Gua Sha

Dating and the limits of the sources

A 2026 narrative review in Cureus states that scraping therapy originated more than 2000 years ago in China and Southeast Asia. The review gives this as a general statement, and the sources behind it were not examined for this draft, so the date is attributed to the review and is not independently verified here. None of the sources opened for this page gives a dated account of a particular classical text or founder.

A 1980 report in JAMA describes cao gio as the Vietnamese practice of rubbing the skin with a coin to alleviate common symptoms of illness, and records the back, neck, head, shoulder and chest as usual sites. Its evidence was a survey of 50 Vietnamese people living in the United States since 1975 and 1976. It documents use in a migrant community at that time and says nothing about origins.

A practice recorded under many names

A 2007 laser Doppler study describes gua sha as a traditional East Asian healing technique also known as cao gio, coining, scraping and spooning. Case literature records comparable practices in other places under local names. A forensic report describes kerokan as a traditional Indonesian treatment in which the skin is abraded with a blunt object such as a coin or a piece of ginger.

A 1992 survey of 80 Cambodian, Lao, Mien and ethnic Chinese refugees at a Seattle clinic found coining and massage in use among all groups except the Mien, whose practices centred on moxibustion and healing ceremonies. The survey shows that coining was reported by several different communities, and it does not show that they share a single origin or the same explanations.

From household remedy to clinical research

A 2010 systematic review located seven controlled clinical trials of gua sha for musculoskeletal pain, all conducted in China. The 2007 laser Doppler study states that, before it, Western literature held case reports of gua sha but no studies of its physiological effects. Clinical and physiological research is therefore recent compared with the community use described above.

A 2021 case report records gua sha used with a palm-sized silver coin at a beauty salon in Korea for body contouring, which is a cosmetic purpose not described in the older sources. The sources reviewed do not trace how the practice passed between regions or professions, and no continuity of method across centuries should be assumed from them.

Gua, sha and the marks

A 2010 systematic review defines guasha as a therapeutic modality that uses tools to scrape or rub the body surface to relieve blood stagnation. A 2026 review explains the term as a combination of gua, meaning to scrape or stroke, and sha, denoting blood or fluid stasis and the resulting petechiae. The 2007 laser Doppler study describes the technique as therapeutic surface frictioning that intentionally raises transitory petechiae and ecchymosis.

Two senses of sha can therefore be separated. As an observation, sha is the pattern of small red or purple marks left on the skin. As a concept within the tradition, it is linked to stagnation that the technique is said to clear. The second meaning is a traditional explanation and not a measured biomedical finding.

Names in English and in other languages

Sources use scraping, coining, spooning and cao gio for the same technique or close relatives. A 2021 case report gives scraping, coining or spooning in English, and a 2014 hygiene paper uses the term press-stroking. Vietnamese cao gio is described in a 1980 JAMA report as coin rubbing, and Indonesian kerokan as abrasion with a coin or ginger. A 2026 review also lists spoon-rubbing in folk therapy and instrument-assisted soft tissue mobilisation in contemporary physical therapy.

Similar names do not establish that the practices are identical. Tools, lubricants, body sites and explanations may differ by region and household, and each source describes its own setting. The 2026 review treats instrument-assisted soft tissue mobilisation as a contemporary framework for the traditional practice without setting out how the two differ, so this page does not treat them as the same.

Place within Chinese medicine and facial gua sha

A 2015 review of Chinese medicine for neck and low back pain lists gua sha alongside acupuncture, cupping, tai chi, qigong, tuina and moxibustion as one of several non-drug Chinese medicine therapies. The sources reviewed for this page concern scraping of body skin. They do not describe the facial tools and routines now marketed for skincare, so this page makes no statement about those.

Technique and tools

A 2021 case report describes gua sha as repeated unidirectional pressured strokes over lubricated skin, intentionally producing transitory petechiae and ecchymoses. A 2010 systematic review lists traditional implements such as a Chinese soup spoon, an edge-worn coin, a slice of water-buffalo horn, a cow rib and honed jade, applied with oil or water.

In a 2014 community survey in Hong Kong, most users applied unidirectional pressured stroking repeatedly on lubricated skin of the back, using smooth-edged tools that were typically spoons. A 2026 review adds that scraping continues until minor bruising or petechiae occur. Standardised procedures for pressure and duration were not described in the sources reviewed.

Marks and what a participant may notice

In the Hong Kong survey of 3209 adults, almost all users reported skin blemishing that faded within seven days. In the 2007 study of 11 healthy volunteers, a single treatment was applied to an area of the back and the authors reported no adverse reactions. Discolouration is therefore an expected feature of the technique as practised, and it is not on its own a sign of an unwanted effect or of benefit.

Home, community and salon settings

The Hong Kong survey found that most users practised gua sha on a non-regular basis and mainly to treat illness, and that spoons were the usual tool, which points to household use. The 2021 case report records two sessions at a beauty salon, and a 2018 trial gave participants two treatments. Settings and schedules therefore vary widely, and the sources reviewed do not describe a typical session length or course.

Uses reported in communities

In the Hong Kong survey, 22.7% of respondents had used gua sha in the previous year and 6.6% in the previous four weeks. Users tended to be older and less educated, and most believed it to be beneficial. Respiratory problems and pain together accounted for 74% of reasons, followed by nervousness, heat stroke, fever, infection, dizziness, diarrhoea and vomiting, oedema and constipation. These are reasons that respondents gave, not outcomes that were tested.

The 1980 JAMA report describes cao gio as used to alleviate common symptoms of illness. Its authors argued that the practice is not harmful and that accepting it as a valid cultural practice would help communication and follow-up. Later reports of infection and burns, described under safety, qualify the statement that no complications are known.

