In the 18th and 19th centuries, Western medicine was institutionalized; thus, the focus was on science and biology rather than traditions and the supernatural. ¹²

CUPPING OR VENTOSAS IN THE AMERICAS

Folk medicine in Latin America preceded the Spanish Conquest, and records indicate that ventosas were practiced in the pre-Hispanic world in Latin America. ¹³ Researchers who study TMM have concluded that its current practice is influenced by pre-Hispanic, Hispanic, and African influences rather than Asian influences. ¹² It is believed that TCM was formally introduced in America in the mid-19th century when over 2 million Chinese migrants arrived in ports in Latin America.^13,14

Latin American healers’ use of ventosas bears a striking parallelism to the TCM practice of cupping. Ventosas is a form of sobada that curanderos use to treat their patients. The traditional practice of Mexican fire cupping, ventosas, involves glass cups, a combustible liquid like alcohol, and a source of fire that creates a vacuum on the skin over specific body parts. In Latin America, ventosas is used to remove negative energy or mal de aire. The belief in mal de aire, which translates to “bad air,” has been traced to the Aztecs and continues to be prevalent in TMM.^15–17 Because aire is considered a harmful or misplaced energy that causes disequilibrium, it can present as pain in various parts of the body or physical weakness.^17,18 Aire is deemed pathological while its removal, possible with ventosas, is regarded as curative. ¹⁷ In the present, the Nahua commonly continue to attribute diseases to aire, which is randomly “caught” from the natural environment. ¹⁹ This compares to the TCM perspective of balancing yin and yang for optimal health. In TCM, cupping is used to expel invasion of wind and cold and other environmental pathogens. Through both perspectives, health is possible through the balance between each person and their surroundings. ²⁰

The Chilam Balam of Ixil books contain historical anecdotes of Mayan history. Because the original Chilam Balam was destroyed during the Spaniard invasion, the current records are influenced by the Spaniards, but to which degree, it is difficult to confirm with accuracy. ²¹ In the first volume of these books, various healing methods are outlined, including ventosas. ²¹ Before the expansion of TCM and Western medicine, ancient civilizations in the Americas used various rudimentary tools and animal horns to perform ventosas. ⁴ The Chilam Balam indicates that the Mayans used dried, hollow Pumpkins, known as jicara, as a cupping tool. ²¹ The Kaua, another historical text, mentions crystal vases, introduced by the Spaniards, for ventosas. ²¹ These texts even outline how ventosas should be performed, according to the patient’s sex, especially during the month of May. ²¹

The beliefs behind cupping in TCM and ventosas of TMM are similar. The Huangdi Neijing are Chinese texts from scientists with a focus on an understanding of health and disease through direct observations of nature and the human body. ²² The Huangdi Neijing, which based its findings on science rather than philosophy and the supernatural world, identified a key relationship between environment and health much like today’s understanding of health and disease. ²² “Bi” or obstruction in the body was thought to come from the invasion of external factors of wind-cold or wind-dampness that caused disruption to circulation and thus disease and inflammation.^22,23 External factors included pollutants and occupational exposures. ²² This resembles today’s scientific understanding of medicine as the environment is known to greatly influence health and inflammation is a known basis of disease states. The Huangdi Neijing also outlines various therapies to remove bi-obstruction including acupuncture and cupping.^22,23

Cupping in TCM and TMM/NA cultures is practiced with a similar goal in mind: to remove “wind” that is considered the cause of a disease. Sobadores believe they must be careful when applying ventosas lest the aire enter them. ²⁴ In Asian culture, wind is considered an illness causation, whereas the Maya have a similar belief of aire. ²⁵ Although the TCM view on cupping is the realignment of Qi, sobadores claim ventosas are used to remove air and reposition or “untangle” unaligned “cords.” ²⁴ Natives believed there was water “flowing” inside the body, like the body meridians of TCM. ⁵

Cupping has been shown to reduce pain and release endorphins, potentially indicating a scientific basis and potential legitimacy for the “healing touch” of traditional healing practices. ²⁶ Cupping has also been found to decrease the perceived intensity of muscular pain and improve quality of life. ²⁷ Some theories behind the mechanism of action include improved oxygenation, increased nitrous oxide, and decreased oxidative stress.^28–30

