The cupping procedure involves creating a small area of low air pressure next to the skin.  The low air pressure required may be created using vacuum cups; the vacuum is created with a mechanical suction pump acting through a valve located at the top of the cup. 

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In practice, cups are normally used only on softer tissue that can form a good seal with the edge of the cup. They may be used singly or with many to cover a larger area.  Skin may be lubricated, allowing the cup to move across the skin slowly. Skin markings are common after the cups are removed, varying from simple red rings that disappear relatively quickly, to discoloration from bruising, especially if the cups are dragged while suctioned from one place to another, ostensibly to break down muscle fibre. Usually, treatments are not painful.