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  • Writer's pictureAndrew Clark L.Ac, LMT

Gua Sha: What is it & Why is it so Amazing?

Updated: Jul 15, 2019

Gua Sha is, quite simply, one of the most powerful and effective tools we use in our practice.

We find ourselves using Gua Sha again and again in the clinic, especially as the seasons change and yet it hasn’t received the wide-spread popular attention that Acupuncture and Cupping Therapy have in the U.S. In this article we will discuss what Gua Sha is, how it feels and what it treats. We will also look at explanations of its effects from the viewpoints of both modern research and classical Chinese medical thought.

Gua Sha is a healing technique traditionally used in China and south east asian cultures. It uses a variety of smooth edged instruments to press-stroke in one direction along an area of skin that has been lubricated with an oil or lotion. The intention is to create a local therapeutic expression of “petechiae” that look like tiny red bumps.

Gua Sha is seeing a significant increase in modern interest and usage due to its immediate effectiveness for certain conditions, and thanks to a growing body of supporting modern research.


If you know someone who might benefit from Gua Sha, Acupuncture or Chinese Medicine, let them know they can reach us via email at or by phone at (603) 686-8069. Please also visit us online at to learn more about Acupuncture, Chinese Medicine and what we do.


Some Background: Gua means to scrape and Sha refers to sand, cholera or a “red raised millet-sized rash”. In the Ming Dynasty (1368-1644) Gua Sha was used to treat a specific type of disease pattern that includes what we now call cholera and in our discussion below you will see how and why this worked. As its use expanded into the modern era the range of indications for the use of Gua Sha broadened significantly. There is now a growing body of high quality modern research supporting the use of Gua Sha in the treatment of pain, respiratory infection and chronic fatigue as well as auto-immune disease, prostatitis, digestive and cardiovascular disease and more. In this article we will focus on pain and respiratory infections.

What does Gua Sha treat?

Pain: In Chinese Medicine there is an aphorism: Bu Tong Ze Tong, Tong Ze Bu Tong; “If there is no free-flow there is pain, if there is free-flow there is no pain.” This means that what we feel as pain is actually a disharmony in movement through the body. We use Gua Sha to reduce pain by increasing circulation and harmonizing flow. Whether the problem is neck or lumbar pain from postural imbalance, elbow or shoulder pain from over-use, an injury or surgery, or a pattern of chronic headaches, the treatment must in some way encourage regular movement to resume. Gua Sha does this both by physically moving local connective tissues and by unblocking areas of stagnant blood. In the case of local injury, spasm or surgery the increase in blood flow to the area will also benefit tissue healing and speed recovery time.

Modern research has discovered that Gua Sha increases the production of nitric-oxide synthase which in turn is known to initiate smooth muscle relaxation, increase blood circulation, decrease pain perception, and effect platelet formation. Research has also found that Gua Sha increased anti-inflammatory cytokine production leading to a decrease in the local inflammation that we know contributes to pain and dysfunction long after the initial injury has healed. In Chinese Medicine we look at many causes for decreased flow from local trauma to environmental or seasonal change to the presence of disease and illness. Each cause warrants a different type of treatment however Gua Sha, with its ability to quickly and harmlessly invigorate flow through an area, can often be a powerful inclusion in the larger treatment picture.

Gua Sha for Colds, Flu's and Respiratory Infection

Respiratory Infection: One of the most common traditional uses for Gua Sha is to treat the acute cough, sore throat, sinus congestion and fever that often come with respiratory infections. It is often quite stunning how quickly these symptoms may reduce or completely resolve after 5 minutes of Gua Sha. In Chinese Medicine we talk about this type of illness being caused by cold, heat, wind, dampness, deficiency or a combination of those factors. Though we are all intuitively aware of the relationship between cold weather and getting a “cold”, recent research lends support by demonstrating how environmental conditions cause physiological changes which lead to symptomatic illness. These environmental and physiological changes can become “lodged” in the surface layers of the body and it is here that Gua Sha shines. By unblocking those surface layers we can stimulate the body's defenses to push out the illness. Western medical research has illustrated this by demonstrating Gua Sha’s effects of increasing white blood cell count in patients with a fever. If you have just started to feel a cold coming on, or if you had a cold and the sore throat or cough is just not going away, think of Gua Sha.

