MD, PhD, FMedSci, FSB, FRCP, FRCPEd

According to Wikipedia, Gua sha involves repeated pressured strokes over lubricated skin with a smooth edge placed against the pre-oiled skin surface, pressed down firmly, and then moved downwards along muscles or meridians.This intervention causes bleeding from capillaries and sub-cutaneous blemishing which usually last for several days. According to a recent article on Gua Sha, it is a traditional healing technique popular in Asia and Asian immigrant communities involving unidirectional scraping and scratching of the skin until ‘Sha-blemishes’ appear.

Gua Sha paractitioners make far-reaching therapeutic claims, e.g.” Gua Sha is used whenever a patient has pain whether associated with an acute or chronic disorder… In addition to resolving musculo skeletal pain, Gua Sha is used to treat as well as prevent common cold, flu, bronchitis, asthma, as well as any chronic disorder involving pain, congestion of Qi and Blood“. Another source informs us that ” Gua Sha is performed to treat systemic toxicity, poor circulation, physical and  emotional stress, and migraines. Gua Sha healing promotes the flow of Qi  (energy) and blood throughout the body for overall health“.

Gua Sha “blemishes” can look frightful – more like the result of torture than of treatment. Yet with our current craze for all things exotic in medicine, Gua Sha is becoming popular also in Western countries. One German team has even published several RCTs of Gua Sha.

This group treated 40 patients with neck pain either with Gua Sha or locally applied heat packs. They found that, after one week, the pain was significantly reduced in the former compared to the latter group. The same team also published a study with 40 back or neck-pain patients who either received a single session of Gua Sha or were left untreated. The results indicate that one week later, the treated patients had less pain than the untreated ones.

My favoutite article on the subject must be a case report by the same German research team. It describes a woman suffering from chronic headaches. She was treated with a range of interventions, including Gua Sha – and her symptoms improved. From this course of events, the authors conclude that “this case provides first evidence that Gua Sha is effective in the treatment of headaches”

The truth, of course, is that neither this case nor the two RCTs provide any good evidence at all. The case-report is, in fact, a classic example of drawing hilariously over-optimistic conclusions from data that are everything but conclusive. And the two RCTs  just show how remarkable placebo-effects can be, particularly if the treatment is exotic, impressive, involves physical touch, is slightly painful and raises high expectations.

My explanation for the observed effects after Gua Sha is quite simple: imagine you have a headache and accidentally injure yourself – say you fall off your bike and the tarmac scrapes off an area of skin on your thigh. This hurts quite a bit and distracts you from your headache, perhaps even to such an extend that you do not feel it any more. As the wound heals, it gets a bit infected and thus hurts for several days; chances are that your headache will be gone for that period of time. Of course, the Gua Sha- effect would be larger because the factors mentioned above (exotic treatment, expectation etc.) but essentially the accident and the treatment work via similar mechanisms, namely distraction and counter-irritation. And neither Gua Sha nor injuring yourself on the tarmac are truly recommendable therapies, in my view.

But surely, for the patient, it does not matter how she gets rid of her headache! The main point is that Gua Sha works! In a way, this attitude is understandable – except, we do not need the hocus pocus of meridians, qi, TCM, ancient wisdom etc. nor do we need to tolerate claims that Gua Sha is “serious medicine” and has any specific effects whatsoever. All we do need is to apply some common sense and then use any other method of therapeutic counter-irritation; that might be more honest, safer and would roughly do the same trick.

No, I am wrong! I forgot something important: it would not be nearly as lucrative for the TCM-practitioner.

397 Responses to Gua Sha: torture or treatment?

  • You had it out in the second last paragraph, but I think this one here is too good to be wasted:

    In Germany children’s books of an author called Janosch were quite popular. Amongst others, the main characters are Tiger and Bear that live together in the same cave. One night Bear feels annoyed by the noise of the faucet dripping water and discusses with Tiger what can be done about it. Tiger solves the problem by starting the vcauum cleaner, so the dripping faucet could not be heard any more.

      • @Lisa
        This link does not refer to reliable scientific information. The information about “Gua Sha” provided in this website is largely anecdotal and some of the propositions constitute dangerous pseudoscientific fantasy. Arya Nielsen is not a doctor but an acupuncturist and as far as I have been able to find, her Phd research in Germany “discovered” increased perfusion in injured skin, a phenomenon which any second year medical student could have told her would happen. The nonsense about Gua Sha being useful for Hepatitis B is dangerous, unsubstantiated fantasy, seemingly based on an anecdote.
        Please do not think injuring the skin is any good for anything.

        • I would see Arya Nielson findings more useful than some sophomoric med students speculations.

          • Mr Wu has obviously never been a sophomore med student and read the basic well known and understandable facts about reaction to injury.
            “Speculation” is what Ms. Nielsen applies to the effects of skin scraping, such as her speculation about healing Hepatitis-B, a deadly serious disease.

          • Bjorn, why don’t you email Arya Nielson, and let her know she’s doing it wrong. As you’ve pointed out, “Real GS involves inflicting painful injury. If not it is not GS.” I don’t think she’s aware of that.

            (Neither is any other practitioner, actually. Everyone’s under the impression that it’s a surface treatment, and actually feels great when performed correctly. Well…correctly according to every teacher and traditional medical system out there. You need to set everyone straight.)

            While you’re emailing, you should inform Mount Sinai Beth Israel that “People like Arya Nielsen are a threat to their fellow humans.”. It’s your duty to protect the unsuspecting public, yes? I hope you post their response.

          • Interestingly “jm”‘s obsessively asserted* notion that Gua Sha does not cause injury is not shared by Arya Nilesen.

            Gua sha produces transitory therapeutic petechiae that represent extravasation of blood in the subcutis.

            What she is saying is the blood vessels in the skin and underlying tissue (subcutis) are torn by the scraping, whereby blood cells leak out into the tissues (extravasation) causing bruises (petechiae).
            What follows in her explanation of her “science” on Gua Sha is a cavalcade of misinterpreted effects of normal repair after injury with wild speculations on it having useful systemic effects such as in hepatitis.
            Dangerously naive misapplication of science.

            What happens with healing is minute scarring and repeated Gua Sha or cupping will cause accumulated microscarring of the skin resulting in hardening and decreased blood flow.

            *For those new to this discussion, “jm” seems to be a practitioner of oriental woo, who has been claiming all sorts of strange nonsense here. He has been desperately trying to claim that Gua Sha and cupping are benign and pleasant and do not cause injury. If you Google for these terms and look at pictures of the bruises and blemishes produced by such quackery, I am sure most sensible people will disagree strongly.
            The notion that superficial bruising injury has beneficial effects on diseases is wrong and may be dangerous as I have repeatedly pointed out before in this overly long thread.

          • Actually Bjorn, most sensible people would do more than reading a couple of web pages and looking at some pictures, before claiming (as you repeatedly have):

 “Real GS involves inflicting painful injury. If not it is not GS.”

            I’ve talked to people who have had treatments from Arya Neilson – no pain, no injury, felt great during and after. So according to your thorough research (“I looked up everything there was to know about the phenomenon.”) – she’s not doing gua sha. You should tell her. You should let her know about the decreased blood flow, too. I think she’s been finding just the opposite.

            You need to contact Mount Sinai Beth Israel (where she is employed and doing research), since you have come to the conclusion that “My personal stance is that practices like Gua Sha, cupping, paida and even acupuncture should be criminalised.”. You should report suspected criminal activity, don’t you think?

            Be sure to mention that you know what you’re talking about (“I AM an expert in this matter, I have tons of paper to substantiate my claims”), and “I have good reasons to sound condescending towards people with stupid and dangerous ideas about health and related matters.”.

            Report back with your progress, please.

          • 😀 I suggest “jm” try reading Arya’s description of GS with a dictionary at hand.
            And she’s not working at the real Mount Sinai, only the Imitation medicine department, where they offer make-believe medicine for entertaining the gullible.

            Here’s this Integrative departments “recipe” of unproven, fantasy-based theatricals for preparation for surgery:
            – Centering and Grounding
            – Aromatherapy
            – Guided Imagery
            – Biofeedback
            – Energy Healing (Therapeutic Touch, Reiki)

            I am sorry but the American health care system is full of rot like this. A.Nielsen’s GS is just a small part of the imagination based medicine metastasising through and threatening the safety and efficacy of real health care, led on by simpletons like Mr. Wu and “jm” who don’t care whether their theatrical “services” make any sense or if it really is doing anything useful.

          • Bjorn, I think you pasted in the wrong link. The one you posted talks about increase in circulation, not decrease. Scanned with Doppler imaging and such. (maybe they are unfamiliar with accumulated microscarring of the skin resulting in hardening and decreased blood flow). In any case, you should read the page you posted.

            And when you email the “Imitation medicine department” to explain how petechiae is ‘bodily assault’ and should be criminalised… let us know how that goes. 🙂

          • As long as we are going off topic into aromatherapy:

            “Did you know that Listerine (mouth wash) was originally created as a surgical antiseptic?
            The active ingredients in the original formula were essential oils of eucalyptus, peppermint, thyme and wintergreen. It was named after Dr Joseph Lister, Scottish surgeon, who discovered around 1896 that by vapouring in the operating room and disinfecting wound with substances derived from natural essential oils, he was able to dramatically cut down post-operative deaths from 50% to 3%.”
            (getting late so I got lazying clipped and paste somebody else’s work. Lister himself used phenol.)

            There is also new interest in “Aromatherapy” in hospitals as several essential oils show effected against MRSA.

          • @Howard Wu

            “getting late so I got lazying clipped and paste somebody else’s work.” So late you can’t even reference the source?

            What you say about Listerine’s original history is perfectly correct. Lister himself, as you state, used phenol as a disinfectant (an antiseptic is a disinfectant that can be safely applied to the skin or other parts of the body). It was with phenol (definitely not an antiseptic), and not essential oils that Lister was able to reduce post-operative death rates from 50% to 3%. Your muddling together of the two (disinfectant and antiseptic) is pure spin.

            Very many essential oils have antimicrobial properties in vitro, and this occasionally translates to (modest) effects in vivo (e.g. Listerine). But you make a big sweep from this fact (spin again?) to embrace aromatherapy, which is a form of pampering with no demonstrable therapeutic effects beyond Tender, Loving Care (TLC). In other words: it’s a placebo treatment. Search this blog for many posts on aromatherapy for information and specific references. Translating inhibition of MRSA growth in a petri dish to a cure of MRSA infection requires more than your hand-waving, unsupported statement about a “new interest in “Aromatherapy” in hospitals”.

          • Ah, yes Mr. Wu. There are a couple of papers that tell of small experiments how aromatherapy enthusiasts found essential oils to kill or inhibit MRSA strains… in Petri dishes! Problem is, people are not Petri dishes.
            Very many things kill bacteria in Petri dishes. Alcohol kills bacetria in Petri dishes but a drinking binge is no good against infection 😀

            For “jm” I was thinking of finding a text on the wound healing process. Fascinating stuff for those who are interested in biology etc. But I found all the texts that came up to be too complicated for him/her. Try reading the Wikipedia article on wound healing. Wery technical. “Vasodilation” is the keyword for the increased microcirculation phase.

          • Frank Odds. I assume you meant to say hand washing and not hand waving in hospitals.

            http://semmelweis.org/about/dr-semmelweis-biography/

          • Why tell me, Bjorn? Send it to the Mount Sinai “Imitation medicine department” to explain how petechiae is ‘bodily assault’ and should be criminalised.

            You could also contact someone about the link Edzard has toward the bottom of the comment section (http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0117146). Apparently, they aren’t familiar with “real GS” either, since it didn’t seem to include “inflicting painful injury”.

            If you’re seriously concerned about “bodily assault” – do something about it. If it’s just to sound alarmist on a blog…just keep going back and forth with me. Folks not willing to get a 10 minute demo from a practitioner might actually believe what you’ve been saying.

          • A journalistic article of a MRSA study in a hospital setting, The orginal may be behind a firewall somewhere. https://samaritanministries.org/blog/essential-oils-used-to-treat-antibiotic-resistant-infections

            Petri dishes are useless for cupping being too shallow but might be used in gua sha cause they have a nice steriliable edge. They are kind of large though.

          • Björn, alchohal turns out to be a very poor antiseptic on the skin or in a glass. It’s continued use while giving injections on cotton swabs may only be promoting a placebo effect.

        • Cupping is not Gua sha. Gua sha is not cupping. Looking at pictures of extravascular effects would show you the difference in effect. In Guasha one attempts to “raise sha” literal translation “sand.” If you create a smooth hematoma you are working too hard. Observation is key to being a good scientist.

          • I hope you do not have reading or comprehension difficulties Mr. Wu.
            No one said Gua Sha or cupping were the same. They are two common forms of injurious quackery. The third, even more common one is acupuncture. Cupping is a suction injury, the other blunt trauma from an instrument applied with scraping force but they produce similar traumatic effects, i.e. they both cause breaks/tears in the small vessels of the skin and extravasation of blood (blood gets out of the vessels where it does not belong). With more force not only blood vessels break but skin and fat cells may be destroyed as well. This will cause even more scarring.
            Many think Cupping affects muscles but that is very seldom the case. For that to happen you have to be very thin and the suction effective. t would also be counter-productive, namely in sports as its effecets would cause sore muscles and hamper performance rather than improve
            Both Gua Sha and Cupping are intended, like Arya Nielsen says, to cause injury in the form of “petechiae” which are small spot-like bruises. I guess that is where the term “sand” comes from, that Mr. Wu says is a translation of Sha. Well, you never stop learning.
            Petechiae is the first or lowest stage of bruising. GS and Cupping can in compromised individuals (e.g. elderly people, steroid treated or those with congenital connective tissue defects, to name some) with undue force produce larger bleedings called purpura or ecchymoses with increasing size. An “hematoma” is technically a collective name for bleedings into tissues.
            The body needs to absorb this blood. Therefore inflammatory processes start that increase blood flow to the area among other effects. To heal something by inflicting an injury of this kind only adds injury to insult and is pure, unsubstantiated nonsense.

          • I thought both gua sha and cupping were intended to relax qi. Rejecting outdated, fanciful concepts like qi is key to rational interpretation of observation.

          • Frank Odds on Thursday 23 February 2017 at 19:04
            I thought both gua sha and cupping were intended to relax qi. Rejecting outdated, fanciful concepts like qi is key to rational interpretation of observation.

            “Relax Qi” isn’t ordinary a meaningful phrase within the terminology of Chinese medicine. Qi is a word used in many context as how Chinese language works compounding monosylable base words. Qi Shui, Qi water, being the words meaning gasoline for example. DaQi would be the sensation invoked by acupuncture needling. Guasha however is more about “Blood” Stasis not “Qi.” Qi and Blood are a yin/yang dualism in this model. As the saying goes, “Qi is the commander of Blood, (though) Blood is the Mother of Qi.” It may be seem as clearing “Qi stagnation” which is perceived as pain. From a western physiological perspective the autonomic nervous system dualism come to mind connecting the circulatory with the nervous system..

            Björn, thankyou for correcting me I meant ecchymoses not hematoma. Or as we would say in class, “itchy noses..

          • Bjorn,

            If that’s what you’ve come up with after “I looked up everything there was to know about the phenomenon.”…. I can only assume that your research into chiropractic, homeopathy, etc. is just as diligent.

            You should supply big grains of salt with your comments.

          • Frank,

            I’ve listened to acupuncturists explain “relax the qi” to patients. It means “it’s relaxing”, like you would use the phrase anywhere else. No big deal. I think we can agree that ”relaxing” is hardly outdated or fanciful, eh?

            But if you’re doing cupping or gua sha and want to communicate to other practitioners (or for your own notes), “relax the qi” could be a useful phrase. (see Howard’s comment ↑) Cupping and gua sha are pretty versatile, and can be used in many different ways.

          • “Cupping and gua sha are pretty versatile, and can be used in many different ways.”

            Especially versatile in their many different ways of prising open wallets.

            Versatile: yes.
            Pretty: yes, as a popular form of street art; otherwise, no.
            Medically efficacious for any known disease: no!

          • Pete Attkins on Friday 24 February 2017 at 17:44
            “Cupping and gua sha are pretty versatile, and can be used in many different ways.”

            “Especially versatile in their many different ways of prising open wallets.”

            Traditionally in Asia these were homebased treatments. Your mom/grandmom didn’t charge.
            Cupping kits are very inexpensive. Coins used for Guasha were recyclable.

          • “Coins used for Guasha were recyclable.”

            As is that quote (I’ll credit my source, of course).

  • yes, that’s about right as a principle – auditory counter-irritation?

  • I disagree. It helps alot and is complementary to western medicine. I find that the pain is similar to a deep tissue massage. I would suggest that you try it and then let us know your thoughts.

  • Gua sha doesn’t hurt and isn’t torturous. Ergo, your argument is invalid. Just as the studies lack scientific proof, so too does your conclusion.

    • Which argument do you believe is invalid?

    • I disagree. Gua sha is painful. I just had my first session. And it is true, the pain stopped the pain of my headache. However, an hour later when the pain from the Gua sha was gone, my headache came back stronger. I get tattoos to mask the pain-it’s the same concept as Gua sha. Speaking from experience.

    • I agree. I’ve been searching the internet for sound research to show effectiveness or ineffectiveness of gua sha. There is certainly a lot of conjecture on both sides but no solid evidence supporting either side. I’m a dyed in the wool skeptic. “Your explanation” is simply your explanation, just as those who support gua sha offer their explanations. Conjecture and anecdote offer nothing in the way of proof one way or the other. The therapeutic effect of gua sha may indeed simply be attributable to the placebo effect; there may be no therapeutic benefits. I would prefer to come to that conclusion through solid scientific method than anecdotes about headaches and knee scraping. Science isn’t a matter of argument. It is a matter of repeatable experimentation.

      • sure – but, as long as there is no good evidence that a therapy is effective, it is wise to categorise it as UNPROVEN.

        • I like Gua Sha a lot. I am treated with it by my chiropractor for chronic back pain associated with myofacial tissue tension, post trauma. I know it’s not proven, but with the pain and numbness I experience daily, the treatment brings blood and oxygen back into tissue that isn’t getting proper flow due to the tension. Western medicine doctors have taken x-rays and oh-so-helpfully offered to make me a narcotic addict to manage my pain, as “nothing is wrong” with me, per their x-rays. So while it may be unproven according to western medicine standards, I’ll take it! Doctors recommend pills, surgeons recommend surgery, and alternative medicine practitioners recommend alternative medicine. None of whom are doing that shit for free. It’s no miracle treatment, but it’s better than drugs. IMO

    • Yes thank you. Gua sha is not painful and if to be considered a distraction then maybe it would be effective for the length of time of the treatment but not for the following days or week, which is how long the ththerapeutic effects can last.

  • I was a skeptic, too. Until I tried it. Also, if you feel great and do it, you will no get the red marks. You only get those if you are tired, a little sick, etc.

    And many people do not find the scraping to hurt at all.

    • @Harun

      I am a skeptic too about this, but what would persuade is not trying it for myself – which would prove nothing – but robust scientific evidence that gua sha has a beneficial effect. That doesn’t seem to be forthcoming.

  • Ever since I was little, my mother would practice ‘Gua Sha’ on me, or ‘Cao Gio’ (in my language). Given that it hurts…although not that badly, it mysteriously works. This scenario has happened so many times: I’d wake up feeling that a cold is coming on, use the ‘Gua Sha’ method with Medicated Oil, and with a little nap afterwards, I’d feel completely normal. The headache would be gone, and with the following days, I’d be fit as a fiddle. I actually believe that this maybe a placebo effect as well (given no scientific evidence), but since this method is working, I’m going to continue using it!

    This topic has interested me for a very long time, if it is in fact a placebo effect… then I must have cheated a lot of colds.

    • Whimsical said:

      it mysteriously works…this method is working

      You may well believe that. Unfortunately, the evidence would not support your belief.

      • Did you not read the part where she said that it may well be the placebo effect? You must have- you quoted the words directly before and after it…. People never cease to amaze with how thick they can be…..

        • Mia

          Yes, Whimsical did suggest it might have been placebo, but still stated that it ‘worked’. I asked for evidence to substantiate those assertions, but none have been forthcoming. If he/she is convinced placebo effects are the only the reason it works, then all he/she has to do is say so.

          But perhaps you have some good evidence of specific effects one way or the other?

