What is Gua Sha?

Sandra Lanshin Chiu, L.Ac., the founder of Lanshin, says “When people hear Gua Sha, they immediately think of a facial technique. But it's important to know thatGua Sha is a Chinese medical technique that looks quite different fromfacial Gua Sha. To understand facial Gua Sha, we have to first understand its roots as a medical technique performed on the body. Then, we can better understand the facial version. 

So, let's approach Gua Sha with cultural humility and from a Chinese medicine expert. Sandra Chiu, L.Ac  is a Chinese medicine practitioner who specializes in cosmetic dermatology. She is the founder ofLanshin, and in this blog, she answers questions about the practice. 


What does it mean to be a Chinese medical specialist and to have expertise in Gua Sha?

Sandra Chiu, L.Ac: “I am an L.Ac., which means I am a Chinese medicine practitioner. I practice Acupuncture, Chinese herbal therapy, Gua sha, Cupping, and all of the things that belong to the system of Chinese medicine. I use these tools in my Brooklyn clinic to treat dermatological and cosmetic concerns like acne, rosacea, jowls, and deep fine lines on the forehead. I love using facial Gua Sha in cosmetic dermatology work.” 

What is Gua Sha?

Gua sha is a Chinese medical practice that roots back to paleolithic times. It consists of stroking the body with a smooth tool or device in a single direction to help the body heal from disease. In most parts of the world, Gua Sha refers to a broader medical practice that is usually performed on the shoulders, back, and body to relieve an internal disorder, pain conditions, and to even give the immune system a boost.” 

Photocred: Today

You might recognize Gua Sha by the hallmark red, rash-like appearance on the skin, a common result of Gua Sha technique. While this can appear a bit brutal or shocking to foreigners who've never seen it, this is actually a very therapeutic response. Another Chinese medical technique called Cupping can leave similar, reddish marks. What’s interesting is that once this color comes out of the skin, the patient usually feels better. 

People often refer to Gua Sha marks as bruises, but they are actually a therapeutic response we call “sha.” Sha refers to the reddish or purplish color left behind on the skin. This is the “sha” in Gua sha. In Western terminology “sha” is called “petechiae,” and it appears as small red specks that are expressed on the skin’s surface as a result of doing medical Gua Sha. What’s fascinating is this only occurs if there is what we call “blood stagnation” in your tissues.  The more stagnation present in the treated area, the more deep and intense the color will be on the surface. It can even turn into a solid block of red or sometimes dark purple. At this level, it is referred to asecchymosis in Western terminology. 

When that surfaces, it means the blood stagnation in the tissues has been essentially removed from the tissue area being treated. And then, the body metabolizes it and clears it up in a few days. Sometimes it takes up to a week if the stagnation was severe.”

Are these bruises different from normal bruises?

“Yes. A typical bruise is a trauma injury to blood vessels. Whereas, the red “sha” (which can appear as lighter petechiae to deeper ecchymosis) from Gua Sha represents the therapeutic removal of excess blood stagnation from the tissues. When you apply Gua Sha to healthy tissue, the skin will pink up and then return to normal within 10-20 minutes. It will not express petechiae or produce ecchymosis unless there is pathological blood stagnation present in tissue. However, bruises are caused by blunt force and injures tissue whether it is healthy or not. This is the best way to understand the difference.” 

What does Gua Sha mean? 

Gua is to scrape, andsha can be translated as illness, disease, or pathology.  So “Gua Sha” means to scrape out the pathology. From resolving hepatitis to cervical pain, there is research that backs up Gua Sha as an effective medical practice. 

In ancient times, Gua Sha was actually used to treat cholera. It's a really powerful and  effective healing technique that's been used for a very long time. When people question if Gua Sha is a real thing, I always think –if it wasn't effective, it wouldn't still be around. 

But, because social media and the internet have now made facial Gua Sha so popular, a lot of people think “Gua Sha” is a facial technique. But, in most parts of the world (Asia in particular), the term “Gua Sha” refers to the medical practice we previously discussed. 

What is facial Gua Sha?

