What is Gua Sha Therapy? [A Simple Guide]

By: Dr Jason Chong (Traditional East Asian Medicine Physician)

What is Gua Sha Therapy? [A Simple Guide]

Gua Sha? Spooning? Scraping? Is it a hippy love thing or sadistic torture? This deep scraping therapy helps with pain and is used for common colds? You are going to ask me about strapless backed dresses? What?!

Learn about Gua Sha as you follow this conversation between Qi Bo and Huang Di. These two characters from one of our most ancient medical manuscripts, the Huang Di Nei Jing, have visited the modern age to answer your questions (press the 3 orange dots on the right at any stage to bring them up) about Gua Sha.*

Click here if you are seeking Gua Sha therapy in Melbourne.

iMessage with Huang Di (Yellow Emperor)

Hey Qi Bo, I was reading about this thing called Gua Sha.

I’m hoping you can tell me a little more about it.

Sure, what would you like to know?

What is Gua Sha therapy?

Gua Sha is a common practice in many Asian cultures, commonly referred to as coining or spooning, and is also becoming popular amongst physiotherapists under the title Graston therapy.

Like cupping, it is most well known as a tool of Chinese Medicine, often used in conjunction with an acupuncture or massage treatment.

Gua Sha massage involves scraping with a Gua Sha tool over the skin. This provides a deep stretch and release of the connective tissue around tense and tight muscles. 

Gua Sha is also known as:

  • Cao Gio (Vietnam)
  • Kerik (Indonesia)
  • Khoud Lam (Laos)
  • Ga Sal (Cambodia)
  • Coining
  • Scraping
  • Spooning
  • Graston technique

When is Gua Sha used?

Gua Sha is a stand-alone therapy, though more commonly used in conjunction with a massage or acupuncture treatment.

What is the best Gua Sha tool?

The traditional tool used is from a polished water buffalo horn.

In modern practice, Gua Sha with a spoon (ceramic) is the most common form of application.

Clinical or home treatments can use a range of Gua Sha tools including:

  • Coin
  • Smooth rock or crystal
  • The lid of a jam jar
  • Graston tool
  • Specific water buffalo or jade Gua Sha tools

So basically anything with a smooth rounded edge then!

Yes, just always check the edge first for any nicks or dents!

What is the benefit of Gua Sha?

Gua Sha stretches the connective tissue and softens adhesions. This helps to reduce pain and restore range of movement. By removing these constrictions it also helps to improve blood and lymphatic circulation.

The mechanical friction created by the Gua Sha tools is like a strong therapeutic massage technique applied to the body.

Gua Sha is used to:

  • Reduce pain
  • Reduce inflammation
  • Reduce tension
  • Remove toxins
  • Enhance beauty

Basically, Gua Sha helps a range of presenting symptoms.

Gua Sha has an anti-inflammatory and immunity stimulation effect on the body.

Decreasing trends were observed in both tumor necrosis factor‐alpha (TNF‐α) and heme‐oxygenase‐1 (HO‐1) levels following Gua sha

Yuen et. al. Complementary Therapies in Medicine

Gua Sha helps to increase circulation, as shown in a 2007 study by Nielsen et. al.

Gua Sha increases microcirculation local to a treated area, and that increase in circulation may play a role in local and distal decrease in myalgia (muscle pain)

Nielsen et. al. The journal of science and healing

It helps release muscular tension and pain and is used to ward off the initial onset of the common cold.

What does Gua Sha do?

The purpose of Gua Sha is to relax the surrounding muscles.

It draws toxins out from deep within the muscles and body. This allows them to the body to flush them away and nourish the local area with fresh blood.

These toxins are a result of the congestion of Qi and blood in the body. This may be the result of trauma or toxic lifestyle factors such as smoking.

Ah the toxin thing again, just like with cupping!

Exactly. The Sha of Gua Sha is the same as in Ba Sha (cupping)

From an Oriental medicine perspective, Gua Sha:

  • Dredges the channels
  • Release blockages of Qi and blood
  • Vents heat

From a Western perspective, Gua Sha:

  • Stretches fascia
  • Stimulates the immune system
  • Has an anti-inflammatory effect
  • Increases metabolic activity
  • Reduces pain

When Qi and blood stagnate, it produces heat (inflammation). As with cupping, it removes diseases that arise from the stasis of Qi and blood.

What does Gua Sha work for?

ie is there Gua Sha research to back it up?

There has been a number of studies conducted. You can read this article by Arya Neilson, one of the leading experts in the field, around the science of Gua Sha.

For high-level studies ie systematic reviews there was one from 2010 into Gua Sha for musculoskeletal pain and one from 2018 into the premenopausal syndrome.

Both reviews highlighted the issue that there are limited high-quality studies which they could include in their reviews.

This doesn’t say that Gua Sha doesn’t work, just that high-quality research is missing.

So according to those standards, it is difficult to say empathetically that it works (especially for registered health care professionals in Australia).

Can I use Gua Sha for sinus congestion?

Yes absolutely your could try an application of Gua Sha to clear sinus/chest congestion.

Use light repeated strokes until redness occurs over the areas indicated in the attached diagram.

