Cupping therapy Richmond BC patients ask me about is usually something they have seen before they have felt: round purple circles on an athlete’s back, or red streaks along a friend’s neck. Cupping and gua sha are two traditional Chinese medicine techniques we use at Artemis Wellness Clinic, most often inside an acupuncture and TCM session. This page is deliberately plain about the parts that matter: what they are, what the marks actually mean, what the evidence does and does not support, and who should avoid them.
What is cupping?
Cupping is the use of suction cups placed on the skin to draw the surface tissue and skin upward. The cups may be glass, plastic or silicone. The vacuum is created either by a hand pump or a squeezable silicone cup, or by fire cupping, where a flame briefly heats the air inside a glass cup and is removed before the cup is placed — the flame never touches you. There are two common ways to use them. Static cupping leaves cups in place for roughly five to fifteen minutes; that is what produces the classic circles. Glide cupping uses oil or balm so the cup can be slid along a muscle, which leaves lighter, streakier colour. Ask your practitioner which method they plan to use, and know that you can decline fire cupping and ask for pump cups instead.
What is gua sha?
Gua sha is a scraping technique: a smooth-edged tool is stroked firmly and repeatedly over lubricated skin, following the line of a muscle. The tool is typically ceramic, stone or stainless steel with a rounded edge, and the skin is oiled first so the edge glides rather than drags. This is not the light facial routine sold in skincare aisles. Clinical gua sha over the neck, shoulders or upper back uses real pressure and is expected to raise “sha” — the fine red speckling that gives the technique its name. You can read how both fit alongside our other TCM techniques.
Are cupping marks bruises?
No — and that distinction is worth understanding, because the marks alarm people. A bruise happens when an impact crushes tissue and tears vessels. Cupping discolouration is produced by negative pressure instead: suction draws blood and fluid out of tiny superficial capillaries into the space just under the skin. Nothing has been struck, and nothing has been torn by force. The colour that appears — pink, red, dusky purple, sometimes grey-brown — is blood pigment breaking down where you can see it. That is why the marks are usually painless (the skin may feel warm or mildly tender for a day, like a light sunburn), and why most fade within a few days to about a week. Darker marks occasionally take around ten days. Gua sha’s speckling usually clears faster, often in two to five days.
One honest correction: the shade of the marks is not a reliable readout of how “stagnant” or “toxic” you are, whatever you read online. Suction strength, how long the cups sat, placement and your own skin all change the colour. Nobody should be reading your health from the darkness of a circle. And because the marks are visible, tell us if you have a wedding, a photoshoot or a beach weekend coming up.
What do people use cupping and gua sha for, and what does the evidence show?
People mostly come in for muscle tightness — and the honest summary is that the evidence base is limited and of mixed quality. The usual reasons are desk-posture neck and shoulder tension, upper back and trapezius tightness, tight calves or quads after training, and a general sense of release. Many patients report the area feels looser and easier to move afterwards, and that relief is real to them.
What I cannot tell you is that it is well proven. Systematic reviews of cupping (mostly for neck and low back pain), and the much smaller literature on gua sha, tend to report short-term reductions in pain and tightness — but the trials are typically small, hard to blind (there is no convincing placebo cup), inconsistent in technique and dose, and rated at high risk of bias. Some of the benefit is likely non-specific: warmth, skilled touch, attention and relaxation reduce muscle guarding on their own.
So the reasonable position is this: treat cupping and gua sha as adjuncts, not stand-alone treatments. They are a comfortable way to take the edge off muscular tension inside a broader plan. If your problem is a compressed nerve, a structural shoulder issue, an inflammatory condition, or anything steadily getting worse, it needs assessment rather than suction — see what we actually assess and treat.
What is a session actually like?
Cupping or gua sha usually takes five to twenty minutes within a longer appointment. We take a history first, including medications and skin conditions. Cups feel like a strong, steady pull; gua sha feels like firm, warm scraping. Both should be tolerable, not agony — intensity is not the goal and the pressure is adjustable, so speak up. Some people feel briefly lightheaded or sleepy afterwards, so eat beforehand and stand up slowly. For the rest of the day, keep the area covered and warm, and skip the sauna, hot tub, hard training and heavy alcohol.
How do cupping and gua sha combine with acupuncture and massage therapy?
They are added to a treatment rather than booked as an event of their own. In practice, cupping or gua sha most often happens inside an acupuncture visit with a registered acupuncturist, applied before or after needling to the same tight muscles. Registered massage therapy covers similar ground with different tools, and where an individual therapist’s training and scope of practice include cupping, it may be used within an RMT treatment — ask when you book. If your issue needs loading and strengthening rather than passive release, our physiotherapy and kinesiology services are the better fit. Passive work feels good; durable change usually comes from what you do between visits.
Who should avoid cupping and gua sha?