  • Some view gua sha as folk medicine, but the scientific research community may beg to differ! Researchers from institutions like Harvard and Beth Israel Medical Center are demonstrating both efficacy as well as offering insight on why gua sha works. A study published in a 2011 edition of Pain Medicine demonstrated that gua sha decreased pain for chronic neck pain sufferers, noting that “neck pain severity after 1 week improved significantly better in the gua sha group compared with the control group (heat therapy).”

    Researchers have used various techniques, including Doppler images, to show that microcirculation is indeed increased in the treated area, therefore decreasing both local and distal areas of pain. In the mice model, gua sha was shown to influence an enzyme (Heme Oxygenase-1) that has a protective antioxidative effect in the cells. An interesting case study showed gua sha decreases inflammatory markers of a patient with liver injury due to Hepatitis B, suggesting gua sha may even have a protective effect on the liver. As is the case for most healing modalities in Eastern Medicine, modern science has yet again validated the effectiveness of this ancient technique.

  • A friend of mine recently had this performed on her but now a couple days later the neck pain is still there. I’m a skeptic of most “ancient Chinese arts” so I poked around and found this article but unfortunately I lack the medical background to analyze the results.

    http://www.pacificcollege.edu/acupuncture-massage-news/press-releases/1198-the-science-of-gua-sha.html

    Any thoughts?

    • Did anyone find out why her neck was hurting? Gua sha will not help if the pain was caused by pressure to the nerve or spine, for example. It will work on tension knots, but only if the knots are properly dissipated. If the pain was reflected from somewhere else, the treatment needs to have been applied to the actual site of the problem as well.

      If the treatment does not raise the red millet like “sha” and if she did not feel a significant relief of the original complaint within 10 min, it was likely not a thing gua sha was going to fix. In Asia we’d stand up and demand our money back for misdiagnosis.

  • If you use cough drops to treat a flu and don’t get better, does this mean that cough drops are ineffective? No! It’s only evidence that cough drops are ineffective against flus. No medicine is a cureall, they all need to be applied to the right things in the right way.

    Whether or not gua sha will work for you depends heavily on what is wrong with you. Gua sha’s chief action is in (temporarily) aggressively encouraging circulation to targeted areas. Its use in pain treatment is hit and miss because what is causing the pain may not necessarily be best treated by the stimulation. In circumstances where it is an appropriate treatment, patients generally experience immediate relief of some degree of the original complaint. The treatment can be painful varying between severity of the condition and the patient’s physiology. but pain from the treatment does not last beyond the immediate application. The area treated may be slightly tender to touch like an old bruise up to the second day, if the session was aggressive. Again, this does not last. But neither are the effects of the treatment if administered alone. Naturally if the root cause of the problem is not fixed, the symptoms will come back.

  • I just had this treatment and would not recommend it to anyone. I was not told how painful it would be but was told I would have a rash for up to five days but the rash would not bother me at all. I am now covered in what I feel are numerous blood blisters and bruising, after 24 hours my skin feels hot, sore and uncomfortable. I think there is some relief from my lung and sinus congestions and am hoping for more improvement. In the past I have had accupuncture and cupping done and found them to be very effective with non of the pain and side effects which I am now experiencing.

  • my right leg a bit longer than other which throws my back of balance. this causes serious tension under my left shoulder blade, also my left shoulder is always higher than right and i’m not able to relax my left shoulder nor to keep my shoulder on the same height as the right one. sometimes tension gets really really bad and i get sever ache under my left shoulder blade and i’m unable to sleep. i’ve been to many different professional masseurs for long sessions every week, it feels nice, but i’ve never been able to relax my left shoulder nevertheless. then without any expectations i just for fun took first gua sha session – and believe it or not after 15 min of gua sha for the first time in 30 years i was finally able to relax my shoulder muscles, my left shoulder first time EVER dropped to normal position and also i felt my head clear up, i felt like flying!!! it was incredible!! i’ve never felt so light and happy and energized!! it was simply amazing!! yes, bruises on and around the left shoulder blade were very very purple, but no other part of my back showed any reddening. bruises appear only on the spots which are sick of tension and strain. after that i went for gua sha treatment once every week, after seventh time no bruises appeared anymore, also my muscle pain and tension was COMPLETELY gone. now i go once over four month to one session treatment, and i have no bruises at all. if some reddening appears, i go back after a week, and then it’s usually sufficient.

    i also have to clear up that misunderstanding – gua sha treatment is not painful at all.
    if your back is okay, no bruises will appear, many of my friends have taken this session and have no bruises at all, or then only few little spots on parts of the back, which have given them muscle pain.
    also before my first gua sha treatment i didn’t mention i have any specific back pain, so one can’t say that this shoulder blade was treated differently for bruises to appear. i sincerely recommend to try gua sha for aching back muscles. try yourself at least once and then you know what i’m talking about.

  • The first time I saw this phenomenon[sic] was when I operated a Korean man for complicated appendicitis many years ago in Sweden. He looked like “God help me!”, with bruise-streaks all over his body (see linked picture from wikipedia below) from the heavy-handed stroking with a coin. I did not know about GS then and my first thought was actually to call the police.
    His family had tried to rely on Gua Sha to cure his increasing abdominal pain. He was very sick and might have died from the complications. He was hospitalized for quite a while and had a long recovery. Had he sought proper medical attention for his appendicitis a day or so earlier he would probably have been back to work in a few days. On top of the injury and infection from the burst appendix, his system was loaded with cleaning up all the blood in his skin and subcutaneous tissues. That put an extra load on his kidneys, which might, in combination with the need for massive antibiotics and the toxic effects of infection, damage the kidneys (http://en.wikipedia.org/wiki/Acute_tubular_necrosis#Toxic_ATN).

    A picture of a (real) Gua Sha victim:
    http://upload.wikimedia.org/wikipedia/commons/thumb/e/e4/Gua_Sha_Massage_Aftermath.jpg/678px-Gua_Sha_Massage_Aftermath.jpg

    I guess everyone can agree that Gua Sha can seem to work for pain that is self limiting. It makes a pain go away in just one hour that would otherwise take all of 60 minutes to disappear (frivolous joke).
    But the pain and soreness of the bruises may linger on. Those who claim that Gua Sha is not painful in itself are victims of charlatans who pretend to be using this method but only apply light strokes.

    No-one would dream of advocating blood letting today, but that is just as old and tried and traditional.
    Those who practice Gua Sha today should be prosecuted for bodily assault. Those who practice sham GS like some of the people seem to be recounting above, should be prosecuted for fraud.

  • All the people above who think Gua Sha is a sham need to stop thinking about their “personal experience” or things they have seen and possibly look to commence a study on it and prove that it works/doesn’t work. For all you doctors whether you’re a medical doctor or have a PHD, MD etc should all understand that to get an proven answer you need to test it so instead of providing an opinion on here, why not come up with a hypothesis and test it? Your opinion will always be just an opinion, it does not prove anything.

    From my personal experience, Gua Sha hurts. My mother does it for me when I’m unwell, she is not heavy handed and my back does not end up looking like some of the horrific photos you can find on google and somehow, I do feel better after and have no further pain to my back.

    I agree with Yun, you cannot expect Gua Sha to fix every problem, it is specific to what it can fix just like some hay fever tablets can only help people who are allergic to certain types of pollen but not ALL types of pollen.

    If you aren’t scared, try it. If it is too painful, ask the practitioner to soften it, like how you can when you get massages. Common sense.

    • Sounds like a good massage to me. That often works wonders for an aching back. Good massage can hurt some, when the masseur hits the tender spots. Massage that does not do this is worthless in my experience.
      From what I have read and seen, Gua-Sha is supposed to leave prominent trauma in form of ecchymoses i.e. bleeding into the superficial tissues. If it does not do that, it is not defined as Gua-Sha. You have a good mother seeing as she gives you good massage but does not inflict trauma at the same time.

  • I got something similar to what the the picture of Björn shows done to me in combination with acupuncture and the whole thing hurt like hell. The resulting red marks took roughly a week to vanish, but only the initial thing hurt for me. The red marked areas did not hurt or feel anything unusual and I was feeling much better than before the treatment already on the next day.

    My personal theory is it works because it’s how the body work. If you consistently perform muscle training then you’ll get muscle ache, and then the trained parts will grow stronger. If you run often you’ll get a better condition. The body is a lazy piece of shit and won’t do anything unless if given a shove and this is just what’s being done. It’s being made to fix whatever those red dots that appear on the skin following the “treatment” and those parts gets better blood circulation and whatever other benefits that comes with that. Simple.

  • I believe the original argument is true, but lacks veracity. The argument is compelling, but simply lacks the the body of evidence to draw the stated conclusion. Saying something is “obviously effective” because of a couple limited case studies (as the 40 patient groups suggest) is foolish; saying it is completely invalid because the study was so small is equally ludicrous.
    That said, I am a TCM practitioner. I have used GS in treatment. I resent the suggestion that I do it to bilk money out of unsuspecting/gullible morons who are too stupid to know if their pain goes away or not. It is like saying a heart surgeon doesn’t really need to charge that much just to make a couple of incisions. Heck I can do it with a jackknife, but if I am the one in need, I want to go to a heart surgeon who is truly qualified. And this brings me to my point in responding to this inflammatory post: TCM practitioners should have the same rigorous training a typical medical doctor receives. (Mine has spanned 30 years.) To us GS on an appendicitis is criminal, just as much as if you went to the doctor and he gave you a heart bypass for it. Neither will effectively treat the condition. BUT that said, to say GS is stupid and ineffective, is like saying that heart bypasses are fringe medicine that should never be performed.
    Simply put, to add my voice to those of reason who have posted before, whether you believe it or don’t, let’s get some scientific research done by qualified practitioners and analyze the results.
    I will even volunteer my services in the testing.

    • @L.A.C.

      On the face of the available evidence, it would appear that GS is BS – unless you have some good evidence to the contrary, of course? But presumably you don’t, given your call for some ‘scientific research’. But if you are admitting there is no good evidence for GS, what is it you are charging your customers for?

      • I’m curious as to your premise. GS is BS by default, prove otherwise. And the Earth is flat. I can’t see it being round; I say the pictures from space are faked (hey I can Photoshop an image too). But that would be silly. Overwhelming evidence shows the Earth is round etc.etc. Of course you are out of hand discounting more than a thousand years of TCM and any research that shows it may not be total BS. After all, who can trust the Chinese when they test such things, given a strong history of cultural bias, unlike those in western medicine. What I am suggesting is a study involving thousands and not tens. Do you honestly believe modern drugs are tested on a dozen people before they are released to the public?
        As for what I charge for, well for your information, if the customer does not feel relief, they do not pay me. I will not charge if I cannot help. But even if it is simply a placebo effect (which I strongly feel it is not) then it would be no more criminal than a fortune teller or psychologist IF no further damage is done AND no serious medical condition is overlooked or mistreated. That is my contention with many TCM practitioners. The TCM may be sound, but it can still be misused. (Like prescription drug abuse.) But the title of this thread is “Torture or Treatment”, not skill or even integrity of the practitioner. By definition, it is treatment (there are much more effective torture methods, see water-boarding), the real question is “is it an effective treatment, or simply charlatanism?” To answer that requires large scientific studies (as in blind and not seeking to prove or disprove from the onset as is the case with much Chinese research and sadly much western research of TCM).

        • L.A.C. said:

          I’m curious as to your premise. GS is BS by default, prove otherwise.

          See above. Of course, if you have any good evidence that GS isn’t BS, please provide it.

          • I assume you are being factious. You clearly are not asking my to list every Chinese medical text in which it appears since the second century. Unless your Chinese is much better than mine and you are simply poking me. A simple Google search shows a bazillion entries on the topic. And numerous books on TCM refer to GS. But you are discounting them all out of hand – certainly you have searched the web as anyone could and discounted everything as unreliable – and perhaps rightfully so. So let me offer this, a bazillion idiots (including myself) have some belief in this stuff, wouldn’t you like to point to a study involving a few thousand people and say with some credibility we are all morons? A case study with a couple dozen people proves nothing – hey David Koresh convinced more than that he was God. (If he was, then perhaps we should rethink everything – until then I want a serious scientific study on GS. And, I will keep doing it if my clients tell me it helps them.)

          • L.A.C.

            We seem to have different ideas about where the burden of proof lies and what constitutes good evidence.

            But if you’re saying that a good quality trial is still needed, do you think GS practitioners should stop what they’re doing until there is that good quality evidence?

          • Copying and pasting from above, since apparently the critics would prefer to ignore it, rather than respond.

            Researchers from institutions like Harvard and Beth Israel Medical Center are demonstrating both efficacy as well as offering insight on why gua sha works. A study published in a 2011 edition of Pain Medicine demonstrated that gua sha decreased pain for chronic neck pain sufferers, noting that “neck pain severity after 1 week improved significantly better in the gua sha group compared with the control group (heat therapy).”

            Researchers have used various techniques, including Doppler images, to show that microcirculation is indeed increased in the treated area, therefore decreasing both local and distal areas of pain. In the mice model, gua sha was shown to influence an enzyme (Heme Oxygenase-1) that has a protective antioxidative effect in the cells. An interesting case study showed gua sha decreases inflammatory markers of a patient with liver injury due to Hepatitis B, suggesting gua sha may even have a protective effect on the liver. As is the case for most healing modalities in Eastern Medicine, modern science has yet again validated the effectiveness of this ancient technique.

          • Jason said:

            Copying and pasting from above, since apparently the critics would prefer to ignore it, rather than respond.

            LOL!

            Researchers from institutions like Harvard and Beth Israel Medical Center are demonstrating both efficacy as well as offering insight on why gua sha works.

            When they publish their findings, please be sure to let us know.

            A study published in a 2011 edition of Pain Medicine demonstrated that gua sha decreased pain for chronic neck pain sufferers, noting that “neck pain severity after 1 week improved significantly better in the gua sha group compared with the control group (heat therapy).”

            For some reason you didn’t provide a link, but can you confirm it is this one? Effectiveness of traditional Chinese “gua sha” therapy in patients with chronic neck pain: a randomized controlled trial. It was easy to find because it’s one of the ones Prof Ernst has already dealt with in his blog post. Perhaps you missed it.

    • @L.A.C.

      To us GS on an appendicitis is criminal,…

      Please tell us L.A.C. Are TCM practitioners like you, experienced and trained in recognizing the signs and symptoms of appendicitis and other serious causes of pain?

      How many TCM practitioners have been criminally prosecuted for delaying the diagnosis of serious diseases?

      • I cannot comment on the training others have received or their ethical standards. Just as you cannot comment on the skill and training of every WM doctor. Yes, one would hope that every WM doctor was trained to the highest standards. But in reality, we all know some doctors are better than others. Some schools are better than others. Some countries train their doctors better. Many factors are involved. The same is true of TCM.
        As for me, I possess degrees in biology and zoology. I have extensive training in anatomy, including prosection (which is nothing to a surgeon, but more than many TCM practitioners ever get). On many occasions people have come to me seeking TCM remedies and I have told them to go to the hospital. It is always better to err on the side of caution. GS, or really much of anything short of surgery will not fix some problems. BUT when someone comes to me having received the diagnosis that they will simply have to live with the pain, that surgery is not required or recommended, and that they can take painkillers (sometimes very strong ones) to deal with it, then I am willing to try. And if they feel better after, please tell me where is the fault? If it is a placebo effect and they don’t have to take Oxycontin for a few days, good. I am cheaper than the drugs and don’t have side effects. Of course, you are speaking here specifically about GS. Which I would list as having a side effect. This muddies the water a bit. And so again, I call for non-biased research.

        • @L.A.C.
          Perhaps you wish to participate in a clinical trial of Gua Sha? We will need non-biased Gua Sha practitioners and non-biased volunteers for the treatment arm. Please send Prof. Ernst your details so we can be in contact when the trial starts.

          On a second thought…
          IMaybe it can prove a bit difficult to obtain the necessary approval from the ethics committee. Do you have any suggestions on where or how we might get an ethics approval for doing a Gua Sha trial? I mean the real thing with prominent red and blu marks all over, not some gentle massage or Bowen-like fondling which seems to be sold as Gua Sha by many practitioners. Maybe in some third world country if we pay them a small fee on the side?

          • Yes, actually I would like to participate in such a study and could think of a few other practitioners who would as well.

            Your second thought is also well founded, however getting approval for human tests are always difficult, but in this situation this treatment is already being given in many places in the western world. IF it is dangerous, then it should be stopped, and testing could bring this to the attention of the appropriate body. IF it is not, then its effectiveness can be tested. Simple.

            I will send contact information to E.E. I have little hope that the testing will be done, but I have been surprised in the past.

          • I am not doing clinical trials ant more
            sorry

          • @L.A.C. Try looking up “verbal irony” or even “sarcasm” on the net and then read my post again 3:) Maybe you will understand it then?

  • The link to Arya Nielsens website FAQ section in Edzard’s post above is faulty. It should be: http://guasha.com/faqs/
    Arya Nielsen seems to practice in New York and be heavily experienced in all sorts of TCM phenomena: http://www.healthandhealingny.org/center/staff_nielsen.asp
    Her version of why this works: http://guasha.com/about/what-is-gua-sha/
    The link to the FAQ section is very important as it points to her collection of indications, which include “…common cold, flu, bronchitis, asthma, as well as any chronic disorder involving pain or inflammation”.

    Here’s another preposterously boastful declaration about the effects of Gua Sha:
    http://www.radianthealthstrategies.com/other_gua_sha_remedied_albuquerque_nm.php
    Notice the disclaimer in minute text at the bottom.

    Now let’s think very open minded about what Gua Sha (GS) really is. GS involves stroking the external tissues heavy handedly. That is usually called massage. GS involves taking massage one step further and at the same time as the tissues are massaged, a superficial injury, the “Sha” is inflicted, which is in fact bleeding into the skin and underlying tissues. To facilitate this, a semi-sharp edge is used for the stroking such as the edge of a coin or a spoon.
    Usually, massage is performed bluntly with the fingers hands or whatever, without(sic) causing injury. It helps releasing tension in the muscles and mobilizing extracellular edema and thus restoring blood flow in aching, knotty muscles. (This sounds much like the jargon of TCM 🙂 )
    As I have said previously, massage for muscle problems needs to be somewhat forceful to have any effect on afflicted muscles. Light handed, superficial massage and manipulations (e.g. Bowen therapy) are in my experience useless for anything but a nice, soothing relaxation at best. Many people who feel ill need soothing relaxation but it does nothing for aching muscles. As a surgeon I have a fair amount of first hand experience with aching and tense muscles after long days of, often ergonomically unsound, operating sessions. a good masseur is a godsend sometimes.

    OK… GS is heavy handed massage with added superficial injury and sometimes quite serious injury at that. GS without the injury is not alternative medicine. It is massage, right? GS without massage (i.e. only bruising) ? Anyone want to guess what that should be called? Let’s be unprejudiced and just call it injury.

    So the difference between massage and GS is the infliction of injury. Is injury needed for any added effect?
    @ARW who relates in a comment above, a classical example of a TCM receiver being misled into thinking it was a magical effect of some mysterious ancient art that cured his/her aching muscles. No, I do not think it was the bruising that did it. In my (educated 🙂 ) opinion, the bruising, which seems to have been thoughtfully modest, only served to add “theatrical placebo” to effective massage, which is what he/she needed in the first place. I hope that he/she will understand this and go to a real masseur in the future instead of a conjuring practitioner who takes money for inflicting unnecessary injury and telling tall stories of the power of unproven phenomena.

    Now, how about safety? The seriously experienced, NY-based TCM practitioner Arya Nielsen, who also sells teaching material so that others can learn to bruise for money, says on her web that GS is safe.
    Is it really? Does anyone know? I certainly do not believe in the safety of inflicting wide spread bruising.

    Let’s play with the thought that Arya Nielsen had invented GS as an additive to massage and started bruising her massage patients without any appeal to tradition or authority. I would be surprised if she had not been prosecuted for any number of reasons. I think we can agree that the evidence for a beneficial, medical effect of bruising is extremely thin, as EE has pointed out.
    On the contrary, injury (other than properly performed surgical procedures of course 😉 )has never been shown to be beneficiary to the body, right?
    I for one am at a loss to understand why a method of inducing physical injury can be exempt from criminal prosecution only because it is said to have originated in an era when nobody knew the first thing about physiology, anatomy or effective medicine?
    Anyone know what the FDA says about GS? I do not at present have the time to find out.