How does Gua Sha work?

Gua Sha involves the use of a smooth-edged tool in what is often described as a scraping massage. This creates friction and stretches the tissue to release tension and congestion.

Sorry but that sounds horrible!

It’s actually quite relaxing really

Does Gua Sha hurt?

Gua Sha, like all treatments, should not be painful. It generally feels like a form of deep tissue massage.

What has been your experience f Gua Sha?x

To reduce any pain when receiving Gua Sha, less pressure or slower strokes reduces any soreness.

Discomfort may occur after treatment, but this should only be temporary if it occurs.

Oh, OK. That’s reassuring

If you are unsure then have a chat to Jason about it

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Is Gua Sha Safe?

Beyond Gua Sha marks, the side effects are minimal. Also know that Gua Sha is safe in pregnancy, though one stays away from the lower abdomen and sacral region.

It does not break the skin which means the chance for infection is minimal. Though of course, a contraindication for Gua Sha is application over already broken skin.

Gua Sha can be a strong therapy and its application should only be for those with adequate vitality. For those in poorer health, prior assessment by a trained practitioner is important.

What is a Gua Sha Facial?

Gua Sha is not only used to reduce tension around the body.

When lightly applied to the face it can help to improve local circulation, leaving the skin appearing more healthy and vibrant. It helps to rejuvenate the skin and reduce wrinkles.

There has been a rise in Gua Sha facial treatments offered as part of cosmetic routines. These cosmetic acupuncture treatments focus on skin health and appearance.

This practice is also often utilised within home health beauty routines utilising a rose quartz or jade Gua Sha tool.

You can teach yourself through the below video or seek a local practitioner to do it for you.

YouTube video

So I have come across this thing that looks similar. Can you answer for me:

Graston technique vs Gua Sha – what’s the difference?

Very little defines the difference between the Graston technique and Gua Sha. Graston technique is a form of instrument-assisted soft tissue mobilization (IASTM)

They both use a smooth edge tool to treat areas of the body in a similar manner. They both move congestion and release inflammation.

The difference mainly lies in the language used to describe the underlying process.

The description of the Graston technique is related to connective tissue and tissue adhesion. Gua Sha is described in the language of Chinese medicine.

Specific tools have been developed for the Graston technique. These are fancy versions of the more simple soup spoon or other traditional Gua Sha tools.

So it is the same thing then?

Yes pretty much

For all intents and purposes, Graston technique is Gua Sha repackaged for other therapists.

Tweet it Out

So the marks after treatment can look fairly shocking

Do you mean like this?

Yes exactly

Is Gua Sha bruising a concern?

After Gua Sha treatment, there may be marks appearing in the treated area.

These marks are not bruises. This is Sha and reflects the toxins which are being released from the body.

Sha describes stasis within the tissue, and also the marks resulting from treatment.

This represents the extravasation of blood in the subcutis. In Western Medicine, this is called transient therapeutic petechiae.

Sha generally disappears within a few days after treatment.

How long does Gua Sha bruising last?

Gua Sha marks should clear within a few days to a week.

Ensure a good intake of water following treatment to assist your body in clearing these marks and toxins away.

Keep the treated area warm and covered to protect the area from cold. This also helps with preventing a recurrence of symptoms.

Are there Gua Sha certification classes?

Gua Sha is taught in acupuncture and Oriental medicine courses.

Professional development courses exist for practitioners of other modalities such as massage therapists. There are a few options of professional development courses:

For the home user, it is a simple technique to learn. Though doing it well requires experience and guidance.

Using a professional improves the effectiveness of the treatment and reduces the risk of pain or severe bruising from excessive force.

Debra Rose Wilson – Healthline

It is a common home remedy throughout Asia. Transmission is through family knowledge rather than any professional training.

You can watch a video of it here to get an idea

YouTube video

Thanks, that helps!

The keys to remember is to lubricate the skin first with oil and to follow the paths of stroking down and out. This is shown in the following picture.

Where can I find the best Gua Sha therapist in Melbourne?

If you are looking for Gua Sha therapy in Melbourne, Dantian Health is in Brunswick in the inner north.

Jason offers Gua Sha as an adjunct to acupuncture and massage sessions, as well as 30-min stand-alone sessions.

You have convinced me, I’ll go try this out.

Dantian Health – Thornbury Acupuncture and Chinese Medicine Clinic

Reclaim your health and restore vitality with responsive, holistic healthcare

What else would you like to know?

I hope you have enjoyed the conversation. Did they miss your question? Was something unclear? Are you itching to join in? Let me know if you found this useful in the comments below, I read and respond to them all!


As an AHPRA registered practitioner, it is my duty to not be misleading in any advertising. So before my friends in the science in medicine crowd (Hi Ken!) and advertising regulators get too excited I must say the following.

This conversation didn’t actually take place. Whilst the information contained within is important and factually correct (to the best of my educated knowledge), this conversation is entirely fictional.

Amongst the many things I can do with Chinese Medicine, time travel is not one of them. What can I say – the DeLorean was out of petrol and I couldn’t get Bill and Ted on the phone!

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