External therapies: When you do not apply it

What you do not touch

Some skin and patient conditions rule out all four techniques at once, and they are not negotiated with the patient however much they insist or however well it went last time.

Damaged skin, a wound or a recent scar

Out, in all four

Irradiated skin or altered sensation

Out: there will be no warning of damage

Clotting disorder or anticoagulation

Cupping and gua sha are out

Implant or superficial fixation hardware

The area is avoided

Anyone who cannot report what they feel

Not a candidate for moxa

Common mistake: Lowering the dose instead of declining. A contraindication is not solved by doing the same thing more gently.

An anticoagulated patient asks for cupping because “it worked really well years ago”. What do you do?

1. Apply it with minimal vacuum and a short dwell
2. Switch to silicone cups, which are gentler
3. Apply it only over large muscle masses
4. Do not apply it: anticoagulation rules out cupping and gua sha

After gentle gua sha, extensive purpura appears, badly out of proportion to the stimulus. What does it mean?

1. That there was a lot of stagnation and the technique worked
2. That there may be capillary fragility or an unknown clotting disorder
3. That the tool had a chipped edge
4. That you should repeat in a few days with less pressure

Why is wet cupping marked as professional content?

1. Because it involves incision or puncture and exposure to blood
2. Because it needs more expensive glass cups
3. Because it hurts considerably more
4. Because it leaves marks that take longer to fade

Fire risk or skin-burn risk?

• Alcohol is kept closed and away from the flameFireSkin
• The cup rim arrives barely warmFireSkin
• Ash goes in a metal container, never paperFireSkin
• Stop at central pallorFireSkin
• Confirm no combustion remains before storingFireSkin
• Avoid skin with altered sensationFireSkin

Why agree beforehand what the person will feel and how to stop?

1. To make the session more relaxed
2. To comply with the paperwork
3. Because it turns the technique into a controlled process, and almost every preventable incident is set up in that phase
4. Because the patient then decides the intensity