  • @Bjorn Geir (my apologies to not typing out your name correctly)
    From reading your posts, you seem to be a smart person who is genuinely concerned with weather or not the practice of Gua Sha is safe for us. I have a couple of questions and in no way am I trying to be smart mouthed or sarcastic. First; have you ever personally dealt with chronic pain? Second; when you say “effective medicine” do you mean pharmaceuticals?

    • @ L. K.

      From reading your posts, you seem to be a smart person who is genuinely concerned with weather or not the practice of Gua Sha is safe for us.

      Thank you for the implied compliment. No, I am not concerned whether Gua Sha (GS) is safe for us. I know that it is not. I am concerned that simple minded charlatans are allowed to propagate such nonsense.

      As I have pointed out before, there is a very important prevailing misunderstanding about what constitutes GS. Real GS involves inflicting painful injury. If not it is not GS. Any practitioner who pretends to perform GS without producing painful bruising is only performing massage.
      GS is not medicine. GS has never helped anybody. GS is unwarranted unproven theatrical placebo left over from medieval torturous quackery. Its practitioners should be prosecuted for harming their misinformed clients.

      Massage is medicine. It can be soothing and healing. Let me know it from repeated personal experience after long and difficult operations. It works every time! GS is injury. Let me know that from decades of experience of trauma and from seeing actual cases which were harmed by GS.

      First; have you ever personally dealt with chronic pain?

      Yes. I have chronic, incapacitating arthritis, mostly in my hands. It hurts every day. Even writing this on the computer keyboard tells me which finger joints are acting up today.

      Second; when you say “effective medicine” do you mean pharmaceuticals?

      Yes. Without my daily dose of NSAID I would not be able to use my hands for anything. Tried to stop it many times. It enables me to live a somewhat active life.

      And if you want to ask me if I have tried alternative therapies the answer is also yes. I have been through the anguish and desperation of loosing my ability to work with my hands and thereby my self esteem as a big-shot surgeon. I spent endless hours studying therapeutic possibilities and even trying this and that.

      If you can cough up something that works better than NSAID and the usual simple things like heat, rest and healthy lifestyle, then please tell me about it so I can have a look at it. That is to say if it does not involve bodily harm like GS. Anything to be free from pain. Well, not exactly anything, I think we will skip anything involving enema’s 🙂
      You can safely skip essential oils, prayer (my mother in law’s), shark cartilage, acupuncture, coconut oil, glucosamine, chondroitin, avocado soybean unsaponifiables, tiger balm, capsaicin cream and chiropractic (I am glad he didn’t tear my vertebral arteries. The income-centric subluxationist charlatan insisted on cracking my neck every time even if I had no symptoms!?)

      • Wow, this is just sad. It’s easy to call something quackery when you’ve never experienced, performed, or have any understanding of the philosophical/scientific (and I say scientific because it has been studied in other Asian cultures) feats behind it. Before you get your panties in a twist, realize that I am in no way defending what is true or not true relating to gua sha. But I find it unscientific to say that there is no potential in this type of treatment due to lack of understanding. That’s just hogwash. Every type of treatment in our modern view of medicine has gone through some type of skepticism. Some of it is still producing skepticism.
        “GS is injury. Let me know that from decades of experience of trauma and from seeing actual cases which were harmed by GS.”
        So you are saying that any type of treatment that is known to cause human injury and harm should be reconsidered? That’s the entirety of medicine! Even Surgery (in your own profession). How many people have been injured, severely suffers, or died from your own judgments? none? unlikely.
        I know there is high praise for NSAIDS but pharmaceuticals most likely have the highest rate of side effects, dependency, and death/overdose. Doesn’t make such a great argument now does it? Could the pain be reduced? certainly. Could you feel a difference? perhaps. Could it be placebo? possibly. Would an everyday person notice a major difference from how they were before? maybe, maybe not.
        The point I’m trying to make (may or may not be succeeding) is that all medicine is not warranted for all cases. All treatments are going to have different outcomes (even as unintended outcomes). Does that make it all perceptible to skepticism? I sure hope so. Does that make it all safe? Absolutely not. Does that make the recommended treatment the correct one? No. What does this all come down to? human capability and variation I suppose. Everyone’s body is different and will react different to all treatments. Will similarities occur? Sure. But correlation isn’t proof of cookie cutter medical treatments. Let’s also not forget the variation of trained practitioners and human error. All practitioners will have human error – enough said. Every practitioner will have a varied approach due to their own personal beliefs of what does and does not work in certain instances. Thank you human mind and emotion for letting everyone have individual thought and allowing people to understand ideas and beliefs to different lengths and variations.
        In the end, the idea of gua sha is no more “ridiculous” than any other type of treatment. If people want to try it that is their choice to make. If people want to believe in it than they certainly can. Should we ban the use of a treatment that people find helpful? maybe maybe not. I would hope not because we all know they will do it anyway. It’s really not any different than an old western home treatment of rubbing (I think it was a nickel?) across the back to promote healing, circulation, and reduce symptoms of illness. Are there medical studies on that old treatment? Unlikely but who knows. Just because we don’t understand something, doesn’t mean it is not helpful in some way. Will things be misused? definitely – look at surgery and pharmaceuticals once again for that statistic. But we don’t quickly discount those do we? I think we are all capable of making our own medical/treatment decisions. Would it be nice if there was more information relating to gua sha? sure. But I don’t feel like looking up and translating it. And others probably don’t find it to be a popular enough source to make the work worth it. That doesn’t mean I will be discrediting this treatment either. That just makes me more curious of how it works, what it’s purpose it, how specific the work gets, and a lot more questions that are sure to fire in my brain in a nonsensical way.

        On another note: could you please refrain from using the word masseur to generally define massage therapists? Masseur is 1) a male specific term and 2) has a sexual implication that is unethical and frowned upon in the massage profession. Thank you.

        Sorry if my thoughts and delivery of said thoughts came out jumbled – it’s been a long day and I have several distractions. Even though I just stumbled upon this website by accident while looking up some information about gua sha, I hope I don’t have to discount this web page to be another “beware of quackery without based on hearsay and opinion website”. Science is not perfect. And this is not an unreal until proven real (or guilty until proven innocent) type of thing. You find it useful or you don’t – but that gives you no reason or right to discredit anything to the public. In the end, you are basing your information off the same stuff – It’s all about how that data is perceived and used.
        Good day to you.

      • Björn – I can easily cough up something that has worked better than NSAIDs for chronic, incapacitating arthritis in the hands. Gua sha. You do have to perform it correctly, however – not the way you’ve been describing it. No belief system is needed, just proper technique and actually doing it. And, no injury. That is not how gua sha works.

        Learning how to scrape (gua sha) your hands and fingers would take about 15 minutes, and the equipment would cost between $1 and $1.50 (for a ceramic Asian soup spoon). Unless you already have one. Then it’s free.

        If you’re waiting for western scientific proof that it works…I wouldn’t hold your breath. If you want to get out of pain, email me.

        • @jm
          I am tempted to believe this is an attempt at a humorous posting.

          If you’re waiting for western scientific proof that it works…I wouldn’t hold your breath. If you want to get out of pain, email me.

          I suspect I would have to wait for a long time for eastern, southern, northern or any kind of (credible) evidence, scientific or whatever?

          Do you believe in fairies too? There’s a lot of “evidence” of the existence of tooth fairies. Just look at all the anecdotes.

          Get a real life “jm”.
          It is dishonest to pretend you can cure or help anyone with this kind of nonsense.

          • @Björn – I tend to avoid getting involved in discussions like these, as it usually devolves into a childish “Do you believe in fairies too” type of discussion. And predictably, here we are.

            I couldn’t help posting, though – after reading about your arthritis. I’ve seen it (gua sha) work many times – not as a cure, but as a treatment that allows people to use their hands again with a minimal investment in time and effort.

            That said, the time and effort investment is key. This isn’t a “take this pill and you’re done” type of thing. You would have to spend 10 minutes a couple of times a day, paying attention to what you’re doing. My clients find the investment worth it.

            As far as “It is dishonest to pretend you can cure or help anyone with this kind of nonsense.”, I’ll pass that along to my arthritis clients that are doing scraping (gua sha) at home. I seriously doubt they’ll stop scraping – as they enjoy the mobility and function too much. And yes…totally anecdotal. Real people getting out of real pain, in the real world.

      • I use systemic enzymes. Pain Power is one i use for acute flare ups. I have the beginning stages of arthritis in my fingers from 12 years of performing trapeze and 6 years of massage (those 6 years were while I was an acrobat). Some people are trying to disprove of it. I didn’t believe until it helped take the pain away from a sprained back after 2 weeks of NSAIDS and the start of a burning stomach. The NSAIDS did not help the pain completely but the Pain Power did. I also cut out extra sugar and try to not eat things that will increase my whole body inflammation. Stretching is also a savior. Same days I have to stretch it away for 2 hours but it beats taking meds and getting a burring stomach. Massage is definitely invaluable.

        • @kim
          Delighted you are finding ways of alleviating your pain. Please read through some of the threads on this blog. The toughest thing for any of us to understand is that subjective experiences and testimony are not evidence for the efficacy of anything. In your own case, you’re cutting out sugar, stretching (for remarkable lengths of time) and taking Pain Power. Imagine how you might go about finding out which of these three really improves your problem. How do you know the source of flare-ups is not something completely different, perhaps something subtle, you haven’t even thought about? How do you know the relief is not coming from something other than the diet, stretching and Pain Power but you haven’t noticed it? Do you realize that most chronic pains fluctuate in severity regardless of what you do about it?

      • http://mobile.abc.net.au/news/2008-03-18/bamboo-bashing-a-hit-with-the-stars/1076896

        this technique, which is similar to gua share, cures my arthritis in hong kong.

      • You are an alien. You are not from planet earth but some where from outer space.

  • “Injury has never been shown to be beneficiary to the body, right?”
    We routinely apply stress to our body to build up resistance to even bigger stress. Weight lifting tears down muscle fibers to build more muscle. Is that self-inflicted injury? Sun tan is the result of the production of melanin in an attempt to protect the skin from further UV radiation damage. Is that self-inflicted injury?
    “GS has never helped anybody. Its practitioners should be prosecuted for harming their misinformed clients … Let me know that from decades of experience … from seeing actual cases which were harmed by GS.”
    Which cases have you reported that were harmed by GS?

  • Our purpose is to dispel ignorance. Educate yourself.

    he Science of Gua Sha
    |
    By: Arya Nielsen, PhD

    Traditional East Asian medicine (TEAM) has come some distance to us: more than 2,000 years of history, a scholarly archive, and many ‘barefoot miles,’ to now be situated in professional clinics and labs of research globally. Gua sha is a modality used across Asia both in the clinic and in the home and now in the West. Gua sha is a part of acupuncture therapy, but not limited by law to acupuncture practice. Research into the physiology of therapies like acupuncture and gua sha qualifies what the ancients ‘knew’. With respect for those who have given us this gift, science works to clarify both benefit and risk of our medicine.

    When I began practice 36 years ago, I was trained in East Asian medicine but had no training in research and there was zero access to research facilities through acupuncture schools. Many years later I consulted Helen Langevin, MD about my interest in researching the biomechanism of gua sha. She advised starting with basic science: what can be used to establish a measure of change that might inform what is actually observed? I mulled this over and looked for a doctoral program that would support my research interest. I matriculated to an academic PhD program, and through a chance meeting at my job at Beth Israel Medical Center in New York, was invited by Dr. Gustav Dobos to conduct research on gua sha at the University of Duisburg-Essen in Essen, Germany. There we performed one of the first investigations on the physiology of gua sha: measuring changes in microperfusion of surface tissue [1]. From that first investigation have come other biomarker studies; we now have something to say about the science of gua sha.

    Gua sha increases surface microperfusion

    Gua sha produces transitory therapeutic petechiae that represent extravasation of blood in the subcutis. Using laser Doppler imaging, we scanned 11 ‘healthy’ (but stressed) subjects (doctors and nurses who worked at the Kliniken Essen) who had ‘normal’ myalgia pain and evidence of ‘sha’ based on palpation. We established a baseline scan for each subject before gua sha, and then scanned each subject 10 times, once every 2.5 minutes following gua sha, and then performed a follow up scan 2 days later.

    We found a 400% increase in microperfusion (surface circulation of blood) for 7.5 minutes following gua sha, and a significant increase for the full 25 minutes following treatment that was studied. Scans returned to baseline at the 2-day point. Every subject experienced a decrease or complete resolution in pain and a sense of well-being. We published the study [1] and it was the basis for my doctoral dissertation [2].

    During this same period, access to the Chinese language database became available to me online through the Kelley Library at the New England School of Acupuncture (NESA). I downloaded and translated 120 articles on gua sha. By 2011, that number increased to over 500 studies. These articles establish how gua sha is used in China and are analyzed in my revision of the gua sha book due out this year [3].

    Then in 2009, a breakthrough study on the physiology of the anti-inflammatory and immune effect of gua sha was published here in West.

    Gua sha’s immune and anti-inflammatory effect: heme oxygenase-1

    Providers familiar with gua sha know that it can reduce a fever and alter the course of an acute infectious illness, as well as reduce inflammatory symptoms in chronic illness. A group at Harvard used bioluminescent imaging with a mouse, and showed that gua sha upregulates gene expression for an enzyme that is an anti-oxidant and cytoprotectant, heme oxygenase-1 (HO-1), at multiple internal organ sites immediately after treatment and over a period of days following gua sha treatment [4].

    HO-1 and its catalysates (biliverdin, bilirubin and carbon monoxide (CO)) exhibit not only anti-oxidative but also anti-inflammatory effects [5]. For example, augmentation of HO-1 expression attenuates allergic inflammation. HO-1 plays a protective role in allergic disease in part by inhibiting Th2 cell-specific chemokines [5]. This work by Kwong’s group is the first to show an immediate and sustained immune response from a traditional East Asian modality that has direct relevance in the healing of ‘internal organ’ and inflammatory problems.

    It is also known that HO-1 regulates cell cycle and anti-smooth muscle hyperplasia, providing protection in many disease models, such as asthma, organ transplant rejection, inflammatory bowel disease and experimental autoimmune encephalomyelitis, even though the immune pathological mechanisms of these diseases are dissimilar [5].

    And then there is hepatitis. Gua sha is used in China to treat symptoms of acute and chronic hepatitis [3]. Induction of HO-1 results in decreased hepatitis C virus (HCV) replication, as well as protection from oxidative damage, suggesting a potential role for HO-1 in antiviral therapy and therapeutic protection against hepatocellular injury in HCV infection [6]. Moreover, the role of gua sha in the treatment of active chronic hepatitis B has begun to be elucidated. Here too the upregulation of the enzyme HO-1 has been reported to be effective in the control of hepatitis B virus (HBV) infection and offers hepatoprotection in animal models [7].

    Gua sha in the treatment of chronic active hepatitis B

    Manual therapies like gua sha may be useful for many conditions, but may become essential clinical options particularly for what are called ‘gaps in care’, i.e. when patients cannot or prefer not to take medicines for a problem, or when those medicines fail or are not available. It is well known that chronic hepatitis is a difficult condition because of the inflammatory breakdown of the liver over time that can cause illness and even premature death. Medications for the treatment of hepatitis are limited in scope and carry uncomfortable or intolerable side effects.

    Back in the U.S., at Harvard/Mass General in 2011, Chan et al. described a case where a single gua sha treatment in a patient with active chronic hepatitis B reduced levels of liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST), modulated T-helper Th1/Th2 balance and enhanced HO-1, which they suggest is responsible for the hepatoprotective effect [8]. In this case, and in general, Gua sha may be effective in transiently reducing the inflammatory injury to the liver when chronic hepatitis B moves into the immune active phase indicated by a liver function test. While Chan et al. represents one case, it coincides with both evidence from China and with what is already known about the effect of upregulation of HO-1, and that HO-1 is upregulated from gua sha.

    Larger trials are needed to establish to what degree and at what dosage/frequency gua sha may be hepatoprotective in patients with active hepatitis. Is it the case that treatment every week or every other week, with other liver sparing dietary cautions, will reduce inflammatory injury to the liver and return a patient to ‘inactive’ status? If the research bears out, gua sha will have an essential role in managing chronic active hepatitis. One could say if it were a drug, establishing this effect would be considered a medical breakthrough.

    Evidence-based research: other conditions responsive to gua sha

    Historically, gua sha has been indicated for any problem that has a feature of surface or internal blood stasis and/or pain, which means in classical Chinese practice in the tradition of Dr. James Tin Yau So, every patient is checked for sha. The articles and studies from the Chinese language database cover an array of conditions responsive to gua sha including headache, migraine, neck, shoulder, back, and knee pain, as well as acute diseases such as fever, flu, earaches, asthma and bronchitis in children and adults. Gua sha is also effective in chronic disease including hepatitis, as discussed above. The bulk of the Chinese articles are large case series as well as randomized controlled trials [3]. However, studies done in China are still subject to skepticism by some unless repeated in the West [9].

    And now there is evidence in Western peer reviewed journals. There are case reports in of gua sha for migraine [10], post herpetic neuralgia [11], and breast distension/mastitis [12] as well as randomized controlled trials reporting gua sha has benefits in treating neck pain [13], neck and back pain (forthcoming) and breast distension/mastitis [14].

    Summary

    In the last decade, research has begun to clarify how gua sha works. Gua sha’s therapeutic petechiae represents blood cells that have extravasated in the capillary bed, and measure as a significant increase in surface microperfusion [1]. As this blood is reabsorbed, the breakdown of hemoglobin upregulates HO-1, CO, biliverdin and bilirubin, which are anti-inflammatory and cytoprotective [5]. Studies show the anti-inflammatory effect of gua sha has a therapeutic impact in inflammatory conditions, such as active chronic hepatitis, where liver inflammation indicates organ breakdown that over time can lead to premature death [8]. The physiology of HO-1 may also explain gua sha’s anti-inflammatory effect in other responsive clinical conditions, such as fever, cough, asthma, bronchitis, emphysema, mastitis [14], gastritis, musculoskeletal and other painful conditions presenting as neck pain [13], back pain, migraine [10], postherpetic neuralgia [11], and others. That gua sha has anti-inflammatory and immune stimulation properties is important for providers to understand and to be able to communicate to their patients as well as other health care providers. *

    Dr. Arya Nielsen is an American acupuncturist taught in the classical lineage of Dr. James Tin Yau So and in practice for over 35 years. She graduated in the first class of the first acupuncture college in the United States in 1977. She is a practitioner, a teacher, an author, and researcher and is considered the Western authority on gua sha. Dr Nielsen has a faculty appointment at a New York teaching hospital, Beth Israel Medical Center, where she directs the Acupuncture Fellowship for Inpatient Care.

    *New safety protocols for gua sha and baguan are being proposed by Dr. Nielsen and her medical team at Beth Israel Medical Center in New York. [15]

    [1] Nielsen A, Knoblauch NTM, Dobos GJ, Michalsen A, Kaptchuk TJ. The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects. Explore (NY). 2007;3(5) (October):456-466.

    [2] Nielsen A 2007 ‘Gua sha’ and the Scientific Gaze: Original Research on an Ancient Therapy in a Call for Discourse in Philosophies of Medicine [doctoral dissertation]. Union Institute & University

    [3] Nielsen A 1995 Gua Sha: A Traditional Technique for Modern Practice. Edinburgh: Churchill Livingstone.

    [4] Kwong KK, Kloetzer L, Wong KK et al. Bioluminescence imaging of heme oxygenase-1 upregulation in the Gua Sha procedure. J Vis Exp. 2009.

    [5] Xia ZW, Zhong WW, Meyrowitz JS, Zhang ZL. The role of heme oxygenase-1 in T cell-mediated immunity: the all encompassing enzyme. Curr Pharm Des. 2008;14(5):454-464

    [6] Zhu Z, Wilson AT, Mathahs MM et al. Heme oxygenase-1 suppresses hepatitis C virus replication and increases resistance of hepatocytes to oxidant injury. Hepatology. 2008;48(5) (November):1430-1439.

    [7] Wunder C, Potter RF. The heme oxygenase system: its role in liver inflammation. Curr Drug Targets Cardiovasc Haematol Disord. 2003;3:199-208.

    [8] Chan S, Yuen J, Gohel M, Chung C, Wong H, Kwong K. Guasha-induced hepatoprotection in chronic active hepatitis B: A case study. Clin Chim Acta. 2011;in412; 1686-1688.

