Gua Sha Massage: What Is It And Is It Safe?

Sharing is caring!

When you have chronic pain you’ll try anything in hopes of finding some relief.

We’re going to look into an alternative therapy for pain management from East Asia called Gua Sha.

In case you’re wondering, it’s pronounced “gwah sah.”

Gua” means “to scrape” and “sha” is the stagnation or blockage in the body that is the cause of the pain or illness. Gua Sha is also referred to as scraping, spooning or coining due to method and tools used to perform the massage.

What Is Gua Sha?

What is Gua Sha Massage? Gua Sha is a type of message that is performed with a round, smooth-edged tool used to rub and press the skin’s surface in downward strokes to draw stagnant blood and other impurities to the surface which allows the body to stimulate new blood underneath the skin to create new cells. The impurities are drawn to the skin’s surface and manifest as red dots on the skin called petechiae or sha.

How Does Gua Sha Work?

In traditional Chinese medicine, an imbalance in one’s life force or qi causes the body to be ill and have low immune responses.

These blockages build up and become sha–blood stasis or stagnated blood.

When blood is poorly circulated in the body illnesses build up.

It could manifest as chronic pain, fever, cramps, headaches, muscle tension, or other similar conditions.

Gua Sha works on the premise that blood needs to be recirculated throughout the area worked on by the Gua Sha tool to get fresh blood flowing back to bring nutrients to the body part in pain.

You will feel release from the pain after a Gua Sha session when the petechiae trigger the white blood cells to treat the capillaries broken by the pressure from the Gua Sha tool: kickstarting the immune system, relaxing the tightness in muscle fascia, and promoting circulation.

Back red from gua sha tool

The petechiae are red or purple spots, similar to a rash.

It appears after a Gua Sha massage and is said to be the blockages in the body.

According to traditional Chinese medicine, petechiae or sha are heat toxins caused by sudden changes in weather conditions.

Sha is climate sickness that may be manifested as nausea, cold symptoms, fever, fatigue, cramps, headaches, and chronic pain.

Wherever pain is felt, that’s where you should focus the Gua Sha tool; scraping in steady, downward strokes.

Follow the path of the petechiae that appear to release stagnated blood and breakdown the adhesions that cause muscle stiffness and pain.

The petechiae would look painful and injurious to the body but the rashes and the redness will fade in a few days.

Does Gua Sha Hurt?

Gua Sha uses medium to hard pressure to press the tool on the skin in quick, downward strokes.

The scraping motions, varying in pressure, may cause tiny blood vessels near the skin’s surface to burst and lead to the formation of petechiae.

This is common and is the body’s reaction to stressors and illness.

The broken down blood stagnation is reabsorbed by the body which increases the local circulation.

This process resets the body’s anti-inflammatory response, stimulates the immune system, and boosts the pain-relieving release of serotonin and inhibits pain receptors.

Petechiae that forms after a Gua Sha massage will typically lessen in 48 hours and will be completely gone in 4 to 7 days.

The red spots that characterize petechiae often look painful but aren’t really.

Massage oil, lotion, or similar emollients are used to allow the tool to glide on the skin easily. The use of oil makes the scraping-pressure easier and does not leave the skin surface being scraped raw.

People who have undergone Gua Sha feeling no pain or discomfort.

A Gua Sha treatment is comparable to other forms of massage.

There is relief where the knots and tensions of the body are worked on.

Soreness may be felt but not enough to require taking pain medication.

The Gua Sha massage should also be performed by a trained practitioner, somebody who has experience and training to gauge how much pressure to apply, and the tools to use in the specific areas of the body.

Most importantly, a well-trained Gua Sha practitioner recognizes when someone is not a candidate for Gua Sha.

Health Considerations When Getting A Gua Sha Massage

Gua Sha is commonly used in the areas of the back; the neck and shoulders; the butt and hips; and the limbs.

The treatment is also used on the face to treat headaches and as a lifting facial massage.

For the face, the stroke uses light pressure and petechiae does not have to form nor is it expected to.

A flat tool made out of jade or rose quartz is used.

More about the different tools can be found in the next part of the article.

Below is a list of conditions where Gua Sha is not recommended.

  • People who take blood thinning medication.
  • People who suffer from blood clots or bruise easily.
  • Pregnant women.
  • People who have open wounds, broken skin, or rashes.
  • People who have deep vein thrombosis or similar conditions.
  • People who have circulation problems.
  • People who had recent surgery.
  • People who have implants such as a pacemaker.

Care should be taken by the Gua Sha practitioner when performing the massage.

Health and safety regulations to weigh include the sterilization of the Gua Sha tools between patients.

Some practitioners prefer to use disposable lids to avoid cross-contamination among patients.

Another precaution is for the practitioner to wear gloves when treating patients.

This ensures that infections, if any, will have a low risk of transfer.

For people who had Gua Sha performed on them, it is recommended to scale back on heavy physical activity after treatment.

Rest is preferable.

Taking drugs, alcohol, heavy meals, and working out is discouraged for the rest of the day after treatment.

Take plenty of liquids to help flush out the toxins from the body.

Allow an interval of 5 to 7 days in between Gua Sha sessions to not overwork the body.

This is where the adage “too much of a good thing” applies.

Tools Used In Gua Sha

This is a wooden Gua Sha tool…

These tools are made out of rose quartz and are used for the face…

three pink face tools

Here are a few other tools…

four chinese massage tools

The tools used by Gua Sha practitioners are varied.

