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An illustrated guide to gua sha therapy

  • Checking the Heart and Lung

    Heart and Lung Method 1: Scraping the Major Thenar Eminence, Middle Finger and Little Finger

    When scraping these areas, focus on the tips and roots of the fingernails. Smooth sensations under the gua sha tool without pain suggest a normal condition, while pain, a dark-purple major thenar eminence, or curved fingertips of the middle and little fingers suggest a sub-health state in the heart.


    Heart and Lung Method 2: Patting the Elbow Fossa

    Pat with gradually increasing force on the elbow fossa after applying gua sha oil. Taking intermittent breaks, continue patting until no new sha appears.

    1, Moderate to severe sha on the lung meridian at the radial side of the fossa suggests the common cold, shortness of breath with cough or history of lung disease.

    2, Moderate to severe sha on the pericardium meridian in the middle of the fossa suggests chest oppression, shortness of breath, heart palpitations, insomnia or profuse dreams.

    3, Severe sha on the heart

    meridian on the ulnar side indicates significant lack of oxygen to the heart. These patients should go to hospital for examination as soon as possible.


    Heart and Lung Method 3: Scraping the Area Over the Heart

    Apply gua sha oil, then scrape the center of the chest, the left side of the chest over the heart and the areas corresponding to the heart 011 the left-upper back. Pain, nodules or sha that appear with scraping suggest sub-­health states of the heart, while large areas of dark-purple sha with painful nodules suggest a severe lack of oxygen to the heart. These patients should be examined by a doctor as soon as possible.

    The area over the heart: the center of the sternum, the left chest and the left scapular region on the back.



    Heart and Lung Method 4: Scraping Xinshu (BL15) and Feishu (BL13)

    When scraping Xinshu (BL 15) and Feishu (BL 13) on the back, dense patches of purple sha with pain or nodules suggest chronic qi and blood stagnation in the heart and lung meridians. Dark-purple sha with large nodules and severe pain around Xinshu (BL 15) indicates heart disease. These patients should go to a hospital for examination as soon as possible.


  • Checking the Spine

    Spinal Method 1: Scraping the Third Section of the Back of the Middle Finger

    Apply gua sha oil on the third section of the back of the middle finger, the cervical vertebrae zone, before scraping. A smooth sensation under the gua sha tool during scraping suggests a normal condition. Pain, roughness or sand­sized masses and nodules under the tool suggest sub-health states or pathology of the cervical vertebrae.


    Spinal Method 2: Scraping the Vertex- Occiput Band

    A smooth sensation under the gua sha tool suggests a normal condition, while pain or positive reactions such as nodules suggest sub-health or pathologic states in the corresponding body parts.


    Spinal Method 3: Scraping the Spine Zone on the Back of the Hand

    Apply gua sha oil oil the back of t he third metacarpal bone, the spine zone, before scraping. Smooth sensations under the gua sha tool suggest a normal condition, while pain, roughness or sand-sized nodules under the tool, or the appearance o fsha suggest sub- health or pathologic states in the corresponding vertebrae.


    Spinal Method 4: Scraping the Spine

    Apply gua sha oil on the spine, then use the gua sha tool to first scrape the posterior midline, i.e. over the vertebral column, then the Jiaji points, and muscles of the back and waist.


    Sha on the posterior midline that is not in a straight line, rough or non-symmetrical sensations felt under the comers of the gua sha tool, abnormal protuberances, muscle tightness, spasms or nodules felt under the gua sha tool; or sha that appears in a curve or at varying distances from the midline suggest disorders of the muscles and ligaments that hold the spine in place, and instability of the vertebrae. These can lead to pain or strain of neck, shoulder, back and waist.


    Spinal Method 5: Scraping the Spine Zone on the Foot

    Apply gua sha oil on the arch of the foot, then scrape the medial foot from the back of the big toe to the heel, which is the holographic spine zone. Smooth and even sensations are felt under the gua sha tool, suggest a normal condition, while the appearance of sha, nodules or pain indicate sub-health or pathologic states in the corresponding body parts.


    Gua sha Basics

    What techniques help ensure an accurate diagnosis?