    [9] He J, Du L, Liu G et al. Quality Assessment of Reporting of Randomization, Allocation Concealment, and and Blinding in Traditional Chinese Medicine RCTs: A Review of 3159 RCTs identified from 260 Systematic Reviews. Trials. 2011;12(1) (May 13):122.

    [10] Schwickert ME, Saha FJ, Braun M, Dobos GJ. [Gua Sha for migraine in inpatient withdrawal therapy of headache due to medication overuse.]. Forsch Komplementmed. 2007;14(5) (October):297-300.

    [11] Nielsen A. Postherpetic neuralgia in the left buttock after a case of shingles. Explore (NY). 2005;1(1) (January):74.

    [12] Chiu C-Y, Chang C-Y, Gau M-L. [An experience applying Gua-Sha to help a parturient women with breast fullness]. Hu Li Za Zhi. 2008;55(1) (February):105-110.

    [13] Braun M, Schwickert M, Nielsen A et al. Effectiveness of Traditional Chinese “Gua Sha” Therapy in Patients with Chronic Neck Pain; A Randomized Controlled Trial. Pain Med. 2011;12(3) (January 28):362-9.

    [14] Chiu J-Y, Gau M-L, Kuo S-Y, Chang Y-H, Kuo S-C, Tu H-C. Effects of Gua-Sha therapy on breast engorgement: a randomized controlled trial. J Nurs Res. 2010;18(1) (March):1-10.

    [15] Nielsen A, et al. Safety protocols for Gua sha (press-stroking) and Baguan, cupping

    Complement Ther Med (2012), (in press).

    – See more at: http://www.pacificcollege.edu/acupuncture-massage-news/press-releases/1198-the-science-of-gua-sha.html#sthash.NXPxsOQh.dpuf

  • I don’t think the author’s claim ‘And neither Gua Sha nor injuring yourself on the tarmac are truly recommendable therapies, in my view.’ is reasonable. My reason is, Gua Sha is applied to specific area, not everywhere. For example, the area unter the 7. neck bone is for headache and cold. So if you have headache, you can try this area. But if you stroke your butt very hard until you cry (I’m sure this has the so called distracting effect), the effect won’t be so effective as a not so painful scraping around that area for your headache, in Chinese it is called ‘Da Zhui’. Of course, there are thousands of headache, for some Gua Sha works like a charm, for some it has no serious effect. For example, if you have a big trouble in business or you don’t sleep before 23 o’clock. I don’t think Gua Sha alone can cure your headache.

    Actually, IMHO the TCM mostly is about leading a healthy living style, not so much on Herbs and exotic methods.

    By the way I’m a masseur, and I’ve tried a lot of times Gua Sha on my clients. It will hurts only if you put a lot pressure on the bone, for example, shoulder plates.

    The so called awful picture in Wiki is a typical ‘uneducated’ Gua Sha. And actually from his picture, it’s hard to identify he has pain or problem at all, because the overall color is so even, you cannot say his stomach or his liver has problem. Gua Sha doesn’t mean to scrape everywhere, for specific pain, you have to apply the Gua Sha on the corresponding area.

    Overall, I don’t think Gua Sha is a placebo curing method.

  • I have been diagnosed with a frozen shoulder. I fell and dislocated my arm and fractured the ball at the top of my arm. I am currently doing physical therapy , acupuncture and now Gua Sha. I have been in extreme pain for four months. I am on my second treatment of Gua Sha. It is a very painful procedure. It is breaking up the scar tissue in my arm. After last nights procedure, I was able to lift my arm over my head and touch the pillow I was laying on. I have not been able to do this for four months. It is not a placebo affect. My arm is bruised and sore but the scar tissue is breaking up and enabling me to move my arm. Remember the saying no pain no gain. I am proof that the method when used appropriately does indeed work.

    • No, your anecdote provides no such proof whatsoever.

    • And, eventually, when you hopefully have recovered from your shoulder problem, you will anounce that it was due to the wonderful effects of the Gua-Sha therapy, right? All the other theraputic interventions and excercise did not matter any because Gua Sha is an ancient, mystical, wonderful and traditional chinese medicine.

      Tell me Marie? Why did I recover totally from the same problem you have but without Gua-Sha or any other form of unproven ancient magic? I only had the help of an “allopathic” orthopedic surgeon who operated through a couple of tiny holes and a good, sensible physiotherapist who taught me how to heal myself with ardent excercise. Did I miss out on the wonderful effects of added trauma? Maybe it would have taken me only half a year to recover instead of the long and difficult one hundred and eighty two days?
      I now have no problem with my shoulders. Unbelievable?
      No, I tell you, the trick is excercise and more excercise and even after you recovered, you continue the excercise to avoid the problem recurring. I sincerely hope you will recover as I did, even if you had a charlatan hurt you even more.
      As for breaking up scar tissue and freeing a really frozen shoulder. When such intervention becomes necessary, that is better done by a well trained orthopedic surgeon under anesthesia, than with a coin or a porcelain spoon or whatever your TCM quack is using.

      • I have seen two orthopedic specialists during the last four months. They both told me that ripping the scar tissue for me under anesthesia was not a good idea. I am small in stature and they both said there was a high risk of breaking my arm during the procedure. So lets see break my arm again or try Gua Sha? Surgery to remove scar tissue was an option, but that would cause more pain and more scar tissue. Not an acceptable solution for me. Western medicine has the Graston technique which is similar to Gua Sha. A piece of metal is used to break up the scar tissue. There are currently 17,500 clinicians in the USA certified to use this technique. I am happy that your arm is back to 100% after only a year. I’m hoping to be at 100% much sooner. You endured surgery while I’m using a natural approach. There is always more than one solution to every problem or injury. I am happy with my progress and attribute it to hard work on my part and that of the two clinicians who are treating me.

    • Where is the experimental proof for the placebo effect of gua sha? One is free to hypothesize that GS is a placebo effect. But eventually every hypothesis needs experimental proofs to validate it. Otherwise it is just a proclamation. Not understanding why GS should work at all is not a sufficient excuse to call GS a placebo effect. Before aspirin, willow bark was used to reduce headache pain. For millennium, neither practitioners nor patients understood why willow bark should work. That didn’t make the willow bark treatment a placebo effect.

      • I think it is the other way round: in medicine, those who make therapeutic claims such as gua sha is effective beyond placebo have to provide the evidence – not those who doubt the claim.

        • I agree wholeheartedly with “those who make therapeutic claims such as … is effective beyond placebo have to provide the evidence.” In that context, gua sha is in the good company of many surgical procedures, many routines of exercise physiotherapy, myofasical release, and so on. Has anyone read a good randomized double-blinded placebo control study of ice pack treatment of inflammation?

          The research literature on gua sha with control is fairly new and far from adequate but initial efforts are being made by researchers from Germany and yes Ms. Arya Nielsen. More research is needed. There is room for doubters and supporters. What is the justification to ask for positive proof of placebo effect for gua sha? The burden of proof is perhaps more demanding for a proponent of the specific placebo effect being solely responsible for all the benefits observed in GT than for a doubter who questions the quality or state of art of gua sha research. There is no disagreement on the beneficial outcome of gua sha. The disagreement is on the mechanism.

        • It is much simpler than that… If you don’t want to try it don’t. No one has to prove anything to you or anyone else. Gua Sha works when done right and when needed. If you donut think Excederin works, don’t take it and if you don;t think Gua Sha will work, don’t try it. Either of those things will likely get rid of your headache or you can just doubt them and keep your headache. No one cares or owes you proof.

      • Ted Kaptchuk MD (Harvard) wrote the forward to Ayra Nieslsen Ph.D book “Gua Sha: A Traditional Techique for Modern Practice” published by Churchill Livingstone owned by medical publishers Elvsevier which I assume editors reviews what goes out the door. I suggest you read it instead of making continuous erroneous armchair speculations of what Gua sha is or isn’t. He has been an major NIH grant recipient in studying variations of what constitutes a placebo effect and has made no such observations against Gua Sha.

        • There it is, then. An authority figure thinks gua sha is fine, so it must be. Wait a minute, though… haven’t I read somewhere else on this blog that argument from authority is one of several fallacies people use mistakenly to justify their beliefs?

          • And yet another thing… you give us two authority figures. Even if the book (by a PhD) is total crap, the foreword (please learn how to spell) is by an MD (Harvard)!!! My knees ache from the genuflecting.

          • kaptchuk is not even an MD!!!

          • I only mentioned medical credentials as you challenged Arma Neilson’s medical experience and credibility. Rather circular rejection, acupuncturist publish in acupuncture journals just like dermatologist in dermatology journal. Etc. My commented that this book now with revisions after 16 years including new appendix of referrences was more authoritative than a wiki article. I have both heard both lecture and read their books and find their scientific integrity exemplary.As to petty spelling assaults and yelp searches smells of despiration.

          • YOU DID MENTION THEM – BUT FALSELY!

          • Sorry, my correction. Ted Kaptcheck is a now a full professor at Harvard Medical school. He use to have a clinical practice in Boston as I recall. My bad.

        • And another thing… “published by Churchill Livingstone owned by medical publishers Elvsevier which I assume editors reviews what goes out the door.” Congratulations on your naiveity about medical publishing. Do you really think these folks have editors who tell their bosses “We shouldn’t make money on this one, it’s nonsense”? It’s commonly Elsevier journals that put up $30 paywalls to before you can read even a single scientific paper.

  • Edzard – I re-read your post. And as wonderful as Wikipedia and eHow are…they do fall into the “everything’s on the internet, some of it’s true” category. But they can lead to conclusions like this:

    “My explanation for the observed effects after Gua Sha is quite simple: imagine you have a headache and accidentally injure yourself – say you fall off your bike and the tarmac scrapes off an area of skin on your thigh. This hurts quite a bit and distracts you from your headache, perhaps even to such an extend that you do not feel it any more. As the wound heals, it gets a bit infected and thus hurts for several days; chances are that your headache will be gone for that period of time. Of course, the Gua Sha- effect would be larger because the factors mentioned above (exotic treatment, expectation etc.) but essentially the accident and the treatment work via similar mechanisms, namely distraction and counter-irritation. And neither Gua Sha nor injuring yourself on the tarmac are truly recommendable therapies, in my view.

    But surely, for the patient, it does not matter how she gets rid of her headache! The main point is that Gua Sha works! In a way, this attitude is understandable – except, we do not need the hocus pocus of meridians, qi, TCM, ancient wisdom etc. nor do we need to tolerate claims that Gua Sha is “serious medicine“ and has any specific effects whatsoever. All we do need is to apply some common sense and then use any other method of therapeutic counter-irritation; that might be more honest, safer and would roughly do the same trick.”

    At it’s core, gua sha is folk medicine – not rocket science. With minimal training, folks that wake up with an immobile painful neck can treat it in about 10 minutes. If that prevents a trip to the doc and a prescription for muscle relaxers…I’d say that’s time well spent. But like you say, common sense needs to be applied. For instance, don’t scrape the neck and go out into the wind without covering it up – that will make things worse. You do need to follow the rules of the system. You really can’t fault the philips head screwdriver because it won’t turn a hex screw. That would be the user not understanding the core principles. As simple and ‘folk’ as they are.

    Referring to meridians and qi as hocus pocus is superstitious – qi takes more than a one word translation, but a decent one would be electromagnatism. I guess you could argue that electromagnatism is magic…in a ‘we don’t understand how to break it down any smaller yet’ kind of way. And surely you don’t think meridians are any kind of magic – look at Gray’s Anatomy for some beautiful drawings of the paths of blood circulation through the body. That would be considered a meridian, or channel, or sen, or however you want to translate the idea – the pathway through which things move.

    Dismissing something as safe, simple, and effective as gua sha because you don’t understand the core principles is a waste. I see it like those who refuse to immunize against things like polio or measels – humans have figured out how to sidestep these diseases, in a fairly easy and straightforward way. We’ve also figured out how to deal with simple neck pain and myriad other basic annoyances – partly with gua sha. The “don’t immunize” folks and “gua sha is superstitious magic” folks are adrift in the same canoe…with the lifeline sitting right next to them.

    • jm said:

      Referring to meridians and qi as hocus pocus is superstitious – qi takes more than a one word translation, but a decent one would be electromagnatism. I guess you could argue that electromagnatism is magic…in a ‘we don’t understand how to break it down any smaller yet’ kind of way.

      Why just ‘argue’ that qi is electromagnetism? Don’t we know whether it is or isn’t? Can’t it be measured?

      • Alan – last I heard, electromagnetism was considered one of the four ‘fundamental interactions’…which we haven’t really been able to break down any further, definitively measure, or ‘prove’. There are lots of theories, though. Although I don’t keep up with the latest in quantum physics…maybe we can now.

        As far as the term ‘qi’, that’s a much longer discussion. Any one word translation into English is lacking.

        • jm

          We have a pretty good idea of what electromagnetism is and how to measure it, but I was asking about whether qi was electromagnetism and whether it can be measured. Do you know?

          • Alan – Like I say, I haven’t kept up on quantum physics. Quite cool that we can measure electromagnetism. A while ago (…almost 20 years…now I’m feeling old) my neighbor was a physicist. She patiently explained to me (at the time) that we could only measure the effects of electromagnetism (like electromagnetic fields, waves, etc.) But the force causing all of the effects was still in the technically theoretical realm. We knew it existed, but could only prove what it could do, not what it was. Similar to the way a lot of people describe qi.

            But, there’s no one word translation (for qi) that doesn’t lead to confusion. Electromagnetism has just always been my favorite. Less poetic than others, but what can you do. In recent years, I just stick with using the term qi – and if anyone’s really that interested we talk about it over a beer. If they’re really really interested…some good Scotch :).

          • jm

            There’s no need to bother with QM. The proposition is simple: if qi has something to do with electromagnetism, it should be possible to make measurements of it. Has this been done?

            If it has, please provide references.

            If it has not, doesn’t that leave any relationship between qi and electromagnetism in the land of wishful thinking?

        • Of course there is a good one word translation for Qi: Delusion

          • Indeed. Unless jm can come up with something concrete that demonstrates that it exists.

          • Alan – concrete demonstration is easy, defining the term is harder. While you’re sitting at your computer, think about the index finger on your right hand.

            We can measure what’s going on physiologically with the brain, the nerves, the blood, etc in relation to what’s going on with your finger when you simply think about it. Why all that can happen, and how it happens in the first place you could call qi. Or you could pick an equivalent term from another culture.

          • jm said:

            concrete demonstration is easy

            Glad to hear that. I therefore await your references demonstrating that qi is electromagnetism.

            defining the term is harder.

            First, provide good evidence it exists, then we can worry about what it might be called.

            While you’re sitting at your computer, think about the index finger on your right hand.

            We can measure what’s going on physiologically with the brain, the nerves, the blood, etc in relation to what’s going on with your finger when you simply think about it. Why all that can happen, and how it happens in the first place you could call qi. Or you could pick an equivalent term from another culture.

            You could call it Sherbet if you like; it’s not defined by the word applied to it and it takes us nowhere and provides no insight. But to call the processes you mention qi, is simply to equivocate.

          • Yup, never should have used a one word translation. I knew better than to do that. I’m definitely not the one to explain the concept of qi to you…but since we’re here, let’s approach this from a different angle.

            What is the modern western scientific term for the potential for energy to become matter, the potential for things to move or change, the ‘thing’ that preceeds the impetus for thought or movement (voluntary or involuntary)? And how is it quantifiably measured?

            I realize that we’re way off the topic of this post – but could you give me a link to how electromagnetism is measured? I’ve only been able to find measurements of the effects (elecromagnetic force, waves, etc). This is way above my pay grade…so any help would be greatly appreciated.

          • jm

            Let’s not get too bogged down in EM measurements at the moment; just provide a link describing how qi (whatever it means) can be measured (by whatever means).

          • Alan – Measurement can be done on specific aspects of qi. For instance, qìmén (氣門) is commonly measured. I’m not sure (nor do I care) if there are any modern western scientific studies done on the ‘validity’ of measuring this specific type of qi. But here is a link to the sophisticated, high tech measurment device:

            http://www.amazon.com/Gorilla-Automotive-TG1-Pencil-Pressure/dp/B00280BL9O/ref=sr_1_2?ie=UTF8&qid=1392662997&sr=8-2&keywords=tire+pressure+gauge

            I’m sure there’s video on YouTube somewhere that shows how to use it. I’m betting you already know, though.

            You can measure other types, or aspects, or qualities of qi as well – qìwēn (氣溫) with a simple, inexpensive, household thermometer. You could measure diànqì (電氣) with a simple volt meter from a hardware store. For lìqì (力氣) you could use a simple bathroom scale…or a more sophisticated device that would measure the specific type of lìqì (physical force) you wanted to observe. But, all of these are measurements of qi.

            Others would be harder to measure objectively. No less important in clinical assessment, though. Things like yǒngqì (勇氣, courage) or píqi (脾氣, temperment), for example.

            But getting back to the suject of this post: understanding the basics of gua sha is necessary if you’re going to study it or practice it. But understanding what qi is…not necessary at all.

          • jm

            You keep saying qi can be measured and I keep having to ask you for a link describing how this has been done. I’m still waiting.

            I assume that a paper, published in a peer-reviewed, respectable journal, describing in detail how qi was measured, under what conditions and what the results were would be asking for rather too much, so I’m willing to look at something of a somewhat lower standard to get us going. And just to make it clear, a youtube video, whilst it may be interesting or entertaining, is hardly going to be convincing, is it?

          • Alan – I was talking about a YouTube video on using a tire gauge. That would be a video of someone measuring qi. As would a video of someone taking their temperature, or blood pressure. Thrilling video, eh?

            Your guess is as good as mine about a paper, published in a peer-reviewed, respectable journal, describing in detail how qi was measured. Other than people trying to compare totally different systems (Chinese med theory and modern western, for instance), I’ve never heard of anyone wanting to measure qi. Assess, yes – measure, no. Assessment would be relative to what’s going on with a particular individual – it wouldn’t be a “normal qi level is x” type of thing.

            I’ve heard folks talk about measuing bio-electricity (which would be a type or quality of qi) but I never cared enough to get details. It really isn’t that relevant to what I do.

            The only qi measurement I do is measuring xiéqì (邪氣). The literal translation of the characters is “evil qi” but what it means is “stagnating influence”. The marking that gua sha brings up would be xiéqì. You measure it by simply observing it…with your eyes. Comparing quantity from one person to another isn’t useful, except in a very broad sense. What is more practical is assessing relative quantity session to session on the same individual, color, pattern, things like that.

            As I mentioned to Bjorn, with repeated treatments, markings generally decrease. So that would be a quantitative measurement of xiéqì, I suppose. I can’t imagine a paper on that – I’m not sure what the point would be. Time would probably be better spent on education, as this is a simple way to maintain your health and prevent bigger problems. If you wake up with a stiff neck, why not spend 10 minutes getting rid of it with gua sha? More often than not, it would clear up on its own, in time. Personally, I’d rather deal with it and move on with my day. I enjoy being able to use my neck – I’ve grown quite attached to it over the years.

            Plus, a treatment from a good gua sha practioner feels great – particularly if you’re focusing on maintenance rather than an issue.

            Gua sha is especially easy to self administer – I find it quite valuable on long flights. Some quick scraping on the lower legs and feet before landing takes care of any swelling. For me, anyway. Well, me, my wife, and everyone I’ve talked to that’s tried it. I now always travel with a ceramic Asian soup spoon – although from my extensive personal research…the edge of an iPhone works quite well, too. Haven’t tried an Android, so you’re on your own there.

            There’s no need for any kind of formal study – find a practioner, have them show you how to do it. Make sure you keep worked areas covered up and warm following a treatment. A study of one (yourself) is all that’s needed – and it’s the most relevant. Try a ceramic soup spoon. Or spend the big bucks and get a “professional” gua sha tool – but be prepared, that’ll set you back about $5 US. And in my opinion, the spoon is much more versitile.

    • @jm

      Dismissing something as safe, simple, and effective as gua sha because you don’t understand the core principles is a waste.

      You obviously have not read the post or comments here with any sort of open mind or understanding. Gua Sha is neither effective nor safe nor useful. It is an injurious theatrical placebo. I have described how it is injurious to the body, can jeopardise renal function in sick people and delay diagnosis and treatment of dangerous conditions.
      There are no “core principles” as you say. What you are talking about is pure imagination. Gua Sha has no credible or demonstrable mechanism of action and it has never been shown to work beyond wishful thinking and the post hoc fallacy. People like you who idiotically propose this nonsense are dangerous. As I have said before, Gua Sha should be classified as wilful injury, just like cupping and similar antiquated witchcraft.