The ones used in the body can be made of bone, horn, bian, jade, rose quartz, wood, plastic, or metal.

The most commonly used for the body is made from bone, bian, and high-grade plastic.

Therapy clinics typically use metal bottle caps lined with plastisol which can be sterilized or tossed after use.

The tools for the face are made of jade or rose quartz, semi-precious stones that can drive up the price.

Specialty Gua Sha tools have unique shapes that serve a specific purpose for use in different parts of the body.

A practitioner will apply massage oil as a lubricant to move the Gua Sha tool across the skin in firm, even strokes.

The strokes must be strong enough to produce the petechiae effect on the skin but light enough to not break the skin.

The strokes go in one, downward direction and must be no more than 8 to 10 broad strokes per area.

For the face, the tool is used flat against the skin.

The edge may be sharp and should not be placed at an angle to avoid cutting the skin.

Use light to medium pressure and slow mindful strokes to relax your nervous system.

The massage starts on the neck going front to back and moving up to the face.

Petechiae are not expected to appear on the face.

The effect will be a draining of the lymph which would make the face appear tighter and less puffy.

Keep your strokes slow and mindful in an upward direction to create lift.

Do not go more than 5 passes per area with the tool to avoid bruising.

Gua Sha Color Chart

The petechiae that come out during a Gua Sha session are usually red but may be darker or lighter.

Traditional Chinese medicine assigns meaning to the different colors that a petechia has.

The color tells you what is wrong with the body and the possible outcomes after the treatment.

The typical pink to bright red may mean a deficiency in blood and the illness is recent.

A deep dark red means there is inflammation in the area and the stagnation is building up.

Black or purple indicates a long-standing condition and even tissue damage.

Brown shows dehydration and a lack of fluids in the body.

In healthy people with strong circulatory systems, the petechiae fade quickly in 2 to 3 days.

For older people with circulation issues, it may take up to a week for the petechiae to fade entirely.

Gua Sha vs Graston: What’s The Difference?

Gua Sha and the Graston Technique share a few similarities.

The first being both apply pressure using tools to treat an area of the body and bring relief from the tension or inflammation it is experiencing.

The next is the use of hand-held tools to work the treatment instead of using bare hands as with traditional massage methods.

The last is the effect, both treatment forms produce redness, bruising, and petechiae on the area of the skin being treated.

The differences between Gua Sha and Graston also lie in the three similarities stated above.

The technique used to apply the stroke by a Gua Sha practitioner is limited to 1 move, a downward scraping motion.

The Graston Technique, on the other hand, uses 7 different strokes to apply deep, rhythmic pressure.

The tools used to work Gua Sha strokes can be made out of horn, bone, bian, jade, rose quartz, high-grade plastic, and even metal.

While the tools used for the Graston Technique only use stainless steel.

The outcome of both treatments is to bring relief.

The redness and petechiae produced by the scraping in Gua Sha are described as the imbalance in the qi and toxins of the body being drawn to the surface that will bring healing and restoration to the body.

The bruising and petechiae from a Graston treatment are characterized as the breaking down of adhesions in the fascia to improve motion and loosen the tightness in the muscles.

The microtrauma in the bruising will facilitate the correct healing of the tissue and muscle adhesion.

What The Research Suggests About Gua Sha

Research done by Arya Nielsen of Beth Israel Medical Center and Holger Cramer from Universität Duisburg-Essen suggests positive results from the test subjects.

The outcomes point to similarities with the microtrauma healing theory promoted by proponents of the Graston Technique.

Although there is evidence for the use of Gua Sha to treat a wide variety of conditions such as headaches, migraines, neck, shoulder, back, and knee pain, details for the study is limited and the subjects involved in the study are small.

Anecdotal evidence from over 2,500 years of practice can’t be wrong and with acceptance of alternative medicine, Gua Sha has been gaining more converts.

Aside from pain treatment,  Gua Sha was shown to be receptive to fever, flu, earaches treatment in children and adults.

Some claims are still in question though, like in the use of Gua Sha to treat herpes, hepatitis, asthma, and bronchitis.

The Verdict: Gua Sha has its merits.

The immediate effects of petechiae and possible bruising may be off-putting for some but it offers relief so that’s a big plus in its favor.

Just remember to go to a skilled and trained practitioner to make sure they know what they are doing.

Also, take note of safety practices to ensure health and safety for you and your practitioner.


Braun, M. (2011, March 12). Effectiveness of traditional Chinese “gua sha” therapy in patients with chronic neck pain: a randomized controlled trial. Retrieved from ttps://

Lee, M.S. (2010, January 29). Using Guasha to treat musculoskeletal pain: A systematic review of controlled clinical trials. Retrieved from

Higuera, V. (2017, June 16). Understanding Gua Sha: Benefits and Side Effects. Retrieved from

Kotak, J. (2016, August 1). Gua Sha vs. Graston – What is the difference? Retrieved from

PT Health Staff. (2017, May 26). What is the Graston technique? Retrieved from

Nielsen, A. (2015, May 5 ). The Science of Gua Sha. Retrieved from

Sissons, C.( 2017, December 23). Gua sha: What you need to know. Retrieved from

Editorial Staff

Editorial Staff at MindBodyPal is a team of experts led by Tyson Chiu. We love tacos, lattes and Funky Fridays.