1. Introduction to Gua Sha Therapy
(1) Historical Evolution of Gua Sha Therapy
Gua Sha therapy is one of the invaluable legacies of traditional Chinese medicine (TCM) and is an ancient non-pharmaceutical natural health care method. It has a long history, unique methods, simplicity, safety, wide applicability, and reliable efficacy. For centuries, it has been widely practiced among the Chinese people and is deeply favored by the public.
Gua Sha therapy refers to the application of smooth hard objects, fingers, metal needles, or soft cotton balls on specific areas of the human body, repeatedly performing scraping, pressing, pinching, and pricking physical stimuli. This creates bruises or petechiae on the skin surface, stimulating the body’s meridians and improving the flow of Qi and blood, thereby achieving effects such as strengthening the body, expelling pathogens, detoxifying, reducing fever, calming the mind, and benefiting the spirit.
(2) The Concept of “Sha”
Also known as “zhang qi” (toxic heat), it encompasses two aspects: broadly, it refers to the symptoms of “sha” rash; and narrowly, it refers to the appearance of the rash, which manifests as small red spots on the skin resembling millet, felt as slight resistance when touched. In the Qing Dynasty, Shao Xinfus in “Clinical Guidelines for Medical Cases” stated: “Sha is a general term for rashes, with small particles like millet.” It reflects a common manifestation of many diseases during their development and is not an independent disease. Many diseases can exhibit sha symptoms, collectively referred to as “sha syndrome,” hence the saying “all diseases can manifest sha.”
What does sha correspond to in modern medicine? It is currently difficult to determine. The range of sha syndrome is broad, with records in ancient TCM texts covering various diseases in internal medicine, external medicine, gynecology, and pediatrics. The book “Sha Jing He Bi” describes over 40 types of sha syndromes, totaling more than 100 related conditions. Based on the described symptoms, “Jiao Gong Fan Zhang Sha” resembles modern medicine’s tetanus; “Zhui Chang Sha” resembles inguinal hernia; “Chan Hou Sha” resembles postpartum fever; “Peng Zhang Sha” resembles ascites; “Pan Chang Sha” resembles intestinal obstruction; “Tou Feng Sha” resembles migraine; “Suo Jiao Ying Sha” resembles acute appendicitis, etc. Additionally, there are various types of sha in folk medicine, such as cold sha, hot sha, summer sha, wind sha, dark sha, oppressive sha, white hair sha, rushing brain sha, hanging foot sha, and blue vein sha.
Narrowly speaking, sha syndrome specifically refers to a certain disease. Ancient practitioners believed that sha syndrome is primarily caused by the internal wind, dampness, and fire colliding to create illness. There are eight types of wind evils in the sky, damp heat in the earth, and hunger and fatigue in humans. During the summer and autumn, the three evils of wind, dampness, and heat are prevalent. If one overworks or underworks, external evils invade the skin, and Yang Qi cannot be expressed, leading to frequent occurrences of sha syndrome. Sha symptoms can occur throughout the year, but are most common in summer and autumn. The main characteristics of sha syndrome are twofold: sha points and a feeling of soreness and swelling. Depending on the severity of the condition, clinical manifestations can be divided into general and acute severe presentations.
1) General manifestations: Often include dizziness, irritability, general soreness, fatigue, and a burning sensation in the chest and abdomen. Limbs may feel numb, and in severe cases, they may feel cold as ice. If the evil enters the Qi level, it causes swelling; if it enters the blood level, it leads to accumulation and stasis; if food stagnation and phlegm heat occur, it results in abdominal distension. Severe cases may lead to nausea and vomiting.
2) Acute severe manifestations: Sudden onset of chest tightness and irritability, severe chest pain, vomiting or diarrhea, or a desire to vomit without being able to, or to have diarrhea without being able to, and in severe cases, sudden dizziness and fainting, with pale lips and face, inability to speak, fainting like a corpse, cold hands and feet, or cold sweat on the forehead, or no sweating at all, with blue veins protruding, and the appearance of sha points that appear and disappear, with bluish-black lips and tongue, all indicating a critical condition.