      • Björn – I actually have read the post and comments…which is why I had to put in my two cents. You description and understanding of gua sha is in no way accurate, and in fact potentially harmful. Harmful in the sense that simple treatment with gua sha can eliminate problems that left untreated could lead to chronic conditions. Chronic conditions are difficult to treat, take a lot of time and effort (even more so on the part of the patient), and just generally aren’t a lot of fun.

        When you say that “gua sha has no credible or demonstrable mechanism of action”…again, you don’t understand the basics of the therapy.

        • @jm

          I am curious.
          Can you post a link to a picture of the results of the Gua Sha that you are talking about? Maybe even something of your own doing?
          I am starting to suspect that you have not got a clue as to what we are talking about.
          The tissue injury that I know as Gua Sha and have seen examples of, and described above along with the problems and dangers it causes, constitutes factual injury to superficial tissues with extravasation (going out of the vessels) of blood because of rupture of blood vessels.
          If the “”treatment” that you are advocating here and call Gua Sha is not causing bruising of the skin then you are talking about something very different i.e. massage or simply stroking and caressing. In that case you are way off topic and should not be taking part in this discussion at all.

          If what you (jm) are describing leaves the skin normal then you are not talking about Gua Sha.

          This is a good description of Gua Sha with pictures of real victims: https://en.wikipedia.org/wiki/Gua_Sha

          • Your statement “If what you (jm) are describing leaves the skin normal then you are not talking about Gua Sha.” sums up why I’m sure you don’t understand the therapy.

            Assuming that you are working directly on the skin (not through clothing): if there is nothing going on with the patient, gua sha will not leave any markings whatsoever. If there is something going on, the patient will mark.

            Gua sha performed with the same technique, lubrication, and pressure on both sides of the back – marks will only be raised where there is an issue. Where there is no issue – no markings. It really is that simple and straightforward.
            Arya Nielsen’s pics are excellent examples of gua sha performed expertly (http://guasha.com).

            Anyone familiar with bruising will recognize that the pics on Wikipedia are not bruising. A bruise would look more like this (http://www.flickr.com/photos/azyxa/4406227183/) or this (http://www.flickr.com/photos/thirteenofclubs/5220240420/). Markings from gua sha look and feel (both to the practioner and the patient) quite different.

            If you claim to understand gua sha, you already know this. And you already know that if the fellow on the wikipedia page was scraped in the same locations, every week, the markings would be less every session. You would also know that after relatively few sessions…there would be no markings at all.

            You would also know that he would have more articulation in his ribs and be breathing easier. In my view, that would be the opposite of injurious.

            Gua sha markings look similar to bruises, but with some basic observational and palpation skills – it’s pretty easy to tell the difference. If the patient has no clotting issues, or is not on a warfarin type medication – it’s pretty difficult to cause actual bruising or injury with gua sha.

          • As I suspected…
            You are thoroughly confused as to what is real healthcare and what is healthquackery.
            Superficial, dermal bruising[sic] is no less an injury to the body than deeper bruising.

            Your particular version of quackery is injurious on top of being useless. You can rant about my lack of understanding until it snows in Sahara, I am a physician and a surgeon who cares about his fellow humans. I have several degrees and decades of experience that says that I can call myself authority on these matters. (Please refrain from starting a rant about arrogance or appeal to authority on my behalf)

            You are nothing but a deluded amateur who thinks he is doing good with his/her theatrical placebo. Good intentions are not an excuse for injuring people wilfully.

            If my children or anyone under my care was treated with this kind of nonsense and left with injury, albeit superficial, of this kind, I would call the police and file a complaint of assault.
            My suggestion is that anyone who comes across a victim of cupping, Gua Sha, bloodletting or other antiquated nonsense that in effect constitutes bodily assault, consider submitting a complaint to the police or whatever suitable authority as any citizen should who observes a fellow human being attacked under any circumstances.

            I do feel sorry for your victims “jm”.
            Please, if you despite my warnings, continue with this quackery, do try to avoid delaying or jeopardising proper treatment in someone with a real illness.

          • Björn – I don’t think you’re arrogant, I just don’t think you understand traditional medical theory. Which is too bad, for reasons I stated above.

            I’m not sure where in the world you’re located – but here in the US many authorities (police, hospitals, social services, etc) are trained to recognize the difference between bruises and the markings from gua sha or cupping. It’s not that hard.

            What is hard is hearing about social services being called because a Vietnamese mother performed scraping (cao gio in Vietnam) on her child because the child was showing signs of catching a cold. Naturally, you would scrape it out and save the child from sufferng through a cold. Not the worst suffering ever, but unnecessary if you have the proper knowledge and tools (in her case, most likely it was a coin).

            From her perspective, it must seem quite odd that we don’t take simple steps like scraping to sidestep the annoyance of the common cold. From that perspective, not scraping your child and letting them get sick would probably seem like abuse.

            On the upside, the social service workers I’ve talked to now receive cao gio on a regular basis – particularly when they’re starting to feel a bit under the weather.

            From one of your previous comments, I’m assuming you suffer from chronic pain (hands, if I remember right), so I take the language in your comments (the whole ‘victim’ thing, healthquakery, etc) with a grain of salt. It’s pretty common for chronic pain folks to be defensive and lash out – understandably. Chronic pain sucks, and I hope you find some help.

          • My insights into human ignorance, stupidity and irrationality has just been markedly augmented.

          • Well, we agree on that, anyway.

  • Woops – and when I say “electromagnatism”…what I really mean is “electromagnetism”. Easier just to say ‘qi’ anyway.

  • Ow! Just had gua sha done. Its day 2 and I feel like I fell down the stairs or was beaten 🙁 too sore to lay on my back in bed or sit on my couch comfortably. I have quite a few marks on my back and sacrum 🙁 I will not get this again.

    • Melodie – I’ve been sore afterwards (occasionally, for a day or two), but nothing like you’re describing. I can see how that would turn you off to that particular practice. Ow indeed.

      I’ve performed it hundreds of times, and have received it many many times. Never been too sore to lay on my back or sit comfortably. In fact, just the opposite – gua sha has removed pain that nothing else would touch. I’m usually sore if I’m getting scraped after some really intense overuse like splitting wood all day, heavy martial arts training – and once after a long term injury was being worked. In every case, the soreness from gua sha was less than if I had not had it done. And again – nothing like you’re describing. More like the soreness from a good, deep massage.

      Even in workshop situations, the feedback hasn’t been what you’re describing. In a workshop, folks are getting much more scraping than normal – and from people who are doing it (usually) for the first time.

      I’ve seen gua sha stories like yours on the internet, and from a couple of folks after they received some Graston work (Graston tools and techniques look similar, but it’s fundamentally different). To be fair, one of the folks that received a Graston treatment went home and iced…which is a sure fire way to end up with pain. I’m not familiar with Graston post treatment care instructions, but I’m assuming they would be similar to gua sha – keep the marks covered, protected from heat/cold/wind/water, no extreme activities afterwards, etc.

      What did the practioner say when you told him/her about your post treatment experience? If you haven’t talked to them…please do.

  • melode- hi! i’ve been using gua sha for my whole life we are Chinese at home and it works like a charm if ever you use gua sha, get concerned after 1 wk if you feel sore- the Chinese traditional med works but s-l-o-w-l-y

    • @Tiffany can perhaps tell us what ailments it is that Gua Sha is helpful for and how she can tell that it is the Gua-Sha that “works like a charm” and not normal, natural recovery, which also works albeit s-l-o-w-l-y at times?

      @Melodie
      Did the treatment help? Tell us.

      • Gua sha works best for wind and heat, but also treats damp, cold and phlegm. It works by assisting normal, natural recovery.

        • @jm

          ..wind and heat… damp, cold and phlegm…

          It is not civil to make fun of ladies who are discussing their ailments.

          It works by assisting normal, natural recovery.

          So you mean that instead of a cold taking seven days to clear, with Gua Sha it only takes a week? 😉

    • Tiffany- 1 week of soreness! Maybe next time you should just wait a week and see what happens. It might get better without the week of pain(regression to the mean and all that). Unless you like pain, then, fill your boots.

      • @ Neil – In my experience, soreness usually indicates that the pathogen has reached deeper into the body than gua sha can reach – which would indicate cupping, moxibustion, acupuncture, or internal herbs.

        So I’m curious as to why you recommend “wait a week and see”?

  • In my experience soreness indicates pain. I don’t think i have the same definition as pathogen as you do. If i thought i had a pathogen i would not wait a week. I would seek appropriate treatment from a medical doctor to try figure out which pathogen it was.

    In this instance, If we had some kind of neuro/muscular pain that was made worse for a week before settling it is possible that the treatment actually irritated the tissue/nervous system and she recovered despite the therapy received. So, if in future she had similar problems, if she waited, she might find it takes less than a week to settle as it wouldn’t have been irritated by treatment in the first place.

    • “I don’t think i have the same definition as pathogen as you do.” – I’m using the definition as it applies to gua sha. A western medical doctor would have a different definition. Different systems have different approaches to solving the same problems.

      It’s best not to mix and match.

      • but there is also something called objectively verifiably facts…a broken leg is not a blockage of kidney chi, foe instance.

      • How can it be helpful to take a word that exists with a very specific definition and then say ” I’m using the definition as it applies to gua sha”?

        Changing the definition is dangerous- for example someone walks into your clinic with what they perceive to be a muscular pain and leave thinking they are diseased! So we create a nocebo!!!!Then by further treatment reassuring and feeding the placebo effect they regress to the mean. All of a sudden you saved their lives and they forever need to see you otherwise how will these different pathogens ever go away?

        I am by no means against manual therapy of any kind and you are correct, its best not to mix and match language. So i suggest that you make up some new word to describe what you would describe as a pathogen.

        • Gua Sha is not manual ‘therapy’. Like cupping and moxibustion and even acupuncture, it is injury (in effect bodily assault) with no useful purpose beyond a brief placebo effect. When sold as therapy it is plain and simple fraud as well.
          Ignorance and delusions of oriental grandeur, which seem to afflict the perpetrators to varying degrees, do not justify the wrong.

          • @ Bjorn – do we really need to go back there? Your quacktacular rants earlier in the comments pretty thoroughly demonstrate that you don’t know the first thing about gua sha.

            Again, I mean that literally. You don’t know what “gua” means. And you don’t know what “sha” means. Let alone the theory and practice behind the modality. And yet you claim that it is injury or assault. You are pretending to have knowledge on a subject, that you do not possess. And making some pretty specific conclusions.

            The dictionary definition of a quack: a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess; a charlatan.

            By definition, you are a quack.

            You may or may not do the same thing on homeopathic and chiropractic threads. I have no idea, I don’t knkow anything about either of those, and I don’t really care. Those therapies generally aren’t considered folk medicine, performed by family members, at home. Gua sha is. So you need to get your information right.

          • Well… the injurious antics that you call “folk medicine” almost killed a patient of mine a long time ago. I have told that story before in this blog. That was the first time I looked up everything there was to know about the phenomenon. Since then I have seen more patients extensively bruised by ignorants, sometimes family members, sometimes “professional” quacks.

            Decades of genuine medical school and training and working as a general and trauma surgeon on both sides of the Atlantic suggests that I know injury when I see it and know its effects on the body. It is difficult to see what better qualifications to understand what gua sha, cupping etc. is and what it is not!
            Do I have to read The Yellow Emperor to understand the imaginary terms and fabulous fantasies of dated oriental superstition? I actually read a few pages of that nonsense. It was enough to realize that it is not applicable to real life.

            You talk about “theory”, “practice” and “modality” like you know something important.
            Someone who purports to know how to treat disease and talks about “heat, cold, wind, dampness, dryness, and summer heat” as “pathogens” and advices bruising as therapy is demonstrably wrong and in effect pretending. I believe that fits well the definition of quack that you were so kind as to lay out.

            I do not see any reason why we should not use cleartext and concise terms in a discussion like this. Maybe you failed to notice, but I was not addressing you specifically in my last post. It is you who seem to have taken it personally.
            Anyone is welcome to describe their fantastical belief in the folly of their choosing. You are welcome to repeat your low opinion of my knowledge as often as you like. It does not alter the facts. I also have the right to communicate my (in this case professional) opinion which happens to be that those who sell false therapy to other people and thereby not only defraud them but even put them at risk, are to be called frauds and treated thereafter.
            Is that objectionable?

          • “the injurious antics that you call “folk medicine” almost killed a patient of mine a long time ago. I have told that story before in this blog. That was the first time I looked up everything there was to know about the phenomenon.”

            Apparently you didn’t look up “gua”, any terminology related to the therapy (including “sha”), how it is performed, or what it’s used for. I hope you did better research in medical school.

          • Bjorn, I’m glad things turned out ok for the appendicitis patient – but aren’t you one of the folks on here that likes to cry “anecdote”? Or am I confusing you with someone else? (Or many other people…)

            But you’re right in that gua sha isn’t appropriate for appendicitis. That’s not what it’s for. You should know that after looking up everything there was to know about gua sha, yes? As for the rest of your comment:

            http://edzardernst.com/2013/01/gua-sha-torture-or-treatment/#comment-54789

        • @ Neil – yes, changing definitions is dangerous. Gua sha is a Chinese therapy, and so I’m using the definition of pathogen from Chinese Medicine. That’s what I mean by “I’m using the definition as it applies to gua sha”.

          The main external pathogens in Chinese Medicine are heat, cold, wind, dampness, dryness, and summer heat.

          • yes, but this is a philosophy at best; it has nothing to do with reality.

          • I wish I could convince our rhododendrons that heat and dryness were just philosophical….

          • very funny!

          • …but also the sad reality of elements affecting health…

          • so you really think you can cure diseases with heat and wetness?

          • You’re using an outdated model of medicine, jm. Tibetan medicine states that all illness ultimately results from the three poisons: ignorance, attachment, and aversion.

            “A key objective of the government of Tibet is to promote traditional Tibetan medicine among the other ethnic groups in China.”
            http://en.wikipedia.org/wiki/Traditional_Tibetan_medicine

          • Yup. My wife proved it yesterday. The plant is doing much better now. She has this crazy theory that if you pay attention to how the weather is affecting its health, you can nudge it toward balance and avoid drastic measures. She diagnosed a water imbalance (or “dryness” in CM, if you prefer). She watered it.

            She has another plant with an aphid infestation. With that plant, things have gotten so out of balance that chemical intervention is needed.

            Dealing with the water imbalance was much easier on her, and the plant, than dealing with the emergency aphid situation (that particular patient is touch and go right now).

            So when you say that CM pathogens have “nothing to do with reality”…I’m wondering where you live that weather has no effect? The reality over here is that steps taken early on to help deal with imbalances can help prevent the need for bigger interventions later.

            Then again, Europe IS much more advanced than the US.

          • quite so!
            in Europe we have water supply that enables humans to raise above vegetables and drink when they are thirsty.

          • @pete 628 – true enough, but that’s well above my pay grade.

  • @Edzard It’s not that disease can be cured ‘by heat and wetness’ (although I suspect you’ve picked up more about Chinese medicine over the years than than you let on here?). Surely the notion that a person’s environment can have a drastic influence upon their health isn’t so far fetched? Chinese medicine at its best observes and interprets these influences in order to better understand human health and disease.

    • yes, I know, this is the claim – but where is the evidence that this actually cures any disease?

    • Tom, it doesn’t require ancient Chinese “medicine” for it to be blindingly obvious that one has three choices in reducing one’s environmental risks of disease: move to a better environment; improve one’s environment; do nothing and accept the risks.

      It is both abhorrent and disgraceful that cities in China have become some of the most polluted human environments on Earth. So much for Chinese ancient wisdom claiming to be an exemplar of modern healthcare. Or, are you trying to claim that Chinese medicine is so efficacious that its citizens are able to withstand this level of pollution far better than would the citizens of, say, Europe and the USA?

      There is mounting evidence that Chinese medicine is far more likely to be a major cause of disease rather than a cure: due not only to the toxic level of unwanted ingredients found its unregulated potions, but also its abjectly false tenets.

      • I agree Pete 628. The horses i look after all seem to have a really firm grasp of Chinese Medicine. For example they understand how to eat, drink, seek shelter and so on. They have had no medical training what so ever as far as i am aware, yet they understand these principles.

        Lets not complicate the obvious as some mystical energy or special understanding/definition that has the potential to create more misunderstanding than anything else.

        • @Neil – I agree, horses (and other animals) seem to abide by the laws of nature much more readily than humans in general. Unlike your horses, many people will continually eat the wrong food, drink the wrong drinks, and live in poor environments despite the damage they do to themselves.

          And who said anything about mystical energy?

      • @Pete 628 – what you consider blindingly obvious sadly isn’t to many people. And the Chinese concept of environmental influence is a lot more subtle and complex than you make out too. Why do some people’s conditions worsen in damp weather, for example? Why do certain people react badly to a type of chemotherapy that helps someone else? Could there be links here? Chinese medicine has considered these kinds of questions for a long time, and although many misunderstandings and dilutions have occurred over the years, there is an awful lot to be learned by those willing to make the effort.

        I agree with you about the state of modern China, but I don’t see that it’s relevant to the discussion – I don’t make any claims about the current Chinese government or industrial complex, or their understanding of Classical Chinese thought.

        Can you provide the evidence you speak of in your last paragraph? I don’t mean evidence that some Chinese herbs have been found to contain unwanted ingredients – that can be avoided by seeing properly trained practitioners who use decent suppliers – I mean evidence for your claims that ‘Chinese medicine is far more likely to be a major cause of disease than a cure’, and that its tenets are ‘abjectly false’?

        • Tom, perhaps you will enlighten me as to which ancient tenets (i.e. core principles) are used to correctly diagnose and successfully prevent or treat conditions such as: asthma; bacterial and viral infections; diabetes; heart disease; malaria and other parasitic infections; genetic disorders; clinical depression; anxiety disorders; learning difficulties; and a wide range of neurological disorders.

          When you’ve listed the tenets we can proceed to discuss which of them are supported by evidence and which of them are abjectly false.

          • I’m sorry Pete, but it was you who brought up ‘ancient tenets’ and as you seem to know all about them, why do I need to list them? I’m just asking you to supply the evidence you mention.

          • Tom, I am not the one who is an apologist for Gua Sha, TCM, or any other form of CAM therefore do not shift the burden of proof onto me. Doing so is asking me to provide evidence of, a lack of evidence of, things which have never been demonstrated to exist: attempting such a feat would be absurd. You are the one who must list the tenets (the premises) that you use to support your arguments. By not stating your tenets you have no argument to present for discussion; all you present is an opinion.

            However, I shall partially indulge your request simply by asking you questions that are totally on-topic. The Wikipedia reference Edzard linked to states: “Practitioners believe Gua Sha releases unhealthy elements from injured areas and stimulates blood flow and healing.”

            Q1: What diseases does this treatment actually cure?
            Q2: What are the tenets used in this treatment (and are they scientifically tested, or even scientifically plausible)?
            Q3: Are Gua Sha practitioners qualified to identify conditions that require urgent 21st Century medical treatment?
            Q4: What safeguards are in place to protect not only the patient, but also the spread of infectious diseases that could result from a practitioner failing to identify an infectious disease?

            Tom, it seems to me that you and I are using completely different definitions of the word medicine. My definition is along the lines: The science or practice of the diagnosis, treatment, and prevention of disease.

    • @ Tom – thanks for correcting that. I read Edzard’s comment too fast and the brain swapped out “with” with “of”… The dogs are in the details, or something like that.

  • Pete, I’m not shifting the burden of proof. I haven’t made any claims for Gua Sha. You made a statement about evidence that you failed to back up, that’s all.

    But here’s one example to set you on your way to understanding the weird and wacky ‘ancient tenets’ of Chinese medicine: cold has a tendency to constrict movement, and as free-flowing circulation is fundamental to health (another core principle for free!), exposure to cold best avoided. Sounds pretty obvious perhaps (when you boil it down, most of Chinese medicine is just common sense). But why then has it been common Western medical practice for the past 30+ years to apply ice to physical injuries? Here’s an interesting article which discussed new evidence that seem to very much back up the ancient view that exposing a natural organism that thrives on warmth and movement to something that constricts and inhibits is counter-productive:

    http://guardianlv.com/2014/04/ice-age-melting-rice-may-no-longer-be-the-treatment-of-choice-for-injuries/

    Just because medicine is modern doesn’t make it right; just because it’s ancient doesn’t make it outdated. The opposite to these statements is true as well of course, which fits in nicely with Yin Yang theory, but I won’t overdo it…

    • but anything that is not proven in health care has to be categorized as UNPROVEN!

