You may never have heard of gua sha —but if you experience recurrent muscle or joint pain, particularly in the back, neck or shoulder, this drug-free hands-on therapy is certainly worth learning about.

An East Asian healing technique, gua sha (pronounced gwah sah) is typically performed by an acupuncturist, but no needles are used. Instead, the practitioner uses a round-edged, handheld instrument on a particular area of the body to repeatedly “press-stroke” (stroke while applying gentle pressure) without breaking the skin.

“The purpose is to alleviate what in Chinese medicine is called ‘blood stagnation.’ This represents a kind of contraction of capillaries near the skin’s surface and is associated with fixed or recurrent pain and sometimes illness. Moving the congested blood improves circulation to the muscles, tissues and organs directly beneath the area being treated. The patient experiences immediate changes in pain, stiffness and mobility,” said Arya Nielsen, PhD, an authority on gua sha who practices at the Beth Israel Medical Center’s Department of Integrative Medicine and who is the author of Gua Sha: A Traditional Technique for Modern Practice.

Dr. Nielsen explained that the press-stroking motion forces red blood cells out of the tiny capillaries and into the surrounding tissues. The capillaries are not broken and there is no external bleeding. However, numerous tiny reddish spots of blood called petechiae do appear just beneath the skin’s surface, giving the area a rashlike appearance. (This is not the same as bruising, she said—a bruise represents traumatic damage to the tissue and can take a week or more to heal, but with gua sha the tissue is not damaged.) The red blood cells immediately begin to be reabsorbed. The resulting breakdown of hemoglobin (the oxygen-carrying pigment of red blood cells) increases the response of a particular enzyme and the bile pigments bilirubin and biliverdin—all of which are anti-inflammatory and stimulate the immune system, promoting healing over a period of days.


Gua sha often is done on the back, neck, shoulders and hips, Dr. Nielsen said, though it can be used on other parts of the body. Sometimes the area treated is the painful spot itself, but other times it is an area that corresponds with a certain organ or body channel (meridian), according to the traditions of Eastern medicine.

A gua sha session usually lasts about 10 minutes. First the practitioner palpates an area to assess whether there is “sha” (stagnation) present in the tissue. The area to be treated is then lubricated with oil or a product like Badger Balm.

Next comes the press-stroking. Traditionally the Chinese used a smooth-edged soup spoon, but modern practitioners typically use a handheld instrument that looks like a metal cap with a smooth lip. “There is a small but real risk of exposure to blood-borne pathogens, so gua sha instruments should not be reused on other patients. Simple metal caps that can be disposed of after one use are recommended, rather than the outdated spoon, coin, jade, stone or bone tool,” Dr. Nielsen said. Each particular narrow section of skin, or “stroke-line,” is press-stroked with about six to 10 strokes. Where there is no blood stagnation, the skin simply turns pink…but where stagnation has occurred, gua sha causes the tiny red petechiae to appear.

“To the patient, gua sha feels invigorating. It does not hurt if done correctly. I have even treated babies and children without a problem,” Dr. Nielsen said. The red marks raised on the skin immediately begin to change and fade and are completely gone within a few days. After a session, it is best to drink water and moderate your activity. Dr. Nielsen said, “I tell my patients, ‘No drugs, booze, sex, fasting, feasting or hard labor, including working out, for the rest of the day after treatment. In other words, mellow mode.”

The number of sessions needed varies based on patients’ conditions. Some people experience lasting relief after just one or two sessions. For patients with chronic conditions, Dr. Nielsen typically recommends three sessions one week apart, followed by sessions every other week as appropriate. The cost of treatment depends on the training of the practitioner and your location, as with most medical treatments. Check your insurance—it may pay for the treatment if it covers care by an acupuncturist.

Gua sha often can be safely used even on people who have a condition such as diabetes, who are pregnant or who use anticoagulant medication, Dr. Nielsen said—but for safety’s sake, it is essential to be treated by a qualified licensed practitioner who is trained in gua sha. Acupuncturists often have such training, as do some physical therapists and massage therapists. To find a practitioner, Dr. Nielsen recommended contacting licensed acupuncturists in your area and asking about their level of experience with the technique. You can find nearby acupuncturists and verify their licensure through your state’s department of public health, office of consumer affairs, office of professional regulators or similar agency.