Principle of Gua Sha
Gua Sha is based on the twelve meridians and eight extraordinary vessels of Traditional Chinese Medicine (TCM), following the principle of treating the symptoms in acute conditions. It involves strong stimulation of the meridians using hand techniques to cause local skin redness and congestion, thereby achieving effects such as awakening the spirit, relieving heat, detoxifying, promoting qi circulation, alleviating pain, and strengthening the spleen and stomach.
Areas for Gua Sha
Many areas of the body can be treated with Gua Sha, commonly including the area around the seventh cervical vertebra, the sides of the throat, the bends of the arms and legs, the sides of the spine, between the ribs on the front and back, the tendons behind the inner and outer ankles, the liver and spleen areas below the ribs, and above and below the shoulder blades. For back Gua Sha, the patient should lie face down, while for shoulder Gua Sha, a sitting position is preferred. After scraping, ecchymosis may appear.
The most commonly scraped area is the neck and shoulder region, known as the “three neck lines,” which can help reduce fever, dispel summer heat, and eliminate wind-cold. This area is located at the junction of the head and neck; if it is tense, it can cause obstruction of qi flow throughout the body, preventing heat from dissipating.
How to Perform Gua Sha Correctly?
① Gua Sha Tools
The tools for Gua Sha are often specially made scraping boards made from water buffalo horn, typically rectangular with rounded edges.
② Indications for Gua Sha
Common conditions treated with Gua Sha include colds, fevers, heat stroke, headaches, gastrointestinal disorders, stiff neck, shoulder periarthritis, lumbar muscle strain, muscle spasms, and rheumatoid arthritis.
③ The Gua Sha Process
First, clean the area to be scraped. Dip the edge of the scraping board in Gua Sha oil or massage oil, and then perform Gua Sha on the designated area. Scrape in one direction only, avoiding back-and-forth motions, and apply even pressure without alternating between light and heavy strokes. If there are sha marks, scrape the bends of the arms about ten times to produce dark purple streaks. Generally, scrape each area about 20 times.
If experiencing headaches or throat pain, sit upright; if feeling dizzy or having chest or abdominal pain, lie on your back; if there is pain in the shoulders, back, or lower back, lie face down.
Following the previously mentioned scraping areas, if completed in sequence, the patient will feel immediate relief. Allow the patient to rest for a few minutes, then scrape the front and back rib areas, the cervical vertebrae, or above and below the shoulders, each for about ten strokes. Drinking ginger sugar water or plain water afterward will enhance comfort.
Precautions for Gua Sha
1. Ensure the room is warm during Gua Sha treatment, especially in winter, to avoid cold drafts. In summer, avoid direct airflow from fans on the scraped area.
2. Avoid taking a cold shower within 30 minutes after Gua Sha.
3. Do not scrape the same area again until the previous sha marks have faded, which typically takes 3-6 days.
4. After Gua Sha, it is best to drink a cup of warm water (preferably lightly salted sugar water) and rest for 15-20 minutes.
What is “Sha”?
When pressure is applied with the Gua Sha board, blood that has accumulated due to microcirculation obstruction seeps out from the gaps in capillaries, remaining between the skin and muscle, which is what we see as “sha.”
In TCM, “sha” represents a type of stagnation, indicating an imbalance within the body. Stagnation implies blockage; when the body is obstructed, qi and blood cannot flow smoothly, leading to pain and various symptoms.
Modern science has shown that Gua Sha can dilate capillaries, increase sweat gland secretion, and promote blood circulation, providing immediate effects for conditions such as hypertension, heat stroke, and muscle soreness.
Regular Gua Sha can help regulate qi, relieve fatigue, and enhance immune function.
Why Perform Gua Sha?
The effects of Gua Sha on the skin can be broadly categorized into two types: preventive health care and therapeutic effects.
1. Preventive Health Care
Preventive health care includes both health maintenance and disease prevention. The areas treated by Gua Sha are the skin, which is the body’s most superficial layer exposed to the external environment and plays a role in adapting to and defending against changes in climate.
The skin’s functions rely primarily on the body’s wei qi (defensive qi). Wei qi originates from the upper jiao and is propelled by lung qi, circulating through the skin. When wei qi is balanced, the skin is supple and the pores are tight (as stated in the “Lingshu, On the Organs”).
