Guasha (刮痧) is a tissue-scraping therapy technique long used in traditional Chinese medicine and other East Asian medical systems. Guasha therapy has become popular in both Vietnam and Thailand and is now used throughout Europe and the Americas. The name guasha (pronounced gwahshah) comes from the Chinese word “gua” for scraping and “sha” for redness. Actually, “sha” describes stasis within the tissue as well as the petechiae raised from guasha signifying liberation of that stasis. Sha is most closely described as petechiae - though much of the time the extravasated blood appears as red macula that immediately change and fade to ecchymosis. Guasha is also called skin scraping, spooning, or coining because spoons and coins are sometimes used as scraping tools.
TCM therapies, such as acupuncture, moxibustion, tuina massage, guasha and cupping, basically share similarities in their functions and mechanisms as they all developed from concepts of vital energy (qi) and involve meridians and acupuncture points. In the 56th chapter of Plain Questions, an ancient work in TCM, it mentions that “the 12 meridians and collaterals distributed in their relevant cutaneous regions”. Therefore, it is speculated that the efficiency of guasha therapy on certain skin regains is closely related with the function of collaterals and organ meridians.
Tools and Technique
The treatment involves using a tool to rub the skin in long strokes, applying enough pressure to create a redness in the skin. This therapeutic surface friction intentionally raises transitory petechiae and ecchymosis, thereby stimulating microcirculation and vital energy flow “qi”. Practitioners apply oil to the area of the body that is being treated, allowing the therapist to move the tool across the skin more smoothly. The guasha practitioner presses the tool into the body with smooth, firm strokes in one direction. If guasha is being carried out on the back, or back of the legs, a person may need to lie face-down on a massage table.
Scraping is performed according to the location of acupuncture points along meridians as described in traditional Chinese medicine.
As an essential technique of traditional East Asian medicine, both in the home and in the clinical setting, tools used to apply guasha vary from a simple Chinese soupspoon, a smooth coin, to instruments fashioned from cow bone, water buffalo horn, jade or stone. The important feature of a guasha tool is that the edge be smooth, not so sharp that the skin breaks but also not too blunt as to cause pain.
Guasha applied to the back begins at the center-line using a smooth round-edged tool that is press-stroked into the flesh enough to contact the fascial layer but not so hard that it causes pain or discomfort. A stroke line is typically 4-6 inches long. Stroking is repeated in one direction until the sha is raised on that stroke line, typically 8-12 strokes. Some articles incorrectly describe application by rubbing back and forth with a coin. This represents a misapplication of technique that could result in abrasion and not the therapeutic petechiae sought. Sha petechiae fill the stroke line area as stroking proceeds. Stroking stops when all the sha is expressed as petechiae or macula at the stroke line, before producing ecchymosis, which occurs naturally as petechiae begin to fade and blend. Guasha stroking is then continued at the next stroke line directly adjacent to the one before. This goes on until the area to be treated is covered.
Guasha is most often used for musculoskeletal disorders, especially to relieve muscle and joint pain. In traditional Chinese medicine it is commonly used for back pain, neck pain, connective tissue disorders, neuralgia and migraine headaches. Guasha has also been used to benefit the immune system. It is very effective to break up scar tissue and connective tissue adhesions. Thus, it can assist in improving circulation to connective tissues thereby improving movement in the joints.
Guasha is used to treat a range of illnesses and disorders, but research has only been carried out on a small number of specific medical conditions. There have been a few international studies showing the beneficial effects of guasha treatment on microcirculation, lymphatic stasis and pain management. The following are a few of the more recent studies.
A 2007 study was conducted at the Department of Nephrology, Unit of Circulation Research, University Hospital of Essen, Germany in which Laser Doppler imaging was used to make sequential measurements of the microcirculation of surface tissue before and after Gua Sha treatment in 11 healthy subjects.1 It was shown that Gua Sha increases microcirculation local to a treated area, and that increase in circulation may play a role in local and distal decrease in myalgia (muscle pain). Decrease in myalgia at sites distal to a treated area is not due to distal increase in microcirculation. There is an unidentified pain-relieving biomechanism associated with Gua Sha.
