Combining Chinese and Persian medicine techniques of cupping in hospitalized COVID-19 patients: a single-blind, randomized, controlled trial

COVID-19 pneumonia and long COVID is commonly associated with cough, dyspnea and declined oxygen saturation (SpO(2)). Cupping has been used as an adjuvant therapy to improve SpO(2) and respiratory symptoms. This research was conducted as an assessor- and analyst-blinded, randomized controlled trial. A total of 72 hospitalized patients with moderate-to-severe COVID-19 were randomly assigned into two groups: (1) cupping (CUPP); and (2) control (CTRL), all receiving conventional treatment. In CUPP, warm cupping was performed for 3-7 days (three times, daily). The primary clinical outcomes were SpO(2) and respiratory rate (RR). COVID-19-related hospitalization duration, intensive care unit admission and duration, need for intubation, and mortality (all up to day 28) were evaluated as secondary efficacy endpoints. Furthermore, severity of cough, dyspnea, chest tightness, and oxygen demand were considered as secondary outcomes. Thirty-four patients in CUPP and 33 patients in CTRL completed the study. After 3 days, RR decreased in CUPP significantly (p < 0.001), unlike CTRL (p > 0.05). After 7 days of intervention, SpO(2) improved up to 13% in CUPP versus 0.07% in CTRL (p < 0.001). Compared with CTRL, patients in CUPP were discharged sooner (mean: 12.1 vs. 3.9, respectively) and faced no serious adverse events (p < 0.001). Moreover, after 28 days of follow-up, all CUPP patients were discharged from the hospital. In contrast, eight patients from the CTRL expired. Within 3 days, respiratory symptoms improved significantly in CUPP compared with CTRL (p < 0.05). Adjuvant cupping therapy accelerates alleviation of respiratory symptoms and prevents morbidities and mortalities in COVID-19 patients.