      • “unproven by modern research” would be more accurate/truthful.

        • as opposed to ??? unproven/proven by non-modern research??? proven by ‘the test of time’ [as blood-letting had been for centuries]???

        • Science:
          • the intellectual and practical activity encompassing the systematic study of the structure and behavior of the physical and natural world through observation and experiment: the world of science and technology.

          Gua sha is probably the easiest, most straight forward therapy to gather proof/evidence for.

          – scape
          – where there’s illness or injury, markings will come to the surface
          – where there’s no illness or injury, there will be no markings

          The proof is (relatively) instant. If you’re not producing marks after 30 – 50 strokes…there won’t be any. This is repeatable and predictable.

          That’s why I said “unproven by modern research would be more accurate/truthful”.

          So “as opposed to ???” As opposed to classical Chinese medical science…if we’re talking about gua sha. Or Vietnamese traditional medical science if we’re talking about cao gio (same therapy in Vietnam), Thai medical science if we’re talking about khoodt (same therapy in Thailand), etc. Different cultures have codified nature in different ways.

          Each system will perform the therapy in a similar way, and the same markings (or no markings) will be produced. But each will interpret the results differently.

          • – scape

            You mean ‘scrape’, right?

            – where there’s illness or injury, markings will come to the surface
            – where there’s no illness or injury, there will be no markings

            This is pure fantasy. A well meaning and quasi-religious one perhaps but hogwash nonetheless.

            I am wondering how much you really know and understand about natural science? What is your formal education? Certainly not medical…
            But I will try anyway.
            Have you ever heard of individually differing fragility of skin vessels?
            Have you ever heard of different strength of tissues i.e. such factors as collagen and elastin content, affected by age and genetics among other factors?
            Do you ask your victims whether they take ASA, NSAID’s or other anticoagulants?
            Do you realize that some people bruise more easily than others because of such factors that have nothing to do with illness or injury?
            Have you ever heard of the ideomotor effect, which quite normally but subconsciously governs the force, angle and whatnot of your manipulations?

            Let’s say this fantasy of yours was to be tested in a proper study. How do you propose to correct for the ideomotor effect? You would have to device a machine for the purpose to insure uniform scraping and eliminate this problem, which otherwise would make the study worthless.

            The reality is this:
            When you perform your manhandling, it is variations due to your unconsciously differing efforts and individual factors in the victim[sic] that cause varied results, not some illness or injury that you by the way are not qualified to assess anyway.

            Now, prove me wrong if you can.
            But you will of course have to obtain the approval of your ethical board. My guess is that they will throw the application straight into the trashcan. If not, they will certainly require detailed and thourough information to the participants about the origins, absence of a probable mechanism of action, absence of scientific basis, injurious nature and inherent risks of this unproven make-believe ‘therapy’.

          • Why yes indeed, I did mean ‘scrape’. Excellent catch.

          • I just scraped my leg 50 times and it became marked. I am as fit as a butchers dog. Does that mean i have a illness/injury or disprove your (relative) instant proof?

            Why separate common sense or Science into Chinese, Thai, Western wherever? Lets just have one science.

          • “I am as fit as a butchers dog.” That’s a fantastic phrase – and it sounds like quite a few folks here are as fit as a butchers dog. Brilliant!

            Before settling on one way of organizing the world, let’s work on standardising measuring. The Imperial system is quite annoying…let’s all go metric. For everything but length. For length, let’s use shaku. That would just be fun, and it’s pretty easy to find Sashi Gane in shaku.

            Of course, I’m making a huge assumption that length measurment systems from other cultures don’t fall into the “fantasy” category like the physical sciences do. It’s so hard to keep track of what’s “in” these days.

          • 
Hey there Bjorn,

            “Have you ever heard of individually differing fragility of skin vessels?”

            I’ve never heard it phrased that way, but I think that’s pretty common knowledge. More important, (but also common knowledge) is that skin is different in different parts of the body. You have to pay attention.

            
”Have you ever heard of different strength of tissues i.e. such factors as collagen and elastin content, affected by age and genetics among other factors?”

            Again, common knowledge. At least it is here in the States. To be fair, we have a pretty diverse population, so it’s pretty obvious that tissue varies from individual to individual. Even in the same individual – and, from day to day! And believe it or not…the weather (yes, the fantasy that weather affects people) plays a part too. How cool is that?

            
”Do you ask your victims whether they take ASA, NSAID’s or other anticoagulants?”

            Ignoring your childish use of “victim”…of course. I also ask about diet and exercise, because as we all know diet and exercise affects tissue response (as well as everything else). But thanks for asking. I’m sure ask the same questions, being the responsible medical professional that you are. Look at that, something in common!

            
”Do you realize that some people bruise more easily than others because of such factors that have nothing to do with illness or injury?”

            Yet again, common knowledge. Fortunately, gua sha doesn’t involve bruising. But it’s good to be aware of for compressive massage…where bruising is a possible issue. Gua sha is much safer than massage. So is cupping. Surprise!

            
”Have you ever heard of the ideomotor effect, which quite normally but subconsciously governs the force, angle and whatnot of your manipulations?”

            I’m surprised you don’t put the ideomotor effect in the “fantasy” realm, as it usually gets shorthanded as qi. (Knowing of course that it would be only one aspect of qi. Also knowing of course that we’re assuming renqi.)

            “Let’s say this fantasy of yours was to be tested in a proper study. How do you propose to correct for the ideomotor effect? You would have to device a machine for the purpose to insure uniform scraping and eliminate this problem, which otherwise would make the study worthless.”

            Your insistence on ‘fantasy’ continues to crack me up. “…propose to correct for the ideomotor effect” cracks me up more. You’re such a card! I do agree with you – an accurate study is riddled with problems. Since you’re not after a consistent amount of force, but a consistent relationship…it would take a pretty sophisticated machine, I would think. To study a therapy that most of the world learns from their mother…and uses a household tool…and is safer than massage…and really has no adverse side effects…you’d have to find quite the sucker to fund something like that. Next thing you’ll tell me is that they studied Swedish massage, and found it to be “relaxing”. That would be a hoot!

            Sorry it’s taken so long to respond. I’ve been surveying folks about to see if the term “chinamen” is in fact considered racist (it definitely is). Turns out, the term “jaundiced emperor” is even more offensive. It seems that folks object to comparing natural skin coloring to a disease.

            And here I thought that the most offensive part of this webpage would be the casual use (for dramatic effect) of “torture”. It takes a pretty callous individual to compare folk medicine to sadistic practices that many consider worse than death. If you know anyone that’s actually been tortured…you wouldn’t use the term lightly.

          • Quacks are usually desperate to have the last word. There is nothing here that has not been answered before, just the usual bunk.

            But it is interesting how “jm”, who seems to be a skin-scraper and maybe skin-sucker by profession insists that

            …gua sha doesn’t involve bruising…

            Then what is this?

            Perhaps (s)he is selling ordinary massage as Gua Sha??

          • “Then what is this?”

            Yes…it has been answered before (http://edzardernst.com/2013/01/gua-sha-torture-or-treatment/#comment-54789). Perhaps you should read it.

            You can repeat your fantasy of what you think gua sha is as much as you want…but repeating it won’t make it any more true or accurate. Although, I admire your perseverance!

          • Repeated, erroneous and potentially harmful disinformation from uneducated and deluded persons needs to be corrected when it appears on a public website where people may be seeking information about specific therapy forms. Otherwise I would not care to address the matter.

            A bruise is defined as extravasation of blood caused by trauma.
            Superficial trauma to the skin by scraping with a blunt edge (as in the practice of “Gua Sha”) causes extravasation of blood, which means blood escaping out of the vessels into surrounding tissues. In Gua Sha, the traumatic extravasation is quite superficial so it may be confused with ecchymosis or petechia, which are not caused by trauma but by rupture of superficial skin vessels from a non traumatic condition e.g. septicemia. The bruising by Gua Sha can be easily recognized and distinguished from non-traumatic petechiae by the pattern, which is clearly not following any anatomical boundaries but evidently the result of mechanical trauma.
            “Gua Sha”
            is one of several old and disproven methods of therapy, which have no benefit against any health condition. Certain make-believe therapists have chosen this traumatic practice as their favourite method of fulfilling their delusions of “medical” grandeur. They often combine GS with other traumatic make-believe i.e. “Cupping” and “Acupuncture”. Some have even made quite a show of it, pretending to be academic and scientific in their practice*, making exaggerated and false claims that research has shown anti-inflamatory and other possible beneficial effects*.
            As usual with false medical care (alternative) they mostly support their belief by anecdotal stories, which obviously prove nothing. No scientific evidence exists to support GS and as can be readily understood with only basic knowledge of anatomy and physiology, superficial extravasation of blood is not beneficial for any health condition. If extensive, the bruising can prove dangerous in certain circumstances where the kidneys are compromised by other conditions or it may simply prove harmful by delaying proper care as in the case of appendicitis I have previously described here.

            *I try to avoid linking to sites containing false and harmful information about healthcare. Anyone can find examples of what I am referring too by Googling “Gua Sha”

          • Wow Bjorn, that first paragraph is the best (and most accurate) thing you’ve written:

            “Repeated, erroneous and potentially harmful disinformation from uneducated and deluded persons needs to be corrected when it appears on a public website where people may be seeking information about specific therapy forms. Otherwise I would not care to address the matter.”

            That’s exactly why I posted here in the first place – the BS you continue to post about gua sha on this public website is indeed harmful disinformation. Your definition and description of the therapy is completely backward – mechanically and therapeutically. Obviously you don’t have the first clue as to what gua sha is, how it is performed, or why it is used. That is harmful disinformation, especially considering that it’s a therapy that would actually be used by non-professionals, at home.

            Your description of gua sha is dangerous – compounded by claiming that you know what you’re talking about- because you claim to have medical training. The casual reader may not know that in terms of gua sha, you are a complete and total Quack. Someone reading your comments might actually think you know what you’re talking about, and could do actual damage to themselves.

            You claim “Science! Evidence!” but start with bad information, misunderstanding, and back it up with anecdote (you appendicitis person), claims of fantasy, tooth fairies, (did you also invoke JK Rowling in this thread?), grade school name calling, and general Dadaist jibberish. And you expect me to take you seriously?

            You can use your pseudo-scientific ramblings on other topics. People probably aren’t going to try chiropractics or acupuncture at home. So feel free to quack away. Gua sha and cupping are different – you need to be a bit more responsible with how you spread your BS, since they ARE used at home.

            At least you got the definition of “bruise” in the realm of reality. A bruise is caused by trauma. Gua sha does not produce trauma. Gua sha removes the effects of trauma. Scrape an area with previous trauma from injury or illness – marks will appear. No previous illness or injury – no marks. Simple, straightforward, immediate, consistent. It’s so simple you could teach a 12 year old to do it. (Probably younger, but 12 is the youngest I’ve personally seen.)

            I want you to read this again, since you seem to miss it every time I post it. I’ll type it slower this time: Scrape an area with previous trauma from injury or illness – marks will appear. No previous illness or injury – no marks.

            Normally I would say you could easily prove this yourself. But I don’t think you are personally capable, based on how you describe “scrape”. You personally should find someone who knows what they are doing…and have them do it. I know some kids that could help you out with that…

            So when you claim that gua sha is trauma or injury, you are outright lying. On a public website, where people may be seeking information about a specific therapy.

          • Hey there Bjorn,

            This is from one of Edzard’s latest posts (http://edzardernst.com/2014/06/a-tribute-to-arnold-s-relman/). Arnold S Relman writes:

            “And overriding all discussions of the meaning of quantum physics is the fundamental fact that quantum theory, like all other scientific law, is only valid to the extent that it predicts and accords with the evidence provided by observation and objective measurement. Richard Feynman said it quite simply: “Observation is the ultimate and final judge of the truth of an idea.” Feynman also pointed out that scientific observations need to be objective, reproducible, and, in a sense, public — that is, available to all interested scientists who wish to check the observations for themselves.

            Surely almost all scientists would agree with Feynman that, regardless of what theory of nature we wish to espouse, we cannot escape the obligation to support our claims with objective evidence. All theories must conform to the facts or be discarded.”

            Thought you might be interested, as it speaks to your comment “As usual with false medical care (alternative) they mostly support their belief by anecdotal stories, which obviously prove nothing. No scientific evidence exists to support GS and as can be readily understood with only basic knowledge of anatomy and physiology, superficial extravasation of blood is not beneficial for any health condition.”

            Turns out that gua sha is not only ancient folk medicine, but also fits the criteria of modern science (according to Feynman, anyway), and is pretty much the definition of evidence based medicine. Although the author does have the caveat of “almost all scientists would agree with Feyman…”, which does imply that you’re not alone.

    • Tom, I don’t need to read yet another article about cold restricting movement. I’m already fully aware that too much cold results in restricted movement. In recent times it is often known as death resulting from hypothermia. E.g. I don’t expect a defrosted chicken to start clucking and pecking at me before I cook it.

      Oh, silly me, I have only to apply acupuncture to the chicken, give it some other forms of TCM, appropriate homeopathic remedies, plus some reiki and it will soon come back to life. Let’s face it, CAM as whole system of medicine claims to be able to cure anything and everything.

      I am very curious to learn about something that has frequently worried me regarding food: When I buy fresh chicken, other meat and fish, even fruit and vegetables, how many days does it take for their Yin & Yang and qi (chi) to drop to a level that can no longer negatively impact my health? I’d hate to consume even an orange that might still contain the negative energy resulting from its fear as it was being detached from its host plant.

      I eagerly await your reply.

      • Pete – I am bemused by your response. Either you are intoxicated, or you know even less about Chinese medicine (something that you see fit to criticise forcefully) than I realised. I wish you all the best in your personal quest for meaning.

        • You completely missed my points. Provide me with solid evidence for the existence of Yin Yang and Qi.

          Furthermore, and much more importantly, you have avoided answering my questions above (Q1 – Q4): use, say, acupuncture as the treatment. My questions are perfectly reasonable for any named treatment or branch of medicine. Indeed, these are the basic questions that every patient should ask before they consent to a treatment and it is the duty of every practitioner to obtain *informed consent* from the patient.

          Bonus question, Q5: Is Chinese medicine more effective than homeopathy, reiki, and reflexology? Explain your answer using the tenets of each so that we can learn from you which tenets are true and which are false.

          PS: I forcefully criticise “medicine” based on Tooth Fairy Science, mysticism, obfuscation, appeals to antiquity, no mechanism for self-correction, and/or abjectly false tenets because this is not alternative medicine, it is not even medicine.

          • Pete – could you tell me what you mean by yin & yang? I don’t think those words mean what you think they mean…

  • Pete – it doesn’t seem likely this discussion is going to get us very far, so I’ll make this my last post. It isn’t possible to give you ‘solid evidence’ of Yin and Yang or Qi, because they are philosophical concepts rather than discrete things that can be seen under a microscope. This is the language of Chinese medicine, and it is used to describe and understand the patterns of nature. Chinese medicine is far more concerned with patterns than it is with form, as opposed to Western medicine.

    Your questions are reasonable, and you have legitimate concerns. The world of Chinese medicine is not perfect by any means, and many people (myself included) need to work harder to really understand the principles of what we do, and apply them to greater effect. The truth is (in my opinion) that acupuncture can be somewhat helpful even without much knowledge or experience, via the release of endorpiins/placebo effect etc., which means a lot of people settle for what they get out of TCM school, in the false belief that they are great at what they do. The fundamental difference between my opinion and yours (and many others here) is that there is enormous benefit available to people from Chinese medicine when it is really understood, and that is very much worth makking the effort to understand it deeply. Based on the experiences I have had in my clinic and the superficial knowledge I have recently gained in the Classical Chinese texts, I will be putting my energy into learning, applying this learning, and hopefully getting involved in research that will one day throw a completely different light on acupuncture and what it is capable of. I am aware that this will sound like a waste of time to anyone who has already made up their minds – based on very little personal experience or knowledge it has to be said – that only Western science can offer real benefit. But I am very comfortable with this decision, and I feel fortunate to live in a free society where I can follow this ambition.

    I won’t give specific answers to your questions because it would take some time to compile a proper response, and I suspect it wouldn’t satisfy you anyway. Suffice it to say I think I could come up with reasonable responses, but at the same time I admit there is plenty more work to be done before I or anyone else could come to a forum like this and say the sceptics have no basis for their position.

    • Many thanks for your reply, Tom. I’m sure that, had we met in person rather than via our comments on Edzard’s blog, we would engage in very enjoyable discussions on a wide variety of subjects.

      I was fully aware that Yin & Yang and Qi are philosophical concepts rather than measurable scientific quantities. If I’m reading your reply correctly it seems that we share similar concerns rather than having mostly unresolvable opposing views. It is entirely reasonable to develop philosophy-based models (in the absence of existing science-based models), which can be demonstrated to work acceptably well under a restricted range of boundary conditions. What concerns me is that models are frequently extended over the years by people who fail to understand the boundary conditions of the original model plus the limitations of the original philosophy upon which the model was based (the tenets/premises). Not only are the models extended far beyond their breaking point, the underlying philosophy is also gradually extended to the point that the whole branch falls off the tree of knowledge and ends up becoming little more than a bad joke in the 21st Century.

      The blame falls on those who incompetently extended the original models and principles. E.g. I could reply to the question from jm “Pete – could you tell me what you mean by yin & yang?” by quoting references to many prominent vendors of TCM in order to justify a sarcastic response such as: Yin is even numbers; Yang is odd numbers; therefore should I eat one apple, two apples, or one and a half apples per serving? Is 1.5 apples Yang because 1 and 5 are odd numbers? And what about French and other languages where most nouns have a gender: Yin also represents female; Yang also represents male? What is the definitive attribute precedence order in Yin-Yang philosophy? Why is there still (after so many centuries) no mathematical method to calculate the overall Yin-Yang balance of situations and decisions that we regularly encounter? Etc. etc.

      Tom, if you delve into the ancient texts you will likely discover the deplorable extent to which ancient Chinese philosophy has been distorted over the centuries (especially during the last century). I sincerely admire your endeavour and I think you will find it fun and rewarding. Your hardest task, if you decide to take it on, will be dispelling the huge piles of accumulated myths that are making its few gems of wisdom extremely hard to find. The field of psychology suffers from the same problem, but fortunately, there are many now working diligently to resolve its many problems.

      • I had an epiphany… !!

        It was something that someone wrote here recently about how the Qi, i.e. the life force escapes at death
        This made me realize that Qi is of course very detectable in certain situations.

        When a living organism dies the life force escapes the dead body, as some of the experts on the alternative natural sciences have explained, albeit for some reason not in any detail.

        My revelation was that of course Qi may be detected, especially in close proximity to the dead tissue, simply by olfactory examination. We have all sensed this at one time or another when coming into contact with the carcass of something dead. The olfactory sensation can be quite strong and overwhelming, especially when the Qi escapes the tissues rapidly in hot and humid conditions
        Why didn’t anyone realize this before. As anyone can confirm, the smell of Qi is for some reason not very pleasant. Perhaps the alternative nature wants people to avoid it? Can it be dangerous to inhale Qi?

        So, now we actually know what Qi smells like. Of course different living organisms eject slightly different Qi’s. Eggs give a different Qi-sensation than fish for example.

        I am just wondering about one thing: Why do some people smell Qi from the mouth all the time, even when they are not ill or dying while others do not? Can anyone explain that?

        • Well…just call you The Wandering Dadaist.

          • I said my previous message was my last, but I wanted to sign off with a couple of final thoughts, Jerry Springer style. So, here are my farewells:

            Björn – Qi is a complex, intricate and beautiful concept which certainly can’t be summed up as ‘life force’, in fact it can’t be summed up at all. Understanding Qi (which I don’t profess to do after several years of study) is more akin to understanding the way nature expresses itself – not something that can be done without real application, great teachers, and the willingness to consider the world in more than just a reductionist way. Clearly you are not inclined to do that, which is fine – you have your own calling. I would respectfully suggest, though, that sarcastic rants are not the way to make progress.