HISPANICIZATION OF TMM

As NA were subject to the Spaniards’ influence, the culture undoubtedly changed. The Indigenous communities valued collectivism and community; however, this new Western style of medicine introduced focused more on individualism. ³¹ Healers who had historically been considered effective but lacked social class were replaced by respected physicians who were science-based rather than tradition-based. ³²

Few sources have identified how sobada and ventosas changed after the Spaniards’ arrival. Of note, the earliest evidence of NA medicine indicates that they believed in the hot-cold theory but not the four humoral theory. ³³ The “wet-dry” aspects of the humoral model were not accepted during colonization and are still not prevalent, even after the Hispanicization of Mexico. ³³ The antagonistic forces between hot and cold parallel the balance of yin-yang in TCM. ³⁴ Similar to the warming and cooling foods in TCM, NA healers also apply this principle by encouraging the consumption of “hot” or “cold” herbs, depending on the nature of the disease. ³⁵ In a 2016 interview with 67 present-day Mayan healers in Guatemala, about 50% continue to use herbs and the principle of harmonizing hot and cold to heal. ³⁵

Although sobada was present before their arrival and continues today, the extent to which its practice transformed because of Spanish influence is unknown. A major historical change was the integration of Catholicism and sobada. Earlier, the native technique for sobada focused on the relationship between body and mind, especially for treating pain and infertility. ³⁶ This period was tumultuous for the Natives, given the lives lost because of diseases and the imposition of a new religion. ³³ Now, curanderos often incorporate Catholic symbolism and prayer into their practices. ³⁷ For example, during a healing session, it is not uncommon to invoke saints or use candles and crosses. ³⁸

PRESENT-DAY SOBADORES

In Latin America, sobadores still provide various traditional methods of healing like ventosas. Therapies they regularly use include massage, often with the use of oils, herbal remedies, or joint manipulation. ³⁹ Their work is analogous to modern-day chiropractors as they perform massage and bone setting. More than a simple masseuse or therapist, they believe they are “blessed” with the skills to perform sobada and to offer words of wisdom. ⁴⁰ The cultural understanding of these beliefs is often misunderstood in formal medical settings, where it may appear the goal of a sobador is to alleviate pain rather than cure the source of pathology. ³ In Mexico, there are two types of shamans. Some shamans have heavy Native influence, whereas other shamans’ practice has more Spanish influence. The former shaman has a leadership role in their community and focuses on pre-Hispanic religious beliefs rather than Catholicism. The latter is considered a layperson who provides healing and manipulative therapy in a community but with little leadership or significant reverence. ⁴¹

WHOLE SYSTEMS OF CARE AND TRADITIONAL HEALING PRACTICES

Whole Health Systems refers to a “multidimensional” and “integrated approach” to healing that is based on both practitioners’ and patients’ humanity and individuality and addresses the whole patient, including their psychology, spiritual life, behaviors, and physical health.^46,47 Whole medical systems include homeopathy, integrative medicine, and traditional oriental medicine. ⁴⁸ The National Center for Complementary and Alternative Medicine describes whole medical systems as “complete systems of theory and practice that have evolved independently from or parallel to allopathic (conventional) medicine,” which describes traditional, cultural medical systems. ⁴⁸ With a strong emphasis on health maintenance, preventative medicine, and reduction of chronic noncommunicable diseases, traditional and complementary medicine is, for that reason, patient-centered and multidimensional. ⁴⁹

Traditional healing often aligns with this type of patient care because of the focus on the patient’s physical and mental well-being. ⁴⁷ NA shamans have a bio-psycho-socio-spiritual approach to well-being. ⁵⁰ This more holistic approach is nonspecific (unlike most common drugs) and aims to produce “patterns” of positive changes rather than specific changes. ⁵¹ This is often less “isolating” than allopathic care because of being patient-centered with a focus on the person’s interaction with their environment, family, and community. ⁵⁰

Contrarily, modern “evidence-based medicine” has a more “reductionist” approach where treatments are used to target a “specific” pathology or symptom. ⁵² This often ignores the fact that humans are more complex than each organ. Although the reductionist approach focuses on treating symptoms, the “whole person approach” focuses on the relationship between the patient and their environment and coping/healing. Because folk medicine focuses on the latter, research has found improved satisfaction with traditional healing methods compared to contemporary medical therapies. ⁵²