    Deep, even pressure with slow strokes should be used to reach the deep muscle layers. When scraping the backs of fingers, such as the second and third metacarpal bones, press down hard so the force penetrates deep into the bones. As you gain experience, you will notice the different sensations felt under the gua sha tool

  • Detecting the Severity of Sub-Health States

    Diagnostic methods Mild sub-health Severe sub-health
    The diagnosis of Sha (color, amount) To mild sub-health person, Sha scatters shallow in depth and bright red in color To severe sub-health person, Sha appears densely purple red or cyanoze in color, deeper in depth with masses or blue veins
    Positive reactions (size, hardness) Rough skin with positive reactions such as superficial, small and soft sand-like masses or nodules. Mild local pain indicates slight lack of oxygen in the meridians or organs without severe symptoms Positive reactions such as nodules are deep, hard and sensitive, and indicate a more severe sub-health state or disease




    Gua sha Basics

    The diagnosis of the sha expressed in the first gua sha session is an accurate reflection of the patient’s condition. Comparing the sha clip_image002produced in subsequent sessions shows the progress or retreat of the patient’s condition. Little or no sha appears in syndromes of deficient qi and blood The final judgment should be made through a comprehensive diagnosis of all positive reactions. For example, even if scraping Xinshu (BL 15),a point related to the heart on the back, expresses little sha, the appearance of nodules or pain indicates the presence of a disorder of qi and blood, and a chronic lack of oxygen in the heart

  • Detecting the Causes and Nature of Sub- Health States


    In traditional Chinese medicine, first the nature of the disease is determined by differentiating cold, heat, deficiency and excess syndromes. This is followed by selecting therapeutic methods based on the syndrome. In gua sha therapy, the existence of cold, heat, deficiency and excess syndromes are determined from the appearance of the sha, such as its quantity, speed of appearance, color, and shape, as well as the temperature of skin after scraping and any positive reactions.


    The left-upper back is the area over the heart, but is also the location of Tianzong (SI 11) of the small intestine meridian and an area corresponding to the breasts. When an abnormal reaction appears in this area, scrape other related body parts.




    Sha that is bright red and radiantSha that is purple-red, bluish- purple or deep blue clip_image004 Deficiency of defensive qi, which are mostly heat syndromes or acute inflammation
    Sha that is purple-red, bluish- purple or deep blue clip_image006 Blood stasis with poor circulation
    Sha that is bluish- purple or deep blue clip_image008 Blood stasis with cold or a deficiency of defensive qi
    Sha that is very dense, dark and without gloss clip_image010 Defensive qi deficiency or old diseases
    With some symptoms, little sha appears, it appears slowly, or there is no sha and only opening of the sweat pores clip_image012 Deficiency of qi and blood, cold syndromes, and deep- rooted diseases of the bones, ligaments and tendons




    Gua sha Basics


    Besides the appearance of the sha, the pain induced by scraping also reflects the state of health and diseases. Soreness suggests deficiency of qi and blood, while distending pain indicates qi stagnation or disorders of qi movement Stabbing pain indicates blood stasis or poor blood circulation. Positive reactions without pain suggest old diseases without noticeable manifestations that involve chronic of qi and blood circulation. Positive reactions with pain indicate local inflammation or active symptoms due to chronic disorders of qi and blood circulation.

  • Chapter III - A Health Check in 10 Minutes

    The process by which diseases develop occurs step by step from mild to severe. Sub­health states also appear in different severities. If mild sub-health states are found early they can be treated effectively with little suffering and a quick recovery. When sub­health states have progressed to a disease state, comprehensive treatments should be used to check the development of the disease.

    Now that you have some knowledge of the principles and methods of gua sha, are you eager to give it a try? This chapter contains a variety of practical methods described in writing and with illustrations. Following the step-by-step instructions will soon make you a gua sha master able to perform self-diagnosis and treatment.

  • How can the therapeutic effect be increased and the pain from scraping be reduced?

    Body Position

    Proper body position relaxes the muscles and helps relieve any pain caused by gua sha.

    Scraping Angle

    The smaller the scraping angle, the milder the pain. On sensitive areas, scraping can be performed relatively painlessly at angles less than 15 degrees.

