To evaluate the effectiveness of cupping and bloodletting therapy in the treatment of musculoskeletal diseases. Systematic searches were conducted on KSI, KISTI, DB Pia, KIOM Database, and Koreamed until January 2007 Hand-searches included conference proceedings and our own files. There were no restrictions regarding the language of journals published in Korea. Controlled trials of dry cupping, wet cupping, or blood letting for patients with musculoskeletal disease were considered for inclusion. Trials testing other forms of dry cupping therapy were included. Methodological quality was assessed by two doctors. 20 possibly relevant studies were identified and 5 studies were included. One trial tested wet cupping for ankle sprain and reported positive result. Two trials tested blood letting for low back pain, one was positive and the other one was neutral. One trial tested the types of dry cupping for low back pain, and Ki-gong cupping therapy was superior to other two types of cupping. One trial compared wet cupping with dry cupping for low back pain and the result was negative. The effectiveness of bloodletting plus acupuncture for treating patients with low back pain is superior to acupuncture in spite of low quality. One trial of wet cupping for ankle sprain had effects in reducing pain. However, I suggest that the rigorous RCTs of cupping and blood letting therapy will be conducted in well designed features.