Gua Sha: what it is, what it does, and why it feels awesome


Gua sha is the practice of press-stroking or scraping the surface of the skin to produce intentional redness and petechiae, known as “sha”. It’s also known as scraping, spooning, kerokan, or coining! And, if you’ve ever had Graston Technique performed by a chiropractor or physical therapist for muscle pain and tension, that approach uses the same basic principal of many gua sha techniques.

Gua sha has been used for centuries in Asia, treasured for it’s versatility and powerful healing impact. In much of south and east Asia, therapies like this are a common form of folk medicine, often performed among family members for ailments of all kinds. From a Chinese medicine perspective, when things become stuck, pain and dysfunction result. Gua sha moves what is stuck, resolves pain, and improves function!.Gua sha has beneficial anti-inflammatory and immune system protective effects, helps prevent and treat acute infectious illness, reduces pain, treats acute and chronic musculoskeletal issues, and supports internal medicine concerns like digestive or respiratory disorders.

Although the end result of gua sha can look kind of scary, I swear, it doesn’t feel that way. When done properly, gua sha is very comfortable and believe it or not, is actually relaxing. Most of my patients say that they feel "more open" in the areas that had gua sha, and feel less tension and/or pain. And, if you’ve spent any time on the internet recently, you’ve probably noticed skincare devotees are going wild for facial gua sha as a way to get that treasured “glow”!

What can gua sha treat?

I love using gua sha for a variety musculoskeletal and internal medicine concerns, such as....⠀

  • preventing the onset of colds and reducing fever

  • asthma, chest congestion, chest tightness⠀

  • breaking up scar tissue from injuries or surgeries

  • tight muscles and "knots" anywhere in the body⠀

  • promoting lymph fluid circulation and detoxification

  • plantar fasciitis pain and tension

  • supporting digestion and promoting regular bowel movements⠀

  • when done very light, non-marking pressure on the skin of the face, it encourages movement and drainage of mucous from the sinuses, reduces puffiness, minimizes lines and wrinkles, and supports a vibrant complexion

What does gua sha feel like? Does it hurt?

Everyone’s tolerance for gua sha varies. Some people love firm pressure, while other people do best with very light pressure. Light pressure usually feels extremely soothing. When medium to firm pressure is applied, it feels like a deep massage, and can occasionally “hurt so good”. But - we never want it to be painful. During your treatment, tell your practitioner how things are feeling. If you want them to stop, need a break, or would like different pressure, please say so!

What are gua sha tools made of?

Basically, anything with a smooth edge that you can easily hold on to can be a guasha tool.

In folk healing traditions, gua sha might be done with a soup spoon or a coin - it’s called “coining” in some regions for a reason! One of my patients had intuitively starting doing gua sha to herself, using the dull edge of a butter knife! (For the record, I do not recommend not using a butter knife, but it got the job done for her until I suggested other options).

There are also an abundance of manufactured gua sha tools in a variety of shapes in sizes, made from materials like stone, bone, horn, or plastic. My favorite personal gua sha tool for self-care is made of carnelian, purchased for just a few yuan while I was studying in China. In the clinic, we often use disposable jar lids or lovely jade tools! As you may have seen all over the internet, jade or rose quartz gua sha tools are very popular with skincare devotees these days.

Is gua sha safe?

Although “sha” can look a little scary the first time you see it, the practice of gua sha is safe and non-invasive, and can be used on patients of all ages.

What are the contraindications (reasons not to get gua sha)?

  • If you are very weak, are dealing with a prolonged disease, or have low blood pressure, you may be able to receive gua sha, but it will be gentle treatment and you should give yourself plenty of time to rest afterward

  • If you have a bleeding disorder or taking blood thinners, gua sha treatments may or may not be appropriate, depending on your unique situation

  • Pregnant people should not receive gua sha on the low back, sacrum, or abdomen

  • Gua sha should not be done on areas of severely dry/flaky, infected, broken, sunburned, burned, or inflamed skin

  • Gha sha should not be performed on areas of edema, ascites, or swelling

  • Gua sha should not be performed over broken bones, herniated discs, dislocations

  • People should not receive gua sha if experiencing severe health conditions such as cardiac failure, renal failure, liver failure

How often do I need gua sha?

That depends entirely on your body and your situation. Acute or short-term symptoms tend to resolve more quickly than long-term symptoms. I have some patients who come every week for treatments involving gua sha, while some patients only get it once a month or once a seasons. Because it has a cumulative effect, for chronic issues I recommend coming weekly for 4-6 treatments including gua sha, acupuncture, and other modalities to get the best results, then re-evaluating.

If you had a recent treatment, we should wait for the sha to completely fade before performing gua sha again on that same area.

How do I take care of myself after receiving gua sha?

Avoid exposure to the wind, drafts, direct sun, and cold for at least 24 hours, preferably until the sha is gone! Keep the area well covered and warm.

If activity has been reduced due to pain or stiffness, and feels better after gua sha, build up the activity level slowly to prevent re-injury and to rebuilt strength and mobility.

Avoid large quantities of cold, sour, or salty foods and drinks after gua sha treatment. This may sound wacky, but…. From a Chinese dietary therapy perspective, cold stagnates and congeals the qi, worsening pain! Sour foods contribute to nervousness and increase pain conditions. Salty foods can also worsen pain by increasing swelling and puffiness.

How do I schedule?

You want to experience it now, don’t you?

At the clinic, gua sha can easily be included in acupuncture and cupping appointments. Your provider will help determine if gua sha is right for you during your patient intake!

We love educating our patients on how they can do gua sha themselves as part of their own self-care routine! If this is something you’re interested in, ask about it at your next treatment.

Nielsen, A. (2014). Gua sha: : A Traditional Technique for Modern Practice. London: Elsevier Health Sciences UK.

*The information provided on this site is intended for your general knowledge only and is not a substitute for professional medical advice or treatment for specific medical conditions. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition.