The Ultimate Guide to Gua Sha Therapy

aka Scraping, Spooning, Coining

Despite being around for centuries, Gua Sha is still very new and foreign to the Western world. We scoured books, articles and videos on Gua Sha but couldn’t find anything that really helped the layman understand all it has to offer. That’s when we decided to create the Ultimate Guide to Gua Sha. We spent countless hours putting it together and our only hope is that more people can experience the power of Gua Sha.
Gua Sha 4 people using it

Chapter 1: An Introduction to Gua Sha

The human body is astounding. It’s made up of roughly 7 Octillion atoms – that’s seven with 27 zeroes after it! All those atoms work together to create a mesmerizingly complex yet perfectly harmonious dance of life. The body is not just a machine – it’s a work of art. People have been studying the body for centuries. We’ve amassed a lot of knowledge over all this time, and with the advances in medical technology available to us in this day and Age we’re discovering more about the mystery every day. Still, there is much to learn, and we’re a long way from knowing everything there is to know.
Part of the reason for our lack of understanding is that the more we study the body, the more mind-boggling the complexity appears. Doctors are able to do amazing things for sick or injured people, but still, medical science has more questions than answers.
Breakthroughs in our understanding of the fundamental principles in science – those belonging to the realms of particle physics – have further complicated things. Research has led us to discover that atoms are not the solid particles we once believed they were. Instead, now physicists theorize that all matter is composed of strings of energy. Brian Greene put it this way in his paradigm-changing book, The Elegant Universe: “The central idea of string theory is quite straightforward. If you examine any piece of matter ever more finely, at first you’ll find molecules, atoms, sub-atomic particles. Probe the smaller particles, you’ll find something else, a tiny vibrating filament of energy, a little tiny vibrating string.” (Greene, 1999)
In line with our unfolding understanding of physics and the physical universe, an interesting development in medical science is occurring too. Medical research professionals have started to completely overhaul our ideas about how the mind and body work together to create either health, or disease.
Instead of thinking about the body as a machine that can be fixed by replacing parts and administering pills, (the way a mechanic fixes an engine with spares and lubricants), we now see the body as a dynamic whole – as a dance of living energy.
Along with this paradigm shift, many people are turning to alternative health therapies like Traditional Chinese Medicine, Yoga, Tai Chi and Holistic Therapies for relief from conditions that modern Western medicine can’t cure yet.
The International Journal of Health Sciences, for example, reported that “the use of alternative medicine appears to be increasing. A 1998 study showed that the use of alternative medicine in the USA had risen from 33.8% in 1990 to 42.1% in 1997.” (International Journal of Health Sciences, 2008)
And the trend continues to gather momentum.
Medical science is slowly accepting that many previously overlooked healing methods, some dating back thousands of years (including gua sha), are more beneficial than they had first believed. Well – the proof is in the pudding, so to speak – if it works, there must be a scientific basis somewhere. In recent years more resources have been made available to study these kinds of medical procedures. We’ll examine it in more detail in chapter 3.
It’s a positive change. A great many physicians, specialists and medical doctors are finding ways to combine Alternative Medical therapies with standard clinical medicine. A synergy of the two technologies makes sense, and leads to enhanced healthcare for everyone.
In the West we have developed a bit of an unhealthy obsession with taking pills and antibiotics. But this is becoming less popular as people begin to understand the side effects. People are realizing that prevention is better than cure, and that being healthy takes more than just regular visits to the GP. A balanced, healthy diet, good exercise habits, and a healthy emotional and mental life go hand-in-hand with healthy bodies.
Among the many ancient therapies that are being re-discovered and re-evaluated is TCM – Traditional Chinese Medicine. In the next chapter we will take a closer look at the history and roots of this medical science.
Gua sha is one of the hidden gems of TCM. While it is well-known and widely used in Asian communities, it is still little-known in the West.

What is Gua Sha?

Dr. Arya Nielsen is an American researcher and acupuncturist taught in the classical lineage of Dr. James Tin Yau, and she’s the leading authority on the subject in the West. She defines gua sha this way:
“Gua sha is a healing technique of traditional East Asian medicine. Sometimes called ‘coining, spooning or scraping’, Gua sha is defined as instrument-assisted unidirectional press-stroking of a lubricated area of the body surface to intentionally create transitory therapeutic petechiae called ‘sha’ representing extravasation of blood in the subcutis.”
(Nielsen, 2013)
Using a smooth stone or a specially designed instrument, along with the appropriate oils for lubrication, the gua sha practitioner strokes an area of the body, such as the patient’s neck or back. After a few moments the skin begins to turn red, and then a particular kind of marking starts to appear on the skin.
Results from scraping the right rotator cuff...
The patient here has had his right shoulder worked on for 2-3 minutes using the Sidekick Curve Gua Sha tool. You will notice bright red spots which are a trademark of Gua Sha.
If you’ve never seen the technique in action before, you might mistake the markings for bruises – but that’s not what they are, exactly. The skin is not broken, and the scraping instrument is blunt. It’s not painful at all if done correctly.
Fine capillaries (tiny blood vessels) start to give off the “sha” or petechiae. This is a good thing. What it does is to release toxins from the blood and greatly stimulate circulation in the area. It also has “an anti-inflammatory and immune protective effect that persists for days following a single Gua sha treatment.” (Nielsen, 2013)
It gives almost instantaneous relief from pain and congestion as well as freeing up a greater range of movement in joints and ligaments.
Here is a brief video explaining Gua Sha and the Sidekick Curve (a Gua Sha based tool):
It is used by millions of lay-people in parts of Asia on a regular basis for immediate relief from pain, stiffness, fever, chill, cough, wheeze, nausea and more. It is also effective in acute and chronic internal organ disorders including liver inflammation in hepatitis.
In Vietnamese culture gua sha is known as Cao Gio, which has its roots in the disappearing tradition of the so-called Buddhist Wandering Monks. This goes back many centuries, but the practice is commonplace, even today. It’s common to find gua sha performed by Vietnamese people in their homes.
It is only in recent years that it has become known, and widely accepted in Western culture.
In the chapters that follow we will look at its historical roots, as well as the clinical evidence of its effectiveness.
This book will guide you through the basic technique and explain all the terms and tools. You will find out what kinds of illnesses and injuries it can help heal, and you will learn how to use it effectively and safely.
Let’s start by looking at where it comes from – as well as the ancient philosophy behind it all.

