Gua Sha

 

"I wish I could make a petechial fever; that is I wish I could produce upon the skin that state of counteraction when petechial spots are formed."

Herman Boerhaave
Leiden, 1668-1738

Herman Boerhaave practiced Hippocratic medicine and the quote above expressed Hippocrates reasoning: 'What matters ought to be evacuated, evacuate in the direction to which things tend, through the appropriate passages'ⁱ. Recovery from illness usually involved some discharge. Whether sweat, vomit, stool, mucous or petechiae, the crisis associated with the discharge was the cure. To cause the right discharge, or crisis, would affect a cure.

In China the Boerhaavian petechiae are called Sha. Classical Oriental medical practiceⁱⁱ holds that there are only 2 ways to resolve Sha: sweating from a true fever is one. Gua Sha is the other.ⁱⁱⁱ

First Appearing in
Anglo-Dutch Institute of Oriental Medicine Magazine
Spring, 1997

What Is Gua Sha and Why Should We Care 

The skin belongs to heaven and the muscles to earth. The Li^iv, or Lining, is the place between heaven and earth. It is the place of half inside, half outside where heaven and earth intermingle and choose one another. The Li is the place of entry and exit. As the Pericardium is the bao or bag that protects the Heart so too the San Jiao, at the Li, is the bao that protects the Kidneys. It is associated anatomically with the superficial fascia.

External factors obstruct the vessels at the Li. There can be a grace period where the obstruction is contained at the surface, slowing circulation inside and out. Entry and exit confuse. The body aches, is devitalized, and on the verge of illness should the external factors deepen. This obstruction is Sha.

Gua Sha is practiced across Asia. Twenty years ago when I asked my teacher where he learned Gua Sha he became frustrated with me: 'where to learn, everyone knows'.

Today I watch the faces of my students as I teach Gua Sha outside the culture where 'everyone knows'. At first demonstration the ‘gua’ strokes seem light and harmless. But the raised petechiae look raw and angry. There is a group murmur. 'It looks like road rash, like a bicycle accident, like the skin has been...’ The Western mind strains for context. Everyone is surprised that the patient feels better. Immediately, so much better. Confounded, the students now ask why this has not been taught before.

The experience is often the same with patients. Last month a patient brought her mother in for treatment for her third bout of bronchitis this season. Petrena, who is 70, had cough, dyspnea, sinusitis and exhaustion. She explained her pattern like this: 'first I get post-nasal drip. Very quickly it goes to my chest. I get a bad cough, phlegm and wheeze. I go to the doctor who sends me to the pharmacy for antibiotics. And soon I get the whole thing all over again. It is like this for me every winter. It's dangerous.'

I needled GV 14, Bl 13 Ding Chuan and GB 20 followed by Gua Sha to the upper back and neck. Her Sha was old, slightly brownish with some edema. The flesh is an indicator like the tongue, the color of Sha diagnostic. The brownish color corroborates a deficiency of Yin, The edema indicates Fluid dyscrasia, not only phlegm excess but also stagnation of fluid in the Upper Jiao.

Because Gua Sha moves the Qi, Blood and Fluid, her expectoration increased immediately as her cough loosened and eased. She relaxed then in a supine position with PC 6, SP 4, CV 22, ST 40, LI 20 and Yin Tang. I supplied her with a Neti pot, some dietary recommendations, and a patent of Qing Fei Tang, Platycodon and Fritilaria combination. She left the office stunned at the ease of her breathing and the correction in her cough.

A week later she returned for a follow-up treatment. Her bronchitis gone, she avoided the antibiotics. The post-nasal drip stopped and she felt for the first time out of the threat of winter illness. Staring me straight in the eye she asked me 'how is it that I am cured and why have I not been treated this way before?"

This scenario repeats itself in my office dozens of times each winter with patients of all ages. After 20 years in practice I have found Gua Sha to be necessary to the complete resolution of certain disorders, and essential to many more. And patients require fewer treatments.

