Cupping and Gua-sha/coining do not seem to have been prominent in Italian or European jurisprudence to date. There are, however, references in the literature (Morton, 2002; William Y. Chin, 2005; Renteln, 2010) to court cases that took place in the United States between the 1980s and 2000s, in which these practices were often equivocally interpreted as actual child abuse. With regard to coining and Gua-sha, a case from 1994 is cited, in which a Vietnamese mother is accused of abusive conduct toward her child, only to have the charges withdrawn after the testimony of a Vietnamese social worker who recognised the traditional care practice of coining in the signs (Morton, 2002). Also in the USA, in 2002, four Hmong children were preventively removed from their parents on the basis of the same suspicions, but then again the charges were dropped when the coining treatment was medically ascertained (Morton, 2002); the same happened in the case of two other Chinese parents who had practised Gua sha on their child and who were later cleared of abuse charges thanks to the intervention in of some experts in the practice at the trial stage (Corwin, 2000).
Regarding the practice of cupping, we report a case from 1983, also in the United States, in which two parents from the Central African Republic were prosecuted for performing this practice on their daughter. The judge, while finding cupping to be an unaccepted healing practice in America, ruled on the child's return to the family after temporary removal, recognising the conduct as not abusive (In re Jertrude O., Maryland Court of Special Appeals, 1983).
It is highly probable that in today's multicultural society, social workers (teachers, educators, social workers) and legal practitioners (especially those working in the first degrees of jurisdiction) have had or may in the future have contact with these practices. This could take place in proceedings involving the assessment of parenting skills and in those examining immigrant families, or even in more serious contexts of suspected child abuse by family members. In fact, these traditional medicine practices leave obvious marks on the body and therefore lend themselves to being mistaken, at first, as forms of abuse, especially in those cases where there is no knowledge of the practice, its purposes or effects.
In these hypotheses, a conflict could arise between the principle of the child's physical and psychological integrity and certain parental rights such as the right to pass on their culture to their offspring, which include traditional care practices, or the right to decide on health treatments to be carried out on their children, even in the area of 'self-medication'.
Unless we are dealing with dysfunctional contexts tainted by dynamics of violence, however, this could be an illusory conflict, easily overcome. The practices in question, in fact, if performed properly as prescribed by the cultures which keep them,[1] do not cause permanent injury to the physical integrity of minors, being compatible with the provisions of Article 5 of the Civil Code: they, in fact, only leave marks, very similar to bruises, destined to disappear in a few days after the final effect of the treatment. Coining and cupping, as traditional medicine practices, are an integral part of the cultural luggage of some minorities, a form of manifestation of the individual not only in his own community but also in his reality, and therefore susceptible to find protection in Article 2 of the Italian Constitution. Finally, such practices recall the right of parents to pass on their cultural heritage to their offspring, a heritage that would remain incomplete if deprived of their knowledge and experimentation since minors would not be able to understand the practice’s meaning or learn how to perform it.
The right to health under Article 32 of the Italian Constitution could be used as a parameter for assessing the compatibility of these practices with the interests of the child. In fact, these are curative modalities that in most cases are not considered substitutes for conventional health treatments, but are used to treat temporary ailments such as colds or transitory febrile conditions. Such practices do not, therefore, imply a specific ban on access to other types of pharmacological or hospital treatment, as is the case with some religious groups who, because of their beliefs, refuse to receive particular health treatments such as transfusions. The physical harm, identifiable in the marks left by the treatment or in the pain that may be felt by the minor during the execution of Gua sha or cupping, is strictly personal and dependent on the perception of the individual, but in any case cannot be used to stigmatise the practice, since it is composed of two elements - the momentary pain during the treatment and the marks left by it afterwards - that are in fact typical of most health treatments that are imposed on minors, especially if these are performed at a young age, from the most invasive ones to those performed in the context of family self-medication (swallowing pills, drops or syrups, undergoing injections, applying disinfectant to wounds, etc.).



