Tong Ze Bu Tong, Bu Tong Ze Tong- so claims an old wise Chinese saying- free flow- no pain; no free flow- pain.
One of the first things on which Chinese Medicine is based upon is the free flow of Qi and Blood in the body.
Gua Sha is a 5,000 year old technique, and by applying it one can move stagnations of Qi and Blood in different areas of the body and encourage free flow to those areas.
Along with cupping, these techniques do not recieve the proper attention during the 4 CM school years in the west. I chose to talk about Gua Sha in this post, as it is a simple enough technique to use, but is very powerful and can help you help your patients a great deal.

Gua- rubbing; Sha- “reddish, elevated, millet-like skin rash, aka petechiae” (1).
Gua Sha is mostly used when we have pain in muscles, but from the name we can understand that we can use this technique when we want to improve the Blood flow in the entire body, in cases of chronic pain, tiredness, cough and more.

The skin belongs to Heaven and the muscles to Earth.
Inbetween we find Li- the pores. This is where Heaven and Earth meet as the pores are half inside and half outside of the body. This is a place where things enter and exit the body.
External pathogen obstruct the pores. As a result, the body aches, weakes and on the verge of illness. This illness, this obstruction is Sha.
The skin is as diagnostical as the tongue, so the color of the Sha- the reaction to the rubbing of the skin- can indicate about the stagnation itself- how deep it is and so on.

Gua Sha promotes recovering because it is very affective of the balance that is a response of the body to the stagnation. When Sha occurs, the inner tissue and the organ is filled with Blood, Qi and fluids.

Since Gua Sha moves Qi, Blood and fluids it is good for various conditions such as chronic pain, systemic toxicity, chronic fetigue, physical and/or mental strain, bronchitis and more.

Across Asia, Gua Sha treatments are very common.
The transition to the west for some reason was not a good one for Gua Sha and it was taken out of the school programs, therefore the schools don’t teach it. Maybe one of the reasons this happened is the reaction that can be seen on the skin after a treatment.

The only book I know about Gua Sha was written by Arya Nielsen, and is called Gua Sha.
Arya Nielsen was born in 1949 in the USA. She got her BA from University of Wisconsin in 1971 and her MA from Queen College in 1976.
Arya had the option to go to medical school but she chose to study Chinese Medicine in New England School of Acupuncture in Chicago. She also studied Naturopathy, Tibetin and Native American Medicines informally.
Arya has been practicing CM for more than 30 years, and currently works in an integrated medicine center where different practitioners of various methods share information and advice, so over the years she learned through her practice to use food suppliments, homeopathy and essential oils.
Arya is a busy lady but she was kind enough to answer all of my questions:

CMNotes: How did you become familiar with Gua Sha?
Arya Nielsen (A.N): I learned from Dr. James Tin Yau So. He was the principal instructor at the first licensed acupuncture school in the US and I was in the first graduating class of that school. I interned with Dr. So at the Newton Center Acupuncture Clinic, where I performed Gua Sha and or moxa/direct moxa for his patients.

CMNotes: How do you see the combination between acupuncture and Gua Sha- what do you think are the benefits and shortcomings of each technique?
A.N: The question implies the techniques are distinct, or somehow therapies like Gua Sha, moxa, cupping, tui na, herbal medicine, recommendations re diet, work and so on, are adjunctive to acupuncture. This was historically not the case. Acupuncture was rarely done alone. Only in the way that acupuncture has been appropriated in the West do we consider it the central technique. Basically acupuncture moves the Qi and Gua Sha moves the Qi and blood. If there is pain that persists at one area, or comes and goes, that is classic blood stasis, and Gua Sha in indicated. I always palpate for indications of Gua Sha, along with taking a detailed history.

CMNotes: Which Gua Sha tool do you use? Are there different results using different tools?
A.N: Gua Sha does not require a special tool. I warn practitioners about people who sell expensive tools. This is for their profit and are often not as good as a simple metal cap with a rounded lip. This kind of cap is readily available in most people’s kitchens, and are handy enough in daily life that it is easy for providers to have a bunch on hand. What is important is the gauge or width of the cap lip. The wider it is or the more blunt, the more uncomfortable it is for the patient. Gua Sha is easy to do and should not hurt. Part of the problem often is the provider uses an instrument that is too blunt, like those sold for the purpose of Gua Sha: jade or water buffalo horn, even Chinese soup spoons work, but are not as comfortable as a simple cap

CMNotes: What are the emotional affects of Gua Sha? Are they different from other techniques, in your experience?
A.N: Of course that varies and I would in no way suggest I expect an emotional response from a patient…since a patient may then produce one to meet my expectation. Still, Gua Sha is often much more powerful than acupuncture alone. In my own practice the events that come to mind are those where a patient has had pain for years and the pain noticeably and immediately reduces. It’s stunning, and sometimes a person reacts paradoxically: incredulous and angry. Why didn’t someone tell me about this sooner?

If a person has had pain related to a condition for a long time, a lot has been organized around that pain and for it to leave is jarring, dislocating, if you will. Other than that, the somatic repatriation that comes from our work goes for Gua Gha too. Patients will make connections and have realizations that are important for them and space needs to be held for that.

CMNotes:  What is the difference between Gua Sha and cupping? What do these two techniques have in common? When will you use one and when the other? Will you combine between them?
A.N: Warm cupping is better for cold in the lower burner. Other than that, I use cupping primarily for bloodletting, or over areas where Gua Sha is contraindicated, but where it’s important to move the blood, as in eczema. Also in the treatment on the upper back used for styes where a point is poked and a cup applied to let blood. This is also used on the lower back, for hemorrhoids. You can see cupping’s benefit because it is limited in that it is localized. Gua Sha is just easier to do over a larger area. Both techniques move blood, but setting cups moves blood in the area of the cup and not adjacent to it. This we have seen in the lab. If the blood is stuck in an area of the body surface, its important to thoroughly address that.
As for combining, not often, unless I use Gua Sha over an tight area, and use cupping over eczema.

CMNotes: How did you come to write the book about Gua Sha?
A.N: I was teaching a seminar on Gua Sha at an acupuncture school and while the students were impressed with the immediate benefit of Gua Sha, they were reluctant to use it because there was nothing in English in print. This also goes to the issue of what is left out in texts from China since the 1980’s, within what is called TCM. Gua Sha is a part of the tradition of Classical practice.  TCM is organized around theory, somewhat packaged for the West and toward abbreviated practice.

CMNotes: What happens in cases like Cancer? There’s a lot of toxic in the body but it seems that the technique can spread the cancer and encourage it’s growth- especially through the lymphatic system. Will you use Gua Sha on cancer patients?
A.N: I will use Gua Sha if it is indicated. Some of the pain cancer patients experience is not related to the cancer. Where does this idea come from that techniques like Gua Sha or acupuncture spread cancer? To my knowledge this has never been demonstrated in fact, and may reflect a fear of dealing with patients who may be dying.

As for toxicity, there is not such concept in East Asian medicine, aside from fire toxin. Illness is seen in terms of its location, quality and mutability, and these in terms of balance of elements or substances. The idea of toxicity, I think, comes out of the Judeo-Christian notion of carnal contamination (and guilt), and the historical practices that helped one to ‘purge’ or cleanse that involved some form of depravation or suffering. Some of those practices, like fasting, were therapeutic, but not because the body is toxic or dirty. Interesting that fasting was not a therapy in China, possibly due to extensive poverty where getting enough warm cooked food was considered therapeutic.

Notes:
1. Taken from the website about Gua Sha: www.guasha.com

I would love to hear your comments from your experience with Gua Sha, either as a patient or a practitioner.