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Wet cupping therapy for treatment of herpes zoster: a systematic review of

randomized controlled trials

Article in Alternative Therapies in Health and Medicine · November 2010

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Author Manuscript
Altern Ther Health Med. Author manuscript; available in PMC 2011 August 7.
Published in final edited form as:
NIH-PA Author Manuscript

Altern Ther Health Med. 2010 ; 16(6): 48–54.

Wet cupping therapy for treatment of herpes zoster: a

systematic review of randomized controlled trials
Huijuan Cao, PhD[Student],
Beijing University of Chinese Medicine
Chenjun Zhu, PhD[Student], and
Beijing University of Chinese Medicine
Jianping Liu, PhD, MD[Professor]
Director of Center for Evidence-Based Chinese Medicine of Beijing University of Chinese
Medicine

Abstract
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Background—Wet cupping is a traditional Chinese medicine therapy commonly used in treating

herpes zoster in China, and clinical studies have shown that wet cupping may have beneficial
effect on herpes zoster compared with western medication.
Methods—We included randomized controlled trials on wet cupping for herpes zoster. We
searched PubMed, the Cochrane Library (Issue 3, 2008), China Network Knowledge Infrastructure
(CNKI), Chinese Scientific Journal Database (VIP), and Wan Fang Database. All searches ended
in February 2009. Two authors extracted data and assessed the trials quality independently.
RevMan 5.0.18 software was used for data analysis with effect estimate presented as relative risk
(RR) and mean difference (MD) with a 95% confidence interval (CI).
Results—8 RCTs involving 651 patients were included, and the methodological quality of trials
was generally fair in terms of randomization, blinding and intention-to-treat analysis. Meta-
analyses showed wet cupping was superior to medications regarding the number of cured patients
(RR 2.49, 95%CI 1.91 to 3.24, p<0.00001), the number of patients with improved symptoms (RR
1.15, 95%CI 1.05 to 1.26, p=0.003), and reducing the incidence rate of postherpetic neuralgia (RR
0.06, 95%CI 0.02 to 0.25, p=0.0001). Wet cupping plus medications was significantly better than
medications alone on number of cured patients (RR 1.93, 95%CI 1.23 to 3.04, p=0.005), but no
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difference in symptom improvement (RR 1.00, 95%CI 0.92 to 1.08, p=0.98). There were no
serious adverse effects with related to wet cupping therapy in the included trials.
Conclusions—Wet cupping appears to be effective in treatment of herpes zoster. However,
further large, rigorous designed trials are warranted.

Background
Herpes zoster, commonly with the pain and rush on skin, is caused by the infection of latent
varicella zoster virus (VZV). VZV usually persists asymptomatically in the dorsal root
ganglia of anyone who has had chickenpox, reactivating from its dormant state in about 25%
of people to travel along the sensory nerve fibres and cause vesicular lesions in the

Corresponding author: Jianping Liu, PhD, MD, Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese
Medicine, Beijing, China, Tel: +86 1064286757, Fax: +86 1064286871, [email protected].
Institution: Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine
Potential conflict of interest
None known.
 Cao et al. Page 2

dermatome supplied by the nerve[1]. The classical clinical presentation of herpes zoster
starts with a mild-to-moderate burning or tingling in or under the skin of a given surface,
often accompanied by fever, chills, headache, stomach upset and general malaise. The pain
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associated with shingles varies in intensity from mild to severe, the lesions usually begin to
dry and scab 3–5 days after appearing. Total duration of the disease is generally between 7–
10 days, and the most common complication associated with herpes zoster is the
development of postherpetic neuralgia (PHN), a condition where pain accompanying the
rash persists long after the lesions have healed.

Herpes zoster has a high infection rate, which is increasing by years. Some studies showed
that the infection rate of herpes zoster and the intensity of the pain were relative with age,
and the elderly were at greater risk for developing this disease. Early treatment can be more
effective to release the pain and reduce the duration of disease [2]. The objective of
conventional therapy in the treatment of herpes zoster is to accelerate the healing of the
lesions, reduce the accompanying pain, and prevent complications. Medications typically
prescribed included antiviral agents, corticosteroids, analgesics, non-steroidal anti-
inflammatory drugs, and tricyclic antidepressants [3].