    Scraping Speed

    The faster the scraping speed, the stronger the pain. Therefore, slower scraping speeds are less painful.


    Use steady and even pressure. Do not suddenly change the amount of force.

    Point of Exertion

    Applying pressure in the proper way keeps the scraping force even and steady. When scraping small areas, only use the elbow and shoulder to apply force. When scraping larger areas while standing, keep the legs grounded and exert force from the legs, low back and arms to the hand.

    Scraping Area

    The smaller the area of contact between the skin and the gua sha tool, the stronger the sensation. Reduce pain by increasing the area of contact between the tool and the skin.

    Scraping Time

    Scraping too long on the same area will cause pain because eventually it will injure the skin. Avoid causing pain by scraping for the proper amount of time based on the patient’s constitution and disease, and by alternating the acupoints and holographic zones that are scraped.

    Five Important Points

    1 Avoid contact with wind and keep warm after gua sha sessions. Cover the areas that were treated before going outdoors in winter. Patients can go outside 30 minutes after gua sha on the face.

    2 Do not administer guasha continuously over large areas and sessions should not last too long. Only use guasha to treat one disease at a time. Alternate scraping acupoints and holographic zones. When scraping holographic zones only, limit to 2〜3 zones each time.

    3 It is not absolutely necessary for sha to appear during a gua sha session. It is not a sign of efficacy. Avoid overusing gua sha as it can consume defensive qi and damage soft tissue.

    4 Drink a cup of hot water to replenish body fluids and promote the excretion of metabolites after each guasha treatment.

    5 Patients can shower three hours after a gua sha treatment.

    Gua Sha Basics

    No sha means no effect?

    There is no need for sha to appear each time. A therapeutic effect can be obtained without it Sha will appear quickly in excess syndromes involving qi and blood stagnation, while small amounts of sha appear in syndromes involving qi and blood deficiency. In deficiency syndromes, the therapeutic effect comes from opening the sweat pores and the reddening of the skin.

  • How long should a gua sha session be?

    1, What is a good interval between two gua sha treatments?

    Session Length

    Gua sha for health maintenance: Gua sha for general health is usually performed on the skin or over the clothes without gua sha oil. This type of gua sha is gentle and should be given in short sessions until the skin becomes slightly hot or pink. There is no need to produce sha, and therapy can be administered every day.

    Gau sha for disease treatment: Sha is occurrs easily in weak patients. When sha appears and the pain is relieved, stop scraping. For patients with strong constitutions, scrape until no new sha appears. On parts of the body where sha does not easily occur, scrape until the sweat pores open slightly. On areas with hard nodules, tightness or spasmed muscles, scrape until the sweat pores open, the nodules become soft, or the tightness relaxes. On the head, scrape only until a local sensation of heat appears. To rejuvenate the face, scrape each part of the face 5 〜15 times, depending on the condition of the skin or until a local sensation of heat appears.

    2, Interval Between Sessions

    Gua sha sessions last 30〜40 minutes using slow scraping and even methods.

    The first treatment should be shorter. Less than 20 minutes is best for weak or thin patients. After scraping, the same part of the body should not be treated for 5〜7 days. The second and later guasha sessions should be on areas that have not yet been scraped and are clear of sha or tenderness.

    The time it takes for sha to disappear depends on the constitution, disease, body part, darkness of the sha and scraping duration.

  • What to do in case of adverse reactions during gua sha?

    symptoms measures
    fatigue If applied gua sha too long time, a few of weak patients feel lassitude after Gua sha in 24 hours. Some weakest patients even catch common cold occasionally because of too long time Gau sha plus with paying no attention to avoiding to wind and keeping warm after Gua sha Usually it needn’t any treatments, we only suggest patients to have a rest. They will recover in short time. Pay attention to avoiding wind and keeping warm after Gua sha. It will not appear fatigue, common cold as we handle with proper time for Gua sha
    faint Fainting patients rarely faint during gua sha. Reasons for fainting include not getting enough food or sleep before treatment, scraping too long, improper gua sha manipulations, and weak or sensitive constitutions. Mild cases of fainting often are accompanied by lassitude, dizziness, a pale complexion, cold sweat, heart palpitations and cold limbs. Severe cases may see rapid drops in blood pressure or temporary loss of consciousness If fainting occurs, stop gua sha immediately. Calm the patient, help him/her to lie down, make sure he/ she is sufficiently warm and has some warm or sugar water to drink. Pressing Renzhong (GV 26),and scraping Baihui (GV 20) and Yongquan (Kl 1) with the corner of the gua sha tool can help speed recovery. Neiguan (PC 6) and Zusanli (ST 36) should be scraped after the patient recovers
  • Gua Sha Order and Direction

