Gua sha

Gua Sha (刮痧), literally "to scrape away disease by allowing the disease to escape as sandy-looking object through the skin" in Chinese (more loosely, "to scrape away fever"), is an ancient medical treatment. Sometimes referred to as "spooning" by English speakers, it has also been given the descriptive French name, "tribo-effleurage".^[1]

The Vietnamese term for this practice is cạo gió (pronounced "gow yaw"), meaning roughly to "scrape wind", as in Vietnamese culture "catching a cold" or fever is often referred to as trúng gió, "to catch wind". The origin of this term is the Shang Han Lun, a ~220 CE Chinese Medical text on febrile disease - like most Asian countries China's medical sciences were a profound influence in Vietnam, especially between the 5th and 7th Centuries CE^[2]. Cạo gió is an extremely common remedy in Vietnam and for overseas Vietnamese.

It is also used in Indonesia. It is a traditional Javanese technique, known as kerikan (lit., "scraping technique") or kerok,^[3] and it is very widely used, as a form of "folk" medicine, upon members of individual households.

Gua Sha: the "folk" technique

In describing the Gua Sha techniques as a form of "folk" medicine, the term "folk" is not being used in any pejorative sense. It is used to emphasize:

the extremely widespread domestic use of the technique (thus, used by the "folk") as a method of first-contact intervention,
that complex medical diagnosis is not required (and, thus, any decision to use or not use Gua Sha can be reliably made by the "folk"), and
the overall safety of the technique (meaning that it is safe for the "folk" to use).

Notwithstanding this, the Gua Sha technique is just as important a part of the legitimate practice of the specialist practitioners of Traditional Chinese Medicine as is the use of fire cupping; and it is a highly reputable technique that is applied just as much by these highly trained experts as it is applied by the "folk" users.

As with many of the "folk" methods that are used domestically as a form of first intervention, the use of Gua Sha often precludes any need for any more complex medical treatment; and, because its use means that further medical treatment is unnecessary, the technique, although extremely widespread, is often hidden from view, and its role as a very significant and very important participant in the overall health care of a community may not be immediately apparent.^[4]

Therefore, in the case of Gua Sha, the term "folk" medicine should not be thought of as separate from the practice of more complex Traditional Chinese Medicine, but far more as an immediate form of domestic "first-aid" intervention that serves to prevent any need for further medical intervention by a medical professional.

The Gua Sha technique

Gua Sha involves repeated pressured strokes over lubricated skin with a smooth edge. Commonly a ceramic Chinese soup spoon was used, or a well worn coin, even honed animal bones, water buffalo horn, or jade. A simple metal cap with a rounded edge is commonly used.

In cases of fatigue from heavy work a piece of ginger root soaked in rice wine is sometimes used to rub down the spine from head to tail.

The smooth edge is placed against the pre-oiled skin surface, pressed down firmly, and then moved down the muscles -- hence the term "tribo-effleurage" (i.e., friction-stroking) -- or along the pathway of the acupuncture meridians, along the surface of the skin, with each stroke being about 4-6 inches long.

This causes extravasation of blood from the peripheral capillaries (petechiae) and may result in sub-cutaneous blemishing (ecchymosis), which usually takes 2-4 days to fade. Sha rash does not represent capillary rupture as in bruising, as is evidenced by the immediate fading of petechiae to echymosis, and the rapid resolution of sha as compared to bruising. The color of sha varies according to the severity of the patient's blood stasis -- which may correlate with the nature, severity and type of their disorder --appearing from a dark blue-black to a light pink, but is most often a shade of red. Although the marks on the skin look painful, they are not. Patients typically feel immediate sense of relief and change.

Practitioners tend to follow the tradition they were taught to obtain sha: typically using either gua sha or fire cupping. The techniques are not used together.^[5]

Indications

In classical Chinese practice, the Gua Sha technique is most commonly used to:

Reduce fever (the technique was used to treat cholera).
Treat fatigue caused by exposure to heat (often used to treat heat-stroke) or cold.
Cough and dyspnea: bronchitis, asthma, emphysema.
Treat muscle and tendon injuries.
Push sluggish circulation, fibromyalgia.
Treat headache.
Treat sunstrokes / heat syncope and nausea.
Treat stiffness, pain, immobility.
Treat digestive disorders.
Treat urinary, gynecological disorders.
To assist with reactions to food poisoning.^[6]

There is an allied technique, Ba Sha (拔痧), or 'tsien sha' literally "to lift up for cholera", which has a similar application to Gua Sha. It is performed by gripping the skin, lifting and then flicking between the fingers until petechiae appear. It is used more often on the tendons, at the center of the brow, or than over specific acupuncture points.