For chronic problems that need longer treatment, Gua Sha facilitates healing because it so effectively upsets the equilibrium of a disorder. Wherever Sha is raised, the interior tissue and organs become flooded with Blood, Qi, and Fluid. As Hippocrates aphorized the body itself is the healer.^v This was the case with Jane.

At 27 Jane was house bound, too weak to work. She presented with chronic lymphatic disorder accompanied by Liver and Spleen enlargement. Her tongue was pink, pale with orange borders, a red dotted tip, cracked center and unremarkable coat. She complained of abdominal pain, loose stool, frequent urine, and somnolence (though sleep was not satisfying). She was dizzy when overheated. Her menses was normal but a bit dark; she had occasional night sweats. Her knees hurt, and her hands and feet were orange. Her Blood was deficient and congealed.

She received 65 treatments over 33 months, using acupuncture, herbs, and Gua Sha at least once a month. Within a month her liver profile became normal, the hepatomegaly reduced. The spleen diminished over 3 months and she was able to resume part-time work. Gua Sha's ability to move stagnate Blood at the surface reduced the congestion at the interior and stimulated the formation of new Blood. She recovered fully without recurrence.^vi

I am interested when a patient calls with chronic pain. Especially if other modalities help only temporarily. I suspect they have Sha. And how the pain responds to Gua Sha not only gives me information but also the opportunity to enter into a deeper relationship with a patient.

When Ron presented his life was organized around his back pain. He said it was his 'barometer'. He overworked, smoked, drank coffee throughout the day and took pills to sleep. But that wasn't what bothered him. What bothered him was his loss of desire. Not just sexual, but desire to continue doing any of it. Gua Sha resolved the back pain. But it was the respite from pain that opened a different conversation.

Ron confessed he believed that hard work meant pain. If he wasn't in pain, he wasn't working hard enough. In Ron's pattern, lack of desire was really a healthy sign. It could be said his choices, the 'will that can be willed', were not an expression of his Destiny: the 'Will that cannot be willed'.

Historically Chinese medicine was practiced with the intention of self-cultivation and fulfillment of Destiny. In practice, the clinical encounter is guided by the patient, the practitioner's experience and by the medical classics. First treat the Exterior, and comfort the painful problem.

I rely on Gua Sha because it releases the Exterior and resolves pain. When the patient is comforted, desire and time widen. We enter the realm where flesh is spirit and destiny. Technique only delivers us to this point. Then practice is guided by something else.

Read the Gua Sha FAQs (included in original article).

 

Epler D C 1980 Bloodletting in early Chinese medicine and its relation to the origin of acupuncture. Bulletin of the History of Medicine 54:337-367

Farquhar J 1994 Knowing practice; the clinical encounter of Chinese medicine. Westview Press, Boulder CO.
Hippocrates Volume IV trans WHS Jones. Harvard University Press, Cambridge, MA first published 1931

Nielsen A, 1995 Gua Sha: A Traditional Technique for Modern Practice. Churchill Livingstone, Edinburgh

 

i

Hippocrates Voume IV: Aphorisms Section I, number XXI.

ii

Farquhar 1994. Classical practice predates and survives the Peoples' Republic of China codification of Traditional Chinese medicine which professionalizes certain interventions such as herbs, and maintains the folk status of other like acupuncture, gua sha, cupping and so on.

iii

Nielsen 1995. Sha is intentionally brought to the body's surface by three methods: gua sha, pak sha, tsien (nieh or niu) sha. Gua means to scrape or scratch, pak means to slap, tsien means to pinch. The most popular method to release sha is to gua sha.As taught to me by Dr. James Tin Yao So 1976, Boston MA.

iv

Eppler 1980. In the Su Wen, Li or Cou Li is also translated as pores.

v

Hippocrates Vol IV

vi

Nielsen A, 1995 Gua Sha: A Traditional Technique for Modern Practice. Churchill Livingstone