Chapter 2: Traditional Chinese Medicine (TCM)

The history of TCM can be traced back at least as far as The Yellow Emperor’s Inner Canon (黄帝内经 or Huángdì Nèijīng) which is more than 2000 years old.

It probably goes back much further than that, but not many written records have survived, so historians cannot tell with great accuracy what the actual date of origin is. It seems to have grown naturally from the more ancient roots of folk medicine.

In the Inner Cannon, yin and yang are described, and so are the Five Phases of nature (wood, fire, earth, metal, water) as well as the concept of Qi. (Komjathy, 2004)

TCM is more than just folk remedies. It has a very deep and beautiful philosophical basis, and it is very wide – covering almost every aspect of the human body, and also incorporating diet, exercise and emotional-mental balance.

What makes it different from Western medical science is that TCM studies the human body in its natural home – the world as we know it – instead of in a laboratory, divorced from reality. It’s based on the observation of nature as a whole, and the patterns and cycles that form part of all life.

To really understand the basis of TCM it is necessary to examine a few key concepts – including yin and yang, Qi and the five elements theory. Let’s look at each one in turn.

Yin and Yang

Perfect health is a perfect, dynamic balance.
Most people on the planet will recognize the classic yin yang symbol, but few are aware of how truly significant and elegant this philosophy really is.

It starts with the idea that everything in the universe is part of a dynamic balance between polar opposites – yin and yang. Examples are day and night, hot and cold, light and dark, up and down and left and right.

Each opposite gives meaning to the other – “up” means nothing unless it is related to “down”. But it goes even deeper than that.

Yin and yang are not absolutes – they are completely relative. To illustrate: Day is considered yang and night is yin, but morning is understood as being yang within yang, afternoon is yin within yang, evening before midnight is yin within yin and the time after midnight is yang within yin.

The two are not static either. Yin contains the beginning, or the ‘seed’ of yang – and vice versa. That is why there is a dot or small circle of the opposite color in each side the symbol. Day contains the ‘seed’ or the potential to become night, and night eventually becomes day. It is constantly flowing, changing, balancing. The balance is not set in stone – it flows like water, tending now towards one extreme, and then to the other. The symbol is supposed to convey the sense of yin flowing into yang while yang is also flowing into yin. Another way to picture it is as two cosmic fish involved in the dance of a mating ritual producing the cycle of life.

Life is the harmonious interplay between yin and yang. That is why life follows a cycle, why old age follows childhood, why seasons come and go, and why life and death go hand-in-hand. It’s a concept that can be used on any scale – from the grand vastness of the cosmos, to the tiniest particle within the atom.

But how does this relate to healing – and more specifically, how does it relate to gua sha?

Simply put, yin and yang exist in dynamic balance in a healthy body. Too much of one means that there is an imbalance – which in TCM language means disease.

Certain parts of the body are naturally more yin, and others are naturally more yang. When the seasons change, or when day becomes night, the body adjusts its balance in harmony with the outside world. When it doesn’t balance properly, disease starts (like catching a cold, for example).

The human body is always trying to heal and balance itself – this is a fact that anyone can easilly observe in their own body. In Western medicine this is called homeostasis. In TCM it’s balanced yin and yang.

The word ‘gua’ means ‘scrape’and the word ‘sha’ in chinese is ‘sand or fever or rash’. The two words together in chinese mean “to scrape away fever” or “scrape away disease by allowing it to escape from the skin” In other words – gua sha helps restore the dynamic balance by releasing the appropriate energy and stimulating the flow of Qi.

And this brings us naturally to the next question: What exactly is Qi?

What Exactly is Qi?

In the opening chapter we briefly looked at the fact that modern Western science has uncovered an ancient truth – everything is energy. Even Einstein’s elegant formula (e = mc2) shows that energy and matter are related to each other – they are different expressions of one and the same thing.

