The Nuance

Should I Be Doing Gua Sha?

The traditional Chinese therapy may not be a beauty elixir, but it is promising for overall health

Credit: Julianna Nazarevska/Getty Images

Every week, the Nuance will go beyond the basics, offering a deep and researched look at the latest science and expert insights on a buzzed-about health topic.

FFrom acupuncture to aromatherapy, many forms of traditional Chinese medicine have found fans in the West. One of the newly popular practices is gua sha — also known as scraping, spooning, and coining — which is a kind of focused skin massage.

Typically, a gua sha practitioner uses a rigid, round-edged instrument to “press-stroke” one section of a person’s lubricated skin over and over again, says Arya Nielsen, a gua sha researcher and assistant clinical professor of family medicine at the Icahn School of Medicine at Mount Sinai. This massaging causes tiny capillaries in the skin to leak blood, which produces some vivid but temporary birthmark-like bruises known as petechiae (which, by the way, is the medical term for a hickey).

Nielsen’s research shows the skin aggravation that results from gua sha produces a surge in surface blood circulation. As these blood cells are reabsorbed, she says, an enzyme called heme oxygenase-1 is created, and this seems to result in some anti-inflammation and “immune protective” effects. She says gua sha has been linked to the reduction of pain, muscle stiffness, and illness symptoms like nausea and fever. There’s also evidence that gua sha can treat some organ disorders — namely liver inflammation related to hepatitis.

One of the best gua sha studies to date, albeit a small one, appeared in the journal Pain Medicine in 2011. A team of German researchers recruited 48 people with chronic neck pain and split them into two groups. One group received a 20-minute gua sha treatment. The other was treated with a heating pad for the same amount of time.

One of the big challenges in studying gua sha (and related therapies like acupuncture) is that it’s difficult to develop a sham procedure to use as a basis for comparison. Rather than create a fake gua sha treatment, researchers used the heating pad intervention because it is “well accepted” as a pain intervention in Germany. They also used pads infused with aromatic ginger and told the people in the study that this showed “promising effects” in treating neck pain. Basically, they did everything they could to stoke the expectation that the pad therapy would work.

If you’re the one in pain, you probably don’t care how a therapy works. You just want it to work.

The results weren’t even close. During seven days of follow-up, mean pain scores among the gua sha group dropped by 64 percent, compared to a 14 percent drop among the pad group.

While that’s promising, some critics have pointed out that gua sha — unlike the heating pad treatment — is mildly painful. These critics say it makes sense that causing pain in one part of the body would reduce a person’s perception of pain in another. They also say gua sha’s exoticism and history may induce an especially large placebo effect.

That may all turn out to be accurate. But if you’re the one in pain, you probably don’t care how a therapy works. And research on some related therapies — including massage and foam rolling, both of which involve applying pressure to the skin — have also turned up pain-relieving benefits.

It’s also worth noting that experts who study the placebo effect say it isn’t given enough credit.

“The term ‘placebo’ has always had this very negative connotation,” says Vitaly Napadow, PhD, director of the Center for Integrative Pain Neuroimaging at Harvard Medical School, who has studied acupuncture. The human body has built-in systems for stoking or calming pain and other subjective sensations. If a placebo treatment can target and activate these systems in ways that provide relief, “that’s a good thing,” Napadow says.

But attributing gua sha’s benefits strictly to a placebo effect may be shortchanging the practice.

A 2011 case study, conducted in part by researchers at Massachusetts General Hospital and involving a patient with hepatitis, found that gua sha therapy led to a drop in some inflammation-related blood biomarkers. Gua sha also seemed to trigger a rise in an enzyme associated with improvements in liver function.

It’s hard to take away much from a single case study. But viewed together, the existing gua sha research suggests the therapy is deserving of further study.

Gua sha facials and beauty treatments, which are not part of traditional Chinese medicine, are not supported by much evidence.

“From a dermatological standpoint, I’m unaware of any research showing this has a direct clinical or cosmetic effect on the skin,” says Tina Alster, MD, a clinical professor of dermatology at Georgetown University Medical Center. Alster says it’s possible that lightly rubbing the skin could temporarily increase blood flow and cause mild inflammation, which could make skin look “rosier and a little brighter.” But you’d get the same sort of effect from a run-of-the-mill facial, or even from lightly massaging the skin, she adds.

In very rare cases, gua sha could even cause permanent discoloration of the skin, says Ilana DeLuca, MD, a clinical assistant professor of dermatology at the George Washington University School of Medicine and Health Sciences. “Anytime you injure the skin, the local inflammation can cause deposits of pigment, which results in discoloration or darkening once the inflammation has resolved,” she explains. While this discoloration is almost always temporary, that’s not always true. “I’ve seen some case studies reporting permanent cases,” DeLuca says.

So you can probably skip the gua sha facials and beauty treatments. But when it comes to treating pain and some other medical conditions, gua sha may actually prove helpful.

I write about health and science. I live in Detroit with my wife and kids. I’m trying to learn German, but my progress so far is nicht gut.

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