    The genera] order of gua sha is as follows:


    1, upper parts before lower parts;
    2, back and lower back before chest and abdomen;
    3, trunk before the limbs;
    4, yang meridians before yin meridians.

    To save patients the trouble of taking off and putting on clothes repeatedly, scrape exposed areas first, then the trunk, lower limbs and feet.

    Scraping direction: scrape from top to bottom on the back, abdomen and limbs (reverse the direction with edema of the limbs, varicosities or organ prolapse) and medial to lateral on the face, shoulders and chest.

    Three-Step Treatment Procedure

    Rooms with good ventilation and moderate temperature are best for gua sha therapy. If the temperature is too high and an air conditioner or fan must be used, avoid having air blow directly on the patient. The proper room temperature is above 18 degrees Celsius.

    1, Step one: Position the body properly

    The patient should be in a position that allows gua sha to be performed easily and the areas to be treated exposed. An appropriate body position will relax the muscles and improve compliance.

    The sitting position is suitable for scraping the head, neck, shoulder, limbs, chest, back and lower back. Patients should straddle the chair with their chests against the back of the chair.


    Lying face down is suitable for scraping the occiput, back, waist and back of the legs. Place a pillow under the patient’s abdomen to provide support and relax the muscles of the lower back.

    This position is suitable for scraping the sides of the head, chest, back, waist, hip and lateral legs.

    Lying face up is suitable for scraping the forehead, vertex, temples, face, chest and abdomen.



    2, Step two: Select the acupoints and body parts to be treated, apply guasha oil or cosmetic lotion, and begin scraping The areas to be treated are selected based on the patient’s constitution, disease and treatment strategy.

    Use paper to protect the clothes from oil and apply guasha oil on the holographic zones and acupoints to be treated. When treating the face, apply cosmetic lotion before scraping.


    3, Step three: Wipe off oil, instruct the patient to keep warm and covered, and give him/her some warm water to drink


  • Gua Sha Indications and Contraindications


    Holographic meridian Gua sha therapy can be used to prevent and treat many common diseases. It is excellent for pain management, sub-health states, and disorders of the zang-fu organs and nerves. For structural diseases, gua sha can only serve as an auxiliary therapy. For severe or complicated cases, medication and other comprehensive therapies should be combined with gua sha.


    Diseases of pain Headache,toothache,gastrointestinal pain with spasm,various neuralgias,lumbago,leg pain.neck pain,shoulder pain and the diseases of bone and joints
    Diseases of external pathogenic factors diseases of Zang-Fu organs Fever due to the common cold, cough, asthma, gastrointestinal diseases, poor appetite, diabetes, cardiovascular and cerebrovascular diseases, breast hyperplasia, dysmenorrhea, irregular menstruation
    Cosmetic purpose Acne,chloasma,keeping the beauty of face,losing weinghe for beautiful body shape
    Sub-health states Early diagnosis and treatment, improving sub-health states, disease prevention, slowing the aging process



    1, Bleeding disorders such as thrombocytopenia, leukemia or severe anemia.

    2, Severe acute cardiovascular or cerebrovascular diseases, or insufficiency of the liver and kidney.

    3, Acute ligament or tendon injuries, or new bone fractures.

    4, Local scarring in areas where malignant tumors were operated on, and areas around malignant tumors or unidentified masses.

    5, On the lower abdomen and lumbosacral region in women during pregnancy or menstruation.

    6, Near infectious skin diseases, skin lesions in diabetic patients, and severe varicosities on the legs.


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