In United States and Mexico, NA have expressed mistrust in formal clinical settings due to higher rates of perceived racism and discrimination.^53,54 Some reasons for this negative sentiment include unconscious bias from providers and the historical imposition of Western medicine. ⁵⁵ Unfortunately, over 20% of NA report discrimination in medical settings and refusal to seek medical care. ⁵⁶ This leads to higher rates of preventable conditions like diabetes and cardiovascular disease because of fewer opportunities for screening and lifestyle interventions. ⁵⁷

It is important to better understand the healing traditions of Natives as historically these approaches promote well-being in their communities. Unfortunately, younger NA generations are abandoning healing traditions and opting for more Westernized lifestyles and medical care. Not surprisingly, this transition has resulted in the younger generation having worse physical health when compared with their elders who continue traditional health practices. ⁴² In the present, there is an increased understanding of the relationship between mind and body. Thus, it is vital to understand the benefits and challenges of adopting and maintaining a multidimensional approach in modern medicine, especially its potential to help control and prevent chronic diseases.

LIMITATIONS

Although sobada, ventosas, and the overall practice of TMM largely depend on noninvasive practices that are benign, there are some limitations that must be addressed. First, the safety of TMM and ventosas is questionable as sobadores’ lack of formal medical training and the application of cups on people with certain conditions can lead to bleeding and skin infections. Furthermore, some plants can be harmful when ingested in excess. Some herbs can interfere with medications, whereas some oils may cause allergic reactions. There is a lack of studies on the practice and efficacy of ventosas performed by healers as opposed to practitioners who have gone through a formal training process. There is also little oversight and regulations on curanderos’ practices. An additional concern is that seeking treatment from sobadores during emergencies may be dangerous and delay effective treatment. Likewise, although sobadores help heal their patients by minimizing physical pain and encouraging better coping skills, they do not offer cures for underlying pathologies.

Some limitations regarding the gathering of research on NA folk healers of Latin America include the scarcity of records. Their culture lasted for hundreds of years, and historical records were mainly passed through verbal histories. Written documentation was often wiped out through colonization. If records are available, they are often heavily influenced by the settlers. It is likely that the historical information we have to date is incomplete. Similarly, much of the data gathered come from secondary sources rather than direct firsthand experiences. Although there are accounts of the NA’ descendants’ rituals, the original Natives’ practices are mostly recorded from the perspective of the colonizers. In general, there are a few historical records available on TMM. Such limitations and potential bias may put into question the accuracy of the information available. More research is needed to establish the extent to which these traditions have carried over and changed into their present-day practice. Furthermore, more information is necessary to analyze if these practices exacerbate or ameliorate health disparities and overall access to health care in minority communities.

There are limitations in researching the potential simultaneous development or various origins of cupping around the world. Primarily, the fragmented, and often missing, documentation of Indigenous healing practices is common. ⁴ Regarding NA practices, which many times are perpetuated through word of mouth, records are scarce, and the opinions of researchers may sometimes be contradictory.

CONCLUSION

Although the Western world has historically been ambivalent toward more traditional medicine practices, there has recently been a rise in its acceptance. These treatments are more accessible, and research has shown that cupping (or in this case ventosas) can increase blood flow and oxygenation.^58,59 Many patients of NA and Latino origins, especially those who come from a low socioeconomic background, engage in medical pluralism or the use of traditional and alternative treatments like ventosas as well as Western medicine. Folk healers are consulted because of culturally sensitive care, language barriers, or lack of insurance. ⁶⁰

Furthermore, a sobador often uses a “pay as you can” model and is more affordable than treatments provided by medical doctors. ²⁴ Given that the Hispanic population continues rising and most Latinos in the United States use a form of alternative medicine, further research is needed to investigate folk healers’ practices and their potential as adjuvant treatments. ⁶¹ In the United States, TCM is now accepted by the medical community and general population. Thus, with the increased acceptance of TCM, integrative medicine practitioners and acupuncturists can appeal to a broader population of patients who can identify the similarities between TCM and cultural medicine. Owing to the growing diversity of patients, it is important to continue researching the efficacy of folk medicine on physical and mental health to provide holistic care that is safe and patient-centered.