In Traditional Chinese Medicine, herpes zoster is called She Chuan Chuang, its pathological
mechanism is insufficient of anti-pathogenic energy, toxin invades the body and
transformation into heat, damp-heat spreading to the skin; or is stagnation of liver qi, and
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extreme heat generate wind, the fire depressed in skin; or is damp-heat in spleen and
stomach, and spreading to the skin [2]. The treatment including herbal decoction, Chinese
formulated products, acupuncture, moxibustion, cupping therapy and so on.

Cupping therapy is a method mainly using horn, bamboo or glass cups on patients’ skin by
creating minus pressure inside the cups, which exerts as an approach for diagnosis, treatment
and prevention of diseases [4]. There are many types of cupping therapy, but 8 types of
cupping are commonly used in clinical practice, i.e., empty cupping, moving cupping,
retained cupping, needle cupping, moxa cupping, wet cupping, herbal cupping and water
cupping [5]. Wet cupping, also called full (bleeding) cupping, was the most favored and
practiced cupping method of all by the early practitioners, who particularly in Europe,
employed the Bleeding cupping technique in order to purge foul blood, which was
considered the source of disease, from the body. It can be used in the treatment of a sudden
increase in blood pressure, and in discharging pus from boils and furuncles, which
represents excess, with blood-heat and stagnation. Sterilize the selected points with alcohol
and make a very small incision with a triangle-edged needle or, using a plum-blossom
needle, firmly tap the point for a short time to cause bleeding. Once the point is bled, choose
a cup and apply a strong cupping method to the point. The blood will quite quickly be
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observed being drawn slowly into the cup. If the incision is sufficient, blood with about 30–
60 ml can be expected to be drawn into the cup. Remove the cup after 5 or 10 minutes with
attention and care. Cupping regulates the flow of qi and blood. It helps to draw out and
eliminate pathogenic factors such as damp and heat. Cupping also moves qi and blood and
opens the pores of the skin, thus precipitating the removal of pathogens through the skin
itself [6].

From literature, we found some clinical trial reports on wet cupping therapy for herpes
zoster, but there is no systematic review about the therapeutic effect of the therapy.
Therefore, this review aims to evaluate the beneficial and harmful effects of wet cupping
therapy for treatment of herpes zoster in randomized trials.

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 Cao et al. Page 3

Methods
Inclusion Criteria
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Parallel randomized controlled trials (RCTs) of wet cupping compared with no treatment,
placebo or basic medical therapy in patients with herpes zoster and PHN were included.
Combined therapy of wet cupping and other interventions compared with other interventions
in RCTs was also included. Outcome measures include reductions in severity of pain,
duration of relief of pain, percentage of cured patients and the incidence rate of PHN.
Multiple publications reporting the same groups of participants were excluded. Combined
therapy of wet cupping and acupuncture compared with medication or other interventions
except acupuncture was also excluded. There was no limitation on language and publication
type.

Identification and selection of studies

We searched China Network Knowledge Infrastructure (CNKI) (1979–2009), Chinese
Scientific Journal Database VIP (1989–2009), Wan Fang Database (1985–2009), PubMed
(1966–2009) and the Cochrane Library (Issue 3, 2008), all the searches ended at February
2009. The search terms included “post-herpetic neuralgia”, “PHN”, “herpes zoster”, “zona”,
or “shingles” combined with “venesection”, “phlebotomy therapy”, “three edged needle”,
“triangle-edged needle”, “ventouse”, “cupping” or “blood-letting”. Two authors (HJ Cao
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and CJ Zhu) selected studies for eligibility and checked against the inclusion criteria
independently.

