Principle of Gua Sha
Gua Sha is based on the principles of the twelve meridians and the eight extraordinary vessels in Traditional Chinese Medicine (TCM). It follows the principle of treating the symptoms when they are acute, using strong manual stimulation on the meridians to cause localized skin redness and congestion. This method serves to awaken the spirit, relieve stagnation, detoxify, clear heat and expel pathogens, promote qi circulation, alleviate pain, and strengthen the spleen and stomach.
Areas for Gua Sha
Many areas of the body can be treated with Gua Sha. Commonly used areas include the vicinity of the seventh cervical vertebra, both sides of the throat, the bends of the arms and legs, both sides of the spine, intercostal spaces in the front and back, the Achilles tendon behind the inner and outer ankles, the liver and spleen regions 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 Gua Sha, 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 and blood 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 treated. 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. The pressure should be even and appropriate, avoiding fluctuations between light and heavy pressure. If there are signs of stagnation, scrape the bends of the arms about ten times, which will typically result in dark purple streaks. Generally, each area can be scraped about 20 times.
If the patient suffers from headaches or throat pain, they should sit; if they experience dizziness or abdominal pain, they should lie on their back; if there is pain in the shoulders, back, or lower back, they should 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 intercostal spaces in the front and back, the cervical vertebrae, or above and below the shoulder blades, scraping each area about ten times. Afterward, the patient should drink ginger sugar water or plain water, which will enhance their comfort.
Precautions for Gua Sha
1. During Gua Sha treatment, ensure the room is warm, especially in winter, to avoid cold drafts. In summer, avoid direct airflow from fans on the treated area.
2. Avoid taking a cold shower within 30 minutes after Gua Sha.
3. Do not perform Gua Sha on the same area again until the previous marks have faded, which typically requires a gap of 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, it causes blood that has accumulated due to microcirculation obstruction to seep out from the gaps in capillaries, remaining between the subcutaneous tissue and muscles, 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, it leads to poor circulation of qi and blood, resulting in pain and various symptoms.
Modern science has proven 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 caused by wind-cold obstruction.
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 ability to perform these functions relies primarily on the body’s defensive qi. The defensive qi originates from the upper jiao and is propelled by lung qi, circulating through the skin. When the defensive qi is balanced, “the skin is soft, and the pores are dense” (from the “Lingshu, On the Organs”).
Healthy individuals who regularly undergo Gua Sha (such as at the back shu points or Zusanli point) can enhance their defensive qi. A strong defensive qi improves the body’s ability to resist external pathogens, maintaining health. If external pathogens invade and symptoms such as chills, fever, nasal congestion, and runny nose occur, timely Gua Sha (such as at the Feishu and Zhongfu points) can help expel these pathogens, preventing them from penetrating deeper into the internal organs and causing 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 internal organ functions. For example, in cases of hyperactive intestinal peristalsis, applying Gua Sha techniques on 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 the functions of the internal organs.
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, causing muscle contraction, tension, and even spasms as a protective response to reduce movement and alleviate pain. If not treated promptly or adequately, the injured tissues may develop adhesions, 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 is muscle tension; wherever there is muscle tension, there will be pain. They often have a cause-and-effect 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 the following mechanisms:
First, it enhances local circulation, increasing the temperature of the affected tissues.
Second, the various techniques used with the Gua Sha board directly stimulate the local tissues, raising their pain threshold.
Third, the relationship between the 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, there are also twelve skin areas, 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 be considered subdivisions of these collaterals. Thus, the “Su Wen, On the Skin” states: “All twelve meridians 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 the pathogens to enter the collaterals. If the collaterals are full, they will enter the meridians, and if the meridians are full, they will affect the organs.” This indicates that pathogens can enter the body 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 relieving pain.
④ Information Adjustment
Each organ in the body has its specific biological information (inherent frequencies and bioelectricity). When an organ becomes diseased, the related biological information changes, 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 and transmitted to the relevant organs, adjusting the abnormal biological information, thus affecting the diseased organs. This is one of the bases for Gua Sha’s therapeutic and health-promoting effects.
For example, using scraping, point pressing, or massage techniques on the Neiguan point can adjust coronary blood circulation, prolong the 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.
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” to appear on the skin) can lead to localized hyperemia, stimulating blood vessels and nerves, causing vasodilation, accelerating blood and lymph flow, enhancing phagocytosis and transport, 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, unblocking the meridians, allowing qi and blood to flow freely, thus dispersing stasis and resolving blockages, leading to relief of localized pain.
Modern medicine believes that Gua Sha can cause localized skin hyperemia, 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 “Sha” appearing is a phenomenon of 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 due to autolysis, creating a new irritant that can enhance local metabolism and exert anti-inflammatory effects.
Autolysis 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 the darker the “Sha,” the better the effect. These notions are incorrect; Gua Sha does not need to be painful to be effective, nor should it be scraped until it is red and purple.
Feeling pain during Gua Sha indicates that the flow of qi and blood is obstructed; areas with issues will typically be more painful. The deeper, redder, and more purple the “Sha,” the more severe the symptoms, and those with severe symptoms often have a weaker constitution, so they should not be scraped too hard.
Additionally, improper technique 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 that look alarming. The depth of the “Sha” reflects the severity of the condition.
For milder cases, the “Sha” will be less and lighter in color, recovering quickly; for more severe cases, the “Sha” will be more and darker, requiring a longer recovery time. Generally, the time for “Sha” to fade can be as quick as 2-3 days or as long as two weeks, with most cases resolving 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 to be scraped, start with the head and face, then move to the body; for the body, start from the top down, first 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 each scrape should be about 8-15 cm, centered around the acupoint, extending beyond the acupoint area. If a longer meridian needs to be scraped, a segmented scraping method can be used.
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 in the acute phase of severe cardiovascular and cerebrovascular diseases.
3. Areas with malignant tumors or unknown lumps, and severe varicose veins in the lower limbs should not be scraped.
4. Diabetic patients with skin ulcers or wounds, such as 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 within three months.
7. Women during menstruation, pregnancy, or those who are intoxicated, as well as those who have eaten within half an hour before or after Gua Sha, should avoid the treatment.
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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