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Gua Sha
Smoothly scraping out the sha

Bruce Bentley has studied with expert gua sha practitioners at method, and can even be performed through light
clothing (without the intention of raising sha).
the Shanghai Hospital of Traditional Chinese Medicine (China),
and with Mr Trang Lee when he completed a 12-month research Meaning of the term
project for the Victorian Government titled Folk Medical
You may know it as “spooning”, “coining” or
Practices within the Vietnamese Community. The latter proved “scraping”, but all these recent English language
an outstanding opportunity to gain rare information about substitutes fall short of the tidy meaning that gua
sha has in Chinese language. The term gua sha
gua sha from a lineage known as the Buddhist comprises two characters. The first, gua, means
wandering monk medical tradition. to rub or to scrape, and the second, sha, is the
name given to the distinctive type of red dotting
and discolouration that appears at the skin sur-
face during and after treatment. Gua sha therefore
By Bruce Bentley means to rub out sha.
For this reason, I will no longer italicise these
Chinese words, as the real meaning is so much

G ua sha is typically performed


by rubbing a smooth-edged instru-
ment across the skin surface where a
better conveyed when left as Chinese terms to
become part of the common vernacular. Another
term commonly used by the rural population in
subcutaneous injury or imbalance resides. When China is gua feng, meaning to “scrape out the
treatment is effective, distinctive reddening of the wind”. The Vietnamese call it cao gio (pronounced
skin, known as sha, is observed. This is a posi- “gow yor”) meaning “to scrape out wind”. This is
tive response and brings the immediate and last- interesting because it specifies the etiology of the
ing benefit of dispelling wind, reducing heat and problem being treated – wind typically being held
inflammation, eliminating coldness, and releas- responsible in rural or traditional communities
ing pain from the superficial and deeper levels of for just about every type of common illness.
the body. Gua sha is used to treat many acute and
chronic health problems including colds and flu, Historical and social background
fever, headache, indigestion, dizziness, injury, joint
pain, fibromyalgia and heat exhaustion. It is also Like many traditional medical practices, gua sha
commonly performed to relax tight and aching was probably performed as a folk method long
muscles and to relieve tiredness and fatigue. The before its first written recording, which dates back
stroking action of gua sha to the points and chan- around 700 years ago in the Chinese tradition. It
nels can also be practised as a health enhancement may have been discovered way back in prehistoric

