We’re Doing Gua Sha All Wrong

A beauty cabinet can hold a multitude of stories: the face wash bought from the drugstore to fix a surprise breakout, the lipstick received as a birthday gift, the hand cream picked up on a trip to Italy with friends. But though treasured beauty products can hold personal memories, they can also offer a glimpse into another country’s culture and history. Case in point: gua sha. Over the past few years, this buzzy tool and practice has migrated from its roots in the East and become an impactful part of Western beauty rituals. But there are many common misconceptions about how to use this tool, and in many cases, an ignorance of its rich history. We spoke to Eastern medicine practitioners to find out the truth about the history of gua sha and its original intended use.

Healing Roots

Tracing as far back as the Paleolithic Age, gua sha was historically practiced with hard, flat, smooth objects — from horns to coins to bones. It has roots in East Asia, primarily China, and was used as a healing modality within the Traditional Chinese Medicine (TCM) practice. The words “gua sha” are actually Chinese characters — “gua” meaning to scrape and “sha” meaning sand. “It was used to treat pain, and even illnesses as serious as cholera,” says Sandra Chiu, licensed acupuncturist and founder of Lanshin. “Gua sha was not a lymphatic drainage technique, or a cosmetic technique.”

Instead, Chiu says that gua sha was used to improve lymphatic circulation and positively impact qi, a term used in TCM to refer to energy circulation. “Gua sha also relaxes tension and smooths the fascia and muscles,” she notes. “Unlike lymphatic drainage techniques, gua sha is not only applied to the superficial lymphatic layer at skin level, but contacts deeper into the fascia and muscles. It’s an important medical tool used throughout history.”

The TCM system looks at the body and health in a completely different lens than the modern Western lens — namely, a more holistic one. Instead of focusing on just treating the problem in isolation, TCM looks at the body as whole and uses holistic modalities like acupuncture, herbalism, and gua sha to balance qi and keep the body balanced healthy. The theory of TCM is that ailments and illnesses are caused by stagnation of the natural energy — the previously-mentioned qi — of the body, which can lead to disharmony and imbalance. It was believed that physically scraping the skin with a smooth tool could clear stagnation and encourage circulation of energy.

Traditionally, the patient receiving gua sha would first lay down in a comfortable position, then, an oil or a balm would be applied to the area being treated. “The practitioner would hold the selected tool at a certain angle and firmly scrape the skin in a specific direction, typically in long, sweeping motions,” says Gudrun Wu Snyder, acupuncturist and founder of Moon Rabbit Acupuncture. “The scraping would be performed with a moderate amount of pressure, but not so intense as to cause pain or discomfort.” The scraping done with traditional gua sha would be carried out along specific pathways (also known as meridians, which are energy channels in TCM). “The practitioner would generally follow a predetermined pattern, often starting from the center of the body and moving outward,” she says. “The scraping might be performed on various parts of the body, depending on the purpose of treatment.”

The point was to scrape the skin with a gua sha tool until the skin bruised and showed little purple and red spots — this was not a soothing skin ritual, or pretty jade tool to be displayed. The little purple and red spots (called petechiae) were thought to be a signal from the body that the stagnant energy was being re-invigorated and was flowing properly again. After the treatment was finished, the oil or balm would be cleaned off the skin and the person receiving gua sha would be told to keep the area warm and protected from cold, or wind.

In short: gua sha was never a beautifying tool. It was never used for lymphatic drainage, or lifting, or sculpting. Gua sha was a respected medical practice that was used for hundreds of generations in China and the East.

Popularity In The West

After the Communist Revolution, traditional healing modalities like gua sha fell heavily out of favor. But thanks to social media, gua sha soon saw a resurgence — this time, as a beauty treatment adapted by millions of people in America. Something about the process of applying oil to one’s face, then gently gliding a jade or metal tool along the cheekbones and jawline clearly struck a collective nerve. “Facial gua sha in the West seemed to catapult interest in it around 2017, with the help of social media to fuel the fire of its virality,” says Chiu. (The hashtag #guasha has 2.5 billion views on TikTok.)

The current modern gua sha technique has changed from its original usage of repeated scraping, petechiae, and deeper pressure to promote stagnant qi, to using lighter, more soothing strokes on the face to de-puff temporarily. Most traditional metal or wooden tools were swapped out for the more aesthetically-pleasing jade, which looks like a work of art sitting in anyone’s beauty cabinet and feels like a treat to use. In modern facial treatments, gua sha is often touted as a natural alternative to Botox for its skin-sculpting abilities, and social media is full of rave reviews from people proclaiming that gua sha can help to do everything from reduce puffiness to relieve jaw tension.

Gua sha’s explosive popularity as a beauty ritual has been followed by a wider acceptance and respect for its healing abilities. Modern scientific research around gua sha has revealed that gua sha can benefit the immune system, improve microcirculation, and can even have analgesic effects. Snyder also says that some healthcare professionals — including chiropractors, physical therapists, and massage therapists — have even begun to incorporate gua sha as an adjunct therapy to address pain, inflammation, and other musculoskeletal conditions. “The integration of gua sha into modern healthcare settings helps bridge the gap between traditional and evidence-based medicine,” she says.

But for the most part, gua sha’s popularity in the West remains centered around using the tool as a cosmetic modality. Maybe it’s the soothing, ritualistic aspect of the action — or maybe it’s because it can be adapted to treat everyday ailments, like headaches and jaw tension. While there’s nothing wrong with adapting a TCM tool into your own beauty routine, it is important to understand and acknowledge its long history, origins and cultural significance. To maximize the benefits of your beloved gua sha, beware of “experts” who define gua sha simply as a “lymphatic drainage tool” and instead, listen to trained TCM experts — like Chiu and Snyder — who are well-versed on the tool’s benefits and proper usage. And the next time someone calls gua sha a “trend,” you can correct them with the the facts: it’s an ancient Chinese medicinal tool that’s been around for longer than any of us.

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Studies:

Chen, T., Liu, N., Liu, J., Zhang, X., Huang, Z., Zang, Y., Chen, J., Dong, L., Zhang, J., & Ding, Z. (2016). Gua Sha, a press-stroke treatment of the skin, boosts the immune response to intradermal vaccination. PeerJ, 4, e2451.

Nielsen, A., Knoblauch, N. T., Dobos, G. J., Michalsen, A., & Kaptchuk, T. J. (2007). The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects. Explore (New York, N.Y.), 3(5), 456–466.

Lee, M. S., Choi, T. Y., Kim, J. I., & Choi, S. M. (2010). Using Guasha to treat musculoskeletal pain: a systematic review of controlled clinical trials. Chinese medicine, 5, 5.