Scrape Away Pain: Gua Sha

When I was finishing my undergraduate coursework, I was working part-time in a hospital research department. My co-workers knew I had my eyes set on Eastern Medical training. On rare occasions, questions concerning Eastern Medicine would arise, and these questions would always be directed toward me.

Young, naïve and inexperienced, I was just as curious as they were. One morning, I had an email sent to me, with a web link to a forum for cardiologists. A picture depicting the back of a gentleman was displayed on the website. His back was scraped and bruised in a specific pattern unlike anything I had ever seen before. Under this picture, a simple caption read “What is this?” and I was utterly dumbfounded. As it turns out, gua sha is what it was.  

As I was finishing my clinical training in Beijing, I would find myself smiling at the memory of that picture; something that once seemed so dumbfounding had become something I was so commonly administering to patients.  Gua sha is a common practice in Traditional Chinese Medicine (TCM), and an invaluable technique in an acupuncturist’s armamentarium.

Gua sha is an ancient healing technique used by many clinicians of TCM. In this procedure, a lubricating medium, such as massage oil, is applied to the skin of the area to be treated. A smooth-edged instrument is used by the acupuncturist to apply short or long strokes on the skin, typically in the area of pain or on the back parallel to the spine. This stroking motion creates raised redness (petechiae) or bruising (ecchymosis).

Pain, both acute and chronic, is the most common indication for gua sha. In the TCM tradition, pain is oftentimes caused by the stagnation of blood in the local area of discomfort. The guiding principle behind gua sha is that this technique has the ability to break up stagnation, to promote the smooth flow of blood in the area, thereby relieving pain.

While gua sha is most commonly used to treat pain, it can also be utilized by TCM clinicians to address conditions such as asthma, bronchitis, colds, flu, fever, heatstroke, fibromyalgia, strains, sprains, and muscle spasms.

There are several theories that may explain why this ancient technique works: gua sha increases blood flow (microcirculation) in the soft tissue, potentially stimulates the body’s natural pain-relieving opioid systems, and it may block the pain response pathways so you feel pain relief. 

Some view gua sha as folk medicine, but the scientific research community may beg to differ! Researchers from institutions like Harvard and Beth Israel Medical Center are demonstrating both efficacy as well as offering insight on why gua sha works. A study published in a 2011 edition of Pain Medicine demonstrated that gua sha decreased pain for chronic neck pain sufferers, noting that “neck pain severity after 1 week improved significantly better in the gua sha group compared with the control group (heat therapy).”

Researchers have used various techniques, including Doppler images, to show that microcirculation is indeed increased in the treated area, therefore decreasing both local and distal areas of pain. In the mice model, gua sha was shown to influence an enzyme (Heme Oxygenase-1) that has a protective antioxidative effect in the cells. An interesting case study showed gua sha decreases inflammatory markers of a patient with liver injury due to Hepatitis B, suggesting gua sha may even have a protective effect on the liver. As is the case for most healing modalities in Eastern Medicine, modern science has yet again validated the effectiveness of this ancient technique.

If you are interested in gua sha therapy, seek out a licensed acupuncturist in your area. The acupuncturist will first perform a thorough evaluation during the initial consultation to be sure you are a good candidate for this type of treatment. You can find an acupuncturist by visiting the National Certification Commission for Acupuncture and Oriental Medicine and searching for a clinician in your area.


Braun, et al. “Effectiveness of Traditional Chinese ‘Gua Sha’ Therapy in Patients with Chronic Neck Pain: A Randomized Control Trial” Pain Medicine 2011; 12:362-369

Chan, et al. “Guasha-induced Hepatoprotection in Chronic Active Hepatitis B: A Case Study” Clinica Chimica Aca 412 (2011) 1686-1688

Kwong, et al. “Bioluminescence Imaging of Heme Oxygenase-1 Upregulation in the Gua Sha Procedure” Journal of Visualized Experiments 2009; 1-3.

Nielsen, et al. “The Effect of Gua Sha Treatment on the Microcirculation of Surface Tissue: A Pilot Study in Healthy Subjects” Explore September/October 2007, Vol. 3, No.5