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‘’
times when a person happened to rub a painful ly on his patients that he soon developed debilitat-
area repeatedly against a stone jutting out from ing hand injuries. Unable to continue his practice,
a cave wall and noted that along with a show of he asked an engineer friend to make a tool he
colour, their pain was reduced. could hold to allow him to resume his practice. He
Gua sha is performed throughout Asia, where it made an iron tool with rounded edges and to his
Sha and the associated
is especially popular in China, Taiwan, Vietnam, amazement, his treatments produced sha, which
Cambodia, Laos and Indonesia. During the very he thought was his unique discovery. He inter- discolouration also contains
sombre Khymer Rouge (Pol Pot) Era in Cambo- preted sha as “digging out arthritis”. Despite the the pathogenic factor(s)
dia (1975–79), all traditional medical treatments, great pain that his style of treatment caused, he responsible for the
as well as biomedical practices, were strictly pro- had great success and soon had a remarkably large blockage, and when it has
hibited except for gua sha. Anyone found practis- clientele. He was given the title “Iron Bar Bob”.
been released, normal
ing any therapy besides gua sha was executed, or Things went bad again when jealous colleagues in
if lucky sent to prison – or so a village healer, who the massage fraternity got upset about “Iron Bar” integrity of the area is
was also a school teacher, informed me when I and forced his disbarment from practice. restored.
was in Cambodia in 2003. He himself managed to Not to be deterred and looking for an income
escape detection by perceiving what was in store during the Great Depression of the ’30s, he decid-
and pre-emptively leaving the area where he was ed to put his “discovery” to work on greyhounds.
known, and travelling to the north where he acted So he and some mates bought retired greyhounds
as a homeless “idiot” during those years. He told for next to nothing and rejuvenated their careers
me that gua sha was such a common practice per- by getting rid of their arthritis, as it was conceived.
formed by everyone that it was not considered the Brought back to form, the dogs were then entered
work of intellectuals and therefore not suspect by in races and bet on, to the disbelief and jeers of
the Party. Even cupping and massage were forbid- the bookmakers – until they had to pay out!
den. This was all told to me by “Iron Bar’s” one and
Although experts in the method have developed only student (Bob was very protective of his dis-
a broad array of uses for gua sha treatment, for covery) who came down to Melbourne to study
most people gua sha is used as a preventative or with me during the ’90s. He was surprised and
as a first-aid treatment for many common health relieved to learn that, far from being painful, gua
conditions. The vast majority of its use is as a folk sha can be performed to the same effect in a gen-
medical practice in the domestic setting. In these tle and pleasant manner which, he agreed, makes
households, usually mum or dad or a grandpar- it a much better technique.
ent knows how to perform it. As I have heard said
by many Vietnamese Australians, “I do it for my- What is sha?
self” or, “It’s never hard to find someone who can
help you with cao gio.” Sha is the term for the small reddish dots that
Knowledge of the method is passed down the emerge from the superficial or deeper levels of
generations by an oral and visual tradition, rather the body to the skin surface during gua sha treat-
than from book learning. There is also no par- ment. In biomedicine, sha is labelled petichiae by
ticular gender divide with its practice. Men and dermatologists, and understood only as a patho-
women both perform it, although it would be cor- logic abnormality. A more dispersed pattern of
rect to say that it is done mostly by women, who redness, thought of as ecchymosis (bruising) in
adopt the role of the care-giver in most traditional conventional Western medicine, is also produced,
households. Due to being a safe, effective and and is also seen only as abnormal. However,
cost-effective treatment, the Chinese Government when these forms of discolouration appear, gua
in recent times has also encouraged its practice in sha practitioners are pleased and assured that the
the broad social setting. treatment has been positive. In other words, with
But gua sha is not an exclusively Asian medi- gua sha (and the same can be said of cupping), we
cal practice, as a friend of mine discovered dur- are steered to reconstruct our usual way of think-
ing a discussion with a 97-year-old Greek woman ing about “abnormal markings” and appreciate
renowned for her skill as a village healer. When that such presentations, far from being considered
asked if she knew of the method, she replied, “Oh, “bruising”, have completely different associations
that’s like what I used to do back home. We’d go in practices like gua sha and cupping. In light
to the river bed to find smooth stones and rub of Western medical thinking, sha does not exist n FACING PAGE: Bruce perform-
a painful area of the body until the redness ap- as the same body phenomenon in the East. The ing gua sha on a woman who
peared – then I knew it would feel better.” rationale for what produces sha is therefore best suffers chronic neck and shoulder
explained by how it is understood in traditional pain after a skiing accident six
A great ‘Aussie’ gua sha tale medical terms. years before. Immediately after
According to traditional Chinese medicine, sha treatment she reported her
Some 80 years ago, an eager young massage thera- is produced when the regular flow of qi and blood mobility had increased and the
pist in New South Wales worked so hard and deep- becomes stagnant or blocked. This can be due to pain was much diminished.

