What Is Gua Sha? A Complete Guide to This TCM Practice

Some social media trends are a bit questionable (hello, Sprite chug challenge). Others may be worth paying attention to.

Take gua sha. This practice, which involves scraping your skin with a coin, spoon, or stone until tiny red spots appear, is not only rising as a social media trend but also hails from an ancient therapeutic technique.

Some people claim gua sha can smooth wrinkles and tame facial puffiness, whereas others turn to the practice to help manage diseases, promote circulation, and ease muscle pain.

Here's what you might want to know about gua sha, the potential benefits, risks, and how to get started.

Gua sha originated in ancient China. In fact, it's one of the oldest forms of traditional Chinese medicine ever recorded, with historical records dating back to the Stone Age, according to China's Ministry of Culture and Tourism.

This folk remedy was often used to "scrape away illness," and it was eventually written into major medical texts during the Ming Dynasty (1368 to 1644), per the ministry.

Gua sha is still practiced within families in many cultures today. "It's common among Asian and Eastern European families," says Jeff Gould, a licensed acupuncturist with the Johns Hopkins Integrative Medicine and Digestive Center in Lutherville, Maryland. "I’ve had a lot of Russian and Asian patients who said that their grandparents or parents did it to them when they were growing up."

This traditional Chinese medicine technique is becoming more common in the United States, as more medical practitioners come to understand its potential health benefits. Today, gua sha is routinely performed by a variety of professionals, including acupuncturists, massage therapists, chiropractors, and physical therapists.

Gua sha involves using a smooth-edged tool (like a small wooden spoon, buffalo horn, or a gemstone gua sha tool) to gently scrape areas of your body, which raises tiny round spots on your skin. The spots are known as petechiae, and their presence signals that there's bleeding under the skin, Gould says.

In fact, "gua" means scrape, while "sha" means sand, referring to the sand-like appearance of petechiae, Gould explains.

From the perspective of traditional Chinese medicine, many diseases and health complaints can be traced back to stagnant "qi" (known as life force energy) and blood in the body, per Johns Hopkins Medicine. By stimulating petechiae at specific points, gua sha is believed to encourage a healthy flow of energy and blood.

Gua sha is typically performed by acupuncturists, Chinese medicine practitioners, chiropractors, massage therapists, and physical therapists (using a form of gua sha known as the Graston Technique).

You may come across a few different forms of gua sha. They include:

This is the traditional Chinese medicine technique in which a practitioner (often an acupuncturist) gently scrapes areas of your body with a smooth-edged tool. The aim, from a conventional medicine view, is to potentially reduce systemic inflammation, improve circulation, and/or increase range of motion, per Gould.

Physical therapists sometimes use a scraping method known as the Graston Technique. It's similar to gua sha in that the practitioner scrapes the skin with a smooth-edged instrument. However, while gua sha targets the skin and capillaries, the Graston Technique specifically seeks to target underlying muscles, tendons, and fascia. The aim is to encourage collagen production, stimulate proprioceptors (sensory receptors in the body that receive information about the environment), and/or help inhibit pain, according to Mike Ploski, MS, PT, ATC, a physical therapist and clinical advisor for Graston Technique based in Indianapolis, Indiana. Not all physical therapists practice the Graston Technique, and those who do must first be trained in the method, Ploski says.

Some people practice gua sha on their face to relieve tension, puffiness, inflammation, and even sinus pressure, per the Cleveland Clinic. "Some claim it has anti-aging benefits, but there are no studies that show that," says Elizabeth Bahar Houshmand, MD, a board-certified dermatologist based in Dallas and fellow of the American Academy of Dermatology.

There's still a lot we don't know about gua sha and how it works. However, research suggests that there are many potential benefits of the practice, including:

Gua sha helps promote blood flow to the area being scraped, which can help reduce pain and stiffness.

For example, adults with chronic neck pain saw significant improvements in pain after a single gua sha treatment, compared with adults who used a heating pad, according to a past study. Plus, those who had received gua sha still felt less pain one week after treatment.

