How is Gua Sha Used in TCM?

Table of contents

• What is Gua Sha?
  • Origins and Names Across Cultures
• How Gua Sha Works (TCM Perspective)
  • Benefits of gua sha
  • Common Uses of Gua sha
  • What are the Red Marks After Gua Sha?
• Research
• Safety and Expectations
  • Contact CCHW to Learn More
• References

What is Gua Sha?

Within Traditional Chinese Medicine (TCM) and Traditional East Asian Medicine (TEAM), Gua Sha is a healing technique that uses a flat-edged tool to press-stroke lubricated skin in a single direction. Typically performed on larger areas such as the back, the method aims to improve circulation, relieve muscle tension, reduce inflammation, and support natural healing processes. Graston Technique® is a similar technique utilized by chiropractors, physical therapists, and other healthcare professionals, but it is not the same as gua sha.

Origins and Names Across Cultures

Gua sha has historical roots across several cultures and appears in Traditional Chinese Medicine (TCM) and other East Asian healing systems. The term gua means “to scrape” or “to scratch,” but in practice the skin remains intact, so clinicians prefer the term “press-stroking.” Sha (pronounced sha/sa/saw) literally translates to “sand,” describing the sand-like texture sometimes felt on the skin as metabolic waste rises to the surface.

Alternate names include: Gua sha (China), Cao Yio (“kow yo”, Vietnam), Kerik (Indonesia), Khoud Lam (Laos), Ga Sal/Kos Khyal (Cambodia).

How Gua Sha Works (TCM Perspective)

According to TCM, gua sha helps to release stagnant energy, promote blood circulation, and reduce inflammation. It is commonly used to alleviate muscle pain and tension, improve mobility, and boost the body’s  immune system and natural healing processes. Gua sha can be applied to various parts of the body, including the back, neck, shoulders, arms, legs, and face, and has an effect on connective tissue.

Benefits of gua sha

• Releases the effects of Wind Cold in the surface of the body. When water is placed in the freezer, the water turns solid. This is the theory that is associated with the TCM concept of cold congealing fluids. It slows down metabolic and other functions, and can cause congestion. 
• Opens pores and vents heat. Gua sha can mimic the body’s natural process of sweating. It has been shown to help resolve fevers, alter the course of acute infectious illness (like the common cold) and reduce inflammatory symptoms of chronic illness.
• Immediately reduces pain and congestion, by moving Qi and Blood stasis that is related to acute and chronic pain conditions. Gua sha relieves pain, increases range of motion, improves breathing and reduces inflammation
• Has an anti-viral effect. Heme-oxygenase-1 (HO-1) acts as an anti-viral factor in laboratory tests. There is evidence that the upregulation of HO-1, including by means of gua sha, not only protects cells, but is an anti-viral agent.

Common Uses of Gua sha

Gua sha can be applied to multiple body areas including back, neck, shoulders, arms, legs, and face. Typical conditions treated include:

What are the Red Marks After Gua Sha?

‘Sha,’ the red marks that come to the surface of the skin during a gua sha treatment, represent the extravasation of blood in the subcutis that leaks from the capillaries without damaging them. Sha will dissipate on its own within a couple of days to a week. 

From a TCM perspective, these marks indicate movement of stagnant blood and metabolic waste toward the surface, along with associated anti-inflammatory and immune-stimulating effects.

Research

A growing body of research is expanding our understanding of how Gua Sha works and its effectiveness as a treatment method. Gua Sha treatments are thought to work because the extravasation of blood cells and/or the stretching effects on connective tissues¹ of the epidermis stimulate anti-inflammatory and immune responses.

One study explored how Gua Sha treatment can up-regulate the innate and adaptive immune functions of the skin and boost the response against intradermal antigens.² Another study confirmed that calibrated stretching of connective tissues can create a bio-mechanical trigger mobilizing an anti-inflammatory, pain-reducing response.³ Yet another study documents the effectiveness of Gua Sha in treating chronic neck pain⁴

It is thought that the circulating hemoglobin products released by Gua Sha trigger the upregulation of heme oxygenase-1 (HO-1), which has long been known to provide protection against oxidative stress.⁵ One study has confirmed the upregulation of HO-1 caused by Gua Sha.⁶ Another has tracked this effect on liver disease⁷

Safety and Expectations

When performed by a trained practitioner, gua sha leaves the skin intact and rarely causes lasting damage. Expect temporary redness or petechiae that dissipate naturally. People with bleeding disorders or on anticoagulant therapy should consult a healthcare provider before treatment. It is contraindicated over skin conditions like acne, eczema etc., sunburn, and new tattoos.

Contact CCHW to Learn More

Calandra Center for Health and Wellness offers gua sha as a complementary element of acupuncture sessions, when appropriate for the individual. If you’re curious whether this approach might be a good fit for you, we’d love to connect — feel free to reach out to schedule a complimentary 15-minute phone consultation.