Gua sha is a traditional East Asian medical treatment that has been used for centuries to relieve pain, improve circulation, and boost immune function. It involves the use of a smooth-edged tool, such as a coin or jade stone, to apply firm pressure and scrape the skin. The practice has a long and rich history dating back to ancient China, and it has been used in various forms in other East Asian countries such as Japan, Korea, and Vietnam. In this article, we will explore the history of gua sha and its modern variants.
Tracing the Ancient Origins of Gua Sha
Scraping therapies are one of East Asia's oldest forms of medicine. Gua Sha, in China, dates back 5,000 years, 1 and likely has its origins in the neolithic period with the use of bian stones. Bian stones were made from various materials to scrape, rub or incise body parts for a therapeutic effect. The earliest such tool was discovered in neolithic ruins in Inner Mongolia, and two other bian stones were found in a neolithic grave in Shangdong Province, China.3 The earliest written record of bian stones in a medical text was in Chapter 12 of the Huang Di Na Jing Su Wan (Warring States period 475 BC- 221 BC). It states:
"Most of the local people there are black in skin and loose in striae, and their diseases are the carbuncle kind. It is suitable to treat the disease with stone therapy, so the stone therapy is transmitted from the east." 4
Quan Yuanqi, a sixth-century commentator on the Su Wen, pointed out that "bian" was a tool for external treatment and that there were three types of stone needles corresponding to the illness being treated.5,6 These were the Zhen Stone(needle stone), “Bian stone”(pointed stone), and Chan stone(chisel stone).
The first three of the nine needles described in the Su Wen's sister text, the Ling Shu, were not inserted into the body, and the Ling Shu mentions rubbing and scraping therapies in its discussions of the nine needles. Scholars such as Jeffery Yuan and Ann Cecil-Sterman especially equate the third of the nine needles with gua sha.7,8 The second and third of the nine needles are described in the following passages:
Second of the nine needles Enshin:
"(Ch. 1) The round needle has the shape of an egg. It is used for rubbing and messaging, to divide and separate so as not to injure the muscles and the flesh. (Ch. 7) When the disease is located at the divisions between the flesh, treat using the round needle. (Ch. 78) Two is the earth. Man's flesh resonates with the earth. Thus, to effect a cure the needle must be straight with a round tip. Do this without penetrating the divisions of the flesh, or the qi will be exhausted. The second is called the round needle. It is patterned after those needles for working cotton. Its body is tubular, and its tip is like an egg. The length is 1.6 cun(38.4mm). It controls and cures the qi which is between the flesh." 9
Third of the nine needles Teishin: "(Ch. 1) The spoon needle has a point which is as sharp as a grain of millet. It controls the channels by touch, not penetration, so as to bring about the qi. (Ch. 7) when the disease is in the channels, and the qi is sparse, tonify at that point. Treat by using the spoon needle at the well, spring, stream and river shu points. (Ch. 78) Three is man. Man becomes alive through blood channels. Therefore, to effect a cure, the needle must be large with a round tip. Use it to massage the channels without penetrating so that it can reach the qi and cause the evil qi to go uniquely. The third is called the spoon needle. Its patterned is a tip like a grain of millet. The length is 3.5 cun(84mm). It controls by massaging the channels and by grasping the qi. This causes the evil to flow out." 9
These passages show that early Chinese medical practitioners used tools to scrap and rub the body to achieve therapeutic effects. Of course, the shape of the tools and techniques used have evolved since these 2500-year-old passages were written, but it is easy to see the origins of the gua sha in both theory and practice from these ancient texts.
A later reference to scraping therapy is presented in Effective Formulas Handed Down for Generations, written in 1337 AD by Wei Yi Lin. He writes:
"With wet hemp, scrape the surface of the neck, elbow, knee, and wrist until there is miliary cutaneous bleeding. Cover the body with thick clothes and quilts. Then, administer orally a little rice porridge or decoction of Chinese green onion and fermented soybean or fresh Chinese onion tea. After sweating, the illness will be healed. This is an effective method of loosening and relaxing the skin."
This passage describes scraping therapy in conjunction with herbal medicine to induce sweating and relax the muscles to heal illness. Wei Yi Lin also gives a cursory description of sha when he describes miliary bleeding.
