Gua sha

Gua sha (Chinese: 刮痧), also known as kerokan in Indonesia or cạo gió in Vietnam, is a traditional East Asian medicine practice involving the use of a smooth-edged tool to scrape the skin, producing light petechiae (small red or purple spots caused by minor capillary bleeding). Practitioners believe that this technique releases stagnation or "unhealthy" elements from the body, particularly from areas of muscle soreness, stiffness, or injury, promoting blood flow and healing. Rooted in traditional Chinese medicine (TCM), gua sha has been used for centuries across East and Southeast Asia and has gained global attention in modern times, though it remains classified as a pseudoscience due to a lack of scientific evidence supporting its efficacy.
The practice is known by various names in English, such as "scraping therapy," "spooning," or "coining," and in French as tribo-effleurage (friction-stroking). While it is widely practiced for pain relief, relaxation, and treating symptoms like colds or fatigue, *gua sha* can cause adverse effects, ranging from mild skin irritation to rare but severe complications.
The term gua sha derives from Chinese: gua (刮) meaning "to scrape" and sha (痧), referring to the petechiae or "bruise-like" marks that appear on the skin post-treatment. In TCM, sha is associated with stagnation or blockages in the body’s energy (qi) and blood, which practitioners aim to release.
The practice is originally from China and spread from China to neighbouring regions, such as Vietnam, where it is called cạo gió ("to scrape wind"). In Vietnamese culture, illness such as colds or fevers is often attributed to "catching wind" (trúng gió), a concept linked to the Shang Han Lun, a foundational Chinese medical text from c. 220 CE that discusses cold-induced illnesses. This cultural exchange was particularly strong between the 5th and 7th centuries CE, when Chinese medical traditions profoundly influenced Vietnam. Similarly, in Indonesia, it is known as kerokan, often using a coin, and in Cambodia as kaos khyal or kors kha-yal (កោសខ្យល់), meaning "scratch the wind." These adaptations reflect local interpretations of TCM principles.
Gua sha traces its origins to ancient China, with evidence of similar scraping techniques dating back to the Paleolithic era, where stones were used to alleviate pain or illness. Its formalized use in TCM emerged during the Ming Dynasty (1368–1644), when texts began documenting the technique as a method to treat sha syndromes—conditions believed to result from environmental factors like wind or cold stagnating in the body. Over time, it became a household remedy across East Asia, passed down through generations, and later integrated into professional TCM practice.
In the 20th century, gua sha gained attention in the West as interest in alternative medicine grew. Its visibility increased further in the 21st century through social media and popular culture, though it has faced scrutiny from the scientific community.
Gua sha involves applying firm, unidirectional strokes to lubricated skin using a blunt, smooth-edged tool. Common tools include ceramic spoons, coins, jade stones, water buffalo horn, or specially designed instruments. The skin is typically prepared with massage oil, balm, or even rice wine infused with ginger (used traditionally for fatigue or colds). Strokes are applied along muscle groups or acupuncture meridians, each stroke spanning 4–6 inches, until *sha* (petechiae) appears.
The technique is often combined with other TCM practices like fire cupping, which also aims to relieve stagnation. Practitioners may vary the pressure based on the condition being treated—lighter for cosmetic purposes (e.g., facial *gua sha*) and firmer for musculoskeletal issues. In professional settings in China, *gua sha* is offered in hospitals, clinics, and massage parlors, reflecting its widespread acceptance and affordability.
Gua sha is considered a pseudoscience by the medical community due to insufficient clinical evidence supporting its purported benefits. Proponents claim it alleviates pain, reduces inflammation, boosts circulation, and treats conditions like colds, migraines, or chronic fatigue. Small studies have suggested temporary pain relief or improved microcirculation, but these lack rigorous methodology and peer-reviewed validation.
Critics argue that any perceived benefits may stem from the placebo effect or the body’s natural healing processes rather than the technique itself. The characteristic petechiae result from broken capillaries, which some practitioners interpret as evidence of "toxin release," though no scientific basis supports this claim.
Gua sha nearly always causes minor skin trauma, including redness, bruising, or dermatitis. More serious adverse effects, though rare, include burns (from excessive friction), blood in the urine, and, in extreme cases, cerebral hemorrhage or injuries requiring skin grafts.
The risk of infection is a significant concern if tools are not properly sterilized or if open wounds are present. While no documented cases of blood-borne pathogen transmission (e.g., hepatitis) have been directly linked to gua sha, the potential exists, particularly in informal settings. Safety guidelines recommend single-use disposable tools, sterilization of reusable equipment, glove use, and avoiding materials like horn or bone that cannot be adequately cleaned.
In immigrant communities, particularly among Vietnamese, Cambodian, and Indonesian diaspora, gua sha (or its local variants) remains a common home remedy. In the United States, healthcare providers in areas with large Southeast Asian populations, such as Orange County, California, frequently encounter patients with sha marks. However, these marks have been mistaken for signs of physical abuse, leading to legal and cultural misunderstandings.
In the 1980s, Vietnamese immigrants in the U.S. expressed distrust toward Western medical providers, partly due to fears of being reported for child abuse when practicing cạo gió on their children. U.S. physicians are legally obligated to report suspected abuse, regardless of cultural context, complicating cross-cultural healthcare interactions.
Gua sha has appeared in various media, reflecting its cultural significance and occasional controversy. The 2001 Hong Kong film The Gua Sha Treatment explores a Chinese-American family’s struggle when a welfare agency misinterprets gua sha marks on a child as abuse. The film highlights cultural clashes and differing definitions of care versus harm.
In 2021–2022, gua sha surged in popularity on TikTok, driven by beauty influencers promoting facial *gua sha* for lymphatic drainage and skin rejuvenation. This trend sparked debates about cultural appropriation and commercialization, with some critics arguing that its traditional therapeutic roots were overshadowed by aesthetic marketing.
Beyond its traditional use, gua sha has been adapted into cosmetic practices, particularly in the West. Facial gua sha, using small jade or rose quartz tools, is marketed as a non-invasive way to reduce puffiness, sculpt the jawline, and improve skin tone. While popular in the beauty industry, these claims lack robust scientific backing and are often anecdotal.