Traditional & natural medicine

Gua sha

กัวซา

A traditional East Asian technique in which a smooth-edged tool is stroked firmly over oiled skin until red marks appear, mostly used for muscle aches.

IntensityFirm

Origin

East Asia (Chinese medicine; also known in Vietnam as cạo gió)

Licence in Thailand

Not required

Where it comes from

Gua sha (roughly 'scraping sha') is a traditional East Asian healing technique. It is also known as cạo gió in Vietnam, and in English as coining, scraping or spooning, after the everyday objects that were traditionally used.

It belongs to traditional East Asian medicine alongside cupping, and is practised both by professionals in clinics and at home within families. Western medical literature long described it mainly through case reports; the first physiological studies appeared only in the 2000s.

The principle

In the traditional view, gua sha relieves 'blood stagnation'. Firm strokes intentionally raise small red or purple spots and bruising, called sha, which are seen as part of the treatment.

From a medical point of view, these marks are small blood vessels breaking under the skin (petechiae and bruising) caused by the pressure. A small 2007 study in 11 healthy volunteers found that blood flow at the treated area increased about fourfold for several minutes and that muscle pain eased, but the mechanism behind any pain relief is unknown, and critics argue that the marks are simply minor tissue injury.

What people come for

Relief from stiff, aching muscles in the neck, shoulders or back
A feeling of warmth and release after the session
Relaxation as part of a Chinese medicine treatment
Trying a traditional family remedy in a professional setting

How it works on the body

A smooth tool is pressed and stroked repeatedly in one direction over lubricated skin, usually on large muscle areas.

A session, step by step

01
Health questions
The practitioner asks about your health, medicines and any bleeding problems before starting.
02
Oil on the skin
The area is exposed and covered with oil or balm so the tool glides.
03
Press-stroking
A smooth-edged tool, such as jade, bone or a ceramic spoon, is pressed and stroked in one direction, repeatedly, over the area.
04
Sha appears
Strokes continue until red or purple spots appear; the practitioner then moves to another area.
05
Cleaning and aftercare
Oil is wiped off. Tools should be cleaned and disinfected between clients, because blood can sometimes come through the skin.

Precautions

Avoid gua sha, or ask your doctor first, if you have a bleeding disorder or take blood-thinning medicine: some bleeding conditions are undiagnosed and can cause large bruises.
Do not use it over broken skin, wounds, rashes or skin infections.
Tools can be contaminated with blood; make sure they are disinfected or single-use to avoid bloodborne infections.
Rare serious complications such as severe skin injury have been reported in medical literature; stop if the pain is sharp or the skin is damaged.
The marks can be mistaken for abuse or assault; tell your doctor they come from gua sha.

Complementary practice: does not replace medical advice.

In Thailand

In Thailand, when gua sha is given as part of Chinese medicine treatment, it falls within the practice of Chinese medicine, a licensed healing art under the Practice of the Art of Healing Act (No. 4) B.E. 2556 (2013): Chinese medicine doctors must pass an exam and hold a licence. We could not find a Thai rule specific to gua sha performed outside a medical setting, such as in a spa or beauty salon. Ask your practitioner about their training and licence, and check that tools are cleaned between clients.

Frequently asked questions

Is gua sha painful?

The strokes are firm and can be uncomfortable, especially as the marks appear. Ask the practitioner to adjust the pressure.

Are the red marks normal?

Yes, they are the intended effect: small broken blood vessels and bruising under the skin. They fade as the bruising heals.

Does gua sha work?

A 2010 systematic review concluded that the evidence is insufficient to show that gua sha is effective for pain, because the few trials were of poor quality.

Can I do gua sha at home?

It is a traditional home remedy in parts of Asia, but the same precautions apply: avoid it if you bruise easily or take blood thinners, and never scrape broken skin.

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