Other references to gua sha in formal medical writing are only prevalent in modern times. While it may have fallen out of favor in the establishment, likely giving way to acupuncture and herbal medicine, it became a common folk remedy throughout East Asia. It is not uncommon in parts of modern Asia for a mother to treat her child with gua sha. If a child gets a cold or fever, the mother may go to the cabinet and find the porcelain dish or spoon with a smooth edge and use it as a gua sha tool. The idea of the improvised medical device in folk medicine has been carried into modern practices. TCM schools often teach gua sha using a Chinese soup spoon, and some physical therapists began using metal spoons before the development of specifically designed tools that are now in common use.
Understanding the Meaning and Significance of Gua Sha (刮痧) in Traditional Chinese Medicine
In China, it is known as gua sha or to "scrape away disease," in Vietnam, it is known as Cạo Gió or "to scrape wind." In Indonesian, it is called Kerikan or "scraping technique," A modern derivative of gua sha that focuses solely on muscular-skeletal-related issues is IASTM or Instrument Assisted Soft Tissue Mobilization. Another popular modern derivative of gau sha is facial gua sha which is mainly used for cosmetic purposes.
As is often the case with older Chinese terminology, studying the written language can offer insight into deeper meanings behind the words used to express an idea. 刮痧 Gua sha is made up of several components. 刮Gua means to scrape or shave, but it can also mean to blow, as in the wind. Wind is considered one of the six pathogenic influences that cause external disease in TCM (Traditional Chinese Medicine), and the double meaning in this character is likely intentional. 痧Sha is made up of 沙 Sha, which means sand, and 疒 Chuang is radical for sickness. When combined, they create 痧Sha, which refers to acute disease. In the Chinese written language, context is essential to grasp the meaning of words. In the case of sha, depending on the combined character, its meaning may change; for example, FengSha is measles, FaSha is heat stroke, HongSha is scarlet fever, TiSha is Cholera and ShaZhang is "acute filthy disease." By this translation, we read 刮痧Gua Sha as "to scrape away disease." This translation may also imply that wind as a pathogen is an aspect of the disease being treated. In TCM, wind is said to be the bringer of 1,000 illnesses and is one of the six Xie Qi (evil qi) or pathogenic influences.
The term sha has several meanings for the clinician. Sha can refer to the erythema and petechiae that are sometimes formed during scraping. The look can be similar to that of a cholera rash. The color, tactical quality, the time it takes to fade, and how quickly, or even if, the sha forms are all diagnostic.1,2 (see Gua Sha as Diagnosis) Sha can also refer to the sand-like vibratory sensation that is felt through the tool or by palpation while the procedure is performed. Clinicians can use this tactile feedback diagnostically to understand where the pathogenic influence is most potent. In TCM, sha is a visual expression of the release of latent pathogenic influences from the cou li. In biomedical terms, it is generally viewed as a localized histamine response or targeted inflammation. See Gua Sha: An Essential Diagnostic Tool for Traditional Chinese Medicine Practitioners for more information.
Different Types of Gua Sha Tools from History
Gua Sha Tools tools come in a wide variety of materials, shapes, and sizes. However, they must have a smooth edge that will not break the skin during use.10,11,12 Materials include stone, jade, horn, bone, ceramics, metal, and even plastic. Some materials are used for their energetic properties, while others are selected for their durability or capacity to be disinfected.
Traditional materials are generally chosen for their availability or their energetic properties. For example, in Vietnam and Cambodia, smooth-edged coins are readily available and used quite frequently. In Chinese households, ceramic dishes or soup spoons were easily accessible and commonly used for gua sha.
Traditional practitioners often consider the energetic property of materials as the law of signatures widely used principle in TCM practices. For example, buffalo horn is thought to be a very yang material, jade is representative of longevity, silver is considered reducing, and copper has an affinity to the blood level.