Healthy individuals who regularly undergo Gua Sha (such as at the back shu points or Zusanli point) can strengthen their wei qi. A strong wei qi enhances the body’s ability to resist external pathogens, maintaining health. If external pathogens invade, causing symptoms like chills, fever, nasal congestion, or runny nose, timely Gua Sha (such as at the lung shu or Zhongfu points) can expel these pathogens before they penetrate deeper into the internal organs and cause serious illness.
2. Therapeutic Effects
The therapeutic effects of Gua Sha can be observed in the following aspects:
① Activating Blood and Dispelling Stasis
Gua Sha can regulate muscle contraction and relaxation, adjusting interstitial pressure to promote blood circulation around the scraped tissues. This increases tissue perfusion, achieving the effects of “activating blood and dispelling stasis” and “removing stasis to generate new blood.”
② Balancing Yin and Yang
Gua Sha has a significant effect on adjusting the balance of yin and yang in organ functions. For example, in cases of hyperactive intestinal peristalsis, applying Gua Sha techniques to the abdomen and back can suppress the hyperactivity and restore normal function. Conversely, for those with reduced intestinal motility, Gua Sha can promote its recovery. This indicates that Gua Sha can improve and balance organ functions.
③ Relaxing Muscles and Unblocking Meridians
Injured soft tissues such as muscle attachment points, fascia, ligaments, and joint capsules can send pain signals through reflex actions of the nerves, putting the related tissues on alert. Muscle contraction, tension, and even spasms are reflections of this alert state, aimed at reducing limb movement to alleviate pain, which is a natural protective response of the body.
If not treated promptly or adequately, the injured tissues may develop varying degrees of adhesion, fibrosis, or scarring, leading to persistent harmful impulses, exacerbating pain, tenderness, and muscle tension, which can create secondary pain foci in surrounding tissues, resulting in metabolic disorders and further aggravating the pathological changes of “no flow equals pain.”
Clinical experience shows that wherever there is pain, there must be muscle tension; wherever there is muscle tension, there will inevitably be pain. They often have a causal relationship. In Gua Sha treatment, we observe that eliminating the pain focus also alleviates muscle tension; if tense muscles are relaxed, pain and pressure symptoms can significantly reduce or disappear, facilitating the healing of the pain focus.
Gua Sha is an effective method for relieving pain and muscle tension or spasms, primarily through:
1. Enhancing local circulation, thereby increasing local tissue temperature.
2. Directly stimulating local tissues through various techniques with the Gua Sha board, raising the pain threshold.
3. The relationship between tense or spasmodic meridians and the twelve skin areas: “To understand the skin areas, one must refer to the meridians; all meridians are like this.”
The division of the twelve skin areas is based on the distribution of the twelve meridians, each of which has branches that float on the surface of the body, each with its own distribution area. Since there are twelve meridians, the skin areas are also divided into twelve, with the six meridians of the hands and feet corresponding to the six skin areas.
The branches of the meridians are called collaterals, and the skin areas can also be seen as subdivisions of the collaterals. Thus, the “Su Wen, On the Skin” states: “All twelve meridian collaterals are parts of the skin.” The relationship between the meridians and the skin areas is significant for diagnosing and treating diseases.
The “Su Wen, On the Skin” states: “The skin is the part of the meridians; if pathogens invade the skin, the pores open, allowing pathogens to enter the collaterals. If the collaterals are full, they will enter the meridians, and if the meridians are full, they will enter the organs.” This indicates that pathogens can enter from the outside, and through the use of the Gua Sha board and various techniques, the muscles can be relaxed, alleviating tension and spasms, thus eliminating pain.
④ Information Adjustment
Each organ in the body has its specific biological information (inherent frequencies and bioelectricity). When an organ undergoes pathological changes, its biological information alters, affecting the balance of the entire system and the body’s functions.
By applying various stimuli or energy transfer forms to specific areas of the body, certain biological information is generated, which is transmitted to the relevant organs through the information transmission system, adjusting the abnormal biological information and thus affecting the diseased organs. This is one of the bases for Gua Sha’s therapeutic and health maintenance effects.
For example, using scraping, point pressing, or massage techniques on the Neiguan point can adjust coronary blood circulation, prolong left ventricular ejection time, enhance myocardial contractility in angina patients, increase cardiac output, and improve the ST segment and T wave on the electrocardiogram of coronary heart disease, increasing coronary blood flow and oxygen supply.
Similarly, using scraping, point pressing, or massage techniques on the Zusanli point can positively regulate the functions of the pituitary gland and adrenal medulla, enhancing immune capacity and adjusting intestinal motility.
