Cupping is a form of therapy widely used in China

Treatment employed as early as the 1500s BC has been trending thanks to its use by athletes and stars.

There was a gasp of surprise at the Rio Olympics when US swimmer Michael Phelps added one more gold to his record tally of 18 (he has added four more since, for a total of 23). But the surprise was not only for his remarkable achievement, but also for some dark purple circles on his shoulders and back.

They were signs of cupping, which he had undergone before the race.

Cupping is a form of therapy widely used in traditional Chinese medicine. It consists of creating a local suction on the skin using either heat (fire) or mechanical devices (hand or electrical pumps). This method is believed to draw out toxins, facilitate blood flow, soothe muscle pain and, in some cases, help cure insomnia.

The treatment has a long history. The Ebers Papyrus, written circa 1550 BC, considered one of the oldest medical textbooks in the Western world, describes how the Egyptians used cupping to help cure frequent medical conditions and how it was also used by Saharan peoples.

Hippocrates, a Greek physician who many credit with laying the foundation of scientific medicine, also used this technique circa 400 BC to treat internal diseases and structural problems.

Ge Hong (AD 284-364), a minor southern official during the Eastern Jin Dynasty (AD 317-420), was the first to use cupping in China. Ge was interested in alchemy, herbalism and techniques of longevity, and popularized the saying: "Acupuncture and cupping, more than half of the ills cured." Later, this method came to be used across Asia and Europe.

In the dry cupping procedure, practitioners use specially made cups placed on the skin. They then use either heat or an air pump to create suction between the cup and the skin. The vacuum on the patient's skin dispels stagnant blood and lymph, thereby improving the flow of qi. It's used on the back, shoulders and other muscles, such as those on the back of the neck.

Athletes who use this therapy claim that it's highly effective. Among those who use this method are gymnast Alex Naddour, also of the United States, and Belarusian swimmer Pavel Sankovich, who reportedly said cupping is a great recovery tool. Hollywood stars Gwyneth Paltrow and Jennifer Aniston, and Canadian pop star Justin Bieber use it, too.

In the US, the therapy was popular until about the middle of the 20th century. Now, people use it only occasionally.

The purple patches on Phelps' shoulders have significantly driven up sales of cupping equipment, says Jessica MacLean, acting director of the International Cupping Therapy Association.

The swimmer has even been featured in a recent promotional video on cupping treatment for a sponsor.

Cupping is used to treat a wide variety of medical conditions, including blood disorders, rheumatic diseases, gynecological problems, and skin disorders such as eczema and acne. Those who receive the treatment also claim improvement in their physical and psychological well-being.

Some practitioners have also used cupping as an alternative treatment for cancer. Despite the practitioners' claim for effectiveness, however, the American Cancer Society recently said: "There is no scientific rationale for expecting any health benefit from cupping." It warned that the treatment carried a small risk of burns.

It's difficult to carry out controlled experiments to test the efficacy of cupping, but 40 people suffering from arthritis (in the knee) who took part in an experiment reported less pain after four months of treatment compared with those who hadn't received the treatment.

The obvious question is: How effective is this treatment? One cannot deny there could be a placebo effect. This is a beneficial effect, produced by a placebo drug or treatment that cannot be attributed to their properties, and must therefore be due to the patient's belief in that treatment. Perhaps, as with other alternative treatments, cupping is as good as it makes you feel.

The author is an international public health consultant. The views do not necessarily reflect those of China Daily.

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