Modern medicine considers sha to be the rupture of skin or subcutaneous capillaries, a natural hemolytic phenomenon that easily occurs in areas with poor meridian flow and blood circulation. It differs from traumatic bruising and swelling. Conversely, Gua Sha can promote meridian flow, accelerate the absorption of bruises and swelling, and relieve or eliminate pain, thus facilitating faster recovery from illness.
(3) Clinical Significance of Different Sha Manifestations
Gua Sha therapy utilizes its tools on the skin surface, which elicits various responses, primarily changes in color and shape. These manifestations are referred to as “sha manifestations.” Common sha manifestations include localized redness, purple-red or purple-black bruises, and small purple-red rashes, often accompanied by varying degrees of heat and pain. These skin changes can last for several days. After just a few minutes of scraping, any area with a disease source may show slight redness or red spots; in severe cases, it may form patches or nodules, or even blue-black lumps that feel slightly resistant or protruding. More severe blue-black patches may cause pain during scraping. If there is no pain, there will be no reaction.
The “sha manifestations” primarily refer to the different locations and forms of sha rashes, which have certain clinical reference significance for diagnosing, treating, and predicting the course of diseases. Generally, bright red sha indicates a superficial condition, suggesting a short course of illness, mild condition, and good prognosis; dark red sha, in patchy or bruised form, indicates a deeper condition, suggesting a long course of illness, severe condition, and poor prognosis. With Gua Sha treatment, if the sha manifestation changes from dark to red, from patches to scattered points, it indicates improvement in the condition and effectiveness of the treatment. Generally, healthy individuals or those undergoing weight loss, beauty treatments, or health maintenance do not easily develop sha or have insignificant sha manifestations.
2. Common Tools and Mediums for Gua Sha Therapy
(1) Gua Sha Tools
1. The Tai Chi Balance Health Pen is a newly patented product invented by the author, which can be used for Gua Sha detoxification, acupoint pressing, ear acupoint pressing, beauty care, spinal therapy, foot massage, etc., integrating multiple functions into one. Using it allows for accurate acupoint selection, saving time and effort, with strong stimulation that helps improve efficacy. This pen is made of pure copper, compact, portable, durable, and not easily damaged, making it an ideal tool for Gua Sha therapy.
2. The specially made Gua Sha board is made from water buffalo horn, which has heat-clearing and detoxifying properties and is non-conductive and non-heat-conducting. It is shaped with different edges, curves, and thicknesses to apply to various body parts effectively.
3. Ramie – mature ramie is selected, peeled, dried, and the thicker fibers at the root are twisted into a ball. During scraping, the practitioner holds the ramie ball in the right hand, moistens it in clean water or vegetable oil, and scrapes it on the patient’s specific areas until a large number of purple-black sha spots appear. This method is rarely used now, but in some remote areas, it remains a viable emergency measure when other tools are unavailable.
4. Eight-sided ramie (commonly known as Tuo Tuo leaves) is made from the stems and leaves of eight-sided ramie, washed, softened in a pot (without oil), and squeezed to remove juice, then wrapped in cloth for scraping. It is mainly used for the delicate skin of children and the chest and abdomen of adults.
5. Small clam shells are commonly used Gua Sha tools by fishermen in coastal or lake areas. The small clam shell should have a smooth edge or be ground to a blunt edge. During scraping, the practitioner holds the shell in the right hand, moistens it in water or vegetable oil, and scrapes it on the patient’s specific areas until purple-black sha points appear.
6. Coins (made of copper or aluminum) – copper coins or copper plates were the most commonly used Gua Sha tools before the 1950s, easily sourced. Generally, a thicker-edged coin or plate is selected (too thin edges are sharp and can easily break the skin). The scraping method is the same as with small clam shells; aluminum coins are modern commonly used Gua Sha tools, easy to source, but due to the serrated edges, scraping must be done gently to avoid breaking the skin, following the same method as small clam shells.
7. Copper spoon handles – select a small copper spoon handle with a thick and smooth edge, using the same scraping method as with small clam shells.
8. Porcelain bowls and cups – select those with thick, smooth edges and no damage, using the edge for scraping, following the same method as small clam shells.
9. Porcelain spoons – select those with smooth edges and no damage, using the edge for scraping, following the same method as small clam shells.
10. Medicine spoons (used in hospitals for dispensing medicine and powders) are also ideal Gua Sha tools.
11. Acrylic buttons are a commonly used modern Gua Sha tool. They are easy to source and clean, but a larger button with a smooth edge is preferred for easy handling, following the same method as small clam shells.