            Pete – indeed, I think we (and perhaps many other apparent ‘enemies’ here) would have more interesting and productive discussions in person. I’m quite sure there is more common ground than it often seems. I agree with a lot of your last post, with a few notable exceptions. 1) I don’t think the Chinese medical model has been ‘extended’ over the years, I think it has been drastically reduced. In an attempt to make it fit Western thought more comfortably (and to make it more exportable as a commodity), it has become something far less coherent and effective. 2) I think there are far more than ‘a few gems’ available. I am indeed enjoying my exploration of these ancient ideas, but I am also overwhelmed by the scope and depth of what is contained there. Thank goodness I’ve found a good teacher!

            Edzard – When I first came here I got very angry about a lot of what you said, and I still do at times. But I now see the value in your relentless mission. I personally don’t feel your presentation of the ‘facts’ is without considerable bias, but there does need to be a counterbalance to the tide of nonsense that is undoubtedly out there. You hold people to account, which is only right, and I have learned a lot by being spurred into looking at the evidence more closely. I sometimes draw different conclusions, but your work has been an invaluable catalyst for me. Keep up the good work!

            jm (and other enthusiastic defenders of alternative medicine) – I’ve made the decision that I’m better off channeling my energies (I don’t mean that in a woo woo way!) into understanding what I do better, and hopefully getting involved in research that may offer answers to the legitimate concerns of sceptics. You should do what you feel is right to you, but you can’t ‘win’ arguments here – people have already made up their minds, and they come here to further validate their positions, not to be swayed. It takes a lot of energy to continually run into a brick wall, and I’ve personally concluded that that energy could be put to better use.

            Good luck with all you do everyone!

          • Tom – well said, and best of luck with you teacher, and your studies. Great teachers are hard to come by and I’ve been quite lucky to have found a few over the years. Enjoy the ride!

          • @Tom

            Dream on. I hope you wake up one day though. Reality will always defeat make-believe, especially in the case of medicine.

        • Mouth Qi indicates an imbalance in the Quiches. Treatment options:
          1) Gua Sha in the mouth.
          2) Duct tape.

  • This is one of the most ignorant articles I have ever read. Undoubtedly, you have never tried gua sha and so you have no basis for your conclusion. I am not a practitioner of any type, but I have done gua sha hundreds of times on family members and occasionally on friends with pain and have had successful results 100% of the time. Your assertion that the pain of gus sha masks the original pain is completely absurd and typical of people who state there baseless opinions as facts. The reality is that gua sha does not always hurt, but it does work WHEN DONE RIGHT. Additionally, there is actual science behind it. Just because there has not been research that has proven its efficacy, does not “prove” it is not effective, just that there is no money to be made by researching it.

    I will lay out a few truths for you here to enlighten readers of this post to the truth. Bear in mind I have no agenda here as I am not a practitioner of any kind and have never and will never make a penny on this or any other treatment

    #1) Gua she only leaved bruising if you have blood stagnation in the area being treated and that goes away in a few days.
    #2) Just like with any other sort of massage, it is important to drink a lot of water in the 24 hours following treatment as toxins are released from your muscles. Without water, you may get bad headaches as at least one poster above mentioned
    #3) Some parts of the body (and some people) are MUCH more sensitive than others. This and the technique of the person performing the gua sha determines how much pain, if any, is felt. For example, when working around the spine, scrape away from the spine and not toward it. If the recipient is squirming on the first few passes, go lighter, you are pressing to hard.

    • John Dandell said:

      This is one of the most ignorant articles I have ever read.

      An interesting start, yet you then fail to provide any good evidence that counters what the article says.

      • He doesn’t need to. His comment is more accurate and informative than Edzard’s post. Gua sha produces immediate good evidence, and after a 10 minute session the ignorance of the post is obvious.

        • ROFL! Professor Ernst’s article was evidence-based; John Dandell comment was evidence-free. Please try to understand what good evidence is and isn’t.

          • Thanks for the advice, but I’m pretty clear on what good evidence for gua sha is. Sounds like John is too.

          • It’s just a pity neither of you have been able to present any of it here.

          • Alan, they seem unable to understand the formal fallacy of affirming the consequent:

            If P, then Q.
            Q is observed.
            Therefore, P must be true.

          • John Dandell comment was evidence-free

            No Alan, not evidence-free. It contains ample evidence that JD is totally ignorant as to how the human body really works. He has been foolishly lead to believe that it is the scraping that cures his poor family members of minor, self-limiting ailments.

            His three part list is mostly balloney based on uninformed imagination but it contains one important and smart thing albeit the reasoning is wrong!
            If you have to let someone scrape you and you get extensive marks/bruises, by all means see to it that you are well hydrated (drink water) while your body takes care of the injury[sic]. It will help the kidneys get rid of the breakdown products (which work like toxins for the kidneys if too concentrated) of the extravasated blood, which may be a dangerous burden on the kidneys especially if the victim is dehydrated or even seriously ill. One important exemption though. If you are having severe or accelerating abdominal pain, then please do not drink or eat anything on the way to the ER. The surgeon might want to operate soon and then it is not so smart to have a full stomach. See my story about the appendicitis patient above.

            We have kneaded the GuaSha-dough ad absurdum in this discussion thread. I suggest JD and the other sanctimonious scrapers read (again) my previous posts above for some expert information instead of listening only to ignorami.

            And “jm” & co!
            Please spare us the childish lectures about me being so and so… I AM an expert in this matter, I have tons of paper to substantiate my claims and you have not.
            I know an injury when I see one and I know what it does to the body.

            …you have never tried gua sha and so you have no basis for your conclusion…

            What a silly argument. Of course we do not have to let someone scrape us black and blue for a headache or a stiff neck to know that this archaic idiocy does not help anyone more than other theatrical, injurious placebos.
            Instead, PLEASE SHOW US SOME REAL EVIDENCE other than your aunt’s cold got better or your brothers headache improved. If not, then stop injuring gullible people. In any other context that is called bodily harm or even assault and is punishable by law.

          • @ Bjorn
            And when you make statements like this “I AM an expert in this matter, I have tons of paper to substantiate my claims and you have not.”, is when I call you a quack.

            http://edzardernst.com/2013/01/gua-sha-torture-or-treatment/#comment-60003

            @ Alan
            As has been discussed many times on this thread, the evidence produced by gua sha presents while you’re doing it. It’s very simple and straightforward.

          • jm said:

            As has been discussed many times on this thread, the evidence produced by gua sha presents while you’re doing it. It’s very simple and straightforward.

            Then you have neither learned nor understood anything that Prof Ernst and others have said on this blog.

          • Sadly, I have.

  • Rather curious this “my dad is bigger than yours” argumentation that “jm” keeps falling back on. If you klick on the link in her/his last comment above, you will find an excellent example where “jm” made a lengthy attempt at mirroring all my arguments back at me. A kind of immature polemic would be expected in the sandbox among five year olds.

  • It’s a shame you do not understand. There’s nothing “hocus pocus” about any of it. Qi has been found to be the bio-electric energy that runs through your nervous system. Please research before spreading your ignorance.

  • The world is flat. Only I am correct about it it being flat because all the science I have proves me right. Therefore nothing I don’t understand is valid. Only my assertions and conclusions are sufficient to ascertain what is real. I hereby pronounce Gua Sha as bogus

  • Ezard and Bjorn you both are the prime example of badly behaved western medicine drs. Arrogance and privaledge blind you and stupidity, despite education, infects your thought processes. You are sad little men afraid of anything that you can’t understand. Thank goodness I will never have the misfortune to be treated by either of you. Keep practicing the limited symptom treating medicine you do. Pop your pills and keep your symptoms under control and call that healing, but never find or remedy the root cause of the illness. It is all you appear to be capable of doing. Western medicine is good for emergenies ex. surgery when all else fails. Accept it for that and you’d look less foolish and save yourself many unnecessary arguments. TCM is a healing through balance and proper function of all the human body is. There is a place for both. Western for emergency treatment and TCM for all else. None of this is something you can be expected to understand. What a sorry website to have stumbled across. Cute to tout so many educational degrees only to have such a small mind.

    • Oooh, LSY. My computer screen is now soaking wet from the vitriol and venom that dripped from your comment…

      Pity you didn’t bother to provide a jot of evidence for anything you said.

      • There’s much more than a jot of evidence that Edzard and Bjorn don’t know the first thing about gua sha. You’re right though – it certainly is a pity.

    • @LSY

      Thank you… I am humbly grateful for this unsolicited flattery. I am afraid it is not entirely justified in my case but thank you so much anyway.
      To be put on a pedestal right next to Professor Ernst is not a small honour. My meagre publication list is a mere fly-speck besides the massive life work of Professor Ernst with more than 700 scientific publications and his many books. I don’t even have my own Wikipedia article and probably never will.
      His books are great by the way. I just started reading his last book, A Scientist in Wonderland: A Memoir of Searching for Truth and Finding Trouble . It is really well written and catching. Not often that you get to chuckle heartily right on the first pages.
       
      I am curious LSY?
      Is your desperation due to clients of yours demanding their money back after reading this thread? Or maybe reading Dr Ernsts and S. Singh’s book, “Trick or Treatment” where there’s a good takedown of the TCM nonsense, including scraping, suck-marking and other injurious antics?
      Is that why you got yourself pickled to the gills and wrote this excrement, because you lost clients?
      Very few people are dumb-witted enough to be able to write such drivel in a state of sobriety. So most probably you were quite inebriated, right? Must be that.
      But I note that the timestamp of your puddle of vomit is at 08:34 so either you’re somewhere on the other side of the big pond where it was still night at that time or you have a drinking problem seeing as you were still delirious when other people were going to work? Maybe you need help with this?

  • I had my first experience of Gua sha in HK on last Friday. The lady said it would be good cause I havent had a massage for ages and because my legs are very sore (due to the amount of sport I do on these days…) . I agreed to try, and I usually like the strong massages.
    But this time: NOT at all! She was using a metal tool in a fork shape (of course not sharp but rounded ends). Is that also Guasha? It was so painful! After one hour, she said I might have bruises the day after, but they would be gone the day after tomorrow. Its been 3 days and I really look like if I had a heavy accident. I have bruises everywhere behind my legs. Some are just as small as dots and some are the size of my hand! One bruise is actually as big as my calf. The darkest one is on my thigh and it really looks like a hematoma more than a bruise… it looks absolutely awful. Had I known the result before I would never had done this to myself! Luckily, most of them are not painful. Unfortunately for me, it’s summer in hk and I cant go out like this, plus I have ruined by next week holiday to the beach.

    My conclusion: Yes my legs feel lighter and I dont have any more muscular pain in my neck. BUT Gua sha is not for every one. It could be okay for Asian-type skin colour and skin thickness maybe, but not for caucasian people with sensitive skin…
    Thanks for reading this.

    • @Mary
      Why do you think Gua Sha might be good for anyone and what makes you think skin colour might have something to do with its applicability? There is nothing in the function and structure of the human body that would even begin to support such notions.

      Gua Sha is a prescientific magical rite involving injury to the superficial layers of the skin and without any beneficial effect, neither credible nor proven. What happens is that the small vessels in your skin break and blood gets out into the tissues. This is of course painful and the body will have to clean up the mess. There are situations where such injury may prove dangerous and I have before in this long thread described how such useless healing attempts may prove perilous when they delay proper medical attention.
      Injury is never beneficial to the body. As with any nonsense therapy, old or new, its proponents are living in a self-fulfilling delusion.

      • Bjorn

        “Reading up on a subject before making public statements about them is a habit you should adapt (sic).
        If you had done a little research, which is so very easy nowadays, you could have spared yourself the little embarrassment of being demonstrably wrong.”

        You’re still seriously misinformed about gua sha. Keep trying, though – you got the skin color thing right. Baby steps, I guess.

        • @jm
          Repeating something again and again does not make it true 😉

          • Wise words indeed, Bjorn. Now go do a little research on gua sha.

            At the very least, during your next Bjorn-splaining, cut this part out – “What happens is that the small vessels in your skin break and blood gets out into the tissues. This is of course painful and the body will have to clean up the mess.” If you’re going to make stuff up…it probably shouldn’t be things that are demonstrably wrong.

            Keep the other stuff, because it’s quite amusing. (Especially the “Injury is never beneficial to the body.” You claim to be a surgeon, yes?)

          • the surgical trauma/injury is not what is beneficial about surgery! did you not know? or are you just playing stupid?

          • “the surgical trauma/injury is not what is beneficial about surgery!”

            No kidding. But last time I checked, you don’t get the benefit without the trauma/injury. So what? Who would perform or agree to surgery if the benifit wasn’t worth the injury? Playing stupid would be thinking you can have one without the other.

            Another form of playing stupid would be comparing gua sha to torture. At least I hope it’s just stupidity, and not straight up trivializing the trauma of torture.

          • I cannot imagine that you are so daft that you do not know what you write is utter nonsense. not worth going it to it.

          • I think you’re fully aware that trivializing torture by comparing it to gentle scraping of the skin with a dull edge is in poor taste. Let’s pretend it’s amusing, shall we? Good grief.

          • “I cannot imagine that you are so daft that you do not know what you write is utter nonsense. not worth going it to it.”

            Oh yes, he/she it is. What’s more, jm has a superior air when talking about things that have no evidence for existence. It does, however, give an insight in to the mind of the alt-med where rationality does not apply.

          • If it were not for the fact that (s)he is advocating GS, which is one of several injurious, alternative practices that have NOT been credibly demonstrated to work but instead to have inherent risks, the irrational ramblings of this “jm” character could have had a slight entertainment value.
             As jm does not crawl out of hiding, one cannot but guess to the nature of his/her practice. (S)he repeatedly blurbs about GS being gentle and painless and (if memory serves me) that the “Sha” (bruises) only appear if something ill needs to get out.
            My guess is that jm’s scraping involves an unconscious tendency to apply different pressures according to her/his subliminal expectations. This is called the ideomotor phenomenon and is often seen in make-believe practices. A good example is applied kinesiology.
            Notice how (s)he constantly avoids rationally explaining and substantiating the therapy (s)he believes to be so wonderful but instead constantly attacks her/his opponents and ejects unsubstantiated claims and grandiose statements.
            An honest, ambitious therapist would go out of his/her way to argue with integrity, explain rationalize and discuss but this character is plain belligerent, a quality that often floats to the surface in purveyors of snake oils and theatrical therapies, when spoken against.
             
            I guess we’ll have to brace ourselves once again for jm’s reflexive regurgitations…
            I really should try to break this habit of feeding the trolls. 😀

          • Bjorn,

            Have you published your interpretation of gua sha anywhere? Seriously, you should – I find your comments both educational and entertaining.

            (Apologies if you’ve already done that and I haven’t seen it. I really should google you sometime. But running a google search on a blog post commenter has the flavor of some mentally ill guy in his mother’s basement, wearing a tin foil hat. So if you’d just post a link, that would be great. )

        • “Have you published your interpretation of gua sha anywhere? Seriously, you should – I find your comments both educational and entertaining.”
          More entertaining than scraping skin with a flat blade and thinking it has therapeutic benefit? As Gua Sha is a cousin of acupuncture, it is reasonably safe to assume it has the same level of benefit, as Cochrane attests.

          “(Apologies if you’ve already done that and I haven’t seen it. I really should google you sometime. But running a google search on a blog post commenter has the flavor of some mentally ill guy in his mother’s basement, wearing a tin foil hat. So if you’d just post a link, that would be great. )”
          How odd (perhaps not so odd), that is the mental picture I had of you.

  • Response #194 to this thread. Are we breaking some kind of record here?
     
    One click is sometimes enough to lead anyone on the way to the truth 😉
    Let’s leave it to the trolls to find out how. Might keep them preoccupied with something else for a good while 😀

  • My experience with alternative treatment that is said to work.
    Many doctors in my country do not want to treat erysipelas – instead of prescribing antibiotics, they tell patients to find somebody who is believed to be able to treat this disease by incantations.
    When I got this infection, I was also told that antibiotics would take many weeks to work and maybe they would never work, so ….
    My parents found such woman and it seemed that her incantation worked, because I felt better almost immediately, though I could not understand why. I did not believe in these things but was too weak to protest.
    Only recently I realised that maybe the fact that, despite high fever and lot of pain, I had been dragged out of the house (I could not even stand unaided), then taken to that woman (about 30 minutes in hot car) and dragged up the stairs that worked.
    It could have made things much worse, but I was lucky. And that woman insisted that I had to visit doctor as soon as I would feel strong enough. So, as soon as I felt strong enough, I did it, doctor prescribed antibiotics and all went well.
    But, of course, I have no reason to say, that incantations work, or that antibiotics would not have worked without them.

  • Wow, Ernst, you’ve got a lot of initials behind your name. If you’ve got more initials after your name than the number of letters in your name, you lose credibility.

  • Your assessment doesn’t account for the effectiveness of gua sha within Chinese culture, where the treatment is not considered exotic and does not come with an unusually high level of expectation.

    Why would practitioners of Chinese medicine use this technique for thousands of years if it doesn’t work?

  • Some evidence on the medical benefits of Gua Sha including journal references.
    http://69.195.124.112/~guashaco/wp-content/uploads/2013/07/Science_of_Guasha_Nielsen.pdf

  • Gua Sha moves lymph and blood. What more scientific proof do you need than that, plus all the people of the world that say it works for them. One naysayer will not persuade me to stop using gua sha. It works for me and there is anecdotal and scientific theory behind it’s use to help people. Where there is pain, there is inflammation. Think of it that way. Here is a new one…go run Paida through the mud. It works too.

    • Trish said:

      Gua Sha moves…blood.

      I thought the heart did that perfectly well on its own?

      What more scientific proof do you need than that, plus all the people of the world that say it works for them.

      That doesn’t even begin to constitute scientific proof.

    • Gua Sha moves lymph and blood.

      Massage does that nicely, without injury and pain.

      What more scientific proof do you need than that

      Is there scientific proof in that? I cannot see it.

      , plus all the people of the world that say it works for them.

      All the people who believe in Santa Claus and astrology provide no evidence of their existence or utility.

      One naysayer will not persuade me to stop using gua sha.

      That’s your problem

      It works for me and there is anecdotal and scientific theory behind it’s use to help people.

      Anyone who cares to think rationally knows that anecdotes provide no evidence. If you have found scientific evidence that stands up to even the simplest scrutiny, then please provide references. None of us can find any.

      Where there is pain, there is inflammation. Think of it that way.

      Eh… which way? I think you are mixing up cause and effect. Do you know anything about how the body functions?

      Here is a new one…go run Paida through the mud. It works too.

      Please, if you are stupid and gullible enough to slap yourself all bruised and sore then please, do it as much as you like. Even in the mud if that tickles your fancy.
      But please do not defraud other gullible people with such pernicious charlatanry.
      If you want to convince us of anything, you will have to come up with more than your stupid, unfounded, unsubstantiated claims.

      • Another false comparison that shows ignorance on this topic. Slapping yourself black and blue is not guasha. Your canard is analogous to calling surgery stabbing oneself repeating then blabbering on the dangers of surgery.

        • @Howard Wu

          Next time I advise you to read the passage you want to comment on at least twice, and then again slowly, follow the links, do a little Google-ing of the terms involved and give your comment a good deal of thought before risking that people thinking you might be intellectually inadequate.

          • Top Google site for Gua Sha is from Arya Nielsen. Her definition of Gua Sha:

            “Gua sha is a healing technique of traditional East Asian medicine. Sometimes called ‘coining, spooning or scraping’, Gua sha is defined as instrument-assisted unidirectional press-stroking of a lubricated area of the body surface to intentionally create transitory therapeutic petechiae called ‘sha’ representing extravasation of blood in the subcutis.”

            I have seen Dr. Nielsen photos of properly done Gus sha to raise “transitory therapeutic petechiae called ‘sha’ representing extravasation of blood in the subcutis.” “Sha” meaning “sand” in Chinese when it gets it’s name, small red spots. This is not slappy yourself into a massive hematoma.

            I have no experience with “paida lajin” except to comment this clearly not the same as Gua sha from the photo in link you presented though you tried to obfuscate the two. Nor is this photo typical of “paid lajin” following principle Google landings. “Strenching and slapping.” https://www.youtube.com/watch?v=hpgLxrGJ6y0

          • @ Howard Wu on Monday 04 April 2016 at 20:18

            “Top Google site for Gua Sha is from Arya Nielsen. Her definition of Gua Sha:”

            is as much nonsense as anyone else’s.

          • I You are quarelling over a definition of what gua sha is? Or are you just being condescending?

