Gua Sha

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Gua Sha 2016-10-24T13:58:48+00:00

What is Gua Sha?

Gua Sha is a traditional East Asian healing technique used to treat a variety of ailments including acute and chronic pain (Nielsen, 2007). It involves scraping of the skin with a smooth instrument to create a temporary, therapeutic rash. Creation of the rash is believed to alleviate pain and other conditions attributed to “congestion” of blood, or blood that has become stagnant and is not freely flowing as it should.

According to practitioners of Gua Sha, acute and chronic pain and inflammation are caused by sluggishness of a patient’s blood and Qi (“life force”) (Nielsen, 2009). It is believed that scraping of a large area of skin (“Gua”) to raise a rash treats pain and other characteristics of illnesses by compelling stagnant blood and other fluids to move (Nielsen et al, 2012). Movement of blood and fluids is believed to move metabolic waste within surface tissues and muscles, and increase microcirculation in a treated area (Nielsen et al, 2007).

The rash of Gua Sha consists of small extravasations of blood just deep to the surface of the skin (“Sha”). These small leakages of blood, described as “petechiae” or “ecchymoses” in Western medicine, are interpreted as a visible sign that static blood has regained a healthy flow (Schwickert et al, 2007). Typically, the rash clears within two to four days (Nielsen et al, 2007).

Examples of illnesses treated with Gua Sha include flu and fever; respiratory conditions such as common cold, asthma, bronchitis and emphysema; and musculoskeletal problems such as fibromyalgia, strain and spasm (Nielsen, 2007). In pain management, Gua Sha is used to treat acute and chronic pain that may pertain to these and other conditions.


In Gua Sha, the practitioner palpates (presses) the patient’s skin to search for tender points and knots in the underlying musculature. The practitioner also looks for areas that display blanching or delayed capillary refill. Based upon the findings, the practitioner lubricates target areas on the patient’s body with oil and scrapes the areas in broad strokes with a smooth instrument until the characteristic rash appears (Nielsen, 2002). Common instruments used to produce the rash include soup spoons, coins or slices of animal horn; and areas often treated include the back, neck, shoulders, buttocks, limbs, chest and abdomen (Nielsen, 2002).

It is believed that the color and duration of the rash helps the Gua Sha practitioner diagnose and tailor a treatment plan to suit the patient (Nielsen, 2007). For example, according to Nielsen (2007), light-colored Sha can indicate a “deficiency of blood,” whereas dark-colored Sha suggest the blood has been stagnant for an extended period.

Benefits of Gua Sha

There is increasing clinical evidence that reflex therapies such as massage, Gua Sha, cupping and acupuncture help to reduce symptoms of pain by affecting the function of nociceptors, or pain-sensing neurons, and the spinal cord. Moreover, these social, comforting therapies may benefit patients experiencing pain by promoting relaxation (Musial et al, 2008).

An open randomized controlled clinical trial found that Gua Sha produced beneficial short-term effects on pain and functional status in patients with chronic neck pain (Braun et al, 2011). A total of 48 patients were randomized to receive Gua Sha or a control treatment of local thermal heat pads and monitored for seven days. Severity of neck pain improved significantly in the Gua Sha group compared with the control group, and patients who received Gua Sha reported reduced pain at motion and scores on the Neck Disability Index (NDI), and improved quality of life. The researchers noted the Gua Sha treatment appeared to be safe and well tolerated. And a similar randomized, controlled study that measured the effects of Gua Sha therapy on the pain ratings and pressure pain thresholds of patients with chronic neck pain and chronic low back pain found patients who received Gua Sha treatment reported decreases in two different pain scales (Lauche et al, 2012).


Neither the literature nor the current national standards sufficiently address safety standards for Gua Sha (Nielsen et al, 2012). However, it is generally believed that Gua Sha should be contraindicated in patients taking blood thinners or who have bleeding disorders. It is also thought that Gua Sha should also be avoided in areas with bruising, or superficial skin lesions such as burns and open sores, and in areas overlying bony prominences such as the spine. Gua Sha is also contraindicated in the genitalia.


The patient’s response to Gua Sha guides the practitioner in the development of an individualized treatment plan. For example, the color and duration of the rash provide information used in planning future treatment.

In addition, the patient’s personal experience may determine whether Gua Sha is an appropriate pain-relieving technique for that individual. Patients who report pain relief and relaxation are likely to benefit from additional sessions.

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Journal Articles

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):362-9.

Lauche R, Wübbeling K, Lüdtke R, Cramer H, Choi KE, Rampp T, Michalsen A, Langhorst J, & Dobos GJ. 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.

Musial F, Michalsen A, & Dobos G. (2008). Functional chronic pain syndromes and naturopathic treatments: neurobiological foundations. Forsch Komplementmed. 15(2):97-103.

Nielsen A. (2002). Gua Sha Step-by-Step, a Teaching Video. Kötzting, Germany: Verlag für Ganzheitliche Medizin. June. 55 minutes.

Nielsen A. (2007). ‘Gua Sha’ and the Scientific Gaze: Original Research on an Ancient Therapy in a Call for Discourse in Philosophies of Medicine

[doctoral dissertation]. Union Institute & University.

Nielsen A, Knoblauch NT, Dobos GJ, Michalsen A, & Kaptchuk TJ. (2007). The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects. Explore (NY). 3(5):456-66.

Nielsen A. (2009). Gua sha research and the language of integrative medicine. J Bodyw Mov Ther. 13(1):63-72.

Nielsen A, Kligler B, & Koll BS. (2012). Safety protocols for gua sha (press-stroking) and baguan (cupping). Complement Ther Med. 20(5):340-4.

Schwickert ME, Saha FJ, Braun M, & Dobos GJ. (2007). [Gua Sha for migraine in inpatient withdrawal therapy of headache due to medication overuse]. [Article in German]. Forsch Komplementmed. 14(5):297-300.

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