Cross-cultural confusion with physical abuse

A slightly different form of Gua Sha, using the edges of coins, rather than porcelain, is practiced as a "folk medicine" technique, by individuals amongst their own family members, in many Asian cultures such as Vietnam (where the coin scraping is known as "cạo gió", scraping for wind), in Cambodia, and in their immigrant communities abroad.

Cạo gió was introduced to the USA in 1975, when large numbers of Vietnamese were airlifted from South Vietnam near the end of the military conflict between North and South. Well-meaning practitioners of western medicine are sometimes shocked at the sight of these marks and fear that a child with the marks has been abused. The practice was observed by military physicians who publicized the harmless nature of this practice.

In 1980, it was found that many Vietnamese still distrusted US medical practitioners in part due to fear of being falsely accused of child abuse.

For professionals in this position, it is helpful to be familiar with the appearance of Gua Sha marks and to understand its traditional therapeutic value, and to be able to make the distinction between gua sha marks and signs of abuse.

Gua Sha is not known to be harmful. The technique called cupping also leaves distinctive, petechial marks on the skin, but is also harmless.

In 2001, a movie called "Gua Sha" (see The Treatment) was made addressing this practice and the cultural misunderstandings it causes. The movie stars Tony Leung Ka-Fai.

Artwork Portraying Gua Sha

In 2000 movie Beijing Herbs (Chinese: 黄连.厚朴) was made in Hong Kong showing Gua Sha among other things. Movie starred Tony Leung Ka-Fai, Jiang Wenli, Zhu_Xu.

Notes

^ Huard & Wong (1977), p.126. They also cite a French romanization for the same set of two Chinese characters: koua sha.
^ Needham, J., Celestial Lancets, Cambridge, UK: Cambridge University.
^ Although most Indonesians would understand it to have a far more general meaning of something like "to take out "the wind" by scraping".
^ In a similar fashion, the cleaning and bandaging of minor cuts and scrapes or, even, the washing of hands before eating, are extremely significant factors in the overall maintenance of health, but may not be immediately recognized as components of the overall delivery of health-care. However, the cleaning and bandaging of minor cuts and scrapes and the washing of hands before eating are practices that can be observed in every hospital.
^ One of the first to introduce the technique of Gua Sha to non-Chinese students in the United States was James Tin Yau So (1911 - ).
^ This includes the reactions to state altering substances (such as LSD, and psychedelic mushrooms) which are included under the generic title of food poisoning from a Traditional Chinese Medicine perspective.

References

Huard, P. & Wong, M. (Smith, D.N. trans.), Oriental Methods of Mental and Physical Fitness: The Complete Book of Meditation, Kinesitherapy, and Martial Arts in China, India, and Japan, Funk & Wagnalls, (New York), 1977. ISBN 0-308-10271-1
Nielsen, A., Gua Sha: Traditional Technique for Modern Practice, Churchill Livingstone, (Edinburgh/New York), 1995. ISBN 0-443-05181-X
Nielsen, A., "Gua Sha. Step-by-Step: A Visual Guide to a Traditional Technique for Modern Medicine" (teaching video)Verlag fuer Ganzheitliche Medizin, Koetzing, Germany. 2002. ISBN 3-927344-63-X
Yeatman GW, Dang VV. Cao gio (coin rubbing): Vietnamese attitudes toward health care. JAMA. 1980;244:2748-2749

[1] Huard & Wong (1977), p.126. They also cite a French romanization for the same set of two Chinese characters: koua sha.

[2] Needham, J., Celestial Lancets, Cambridge, UK: Cambridge University.

[3] Although most Indonesians would understand it to have a far more general meaning of something like "to take out "the wind" by scraping".

[4] In a similar fashion, the cleaning and bandaging of minor cuts and scrapes or, even, the washing of hands before eating, are extremely significant factors in the overall maintenance of health, but may not be immediately recognized as components of the overall delivery of health-care. However, the cleaning and bandaging of minor cuts and scrapes and the washing of hands before eating are practices that can be observed in every hospital.

[5] One of the first to introduce the technique of Gua Sha to non-Chinese students in the United States was James Tin Yau So (1911 - ).

[6] This includes the reactions to state altering substances (such as LSD, and psychedelic mushrooms) which are included under the generic title of food poisoning from a Traditional Chinese Medicine perspective.

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