Avoid cupping and gua sha if you take blood thinners or have a bleeding disorder, if the skin is broken, irritated or sunburned, if you have an active infection, or if there is any possibility of a blood clot. Several other situations call for caution and a conversation with your physician first. Check with both your practitioner and your doctor before booking.
| Situation | What it means |
|---|---|
| Blood thinners (anticoagulants) or a bleeding/clotting disorder | Avoid. These techniques deliberately draw blood toward the surface; impaired clotting can turn a normal mark into real bleeding under the skin. Physician’s advice first. |
| Broken or irritated skin, open wounds, eczema flare, sunburn | Avoid the area entirely. Cups and tools go on intact, healthy skin only. |
| Active infection or fever | Postpone until you are well. |
| Suspected DVT (deep vein thrombosis): calf pain, swelling, warmth; recent immobility or surgery | Do not treat. This needs same-day medical assessment. |
| Pregnancy | Caution. The abdomen and the lower back/sacral area are avoided. Tell us before booking and check with your prenatal care provider. |
| Recent surgery, recent fracture, healing scar | Avoid the area until you are medically cleared. |
| Very fragile or thin skin (many older adults, long-term corticosteroid use) | Real risk of skin tears and extensive bruising. Gentle technique at most, often skipped. |
| Moles, skin tags, undiagnosed lumps, varicose or spider veins | Never cupped or scraped over. |
| Cancer, severe anaemia, significant heart, kidney or liver disease, poorly controlled diabetes | Physician guidance first; frequently left out of the treatment. |
Blistering can occur with excessive suction, and fire cupping carries a small burn risk — both are uncommon but documented. Tell your practitioner everything you take, including anti-inflammatories and supplements that affect bleeding. If there is doubt, we leave it out; there are always other ways to treat a tight muscle.
When should you see a doctor first?
See a physician before booking any treatment if you have new, severe or rapidly worsening pain; pain with fever, night sweats or unexplained weight loss; calf swelling, redness or warmth; numbness, weakness or pins and needles that is spreading; chest pain or shortness of breath; bruising or bleeding that appears for no reason; or loss of bladder or bowel control (that is an emergency). Also get checked if a treatment mark blisters, becomes hot or increasingly painful, or has not faded after about two weeks. Cupping and gua sha are not a way to push through any of these, and nothing on this page replaces medical advice.
Does insurance cover cupping and gua sha in BC?
Coverage follows the practitioner’s designation, not the technique — most extended health plans have no separate cupping or gua sha benefit. When these techniques are delivered inside an acupuncture visit by a registered acupuncturist, the appointment is billed as acupuncture and draws on your acupuncture coverage. When cupping is used within a massage treatment by a registered massage therapist whose training and scope include it, it is billed as massage therapy. Whether either is reimbursed, at what percentage, and up to what annual maximum depends entirely on your plan. Artemis direct bills Pacific Blue Cross, Sun Life, Manulife, Canada Life, Green Shield and 20+ insurers through TELUS Health, plus ICBC and WorkSafeBC for eligible claims — details on our direct billing page. Direct billing is a convenience, not a promise: we cannot guarantee what your insurer will pay, so verify your benefits first.
How do you book cupping or gua sha in Richmond BC?
Book online at artemis.janeapp.com or call 604-242-2233 and mention that you are interested in cupping or gua sha. You will be booked into an acupuncture or massage appointment, and after assessment we decide together whether either technique is appropriate for you that day. Artemis Wellness Clinic is at 5911 No. 3 Road #130, Richmond BC V6X 0K9 — a 3-minute walk from Brighouse SkyTrain on the Canada Line. If you are unsure, say so; we would rather talk you out of a technique than into one.
Written by Ethan Choi, R.Ac, R.TCMP, DOMP — registered with CCHPBC for acupuncture and TCM, practising in English and Korean. More about Ethan.
Frequently asked questions
Do cupping marks hurt?
Usually not. The marks themselves are typically painless, though the skin may feel warm or mildly tender for a day, similar to a light sunburn. The suction feels like a strong pull and gua sha feels like firm scraping — both should be tolerable, never agony. Say something immediately if it is too intense.
How long do cupping marks last?
Most cupping marks fade within a few days to about a week; darker ones occasionally take around ten days. Gua sha speckling usually clears faster, often in two to five days. If a mark blisters, turns hot or increasingly painful, or is still there after two weeks, have it looked at by a doctor.
Is cupping safe if I take blood thinners?
Generally, no. Anticoagulants and bleeding or clotting disorders are a clear reason to avoid cupping and gua sha, because both techniques deliberately draw blood toward the skin surface. We would not proceed without your physician’s guidance, and in most cases we would choose a different technique. Tell us about supplements too.
What is the difference between cupping and gua sha?
Cupping uses suction to lift skin and superficial tissue; gua sha uses a smooth-edged tool stroked firmly over oiled skin. Cupping leaves round marks, gua sha leaves red speckling along the strokes. Neither is inherently stronger — the choice depends on the area and what suits you.
Does the darkness of the marks mean anything?
Not reliably. Colour depends on how much suction was used, how long the cups stayed on, where they were placed and your own skin. Claims that darker marks reveal more “toxins” or “stagnation” are not supported by evidence, and we do not diagnose anything from the shade of a circle.
Can I have cupping or gua sha while pregnant?
Only with caution, and some areas are avoided entirely — including the abdomen and the lower back and sacral region. Tell us you are pregnant before booking so the appointment can be planned properly, and check with the provider managing your pregnancy first. Where there is uncertainty, we leave these techniques out.
Does my insurance cover cupping in Richmond?
Usually indirectly, but you must verify. Most plans have no separate cupping benefit, so coverage follows the practitioner: cupping inside an acupuncture session draws on acupuncture coverage, and cupping within an RMT treatment draws on your massage benefit. We direct bill many insurers through TELUS Health, but reimbursement is never guaranteed.
Can I shower or exercise after a session?
A warm shower is fine; hold off on the rest for the day. Keep the area covered and warm, and skip the sauna, hot tub, ice bath, intense training and heavy alcohol for the remainder of the day. Do not let marked skin get sunburned while the discolouration is still visible.