But this idea isn’t new, at least, not in principle. Esoteric masters from ancient times knew of the subtle nature of physical reality, and that everything in the cosmos forms part of one vibrant sea of energy. In Traditional Chinese Medicine, as well as the ancient writings such as the I Ching or Book of Changes and the works of Lao Tzu this energy goes under the name of Qi – the vital cosmic breath.

Sometimes the word is written as “Chi” – the two words are interchangeble, and it’s pronounced “Chee”. It can be translated as “air” or “breath” or “vital breath” but it is more than just air. It’s the life force itself. It’s more subtle than air, and more powerful than electricity.
Qi is not exactly electromagnetic energy, and it is not equivalent to any energy that can be measured by modern science. It exists everywhere in the universe as a living, intelligent force. It’s what shapes and balances all life on the planet, including the tiniest microbes, the great whales in the ocean, and our human bodies too.

It flows around mountains and through valleys, following rivers and riding the air, through plants and water and throughout the natural as well as man-made landscape. The ancient art of Feng Shui is a study of how this force flows through nature, and how it changes and flows through buildings, furniture, windows, and back out into nature again. Qi never stands still – it flows all the time.

It also flows through the human body in streams or rivers – and these rivers are known in TCM as the meridians.
In ancient times these were mapped out, and around 400 specific points of intersection were identified. They’re known as “pressure points.”

These points are used during accupuncture (where the needles are inserted) to balance Qi flow and adress the imbalance that’s causing disease. It’s like Feng Shui for the body, in a way.

QiGong master Luk Chun Bond explains it in a beautiful way:
“Translated from Chinese, feng shui means “wind water.” Both of these fluid elements are used as symbols for the movement patterns of chi. In nature, wind and water carry energy, like the rush of wind before a rain storm, or the gusts we feel when standing beside the crashing cascade of a waterfall. Like wind and water, chi moves in straight, powerful lines, in graceful arcs and curves around obstacles, and sometimes in confusing swirls and spirals.

Metaphors for chi movement can be seen in nature. For example, a fallen tree will sometimes land in a stream, causing an obstruction. Most of the water finds a way to flow around it. But some backs up behind the tree, becoming trapped in an eddy. If the tree is not moved, the water in the eddy eventually stagnates. Chi behaves in much the same way. It is important to keep chi in motion, flowing freely without encumberance.” (Bond, 2002)

The streams of Qi permeate each cell, every bone and every nerve. Qi flows through them all, nourishing and sustaining everything. There are twelve major meridians that run on each side of the body, one side mirroring the other – once again a perfect balance of yin and yang.

Each meridian corresponds to an internal organ. There is one for the heart, one for the lungs, another for the liver – and so on. No stream is independent – they all work in harmony. When one part is affected, the entire system suffers.

In the TCM approach to healing, a sickness develops when there is a blockage or stagnation of the Qi (like the tree in the stream). This can happen because of a physical injury, infection by pathogens, or because of exposure to the elements (such as too much cold or heat) or even from emotional trauma. Remember, TCM is holistic – it sees the body, mind and spirit as one unit, working together.

A person who regularly allows himself to get too angry, for example, will clench his jaw, tighten his stomach muscles and develop muscle knots in the back and neck. This happens mostly on a subconscious level. But the mind, body and emotions are one unit. This continuous anger will eventually lead to an obstruction to the natural Qi flow, and affect the heart and liver meridians, and then the entire system. Although this can be prevented by paying attention to the body and the emotions, most often it is ignored until there is already sickness. Then it is more difficult to fix the problem – but still possible. The body is always naturally inclined to restore balance and heal all by itself, now matter how serious the sickness.

A skilled TCM practitioner will consider the physical symptoms in the body. He will look at skin tone, feel the pulse and temperature, as well as the patients overall mental and emotional state, and then take steps to help the body restore its natural balance. Depending on the problem a course of herbal medicine, a diet change or treatment like accupuncture, accupressure or gua sha will be recommended. (Depending on what kind of TCM practitioner you consult, he may also advise you to try to manage your anger a little better!)

Gua sha is just one tool among many in the TCM tool kit.

Another TCM tool is the widely known practice of Tai Chi and Qigong which uses gentle dance-like movements combined with breathwork and focused concentration to naturally stimulate Qi flow and balance. It’s actually possible to become more aware of the Qi flow in your own body. Using these practices you can learn to quiet your mind, and focus with concentration – it just takes a bit of practice. The idea is to constantly manage the harmony in your body and mind, and prevent illness from developing in the first place.

There are also different forms of Qi. The surrounding energy in the universe is the most plentiful. “Chinese refer to the unfettered movement of chi balanced with both yin and yang as ‘the cosmic breath of the dragon’ (or sheng chi). This creates a desireable environment of vibrant energy that promotes mental, physical and spiritual health.” (Bond, 2002)
Living things generate their own Qi too. The energy generated by the human body is called Jung Qi, and this can be cultivated and used to heal, protect and nourish you.

Certain advanced forms of martial arts (in the Kung fu tradition) teach students how to store and use this energy for self-defense.
The incredible physical feats of the Shoalin monks are examples of what can be achieved with the sustained use of Qi. It’s more about mental power,discipline and focus – allowing Qi to do the work in a natural, almost spiritual way – rather than weight training or gym exercise.

