If you’re wondering what the hell happened to my back (pictured above), you’re certainly not alone! Don’t be alarmed, though; absolutely no pain or drama was involved. This photo was taken immediately post-gua sha treatment done by my friend and Shiatsu practitioner Michael Croes, to address the tension and pain in my upper back and shoulders. The redness went down pretty quickly, with most of it clearing up within hours, and a few lingering spots disappeared over the following 3 days. I personally have used gua sha on patients every day for at least the past week, as it is amazing for helping the immune system adjust to a new season.
Gua sha is a little known but powerful technique which has been largely dismissed in the West as outdated folk medicine, but has been in widespread continuous use in East Asia for ages. In the past 10 years, however, the clinical research on gua sha has been shedding new light on the mechanisms and uses of this ancient technique, contributing to its growing popularity and relevance in the modern acupuncture clinic.
What is it, anyway?
Gua sha is the light stroking of the skin to promote healing underneath the skin. While gua sha technique can be performed anywhere on the body and in many clinical situations (more on that later), it is most often applied to the neck and back, and it is called for anytime there is pain in the body. The idea behind gua sha has roots in both Eastern and Western medicines. The concept of resolving inflammation on the interior by eliciting inflammation on the exterior has made an appearance in many medicines throughout history; this was historically known in the West as “frictioning,” and shares some similarities with Ayurveda’s skin brushing. (Gua sha also shares similarities with the Graston Technique, a modern Western sports-injury focused treatment method.) Modern clinical research, which I’ll discuss below, can now explain the body’s complex exterior-interior connection, the basis for the mechanism and effectiveness of gua sha.
Let’s say you’ve been having some muscle tension and pain in your upper back, between your shoulder blades. I may apply a lubricant such as massage cream or an aromatic oil to your neck, upper back, and middle back, and then, using a round-edged tool (such as the edge of a Chinese soup spoon, the lip of a metal jar cap, or a specially made jade or bone gua sha tool), lightly stroke the surface of the skin in one direction. Within a few seconds, this stroking will bring some red or purplish dots or coloration to the surface of the skin around the area where you’ve been feeling the pain.
This is the sha, translated as “sand,” “sharkskin,” “sediment, gravel or sand deposed by water,” or “red, raised, millet-size rash.” The technical term is petechiae and ecchymosis, but you can visualize red dots or reddish tinge to the skin. Note: this is not the same thing as a bruise, in which a blood vessel is broken, spilling out blood into the surrounding area. Raising the sha is the goal of the technique, but it’s also part of the diagnostic process; I evaluate the color, distribution, and intensity of the sha to further confirm your diagnosis and prognosis within the East Asian medical theoretical framework. The sha will fade quickly, within 1-3 days.
As the patient, you may be so relaxed that you fall asleep during the gua sha session, or, it may be a little uncomfortable, depending on the type of pain you’ve been suffering with. Most patients feel immediate relief in their pain, increased range of motion or freedom of movement, relaxation, an energized or elated feeling, welcome changes in temperature (such as warmth when you’ve been feeling too cold, or finally sweating when you’ve had a fever), or changes in other symptoms such as wheezing.
How does it work?
Acupuncturists understand the mechanism behind gua sha through East Asian medical theories like the San Jiao system and the cou li -- but, I’m guessing you don’t speak East Asian Medical theory. So, let’s turn to the language of modern science, which finally can explain to the Western scientific mind the mechanisms behind many traditional medicine techniques that practitioners have been describing and documenting for millennia.
In the case of gua sha, think about connective tissue, which supports, connects, transmits, and contains every cell in the human body. Fascia, a type of connective tissue, connects the skin to deep layers of muscle, and to all other tissues, in what has been called a “body-wide signaling network.” When you intentionally stroke the skin in one direction, you activate the most superficial level of fascia, which in turn activates both deep layers of fascia and organs far from the site of the stroking. This releases deep muscle tension, increases microcirculation, and causes vasodilation, all associated with pain reduction. Clinical research has demonstrated that gua sha immediately reduces pain near the site of application and far from the site of application, making it a fantastic treatment method for any type of pain in the body (new, old, musculoskeletal, organ, digestive, headache, or just about anything else you can think of).
In addition, clinical trials have shown that gua sha stimulates the production of heme-oxygenase-1, an antioxidant that is part of the anti-inflammatory cascade. This has a wide-ranging relevance, as many illnesses include an inflammatory response; research has been done that shows gua sha is effective in cases of hepatitis, mastitis, digestive disorders, and breathing disorders (such as asthma, bronchitis, emphysema, and COPD). In addition, gua sha causes sweating, which makes it fantastic for resolving fevers (think sudden onset of a cold, which is often accompanied by a slight fever).
So: while gua sha has been around for a long time, it is incredibly useful and versatile in my modern-day acupuncture clinic because of its unique stimulation of the immune system through fascia and connective tissue. An added bonus is that it is safe to use on a wide range of patients, including kids, and it doesn’t require any needles: if you’re among the needle-averse, know that there's still a place for you at my acupuncture office, since we can turn to gua sha!
For more information, click here, or check out Nielsen, A. (2013). Gua sha: Traditional technique for modern practice. Edinburgh: Churchill Livingstone. (from which all quotations in this piece come from. With apologies, I haven't yet figured out how to get endnotes to appear properly on this blog thing.)