J Acupunct Meridian Stud 2012;5(3):136e137
Available online at www.sciencedirect.com
Journal of Acupuncture and Meridian Studies
journal homepage: www.jams-kpi.com
- C O M M E N TA R Y -
Does Wet-Cupping (Blood-Letting Cupping) Cause
Iron Deficiency Anemia? Comments About “A
Prospective Evaluation of Adult Men with
Iron-deficiency Anemia in Korea” Published in
Internal Medicine
In a recently published article of Internal Medicine, Yun
and colleagues [1] suggested possible causes of iron-
deficiency anemia (IDA) of Korean men. In this study,
a total of 206 adult men diagnosed with IDA were included
and possible causes were evaluated from the medical
histories, gastroscopy, and colonoscopy tests. Among all
detected causes, one thing that attracted our interest was
the description of “blood-letting cupping.” According to
this manuscript, 11 patients who previously experienced
repeated wet-cupping therapy met the criteria for IDA.
If the authors wish to make this study rigorous and
transparent, several things need to be clearly declared.
First, they should prove that wet cupping was the only crit-
ical cause of IDA in those patients. Did any of them have
upper gastrointestinal disorders or colon diseases concomi-
tantly? Were all the possible risk factors for IDA evaluated
properly? In addition to the pathologic causes reported in the
study, many factors such as ethnicity, frequency of blood
donation, socioeconomic status, and diet pattern contribute
to IDA [2]. It seems reasonable to declare wet cupping as the
primary cause only after ruling out all other possibilities.
Second, the authors should prove causality between the
intervention (wet-cupping) and the adverse event (IDA). The
authors did not suggest any criteria of the repeated wet-
cupping therapy. If they use the word “repeated,” there
should be predefined criteria for it. Otherwise, the term is
confusing and may exaggerate the negative side effects to
the readers. In addition, location, duration, frequency of
treatment, and the amount of bleeding are necessary
factors that must be described for this intervention as well.
Copyright ª 2012, International Pharmacopuncture Institute
doi:10.1016/j.jams.2012.03.004
Apart from the issues related to the reporting methods, if
the cause of IDA for those patients actually was wet
cupping, the blood test results of them should have returned
to normal after discontinuing therapy [3]. The authors
should present these confirmatory data in the text.
All medical interventions have both pros and cons;
reporting the adverse events of any treatment should be
balanced with descriptions of possible benefits so that the
safety of the intervention can be fairly evaluated. There
are several reporting guidelines for adverse events [4,5]. A
scientific article published in a major journal should be
expected to follow the rigorous methodology outlined
above. If not, the truth may be distorted and lead to
groundless assumptions by the public, a result that is not
desirable for either medical professionals or consumers.
References
1. Yun GW, Yang YJ, Song IC, Park KU, Baek S, Yun HJ, et al. A
prospective evaluation of adult men with iron-deficiency
anemia in Korea. Intern Med 2011;50:1371e5.
2. Killip S, Bennett JM, Chambers MD. Iron deficiency anemia. Am
Fam Physician 2007;75:671e8.
3. Sohn IS, Jin ES, Cho JM, Kim CJ, Bae JH, Moon JY, et al.
Bloodletting-induced cardiomyopathy: reversible cardiac
hypertrophy in severe chronic anaemia from long-term blood-
letting with cupping. Eur J Echocardiogr 2008;9:585e6.
4. World Health Organization. WHO toxicity grading scale for
determining the severity of adverse events. Available at: http://
www.icssc.org/Documents/Resources/AEManual2003Appendices
February_06_2003%20final.pdf [accessed 13.05.11].
Commentary 137

5. Ioannidis JP, Evans SJ, Gotzsche PC, O’Neill RT, Altman DG, Jung Won Kang
Schulz K, et al. Better reporting of harms in randomized trials: Department of Acupuncture & Moxibustion,
an extension of the CONSORT statement. Ann Intern Med 2004; College of Oriental Medicine, Kyung-Hee University,
141:781e8. Seoul, South Korea

Tae-Hun Kim Myeong Soo Lee*

Korea Institute of Oriental Medicine, Korea Institute of Oriental Medicine, Daejeon,
Daejeon, South Korea South Korea

Kun Hyung Kim *Corresponding author. Korea Institute of Oriental

Department of Acupuncture & Moxibustion, Medicine, 1672 Yuseongdae-ro, Yuseong-gu,
Korean Medicine Hospital, Pusan National University, Daejeon 305-811, South Korea
Yangsan, South Korea E-mail: drmslee@gmail.com