In the relief of pain there is a growing body of evidence that an ancient form of Chinese medicine called gua sha works extremely well. This form of therapy is a modality in which the skin is scraped by a blunt instrument.

Gua sha therapy is a 2,000-year-old healing procedure used by Chinese mothers for generations as a home remedy to treat their sick children. Gua sha is now used among Asian immigrant communities and throughout Southeast Asia, as well as by practitioners of traditional Chinese medicine in Tarzana and all over the world.

Over 120 studies on gua sha was conducted since 2005, usually pertaining to its effect on chronic back pain and other severe musculoskeletal conditions. Harvard university scientists in 2009 discovered that gua sha can potentially be used to treat immunological and anti-inflammatory conditions. Another Harvard research in 2011 demonstrated that gua sha lessened liver inflammation in active chronic hepatitis B.

Several months ago, research was done that investigated the healing outcomes of gua sha on 40 patients suffering from chronic lower back and neck pain. In the study, which was featured in the American Journal of Chinese Medicine, the subjects were assigned randomly to either a waiting list control group or a treatment group that was treated with gua sha therapy only.

Both groups were then reviewed a week after the treatment. As compared to the control group, the subjects in the treatment group reported a decrease in pain and improved health status. In the treatment group however, pain sensitivity got better in subjects suffering chronic neck pain but not in the subjects suffering from lower back pain. The conductors of the study suggest this was because of increased pressure sensitivity in the neck region.

In the University of Essen-Duisburg, a researcher by the name of Romy Lauche recalled that several patients found substantial relief for over a week, and one subject, who had felt anxiety about the treatment, experienced unexpected outcomes. “A woman suffering from back pain with a scale of seven on a 10-point scale came back for assessment without any pain. Before and after examination, Mr Lauche could observe that gua sha had cured all muscle tension. “The number of tight muscles had vanished,” recalled Lauche in a phone interview.

Similar to several alternative and complementary therapies, gua sha is not without issues, mainly because of the seemingly and distinctive severe marks that are the trademarks of the therapy. These marks are neither rashes nor bruises, but something known as petechiae. It appears severe enough to put off a lot of patients looking for an alternative type of medication-free pain relief.

A 2001 film starring Hon Kong star Tony Leung Ka entitled Gua Sha Treatment, did something to mitigate the misconception. Gua Sha Treatment is a tale about Chinese-American immigrants who battled head on cultural misapprehensions when a physician finds out the outrageous gua sha marks on the school-aged son and phones the authorities. While the movie had a happy ending, it does not mean that all gua sha therapies are equal in reality.

Hong Kong resident Annie Tong underwent the treatment in a Kowloon clinic more than ten years ago, and still vividly remembers the discomfort. She remembered that her back was as red as a tomato. The treatment hurt for days, and there was little relief. Ms Tong says she would never try the therapy again.

TCM practitioner Dr Gladys Leung thinks that gua sha doesn’t need to be painful. It is contingent on the communication between practitioner and patient, and the sensitivity of the patient’s skin. She says “A healer may be administering it too vigorously without requesting feedback from the patient”.

Singapore practitioner of TCM Dr Wu Yue, a specialist in acupuncture treatment states there are various levels of firmness for varying degrees of pain in patients. According to Dr Yue, “It depends on the state of congestion in qi and blood flow of the patient”. A heavy stroke may be utilized for every blocked Chi indicated by extremely tense muscles.”

Acupuncturist Arya Nielsen has spent a considerable part of her career teaching gua sha to physicians throughout North America and Europe. She wrote a book on gua sha fundamentals, spearheaded studies to provide proof of gua sha effectiveness for pain, and deems the treatment as “an easy and elementary medical miracle”.

To raise the caliber of practice standards and eliminate risks, Nielsen has proposed safety guidelines for cupping and gua sha therapies. She says that during the procedure pain should not be part of the patient’s treatment.

The belief that the treatment causes bruises is the biggest misunderstanding about gua sha therapy. Nielsen says “Gua sha doesn’t result in bruising. Bruising signifies traumatic injury and bleeding to the tissue.” After gua sha therapy, the red marks that arise signify the movements of red blood cells in the surface of the skin.

“Gua sha will cause the cells to go ‘outside’ the vessels, when there is blood stasis [seen as recurring, persistent, or fixed pain] and the cells will begin to be immediately reabsorbed.”

The procedure boosts nervous system function, bolsters blood flow, and releases pain. Skin oil is applied during the therapy because of its relaxing, detoxifying, or protective properties based on the patient’s needs. The practitioner starts the therapy by press-stroking or scraping with a smooth-edged tool made from metal, horn, or jade.

These days, to eliminate infection, practice protocols entail the tools be single use or sterilized.
Press-stroking should be done in one direction and should be done again until the red dots or petechiae develop. From the petechiae’s color, we may see if the blood stasis is a chronic (black, purplish or dark reddish) or recent (lighter red) type of stagnation. The red marks typically vanish completely in three days to a week.

Patients can feel a gamut of symptoms after the therapy. Nielsen says they notice, “an instant change in wheeze, vomiting, nausea, cough, fever, range of motion, pain, etc.”

According to Nielsen, the treatment is not recommended over pimples, moles, wounds, rash, or sunburn. A lot of physicians think that those with diabetes or pregnant women or people with cancer should not also be treated with gua sha. However Nielsen disagrees saying that “gua sha provides a defensive immune reaction at the internal organs”.

At the Korean Oriental Medicine Institute, researchers conducted a systematic review of clinical studies of gua sha in controlled settings and released their findings in BioMed Central journal in 2010.

They found seven trials in eleven databases, three of which the scientists claimed exhibited positive effects in the relief of pain but were of insufficient quality of research. They concluded that “Recent proof is inadequate to claim that gua sha works well in the management of pain.”

The Pain Medicine journal published another study conducted by German scientists who assigned randomly 48 patients suffering from long term neck pain either to a localized thermal heating pad therapy or a gua sha treatment to be followed up a week after the end of the study.

In patients with chronic neck pain, the scientists agreed that gua sha showed positive short-term benefits on functional status and relief of pain;, its efficacy remains to be seen, over the long-term.