Facial Gua Sha is a gentler form that has many benefits for skin health and treating facial aging concerns. And  it’s safe to practice at home. However, you can consult a trained Chinese medicine practitioner for best results and safety. Whereas, the medical form of Gua Sha should not be performed at home without supervision, unless you're a trained Chinese medical practitioner.

But, there is one caveat to that. In many Asian families, Gua Sha is a familiar technique that gets passed down. From the time we’re young, many Asian people have memories of relatives using it as a remedy when we’re feeling ill, coming down with a cold, or getting a bad crick in the neck.  My aunt used to give me treatments when I was little. I remember a time when I felt so sick from heat stroke. As soon as she saw me in that state, she immediately started to do Gua Sha on my shoulders and neck. Within minutes, I was back to normal. 

So, in the case of Asian families, you may see people who are not formal practitioners performing Gua Sha because it is also a cultural practice. However, here in the West, it is best to seek a trained and licensed Chinese medical professional because there are important safety precautions one must take. I do not recommend attempting medical Gua Sha at home without professional guidance. While medical Gua Sha is a very effective practice, you need to know what you're doing.”

How are medical Gua Sha and facial Gua Sha different?

“Facial Gua Sha is a much gentler, softer, and lighter form of Gua Sha. One of the main differences is that we don't intentionally try to produce sha or petechiae on the face. 

The goals for facial gua tend to be more cosmetic. For instance, smoothing skin texture, reducing puffiness, softening lines, etc. Whereas with medical Gua Sha, our goals are more to relieve pain or help an internal disorder. That said, facial Gua Sha can also help relieve the discomfort of jaw tension, TMJ disorder, sinus congestion, and headaches. By literally  improving the health of your body, facial gua is a unique skin improvement technique that works. Improving skin health and vitality is the mechanism of Gua Sha, and thus, it improves the condition of your skin.” 

What materials are good for Gua Sha tools?

“When I do facial Gua Sha, I tend to use tools made of stone materials like jade. These offer the perfect density, weight, and smoothness for Gua Sha strokes across the face. When I perform medical Gua Sha in my clinic, I use different tools. My favorite are metal lids that look like a mason jar lid. I find these more suitable to the goals of pulling up sha/petechiae from  treatment areas like eck, shoulders, back, etc. 

For the face, I love jade stone tools. “Xiu yan” jade is that lighter green almost, lime-colored stone that has a wonderful texture for facial Gua Sha. But, ,y absolute favorite stone is nephrite jade, a darker, richer, and denser jade that's known for having extra healing properties. I also enjoy using rose quartz. A more modern material that is great for use on sensitive skin is surgical stainless steel. 

In ancient times,  Gua Sha was sometimes called “coining” because you could use a coin. There's a breadth of things that you can use Gua Sha with. Of course, we want to be hygienic and safe. So, you should use tools that are made for it or tools you can properly take care of by washing them off.”

Any smooth surface object that will feel comfortable gliding across skin can technically serve as a Gua Sha tool. For instance, one could use a porcelain soup spoon as an accessible option.

Something to watch out for when purchasing Gua Sha tools are fake jade tools. There are some tools sold as jade, and their price seem like a bargain. But in reality, the tool is more like a dyed marble. I’ve also seen green, aventurine stones sold as jade. Aventurine is nice, but is far more fragile than real jade. 

While you can still use a fake jade tool or facial Gua Sha, as long as it is smooth, I find it very dishonest to pay for something that isn’t what it promises to be. 

Is Gua Sha a technique or a tool?

“Gua Sha is the technique of using a smooth tool to stroke along the body or face. A Gua Sha tool is what you use to do the technique. I hear people often referring to a Gua Sha tool as “a Gua Sha,” and technically, that is incorrect. When used correctly in a sentence it sounds like, “I use my Gua Sha tool to do Gua Sha on my face and neck.” 


What type of Gua Sha tool should I get?

“I always tell people that their first Gua Sha tool should have a larger flat surface area, like ourLanshin Intro Gua Sha orPro Gua Sha tool. From there, select a tool that fits your preference. People often ask me if the stone type matters, and I always say that good technique is the number one thing that matters for getting results. So, you should choose whatever stone speaks to your heart. My personal favorite is nephrite jade because when you warm nephrite, it emits Far-Infrared (FIR) energy which gives circulation an extra boost. 

