• Claire Norton MBaCC

Gua Sha

Updated: Sep 11, 2019

If you have had acupuncture with me there’s a great possibility you will be familiar and even fond of the term ‘gua sha’. My regulars actually request gua sha, they love it; especially after experiencing the remarkable benefits of this wonderful modality. Perhaps lesser known than its popular cousin ‘cupping’, but just as or even more so beneficial. Thambirajah (2009:91) explains that Gua sha ‘… is an ancient therapy associated with extraordinary therapies of acupuncture. Sha means a disease caused by attack of climatic pathogenic factors to the meridians, causing blocks and creating pain, coldness, stiffness or numbness of limbs and even fever or vomiting and diarrhoea…’ Gua sha also leaves you marked after the treatment session for a maximum of 3-4 days but usually the sha will fade much sooner. Those ‘marks’ are petechiae and ecchymosis, which is the result of blood extravasated from the subcutis. The petechiae and ecchymosis are created by lubricated press stroking with an instrument which traditionally would have been something similar to a ceramic soup spoon, horn or a jade piece made specifically for gua sha. In 2019 clinicians prefer to use single use instruments to eradicate the risk of contamination. Cosmetic gua sha uses is used to induce collagen and improve microcirculation, it does not aim to achieve petechiae and ecchymosis… luckily.


Clinically I use gua sha in the treatment of neck/ shoulder /back pain, lack of range of movement/ stiffness, inflammatory conditions, menopausal symptoms, auto immune conditions and stress just to name a few. The most frequent question patients ask is ‘does this hurt?’ as gua sha can look quite jarring to those unfamiliar to East Asian medicine. Gua sha should never hurt, the best familiar comparison would be similar to a massage and you may/may not feel the instrument. Some areas where there may be extreme tension the area may feel tender similar to a sports massage, treatment can be stopped and pressure changed at anytime and is generally a very relaxing treatment. After the treatment the area will feel warm and local pain/ limited range of movement/ stiffness/ aches can sometimes be dramatically improved very soon after treatment. In Chinese Medicine we understand that Gua Sha ‘vents heat’ which is why the area feels warm immediately after, using gua sha to ‘vent heat’ would be considered in the treatment of hot flashes and also to resolve a fever. If you haven’t experienced Gua Sha during your acupuncture session, don’t be disheartened. Gua sha is sometimes counter-indicated or applied with caution in some cases. Sometimes acupuncturists favour cupping, tuina and other modalities. It really depends on preference and your acupuncturists interests and training, we are all so very different even those that trained together.



Immediately after Gua Sha (top photograph), and then 12 hours later (below). Patient presented with neck pain and shoulder tension. Immediate relief after treatment.


Gua Sha in the treatment of lower back, hip and knee pain


The real magic of gua sha comes in to play when the body reabsorbs the petechiae and ecchymosis and then upregulates heme-oxygenase 1 (HO-1 ) which has been known to provide cytoprotection against oxidative stress. According to Nielsen (et al 2007) Gua sha showed an increase of localised surface micro-perfusion by 400% determined by the use of laser doppler imaging. The up-regulation of H0-1 plays a key role in reduction of organ inflammation, Nielsen (2012:27) illustrates ‘… HO-1 regulates cell cycle and anti-smooth muscle hyperplasia providing protection in many disease models such asthma, organ transplant rejection, inflammatory bowel disease and experimental autoimmune encephalomyelitis…’ It is understood that Gua sha represents an antioxidative response to circulating hemoglobin products released during the treatment. Upregulation of heme-oxygenase-01 produces biliverdin, ferrous iron, and carbon monoxide. Kwong (2009) measured the up regulation of heme-oxygenase-01 on rats using gua sha with the use of bioluminescence and measured over a 210 hour period which seemed to hit its peak at 36 hours. If this could be translated to humans, further benefits can be expected not just immediately after gua sha, but in the following days after the treatment and this is has been the case regularly in my experience with Gua Sha.


As a fully qualified traditional acupuncturist, gua sha was a part (yet small part) of our classical acupuncture training. In 2011, when studying cosmetic acupuncture with Radha Thambirajah I learnt how to apply facial gua sha in the treatment of facial rejuvenation. Facial gua sha provided an instant plumping and lifting effect, and even smoothed out some wrinkles, for selfish reasons… I was hooked. In 2015 eager to deepen my knowledge in further medical applications of gua sha, I then enrolled in a certification course with Arya Nielsen, PhD; whom is considered the western authority on gua sha. I was lucky enough to receive in-depth training in gua sha, applications and safety of gua sha followed by hands on training and assessment with Dr Nielsen.


I also stock the best quality gua sha crystals for you to use at home for facial rejuvenation. These hand carved gua sha tools are made from rose quartz and jade natural chemical free crystal and come in silk lined gift boxes. They are a real favourite at my practice.



Kwong, K. K., Kloetzer, L., Wong, K. K., Ren, J., Kuo, B., Jiang, Y., Chen, Y. I., Chan, S., Young, G. S., Wong, S. T. Bioluminescence Imaging of Heme Oxygenase-1 Upregulation in the Gua Sha Procedure. J. Vis. Exp. (30), e1385, doi:10.3791/1385 (2009).


Nielsen, A., Knoblauchp, N.T.M., Dobos, G.J., et al., 2007. The Effect of Gua Sha Treatment on the Microcirculation


Nielsen, A., 2012. Gua Sha. A Traditional Technique for Modern Practice, 2nd ed. Elsevier, Edinburgh.


Thambirajah R (2009) Cosmetic Acupuncture China: Elsevier



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