What are those Gua Sha marks? The marks left by Gua Sha, called Sha, are caused by a micro-extravasion of blood from surface capillaries into the area under the skin. Because of this the marks are a visual representation of what has been stuck in the circulatory system. As such we can used the color of the Sha to help diagnose even as we treat. Of course different skin colors will show the marks slightly differently but what we are looking for is basically the same. In general if there is no damage to flow in the area we are working, the color will be an even, healthy-looking pinkish glow. If there is compromised circulation or reduced flow in the area, we will see small dots emerge as we press-stroke. The appearance of the dots will tell a lot about why the flow has been compromised.

The marks of Gua Sha are fairly dramatic so we will always ask "do you have any reason in the next few days why you might not want these marks" before proceeding with the treatment. Once people have experienced the immediate relief that is possible they come to love and request "that thing that leaves those red dots!"

Does it hurt? Gua Sha should not hurt. The oil or lotion helps to reduce any sensation of friction on the skin and the pressure is relatively light. People generally describe the sensation as being “surprisingly mild”, “soothing and relaxing”, or “exactly what my body has been asking for”. If there is discomfort during Gua Sha, simply tell your practitioner and they will use a lighter touch. It may take a little longer, but will be just as effective.

How long do the marks stay? The marks are almost always totally gone in 2-3 days and even by the end of the first day they are usually significantly less apparent. The speed at which the marks disappear is also diagnostic and tells us a lot about circulatory health in the area. We always recommend that a patient tell anyone who might see the area about the marks before they see them. This way no one is surprised. If you are concerned about anyone's reaction upon seeing the marks, we can reach out to them and explain what they are and why they are there.

As mentioned above Gua Sha is used to treat a wide array of disease and imblalance. Here is a small sample of the modern research on Gua Sha for other conditions:

Other Interesting Modern Research:

- Gua Sha repairs gastro-intestinal damage from NSAIDs like ibuprofen and helps to protect the mucosal lining of the stomach. Thinning and damage to the lining of the G-I tract and the consequent damage to the gut flora are involved in a wide range of disease from IBS, abdominal pain and diarrhea to Parkinson’s Disease, chronic fatigue syndrome and auto-immune disease. (1)

one sick puppy ...

- Gua Sha effectively aids in the balancing of hormone fluctuations and easing symptoms of Peri-Menopausal syndromes.(4)

- Gua Sha upregulates heme-oxygenase-1, a natural antioxidant, anti-allergic and a cell-protector produced by the body. HO-1 also protects against organ transplant rejection, IBS and experimental encephalomyelitis. (1)

- Gua Sha reduces liver enzyme levels (ALT and AST) and modulates Th1 and Th2 cells and has been shown to benefit patients with hepatitis while not damaging those without it. (1)

- Gua Sha’s effects have been demonstrated through blood tests and tissue analysis to NOT be placebo. The placebo effect is something that we hear a lot about in this medicine, but time and again modern research has shown it not to be the explanation for the wonderful results of what we do. (1)

Even though we could talk all day about how wonderful Gua Sha is, we will leave it there. If you have any questions, don't hesitate to reach out to us, and thank you for reading!


To learn more about our approach to Acupuncture and Chinese Medicine, visit us online at

As always, if you have any questions or would like to suggest a topic for our monthly article series please write to

Have a wonderful month!

Andrew & Marielle



1) Gua Sha, A Traditional Technique for Modern Practice; Neilsen, A PhD., 2015

2) 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; Lauche R. et al

4) Effects of Gua Sha therapy on perimenopausal syndrome: A systematic review and meta-analysis of randomized controlled trials.; Ren Q. et al; 2018

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