A 2010 Chinese study was conducted on 54 postpartum women at a medical teaching hospital to compare the effects of two breast-care methods - guasha therapy administered to the experimental group, and traditional breast care (i.e., massage and heat therapy) administered to the control group.2 This trial included postpartum breastfeeding women who had an uncomplicated delivery and who were experiencing breast engorgement problems. The guasha protocol selected appropriate acupoint positions, which included ST16, ST18, SP17, and CV17. Each position was lightly scraped seven times in two cycles. For the control group, they used hot packs and massage for 20 min in accordance with recommendations given in an obstetrical technique text book. The researchers concluded that “the guasha group showed improvements in symptoms that were significantly better than improvements perceived by the control group.” And further stated that Guasha therapy improves mastitis, with its ability to relieve breast engorgement but also has the advantage that it can be used while letting the baby suck the breast, which helps to remove annoying factors that disrupt breastfeeding. With the removal of these factors, breastfeeding can be expected to become easier and hence improve the health of both mothers and babies.”
A 2011 study was conducted in Kliniken Essen-Mitte, Academic Teaching Hospital of the University Duisburg-Essen, Germany to investigate the effectiveness of guasha in the symptomatic treatment of chronic neck pain.3 Forty-eight subjects were recruited into the trial, randomized into guasha or control groups, and followed up for 7 days. Guasha patients were treated once with guasha, while control patients were treated with a local thermal heat pad. Neck pain severity after 1 week improved significantly better in the guasha group compared with the control group. Significant treatment effects were also found for pain at motion and dimensions of quality-of-life. The treatment was safe and well tolerated. The researchers concluded a single treatment of guasha significantly decreased pain intensity and improved disability for up to 1 week in patients with chronic neck pain as compared with patients receiving thermal therapy. Guasha is safe, simple to apply, and inexpensive. The effects of this treatment and its related mechanisms should be further investigated in randomized trials of longer duration using other or similar treatments as controls.
In 2012, a study published in the American Journal of Chinese Medicine evaluated the effects of guasha therapy on the pain ratings and pressure pain thresholds of patients with chronic neck pain and chronic low back pain.4 A total of 40 patients were randomized to either a treatment group or a waiting list control group. Patients in both the chronic neck pain and chronic low back pain treatment groups reported pain reduction and improved health status from their one guasha treatment, as compared to the waiting list group. The researchers concluded that the results suggest that guasha may be an effective treatment for patients with chronic neck and low back pain.
Another 2012 study conducted at the China Academy of Chinese Medical Sciences in Beijing evaluated the therapeutic eﬀects of guasha by investigating the changes of temperature and local blood perfusion volume in healthy subjects after scraping stimulation.5 This was designed to explore the mechanism of guasha scraping stimulation on microcirculation and energy metabolism. Twenty-three health subjects were included in this study. Local blood perfusion volume and body surface temperature was detected at 5 min before scraping stimulation, 0, 15, 30, 60 and 90 minutes after scraping using a laser doppler imager and infrared thermograph. Signiﬁcant increase was noted in the blood perfusion volume in the scraping area within 90 minutes compared to the baseline level and non-scraping area. Compared with non-scraping area, an increase of body temperature with an average of 1◦ C was observed after scraping stimulation. The researchers concluded that scraping can signiﬁcantly improve the blood perfusion volume and increase the temperature in the scraping area, promoting the local blood circulation and energy metabolism.
A 2014 study conducted at Khon Kaen University in Thailand investigated the immediate effects of guasha therapy on pressure pain threshold, pain intensity and cervical range of motion in the 60 subjects who use a computer regularly and experienced neck pain and shoulder pain associated with myofascial trigger points.6 The subjects were randomized into one of the two groups; guasha therapy and sham ultrasound. The results showed that the guasha group had significant reduction in pain compared to the sham group. Moreover, improvement in cervical range of motion among the subjects receiving guasha was significantly greater than the sham ultrasound group. It was concluded that guasha therapy can reduce pain, and improve cervical range of motion in people who have neck pain and shoulder pain associated with myofascial trigger points.
A 2015 study published in Evidence-Based Complementary and Alternative Medicine explored the effects of guasha on heart rate variability (HRV) between healthy volunteers under normal conditions and weightlifters after training sessions.7 Ten healthy male volunteers under normal conditions and 15 male weightlifters after weightlifting training sessions were recruited into two groups.
