Gua Sha: Another Form of Mechanical Load
By Warren Hammer, MS, DC, DABCO
Arya Nielsen, PhD, adjunct faculty in the Department of Integrative Medicine at New York Beth Israel Medical Center, Continuum Center for Health & Healing, and a strong proponent of gua sha, wrote an interesting article in the January 2009 issue of the Journal of Bodywork and Movement Therapies (JBMT).1
She states that often the literature incorrectly describes the results of gua sha as causing battery trauma, bruising, burns, dermatitis, pseudo bleeding and even hematoma.
Although gua means to "scrape" or "scratch" in Chinese, the skin always remains intact and there are no abrasions. Sha represents the "transient therapeutic petechiae." The extravasated blood appears as red macula and fades to ecchymosis immediately, blending into an ecchymotic patch. The scraping reveals blood stasis and its use removes blood stagnation that is considered pathogenic, thereby promoting normal circulation and metabolic processes. Gua sha lets blood from the tissue and is not let from the skin.2
This method originated in Asia and is used today in East Asian medicine and by acupuncturists. Nielsen mentions its use for colds, flu, fever, heatstroke, asthma, bronchitis and emphysema, as well as musculoskeletal problems including fibromyalgia to severe strain. Improving blood stasis and sha may even be significant in asymptomatic subjects who are considered healthy.
A recent study using laser Doppler imaging was used to make sequential measurements of the microcirculation of surface tissue before and after gua sha treatment3 in order to relieve pain.
The result was a fourfold increase in microcirculation for the first 7.5 minutes following treatment and a significant increase in surface microcirculation during the entire 25 minutes of the study period following treatment. There was a decrease in myalgia not only locally but also in sites distal to the treated areas. The authors stated that the distal area of relief was not due to a distal increase in microcirculation and asserted, "There is an unidentified pain-relieving biomechanism associated with gua sha."
Recent theories based on tensegrity and the fascial continuum help to explain distal results from localized mechanical load. Ingber, who has written much on our tensegrity structure,4 demonstrates how living cells and tissues sense and respond to mechanical stresses and in the rearrangement of the structure become mechanochemical transducers, whereby mechanical signals create chemical responses affecting local and distal parts of our structure.
Fibroblasts are the chief cell in the extracellular matrix and reproduce the extracellular matrix upon being loaded; it is thought by Langevin, et al.,5 that the existence of a cellular network of fibroblasts within loose connective tissue may have considerable significance, as it may support as-yet unknown bodywide cellular signaling systems. She states that fascia may serve as a bodywide mechanosensitive signaling system with an integrating function similar to the nervous system. Regarding gua sha and GT, increasing the microcirculation may stimulate platelets which release growth factors related to the healing of tissue.
Graston Technique (GT) has been compared with gua sha, and I have even heard some say that GT adopted the gua sha concept. GT was initially used on a postsurgical knee. It is extremely doubtful that the discoverers were at all familiar with gua sha, but even if they were, the GT application is significantly different. GT research has been directed toward the musculoskeletal system and its effect on various soft-tissue conditions. New studies are continually appearing demonstrating how it may be affecting soft tissue. It has its own protocol and uses instruments of different weights, shapes, and sizes to conform to the bodily contours. Its stainless-steel vibratory effect is used to detect restricted areas after functional tests are performed to determine the involved location.
While both methods can create petechiae, the stroking is not performed in the same manner. GT often achieves results without creating any petechiae at all. GT uses at least seven types of strokes, while gua sha repeats a stroke in one direction about 4-6 inches long specifically to create "therapeutic" petechiae.1
A variety of instrument angulations and pressures may be used in GT depending upon the area of the body treated.
Doctors trained in both methods realize the vast differences. Both methods have their place and there is some obvious overlap, but the differences between the methods are significant. At present, all soft-tissue loading methods are still in their infancy regarding research as to how they affect our structure and function. Einstein referred to a unifying theory of the universe. Hopefully, there might someday be one for soft tissue.
- Nielsen A. Gua sha research and the language of integrative medicine. JBMT, January 2009;13,63-72.
- Nielsen A. Gua Sha: A Traditional Technique for Modern Practice. Edinburg: Churchill Livingstone, 2002.
- Nielsen A, Knoblauch N, Dobos G, et al. The effect of gua sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects. EXPLORE: The Journal of Science and Healing, September 2007;3(5):456-66.
- Ingber DE. Tensegrity: the architectural basis of cellular mechanotransduction. Ann Rev Physeal, 1997;59:575-99.
- Langevin H, Cornbrooks CJ, Taatjes DJ. Fibroblasts form a body-wide cellular network. Histochem Cell Biol, 2004;122:7-15.
A little Background:
Graston TechniqueFrom Wikipedia, the free encyclopedia trademarked therapeutic method for diagnosing and treating disorders of the skeletal muscles and related connective tissue. The method employs a collection of six stainless steel tools of particular shape and size, which are used by practitioners to palpate patients' bodies in order to detect and resolve adhesions in the muscles and tendons. Practitioners must be licensed by the parent corporation in order to use the Graston Technique trademark or the patented instruments.
CriticismThe Graston Technique has not been rigorously scientifically tested and its evidence basis and assumptions are considered questionable by physician Harriet Hall.
However several examples of Graston treatment have been tested in combat sports where scars and contusions are common.[4
From Wikipedia, the free encyclopedia
The Vietnamese term for this practice is cạo gió. This term translates roughly "to scrape wind", as in Vietnamese culture "catching a cold" or fever is often referred to as trúng gió, "to catch wind".
The origin of this term is the Shang Han Lun, a ~220 CE Chinese Medical text on cold induced disease - like most Asian countries China's medical sciences were a profound influence in Vietnam, especially between the 5th and 7th Centuries CE. Cạo gió is an extremely common remedy in Vietnam and for overseas Vietnamese. There are many variants of cạo gió.
Some methods use oil balm and a coin to apply pressure to the skin. Others use a boiled egg with a coin inserted in the middle of the yolk. The egg is wrapped in a piece of cloth and rubbed over the forehead (in the case of a fever) and other areas of skin. After the rubbing, when the coin is removed from the egg, it will appear black.
It is also used in Indonesia. It is a traditional Javanese technique, known as kerikan (lit., "scraping technique") or kerokan, and it is very widely used, as a form of folk medicine, upon members of individual households.
TechniqueGua sha involves repeated pressured strokes over lubricated skin with a smooth edge. Commonly a ceramic Chinese soup spoon was used, or a well worn coin, even honed animal bones, water buffalo horn, or jade. A simple metal cap with a rounded edge is commonly used.
In cases of fatigue from heavy work, a piece of ginger root soaked in rice wine is sometimes used to rub down the spine from head to feet.
The smooth edge is placed against the oiled skin surface, pressed down firmly, and then moved down the muscles—hence the term tribo-effleurage (i.e., friction-stroking)—or along the pathway of the acupuncture meridians, along the surface of the skin, with each stroke being about 4–6 inches long.
This causes extravasation of blood from the peripheral capillaries and may result in sub-cutaneous blemishing (ecchymosis), which usually takes 2–4 days to fade. Sha rash does not represent capillary rupture (petechiae) as in bruising, as is evidenced by the immediate fading of the markings to echymosis, and the rapid resolution of sha as compared to bruising.
The color of sha varies according to the severity of the patient's blood stasis—which may correlate with the nature, severity and type of their disorder—appearing from a dark blue-black to a light pink, but is most often a shade of red.
Practitioners tend to follow the tradition they were taught to obtain sha: typically using either gua sha or fire cupping. The techniques are sometimes used together.