Moxibustion and Cupping Risks: Burns, Smoke and Skin Injury

Why look at risks first

Moxibustion and cupping are both used within traditional Chinese medicine (TCM). Moxibustion burns an herb close to the skin. A Cochrane review describes it as "burning a herb close to the skin". [1] Cupping creates suction on the skin with a cup of glass, ceramic, bamboo or plastic, by applying a flame to the cup or attaching a suction device. In "wet cupping" the skin is pierced and blood flows into the cup, while "dry cupping" does not pierce the skin. [2] Both involve heat or suction on the skin, so injuries to the skin are the main concern. Each practice has its own page: Moxibustion and Cupping Therapy.

Moxibustion burns and smoke

A systematic review of adverse events of moxibustion (14 databases searched) found reports in 4 randomized trials, 1 controlled trial, 2 observational studies, 13 case reports and 1 prospective study. The most common problems were allergic reactions, burns and infections. [3]

In clinical trials the reported events included redness, blistering, itching, discomfort due to smoke, fatigue, stomach upsets, flare-ups, headaches and burns. [3] Case reports included dry eye, dry skin, patches of darker skin and eyelid changes. [3] The authors concluded that moxibustion is not entirely risk free and that the incidence of such events is not known, because large prospective studies are missing. [3]

Smoke. Smoke discomfort appeared in trial reports. [3] We did not find a source measuring indoor air quality from moxa smoke, so we cannot say how much exposure is harmful. If you have asthma or another lung condition, tell the practitioner and ask about smokeless forms and ventilation, and stop if you cough or feel breathless.

Pregnancy. In pregnant women, reports included premature birth, premature rupture of membranes and bleeding associated with pressure over the placenta. [3] A Cochrane review of moxibustion for breech presentation found adverse events (such as nausea, unpleasant odor, abdominal pain and uterine contractions) but said the evidence about their frequency is very uncertain and that adverse events were inadequately reported in most trials. [1] Moxibustion in pregnancy should only be discussed with an obstetric clinician.

Cupping risks

NCCIH lists these effects of cupping:

• Cupping leaves temporary marks on the skin. [2] They can be mistaken for signs of physical abuse, so NCCIH advises explaining their origin to health care providers. [2]
• Possible side effects include persistent skin discoloration, scars, burns and infections, and cupping may worsen eczema or psoriasis. [2]
• Rare severe effects have been reported, such as bleeding inside the skull after cupping on the scalp and anemia from blood loss after repeated wet cupping. [2]
• If equipment is used on more than one person without sterilization between patients, it can spread bloodborne diseases such as hepatitis B and C. [2]

A 2026 meta-analysis of cupping for chronic neck pain (9 trials, 401 people) reported no serious adverse events, though it also noted methodological limits in several trials. [4] Trials are usually short and small, which makes rare events hard to detect.

Who should take extra care

The sources above point to these groups. Ask a doctor before treatment if any apply, and tell the practitioner:

• Skin conditions such as eczema or psoriasis (cupping), or allergy to smoke or herbs (moxibustion). [2][3]
• Pregnancy (moxibustion). [3]
• Anemia or bleeding problems, because repeated wet cupping has caused anemia from blood loss. [2]
• Infection risk: ask how the practitioner cleans or discards equipment; insist on single-use or sterilized items, especially for wet cupping. [2]

Stop signs and when to seek care

Say "stop" right away if you feel burning, sharp pain or difficulty breathing. Afterward, get medical care for blistering that is large or looks infected (spreading redness, pus, fever), a burn on the face or genitals, severe headache after scalp cupping, or a skin reaction that does not settle. Call emergency services for trouble breathing or collapse.

Quality and training

Practitioner rules differ by place; see TCM Qualifications, Licensing and Medical Care. We did not find a source that gives safe home-use instructions for moxibustion or fire cupping, so this page does not provide any.

Related pages

For what the research says about benefit, see TCM Evidence by Use.