Five Elements Theory

This part of the TCM background ties the ideas of yin and yang together with Qi into a meaningful whole. The five elements theory is a framework – a kind of blueprint of how everything in the world fits together. It’s the most important tool in TCM for diagnosis.

The elements go by the titles: Wood, Fire, Earth, Metal, and Water. But they are not just simple ‘elements’ the way we understand the term generally. Those are just convenient names for the five categories that all things fall into – from seasons (with the addition of one season called late summer or harvest time) to colors and sounds, and even the organs in your body.
TCM is a holistic approach to health. It’s a system that takes all parts of the experience of life into account, not just the body as a separate machine-like entity which is divorced from its environment. The five elements theory shows how your body is connected to and related to the outside world, and to the inner world of thoughts and emotions.

Fire, for example, relates to heat, summer, red, the heart and passion. It’s the fire of life, the height of summer that is full of abundance and increase. It naturally provides the energy for growing things, which leads to the harvest time – which is the next element, Earth.

The five groups interact with one another. Following the circle in the diagram clockwise each element has a creative or nurturing (Sheng) impact on the next one in line. It’s like a mother-child relationship.

What this means in terms of healing is that if there is a problem with the heart (fire element) there will naturally be an impact on the next in line – the spleen and stomach. You could also look for an influence coming from the previous element – wood, which relates to the liver.

The elements also exert controlling or inhibiting (Ke) effects on each other. Water suppresses fire, for example. The energetic system in the body is balanced – when there is too much “fire” or heat, the “water” element exerts a restraining, cooling influence to bring the body back into balance.

When gua sha is administered by a suitably qualified TCM practitioner, the sha – the markings on the skin – can be interpreted using the five elements theory.

So, to wrap up the section on Traditional Chinese Medicine, you can see that gua sha comes from a very rich tradition. The philosophy behind TCM is remarkable. We’ve only just scratched the surface with this brief introduction. Gradually these ideas are becoming more widely understood in the West, and along with them comes access to much wisdom, provided you’re open minded enough to allow for a different scientific paradigm.

TCM provides a meaningful framework, not just for healing, but for leading a balanced life. Yin and Yang are constantly flowing, balancing and interacting to the rhythms of life. Qi needs to move constantly, and as it does so it nourishes your body, keeping you fit and vital. If it becomes blocked and dammed up, illness is sure to follow.

The gua sha procedure can be used in restoring and unblocking the Qi flow in the area to which it is applied. In the next chapter we will consider how scientists are trying to understand why and how TCM methods actually work.

