Gua sha

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Gua sha
Gua Sha Massage Aftermath.jpg
Literal meaning"scraping sha-bruises"

Gua sha (Chinese: 刮痧) or kerokan, is part of traditional Chinese medicine (TCM) in which a tool is used to scrape people's skin in order to produce light petechiae. Practitioners believe that gua sha releases unhealthy bodily matter from blood stasis within sore, tired, stiff or injured muscle areas to stimulate new oxygenated blood flow to the areas, thus promoting metabolic cell repair, regeneration, healing and recovery.

Gua sha is sometimes referred to as "scraping", "spooning" or "coining" by English speakers. The treatment has also been known by the French name, tribo-effleurage.[1]


Gua sha was transferred from China to Vietnam, where it became very popular. It is known as cạo gió, which roughly means "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 c. 220 CE Chinese medical text on illness caused by cold. As in 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 expatriate Vietnamese.


Gua sha as practiced in Bali, Indonesia

Gua sha involves repeated pressed strokes over lubricated skin with a smooth edged and blunt instrument. Skin is typically lubricated with massage oil or balm, and commonly a ceramic Chinese soup spoon was used, or a blunt, well worn coin, even honed animal bones, water buffalo horn, or jade, or even a simple metal cap with a blunt rounded edge is used.

In cases of fatigue from heavy manual labor work, a piece of ginger root soaked in rice wine is sometimes used to rub down the spine from top to bottom.

The smooth edge is placed against the 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.

Practitioners tend to follow the tradition they were taught to obtain sha: typically using either gua sha or fire cupping. The techniques are sometimes used together.[3] In China, both gua sha and fire cupping are widely available from institutions ranging from national and public hospitals to private massage shops. Due to local peoples' deep trust in Traditional Chinese medicine and the treatments' reasonable price, both are very popular.


The effectiveness of gua sha is not supported by conclusive research, studies have compared it to acupuncture & sham trial, however these have been of poor quality and further study is needed.[4]

Gua Sha can cause tissue damage.[5]

As reported by a review article in the Journal of the American Academy of Dermatology, the negative side effects of gua sha range from minor ones – including dermatitis, burns and blood in the urine – to rare major ones including bleeding in the brain and severe injuries requiring skin grafts.[5]

A case has been reported of acute epiglottitis due to gua sha treatment on the neck for throat pain. The continuously applied pressure from gua sha could have damaged the underlying soft tissue, resulting in acute swelling and difficulty breathing.[6] Furthermore, the use of gua-sha along other CAMs was associated with a lower quality of life in patients with rhinitis.[7]

Some studies have found that gua sha has beneficial short-term relief effects in patients with stiff muscles and chronic muscular pain,[8][9] but further study is needed.

The use of hospital standards of sterilization and personal protective equipment is important to prevent contamination of infectious pathogens. Although no cases of blood-borne pathogens have been reported, the risk of transmission of blood cells and fluids cannot be ruled out. Protective measurements against infectious agents that are recommended include the single use of disposable devices, sterilization of re-used equipment and glove use. Lubricants should be poured out into cups and they are to be disposed after each use. Devices that cannot be adequately sterilized such as horn and bone are not recommended.[10]

Cross-cultural confusion with physical abuse[edit]

A slightly different form of gua sha using the edges of coins rather than porcelain items is practiced as a folk medicine technique. Individuals practice this "coining" amongst their own family members in many Asian countries, such as in Vietnam (where the coin scraping, or "coining" is known as "cạo gió", 'scraping for wind'), or in Cambodia, and also in their respective emigrant communities abroad. Health care practitioners in hospitals in Orange County, California, routinely see evidence of coining among hospitalized Vietnamese patients.[citation needed]

In 1980, it was found that many Vietnamese still distrusted U.S. medical practitioners in part due to fear of being accused of child abuse.[citation needed]

"This practice has been misidentified as child abuse in case reports," despite the intention of the parents.[11] However, physicians are required by law to report injuries from remedies such as "coining" to the appropriate agency (e.g., state child-protective service or state adult-prgraotective service), regardless of intention.[12]

In popular culture[edit]

The 2001 movie The Gua Sha Treatment (Chinese: 刮痧; pinyin: guā shā) was made in Hong Kong and showed gua sha.[13] It is a story about cultural conflicts experienced by a Chinese family in the United States.[14]

See also[edit]


  1. ^ Huard & Wong (1977), p.126. Also cited is a French romanization for the same set of two Chinese characters: koua sha.
  2. ^ Needham, J., Celestial Lancets, Cambridge, UK: Cambridge University.
  3. ^ 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 - ).
  4. ^ Lee MS, Choi TY, Kim JI, Choi SM (2010). "Using Guasha to treat musculoskeletal pain: a systematic review of controlled clinical trials". Chin Med. 5: 5. doi:10.1186/1749-8546-5-5. PMC 2827462. PMID 20205902.
  5. ^ a b Vashi NA, Patzelt N, Wirya S, Maymone MB, Zancanaro P, Kundu RV (2018). "Dermatoses caused by cultural practices: Therapeutic cultural practices". J Am Acad Dermatol (Review). 79 (1): 1–16. doi:10.1016/j.jaad.2017.06.159. PMID 29908818.
  6. ^ Tsai, Keng-Kuang, and Chih-Hung Wang. (2014) "Acute Epiglottitis following Traditional Chinese Gua Sha Therapy." CMAJ 186.8
  7. ^ Koo, Malcolm; Liang, Kai-Li; Jiang, Rong-San; Tsao, Hsin; Yeh, Yueh-Chiao (2014-01-01). "Association between Disease-Specific Quality of Life and Complementary Medicine Use in Patients with Rhinitis in Taiwan: A Cross-Sectional Survey Study". Evidence-based Complementary and Alternative Medicine : eCAM. 2014. doi:10.1155/2014/958524. ISSN 1741-427X. PMC 4228815. PMID 25530792.
  8. ^ Braun M; Schwickert M; Nielsen A; Brunnhuber S; Dobos G; Musial F; et al. (2011). "Effectiveness of traditional Chinese "gua sha" therapy in patients with chronic neck pain: a randomized controlled trial". Pain Med. 12 (3): 362–9. doi:10.1111/j.1526-4637.2011.01053.x. PMID 21276190.
  9. ^ Lauche R; Wübbeling K; Lüdtke R; Cramer H; Choi KE; Rampp T; et al. (2012). "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". Am J Chin Med. 40 (5): 905–17. doi:10.1142/S0192415X1250067X. PMID 22928824.
  10. ^ Nielsen, Arya, Ben Kligler, and Brian S. Koll. "Safety Protocols for Gua Sha (press-stroking) and Baguan (cupping)." Complementary Therapies in Medicine 20.5 (2012): 340-44.
  11. ^ "FAQ - Child Abuse - Stanford University School of Medicine".
  12. ^ Fadem, Barbara (2009). Behavioral Science - Board Review Series. Baltimore, MD: Lippincott Williams & Wilkins. p. 206. ISBN 978-0-7817-8257-9.
  13. ^ "EFL Movie Study Guide for: The Gua Sha Treatment". Krigline. Archived from the original on 17 February 2019. Retrieved 17 February 2019.
  14. ^ "The Treatment: User Reviews". IMDB. Archived from the original on 17 February 2019. Retrieved 17 February 2019.