Gua Sha: What It Is and How To Do It

If you’re seeing gua sha on social media for the first time, you might assume it’s a new trend. But this muscle scraping technique has roots in traditional Chinese medicine (TCM), dating back thousands of years.

Licensed acupuncturist Tim Sobo, LAc, explains what gua sha is and what benefits it may have.

What is gua sha?

Gua sha (pronounced “gwa-shah”) is a technique usually done by an acupuncturist or massage therapist. They use a small, smooth-edged tool to gently stroke or scrape areas of your skin to try to improve circulation and promote healing.

“Gua sha is a standard treatment modality that most acupuncturists use,” Sobo says. “The term loosely translates to ‘scraping, rubbing or pushing’ — essentially, a tool-assisted type of massage.”

Though “scraping” might sound painful, gua sha is a gentle technique. It’s done on your face using very light pressure. And if a provider performs it elsewhere on your body, like overly tight muscles, they may increase the intensity depending on the knots they encounter.

“We identify areas of tense tissue, work on them gently and gradually build up the intensity to promote circulation to help break up those areas,” Sobo explains.

In traditional Chinese medicine, gua sha is said to help balance the flow of qi (pronounced “chi”), or energy, throughout the body. Western medicine doesn’t follow those principles, but modern research shows gua sha may have benefits.

Benefits of gua sha

There’s not enough high-quality research to definitively declare the benefits of this technique, but studies continue to look into it. Here’s what gua sha may be able to do.

Increase blood flow

Gua sha has been shown to increase microcirculation in the areas where it’s performed, meaning it helps promote blood flow through your body’s smallest blood vessels.

“That helps ensure a better blood supply so everything is moving through your body as it should,” Sobo explains.

Reduce inflammation

Gua sha can cause small reddish-purplish spots to form on your skin. They may look like a rash, but they’re petechiae — tiny spots of bleeding under the skin caused by broken capillaries.

The thinking is that this triggers an anti-inflammatory response, prompting your body to promote healing in that area. But this hasn’t been scientifically validated.

Relieve pain

In Eastern Asia, gua sha is commonly used for pain relief. Advocates say it can help relieve pain from musculoskeletal problems, like tightness in your shoulders, neck, back and legs.

Though a 2010 review of studies didn’t find enough evidence to prove pain relief benefits, it didn’t rule out the possibility either. A small study later showed that gua sha may provide longer-lasting relief from chronic lower back pain than heat therapy.

Improve lymphatic drainage

Social media influencers rave that facial gua sha can reduce puffiness, though research doesn’t address this benefit. But much like lymphatic drainage self-massage, the gentle downward motion of gua sha may help get your lymphatic fluid moving. This may lessen facial puffiness and help you feel more relaxed and refreshed.

Other possible benefits

Researchers have looked at how gua sha could help relieve symptoms of specific conditions, though data is limited and studies have been very small. Here’s what they’ve found:

• Breast engorgement: Gua sha could be one type of complementary therapy to bring relief to breastfeeding mothers, a 2023 study showed.
• Diabetes-related neuropathy: A 2019 study found that gua sha could help reduce symptoms of this diabetes complication.
• Migraines: In a 2020 study, 50% of participants said they found migraine relief when they used gua sha during episodes of acute pain.
• Perimenopause: A 2017 study found that 15 minutes of gua sha per day could help relieve symptoms like hot flashes, headaches and nervousness.

Risks and side effects

Gua sha is generally safe, but there are a few risks, especially if it’s not done correctly. If you or your practitioner scrapes your skin too aggressively, it can cause muscle soreness, bruising or skin discoloration. And it should never be performed over irritated or inflamed skin, like rashes, wounds or sunburns.

It may also not be a fit if you:

• Have circulation problems
• Have diabetes
• Have a skin condition, like eczema or psoriasis
• Take blood thinners like aspirin, coumadin, or apixaban
• Are undergoing chemotherapy
• Are pregnant

“If you have any health conditions, let your practitioner know before your session starts,” Sobo advises. “That way, they’ll know to adjust the pressure, if needed.”

And if gua sha hurts, always let your practitioner know ASAP.

“If you’re in pain, you’re not getting a beneficial treatment,” he adds. “We’re trying to loosen things up, but if it hurts, you’re just going to tighten up more. For you to get relief, you and your practitioner need to be on the same page.”

How to do it yourself

Want to try gua sha on yourself? If you don’t have a background in it, it’s best to see a trained provider to have this technique done on your body — but it’s typically OK to try it on your face. Here’s how:

• Clean your gua sha tool. Some can be sanitized in boiling water or with a watered-down bleach solution.
• Apply moisturizer. Apply lotion or a serum to your face, which helps your gua sha tool glide across your skin more easily.
• Use a gentle touch. The structure of your face is thinner than the rest of your body, so don’t apply too much pressure. “A little redness should start to form, but not so much that it hurts,” Sobo clarifies.
• Work outward from the center of your face. Imagine dividing your face in half vertically, using your nose as a middle point. If you’re working under your eyes, for example, start at your nose and work your gua sha tool outward.
• Move in one direction. Keep your tool moving in a smooth, straight line. Don’t rub back and forth, up and down or in all different angles. That can stretch and aggravate your skin.
• Avoid swollen areas. Skip parts of your face where you’re experiencing swelling. “You don’t want to press too hard into those because you can burst capillary beds and end up with bruises on your face,” Sobo cautions.

One more thing: Though you can purchase a dedicated gua sha tool made of jade or another type of gemstone, Sobo says a small wooden spoon works just as well. Whatever you choose, keep it clean and in good condition. And if it chips or breaks, stop using it and find a replacement.

Should you try gua sha?

Ask your acupuncturist or massage therapist about adding gua sha to your treatment. Depending on where you live and who you see, you might hear it called something else, like coining, spooning or muscle scraping. But no matter its name, the goals are the same.

“With gua sha, acupuncture and other TCM practices, we aim to promote a smooth blood flow and healthy tissue,” Sobo says. “Our overall goal is always that any symptoms you’re experiencing will subside.”