Data extraction and quality assessment

Two authors (HJ Cao and CJ Zhu) extracted the data from the included trials independently.
Quality of the included trials was evaluated according to following categories [7]. Category
A (good): studies have the least biases and their results are considered valid. These studies
are likely to consist of (1) clear description of the population, setting, interventions and
comparison groups; (2) appropriate measurement of outcomes; (3) appropriate statistical and
analytical methods; (4) no reporting errors; (5) less than 20 percent dropouts; (6) clear
reporting of dropouts; and (7) appropriate consideration and adjustment for potential
confounders. Category B (fair): studies are susceptible to some degrees of biases that are not
sufficient to invalidate the results. These studies may have sub-optimal adjustments for
potential confounders and may also lack certain information that is needed to assess
limitations and potential problems. Category C (poor): studies have significant biases which
may invalidate the results. These studies either do not consider potential confounders or do
not make adjustments for them appropriately. These studies may have critical flaw in design,
analysis and/or reporting, missing information and/or discrepancies in reporting.
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Data analysis
Data were summarized using relative risk (RR) with 95% confidence intervals (CI) for
binary outcomes or mean difference (MD) with 95% CI for continuous outcomes.
Revman5.0.18 software was used for data analyses. Meta-analysis was used if the trials had
a good homogeneity on study design, participants, interventions, control, and outcome
measures. Publication bias was explored by funnel plot analysis.

Results
Description of studies
After primary searches from seven databases, 389 citations were identified, and the majority
was excluded due to obvious ineligibility, and full text papers of 14 studies were retrieved.

Altern Ther Health Med. Author manuscript; available in PMC 2011 August 7.
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At last, 8 [8–15] trials were included in this review, 5 trials [16–20] were excluded as they used
wet cupping therapy combined with acupuncture or moxibustion compared with other
medications, 1 trial [21] was excluded due to the ineligible data reporting (Figure 1: The
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process of including and excluding studies). The characteristics of included and excluded
trials were listed in Table 1 (Characteristics of included studies) and Table 2 (Studies
excluded from the review and reasons for exclusion).

The 8 trials involved a total of 651 patients with herpes zoster. The variation in the age of
subjects was 12–82 years and disease duration was from 1 day to 14 days. Five trials
specified four diagnostic criteria, including two criteria in different kind of text books in
China, two national criteria in China. The interventions included wet cupping therapy (prick
on lesion with triangle-edged needle, plum needle, or seven-star needle), wet cupping
therapy plus conventional medications or acupuncture. The controls included medications or
acupuncture. The total treatment duration ranged from 7 days to 10 days. All the included
trials used two, three or four of four classes to evaluate treatment effects including cure,
markedly effective, effective/improve, and ineffective according to the degree of overall
symptom improvement.

Methodological quality
According to our pre-defined quality assessment criteria, all the included trials had clear
description of the population, setting, interventions and comparison groups, appropriate
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statistical and analytical methods, the sample size varied from 30 to 50 participants, with
average of 43 patients per group, though none of the trials reported sample size calculation,
method for allocation concealment and blinding. Two trials [8, 9] described the
randomization procedure, using random number table, and drawing. All the included trials
chose the improvement of the symptoms as the outcome measurement, but whether the
assessors of outcome were blinding were not reported in all the 8 trials. There was no
participant dropped during all the studies, only two trials [9, 13] mentioned follow-up, but
intention-to-treat was not used. No trials had appropriate consideration and adjustment for
potential confounders. It has high potential to have some degrees of biases that are not
sufficient to invalidate the results, so we generally concluded that all the 8 trials (100%)
were evaluated as fair (B).

Effect estimates (Table 3: Effect of estimates of wet cupping treatment in 8 RCTs)

Wet cupping versus medications—Four trials [9–11, 13] compared wet cupping with
medications. Three of them [9–11] showed that wet cupping therapy was significantly better
than medications on increasing the number of patients whose herpes zoster were cured (RR
2.49, 95%CI 1.91 to 3.24, p<0.00001), and also on increasing the number of patients whose
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symptom was improved after treatment (RR 1.15, 95%CI 1.05 to 1.26, p=0.003), though one
trial’s result showed not estimable [10].

Three trials [9, 10, 13] reported the incidence rate of PHN after treatment. The meta-analysis
showed that wet cupping therapy was significantly more effective to prevent the
complications (RR 0.06, 95%CI 0.02 to 0.25, p=0.0001).

One trial [10] reported the average cure time, which showed no significant difference
between wet cupping with medications (MD −3.14, 95%CI −6.45 to 0.17, p=0.06).