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‘’
traumatic injury or to the penetration of adverse icine: Application and Safe Practice and Folk Medi-
climatic factors such as wind or internal patho- cal Practices in the Vietnamese Community for dis-
genic conditions. In Chinese there is a famous tribution throughout the Vietnamese community,
medical saying that goes: “Where there is block- as well as to health-care services and educational
age of qi and blood, there is also pain.” institutions. The therapies focused on were gua
Qi and blood are both warm by nature, so when sha (cao gio), cupping, pinching, steaming, mas-
Qi and blood are both these two become compressed, as happens with sage and diet. With regards to gua sha, one of the
warm by nature, so when blockage or stagnation, heat manifests and con- reasons why Vietnamese community leaders were
these two become centrates into a new substance, which is sha. Sha so keen on this research project was to inform the
and the associated discolouration also contains community about the safe and effective manner
compressed, as happens
the pathogenic factor(s) responsible for the block- in which it should be performed.
with blockage or stagnation, age, and when it has been released, normal integ- The very common practice of using a coin, espe-
heat manifests and rity of the area is restored due to the qi and blood cially when used in a forceful way (as it too often
concentrates into a new being able to resume flowing smoothly. is) can cause pain, besides the chance of injury.
substance, which is sha. In the case of musculo-skeletal conditions When the skin is broken this can lead to cross-
many people familiar with gua sha often have it infection of blood-born diseases such as hepatitis
performed as a first-line treatment, in the knowl- and AIDS.
edge that ridding the body of sha takes out the An important chapter in the report highlighted
irritant toxins that clog and cause pain. the common misinterpretation of the marks left
From a well-informed traditional perspective, after gua sha (and cupping) by Western health
massaging the area intended for gua sha is es- practitioners or social workers and the like. The
sential to disperse any strong concentration of qi report explained that these should not be con-
and blood that can cause painful knotting during fused as bruising due to abuse or as the outcome
treatment. of a misinformed therapeutic practice.
I also had the good fortune, thanks to
Demonstrating gua sha my contacts, to become the year-long stu-
dent of a reclusive Vietnamese man who is
It is always a fascinating time for me when I get a holder of the disappearing healing line-
the opportunity to demonstrate gua sha to stu- age known as the Buddhist Wandering Monk
dents for the first time — to see the amazement Medical Tradition – a topic for submission to The
on their faces. What does convince them of its Lantern in the future. Some of the information in
bona fides is the way such a vivid display of sha this essay comes from this source. But first here
so readily appears with just a few benevolent light is a brief account of some of the more interesting
stroking applications over the painful regions. results gathered from 360 oral questionnaires and
They can appreciate that under “normal” circum- 25 in-depth interviews conducted for this project.
stances, there is no way that such discolouration According to the questionnaire results, gua sha
would appear. is the most popular form of treatment used by the
What is also convincing is how the receiver will Vietnamese community in Melbourne, with a us-
immediately report that they feel much better. A age rate of 63 per cent. This means that of all the
good demonstration of the efficacy of gua sha is medical interventions available to the Vietnam-
when a person in class with a stiff and sore neck ese, including other traditional therapies as well
nominates themselves as a “model”. as Western pharmacological medicine, the most
Before treatment it is always worthwhile to test popular of all was gua sha. The 63 per cent usage
their range of movement for observers to note the means that gua sha is the first contact treatment
increase in range and comfort level afterwards. preferred by this large percentage of people.
Comments such as “intriguing” or “totally un- Among the questionnaires, some of the com-
expected” are often heard. One of the reasons that ments in relation to gua sha (cao gio) and the ques-
many rural people throughout Asia enjoy gua sha tion “Why do you prefer this method?” were:
is due to the immediately felt benefits. They say Because it works and I don’t need to take medi-
they can get on with their work for the day. cine. (Female, aged 17).
My mum likes to do it. (Female, aged 15).
Vietnamese practice This method doesn’t cost money, it’s effective and
I can avoid waiting in a long queue to see a doctor.
In 2002 I was nominated by representatives of the (Male, aged 51).
Vietnamese community in western Melbourne Because it has good results for many people and
to conduct a 12-month research project funded so the tradition is maintained. (Female, aged 67).
by the Department of Human Services (Victo- When I get a cold or a flu I feel like getting cao gio
ria) titled Folk Medical Practices in the Vietnamese done for me because it opens up the points and gets
Community. I wrote a 180-page report, eventually the blood circulating. It makes my body feel better
dissected into two booklets, Vietnamese Folk Med- and relaxed straight away. (Female, aged 29).