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It could be argued that in the case of Gua sha and cupping, the pain inflicted cannot be justified by the efficacy of the treatment, but this would also invalidate the recognition of any value, even spiritual, of many family and traditional remedies, which are widespread in all cultures, even the majority culture; and it would also ignore the profound value hidden behind traditional healing gestures, handed down from generation to generation, and would fail to recognise that the strengthening of the healing relationship between parents and children also passes through these gestures. It should also be emphasised that Gua sha and cupping are treatments that do not involve the use of pharmacological elements and in this sense are much less invasive than some self-medication practices widespread in today's society, which now have a pharmacological guise, often administered without any medical consultation because they can be purchased without a prescription.
The condemnation of these treatments on the grounds that they leave marks on the body, even if they can be healed in a few days, would respond to a monocultural paradigm (Renteln, 2010) heedless of the real consistency of the practices or their cultural value, and one that also fails to respect the minor's interest, especially when the suspicions give rise to his removal from the family nucleus, thus generating indelible traumas, even if only temporary, when such removals are subject to protection under the right to private family life pursuant to Article 8 of the ECHR.
The other case law that those practices could potentially implicate is that of parents who chose to cure their children only with traditional remedies, without resorting to Western medicine, resulting in harm caused to the health of the child. Such cases, to date, have not approached Italian courts. Leaving to the judge the evaluation of all the facts (e.g. did the family had a consciousness that the child was at risk? could the parents have in their mind the option of taking the child to a Western hospital?), in general when the minority sincerely believed that the traditional medicine was a proper solution, this should be taken into account in the judgment. Given the level of recognition of traditional East Asian medicine (see below for anthropological insights), it is often seen as an equally valid choice to treat one's child exclusively with traditional medicine, as it is to treat one's child exclusively with Western medicine.
In Italy Western medicine is the official system, and the only one recognized as scientifically proven. Although the medical system allows other types of treatments (e.g. homeopathy, reflexology, acupuncture, folk remedies etc.), Italy has actually a mono-medical paradigm in which the only scientifically proven medicine is standard. Therefore in cases when the health of the child is compromised, the judge often takes for granted that the diligent parent is one who takes their child to an “official” doctor and no other. While, from a legal point of view, only the legislature can change this status quo, from a philosophical point of view, aimed to enhance intercultural reasoning, it is important to explore this provocative question: given the value widely recognized in East Asian traditional medicine, might it not be a sign of negligence from certain parents to eschew traditional Chinese medicine, and instead seek only Western medicine as a resort?
​ This provocative question arises also when considering the side effects, complications and wrongful deaths which are present in the Western medical system itself. Thousands of patients die by Western medicine every year, whether through simple negligence, lack of proper sanitation, or even by the action of the treatment working exactly the way it was intended to (as Western medicine, like all treatment courses, is not infallible). In cases of negligence, the doctor or hospital can be sued, but never has it ever happened that a Western parent was prosecuted because they, in good faith, took their child to a Western hospital. Is there a double standard in the way in which Italy and the West in general is approaching the issue of what cures are duly available to parents? Perhaps on an abstract level, yes: one could believe that in a global world which offers numerous certified medical remedies, all officially recognized treatments should be attempted and therefore also the East Asian ones, but it is also true that in court the average diligence of parents is measured on the basis of the standards that they know in their own cultural sphere, and of basic scientific knowledge accepted in the system of origin. Therefore the Italian parents that limit their choice to a Western hospital are not guilty. This same reasoning could also help the judge to better evaluate the behavior of parents belonging to different cultures.
In perspective, once another medicine system has proven to be scientifically valid, as is the case of East Asian medicine, it would be important to enhance the opportunities for both children and adults to be treated within a plural medical system.

NoTEs

[1] The Chinese medicine manual in relation to Gua-sha, for example, prescribes the performer to be cautious when performing this practice and observe the patient's expressions while performing it (A Barefoot Doctor's Manual: The American Translation of the Official Chinese Paramedical Manual 80 (1977)