Effects of fire dragon cupping therapy for patients with post-stroke shoulder-hand syndrome: a systematic review and meta-analysis
In brief
Fire dragon cupping raises overall response by roughly 20% in post-stroke shoulder-hand syndrome
A meta-analysis of 11 Chinese RCTs (1,087 patients) found that fire dragon cupping improved clinical efficacy by about one-fifth compared with usual care, and it also boosted upper-limb motor scores. However, results for hand swelling and pain were highly inconsistent, and the studies lacked blinding and diverse populations, so the evidence remains too uncertain for firm treatment recommendations.
- Journal
- Frontiers in neurology (Q2)
- Published
- 30 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yiqiang Xu, Hongman Shen, Yue Yang
- PMID
- 42597375
- DOI
- 10.3389/fneur.2026.1857245
Why clinicians should know about it
- Picked for Epidemiology (top studies of the week, 16 August 2026).
Abstract
BACKGROUND: Shoulder-hand syndrome (SHS), as a significant complication of stroke, has seen a continuous increase in incidence. The Fire Dragon Cupping (FDC) therapy is an emerging cupping therapy (CT), and this study aims to summarize the clinical evidence of FDC therapy intervention for SHS, providing guidance for its application and development. METHODS: We searched 11 databases from inception to December 12, 2025. Data were pooled using standardized mean differences (SMD) and risk ratios (RR) with 95% confidence intervals (CIs) and 95% prediction intervals (PIs). To explore high heterogeneity, we prespecified subgroup analyses, univariate meta-regression, and Trial Sequential Analysis (TSA). Risk of bias and certainty of evidence were assessed using ROB-2 and the GRADE framework, respectively. RESULTS: A total of 11 Randomized Controlled Trials (RCTs) were included in this study, involving 1,087 patients. Notably, all these studies were from China. Pooled estimates indicated FDC might improve clinical efficacy (RR = 1.20, 95% CI:[1.12 to 1.28], 95% PI: [1.10-1.31], p < 0.0001, TSA confirming sufficient cumulative sample size, required information size (RIS) = 267) and upper motor function (SMD = 1.01, 95% CI:[0.76 to 1.26], 95% PI: [0.21 to 1.80], p < 0.0001). For hand swelling (SMD = -1.34, 95% CI:[-1.98 to -0.70], 95% PI: [-3.59 to 0.91], p < 0.0001, I2 = 91.9%), and pain intensity (SMD = -1.57, 95% CI:[-2.15 to -0.98], 95% PI: [-3.74 to 0.60], p < 0.0001, I2 = 92.3%), heterogeneity was high and its sources were not identified. Given the prediction intervals that cross the null, the pooled estimates for hand swelling and pain intensity are reported for transparency only and should not be interpreted as summary effects, in line with the cautious reading in the body. CONCLUSION: The apparent therapeutic benefits must be interpreted with extreme caution due to unresolvable severe heterogeneity, inherent lack of blinding, disparate control interventions, and limited generalizability due to an exclusive reliance on Chinese-language literature. Current evidence is insufficient to formulate strong clinical recommendations, future multi-center, adequately blinded RCTs are mandated.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.