Article: Gua Sha

Gua Sha (刮痧), literally "to scrape for cholera", sometimes given the descriptive French name "tribo-effleurage" by English speakers,^[1] is a very ancient technique of treatment that is still widely used by practitioners of Traditional Chinese Medicine. It is used even more widely as a "folk" technique, by Chinese, as a preventive or remedial treatment upon members of individual households.

It is also widely used in Indonesia. It is a traditional Javanese technique, known as kerikan (lit., "scraping technique"),^[2] and it is very widely used as a form of "folk" medicine, upon members of individual households.

Gua Sha: the "folk" technique

In describing the Gua Sha techniques as a form of "folk" medicine, the term "folk" is not being used in any pejorative sense. It is used to emphasize:

• the extremely widespread domestic use of the technique (thus, used by the "folk") as a method of first-contact intervention,
• that complex medical diagnosis is not required (and, thus, any decision to use or not use Gua Sha can be reliably made by the "folk"), and
• the overall safety of the technique (meaning that it is safe for the "folk" to use).

Notwithstanding this, the Gua Sha technique is just as important a part of the legitimate practice of the specialist practitioners of Traditional Chinese Medicine as is the use of fire cupping; and it is a highly reputable technique that is applied just as much by these highly trained experts as it is applied by the "folk" users.

As with many of the "folk" methods that are used domestically as a form of first intervention, the use of Gua Sha often precludes any need for any more complex medical treatment; and, because its use means that further medical treatment is unnecessary, the technique, although extremely widespread, is often hidden from view, and its role as a very significant and very important participant in the overall health care of a community may not be immediately apparent.^[3]

Therefore, in the case of Gua Sha,the term "folk" medicine should not be thought of as separate from the practice of more complex Traditional Chinese Medicine, but far more as an immediate form of domestic "first-aid" intervention that serves to prevent any need for further medical intervention by a medical professional.

The Gua Sha technique

Gua Sha involves firmly rubbing a person's skin with the smooth edge of a ceramic soup spoon (the edge of a plastic spoon is neither thick enough or smooth enough) or a fragment of the perimeter of a porcelain plate -- originally animal bones were used -- or, in the case of some of the "folk" applications, the edge of a large coin may be used.

In cases of fatigue from heavy work a piece of ginger root soaked in rice wine is sometimes used to rub down the spine from head to tail.

The spoon is placed against the pre-oiled skin surface, pressed down firmly, and then moved down the muscles -- hence the term "tribo-effleurage" (i.e., friction-stroking) -- or along the pathway of the acupuncture meridians, along the surface of the skin, with each stroke being about 10cm (4in) long.

This causes rupture of the small sub-dermal capillaries (petechia) and may result in sub-cutaneous bruising (ecchymosis), which may take quite a few days to fade entirely. The depth of colour varies according to the patient's internal reaction to treatment -- which is determined by the nature, severity and type of their disorder (generally speaking, the more severe the disorder, the stronger the reaction) -- and it may vary from a dark blue-black to a light pink. Although the marks on the skin look painful, they are not.

It is often used in conjunction with fire cupping. In such circumstances, the Gua Sha is always used before the cupping, never after.

Indications

The Gua Sha technique is most commonly used to:

• Reduce fever (the technique was first used to treat cholera).
• Treat fatigue caused by exposure to heat (often used to treat heat-stroke).
• Treat muscle and tendon injuries.
• Push sluggish circulation.
• Treat headache.
• Treat stiffness.
• Treat indigestion.
• To assist with reactions to food poisoning.^[4]

There is an allied technique, Ba Sha (拔痧), literally "to lift up for cholera", which has a similar application to Gua Sha. It is performed by gripping the skin, lifting and then flicking between the fingers until a bruise comes up. It is used more often on the tendons than over specific acupuncture points.

Cross-cultural confusion with physical abuse

A slightly different form of Gua Sha, using the edges of coins, rather than porcelain, is practiced as a "folk medicine" technique, by individuals amongst their own family members, in some Chinese traditional cultures, in Vietnam (where the coin scraping is known as "Cao Gío"), in Cambodia, and in their immigrant communities abroad.

Cao Gio was introduced to the USA in 1975, when large numbers of Vietnamese were airlifted from South Vietnam near the end of the military conflict between North and South. Well-meaning practitioners of western medicine are sometimes shocked at the sight of these marks and fear that a child with the marks has been abused. The practice was observed by military physicians who publicized the harmless nature of this practice.

In 1980, it was found that many Vietnamese still distrusted US medical practitioners in part due to fear of being falsely accused of child abuse.

For professionals in this position, it is helpful to be familiar with the appearance of Gua Sha marks and to understand its traditional therapeutic value, and to be able to make the distinction between gua sha marks and signs of abuse.

Gua Sha is not known to be harmful. The technique called cupping also leaves distinctive, bruise-like marks on the skin, but is also harmless.

In 2001, a movie called "Gua Sha" (aka "The Treatment") was made addressing this practice and the cultural misunderstandings it causes. The movie stars Tony Leung Ka-Fai.

Notes

1. ^ Huard & Wong (1977), p.126. They also cite a French romanization for the same set of two Chinese characters: koua sha.
2. ^ Although most Indonesians would understand it to have a far more general meaning of something like "to take out "the wind" by scraping".
3. ^ In a similar fashion, the cleaning and bandaging of minor cuts and scrapes or, even, the washing of hands before eating, are extremely significant factors in the overall maintenance of health, but may not be immediately recognized as components of the overall delivery of health-care. However, the cleaning and bandaging of minor cuts and scrapes and the washing of hands before eating are practices that can be observed in every hospital.
4. ^ This includes the reactions to state altering substances (such as LSD, and psychedelic mushrooms) which are included under the generic title of food poisoning from a Traditional Chinese Medicine perspective.

See also