 Vol 4–2
Cao gio is effective. I have always used it. (Male
aged 22).
“It seems to work every time I have a cold”. (Fe-
male, aged 22).
Many times cao gio feels very effective, therefore
I use it frequently. (Male, aged 67).
I believe that cao gio is good because when you
take the Wind out you feel very well. (Female, aged
16)
It gives a quick result. My first preference is to
treat myself before I go to see a doctor. (Male aged
61).
I don’t like it because it’s painful – but it’s effective
when I have been struck by poison Wind. (Female,
aged 18).
Quick, convenient and effective. (Male, aged 18).

Gua sha instruments

While a Chinese porcelain soup spoon or a better way depends on the strength of the person A selection of gua sha instru-
smooth-edged coin or metal top from a glass jar receiving treatment. If the patient is robust, then ments, ranging from buffalo and
are commonly used to perform gua sha, nothing gua sha can be applied quite slowly with a degree goat horns, an old bronze coin
accomplishes the task better than a polished wa- of pressure. However, for anyone who is weak or with wooden handle, to a porce-
ter buffalo horn tool made specifically for the job. ill, the pressure should be light and brisk to in- lain spoon, from Bruce’s collection.
These are manufactured in China. Besides having vigorate the points and clear the channels. It is (Artwork and photos from author’s collection.)
an excellent smooth edge, according to the Chi- most unfortunate that some practitioners use far
nese materia medica, water buffalo horn taken too much pressure when they perform gua sha. I
internally clears heat and fire toxin in the blood. have heard many stories from people complain-
Used externally as a gua sha tool, it releases sha ing that gua sha was painful, even excruciating.
factors of wind and heat. This is bad practice, completely unnecessary and
It is also good to note, as I trust my informant wrecks the reputation of the treatment.
was correct, that the water buffalo are not killed
for their horns – they are far too valuable as do- Informed consent
mestic farm animals. Instead, once they have died
naturally, their horns are taken and slices are One of the challenges for practitioners during
fashioned into gua sha tools. Other means, when the process of obtaining informed consent before
resources are scarce, can be the knuckles of the proceeding with the therapy, is explaining to the
fingers, or even as I observed in the Taiwanese patient what gua sha is; and the likelihood that
countyside in the 1970s, a man using a bundle of even with light stroking, a series of markings are
horse mane hairs, wrapped around the index fin- likely to appear. In a nutshell, this is how I usually
gers of his hands to treat his neighbour’s aching go about it. The explanation serves a better pur-
muscles. pose if it is informative and brief. Let’s imagine
this patient has painful shoulders.
Diagnosis
I think it would be a good idea to do some gua
One way to diagnose the presence of sha is to sha for you. It’s a Chinese method for relieving sore
press one’s fingers on the site of pain. Under reg- muscles by stimulating the release of a special type
ular conditions, as soon as the fingers are taken of toxin called sha, which causes pain and stiffness.
away, the impressions left by the pressure quickly It is a relaxing and comfortable method using this
disappear. However, when sha is present the im- instrument [buffalo horn tool is shown] and it will
pressions of whitening or blanching remain for probably bring the toxin to the surface, which will
longer than usual and fade slowly, due to local temporarily cause marking to the skin. When this
circulation being restricted due to the clogging happens, you should feel much better. It will quickly
effect of sha. fade within 24 hours and usually disappear within
three to four days.
Recommendations for gua sha
After checking for any contraindications (dis-
Gua sha is relatively easy to perform. It is quite cussed next page) and inquiring whether the
common, however, to see gua sha performed with markings may cause social distress, you can then
the same pressure from one person to the next. A ask: “Does this sound fine by you?’