12. Cotton yarn or hair is often used for scraping the face and skin of infants. A suitable amount of cotton yarn or hair is twisted into a ball, moistened with vegetable oil, and scraped from top to bottom.
13. Other containers such as small wine cups or tea cups are used to hold Gua Sha mediums.
(2) Gua Sha Mediums
Gua Sha mediums serve as lubricants between the Gua Sha tools and the skin, reducing resistance during scraping, facilitating the process, and protecting the skin from abrasions. Adding certain medicinal ingredients to the medium can enhance therapeutic effects. Common mediums include:
1. Tai Chi Balance Gua Sha agent is a medium developed by the author, with main ingredients including Angelica sinensis (Dang Gui), Chuanxiong (Chuan Xiong), safflower (Hong Hua), borneol (Bing Pian), mint (Bo He), patchouli (Huo Xiang), and sesame oil (Ma You). It has effects of invigorating blood circulation, promoting Qi flow, detoxifying, reducing inflammation and pain, and balancing the Yin and Yang of the organs and meridians.
2. Water – commonly used boiled water; if the patient has a fever, warm boiled water or white liquor can be used.
3. Oil – commonly used sesame oil or other vegetable oils.
Additionally, some 75% alcohol and disinfecting cotton swabs should be prepared for disinfecting the skin and tools when necessary.
(1) Classification of Gua Sha Methods
Gua Sha methods include two main categories: tool-assisted operations and manual operations.
(2) Gua Sha Operational Methods
1. Tool-assisted operations include Gua Sha method, picking sha method, and releasing sha method.
(1) Gua Sha Method: Depending on clinical applications, the Gua Sha method is further divided into direct scraping and indirect scraping.
Direct scraping: This involves the scraping tool directly contacting the patient’s skin and repeatedly scraping specific areas on the body. It is the most commonly used method in Gua Sha therapy.
Specific operational method: Have the patient sit or lie face down on a chair or table, with their back to the practitioner. Use a hot towel to clean the area to be scraped, and evenly apply the Gua Sha medium. The practitioner holds the Gua Sha tool in the right hand, first scraping the depression at the back of the patient’s neck to create a long purple-black sha point, then having the patient lie face down to scrape along the spine (if the patient is thin or has pronounced spinal protrusions, scrape on either side), and then scrape in the 7th to 9th intercostal spaces under the scapula on both sides until purple-black bruises appear (see Figure 1).
Indirect scraping: A thin cloth is placed over the area to be scraped, and then the scraping tool is used on the cloth. This method not only has the effects of Gua Sha but also protects the skin. It is mainly used for children with high fever or central nervous system infections, or those experiencing convulsions. Specific method: Place a clean handkerchief (of appropriate size, clean, and soft) on the scraping area, and use the Gua Sha tool to scrape quickly in one direction on the handkerchief or cloth, scraping each area 20 to 40 times. Generally, after about 10 scrapes, lift the handkerchief or cloth to check; if the skin shows dark purple, stop scraping and move to another area. If the patient is unresponsive, slightly comatose, or has persistent high fever, also scrape the palms and soles and the areas around the 7th cervical vertebra, scraping each area about 50 times (see Figure 2).
(2) Picking Sha Method: The picking sha method, also known as “picking sha therapy,” involves the practitioner using a needle to prick specific areas on the patient’s body to treat diseases. This method is mainly used for treating dark sha, residual sha, stagnant sha, and oppressive sha.
The practitioner first disinfects the local skin with an alcohol swab, pinches the skin at the pricking site with the left hand, and holds the needle in the right hand, preferably targeting areas with visible blue veins, then quickly pricks and pulls outward, squeezing out purple-dark blood from each area 3 times, repeating 5 to 6 times, and finally cleaning the blood with a disinfecting cotton ball. The picking needle can be a three-edged needle, a large sewing needle, or a 9 to 16 gauge injection needle (see Figure 3).
(3) Releasing Sha Method: The releasing sha method, also known as “pricking and bleeding therapy,” is similar to the picking sha method but is more intense and is often used for patients with fever and severe conditions.
