Gua Sha – An Ancient Therapy for Contemporary Woes

In the theory of Chinese Medicine pain is almost always caused by a slowdown or blockage of blood or energy flow called stagnation. Gua Sha, translated as “raising sand,” is the ancient technique of frictioning the skin with a blunt-edged tool to unblock stuck blood and energy and vent the stagnation to the surface of the body to relieve pain and clear heat.

The practice of Gua Sha is ubiquitous throughout East Asia, although it is known by different names in different areas, and has been practiced throughout history as a family or folk therapy. Almost everyone in East Asia has seen Gua Sha done, had Gua Sha done, or done Gua Sha for someone. When asked where he learned to do Gua Sha, Dr James So, the founder of the New England School of Acupuncture (the oldest acupuncture school in the U.S.), is quoted as saying, “Where to learn? Everyone knows!”

In Gua Sha: A traditional Technique for Modern Practice Arya Nielson, the foremost western expert on Gua Sha, shows how Gua Sha can be used as a supplementary treatment for almost any ailment. Historically, Gua Sha was even used as a treatment for cholera. For many modern practitioners, however, the application of Gua Sha is focused on chronic muscle pain and tightness, and on relieving the symptoms of cold or flu. Gua Sha has a nourishing quality over time, since it improves circulation and transfer of nutrition and waste products to and from the cells. But initially, and most dramatically, it has the effect of mobilizing stuck blood or energy and dispersing the heat that often accompanies stagnation.

The first step is to determine if “sha” is present. Dr. So passed on a very simple test for sha: simply press your finger pads firmly into the flesh of the area being checked. If the blanching from the pressure disappears immediately no sha is present; if the finger marks take a while to fade there is sha and treatment is warranted. Sha occurs when there is a disruption of the circulation of blood/qi to an area of tissue. Classically the disruption is caused by the penetration of an external climactic factor, often cold, through the body’s defensive qi. Looking at the phenomenon from a western perspective, we would liken the presence of sha to the development of a  trigger point in the muscle. The cause would be a sticking or blockage of the fluid that surrounds tissues and facilitates the nourishment and waste product removal for the individual cells. Areas that are not getting good exchange of nutrition and waste products are likely to have reduced function and may become painful or stiff.

The mechanics of Gua Sha are very simple. Traditionally the technique was performed with a shaped bone or horn tool or even the edge of a coin. When I was taught the technique, we used the ceramic soup spoons that you see in Chinese restaurants. Because of concerns about proper cleaning and sterilization of the tools after use, many practitioners have switched to disposable tools (like jar lids that we can buy from packaging companies). The second ingredient is a thick oil or salve to protect the skin surface and allow the friction to pass through the skin layer to the tissue below. Petroleum jelly, Tiger Balm, Badger Balm, Vick’s Vaporub are all popular choices for lubricant.

The technique itself is simply to stroke the skin with the tool, with moderate pressure, in one direction, with the tool at about a 30% angle to the skin, until the sha surfaces. In general the skin will start to become pink and there may be a sensation of warmth, then small petechiae (red dots) will appear, which will merge together to form reddish “hicky” marks. This is the characteristic signature of sha — stagnation being moved out to the surface from a deeper layer. The treatment is complete when no more sha surfaces in the area being worked. Depending on the individual, the petechiae and a bruised appearance may take from 2 to 7 days to disappear. There may be some soreness in the area that was worked, similar to the soreness of a vigorous workout or an afternoon of pulling weeds in the garden. It’s important to keep the area protected and warm for about 24 hours after treatment, to allow the protective qi that is dissipated in the venting process to reassert itself.

Because the pressure of the technique is spread across the entire edge of the scraping tool, and the pressure can be easily varied to accommodate the individual, most people find that Gua Sha is easily tolerated. The relief that Gua Sha can bring is sometimes dramatic. I treated a woman several years ago who complained of intractable upper back pain. When I called her several days after the treatment to check in, she was delighted to tell me that she was completely pain-free for the first time in ten years!

Last winter I deepened my knowledge of the technique by taking a Gua Sha class with Arya Nielsen. In addition to practical tips and advice, she presented some great research that she is involved with, looking into the mechanisms of how Gua Sha works from the scientific point of view. One interesting point was that Gua Sha increases the circulation of blood and intercellular fluids in the surface layers of the area being treated by 400% during, and immediately after, treatment. This is important because it brings a flood of nutrition, and oxygen to an area that has been on something of a starvation diet. Although massage and acupuncture also increase local circulation the effects of Gua Sha are more long lasting. Another interesting discovery was that Gua Sha increases the expression of an enzyme called heme oxygenase-1, which is a strong anti-oxidant and cytoprotectant. The heme oxygenase-1 also demonstrates anti-inflammatory effects that persist for several days post-treatment.

Gua Sha is commonly used to treat painful muscular-skeletal conditions, but it can also be used to reduce symptoms and improve comfort in chronic internal pathologies as diverse as asthma, chronic headaches and IBS. Gua Sha should not be performed over broken skin, rash, or sunburn. Raised moles should be protected during treatment. Gua Sha is usually not repeated until signs of the previous Gua Sha treatment are completely gone. If you have chronic pain and are interested in trying Gua Sha, ask your practitioner to test for sha. Because Gua Sha leaves potentially large and colorful marks, you may not want to schedule your treatment before a trip to the beach or that formal banquet where you want to show off that strapless dress. Likewise, unless you want to alarm your primary care physician, have your Gua Sha after your yearly checkup, not right before!

If you would like to see a quick demonstration of the technique please check out the video tab on the home page


1)    Neilsen, Arya: Gua Sha class notes NESA Feb 2013

2)    Neilsen, Arya: Gua Sha: A Traditional Technique for Modern Practice, second edition, Churchill Livingstone 2013