"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."
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.
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
Nielsen, MS, MA, LAc
Appearing in Anglo-Dutch Institute of Oriental Medicine Magazine
Is Gua Sha and Why Should We Care
belongs to heaven and the muscles to earth. The Liiv,
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.
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.
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'.
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.
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.'
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.
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.
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?"
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.
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.
Hepatomegaly and Splenomegaly
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
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
Sha as entry; treating flesh, spirit and destiny.
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
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.
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'.
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
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.
D C 1980 Bloodletting in early Chinese medicine and its relation
to the origin of acupuncture. Bulletin of the History of Medicine
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
A, 1995 Gua Sha: A Traditional Technique for Modern Practice.
Churchill Livingstone, Edinburgh
Voume IV: Aphorisms Section I, number XXI.
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.
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.
1980. In the Su Wen, Li or Cou Li is also translated as pores.
A, 1995 Gua Sha: A Traditional Technique for Modern Practice.