Electrocardiography was recorded before and immediately after 20-minute guasha. HRV was calculated in both the time domain and the frequency domain. The researchers concluded that guasha therapy facilitates the parasympathetic nervous activity and modulates the balance between parasympathetic and sympathetic activities in both healthy men under normal condition and weightlifters after training sessions as indicated.
Side Effects and Risks
Guasha therapy is unlikely to have any serious side effects, but it can be somewhat painful for some people. A person who plans to have guasha should make sure that they go to an experienced practitioner. Guasha causes tiny blood vessels near the surface of the skin called capillaries to burst. This creates the distinctive red or purple bruises, known as “sha”. The bruises usually take a few days or a week to heal and sometimes can be tender while healing. Applying an ice pack can help reduce inflammation and ease any pain.
Guasha is contraindicated over any area that has been recently traumatized, fractured, contused, broken, scratched or burned. Guasha practitioners should not break the skin during treatment, but there is a risk it could happen. Broken skin increases the possibility of infection, so a guasha practitioner should always sterilize their tools between treatments. Lastly, be aware that guasha marks are sometimes reported to authorities by teachers and neighbors and misinterpreted as abuse.
Research into biomechanisms and effectiveness supports traditional use of Guasha and piques interest in its relevance in the modern clinical setting.
For more information and instructions on how to apply guasha:
Gua sha: A Traditional Technique for Modern Practice by Arya Nielsen
Gua Sha Scraping Massage Techniques: A Natural Way of Prevention and Treatment Through Traditional Chinese Medicine by Wu Zhongchao
The BIG "Little" Gua Sha Book: Learning (and Loving) the Ancient Healing Art of Gua Sha by Leta Herman, Jaye McElroy
Guasha: Step-by Step, a Teaching Video by Arya Nielsen
Nielsen, Arya, Nicola TM Knoblauch, Gustav J. Dobos, Andreas Michalsen, and Ted J. Kaptchuk. The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects. EXPLORE: The Journal of Science and Healing 3, no. 5 (2007): 456-466.
Chiu, Jin-Yu, Meei-Ling Gau, Shu-Yu Kuo, Yung-Hsien Chang, Su-Chen Kuo, and Hui-Chuan Tu. Effects of Gua-Sha therapy on breast engorgement: a randomized controlled trial. Journal of Nursing Research 18, no. 1 (2010): 1-10.
Braun, Maximilian, Miriam Schwickert, Arya Nielsen, Stefan Brunnhuber, Gustav Dobos, Frauke Musial, Rainer Lüdtke, and Andreas Michalsen. Effectiveness of traditional Chinese ‘gua sha' therapy in patients with chronic neck pain: a randomized controlled trial. Pain Medicine 12, no. 3 (2011): 362-369.
Lauche, Romy, Klaus Wübbeling, Rainer Lüdtke, Holger Cramer, Kyung-Eun Choi, Thomas Rampp, Andreas Michalsen, Jost Langhorst, and Gustav J. Dobos. Randomized controlled pilot study: pain intensity and pressure pain thresholds in patients with neck and low back pain before and after traditional East Asian ‘gua sha’ therapy. The American journal of Chinese medicine 40, no. 05 (2012): 905-917.
Xu, Qin-Yan, Jin-Sheng Yang, Bing Zhu, Li Yang, Ying-Ying Wang, and Xin-Yan Gao. The effects of scraping therapy on local temperature and blood perfusion volume in healthy subjects. Evidence-Based Complementary and Alternative Medicine 2012 (2012).
Saenlee, Krittaya, Wichai Eungpinichpong, and Uraiwan Chatchawan. Immediate effects of Gua Sha therapy for reducing neck and shoulder pain associated with myofascial trigger point in computer users. Journal of Medical Technology and Physical Therapy 26, no. 2 (2014): 169-179.
Wang, Xingze, Uraiwan Chatchawan, Saowanee Nakmareong, Atit Silsirivanit, Yingying Wang, Dongbei Xie, Jinsheng Yang, and Wichai Eungpinichpong. Effects of GUASHA on heart rate variability in healthy male volunteers under normal condition and weightlifters after weightlifting training sessions. Evidence-Based Complementary and Alternative Medicine 2015 (2015).