Chapter 3: The Science of Gua Sha

In the introduction we stated that alternative medicine is experiencing something of a renaissance in recent times.
Mainstream journals are running an increasing number of articles related to a wide variety of traditional or “folk” medical treatments, including holistic, energy, herbal and TCM remedies – it seems that more and more people are open to the possible benefits of traditional medicine, provided of course that it’s not dangerous.
The New York Times writer, Stephen T. Asma described the current mixed milieu of acceptance and skepticism in an article from 2013 entitled “The Enigma of Chinese Medicine.” He describes his own approach to TCM in the article.
Like many people reared in a Western culture, he is a little skeptical about TCM. At the same time he is very open to the possibility that it might actually be effective – realizing that Western medicine isn’t always completely successful. If TCM is not going to hurt - why not give it the benefit of the doubt?
To quote Asma: “Many Westerners will scoff at the very idea that [TCM methods] could have medicinal effects. But at least some of those same people will quaff a tree-bark tincture or put on an eggplant compress recommended by Dr. Oz to treat skin cancer. We are all living in the vast gray area between leech-bleeding and antibiotics.” (Asma, 2013)
The times are indeed changing for medicine. People are adopting a new mindset when it comes to healthcare. Many have realized that the most sensible way to go about healthcare is to keep what is useful in old-fashioned methods, and bring them up to date using the technology and knowledge we have available today.
Chinese Medicine has its own scientific journal these days too. It’s published by BioMed Central, a respected scientific publisher. The Chinese Medicine journal promotes studies of “acupuncture, Tui-na, Qi-qong, Tai Chi Quan and energy research.”
Even the highly regarded scientific publisher, The American Association for the Advancement of Science, in its popular magazine: Science has taken a positive approach to traditional healing methods.
There is a movement to integrate and legitimize traditional medicine in a controlled, systematic way. Instead of a war between alternative or “pseudo-scientific” methods and clinical methods – there is an effort towards cooperation.
Science published a three part report entitled: The Art and Science of Traditional Medicine. In the introductory section it mentions their goal with this pioneering work:
“From the new WHO (World Health Organization) Traditional Medicine Strategy to the application of systems biology in studying TCM, we aim to highlight the potential for creating an integrated, network-based health care system.
“Nearly a quarter of all modern medicines are derived from natural products, many of which were first used in a traditional medicine context.
“Traditional medicine researchers are applying modern'omics and the latest technologies in an attempt to standardize traditional treatments.” (The American Association for the Advancement of Science)
This is a sensible approach.
Instead of being forced to label and take sides with either “scientific” or “unscientific” medicine, it’s better to accept that millions of people have benefited from both approaches, and look for ways to create a synthesis of the two.
In the previous chapter we learned that TCM has a very sophisticated history, and a deep philosophical framework. Despite the skepticism in the scientific community about Qi and the meridians, there is much evidence that acupuncture and gua sha are effective. These therapies wouldn’t still be popular today if that was not the case. Science still needs to answer the basic question though: Why does it work?
When it comes to diligent scientific research into gua sha, there is still much work to be done. It’s a technique that has escaped the notice of mainstream science for a long time. While the science behind acupuncture is documented a little more thoroughly, gua sha studies are still very limited.
This video may help shed some light:
The pioneer in this field is Dr. Arya Nielsen (mentioned in the introduction). An article published in the Pacific College of Oriental Medicine describes her journey towards the scientific validation of gua sha:
“When I began practice 36 years ago, I was trained in East Asian medicine but had no training in research and there was zero access to research facilities through acupuncture schools.
Many years later I consulted Helen Langevin, MD about my interest in researching the biomechanism of gua sha. She advised starting with basic science: what can be used to establish a measure of change that might inform what is actually observed? I mulled this over and looked for a doctoral program that would support my research interest. I matriculated to an academic PhD program, and through a chance meeting at my job at Beth Israel Medical Center in New York, was invited by Dr. Gustav Dobos to conduct research on gua sha at the University of Duisburg-Essen in Essen, Germany. There we performed one of the first investigations on the physiology of gua sha: measuring changes in microperfusion of surface tissue. From that first investigation have come other biomarker studies; we now have something to say about the science of gua sha.” (Arya Nielsen, 2015)
The results of studies conducted by this group of researchers were published in the National Center for Biotechnology Information (NCBI) and other scientific medical publications such as Pain Medicine.
What did the research show? Is there really clinical evidence that gua sha works? Nielsen answers:
“We found a 400% increase in microperfusion (surface circulation of blood) for 7.5 minutes following gua sha, and a significant increase for the full 25 minutes following treatment that was studied.
Gua sha’s therapeutic petechiae represents blood cells that have extravasated in the capillary bed, and measure as a significant increase in surface microperfusion . As this blood is reabsorbed, the breakdown of hemoglobin upregulates HO-1, CO, biliverdin and bilirubin, which are anti-inflammatory and cytoprotective .
Studies show the anti-inflammatory effect of gua sha has a therapeutic impact in inflammatory conditions, such as active chronic hepatitis, where liver inflammation indicates organ breakdown that over time can lead to premature death. The physiology of HO-1 may also explain gua sha’s anti-inflammatory effect in other responsive clinical conditions, such as fever, cough, asthma, bronchitis, emphysema, mastitis , gastritis, musculoskeletal and other painful conditions presenting as neck pain, back pain, migraine, postherpetic neuralgia, and others.” (Arya Nielsen, 2015)
So finally there is some hard scientific evidence of the effectiveness of gua sha. It’s no surprise to the millions of Asian families who have been using it all their lives, but it’s news in the scientific community.