Wet cupping plus other interventions versus other interventions—Five

trials [8, 10, 12, 14, 15] compared wet cupping therapy plus other interventions versus other
interventions alone. Result of meta-analysis showed significant difference between wet
cupping plus medications or ultraviolet radiation compared with the same interventions on

Altern Ther Health Med. Author manuscript; available in PMC 2011 August 7.
 Cao et al. Page 5

increasing the numbers of patients whose herpes zoster were cured (RR 1.93, 95%CI 1.23 to
3.04, p=0.005). Four trials’ [8, 10, 14, 15] results about number of patients whose symptom
was improved after treatment were also be synthesized, but three of them showed not
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estimable, only one trial [8] showed no positive result of this comparison (RR 1.00, 95%CI
0.92 to 1.08, p=0.98).

Two trials [8, 10] reported the average cure time, and the meta-analysis showed significant
difference between wet cupping plus medications compared with medications alone on
accelerating the time of cure (MD −2.67, 95%CI −3.97 to −1.37, p<0.0001).

Adverse effect—Outcome of adverse effect with related to wet cupping therapy was
described in two trials [10, 13], but no adverse effect was observed in wet cupping group. One
trial [13] reported one patient with diabetes had several depressed scars on lesion skin in
aciclovir group (n=48).

As each comparisons included in this review had less than five trials, it was not meaningful
to conduct a funnel plot analysis.

Discussions
Based on the meta-analyses, the results showed that compared with medications, wet
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cupping therapy was significant better on healing the lesions and reducing the
accompanying pain, and the combination of other interventions appears more effective than
those interventions alone, though it is possible that the beneficial effect from wet cupping
was overvalued because of the small sample size, insufficient reporting of methodology of
the included trials.

There are several limitations in this review. First, the quality of the included studies is
generally fair, which may cause moderate risk of bias. Because of inadequate application of
randomization and lack of blinding in majority trials, it was possible for potential
performance bias and detection bias due to patients and researchers being aware of the
therapeutic interventions for the subjective outcome measures. Intention-to-treat analysis
was not applied in data analyses in the included trials. Though the funnel plot can not be
generated due to the limited number of trials in the meta-analysis, all studies reported the
positive result favoring the treatment group, it may have publication bias. Further more, all
the included trials were published in Chinese, it may also affect the possibility of selection
bias. Second, one trial [9] included only the middle-age and senile patients with herpes
zoster, one trial [15] only included the patients with head-face herpes zoster, and there were
different type of needles used in the trials, included triangle-edged needle in 4 trials, plum-
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blossom needle in 2 trials, filiform needle in 1 trials, and seven-star needle in 1 trial. Seven
trials applied the pricking bloodletting on lesion of skin, 1 trial pricking and cupping on
DU14, BL13, BL17, BL18 and bloodletting on ear apex. The variance of participates and
the detail of interventions may create the heterogeneity among the included trials, and affect
the meta-analysis of therapeutic effect. Forth, the use of composite outcome measures in 8
trials to evaluate overall improvement of symptoms limits the generalization of the findings.
The classification of cure, markedly effective, effective or ineffective is not internationally
recognized, and it is hard to interpret the effect. We suggest future trials to comply with
international standards in the evaluation of treatment effect. Although there is not major
statistical heterogeneity among the data analyses, we realized that the clinical heterogeneity
would be very significant due to the variations in study quality, participants, intervention,
control and outcome measures. The interpretation of the positive findings from the meta-
analyses needs to be incorporated with the clinical characteristics of the included trials and
evidence strength. Therefore, the conclusion of the beneficial effect of wet cupping therapy

Altern Ther Health Med. Author manuscript; available in PMC 2011 August 7.
 Cao et al. Page 6

for herpes zoster needs to be confirmed in large and rigorously designed randomized
controlled trials.
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Our searches identified one review of acupuncture and cupping therapy for herpes
zoster [22]. It published in Chinese in 2008 included 399 trials, and the purpose of that
review was to assess the quality of literature of clinical studies on acupuncture and cupping
therapy in treatment of herpes zoster. It reported that in all 399 trials, 86 trials only used
acupuncture as the treatment intervention, and 187 of the left 313 trials used wet cupping
therapy. It showed that as a very commonly used method in treating herpes zoster, wet
cupping therapy combined with acupuncture may have more markedly effect. In our
systematic review, we excluded 5 trials which used wet cupping therapy combined with
acupuncture to treat herpes zoster compared with medications alone, but all the 5 excluded
trials showed positive result of the therapeutic effect of interventions. Therefore the further
rigorous trials are warranted to testify this conclusion.