However, more research is needed to determine whether gua sha is an effective long-term solution for pain management.

Perimenopause, or the transition to menopause, may cause women to experience hot flashes, sleep problems, and mood changes, according to the Mayo Clinic. Hormone therapy and other treatments can help with these symptoms, but pairing them with gua sha may also help mitigate discomfort.

For example, one study from China of 80 women, published in 2017 in Menopause, found that adding a weekly 15-minute gua sha treatment to their conventional treatment led to greater reductions in hot flashes, insomnia, fatigue, nervousness, and headache after eight weeks, compared with conventional treatment alone.

Diabetic neuropathy is a type of nerve damage that can affect people with diabetes. It occurs when high levels of blood sugar (glucose) injure nerves throughout the body, most commonly in the legs and feet, according to the Mayo Clinic.

Research from China published in 2019 in Complementary Therapies in Clinical Practice suggests that gua sha may help lower the severity of diabetic neuropathy. In this randomized controlled trial, patients with diabetic neuropathy saw significant improvements in sensory function, balance, nighttime burning sensations in the legs and feet, and plasma glucose levels (a common method of diagnosing and monitoring diabetes) after 12 weekly gua sessions, compared with a control group.

Gua sha is generally considered safe, provided you don't use too much pressure. Potential side effects from applying too much pressure include severe muscle soreness, skin bruising or discoloration, and damage, Dr. Houshmand says.

Don't do gua sha over inflamed skin, open wounds, sunburns, rashes, or skin that's irritated from psoriasis, eczema (atopic dermatitis), or rosacea. Gould also suggests being careful about scraping skin with moles.

Although gua sha is becoming increasingly popular, the research into its effectiveness is very limited. The studies mentioned above reported some possible upsides of gua sha as a complementary approach for those with chronic pain, diabetic neuropathy, and women who are perimenopausal, but more studies are needed to clarify whether it is widely beneficial.

Gould often performs gua sha to improve circulation in patients with autoimmune diseases like lupus. "Patients say they feel significantly better after a single treatment," he says. The disease is still there, he notes, so gua sha isn't a cure, but it is helpful as an ongoing complementary therapy to manage symptoms.

The Cleveland Clinic interviewed a licensed acupuncturist, Tim Sobo, who stated that gua sha may also help alleviate tension headaches, migraines, anxiety, fatigue, and insomnia, though more research is needed to confirm those benefits.

However, some folks should check with their doctor before trying gua sha — or even avoid it entirely. For example, "people who take blood thinners or have blood clotting disorders aren't good candidates for gua sha," Houshmand says.

Gould doesn't recommend gua sha for children, the elderly, or anyone with very thin skin, as the scraping may tear the skin.

In addition, people who have a chronic skin condition like psoriasis, eczema, or rosacea may not tolerate gua sha well. Houshmand recommends checking with your healthcare provider first.

Women who are pregnant can likely get gua sha, but be sure to let your practitioner know, so that they can take precautions: "I wouldn't do gua sha anywhere near the abdomen, and I’d be very careful about the back," Gould says.

That said, he recommends avoiding gua sha entirely if you’re pregnant and have a history of miscarriages.

Acupuncturists are trained in gua sha, notes the Cleveland Clinic, so you can likely request gua sha from any clinic that offers acupuncture from licensed practitioners. Some chiropractors and massage therapists may also perform gua sha; you can check with licensed individuals in your area to find out whether they offer it.

If you’re interested in pursuing the Graston Technique, search for physical therapists who provide that therapy. You can locate a provider on the Graston Technique website.

Some insurance plans cover the cost of acupuncture, physical therapy, and chiropractic care, when it's medically necessary and prescribed by a doctor. However, most don't extend that coverage to gua sha, even if it's paired with one of these therapies. So, some practitioners will charge extra for the service, Gould says.

Cost varies by practitioner and region. Be sure to check the out-of-pocket rates before starting gua sha therapy.

