Gua Sha

Gua sha (Chinese: 刮痧; pinyin: guā shā), literally “to scrape away fever” in Chinese (more loosely, “to scrape away disease by allowing the disease to escape as sandy-looking objects through the skin”), is an ancient medical treatment.

Sometimes referred to as “spooning” or “coining” by English speakers, it has also been given the descriptive French name, “tribo-effleurage”.

The Vietnamese term for this practice is cạo gió. This term translates roughly “to scrape wind”, as in Vietnamese culture “catching a cold” or fever is often referred to as trúng gió, “to catch wind”. The origin of this term is the Shang Han Lun, a ~220 CE Chinese Medical text on cold induced disease – like most Asian countries China’s medical sciences were a profound influence in Vietnam, especially between the 5th and 7th Centuries CE. Cạo gió is an extremely common remedy in Vietnam and for overseas Vietnamese. There are many variants of Cạo gió. Some methods use oil balm and a coin to apply pressure to the skin. Others use a boiled egg with a coin inserted in the middle of the yolk. The egg is wrapped in a piece of cloth and rubbed over the forehead (in the case of a fever) and other areas of skin. After the rubbing, when the coin is removed from the egg, it will appear black.

It is also used in Indonesia. It is a traditional Javanese technique, known as kerikan (lit., “scraping technique”) or kerokan, and it is very widely used, as a form of “folk” medicine, upon members of individual households.

In describing the gua sha techniques as a form of “folk” medicine, the term “folk” is not being used in any pejorative sense. It is used to emphasize:

  • the extremely widespread domestic use of the technique (thus, used by the “folk”) as a method of first-contact intervention,
  • that complex medical diagnosis is not required (and, thus, any decision to use or not use gua sha can be reliably made by the “folk”), and
  • the overall safety of the technique (meaning that it is safe for the “folk” to use).

Notwithstanding, the gua sha technique is just as important a part of the legitimate practice of the specialist practitioners of Traditional Chinese Medicine as is the use of fire cupping; among professional practitioners it is a highly reputable technique that is applied just as it is applied by the “folk” users.

gua sha involves repeated pressured strokes over lubricated skin with a smooth edge. Commonly a ceramic Chinese soup spoon was used, or a well worn coin, even honed animal bones, water buffalo horn, or jade. A simple metal cap with a rounded edge is commonly used.

In cases of fatigue from heavy work a piece of ginger root soaked in rice wine is sometimes used to rub down the spine from head to tail.

The smooth edge is placed against the pre-oiled skin surface, pressed down firmly, and then moved down the muscles—hence the term “tribo-effleurage” (i.e., friction-stroking) — or along the pathway of theacupuncture meridians, along the surface of the skin, with each stroke being about 4-6 inches long.

This causes extravasation of blood from the peripheral capillaries (petechiae) and may result in sub-cutaneous blemishing (ecchymosis), which usually takes 2–4 days to fade. Sha rash does not represent capillary rupture as in bruising, as is evidenced by the immediate fading of petechiae to echymosis, and the rapid resolution of sha as compared to bruising. The color of sha varies according to the severity of the patient’s blood stasis—which may correlate with the nature, severity and type of their disorder—appearing from a dark blue-black to a light pink, but is most often a shade of red. Although the marks on the skin look painful, they are not. Patients typically feel immediate sense of relief and change.

Practitioners tend to follow the tradition they were taught to obtain sha: typically using either gua sha or fire cupping. The techniques are not used together.