Cupping Therapy: a Final Therapeutic Step in Persian Medicine.

Dear Editor, We read the article of Vaccaro et al1 on cupping therapy (CT) with great interest. As the authors rightly point out, a lack of sufficient knowledge on complementary and alternative medicine (CAM) gives rise to negative outcomes and clinical mismanagement. Dermatology is one of the medical disciplines that makes the most of CAM, with acne vulgaris being a prominent disease in this area2,3. As they point out, CT dates back to many centuries ago1 and while modern medicine is yet to understand its mechanism of action, Persian medicine (PM) explains it largely on the basis of the theory of humors and temperaments4,5. In a recent randomized controlled trial (RCT), we explained the effects of CT combined with oral antibiotics on acne treatment according to the historically described mechanisms, although we note that it is possible to prove them accepting the frameworks of holistic medicine6. It should also be noted that withholding conventional treatment and using CAM alone is not in accordance with the accepted principles of medical ethics7. It should be prompted that contrary to the opinion of Vaccaro et al1, CT does not represent a cornerstone in PM. In fact, according to PM principles, the order of treatment includes (i) lifestyle modifications, (ii) dietary corrections, (iii) simple medications, (iv) compound medications, and, finally, (v) hands-on physical manipulations like CT4,5,8. We conclude by asserting that the optimal use of CAM and its modalities like PM is dependent on sufficient and accurate knowledge of these therapeutic disciplines, thorough knowledge of the possible side effects of treatments, such as CT, and expertise in managing such unwanted side effects. Otherwise, CAM will not only fail to help in the treatment of common diseases such as skin conditions, but also will put the patients’ health at risk.