Gua sha

Gua sha on upper back

Frequently Asked Questions

Gua sha is the rubbing of a round-edged tool over lubricated skin in a particular way which causes some blood to be released from their vessels and move under the skin. This is initially seen as red dots in the skin or petechiae to use the medical term. This causes a cascade of therapeutic chemicals in the body which have anti-oxidant, anti-inflammatory and immune protective effects. This is a wide-ranging action, resulting in Gua sha being used for many health conditions.

Gua sha is part of Traditional Chinese Medicine and used within South Asian communities. The initial red colouring looks dramatic though and unfortunately in the West is wrongly interpreted as abuse or bruising. There was even a film made about this in 2001; it shows western cultural ignorance of the practice. The film tells the story of Chinese immigrants in America using Gua sha to treat their child and the father being wrongly accused of abuse. Watch the full film on You Tube 

 The blood raised by the press-stroking of Gua sha provokes the immune system which jumps into action to breakdown these blood cells as they are reabsorbed, so these initial red dots under the skin merge, fade to red and yellow and disappear over 2 to 4 days. This action promotes the up regulation an important enzyme called Heme-oxgenase 1 (HO-1), as well as carbon monoxide, biliverdin and bilirubin, which are beneficial in the body. The increase of HO-1 by Gua sha is an exciting medical discovery as the enzyme has fantastic therapeutic effects in the body. Lots of research has shown HO-1 to be an anti-oxidant, anti-inflammatory, anti-apoptosis (protects cells from dying), and anti-smooth muscle hyperplasia and helpful in immune cell regulation (Xia et al 2008). Search on PUBMED the biggest online library of biomedical research papers reveals there are nearly 8,000 research studies on HO-1.

The press stroking used in Gua sha is done in a particular way and the direction of force on the underlying tissue (fascia) has been found to induce nitric oxide formation. As this is circulated in the blood stream it causes smooth muscle relaxation and vasodilation (Findley 2009; Hockling et al 2008). It also regulates platelet function, reduces inflammation (less irritation of nerves) and thus reduces pain (Mackenzie et al. 2008).

For the science nerds among you there is a free video which explains the science behind this technique: (you do have to sign-up to gain access).

There are nearly 600 research studies in China on Gua sha, which show the breadth of conditions for which it is used. We are only now starting to see peer reviewed randomised controlled trials in the West starting to happen (neck and back pain and mastitis) – see below.

Gua sha for neck pain Braun M, Schwickert M, Nielsen A et al. Effectiveness of Traditional Chinese, “Gua Sha” Therapy in Patients with Chronic Neck Pain; A Randomized Controlled Trial. Pain Med. 2011 January 28.

Gua sha for neck and back pain  Lauche R, Wübbeling K, Lüdtke R et al. Randomized controlled pilot study: Pain intensity and pressure pain thresholds in patients with neck and low back pain before and after traditional East Asian ‘Gua sha’ therapy. Am J Chinese Med. 2013;in press

Mastitis breast engorgement Chiu J-Y, Gau M-L, Kuo S-Y, Chang Y-H, Kuo S-C, Tu H-C. Effects of Gua-Sha therapy on breast engorgement: a randomized controlled trial. J Nurs Res. 2010;18(1) (March):1-10.

Because of the mechanism of action on the body, Gua sha has wide ranging effects and has been found in studies in China to be useful for a range of conditions. Dr Arya Nielsen, the Western authority on Gua sha, compiled a list of conditions where Gua sha has been researched in China and found to have a positive effect, these are:

  • Musculoskeletal pain, inflammation, effusion – Neck, Shoulder, Back, Hips, Joints (knees, ankles, elbows, wrists)
  • Headache – Head pain, Migraine/cluster, Sinusitis, Cervicalgia related, Trauma
  • Functional conditions – Digestive, Menstrual, regulation/dysmenorrhea, Waking/sleeping/focus, Urinary, frequency, enuresis, Psychological/emotional, Endocrine/diabetes/obesity
  • Inflammatory – Fever, influenza, Respiratory: infection, bronchitis, wheeze/COPD, Neurodermatitis, Myofascitis, Internal organ inflammation, Hepatitis, Colitis, Stomatitis, Peptic ulcer
  • Auto immune – Systemic Lupus Erythematous, Rheumatoid Arthritis, Ulcerative Colitis
Because Gua sha protects cells from dying, which is the opposite of what chemotherapy is trying to achieve, treatment is not given 48 hours before or 24 hours after a chemotherapy treatment.   Outside of this window, Gua sha is beneficial for its anti-inflammatory and cell protective effects. Research suggests that inflammation promotes the growth, invasion and metastasis (spread) of cancer cells.
No, Gua sha does not strengthen autoimmune reactions. Instead it has a regulatory effect on the immune cells and protects other cells, which offers protection of the organs from the effects of chronic inflammation. In this way, immune protection prevents disease progression. Studies have shown protective effects in the cases of Systemic Lupus Erythematous, Rheumatoid Arthritis and Ulcerative Colitis
A key therapeutic effect of Gua sha is ensuring sufficient blood is temporarily raised under the skin. The few days this takes to fade is the peak effect of the treatment, though the beneficial chemical cascade ignited by the treatment lasts much longer. For new injuries or disease the number of sessions is much less than for chronic conditions.

In the case of chronic conditions, such as asthma, autoimmune and endocrine conditions, sessions after the initial resolution of any crisis are usually monthly or every two weeks. This ensures a protective effect.

Yes – you can still gain the therapeutic benefit! If you do not want acupuncture, tell me when booking your appointment.
The best way to describe the sensation of Gua sha is as a type of massage. If you have sore muscles, you feel Gua sha more, as it will then feel more like a deep-tissue massage. It is not uncomfortable though and you will be always asked if the pressure is to your liking.
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