J Tradit Complement Med. 2019 Apr; 9(2): 90–97.
Published online 2018 Apr 30. doi: 10.1016/j.jtcme.2018.03.003
PMCID: PMC6435947   PMID: 30963043
Abdullah M.N.et all.  

The medical perspective of cupping therapy: Effects and mechanisms of action3.5.5. Activation of Immune System Theory
From the perspective of body immunity and defense, practitioners begin to understand the action of cupping therapy through regulating immunoglobulins and hemoglobin,86 and its various immunological effects. Cupping decreases serum IgE and IL-2 levels and increases serum C3 levels which are found to be abnormal in the immune system.87 Cupping is likely to affect the immune system via three pathways. First, cupping irritates the immune system by making an artificial local inflammation. Second, cupping activates the complementary system. Third, cupping increases the level of immune products such as interferon and tumor necrotizing factor. Cupping effect on the thymus increases the flow of lymph in the lymphatic system.16 Overall, activation of immune system by cupping might explain its various effects including therapeutic outcomes in patients with autoimmune diseases. This theory explains the effect of cupping for strengthening immunity which has been the subject of recent research around the world. For instance, Khalil and colleagues (2013) claimed that cupping seems to play a role in the activation of complement system as well as modulation of cellular part of immune system and it may have a protective role by increasing immunity, and thereby, protect the body from diseases.34 A clinical study by XIAO Wei et al. (2010) concluded that cupping significantly improves immunologic functions in patients with chronic obstructive pulmonary disease during stable stage.88 Sahbaa et al. (2005) claimed that cupping therapy significantly reduces the laboratory markers of rheumatoid arthritis activity and modulates the immune cellular conditions particularly of innate immune response Natural killer cells and adaptive cellular immune response the Soluble Interleukin 2 Receptor SIL-2R.89 Mohammad Reza et al. (2012) evaluated Interferon Gamma (IFNγ) and Interleukin 4 (IL-4) concentrations in supernatant of vein and cupping blood cultures with or without the presence of phytohemagglutinin (PHA) mitogen. The results showed IFN-γ and IL-4 concentrations in cupping blood samples were higher compared to venous blood samples without presentation of any mitogen. He concluded that the high level of lymphocytes in cupping blood samples plays an important role in discharge of IFN-γ and IL-4. Furthermore, in the presence of PHA mitogen the levels of IFN-γ and IL-4 in cupping blood samples were equally low as in venous blood samples. The study claimed that lymphocytes in cupping blood samples may not have their natural function, so they cannot properly respond to stimulation of mitogen. Moreover, two weeks after cupping the researcher did not see any difference in IFN-γ and IL-4 concentrations in venous blood. It seems that the reduplication of cupping immune response will be affected and IFN-γ and IL-4 concentrations will increase.90 A study by Ye LH, (1998) revealed that cupping produces a bidirectional effects on human immunoglobulins, corrects the irregular immunoglobulin level, yields insignificant effect on normal immunoglobulin, and the regulation result is related to the original function state.91 Zhang et al. (2001) reported that cupping can upregulate the oxyhemoglobin and deoxyhemoglobin. As the carrier of hemoglobin, the red blood cell is an important defensive system, working to recognize antigens, and eliminate immune complex, tumor cells, and effector cells, as well as bind germs and viruses, and regulate immune function.92 Moreover, Zhong, et al. (1999) discovered the absolute value of C3b receptor rosette and immune complex of red blood cell significantly increased after moving cupping, which indicated that moving cupping can improve the immune function of red blood cell.93 Chen and Li (2004) claimed that cupping suggillation is the manifestation of auto-hemolysis, which can produce histamine-like substances, and consequently strengthen the activity of tissues and organs as well as the immunity.94 The recent study by Yang Guo et al. (2017) proposed that the microenvironment is changed when stimulating the surface of the skin, and physical signals transform into biological signals, which also interact with each other in the body. These signaling cascades activate the neuroendocrine-immune system, which produces the therapeutic effect.95 More immunological studies are needed to measure and validate the early assumption.