Chapter 4: The Basic Techniques

Over the centuries, experts in TCM methods have developed a broad range of uses for gua sha treatment. This is integrated with the philosophy and theory we discussed in Chapter 2. A qualified TCM practitioner will pay careful attention to the sha that appears on the skin. He will examine the location, the nature and severity of the sha, as well the surrounding tissue.
The amount and the type of sha which appears will give a good clue as to where there is a blockage in the patient’s system. Using the five elements theory, he will know which internal organs are out of balance, and adapt the treatment accordingly. In TCM theory, greenish black or dark purple sha is an indication that dead or stagnant Qi (or toxins, if you prefer) is being released. Brown sha indicates a deficiency of fluids in the body. Red sha and heat indicate the release of excess heat from the system.
These types of signs are interesting to take note of as you learn the art of gua sha – but fortunately, to begin with, you don’t have to know all the theory behind it. Gua sha is suitable for beginners too.
Even if you don’t know the first thing about the five elements, gua sha can still be used to relieve muscle pain, congestion, and all the other benefits that go along with it.
For most people it’s used as a preventative or as a first-aid treatment for many common health conditions. In fact, gua sha is very well known throughout Asia, and it is especially popular in China, Taiwan, Vietnam, Cambodia, Laos and Indonesia. Many ex-patriates have brought this tradition over with them to Western countries too.
“Knowledge of the method is passed down the generations by an oral and visual tradition, rather than from book learning. There is also no particular gender divide with its practice. Men and women both perform it, although it would be correct to say that it is done mostly by women, who adopt the role of the care-giver in most traditional households. Due to being a safe, effective and cost-effective treatment, the Chinese Government in recent times has also encouraged its practice in the broad social setting.” - (Bentley)
Many families use it as a folk remedy. In these households, usually the mother or father or a grandparent knows how to use it. Some of the common health problems gua sha is used as a cure for include:
  • Back pain
  • Neck and shoulder pain
  • Common colds
  • Fever
  • Coughs
  • Muscular pain
Very few of these people are qualified in TCM, but the remedy still works. As you get to know the procedure better through practice and experience, you can expand your knowledge base and become a true master. It’s like any skill that you learn in life – practice makes perfect.
The basic procedure is fairly simple to master, and it’s quite safe if you use it sensibly and take a few basic common-sense precautions. For example, if the tool you use is too sharp, you’re going to break the skin.
It’s common in many Asian non-professional gua sha treatment settings to use a well-worn old coin, for example. But this can often break the skin and make the procedure painful – which it shouldn’t be – if done correctly.
Besides causing pain, there is also the risk of infection from coming into contact with another person’s body fluids. It’s sensible to use the right kind of tool, and to sterilize your implements, your hands and your work station before and after gua sha. If you’re already in a similar line of work, such as massage therapy or reflexology – this should already be par for the course. If you’re completely new to the experience, it’s just means you need to be practical and sensible when starting out.
You can easily perform the technique on yourself in areas where you can reach comfortably, but of course if you want to treat your back and shoulders you’re going to need a little assistance – unless you’re a contortion artist!
If instead you’re going to be performing gua sha on someone else there are a few important things to bear in mind:
It’s important to explain the concept of sha to the person receiving treatment. If someone isn’t expecting the skin to show purple and red markings, it might come as a shock, and you might end up being accused of abuse.
If the procedure is done properly, the patient should experience relief from pain – not more pain. Since the practice isn’t widely known in the West, the markings might easily be mistaken for bruises. It just makes sense to be clear about it beforehand and avoid any psychological scarring. It’s also a good idea to get the patient to explain the markings to his or her family too – for the same reason.
First apply a suitably thick balm, ointment or oil to the skin.
Hold the proper gua sha instrument firmly in your hand, with your arms and shoulders nice and relaxed.
Your instrument should be held somewhere between a 30 and a 45-degree angle to the area you wish to treat.
Start scraping in one direction – down, away from the head, or laterally away from the spine. Start with gentle scraping for the first few strokes, then apply a little more pressure as required. Try to keep the pressure consistent, neither going too deep and hard, nor too soft. (If it’s painful, you’re probably pressing too hard – so be sure to ask!)
Make the strokes long (15–20 cm or about 6–7 inches) and continuous. Always scrape in the same direction – never scrape downwards and then draw back upwards on the same spot.
Each stroke should be performed between 10 and 30 times before proceeding to the next area. If there is lots of sha appearing, you can spend a little more time on that area, and if there is no more sha coming up, you can cut it short and move to the next area.
Once you’re done in one area you can cover it up immediately with a towel to keep it warm.
This video shows Gua Sha being applied on the shoulder and rotator cuff region to relieve shoulder pain.

The Technique

You can show the person who is about to receive treatment the instrument that you’re going to use, and demonstrate on yourself how you’re going to press it into the skin.
Another practical consideration: It’s helpful to have a massage table. This is more for the person who is applying the gua sha than the person receiving treatment. A typical massage table will allow the person being treated to lie face down very comfortably, while the person who is performing the treatment can stand, move around the body and easily reach every spot without straining or adopting an awkward posture.
So with all of those practicalities out of the way, let’s look at the actual procedure:
You can also use the technique on the fine muscles of the head and face – provided you stroke very gently. It’s also helpful to have a finer tool that can easily get into the corners and follow the contours. Facial gua sha can reduce lines on the face, and be used almost like a gentle, natural face-lift.
Gently use the smooth edges of the right tool to scrape and lift the skin from the center brow upwards toward the hairline. Then you move to the side of the nose and the jawline and scrape outward and up towards the ears and then scrape downwards on the sides of the face.
Continue in this way until you’ve covered all the painful and congested areas that need to be treated. The person who received the treatment will most likely experience immediate relief from pain, have a greater freedom of movement, and feel almost “unplugged” – as if an obstruction has been cleared somewhere inside.
After your gua sha session you can give the ‘patient’ a glass of water. Avoid ice water. Instead, keep it more or less room temperature. Water that is too cold can have an unhealthy effect on the internal organs.
Allow the person to just rest peacefully for a while. It might not seem like it, but the body has just been through quite a lot, and it’s better to give it a few minutes to readjust.
You can instruct your patient not to shower or bathe directly, for at least an hour after treatment, and to keep covered up and warm.
Also, try to avoid an area with too much moving air while you’re doing gua sha. Open windows, drafts, fans and air conditioning are not recommended during or soon after treatment.

When to completely avoid Gua Sha - Important contraindications

  • It’s very important not to scrape over any mole, pimple or mark on the skin. This might cause damage to the skin. One way to avoid scraping such an area is to place your finger over it to guard against accidental contact. The same counts for varicose veins, skin disorders or open wounds and scratches.
  • During pregnancy gua sha isn’t recommended.
  • Do not use it on people who are very frail, or too weak to tolerate the treatment.
  • Don’t use gua sha on people with bleeding disorders, or for people who are taking anti-coagulant medication, like warfarin.
  • Although gua sha can help you recover from many mild illnesses, it’s not a good idea to use the procedure too soon after major or minor surgery.
  • Since gua sha is very “hands-on” you should avoid giving it to a person suffering from a serious communicable disease.
  • Try to do the technique at least one hour before or after eating.