⑤ Detoxification
The Gua Sha process (causing sha on the skin) can lead to significant local congestion, stimulating blood vessels and nerves, causing vasodilation, accelerating blood flow and lymphatic drainage, enhancing phagocytosis and transport, thereby expediting the elimination of waste and toxins from the body, nourishing tissue cells, purifying the blood, and increasing overall resistance, which can alleviate illness and promote recovery.
⑥ Promoting Qi and Activating Blood
The transmission of qi and blood plays a nourishing and warming role in the body. Gua Sha acts on the skin surface, ensuring smooth meridian flow, allowing qi and blood to circulate freely, thus dispersing stasis and resolving blockages, leading to relief of local pain.
Modern medicine believes that Gua Sha can cause local skin congestion, dilate capillaries, and accelerate blood circulation. Additionally, the stimulation from Gua Sha can regulate vascular dilation and constriction through neuroendocrine mechanisms, enhancing local blood supply and improving overall blood circulation.
The process of producing sha involves gradual vasodilation leading to capillary rupture, resulting in blood leakage and the formation of ecchymosis on the skin. These blood clots (sha) will soon dissolve, initiating a self-hemolytic process that creates new stimulants, enhancing local metabolism and exerting anti-inflammatory effects.
Self-hemolysis is a delayed benign weak stimulation process that not only stimulates immune function for adjustment but also acts on the cerebral cortex through afferent nerves, continuing to regulate the balance of the brain and endocrine system.
Is More Pain and Darker Sha More Effective?
Many people believe that Gua Sha must be painful to be effective or that darker sha indicates better results. These notions are incorrect; Gua Sha does not require pain to be effective, nor should it be scraped until it is red and purple.
Feeling pain during Gua Sha indicates that qi and blood are not flowing smoothly; areas with issues will generally be more painful. The deeper the color of the sha, the more severe the symptoms, and those with severe symptoms often have weaker constitutions, so stronger scraping should be avoided.
Additionally, improper scraping techniques or excessive force can cause microvascular rupture, which not only fails to achieve the desired Gua Sha effect but may also lead to tissue damage.
How Long Does It Take to Recover After Gua Sha?
After Gua Sha, the skin may show many small blood spots, and some may develop dark purple areas, which can look alarming. The depth of the sha color reflects the severity of the condition.
For milder cases, the sha will be less and lighter in color, recovering more quickly; for more severe cases, the sha will be more and darker, requiring a longer recovery time. Generally, the sha fades within 2-3 days for mild cases, while more severe cases may take up to two weeks, with most fading within 5-7 days.
Can Gua Sha Be Performed on Any Area?
When performing Gua Sha, avoid areas such as the chest near the nipples, the face, and the feet where there are visible blood vessels.
Is Direction and Sequence Important?
If multiple areas need scraping, start with the head and face, then move to the body; for body areas, scrape from top to bottom, starting with the back and waist, then the chest and abdomen, and finally the limbs. For the face, shoulders, and chest, scrape from the inside out, while for the limbs and back, scrape from top to bottom (but if there is swelling, varicose veins, or organ prolapse, scrape from bottom to top).
How Long Should Each Scrape Be?
Generally, the total length of scraping should be about 8-15 cm, centered around the acupoint, extending beyond the acupoint area. If a longer meridian needs scraping, segmental scraping can be performed.
Situations and Groups Not Suitable for Gua Sha
1. Patients with bleeding disorders, such as thrombocytopenic diseases, coagulation dysfunction, leukemia, and severe anemia.
2. Patients with poor liver and kidney function or those experiencing acute episodes of severe cardiovascular and cerebrovascular diseases.
3. Areas with malignant tumors or unknown lumps, and severely varicose veins should not be scraped.
4. Diabetic patients with skin ulcers or wounds, such as those from acne, should avoid scraping over these areas to prevent infection.
5. Gua Sha is contraindicated for unexplained abdominal pain or internal bleeding.
6. Acute injuries to ligaments or tendons, fractures, or surgical scars should not be scraped for three months.
7. Women during menstruation, pregnancy, or those who are intoxicated, as well as before and after meals for half an hour, should avoid Gua Sha.
8. Patients with cerebral nerve weakness should avoid Gua Sha before bedtime.
Always pay attention to any discomfort during Gua Sha; if discomfort occurs, stop the treatment and seek a detailed examination at a hospital!
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