External therapies: Gua sha

Scraping the sha

刮痧 Guā Shā

Gua sha literally means “scraping the sha”. The word names two things at once: the speckled response on the skin and a whole family of acute presentations described in the classical texts. It began as a household technique, with the edge of a spoon or a coin, and only later entered the professional repertoire.

Sha, first sense

The speckled response that appears on the skin

Sha, second sense

A family of acute presentations, with its own 1675 treatise

Household origin

Spoon or coin, tied to fever and heat exhaustion

Household versus professional

Not equivalent in pressure or in selection criteria

What sha physically is

Petechiae: pinpoint micro-extravasations that appear in clusters and that the skin reabsorbs over two to five days, changing color like any bruise. Knowing this is what lets you tell the expected response from an injury.

Clustered petechiae, no sharp pain

Expected response; gone in 2-5 days

Sharp pain, blister, linear abrasion

Excess or faulty technique: not a goal

Loss of sensation

Stop and assess

Extensive purpura out of proportion

May indicate capillary fragility or a clotting disorder: refer

Common mistake: Chasing the darkest mark. The aim is enough stimulus with the least possible damage, and those are different things.

After a correct series of strokes, one area has not responded. What do you do?

1. Increase the pressure until it responds
2. Repeat the series two or three more times
3. Switch to a thinner-edged tool
4. Move to the next area: insisting will not make it respond

How does facial gua sha differ from body gua sha?

1. In aim, pressure and expectation: facial does not seek sha
2. Only in the size of the tool
3. In nothing: it is the same technique elsewhere
4. In that facial is done without lubricant

Put a body gua sha session in order

1. Inspect the skin and agree what they will feel↑↓
2. Lubricate the area↑↓
3. Start at minimum pressure and assess after the first series↑↓
4. Go up a step if the skin allows it↑↓
5. Leave the area as soon as the expected response appears↑↓

What matters most about the gua sha tool?

1. The material: stone works better than ceramic
2. The weight, which helps keep pressure constant
3. That the edge is blunt and undamaged
4. The size, which should cover the area in one stroke