Uses that have been studied

Trials have studied gua sha for specific conditions. A 2010 systematic review covered musculoskeletal pain presentations including fibromyalgia, neck stiffness, cervical spondylosis, scapulohumeral periarthritis and lumbar disc herniation. Later work includes a trial in chronic low back pain, a meta-analysis in stage I and II essential hypertension and a meta-analysis in perimenopausal syndrome. A study of one condition does not carry over to the others.

Practitioners and traditional explanations describe sha as stagnation to be cleared. That framework is the stated rationale within the tradition, and the sources reviewed here test its outcomes in particular conditions rather than the theory itself.

Musculoskeletal pain: systematic reviews

A 2010 systematic review searched 11 databases and included five randomised and two non-randomised controlled trials, all from China, comparing gua sha with acupuncture, massage, electric current therapy, herbal injection or no treatment. Two randomised trials suggested favourable effects on pain and response rate, but their quality was poor, and none of the studies reported randomisation methods, allocation concealment or blinded outcome assessment. The authors concluded that evidence was insufficient to show effectiveness.

A 2015 review of 75 randomised trials of Chinese medicine for neck and low back pain (11,077 participants, searches to September 2013) found moderate evidence for acupuncture against sham acupuncture, and for gua sha fair effects without definite conclusions.

A trial in chronic low back pain

A 2018 trial randomised 50 adults with chronic low back pain to two gua sha treatments or a waiting list. After treatment, pain intensity on a 100 mm scale was lower in the gua sha group (p < 0.001) and perceived health status was better (p = 0.002). No other group differences were found, including in the Oswestry Disability Index of back-related function, with no serious adverse events. The comparison was with no treatment, so the trial cannot separate any effect of scraping from expectation, and no follow-up beyond the end of treatment is reported.

Hypertension and perimenopausal syndrome

A 2024 meta-analysis of nine randomised trials (765 participants with stage I or II essential hypertension, searches to December 2022) compared antihypertensive drugs plus scraping therapy with the drugs alone. Systolic pressure was lower with the combination by a mean 5.09 mmHg (95% confidence interval 3.67 to 6.50) and diastolic pressure by 2.66 mmHg (2.14 to 3.17). The authors called for further high-quality studies.

A 2018 meta-analysis of six randomised trials in perimenopausal syndrome, most of low methodological quality, compared gua sha plus Western medicine with Western medicine alone. The Kupperman Menopausal Index was lower in the gua sha group by a mean 4.57 points (95% confidence interval 3.77 to 5.37), with high heterogeneity (I-squared 86%). The authors called the evidence preliminary. Neither review describes a sham scraping comparator, and blinding is hard when a technique leaves visible marks.

Physiological studies and proposed mechanisms

In a 2007 pilot study of 11 healthy volunteers, laser Doppler imaging showed a fourfold rise in skin perfusion for the first 7.5 minutes after a single treatment, and a significant rise across the 25-minute study period. Women responded more strongly than men. Participants reported reduced myalgia. Its abstract describes no comparison group, so it cannot show a clinical benefit.

A 2026 narrative review proposes four pathways: microvascular injury, immune modulation, pain modulation and autonomic effects. It states that most mechanistic studies have been done in rats and that a cause-and-effect relationship in humans remains unproven. Proposed mechanisms are not evidence of clinical benefit.

Expected marks and adverse-event reporting

Skin marks that fade within about a week are the usual finding in community use. A 2018 trial reported no serious adverse events, none of the seven studies in the 2010 review reported adverse events, and the 2015 review of Chinese medicine for neck and low back pain found no serious or life-threatening adverse effects. Small trials with inconsistent reporting cannot exclude uncommon harms.

Infection and burns

A 2021 case report describes a healthy 35-year-old woman who developed widespread painful nodules and pustules after two salon gua sha sessions; cultures grew a nontuberculous mycobacterium. Treatment with clarithromycin and drainage resolved the lesions after five months. The authors called it the first reported case after gua sha and recommended standard safety protocols for practitioners.

A 2014 safety paper identifies a risk of transfer of blood-borne pathogens, classes the instruments as semi-critical and states that reusable instruments must undergo high-level disinfection. A 2000 case report describes a 45-year-old woman burned over 22% of her body when she caught fire during a coining treatment; its authors note that most reported complications are minor burns.

Marks mistaken for injury

Several clinical and forensic reports describe marks from skin scraping that mimic trauma. A 1997 paper says skin scraping, cupping and moxibustion have been misdiagnosed as physical or child abuse by unfamiliar examiners. A 1992 clinic survey notes that coining can leave cutaneous stigmata that may be confused with disease or physical abuse, and the 1980 JAMA report found distrust of physicians among Vietnamese people criticised for cao gio.

A forensic report on kerokan describes abrasions, blisters and bruises around the neck of a woman who died. The examination found no features of neck compression, and histology identified myocarditis as the cause of death. The authors say such practices matter when trauma is assessed. These reports ask examiners to be aware of the practice. They do not suggest that marks should be assumed harmless, and concerns about someone's safety call for proper assessment.

Delayed care, suitability and training

A qualitative study of Indonesian women with breast cancer found that most informants had used kerokan and a traditional drink to relieve breast pain, that kerokan was the first treatment sought because of financial difficulty, and that most were diagnosed at an advanced stage after returning to health services. The study does not show that kerokan caused the delay. New, persistent or worsening symptoms need assessment, and gua sha should not replace or delay necessary care.

The sources reviewed do not set out contraindications for particular groups, such as people with bleeding problems, people taking blood-thinning medicines, pregnant people, infants or people with skin disease, so none is stated here. They describe no statutory regulation or training standard for gua sha, and professional bodies' standards were not examined. The 2014 safety paper gives hygiene recommendations.