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I find most people are receptive to this After gua sha opens the yang channels throughout the
explanation. The only refusals are when head has the most effective and satisfying
the patient had received gua sha previously n Allow the receiver to rest for a while and ability to remove wind-based pain conven-
from a practitioner who had been far too give him or her a glass of warm water. iently and quickly. This is pertinent when
strong with their application. n Instruct the receiver not to shower or we recall the principle from Basic Questions,
After a treatment, it is also a really good bathe within one hour after treatment. chapter 5: “It is best to treat (diseases at the
idea to have two mirrors in your practice A cold water shower or bath should be level of) the skin and hair.”
room so the patient can see the reflected im- avoided for at least 24 hours. A terrific illustration of gua sha’s ability to
age from behind. n Inform the receiver it is important to brighten the senses and allow the clear yang
It can be very disconcerting for someone keep all treatment areas covered up and to circulate can be felt by performing the
to see the markings later when the practi- warm. They should also be sure to keep following practice. Take your gua sha tool,
tioner is not present to provide reassurance. away from windy conditions including close your eyes and for a few minutes scrape
fans and air-conditioning. comprehensively throughout one side of
How to perform gua sha your forehead (very lightly) and head to the
Cautions and contraindications occipital line and on down the jade column
Gua sha is applied primarily on the back, (otherwise known as the upper trapezius
neck, shoulders, buttocks and limbs. A thick- Take care to avoid pimples, moles and other muscle). Allow yourself to rest briefly then
ish oil is spread over the area to be rubbed. skin irregularities that may be scratched or open your eyes. How does that side feel
The instrument is held comfortably in the broken if an instrument is rubbed over it. compared to the other?
hand and the practitioner usually makes 10 Care must also be taken to rub the area with
to 30 strokes in a downward direction away appropriate pressure. The first rule of any Case study 1
from the head. A simple measure to be cer- therapeutic procedure is DO NO HARM.
tain the force used is correct is to ask the In 1998 I was conducting research in Xin-
person receiving if they are comfortable with Do not apply gua sha: jiang province in north-west China, travel-
the pressure. For best results, gua sha is em- 1. To people who are too weak to tolerate the ling by bus to a town that was known as one
phasised on both local and distal acupunc- treatment. of China’s “three furnaces”. In these shim-
ture points determined by diagnosis. 2. To people with bleeding disorders. mering desert landscapes people mostly
3. To people who are taking anti-coagulant live underground and not a soul is seen
Method of practice medication, eg. warfarin. when the sun is high. On the way there, I
4. During pregnancy. passed “Flaming Mountain”, made famous
If you are right handed then hold the gua 5. Soon after surgery. by its description in the classic Journey to
sha instrument in your right hand. Your 6. Over varicose veins, skin disease or open the West. It was incredibly hot as I sat on the
arm should be comfortable and relaxed. wounds, scratches etc. back seat of a bus for four hours with the
1. Your instrument should be held at a 45- 7. To a person suffering from a serious com- sun beating down on the back of my neck.
degree angle to the area you wish to treat. municable disease. When I arrived, as I was getting off the bus,
2. Begin with soft scraping for the first few 8. Within one hour before or after eating. I felt a bit shaky and an hour later as the
strokes, then apply a little more pressure sun began to sink I really began to feel quite
if required. From this point, do not get Gua sha or cupping? unwell and emotionally disoriented.
heavier with your scraping. Remain con- It was my first experience of summerheat
sistent, applying a suitable strength and While there are some similar applications for syndrome (heat exhaustion) and luckily
rhythm. gua sha and cupping, gua sha does a better my hotel manager knew what to do. As I
3. Try to perform long (15–18 cm or about job of removing sha. Sometimes sha can be sat outdoors in the eating area shaded by
6–7 inches) uninterrupted strokes where observed when stationary cups are applied, grape vines, he noticed how I looked and
possible. and often even more is drawn to the surface said: “We get this all the time, let me fix you
4. Scrape in the same direction, ie. down- with the sliding cup method. However, gua up.” He did gua sha to the top of my head,
wards – do not scrape downwards and sha has the superior ability to thoroughly beginning at the point Bai Hui (Du-20) and
draw back upwards. draw this toxin to the surface – where it gets scraped some 6–7cm (two inches) towards
5. E ach stroke should be performed between ejected entirely from the body by the action my forehead. Next, from Bai Hui, he scraped
10 and 30 times before proceeding to the of the wei qi. Gua sha is also considered bet- the same distance to the left and right side
next area. ter at resolving pathogenic influences from of the point and then down the midline to-
6. Once an area is completed, cover it up im- the surface, while the pulling action of cup- wards the back of my neck. He concluded
mediately with a towel to keep warm. ping has the benefit of drawing pathogens by scraping from Feng Chi (GB-20) down
from deeper levels of the body. the midlines of both sides of the trapezius
Note: Be extra careful not to scrape over any A simple example of the value of gua sha, muscles. The process took only a few min-
mole, pimple or irregular skin area. To pro- especially when carried out with a water utes and immediately I felt like I had never
tect a mole, place your finger over it to guard buffalo horn tool, and where cupping is had a problem.
against contact. Open windows, drafts, fans impossible, is in the treatment of headache It was truly an impressive recovery and I
and air conditioning are not recommended (sometimes also associated with itchiness) know of no other method that would have
during treatment to avoid pathogenic wind at the scalp level. Gua sha, (in this case with- come close to the benefit I got in such a
entering the open skin pores. out the need for the presentation of sha) that short time. The explanation is that the heat,