If you’re intrigued by gua sha, look for a practitioner in your area.

Gua sha is typically performed by acupuncturists, traditional Chinese medicine practitioners, physical therapists, chiropractors, and massage therapists. If you go with a physical therapist, be aware that they will use the Graston Technique®, not gua sha. You can find physical therapists who offer this service on the Graston Technique website.

To find acupuncturists and traditional Chinese medicine practitioners, search the directories offered by the National Certification Commission for Acupuncture and Oriental Medicine and the American Academy of Medical Acupuncture.

Note that acupuncturists and traditional Chinese medicine practitioners typically perform gua sha in conjunction with acupuncture. "You can do gua sha as a standalone therapy, but when you combine the two, you may get a stronger effect," Gould says.

You may find practitioners who will instruct you on how to do gua sha at home, but be sure to operate under the guidance of a licensed practitioner that's tailored to your specific needs before attempting gua sha on your own. And regardless of how you approach incorporating gua sha into your wellness routine, be sure to check with your healthcare provider first before trying it.

Your experience with gua sha may vary depending on the practitioner and your reason for seeking out this therapy.

However, expect to go over your medical history and health concerns with the practitioner you choose. That way, the practitioner can customize your therapy and avoid any sensitive areas.

Gua sha is often done at the end of an acupuncture, chiropractic, or physical therapy session. Gould, for example, typically spends 5 to 10 minutes performing gua sha once the acupuncture is complete.

You may find practitioners who only perform gua sha or who do it for longer periods, but typically, gua sha is paired with another treatment.

Practitioners often apply a lotion or oil to the skin before scraping, to help the tool glide across the skin more easily, notes the Cleveland Clinic.

Gould begins by applying very light pressure, but he communicates with the patient and continues to press the scraper deeper if it feels comfortable for the patient. The more he digs, the deeper he's able to go into the layers of muscle, and the better he can break up scar tissue, increase circulation, and generate the other benefits of gua sha.

Gua sha treatments shouldn't be painful, however. If you feel yourself tensing or fighting the urge to scream "ouch," be sure to let the practitioner know, so that they can back off the pressure, recommends the Cleveland Clinic.

Expect redness from the petechiae to last a couple of days. You may also feel muscle soreness similar to what you’d experience after a hard workout, "but it won't necessarily be painful," Gould says.

He recommends avoiding sitting near fans or air conditioners for 24 hours following a gua sha treatment. "With gua sha, you’ve increased circulation and you want to promote that," Gould says. "If cold air blows on your skin, your blood vessels will constrict and you’ll negate the potentially beneficial effect of gua sha."

National Certification Commission for Acupuncture and Oriental Medicine

The National Certification Commission for Acupuncture and Oriental Medicine develops and administers acupuncture, Chinese herbology, and oriental medicine certification programs in the United States. Use their online directory to find a qualified practitioner near you.

American Academy of Medical Acupuncture

The American Academy of Medical Acupuncture is a professional organization of allopathic and osteopathic physicians who utilize acupuncture. The organization provides an online directory to help you find a medical acupuncturist who may be able to treat pain, digestive disorders, anxiety, and a variety of other conditions. You’ll have to check with the practitioner to see if they offer gua sha specifically.

Graston Technique

Check out the official website of the Graston Technique to learn more about the benefits of this physical therapy technique. You’ll find a list of common conditions that Graston Technique therapy can be used to treat, along with answers to frequently asked questions and a directory of providers.

Lhasa OMS

Here is your one-stop shop for gua sha tools. For nearly 40 years, Lhasa OMS has provided quality acupuncture and traditional Chinese medicine products. You’ll find a variety of scrapers, plus essential oils, herbs, and anything else you may need. The online retailer also offers a blog where you can learn about traditional Chinese medicine techniques.

Ying Yu Jade

Based in Florida, Ying Yu Jade has been selling jade since founder Kathleen first visited China to study Chinese medicine in 1999. The online retailer offers a variety of jade gua sha tools, from rollers to combs to traditional scrapers.

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