Modern considerations in a professional practice may be slightly different from traditional ones. Metal gua sha tools are favored by many current practitioners because they are durable and easy to disinfect between patients. Ridged metal tools have the added benefit of providing vibratory feedback during use, giving the practitioner instant diagnostic information while the changes occur in the patient. This real-time feedback helps the practitioner to work efficiently as it tells them what areas are tight, where adhesions may be, and when those areas have been sufficiently treated.13,14 Dr. Arya Nielsen advocates using baby food jar lids as single-use tools. These inexpensive disposable tools subvert the need to disinfect tools between patients when treating large numbers of people in a hospital setting.10,12,15 Modern tools are often designed with specific curvatures to conform with different body parts and provide the patient with a much higher level of comfort during treatments than traditional tools.
Exploring the Resurgence of Gua Sha in Modern Medicine
In the last few decades, Zhang Xiuqin and Hao Wanshan published the book Holographic Meridian Scraping Therapy and a series of videos in Chinese and English.3 This book is one of the most comprehensive books on Chinese scraping therapies ever written and gives a systematic approach to treatment along with six basic scraping methods. Its publication helped stoke a resurgence of gua sha in the Chinese medical establishment. Scraping therapy is currently used in clinical settings and hospitals as well as self-care and family medicine in China17 for treating everything ranging from respiratory illness and muscle-skeletal issues to hepatitis.
Coining, a traditional form of gua sha has played a significant role in helping Cambodians cope with the PTSD that followed the fall of Phnom Penh in April 1975 and the reign of terror under the Khmer Rouge.16 While the horrors of this period have been well-documented, it is crucial to recognize the ongoing impact on the mental health of those who experienced it firsthand. Gua sha has offered therapy and solace for those seeking to heal from past trauma and move forward.
In 1980, it was discovered that a significant number of Vietnamese people were hesitant to seek medical care from American practitioners due to concerns about being wrongly accused of child abuse.17 Traditional forms of healing, such as coining or gua sha, often leave marks on the skin that could be misinterpreted as signs of abuse. This issue highlights the importance of cultural competency and sensitivity in the medical field, as well as the need to address and overcome biases and misunderstandings to provide the best possible care to all patients.
Examining the Similarities and Differences between Instrument Assisted Soft Tissue Mobilization (IASTM) and Gua Sha
Western medical practitioners, such as physical therapists and osteopathic doctors, have begun to use one aspect of gua sha to treat musculoskeletal disorders. This modern practice is generally referred to as Instrument Assisted Soft Tissue Mobilization (IASTM), a form of manual therapy. The techniques used in IASTM are almost identical to those used in gua sha, but the language used to describe the actions are put into modern medical terminology.
IASTM and gua sha are so similar that in recent years, some have criticized IASTM as a form of cultural appropriation. Gua sha has a long history in Chinese medicine and is an important aspect of traditional East Asian medical practices. Some argue that IASTM is simply the rebranding of gua sha by Western practitioners and appropriates this cultural practice without acknowledging or respecting its origins and cultural significance. While a medical procedure must be explained in ways the patients receiving them understand, it is important to recognize and respect the cultural roots of this ancient medical practice.
Tools used for IASTM are usually made from surgical steel or other metals, are much heavier and have a broader edge than traditional gua sha tools. This change in design allows practitioners to press harder and work longer without damaging the skin. The main goal of ISTAM is to break down fascial adhesions and muscle fibers to increase function. Unlike traditional gua sha, IASTM practitioners do not treat internal diseases and only focus on musculoskeletal disorders. This specialization has made IASTM a popular treatment among sports medicine providers.
Understanding the Origins of Facial Gua Sha
Facial gua sha is rooted in traditional Chinese gua sha but, in its modern form, is likely a merger of conventional Chinese medicine techniques and Japanese skincare regimes. It involves the use of tools to massage the skin and stimulate circulation. While traditional gua sha is used to treat illness and musculoskeletal conditions, facial gua sha is focused on cosmetics and skin health.
In recent years, there has been a proliferation of purpose-built tools designed explicitly for facial gua sha, which are often similar to those used in traditional gua sha. These tools are usually slightly smaller and lighter than their traditional counterparts but have essentially the same design. For the most part, facial gua sha tools can be used interchangeably with traditional gua sha tools.
The techniques used in facial gua sha are generally much lighter and gentler than those used in traditional gua sha, as the goal is not to produce the characteristic sha (redness) that is typically seen after traditional gua sha. Instead, the techniques used in facial gua sha are designed to improve circulation, stimulate collagen production, and help reduce wrinkles, all with the aim of achieving a more youthful and radiant complexion.