Rapid pricking: Prick 0.5 to 1 cm deep, then squeeze out a small amount of dark blood. This is used for points like Shixuan, Ren Zhong, Jin Jin, and Yu Ye.
Slow pricking: Slowly prick 0.5 to 1 cm deep, then gently withdraw, squeezing out a small amount of dark blood. This is suitable for areas like the elbow pit, popliteal fossa, and head and face.
For both picking sha and releasing sha methods, the pricking area must be disinfected with an alcohol cotton ball to prevent infection, and the patient should not be overly tense. Excessive bleeding should be avoided, so those who are overly hungry, overly full, or have difficulty stopping bleeding should generally avoid needles; those with blood deficiency, low blood pressure, or pregnant women should use caution.
2. Manual operations include pinching sha method, pulling sha method, squeezing sha method, and pressing and rubbing method.
(1) Pinching Sha Method (also known as “pulling sha method”): The practitioner bends their fingers, using the second joint of the index and middle fingers to pinch the sha area, lifting the skin and muscle, then quickly sliding outward and releasing. This is repeated, producing a “pop” sound. This is done continuously on the same area for 6 to 7 times, resulting in sha marks appearing on the pinched area (see Figure 5).
(2) Pulling Sha Method: The practitioner uses their thumb and index finger to pull the sha area, causing small blood vessels to rupture and producing sha points. This is mainly applied to the head, neck, back, and areas like the temples and Yintang (see Figure 6).
(3) Squeezing Sha Method: The practitioner uses both hands’ index and thumb fingers or one hand’s index and thumb fingers to apply pressure on the treatment area, continuously squeezing out purple-red sha spots until satisfied. This method can also be combined with the releasing sha and picking sha methods (see Figure 7).
(4) Pressing and Rubbing Method: This method is similar to massage techniques but is not as thorough as Gua Sha techniques. However, in practice, the pressing and rubbing method is often used in conjunction with Gua Sha therapy, as it can complement the shortcomings of Gua Sha therapy and enhance its efficacy. The pressing and rubbing method involves using fingers to apply pressure on specific areas or acupoints, performing circular or rotating movements. It combines pressing and rubbing techniques. The key to this operation is that the practitioner’s thumb or fingertip applies pressure on the acupoint or area, with force directed through the fingertip, focusing on the skin and acupoint, gradually increasing pressure from light to heavy, with wrist movements allowing for flexible finger movements, at a frequency of 50 to 100 times per minute, usually lasting 3 to 5 minutes until the patient feels soreness and the skin turns slightly red. At the end, the pressure should be gradually reduced. Note: The force should not be too strong or harsh, and the fingers should not leave the skin during the rubbing. This method has effects of dispersing stasis, relieving pain, invigorating blood circulation, and relieving spasms. It is mainly used for the head, face, abdomen, limbs, joints, and feet.
(3) Steps for Gua Sha Operation
1. First, briefly explain to the patient to alleviate their tension and fear, gaining their trust, cooperation, and compliance.
2. Prepare all Gua Sha tools and supplies. Check that the edges of the tools are smooth and safe, and perform necessary disinfection.
3. Based on the nature of the patient’s disease and condition, determine the treatment area, exposing it as much as possible, and clean it with a towel, choosing an appropriate position.
4. Evenly apply the Gua Sha medium to the scraping area, using a thin layer rather than a thick one.
5. Generally, hold the Gua Sha tool in the right hand, using wrist and arm strength flexibly, avoiding rigid force. The angle between the flat surface of the hard scraping tool and the skin should be about 45 degrees, avoiding a pushing or scraping motion.
6. The force should be even and moderate, gradually increasing from light to heavy, without alternating between light and heavy, and maintaining a certain pressure that the patient can tolerate, allowing the scraping force to reach the deeper tissues rather than just rubbing the skin surface. The scraping area should be elongated, integrating points, lines, and surfaces, with points stimulating acupoints, lines following meridians, and surfaces acting on the skin.
7. During scraping, scrape in one direction only, avoiding back-and-forth scraping, until light purple or purple-black sha points or patches appear. After finishing one area, move to another area without randomly scraping in different directions.
8. For health maintenance and head scraping, Gua Sha medium may not be necessary, and scraping can be done over clothing, depending on the patient’s tolerance.