Most of existing trials are of small size and some risk of bias. Further high quality studies of
larger sample size are needed to confirm the effectiveness of wet cupping therapy in treating
herpes zoster. Randomization methods need to be clearly described and fully reported.
Although blinding of the patients and practitioners might be very difficult, blinding of
outcome assessors should be attempted as far as possible to minimize performance and
assessment biases. Choosing outcome measures should be according to the international
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standards, the continuous data may include change in average daily pain score from the
baseline week to the final study week, measured on Visual Analogue Scale (VAS), Short
Form-36 (SF-36) Quality of Life Questionnaire, Profile of Mood States (POMS), and the
Present Pain Intensity (PPI) score [23], the binary outcomes may include the burden of illness
due to herpes zoster, and the incidence of postherpetic neuralgia [24], et al. Analysis of
outcomes based on intention-to-treat principle is important. In addition, well-defined
diagnostic criteria should be employed to make a precise clinical diagnosis of herpes zoster,
and hence increase the comparability between trials. In its classical manifestation, the signs
and symptoms of zoster are usually distinctive enough to make an accurate clinical diagnosis
once the rash has appeared, but in some cases, particularly in immunosuppressed persons,
the location of rash appearance might be atypical, or a neurologic complication might occur
well after resolution of the rash. In these instances, laboratory testing might clarify the
diagnosis [25]. Reporting of trials should follow by the Consolidated Standards of Reporting
Trials (CONSORT) [26] to explicitly explain the process of the treatment, so that the
clinicians or other researchers can possibly practice. Since herpes zoster may wax and wane
with or without treatment, and it may have complications such as postherpetic neuralgia, a
longer follow-up period with serial measurement of outcomes is important to determine the
effectiveness and long-term effect of wet cupping therapy.
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Acknowledgments
Financial Support: National Basic Research Program of China (‘973’ Program, No. 2006CB504602) and the 111
Project (B08006).

HJ Cao and JP Liu were supported by a grant from the National Basic Research Program of China (‘973’ Program,
No. 2006CB504602) and the 111 Project (B08006). JP Liu was in part supported by the Grant Number R24
AT001293 from the National Center for Complementary and Alternative Medicine (NCCAM) of the US National
Institutes of Health.

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Figure 1.
The process of including and excluding studies
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Table 1
Characteristics of included studies

Trials Patients (M/F) Average age (y) Diagnostic criteria Interventions Duration of treatment Outcome measure
Cao et al.

treatment control Cupping treatment Control

Guo L 2006 [8] 19/17 17/18 unclear Chinese criteria for Prick with triangle-edged Aciclovir 200mg 3 10 days * Cure, improve,
diagnosis needle and cupping on lesion times daily, VitB1 ineffective; average
for 10 minutes, once every two 100mg, VitB12 time of cure.
days, plus aciclovir 200mg 3 250mg injection
times daily, VitB1 100mg, once daily.
VitB12 250mg injection once
daily.

Jin M 2008 [9] 26/19 25/20 55.5 Professional criteria Prick with seven-star needle Aciclovir capsule 10 days * Cure, improve,
in China and cupping on the lesion for 0.2g five times daily, ineffective.
10–15min, once daily for first cimetidine 0.2g three Incidence rate of
3 days, then once every two times daily, postherpetic neuralgia
days and last for 4 days indometacin tablet (PHN)
50mg three times
daily, Mecobalamin
tablets 0.5mg three
times daily, washout
with calamin and use
aciclovir cream

Lin L 2003 [10] 28/22 19/15 55.1 Criteria in text book Group1: prick with plum Aciclovir 0.2g five 10 days ** cure, markedly
in China needle on lesion then cupping times daily, VitB1 effective, effective,
on the same place for 10– 20mg three times ineffective.
15min, once every two days, daily, VB12 500mg The average time of
plus aciclovir 0.2g five times injection once every cure.
daily, VitB1 20mg three times two days, 2%–3% Incidence rate of PHN.
daily, VB12 500mg injection aciclovir cream for
once every two days, 2%–3% external use.
aciclovir cream for external
use.
16/14 19/15 54.2 Group 2: prick with plum Aciclovir 0.2g five
needle on lesion then cupping times everyday,
on the same place for 10– VitB1 20mg three

Altern Ther Health Med. Author manuscript; available in PMC 2011 August 7.
15min, once every two days. times everyday,
VB12 500mg
injection once every
two days, 2%–3%
aciclovir cream for
external use.

