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gua sha

What is gua sha?

Everyone is getting to know acupuncture is a tool of Chinese medicine, more people are aware of cupping, and some are now getting curious about gua sha or scraping. Like cupping, scraping seems downright medieval to some, but it is part of self-help medicine in many countries and there is emerging scientific evidence of its effects.

Scraping uses a edged tool to stroke the skin until redness emerges. It doesn’t hurt, and the redness disappears within a few hours to a day or so later. The Chinese word gua sha 刮痧 means something like scraping out hot disease, and in the Chinese understanding it releases pathogenic influences such as heat from superficial layers of the body. For this reason it is often used to treat heatstroke. Cupping is also thought to remove pathogenic influences but it affects deeper layers of tissue. In one sense inflammation may be thought of hot disease and scrapping has been shown to have anti-inflammatory effects. (1,2, 3)

Just like cupping, guasha relieves pain. Musculo-skeletal pain is often attributed to something the Chinese call “blood stagnation”, and both cupping and gua sha “remove” blood stagnation. Another way of thinking of it is that after an injury, and with the formation of scar tissue and tight, less mobile groups of filaments in muscle tissue, there is poor microcirculation in the region. Scraping has been shown to increase local microcirculation and the resorption of extravasated blood releases anti-inflammatory and cytoprotective agents. (1,2, 3) One case study even showed that the anti-inflammatory effects are systemic, and are able to reduce inflammation of the liver (5). Another showed systemic effects in reducing mortality in rats with heat-stroke (6).

I find gua sha most useful to treat superficial and bony areas, and use it for cervical and lumbar spinal pain, and for tendinopathies near bony attachments such as lateral and medial epicondylitis. A random clinical trial has found that gua sha is effective in relieving chronic neck pain (4).

Many western physical therapists use a gua sha like form of treatment that uses expensive stainless steel tools, and slower strokes with deeper pressure. While I prefer traditional gua sha’s pain relieving effects earlier in treatment, I use larger instruments and more pressure in later treatments on bigger tendons of the leg and upper arm.

Someone suggested that 'spooning' could be a more gentle sounding translation of gua sha than 'scraping'. I replied that I didn't think I should offer 'spooning' on my website, same goes for 'stroking'.

  1. Arya Nielsen PhD (cand), LAc, Nicola T.M. Knoblauch MD, Gustav J.Dobos MD, Andreas Michal sen MD, Ted J.Kaptchuk. 2007. The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects. Explorer 3 (12)
    Available from: https://www.sciencedirect.com/science/article/pii/S1550830707001772
  2. Kenneth K. Kwong, Lenuta Kloetzer, Kelvin K. Wong, Jia-Qian Ren, Braden Kuo, Yan Jiang, Y. Iris Chen, Suk-Tak Chan, Geoffrey S. Young, Stephen T.C. Wong. 2009. Bioluminescence Imaging of Heme Oxygenase-1 Upregulation in the Gua Sha Procedure. Journal of Visualized Experiments 30.
    Available at: https://www.researchgate.net/publication/26777772_Bioluminescence_Imaging_of_Heme_Oxygenase-1_Upregulation_in_the_Gua_Sha_Procedure
  3. John W.M.Yuen, William W.N.Tsang, Sonny H.M.Tse, Wings T.Y.Loo, Suk-TakChan, Diana L.Y.Wong, Hilary H.Y.Chung, Jacky K.K.Tam, Thomas K.S.Choi, Vico C.L. Chiang. 2017. The effects of Gua sha on symptoms and inflammatory biomarkers associated with chronic low back pain: A randomized active-controlled crossover pilot study in elderly. Complementary Therapies in Medicine 32
    Available at: https://www.sciencedirect.com/science/article/pii/S0965229917301772
  4. Braun M, Schwickert M, Nielsen A, Brunnhuber S, Dobos G, Musial F, Lüdtke R, Michalsen A. 2011. Effectiveness of traditional Chinese "gua sha" therapy in patients with chronic neck pain: a randomized controlled trial. Pain Med 12(3)
    Available from: https://www.ncbi.nlm.nih.gov/pubmed/21276190/
  5. Suk-tak Chan, John W.M.Yuen, Mayur-Danny I.Gohel, Chi-ping Chung, Ho-cheong Wong, Kenneth K. Kwong. 2011. Guasha-induced hepatoprotection in chronic active hepatitis B: A case study. Clinica Chimica Acta 412 (17–18)
    Available at: https://www.sciencedirect.com/science/article/pii/S0009898111002658
  6. Wen-zhan Tu (屠文展), Rui-dong Cheng (程瑞动), Jie Hu (胡 洁), Jie-zhi Wang (王杰枝), Hai-yan Lin (林海燕), En-miao Zou (邹恩苗), Wan-sheng Wang (王万胜), Xin-fa Lou (楼新法), Song-he Jiang (蒋松鹤). 2015. Combination treatment with Gua Sha and Blood-letting causes attenuation of systemic inflammation, activated coagulation, tissue ischemia and injury during heatstroke in rats. Chinese Journal of Integrative Medicine 21(8)
    Available at: https://link.springer.com/article/10.1007/s11655-014-1816-4