9. For any condition, it is advisable to scrape the neck area first, then other affected areas. The general principle is to scrape the head and neck first, then the back, followed by the chest and abdomen, and finally the limbs and joints. For joint areas, use pressing or squeezing techniques according to their structure.
10. When scraping the head, forehead, elbows, wrists, knees, ankles, and children’s skin, use cotton yarn or hair balls, or eight-sided ramie for scraping. For soft areas, salt can be used for rubbing.
11. The scraping direction should follow an upward and outward sequence.
12. After scraping, wipe off any water or oil residue. Have the patient dress, rest for a while, and drink some ginger juice or warm water, which will make them feel exceptionally relaxed and comfortable.
13. Generally, about half an hour after scraping, the sha points on the skin surface will gradually merge into patches. After 24 to 48 hours, the sha points on the skin surface may feel painful or slightly warm to the touch. These are normal reactions, and after resting, the patient will return to normal. Generally, deep-seated lumps or nodular sha will gradually present a dark purple or blue-black color on the skin surface, and their disappearance is relatively slow.
14. The duration and frequency of Gua Sha should be flexibly adjusted based on the nature of different diseases and the patient’s constitution. Generally, scrape each area about 20 times, depending on the patient’s tolerance or the appearance of sha. During Gua Sha treatment, the pores open, facilitating the strengthening of the body and expelling evils, preventing the depletion of righteous Qi, or expelling evils without harming the righteous. Therefore, each treatment session should last about 20 to 25 minutes. The initial treatment should not be too long, and the technique should not be too heavy, avoiding excessive pursuit of sha appearance. The second treatment should be conducted after an interval of 5 to 7 days or when there is no pain in the affected area, until the original area is clear of spots, at which point the condition will naturally heal. Typically, continuous treatment for 7 to 10 sessions constitutes one treatment course, with a 10-day interval before the next course. If there is no effect after completing two treatment courses, further examination should be conducted, and other therapies may be necessary.
(4) Supplementing and Draining Techniques in Gua Sha
“Supplement the deficient, drain the excess” is one of the basic principles of TCM treatment. “Supplementing” and “draining” are two opposing but interconnected treatment methods. Their common goal is to regulate the balance of Yin and Yang and enhance the body’s righteous Qi. Therefore, the relationship between supplementing and draining is one of oppositional unity.
On the surface, although Gua Sha therapy does not directly introduce or expel substances into or out of the body, it relies on the stimulation of specific areas on the body surface to promote or inhibit bodily functions, which essentially falls within the scope of supplementing and draining.
The supplementing and draining effects of Gua Sha therapy depend on various factors, including the intensity of the operation, the speed of the technique, the duration of scraping, the direction of scraping, and the areas being treated, all of which are achieved through the skillful application of techniques.
Generally, techniques that involve short stimulation time and superficial effects, which excite the skin, muscles, and cells, are referred to as “supplementing techniques”; while those with longer stimulation time and deeper effects, which inhibit the skin and muscle tissues, are referred to as “draining techniques.”
Techniques that involve longer durations of light stimulation can invigorate and excite the physiological functions of organs, termed “supplementing techniques”; while shorter durations of heavy stimulation that can inhibit the physiological functions of organs are termed “draining techniques.”
Techniques performed at a slower speed are referred to as “supplementing techniques”; while those performed at a faster speed are referred to as “draining techniques.”
Supplementing techniques are commonly used for elderly, weak, chronically ill, severely ill, or thin patients with deficiency syndromes. Draining techniques are commonly used for young, strong, newly ill, acute illness, or robust patients with excess syndromes.
Techniques that fall between “supplementing” and “draining” are referred to as “balanced supplementing and draining.” There are three types of scraping techniques. The first involves strong pressure with slow speed; the second involves light pressure with fast speed; and the third involves moderate pressure with moderate speed. Balanced supplementing and draining scraping techniques are often used for health maintenance in normal individuals or for treating patients with both deficiency and excess syndromes.
In summary, during Gua Sha treatment, techniques should be flexibly selected based on the patient’s condition and constitution. If one can first carefully differentiate the syndrome, then appropriately apply “supplementing” or “draining” techniques according to the principles of “supporting the righteous and expelling the evil” or “expelling the evil while preserving the righteous,” it will surely maximize the therapeutic effects of Gua Sha, achieving significant results with minimal effort.