Chapter 5: The Tools and Terms

Gua sha scraping tools come in plenty of different shapes and sizes. In many homes people make do with a simple porcelain soup spoon, a metal jar lid or an old rounded coin. Anything with a suitable edge will do – but of course each object comes with its own risks.
In TCM the most popular specialist gua sha tools are made from buffalo horn which is thought to have many beneficial qualities in restoring health. Buffalo horn is found in quite a few TCM herbal preparations (taken orally) too. A scraping tool made from jade is also highly recommend, if you can afford it. Jade likewise has many healing properties.
Other kinds of tools are made from stone, wood, plastic or any material that can be shaped into the proper form. There are bulkier tools for the back and finer ones for the face, and everything in between for all the different joints and limbs.
The perfect tool is very much a matter of personal preference.
If you’re just starting out a good option would be to invest in a single tool that can handle both the rugged job of scraping back muscles, and the finer job of scraping the hands and neck. You can always add to your collection later.

Ointments and Oils

Traditionally many different kinds of oils are used in gua sha – ranging from coconut, peanut or sesame oil to olive oil or even Vaseline. A favorite in China has long been the famous Tiger balm. However, some gua sha experts don’t recommend it because it’s too “spicy”.
The best results will come from natural oils and balms that nourish and restore the tissues being treated and help the skin to release toxins. Sidekick's Muscle Emollient is perfect for treating painful muscles in the legs, arms and back, and makes a good, thick lubricant for the scraping technique.
There are plenty of massage oils and ointments to choose from. Sweet almond oil is one of the most popular massage oils among massage therapists. Extracted from almonds, this pale yellow oil works well to provide lubrication with only a small amount of oil being applied. If someone is allergic to nuts, however, you can’t use it.
Apricot kernel oil is similar in texture and color to almond oil, but costs slightly more. It is rich in vitamin E, a quality that gives it a longer shelf life than the typical oil.
Like almond oil, apricot kernel oil is absorbed into the skin, so it won't leave people feeling greasy afterwards.
If you’re just going to use gua sha on your own, a massage table is overkill, but if you’re planning to use it on others regularly, a good massage table is probably a wise investment.
It’s not only for the comfort of the person receiving the treatment. If you’re going to be treating people on a regular basis, it allows you the best access to work around the patient’s body without having to crouch, kneel or adopt an impossible posture.
There are many kinds of tables – some are quite pricey, but there are affordable options too, and some of them are portable or easy to stash away when they’re not being used. If gua sha is going to be a regular thing in your life, it’s highly recommended.
Besides those basics you might also consider adding some of these to your gua sha toolkit:
  • Plenty of clean, comfortable towels
  • Hand and surface sanitizer
  • Paper towels for cleaning up excess or spilled oil
  • Meridian charts for reference
  • You can also burn incense and play soothing music to round out the gua sha experience.
For your reference, here are some of the most common gua sha terms and their explanations:




A TCM procedure where fine needles are inserted into specific points along the meridian lines in the body. The goal is to balance Qi flow throughout the entire system.


Like Acupuncture, Acupressure is also applied to specific points on the meridians, except in this case there are no needles. Instead, pressure is exerted by hand or with a blunt instrument.

Cạo Gió

The Vietnamese equivalent of gua sha


Another common term meaning gua sha, often known to people who use it as a folk remedy. It originates with the common practice of using an old blunt-edged coin to perform gua sha.


Cupping is another relative of gua sha and acupuncture. A glass cup is held onto the skin by means of vacuum pressure, and it is used to stimulate Qi flow and expel toxins from the body.


The word means to rub or to scrape

Five Elements

In TCM the Five elements are Wood, Water, Fire, Metal and Earth. They are categories rather than elements, and the five elements theory is used for diagnosis and prognosis.


A word used in TCM to denote a particular stream or river of Qi in the body (or even elsewhere). There are 12 meridians, each one mirrored on opposite sides of the body


A red or purple discoloration on the skin caused by bleeding or by gua sha

Qi / Chi

The universal life force that flows through everything, including the body in balance between the extremes of yin and yang.


Another term used for gua sha


The red or purple marks on the skin after gua sha treatment. It can be used to diagnose the nature of the imbalance that is causing the pain, and when it disappears the problem has been resolved.


Another common term for gua sha


The fatty layer just under the surface of the skin where petechiae appear.

Where can you buy it?

Sidekick has designed their own Gua Sha tool known as the Curve Muscle Reliever. It is larger and heavier to allow for better handling and ease of use. Click below to learn more.

Chapter 6: Using Gua Sha Effectively

There is something of a cultural divide between people from East and West where it comes to gua sha. Unfortunately there is still a lot of misinformation, and the use of the technique has caused some controversy, with some people going as far as to call gua sha ‘torture’.
It is our hope that the information in this book will help to foster an open-minded and unbiased spirit of investigation, looking into the facts instead of just superstitions and second-hand information. Gua sha isn’t abuse, and it certainly isn’t torture. The technique has been around for centuries, even though it may be new to people in certain parts of the world today.
In 2001 a Chinese film was released based on this exact theme, called The Gua Sha Treatment. In the movie, Grandfather Xu comes from China to visit the family of his son, Datong Xu (Tony Leung) in St. Louis.

