On Gua Sha and Integrative Medicine
An indigenous technology from East Asia that centers accessible care.
For the last few months, most of my writing has focused on meeting assignment deadlines for a doctoral program that I started in January 2023 at Pacific College of Health and Science. In the interest of creating access, I wanted to publish some of the writing that I have been doing, along with my references. When necessary, there is some light editing for brevity and clarity, though the tone and information remains consistent.
I’ll continue publishing some of the academic papers mixed in between regular essays for the remainder of the program. Some of the academic papers lend themselves well to further exploration through practice, and when applicable I’ll add these to the “Praxis Library”. You can browse the index for practices I’ve published so far.
I would be remiss not to note that the core aim of the program emphasizes an integrative healthcare model—which, I am learning, is just one thread in a much larger tapestry. As the Spring term approaches, and I prepare for coursework that will guide me through a deep-dive into how I practice, there are particular themes starting to emerge. I look forward to seeing how these unfold in the coming months.
The first paper is derived from an oral presentation and delves into Gua Sha, a modality that is well utilized throughout East Asia. Here, I mainly focus on efficacy in context to current research about employing Gua Sha for pain management. If you’d like to learn more about the tool, as well as ethical and unappropriated techniques, I highly recommend the work of Dr. Paige Yang and Sandra Chiu.
There are numerous challenges to receiving adequate care within the current medical system. Patients who are uninsured, under-resourced, disheartened by the process, or blatantly rejected from receiving services, are often ostracized, which further exacerbates an already complex issue. Taking an intersectional approach to health has the potential to empower people with knowledge, along with essential tools that put agency back into the hands of individuals and communities seeking access to medical support. This approach also offers an opportunity for greater accountability within the medical profession by encouraging the use of culturally relevant therapies, which have historically been shamed, or denounced.
One such tool, Gua Sha, is an indigenous modality that is commonly utilized throughout East Asia for a variety of conditions including soft tissue injuries, headaches, fever reduction, anxiety, and depression. (1, 2) Gua Sha, also known as cao gio, coining, scraping, and spooning, involves repeated, even, unidirectional pressured stroking using a tool with a smooth edge over an area. (1) The technique is applied until it elicits the appearance of therapeutic petechiae, or sha, which is a direct reference to the emergence of the red, millet-sized blemish associated with stasis (static blood and body fluids) occurring within the tissues. (3) The word gua refers to the tool that is used to administer the therapy. Gua Sha does not damage that skin or cause abrasions, as might be indicated by the term scraping. (1)
Gua Sha is commonly compared to therapeutic scrapping, or The Graston Technique, which is a form of manual therapy known as soft-tissue instrument-assisted mobilization. The Graston Technique is often practiced by chiropractors, osteopathic physicians, physical therapists, occupational therapists, and some licensed massage therapists and athletic trainers. The therapy is designed to help the practitioner identify areas of restriction and attempt to break up scar tissues, reduce pain, and increase function by breaking down scar tissue and fascia restrictions.
It is natural to correlate this therapy with Gua Sha, and because of the long history of East Asian Medicine, it is likely that Gratson was born out of an exposure to the original technique. One study on “The effect of Graston technique on the pain and range of motion in patients with chronic low back pain” by Lee, et al. found that The Graston technique and general exercise resulted in pain relief and increased range of motion. However, the Graston group showed significantly increased relief from pain and range of motion more than the control group. These findings suggest that the Graston technique can be useful to reduce pain and increase mobility in patients with chronic lower back pain.
There are many analogous interventions within the medical field, and the efficacy of manual therapies is well documented through evidence-based research, including studies on Gua Sha. In a case study, “Effect of Gua Sha and Physical Therapy on Fear Avoidance Belief Questionnaire Scores in a Patient With Chronic Cervicalgia” by Edward Bezkor, a patient received two weeks of physical therapy with minimal improvements in symptoms. Following two treatments of Gua Sha in conjunction with physical therapy, the patient had significant improvements. At three month follow-up, the patient was able to work full-time with minimal to no pain.
Similarly, the in-process study “Gua Sha therapy for chronic low back pain: A protocol for systematic review” by Wang, et al., includes reviews from databases that will be searched from their inception to September 2019. Randomized controlled trials will be included if Gua Sha therapy was used as the sole treatment or as a part of combination therapy with other treatments in patients with non-specific chronic low back pain.
A pilot study by two well-known practitioners in the East Asian Medicine profession, Arya Nielsen and Ted J Kaptchuk on “The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects”, found that Gua Sha caused a fourfold increase in microcirculation at the treated area for the first 7.5 minutes following treatment and a significant increase in surface microcirculation during the entire 25 minutes of the study period following treatment. (1) Each subject experienced an immediate decrease in myalgia in both the site treated, in the related distal control site, and in some cases, other distal sites. Pain relief persisted to some extent up to the follow-up visit, and there were no adverse reactions. This study was conducted with healthy volunteers from the nursing and physician staff at the Department of Nephrology, Unit of Circulation Research, University Hospital of Essen, Germany.
There are, however, some considerations and contraindications to consider. Textbooks translated into English originally omitted Gua Sha, and later entered the canon in 1995. (1) Early case reports on the use of Gua Sha were more concerned with distinguishing sha therapeutic petechiae from signs of abuse. (1) Interestingly, other studies addressed Gua Sha in the context of working with patients from immigrant populations. (1) There are also unsubstantiated claims in the literature that associate the therapy with complications with other pre-existing issues, which misconstrues the narrative about its efficacy and safety. (1) Gua Sha is considered safe for most people. Conditions when it is advised not to administer Gua Sha: open wounds, an acute injury or recent surgery, in elderly populations due to thinning skin, people with clotting disorders or taking blood thinners (such as warfarin), or with the onset of a rash or sunburn.
Gua Sha is a therapeutic tool that is commonly considered a folk remedy, but it is also an effective therapeutic tool that can address a wide range of pain and inflammatory issues without the use of prescription medication. It is an affordable and easily transferable intervention that can offer a tangible solution that patients can safely administer as needed, reducing potential barriers to care while also creating an opportunity to improve interpersonal cooperation.
References
Nielsen PhD (cand), A., T.M.Knoblauch MD, N., J.Dobos MD, G., Andreas Michalsen MD, A., & Kaptchuk, T. (2007, September 29). The Effect of Gua Sha Treatment on the Microcirculation of Surface Tissue: A Pilot Study in Healthy Subjects. EXPLORE. Retrieved January 20, 2023, from https://www.sciencedirect.com/science/article/abs/pii/S1550830707001772?via%3Dihub
Bezkor E. (2013). 26B. Effect of Gua Sha and Physical Therapy on Fear Avoidance Belief Questionnaire Scores in a Patient With Chronic Cervicalgia. Global Advances in Health and Medicine, 2(Suppl), S115. https://doi.org/10.7453/gahmj.2013.097CP.S26B
Wang, Y. W., Xi, Z. W., Pu, B., Chen, G. Y., Ma, Y. F., Liu, D. L., & Xu, X. (2020). Gua sha therapy for chronic low back pain: A protocol for systematic review. Medicine, 99(40), e20606. https://doi.org/10.1097/MD.0000000000020606
Listening
For over a week I’ve been listening to Tiny Habits, and I am thoroughly enjoying their graceful and harmonious vocals.
Reading
Slowly but surely I am making my way through Time Is a Mother, by Ocean Vuong. I want to savor every poem, hence the languid pace.
Creating
After the Full Moon last week, I’ve been inspired to sing more often, which has felt really good. I am dusting off my choral and theatre skills, and having a lot of fun in the process.