Liu Q 2004 [11] 32 32 55.6 unavailable Prick with triangle-edged Aciclovir 1.2g five 10 days ** cure, markedly
needle and cupping on lesion. times everyday, poly effective, effective,
I-C injection 2mg ineffective.
once every two days.

Long W 2003[12] 34 30 44.5 unavailable Prick with plum needle on Ultraviolet radiation 10 days Times of treatment for
lesion then cupping on the once every two days. * cured
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Trials Patients (M/F) Average age (y) Diagnostic criteria Interventions Duration of treatment Outcome measure

treatment control Cupping treatment Control

same place plus ultraviolet
radiation once every two days.
Cao et al.

Xiong Z 2007[13] 20/28 16/24 49 Criteria in text book Prick on lesion and cupping Aciclovir plus 7 days Incidence rate of PHN.
in China for 5 minutes. normal saline 250ml
intravenous drip
once daily.

Xu L 2004 [14] 20/20 21/19 unclear unavailable Prick with triangle-edged Aciclovir cream for 7 days * cure, improve,
needle and cupping on lesion external use plus effective, ineffective.
for 15min, aciclovir cream for aciclovir 0.5g and Scores given by
external use plus aciclovir 0.5g glucose 250ml patients according to
and glucose 250ml intravenous intravenous drip their symptom of
drip twice daily. twice daily. disease.
Average dry up time
of lesion; average time
of pain disappear

Zhang Q 2008[15] 14/26 12/28 unclear Criteria in text book Aciclovir 200mg five times Aciclovir 200mg 14 days * cure, improve,
in China daily, acupuncture beside the five times daily, effective, ineffective.
lesion 30min once daily, plus acupuncture beside
prick with triangle-edged the lesion 30min
needle on Dazhui, Feishu once daily
(double), Ganshu (double) and
cupping for 10min once every
two days, blood-letting on
auditive apex twice every
week

Definition of “cure”, “markedly effective “, “effective”, and “ineffective”:

*
cure: rush totally faded, the clinical symptoms are disappeared, no accompanying pain.
markedly effective: rush faded more than 70% (including 70%), the accompanying pain was almost disappeared.
improved: rush faded 30%–69%, the accompanying pain was obviously alleviated.
ineffective: rush faded less than 30%, no alleviation of the accompanying pain.
**
cure: rush totally fade, no accompanying pain.

Altern Ther Health Med. Author manuscript; available in PMC 2011 August 7.
markedly effective: rush faded more than 50%, the accompanying pain was almost disappeared.
effective: rush faded 10%–50%, the accompanying pain was alleviated a little.
ineffective: rush faded less than 10%, no alleviation of the accompanying pain.
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Table 2
Studies excluded from the review and reasons for exclusion

Study Reasons for exclusion

Cao et al.

Cai P 2006[16] Randomized controlled trial (RCT) which used wet cupping therapy combined with acupuncture compared with western medications

Huo H 2007[17] RCT which used wet cupping therapy combined with acupuncture and needle prick round the rush compared with western medications

Luo S 2008[18] RCT which used wet cupping therapy combined with moxibustion compared with western medications

Pang S 2003[19] RCT which used wet cupping therapy combined with needle prick round the rush compared with western medications

Wang H 2007[20] RCT which used wet cupping therapy combined with acupuncture compared with western medications

Zhang J 2004[21] RCT but data were not available for analysis due to inadequate reporting

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Table 3
Effect of estimates of wet cupping treatment in 8 RCTs

Trials Comparisons Effect Estimates( [95%CI]) P Value

Cao et al.