While visiting he gives his grandson, Dennis Xu (Dennis Zhu), a treatment of gua sha to treat a slight fever.
The grandfather is unable to read the English labels of the medicine in the home, so he opts for a treatment that he knows well from experience – gua sha. But it leads to trouble. The American authorities mistake the harmless traditional Chinese medical treatment for child abuse because of the obvious marks left on Dennis' back. The family goes through hell when the child is taken away by the child protection services. Fortunately it’s resolved in a good way in the end.

The story illustrates just how wide the cultural divide can be, and what kinds of problems the lack of education about the subject can lead to.

The information we’ve covered so far should give you a very good idea about what gua sha really is, and how to use it effectively.

It’s most often used for relief from chronic pain in the back and neck. It can also be used very effectively on the shoulders and arms, thighs and shins, or any muscle that is painful, especially after exercise.

People who’ve had this procedure done properly often report an immediate relief from tension and pain, and are able to move much more freely afterwards. When regular massage doesn’t get rid of the chronic knots of tension and pain, gua sha can be a good solution.

Of course, it’s not always going to have the same effect on every person. Some have reported that tension and pain return after a while, and that the gua sha caused the skin to become very sensitive, which they found disagreeable, or even unbearable. It’s important to communicate clearly when receiving or administering the treatment to make sure you’re not causing more pain than you’re relieving. With a little care, and some good old-fashioned common sense, there should be no problems.

Besides muscle pain, another application for gua sha that’s popular is treating the face. It can be a rejuvenating, refreshing experience that helps get rid of wrinkles and improves the muscle tone of the fine facial muscles. It’s almost like a facelift without needing to have plastic surgery!

By stimulating the circulation and invigorating the tissues, gua sha on the face can be used to treat the signs of aging and fatigue. It also helps to lift the sagging of the neck and jawline.

Another popular use for gua sha is to treat the congestion that comes with colds and flu, fevers, coughs, asthma or bronchitis. In chapter 3 we looked at the way that gua sha is beneficial to the immune system. While gua sha won’t directly combat the pathogens that have caused the infection, it definitely helps relieve the symptoms, and gives your natural immune system a boost to help fight off the bug.

One of the best things about gua sha is that it’s basically free.

With the rising costs of medication, that definitely counts for something. It’s one of the reasons that gua sha has remained so popular in communities without easy access to healthcare.

Bruce Bentley conducted a study on gua sha among Vietnamese ex-patriates in Australia, where the practice is very common. One of the questions he asked people was:

"Why do you prefer this method?" - Some of the answers were as follows:

  • “Because it works and I don't need to take medicine”. (Female, aged 17).
  • “This method doesn't cost money, it's effective and I can avoid waiting in a long queue to see a doctor”. (Male, aged 51).
  • “Because it has good results for many people and so the tradition is maintained”. (Female, aged 67).



Natural remedies are becoming more and more popular these days with a worldwide shift from synthetic medications and prescription drugs to a more holistic approach. Methods like gua sha that are inexpensive, natural and safe deserve to be recognized for their benefits.
It makes sense to combine the wisdom of traditional methods that have stood the test of time with the best that medical technology has to offer in the modern age.
The TCM philosophy is based on the sensible concepts of balance and harmony. Health means balance; an imbalance means disease. The whole human system works together – mind, body and emotions – to create health and vitality. When one part is affected, each other part suffers.
Gua sha helps to stimulate circulation of blood, lymph and Qi, and at the same time it helps expel toxins.
While modern Western science might not recognize the existence of Qi, it certainly does recognize the benefits of gua sha. Clinical research has only just started to confirm the therapeutic effect of the technique. When it’s performed in the right way, and when the proper simple precautions are taken, gua sha is safe and effective.
All of this makes gua sha a very useful technique for preventative and first-aid healthcare.
The human body is indeed amazing. It’s so much more than just a machine or a collection of chemicals and reactions. It’s the most perfect, most amazing tool we have – and each one is a work of art. With the body we can create, heal, work and enjoy life, and it deserves the proper respect and care.
It’s our hope that you find much benefit from using gua sha for relief from pain, for health and well-being, and for relaxation and rejuvenation.

Works Cited

Arya Nielsen, P. (2015). The Science of Gua Sha. Paciffic College of Oriental Medicine.
Asma, S. T. (2013). The Enigma of Chinese Medicine. New York: The New York Times.
Bentley, B. (n.d.). Gua Sha : Smoothly scraping out the Sha. (Australia).
Bond, L. C. (2002). The First 16 Secrets of Chi. Berkeley California: Frog, Ltd.
Greene, B. (1999). The Elegant Universe: Superstrings, Hidden Dimensions, and the Quest for The Ultimate Theory. W. W. Norton & Company.
International Journal of Health Sciences. (2008). Complementary and Alternative Healthcare. London: NCBI.
Komjathy, L. (2004). Review of Huang Di Nei Jing Su Wen: Nature, Knowledge and Imagery in an Ancient Chinese Medical Text. Boston University.
Nielsen, D. A. (2013). Gua Sha, A traditional technique for modern practice. New York, NY, USA: Elsevier Ltd.
The American Association for the Advancement of Science. (n.d.). The Art and Science of Traditional Medicine. Science/AAAS Custom.
Tzu, L. (n.d.). Tao Te Ching chapter 42. Unknown.
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