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Gua Sha (Raising Sand)

December 21, 2008

Gua Sha (Raising Sand)gua_sh1

Gua Sha (translates to raising sand) is the ancient Asian technique of frictioning the skin with a rounded edged tool to raise stagnation to the surface and release to the exterior. The practice of Gua Sha is so ubiquitous in China that it is not even taught there in acupuncture programs. Gua Sha was historically practiced within families as a technique of self care. Since in the paradigm of Chinese medicine pain is almost always associated with blood or qi being stagnant or stuck it makes sense that a technique like Gua Sha which breaks up local stagnation would be beneficial.

The founder of the New England School of Acupuncture (the first acupuncture school in the USA), Dr. James So, when asked where he learned to do Gua Sha is quoted as saying: “Where to learn? Everyone knows!”.

Arya Nielsen, in her excellent book Gua Sha A Traditional Technique for Modern Practice shows how Gua Sha can be used as an adjunctive treatment for almost any ailment you can imagine, historically it was even used to treat cholera,  but for many practitioners the application is focused on chronic muscle/tendon pain conditions or on releasing the exterior for acute situations like the beginning stages of a cold or flu. Because Gua Sha is a fundamentally dispersive technique it is usually performed on the Yang surfaces of the body – the back and shoulders, the back of the neck, the dorsal surface of the forearms…. However, with appropriate presentation and careful application it can be done just about anywhere.

The key is first to determine if sha is present. Dr. So passed on a very simple test to check for sha; simply press several fingers firmly into the patient’s flesh in the suspect area and then removed, if the area of blanching caused by the pressure disappears immediately there is no sha, if the blanching lingers then there is sha and treatment is warranted. Sha occurs when there is a disruption of circulation of blood/qi to an area of tissue. Classically the disruption is caused by the penetration of an external climatic factor, usually cold, through the body’s defensive qi. Looking at the phenomena from a western perspective we could liken sha to a pre trigger point or pre ischemic condition in the muscle. The mechanism would be a sticking or blockage of the fluid ground substance that surrounds all tissue and facilitates the nourishment and waste product removal for the individual cells. Areas that are not getting good transfer are likely to have reduced function and may become painful.

The mechanics of Gua Sha are very simple. Traditionally the technique was performed with horn or bone tools shaped for particular areas of the body; however, a ceramic soup spoon like you find in a Chinese restaurant works just fine. In Vietnam the technique is called Cao Gio and is often done with the edge of a coin. The second ingredient is a thick oil or salve to protect the skin surface and allow the friction to pass through the top layer of tissue to the painful areas below. Petroleum jelly, tiger balm, or Vick’s Vaporub are all popular choices for lubricant. The technique itself is simply to stroke down the affected area with the tool at approximately 30 degrees to the skin with moderate pressure repeatedly until the sha surfaces. In general the skin will first start to become pink and there will be and increased feeling of warmth, then small petechiae (red spots) will appear which will generally merge into larger areas of reddish bruising, this is sha, the characteristic signature of stagnation being moved out to the surface from a deeper layer. The treatment is complete when no more sha surfaces in the area being worked on.

Depending on the individual, the petechiae and bruising from Gua Sha can take 3 to 10 days to disappear. A topical herbal preparation like a Dit Da Jiao (a lineament commonly used by martial artists for bruises) many be used to speed healing. Gua Sha is usually not repeated until the marks of the previous treatment have fully vanished. There is often some soreness in the area that has been treated and it is important to keep it covered and warm for about 24 hours to allow the protective qi that is dissipated in the process of venting the stagnation to reassert itself. Because the pressure is spread across the entire edge of the scraping tool and intensity of the treatment can easily be varied to accommodate the individual, most people find that Gua Sha is easily tolerated. The relief that Gua Sha brings is akin to trading in your too tight exterior for a bigger size without the downside of needing a new wardrobe.

Case Study: Gua Sha for Planter Fasciitis

Patient reported suffering from nagging pain in the heel for approximately 2 months. Pain occurred subsequent to daily 4 mile walks wearing flip flops. Pain was described as moderate intensity 4/10 and was worse in the morning upon waking. Pain was enough to cause the patient to limp in attempt to relieve pressure on the foot. Patient was treated 3 times using acupuncture alone with good results. Discomfort was reduced to only when walking. On the 4th visit Gua Sha was combined with electro stimulation and regular acupuncture. Gua Sha was performed on the heel and along the Achilles tendon. Electro stimulation was used directly on the sore spots on the heel. The patient returned for one additional follow up and reported that condition was 85% – 90% better with no heel pain when walking.

As demonstrated in the above case, in addition to the more common issues of back and shoulder pain, Gua Sha can be useful for conditions as diverse as planter fasciitis. Gua sha can also be used as an adjunctive therapy for internal conditions like chronic asthma, especially when the muscles of the neck and upper back have been recruited to help with breathing. Gua Sha should not be performed over a sunburn, areas of broken skin, rash, or recent injury. Raised moles should be protected during treatment. If you have chronic pain and are interested in trying Gua Sha ask your practitioner to test for sha. Because Gua Sha leaves potentially large and colourful marks, like giant hickies, you probably don’t want to schedule your treatment before a trip to the beach or that formal dress banquet where you want to wear that strapless little dress, likewise, unless you want to freak out your primary care physician have your Gua Sha after your yearly check-up not right before!

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