Gua Sha

Dispelling Gua Sha Myths

The traditional Chinese medical practice of gua sha has become trendy in the West, where many claim that it can smooth face wrinkles, decrease puffiness, or reduce fat. In reality, this cosmetic application is a very new phenomenon that bears almost no resemblance to the powerful healing modality that folk doctors and physicians have used in China for 2500 years. In this multi-post series, we examine the history of gua sha in ancient & modern Chinese medicine, and scientific research into its healing mechanism.

The first written record of gua sha comes from the ~400 BC medical manuscript, Prescriptions for 52 Diseases. In an entry for pediatric febrile seizures, the author recommends scraping over the convulsed muscles until “red marks like fly’s wings” appear.” This is a distinct feature of gua sha notably missing from its cosmetic use, namely that scraping should produce petechiae from extravasated blood cells, resulting in red dots on the skin. Extravasation was seen to be key to gua sha’s healing mechanism, allowing for the release of “pathogens with the blood.

Due to culture misunderstanding, there have been many cases of Chinese and Vietnamese immigrants in the US being accused of child abuse, who were performing gua sha on their children or grandchildren. There is even a 2011 movie starring tony Leung Ka-Fai on this issue titled The Gua Sha Treatment. 

A folk practice throughout antiquity, gua sha gained widespread acceptance as a legitimate healing method in the Ming (1368-1644) and Qing (1644-1912) Dynasties, with records showing it was successfully applied to a disease involving fever and severe abdominal pain, attributed to exposure to “dung heap pestilence” or sha (痧)—likely a bacterial or viral infection.

In the 1960s, the Chinese government conducted a large-scale clinical survey of gua sha led by Dr. Jiang Jing-Bo. Through the publication of Gua Sha Treatment Methodology, Jiang expanded the use of gua sha to 400+ medical conditions, from hypertension to colds. Gua sha remains an extremely common healing modality in China and the Chinese diaspora applied to the neck and back for the treatment of colds, neck tension, heat stroke, and more.

Jiang and other modern scholars also defined advanced parameters for gua sha, in which petechiae color and distribution can be used as a diagnostic tool for the health and condition of the body.

Gua Sha Mechanism & Diagnosis

Researchers have begun investigating gua sha’s mechanism of action, with recent studies demonstrating that the traditional Chinese medical practice resulting in red petechiae upregulates the immune system, in particular heme oxygenase-1, a molecule with strong anti-inflammatory and anti-oxidant action.

As extravasated blood cells from the gua sha process are reabsorbed into the circulatory system, they stimulate the release of HO-1, bilirubin and biliverdin, producing an anti-inflammatory response. This helps explain gua sha’s use in treating allergies, asthma, IBS, and colds.

Gua sha also manually stimulates surface lymph and microvascular circulation. A 2019 animal study found that gua sha can effectively stimulate the absorption of interstitial fluid into the lymph and capillary beds, notably improving local circulation. This helps explain why gua sha has also been found to help mitigate painful breast engorgement in new nursing mothers, and partially explains how cosmetic application to the face may assist in relieving puffiness (although this should not be considered gua sha in its intended medical form).

Modern scholars, including Dr. Jiang Jing-Bo—who led the large-scale clinical survey of gua sha—defined advanced parameters for gua sha to serve as a diagnostic tool:

In healthy individuals: sha are very light red, sparse and evenly distributed

Crimson red and densely distributed sha: indicates there is too much “heat,” pointing to an inflammatory state

Darker red or purple sha: indicates cold or blood stagnation—signs of poor circulation

Faint light red sha, scraping triggers pain & soreness: indicates patient may be “deficient”; often occurs in women during menstruation

Further, because acupuncture points down the spine correspond to specific internal organs, denser distributions of sha in particular areas can indicate problems with specific organs, i.e., sha clustered from the 1-6th vertebrae can be a sign of problems with the lung and heart. As a result, gua sha is also used as a means of diagnosing illnesses before they become more serious.

Do these findings change your perception of gua sha?