 Vol 4–2
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which rises in the body (as heat does), was effi- Sha Day course. I again asked for a volunteer for
ciently vented at and around the Bai Hui point as the first demonstration of the day. I asked for
well as released from the neck and upper back. My someone with a sore back and the same person
scalp and trapezius were a veritable mass of sha as before got in first. Now, I am not making it up
– and I could not have been happier. Isn’t it terrific – I had completely forgotten I had previously per-
when we practitioners have such an effective and formed a treatment on this guy. I began doing gua
insightful healing experience – and having a hotel sha along his occipital line, down both trapezius
manager cum gua sha practitioner do it on site is and across his upper shoulders … and nothing!
just one example of what I love about Asia. It is times like this as a teacher when you need to
keep a brave face! Anyway, I proceeded (in des-
Case study 2 peration) and remarkably, as if a line had been
drawn, a mass of sha appeared from the upper
During a tuina class, I introduced gua sha and margin of the scapula and throughout the rest n Bruce Bentley is a registered
asked for a volunteer who had a sore and stiff of the interscapular margin. Strong sha was also acupuncturist and herbalist in
neck. The first hand that shot up belonged to a released from both infraspinatus regions. Whew! private practice in Melbourne
male aged in his 20s who worked with comput- But I was perplexed, and remarked how strange it and Gippsland, Victoria. He lec-
ers all day. Immediately after the treatment he felt was for the upper area to be free of sha while the tures at the Australian School of
much relieved and all the students witnessed a rest of the area had such a flush of the stuff. Therapeutic Massage, teaches
dramatic show of sha throughout the back of his Then my “model” perked up and said: “Don’t tuina, cupping and gua sha in the
neck and upper back. They also noted following you remember that you did the neck and shoul- Chinese Medicine Department at
a mobility test before treatment how much more ders in a quick demo a couple of months ago at Victoria University and is director
movement was possible for him compared with school?” His reminder then proved to be a super- of Health Traditions:
two minutes before. He reported in class a week lative example of gua sha. Firstly, it showed in the www.healthtraditions.com.au
later that the area still felt much better. The other best way possible that only when there is a prob- Email: healthtr@planet.net.au
students of course clamoured to get a look at his lem does sha emerge, and second, in this case at
neck to see whether markings remained, but true least, even though the person did the same job, n Bruce runs workshops through-
to form, all had completely faded by then. the area that was first treated had maintained a out Australia and is contactable
A few months passed and I was teaching a Gua good level of comfort and mobility. via the above.

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