3.1 Numbers of cured patients

3.1.1 wet cupping plus other interventions versus other interventions alone

Guo L 2006[8] Wet cupping plus aciclovir, VitB1, VitB12 versus aciclovir, VitB 1, VitB12 RR 1.48 [1.05, 2.09]

Liu L 2003[10] Wet cupping plus aciclovir, VitB1, VitB12 and aciclovir cream versus aciclovir, VitB1, VitB12 and aciclovir cream RR 3.83 [2.07, 7.06]

Long W 2003[12] Wet cupping plus ultraviolet radiation versus ultraviolet radiation alone RR 1.30 [1.06, 1.59]

Xu L 2004[14] Wet cupping plus aciclovir cream, aciclovir 0.5g and glucose 250ml intravenous drip versus aciclovir cream, aciclovir 0.5g and RR 1.35 [0.93, 1.97]
glucose 250ml intravenous drip

Zhang Q 2008[15] Wet cupping and blood-letting on auditive apex plus aciclovir and acupuncture versus aciclovir and acupuncture RR 4.17 [1.92, 9.05]

meta-analysis RR 1.93 [1.23, 3.04]* 0.005

3.1.2 wet cupping versus medications

Jin M 2008[9] Wet cupping versus aciclovir, cimetidine, indometacin, mecobalamin, calamin and aciclovir cream. RR 2.15 [1.54, 3.00]

Liu L 2003[10] Wet cupping versus aciclovir, VitB1, VitB12 and aciclovir cream RR 2.83 [1.47, 5.46]

Liu Q 2004[11] Wet cupping versus aciclovir and poly I-C injection RR 2.90 [1.71, 4.91]

meta-analysis RR 2.49 [1.91, 3.24] <0.00001

3.2 Numbers of patients with PHN after treatment

Jin M 2008[9] Wet cupping versus aciclovir, cimetidine, indometacin, mecobalamin, calamin and aciclovir cream. RR 0.09 [0.01, 1.60]

Liu L 2003[10] Wet cupping versus aciclovir, VitB1, VitB12 and aciclovir cream RR 0.06 [0.00, 1.09]

Xiong Z 2007[13] Wet cupping versus aciclovir plus normal saline 250ml intravenous drip RR 0.05 [0.01, 0.38]

meta-analysis RR 0.06 [0.02, 0.25] 0.0001

Altern Ther Health Med. Author manuscript; available in PMC 2011 August 7.
3.3 Numbers of patients with improved symptom after treatment

3.3.1 wet cupping plus other interventions versus other interventions alone

Guo L 2006[8] Wet cupping plus aciclovir, VitB1, VitB12 versus aciclovir, VitB1, VitB12 RR 1.00 [0.92, 1.08]

Liu L 2003[10] Wet cupping plus aciclovir, VitB1, VitB12 and aciclovir cream versus aciclovir, VitB1, VitB12 and aciclovir cream Not estimable

Xu L 2004[14] Wet cupping plus aciclovir cream, aciclovir 0.5g and glucose 250ml intravenous drip versus aciclovir cream, aciclovir 0.5g and Not estimable
glucose 250ml intravenous drip

Zhang Q 2008[15] Wet cupping and blood-letting on auditive apex plus aciclovir and acupuncture versus aciclovir and acupuncture Not estimable

meta-analysis RR 1.00 [0.92, 1.08] 0.98

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Trials Comparisons Effect Estimates( [95%CI]) P Value

3.3.2 wet cupping versus medications

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Jin M 2008[9] Wet cupping versus aciclovir, cimetidine, indometacin, mecobalamin, calamin and aciclovir cream. RR 1.07 [0.98, 1.17]
Cao et al.

Liu L 2003[10] Wet cupping versus aciclovir, VitB1, VitB12 and aciclovir cream Not estimable

Liu Q 2004[11] Wet cupping versus aciclovir and poly I-C injection RR 1.27 [1.05, 1.54]
meta-analysis RR 1.15 [1.05, 1.26] 0.003

3.4 Average cure time

3.4.1 wet cupping plus other interventions versus other interventions alone

Guo L 2006[8] Wet cupping plus aciclovir, VitB1, VitB12 versus aciclovir, VitB1, VitB12 MD −2.10 [−3.55, −0.65]

Liu L 2003[10] Wet cupping plus aciclovir, VitB1, VitB12 and aciclovir cream versus aciclovir, VitB1, VitB12 and aciclovir cream MD −5.08 [−8.04, −2.12]

meta-analysis MD −2.67 [−3.97, −1.37] <0.0001

3.4.2 wet cupping versus medications

Liu L 2003[10] Wet cupping versus aciclovir, VitB1, VitB12 and aciclovir cream MD −3.14 [−6.45, 0.17] 0.06

RR: Relative Risk MD: Mean Difference CI: Confidence Interval

*
: Random model for data analysis

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