Gua Sha: A Complete Guide to Traditional Chinese Scraping

Gua sha is a therapeutic method that involves repeatedly scraping the skin with a gua sha tool coated with gua sha oil to treat various ailments. This technique reveals profound cultural differences between Eastern and Western medicine, prompting deep reflection. So, as a practitioner or enthusiast, what exactly is gua sha?

Principles of Gua Sha

Based on the twelve primary meridians and the eight extraordinary meridians of Traditional Chinese Medicine (TCM), gua sha follows the principle of treating acute conditions by addressing the symptoms. Through strong stimulation of the meridians, it causes local skin to become flushed and congested, thereby achieving effects such as awakening the spirit and rescuing from collapse, detoxifying and dispelling pathogens, clearing heat and relieving exterior conditions, promoting qi flow and alleviating pain, and strengthening the spleen and harmonizing the stomach.

Areas for Gua Sha

There are many areas on the body suitable for gua sha. Commonly used areas include: above, below, left, and right of the seventh cervical vertebra; both sides of the throat; the inner elbows; the inner knees; both sides of the spine; the intercostal spaces of the front chest and back; the heel tendons behind both inner and outer ankles; the liver and spleen regions under the left and right ribs; and the areas above and below the shoulder blades. For back scraping, lie prone; for shoulder scraping, sit upright. After scraping, bluish-purple petechiae may appear.

Tools for Gua Sha

Many tools can be used for gua sha. In the past, people commonly used smooth copper coins, copper spoon handles, porcelain soup spoons, etc. These tools were neither hygienic nor easy to disinfect. Nowadays, specialized gua sha tools made from water buffalo horn are widely used. They are rectangular with rounded edges and can be purchased at medical supply stores.

Indications for Gua Sha

Gua sha is indicated for conditions such as the common cold, fever, heatstroke, headache, gastrointestinal disorders, stiff neck, frozen shoulder (periarthritis of shoulder), lumbar muscle strain, muscle spasms, and rheumatic arthritis.

Procedure of Gua Sha

First, clean the area to be scraped. Dip the edge of the gua sha tool in gua sha oil or massage oil, then scrape the designated area. Scrape in one direction only—do not scrape back and forth. Apply even and appropriate pressure, avoiding sudden changes in force. If a sha condition is present, scraping the inner elbows continuously for about ten strokes will produce dark purple streaks of sha marks. According to the areas mentioned above, generally scrape each area about 20 times. For headache or sore throat, sit upright; for dizziness, blurred vision, or chest/abdominal pain, lie on your back; for shoulder, back, or lower back pain, lie prone.

If you scrape all the areas in sequence as described, the patient will immediately feel relief. Allow the patient to rest for a few minutes, then scrape each area—such as the front chest, intercostal spaces of the back, above and below the cervical vertebrae, and above and below the shoulder blades—another ten or so times. Finally, have the patient drink a cup of ginger-sugar water or plain boiled water, and they will feel exceptionally comfortable.

Precautions for Gua Sha

During gua sha treatment, keep the room warm, especially in winter—avoid cold drafts and wind. In summer, avoid direct fan blowing on the scraped area.
Avoid taking a cold shower within 30 minutes after gua sha.
Do not scrape the same area again until the sha marks from the previous session have faded. The interval between sessions should be 3–6 days, depending on when the skin marks disappear.
After gua sha, it is best to drink a glass of warm water (preferably lightly salted with sugar) and rest for 15–20 minutes.

References

1. Nielsen, A. (2014). Gua Sha: A Traditional Technique for Modern Practice. Churchill Livingstone.

2. Chinese Medicine theory: Gua Sha is based on the principles of meridians and blood stasis. For further reading, see: Maciocia, G. (2015). The Foundations of Chinese Medicine. Elsevier.