A Cultural Perspective on the Evolution of East Asian Scraping Therapies
Gua sha and other East Asian scraping therapies have a long and rich history dating back thousands of years. Gua sha has existed in the official medical establishment and as a popular folk remedy. It continues to evolve into modern modalities such as facial gua sha and IASTM. While progress and evolution in medicine can help to make modalities like gua sha more accessible to a broader population, it is essential to remember and acknowledge the cultural origins of these therapies as they become more widely adopted and continue to benefit people worldwide.
References
1. Xiuqin Z, Wanshan, Hao. Holographic Meridian Scraping Therapy. Beijing: Foreign Languages Press; 2000.
2. Nielsen A. Gua sha Traditional medicine for pain , inflammation and immune support. 2012;412(August 28):1.
3. Cheng X, Zheng Q, Xie Z. Chinese Acupuncture and Moxibustion. 3rd ed. (Cheng X, Zheng Q, Xie Z, eds.). Beijing: Foreign Languages Press; 2009.
4. Bing W, Wu NL, Wu AQ. Yellow Emperor's canon internal medicine. China Science and Technology Press; 1997.
5. Kan-Wen M. Acupuncture: Its Place in the History of Chinese Medicine. Acupunct Med. 2000;18(2):88-99.
6. Unschuld PU. Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. Berkeley and Los Angeles, California: University of California Press; 2003.
7. Cecil-Sterman A. Advanced Acupuncture: A Clinical Manual. Ann Cecil-Sterman, PLLC; 2013.
8. Yuen JC, Howard S. Light on the Essence of Chinese Medicine- The Nei Jing. Continuing Education Department, New England School of Acupuncture; 2001.
9. Wu J-N. Ling shu, or, The spiritual pivot = Ling shu. Washington, D.C.; Honolulu, Hawaii: Taoist Center; Distributed by University of Hawaii Press; 2002.
10 Nielsen A. Gua Sha: A Traditional Technique for Modern Practice. Oxford: Churchill Livingstone; 2012.
11. Nielsen A. Gua Sha: A Clinical Overview. 2004.
12. Nielsen A. The Crisis is the Cure. Sites J 20Th Century Contemp French Stud. 1996;(50):5-11.
13. Tools and methods for performing soft tissue massage. August 1994. https://patents.google.com/patent/US5441478A/en. Accessed June 18, 2018.
14. Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc. 2016;60(3):200-211.
15. Nielsen A, Kligler B, Koll BS. Safety protocols for Gua sha (press-stroking) and Baguan (cupping). Complement Ther Med. 2012;20(5):340-344. doi:10.1016/j.ctim.2012.05.004
16.Van Schaack, Beth and Reicherter, Daryn and Chhang, Youk, Cambodia's Hidden Scars: Trauma Psychology in the Wake of the Khmer Rouge (2011). Stanford Public Law Working Paper No. 2758130, Available at SSRN: https://ssrn.com/abstract=2758130 or http://dx.doi.org/10.2139/ssrn.2758130
17. Addressing a lack of culturally sensitive healthcare for Cambodian and Vietnamese communities in O.C." Los Angeles Times. 24 September 2020.
About the Author
Mark Parzynski. DAOM, L.Ac., is a licensed acupuncturist and educator with a diverse background in the field. He has studied in the United States, Japan, and China and uses a range of unique therapeutic approaches to create personalized treatment plans for his patients. Dr. Parzynski has over a decade of experience as a clinical supervisor and has taught graduate students and clinicians.
In addition to his work in acupuncture, Dr. Parzynski is also a skilled craftsman and silversmith. He began making teishin and gua sha tools as an acupuncture student. His passion as an artisan has continued, and for over a decade, he has been making tools for practitioners worldwide, including some of Japan's most renowned masters.
Dr. Parzynski is also a Chinese internal martial arts practitioner, which he incorporates into his acupuncture practice and daily life. He was a senior student of the late Sifu Gregory Fong and has taught Taiji Quan, Yi Quan, and Qi Gong since 2006.
For acupuncture tools and classes provided by Dr. Parzynski, visit www.AcuArtistry.com