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Manipulative and Body-Based Practices

By Steven Novella, MD, Assistant Professor of Neurology, Yale University School of Medicine

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Manipulative and body-based practices focus primarily on the body’s structures and systems (eg, bones, joints, soft tissues). These practices are based on the belief that the body can regulate and heal itself and that its parts are interdependent. They include

Several lesser known therapies are used in various cultures. They include the following:

  • Cupping

  • Scraping (eg, coining, spooning)

  • Moxibustion

Some of these therapies result in lesions that may be mistaken for signs of child abuse. These therapies are thought to stimulate the body’s energy and to enable toxins to leave the body. However, no research has verified their efficacy.


Cupping is used in traditional Chinese medicine and in Middle Eastern, Asian, Latin American, and Eastern European cultures. The practice derives from older traditions of bloodletting, which is still done in some cultures.

The air inside a cup is heated, often using a cotton ball soaked in alcohol, then ignited. The heated cup is immediately inverted and placed on the skin. The resulting vacuum sucks the skin partway into the cup, which may be left in place for several minutes.

Cupping has been used to treat bronchitis, asthma, digestive disorders, and certain types of pain.

Cupping may redden or burn the skin.


Scraping involves rubbing an implement across lubricated (oiled or wet) skin, usually on the back, neck, and shoulders. Coining uses a coin; spooning uses a spoon.

These therapies are used to treat the common cold, influenza, muscle pain and stiffness, and other disorders.

Coining results in linear red marks; spooning results in ecchymosis.


Dried moxa herb (a mugwort) is burned usually just above but sometimes directly on the skin over acupuncture points. The herb may be in the form of incense sticks.

Moxibustion is used to treat fever, digestive problems, and pain due to injury or arthritis.

Moxibustion can result in circular burns (which resemble burns from cigarette tips) and vesicobullous lesions.