I should note that surgical stainless steel is a nice material for people with sensitive skin, or for those who’d like to go without facial oils. If you’ve only applied a serum and cream, steel makes gliding the tool easier on the skin]. Tools like the Lanshin Sculpting Spoons have smaller surface area. So,  I consider them great booster tools that are useful for detailed Gua Sha work around eyes and for acupressure. 

In regards to choosing a brand, many people don’t realize  that most Gua Sha tools on the market are stock tools from the same companies. They sell the same model tool in mass quantities to different brands. Have you ever noticed that so many different companies sell the same looking tools? There’s nothing wrong with those tools or that practice, but I believe in transparency of origin. OurLanshin Pro Gua Sha tool andIntro Gua Sha tools are custom designed and shaped by me according to what I find works best in clinical practice. Our other tools are a mix of customized elements. I selected them to improve on the stock models of existing tool types (our rose quartz and xiu yan jade spoons are the only tools not customized). I work with a factory in China that holds stone authenticity and top quality with the same high regard as I do, and that’s really important to me as a TCM practitioner-led brand.” 

Are hot stones good or a form of Gua Sha?

“As far as I've experienced, hot stones used during massage are technically being used as massage tools, not as a form of Gua Sha practice. The technique of Gua sha specifically involves stroking in a single direction repetitively. Whereas massage does not have the goal of pulling up sha-petechiae. Massages can include oscillating across muscles, or stroking up/down along the muscle. How you work with a Gua Sha tool will determine whether petechiae will be expressed. That's why you need to know what you're doing. There's a way that you can do Gua Sha that will likely produce petechiae, and a way it can be done with far less likelihood of that happening. The latter is the style of Gua Sha we encourage for the face.”  

Who uses Gua Sha?

“In the West, Acupuncturists and Chinese medical practitioners are the only professionals licensed to practice Gua Sha. Although, chiropractors and physical therapists practice something called “the Graston technique.” As a Chinese medicine practitioner, I believe this is essentially Gua Sha except renamed for David Graston, who believes he invented this practice.  

To identify an Acupuncturist, look for someone with an “L.Ac.” or “D.Ac.” after their name. This stands for licensed Acupuncturist or Doctorate of Acupuncture. It signals that a person has completed the necessary training to receive an official license to practice in their state. So, if you are looking for the true experts in Gua Sha with a professional connection to the principles of Chinese medicine, look for an L.Ac. or D.Ac. 

When people think of facial Gua Sha, they think that it must belong to the realm of aesthetics practice, but it doesn’t. It's a Chinese medicine practice, and TCM practitioners are the authority on Gua Sha, and other TCM modalities (Cupping, Acupuncture, Chinese herbal therapy, Moxibustion, etc). 

People  don’t often realize that in most states it takes a minimum of 3-4 years of master’s degree training to qualify for L.Ac. licensing. I see a lot of estheticians or massage therapists teaching Gua Sha and even certifying people into the professional practice of Gua Sha. But, I find this potentially unsafe and problematic. Gua Sha trainers should be able to draw from the full breadth of its history as a Chinese medical technique, and understand important precautions.” 

How do you add Gua Sha to your routine?

“If you're doing it for muscle pain, find an L.Ac. who is licensed to practice this medical modality on patients. If you're interested in gentler facial Gua Sha, then follow tutorials from Chinese medical practitioners. We have a YouTube channel and website where we havevideos to support your Gua Sha practice. I have a video called “Learn facial Gua Sha from a Chinese medical skincare professional.” It's an easy 10-15 minute step-by-step routine you can follow. It’s filmed to feel like you're learning from me one-on-one. 

Think of using facial Gua Sha as a game changing addition to your skincare routine. I always tell people that good skincare products customized to you skin type plus facial Gua Sha equals next level skin health. The two combined  make your skin glow and feel amazing. Movement generating techniques like Gua Sha stimulate blood flow and circulation. It accomplishes what skincare products alone cannot. I truly believe facial Gua Sha is an important modality for anyone interested in natural ways to age beautifully and maintain your best skin health.”