          • You’re obviously not grasping much of the satirical nature of this discourse or simple common sense in general Howard. Whether the injury is caused by scraping ( GuaSha) or slapping ( paida), it is equally daft to even think it does any good healthwise. Arya Nielsen is not even medically educated or trained. She tries to build an aura of science and scholarship but anyone with a modicum of genuine scientific knowledge easily understands from a short perusal of her presentation that it is only delusional make believe. People like her are in fact dangerous in that they not only mislead gullible types like you but promote nonsense that consists of (excuse my rare use of capital emphasis) BODILY ASSAULT! Further, they at times put people at risk by causing delay of real diagnosis and treatment as I have given examples of.

          • Condenscending it is. Satire back at you

            Arya Nielson is board certified to practice in her state and her practices within the greater context of Mount Sinai Beth Israel teaching Hospital in New York. So your fear litany of deprivation is just that. One may disagree on it’s “experimental” medical value, yet her two books printed by Churchill Livingstone were based at least on 35 years of her scholarship to the historical cultural background to what Gua sha is or isn’t.

            As you’re expertise on gua she is to limited to Wikipedia and Google? Would your discrimation in dermatology signs and symptoms be like. “Contact dermatitis? Heat rash? Measles? who care it looks about the same?”

            So excuse me if I find your retreat into a veneer science and fear mongering shallow. Only reason I post here is so that third parties who can judge for themselves to who speaks with any authority on the topic of Gua Sha.

          • Wrong again Mr. Woo Wu, on all points 😀

            Arya Nielsen is not medically educated or trained. She is an acupuncturist. Acupuncture has been disproven as a medically useful entity, both clinically, scientifically and historically and can not be considered a medical discipline any longer. Her affiliation with a hospital does not mean that her fantasies are any good and is based on the misguided, useless concept of “integrative medicine”.
            My knowledge of Gua Sha and for that matter acupuncture and other injury-based quackery as well, is based on both clinical experience of cases as a trauma and emergency surgeon, on an extensive theoretical knowledge and experience of injury and trauma and on perusal of scientific evidence and other non-selective information sources.
            I have good reasons to sound condescending towards people with stupid and dangerous ideas about health and related matters.
            What justification do you have for your own condescending attitude and meager attempts at belittling my person? Your study of pictures of blemishes produced by Arya Nielsen perhaps?
            Arya Nielsen is a deluded quack who among other nonsensical ideas believes Gua Sha can be effective against Hepatitis B – a fantasy that is very unlikely physiologically, has most definitely never been supported by evidence, only Arya’s imagination and is liable to cause more harm than not.

          • Actually I was impressed the Björn brought up hepatitis B. That means you do know a little bit about Arya Nielson writings after all. All this is something that can be argued. I don’t think I she is recommending gua sha for Hep B but suggest it may influence patient recovery. Meanwhile has strongly recommended protocols in clinical settings to make gua sha safer than using traditional folk instruments to avoid spreading pathogens.
            Remember when science recommended bottle feeding because boobs had germs?

          • Found one of the gua sha hepatitis references. Not Arya Neilson’s claim though she probably referenced it. There are others.

            https://www.researchgate.net/publication/51168614_Guasha-induced_hepatoprotection_in_chronic_active_hepatitis_B_A_case_study.

          • Found one of the gua sha hepatitis references

            Did you read it? As it says in the title, it is based on ONE single case! It is a write-up of looking at the blood tests of ONE patient with HepB and seeing changes in his values over time. There is no way you can draw any conclusions about anything, least of all causality, from ONE observation of this kind but the authors have loaded the manuscript with heaps of wishful thinking and guesswork.
            Anyone who thinks this constitutes an iota of evidence in favor of GS must be seriously ignorant and ill-educated… or totally blinded by faith.

            This is yet another sad example of the massive production of cargo-cult-science by naive cult followers to look like scholarly papers and published in obscure pay-for-publishing-anything journals. The only use for such Play-Doh-papers (apart from fire kindling) is for the author’s self-gratification and for filling reference lists in Quackery promotion.

      • Björn. Ahh, your fear rattling rants brings back nostalgic memories of the mindset of the FDA bureaucrats who made dire warnings of harm to those seniors heading to Canada to buy presciption drugs and the Governor of Minnesota’s response. “Show us the dead Canadians. Where are the dead Canadians?” Yes people have left your plantation. When the bodies pile up you can say you gave fair warning. I for one, consider Arya Neilson a national treasure and grateful she is sharing her life experiences.

  • @ Howard Wu on Tuesday 05 April 2016 at 15:03

    “I You are quarelling over a definition of what gua sha is?”

    No. No matter how it is defined, it still does not make any sense.

    “Or are you just being condescending?”

    Again, no. I don’t know how you arrives at that conclusion, however, I suppose someone who believes in magic can arrive at any conclusion they dream up, no matter how outlandish.

    When I was on holiday last week, I saw a magazine in the newsrack for people like you. It had all the conspiracy theories and magic you would wish for; zika virus doesn’t cause microcephaly, a vaccine does; 9/11 was the CIA, and they trained ISIL; and numerous other nutbag ideas. Of course, I thought of you and jm and all of the other people for whom the scientific discoveries of the last 1,000 years mean nothing.

    • I just returned from a Genomics Translational Medicine conference in San Diego which promises in a few years to make all our medicine practices over the last hundred years equally nonsensical. The last speaker meet with roaring ovations, how medicine needs to remember it’s human roots. Calling it Medicine 3.0 Big data misses some basic human observations. ERs arrivals are taught for example not to confuse gua sha appearance with battery. CPT codes will soon be in place.

      Then who has explained Building 7?

      • If only I had a dollar for every failed hypotheses, promises and hopes of all the blue eyed optimists engaged in “translational medicine”…

        Did you get too much to drink at that conference Howard, your recollections of it don’t make much sense?

    • In the meanwhile here is some background bedside reading if anyone actually wishes to argue what being presently invested about gua sha.

      https://en.m.wikipedia.org/wiki/HMOX1

      • @Howard Wu

        “In the meanwhile here is some background bedside reading if anyone actually wishes to argue what being presently invested about gua sha.”

        If you provide a link that makes no reference to gua sha, you might oblige us with a hint as to its relevance.

        “Calling it Medicine 3.0 Big data misses some basic human observations.” “CPT codes will soon be in place.” “Then who has explained Building 7?” Errm.. Is this supposed to make sense to readers??!

      • @ Howard Wu on Wednesday 06 April 2016 at 14:28

        “In the meanwhile here is some background bedside reading if anyone actually wishes to argue what being presently invested about gua sha.

        https://en.m.wikipedia.org/wiki/HMOX1

        What is the relevance of this to anything discussed here? Methinks, you are on another planet.

        • It you the least bit familiar with Arya Nielson writings on Gua Sha you would have heard her speak on the importance of Heme oxygenate 1. I brought this up further up the thread.

          If you are at least bit familiar with any 9/11 conspiracy theories you would have heard of Building 7 of the TWC complex that fell a few hours after the Twin Towers though it was never hit by anything. Also everyone knows Osama Bin Laden was a CIA asset. Matter of record No surprises there. Moving on….

          Translational Medicine conference wasn’t on Gua Sha but Genomics. As a traditionalist I might agree with BG, but genomic sequencing really is a game changer and coming down fast. All T M means is bringing the most modern research in science into practice, in this case total gene sequencing for less than a cost of MRI. Conference showcased real cased examples in oncology and coronary medicine. I wrote this only in response to “people for whom the scientific discoveries of the last 1,000 years mean nothing.” That was my holiday.

          “Big Data” in medicine, what is happening in now as offices, clinics and hospitals get integrated documenting on the internet which will make medicine in part more”scientific.” But must not exclude physicians skilled at:

          “Observations” as to be able to telling the difference between gua sha and “slapping.” If you are presented with a case in an ER that serves a multicultural community such as in a modern metropolis this needs/will to be part of your training. Welcome to my planet.

          CPT codes pending for gua she is an American insurance thingee. Current Procedural Terminology ( BTW these are copyrighted by the American Medical Association) They will likely be in place in the next update.

          Anything else I need to spell out for you?

          • “Anything else I need to spell out for you?”

            No thanks. You need to understand that the majority of people in the world do not live in the USA: it is an unfortunate characteristic of many Americans that they assume the rest of the world should be familiar with their culture and abbreviations. Thank you for taking the care to enlighten me on what I (and others) read as pure gibberish.

            “It you the least bit familiar with Arya Nielson writings on Gua Sha you would have heard her speak on the importance of Heme oxygenate 1.” Which is it? Writings or speaking?

            “I brought this up further up the thread.” So did a number of others. But what you gave us was a link to a protein data bank entry which merely lists the enzyme’s properties. The research into heme oxygenase I and gua sha is unimpressive at present. Microvascular damage, as caused by gua sha, almost certainly upregulates (and downregulates) expression of a lot of genes. The mouse experimentation, now seven years old, does not seem to have been followed up. Perhaps it’s not only Bjorn Geir who regards it as not interesting just now. Add me to the list.

          • Strange on a thread about Gus Sha that people wouldn’t care what the practice is or isn’t’. Or what it’s major proponents have wrote or said about it. Even to refute it. It a confusing ostrich in the sand discourse that won’t make Gus Sha disappear. Still others may land on this site with more curiosity than this small circle. I for one hearing the name theme oxygenase 1 had the curiosity to look up what is this enzyme, probably more than most people have done.

          • @ Howard Wu

            “It a confusing ostrich in the sand discourse that won’t make Gus Sha disappear.”

            Gua sha won’t disappear – it’s too simple, effective, and practically risk free. It’s practiced in too many households all over the world – inexpensive, easy to learn, easy to perform, immediate results. Almost every medical system has adopted its use, for diagnostics and treatment. It’s not going anywhere.

          • Woo never disappears – as long as someone can profit from it. The role of us skeptics is to point out to potential victims that they are about to be defrauded. People like Wu, “jm” etc. are blinded by delusion fuelled by vanity and propagated by financial gain.
            My personal stance is that practices like Gua Sha, cupping, paida and even acupuncture should be criminalised. As generally is the case with quackery, the fools who practice injurious quackery cannot help themselves. They are blinded by cognitive dissonance as can be seen from the intellectual contortions they present in defence against reason and facts. The fact they are driven by delusion and subliminal psychology does not give them the right to defraud and hurt other people with unnecessary nonsense.

          • People with umlaut in their names should make fun of others people’s. I’m perfectly happy living in the real world of compassionate medicine dealing with real people’s problems than your sckeptic’s fishbowl sucking life through a straw. Listening to your dribble about acupuncture reminds me nothing less than creationalist cherry picking studies to prove evolution to be a fiction. I can see you through my side of the glass but you can only see you own reflection. Hubris and skepticism are a poor mix. Your characterization of the motives of those who walk on the wild side is equally dellusional as you other ignorances and are your own invention. There are missing holes in your reality. Though I don’t expect you to understand this through a narcissic prison. Not that I depreciate what is necessary to get through the day as an ER physician. I’ve know many. My father use to work ER before he also became an acupuncturist.

            Anyhow I won’t discount your antedotal experience. I shouldn’t bother to share my cases which you would just dismissed as just that. However I’ve read her books and then meet Arya Nielson in person and observed hundreds of gua sha experiences to answer your question.

            But maybe just one for our readers. Yesterday a young women came in using a walker. 4 years ago was in an auto accident. Had neck surgery and as a sequel today has spasms in her right leg, pain in her legs and arms which she describes as a “ten.” Also said her physicians say there is thing more they could do for her. So here is my “crime.” With acupuncture I did some careful gua sha near the back of her neck. “Oooh, this feels so good!” At end described her pain as a two then walks out of my office with a happiest of smiles on her face. So under her dellusion she now has a vasty better quality of life. While I have to rectify this cognitive difference with you. When she comes back for more “torture” what should I do?

          • It’s pretty clear that that’s your personal stance, Bjorn. So what are you doing about it? You claim to be a doctor – don’t you have some sort of ethical responsibility to do more than just post comments on a blog?

            At the very least, you could publish a paper. Make your diligent research public. Explain how you’ve come to the conclusion (via Wikipedia, YouTube, and actually seeing some examples of markings in real life) that gua sha should be criminalized.

            Your fantasy of how gua sha is performed (heavy handed, must be painful, etc) is contrary to every practitioner, home user, teacher, and everything that’s written. Including the dictionary definition of ‘gua’. You should set folks straight!

            Be sure to include a piece about markings – how it’s ‘bodily assault’, as you say. And how this ‘bodily assault’ is skillfully controlled by the practitioner changing pressure, so that markings only show up in certain areas. (That’s my favorite part of your fantasy, by the way.) Until someone actually tries to do that…they might actually believe you.

            As I’ve told you before, it takes about 10 minutes of demonstration to prove that you’re full of shit. Ten minutes and a dictionary to prove that you’re a quack.

          • We’re all waiting in awe for jm’s pending proof. Been waiting for some years now, as can be seen from the discourse above. The medical system is quite ready to adapt Gua Sha as soon as someone can prove its worth with something more convincing than boastful, nonsupported declarations.
            I even offered to help with contacting the Swedish Nobel institute when irrefutible proof was ready. Until then I’m afraid we will have to go with what evidence have, which says that Gua Sha is not only useless but harmful as well.

          • Correction: In my last comment, “adapt” should read “adopt”.

          • Years? Wow…and you still haven’t written it up? What are you waiting for? Maybe you should do a guest post on this blog, explaining what gua sha REALLY is. I’m sure if you Bjorn-splained in a post, you’d reach a much bigger audience.

            You write it up – and I promise, I’ll help spread the word. (You have to include the markings/ideomotor part though, or the deal’s off – seriously, don’t underestimate the impact of that tidbit.)

          • Bjorn – somewhere up there in the mess of comments, I told you that gua sha will only produce markings where there is illness or injury. Otherwise, there will be no markings. I also told you that with repeated treatments, the markings will be less and less each time.

            You claim that is fantasy, and due to the ideomotor phenomenon, applying different pressures according to subliminal expectations.

            I suppose I can see how that makes sense to you – since you’ve never talked to practitioners or experienced it first hand, and don’t have a clue as to how it’s performed or why. Since you’re working off of pictures and video, I’m sure you miss just how weird your idea is. And, there would be no practical way to test your fantasy.

            But, what’s your explanation for cupping marks? Cupping marks work the same way – if there’s nothing going on, no marks. Where there are markings, they will mark less and less with each treatment.

            For the life of me, I can’t come up with what your explanation would be, since your ideomotor theory doesn’t work for that one. I’m sure you’ve got something though…

          • That for the most part covers it, and when observed can be diagnostic to some pathology in the fascia. Historical this was describe as the Four Stages-Differention of Symptoms: “Wei, Qi, Ying, and Blood.”

            “Modern” micro anatomy/physiology relating to function of dendritic cells could probably could brought up to raise a contemporary explanation as to Wei at least if somebody care to look into it. There has been much progress translating old texts about “Blood Stasis” in recent years. Will admit I’m behind on my reading.

            I hope this language doesn’t make the skeptics throw a clot.

          • Science friction? Suggestion that evidence of real harm is done by Gua sha comes to this.
            The Gua Sha Treatment 2001.
            https://youtu.be/63i7HFN-MgU?list=RD63i7HFN-MgU

          • jm has probably never understood the concept of controlled experiments. When a “cupper” (I suppose that’s a term for someone who plays with suction cups) “cups” they apply either heat with a flame or a few pumps with a pump to produce negative pressure. This is an uncontrolled action and the ideomotor phenomenon comes into play when the subliminal expectations of the gullible practitioner makes him or her differentiate the suction according to expectations. The same with Gua Sha where subliminal differences in applied pressure, angle of instrument etc. affect the production of hemorrhages (bruises, petechiae) in the skin. The ideomotor phenomenon is well studied and many may recognize it as the subliminal effect that is at play in the Ouija board game and similar folly.
            When “jm” or someone else can produce a credible paper describing a controlled experiment that confirms the fantasy that different disease states produce different injury from such mechanical trauma despite exactly the same forces, then I might be able to start believing there was something in it.
            BUT, that would still not come anywhere near saying that it was useful as treatment for a health condition of any kind.
            As I said, I will be the first to applaud if someone was able to show such practices were of any use. Until then it is nothing more than stupid make-believe and injurious as well.

            Our friend Howard has obviously been reading too much science fiction. (of the Arya Nielsen kind)

          • So the raising of sha is some kind of stigmata the patient performs to please the practioneer? That’s some crazy hypothesis. Does it requires telepathy? I’m against paper cuts as therapy? Orginal published paper was circa 1670. I can look it up but was written in Classic Chinese.

            I prefer explaining cupping away as acupressure backwards, providing a mild traction. For example with lumbago it can create a slight release enough to take pressure off a pinched nerve to make a immediate difference. This does not require any change in skin color. The amount. Of relative suction usually can be gauged by the measure the skin puffs up. When using multiple cups this could be the same yet under different cups you will see difference skin changes. And on different days on the same patient. Listen to the patient saying how much better they fell afterwards must be pseudo science.

          • Actually Bjorn, there are a couple of options. I should have mentioned these earlier.

            They are now making cupping devices that are controlled by an electric pump, and you can dial in the amount of vacuum you want. I haven’t looked into them, because I have no need for them. They’re also quite expensive.

            The easier way is to just move a single cup. Oil up a back, attach a cup, and slide it. Simple as that. No difference in applied pressure. The back will mark where there’s stuff going on, it won’t where there isn’t. It’s also way cheaper. (Last I checked the electronic thingy was around $800. A nice glass cup will run about $5.)

            Any other ideas? Again, I’m sure you can come up with something.

          • Yeah that works. It isn’t actual gua sha but kind of a modified gua sha with a cup. I think like myself many Ameican acupuncturists using cups have seen this happen and then become interested in sha. This would always be bought up by someone in her lecture Q and A. Arya Nielson would say it was a incomplete technique and sha likely isn’t completely resolve. Or that the sometimes “hicky” could be excessive, more hematoma like that slapping thingee mentioned early. It is not unidirection. Advocates better results from proper training in gua sha. Not everyone practices to her standard. Lots of grey areas.

          • Thanks for the ideomotor reference. Good gua sha practice of course includes an intuitive element of sensitively and sensory feedback.Continuous communication with subject including verbal and non verbal is very important. I definitely benefited from hands on training. Gua sha by a machine would likely feel like real torture. Nothing like the human touch and personal experience.

          • @ Howard

            Moving cups is definitely different than gua sha, but the cup gets rid of the ideomotor thing. How fast you move the cup coesn’t matter either. It will either mark, or it won’t. Depends on what’s going on.

            I love the “stigmata the patient performs to please the practioneer” idea. Bjorn will have a hard time topping that. Although you never know…

          • Björn,
            Even though all you’ve written makes sense to those of a sound mind, please give up? Wu (I hope he sees the irony) and jm are True Believers. It wouldn’t matter whether my favourite god, Thor, split the earth apart and roared, “GS is crap”, it would not make the slightest difference.

            In their case, reason does not apply.

          • @Frank
            You’re right of course. The resident trolls and stray oddballs wouldn’t be worth spending time on if it weren’t for a couple of factors. Firstly it is great practice to respond with facts and reason to the nonsense and lunacy. It hones the skeptic skills for more important work. It also is a great opportunity for me to practice my English.
            Secondly, there are people coming by here, looking for information that should not have to find only undiluted promotion of harmful charlatanry.
            Decades of dealing with injury, disease and death firsthand has made me completely intolerant of those who endanger ordinary gullible people’s health and finances.
            Thirdly, these types long for having the last word. It can be rather amusing to take away their smug pleasure in what they think is a smart final put-down.

          • @Björn

            “…there are people coming by here, looking for information that should not have to find only undiluted promotion of harmful charlatanry.” And they often find only one page they’ve turned up on Google, which is why we supporters of reason against woo have to keep on repeating ourselves.

            “…these types long for having the last word. It can be rather amusing to take away their smug pleasure in what they think is a smart final put-down.” Good point: I hadn’t thought of that. I tend to back off after feeding a troll. Perhaps I should think twice about that.

          • You could practice by giving me an explanation of why moving cups on a back will only produce markings in certain areas. I like the ‘patient provided stigmata’, but I still think you can do better.

            And, write a blog post, explaining what gua sha really is.

          • You could practice by giving me an explanation of why moving cups on a back will only produce markings in certain areas.

            Because they loose suction.

            I like the ‘patient provided stigmata’, but I still think you can do better.

            I don’t think those are my words?

            And, write a blog post, explaining what gua sha really is.

            Gua Sha is a prescientific practice wrongly believed to bring health-benefit(s) by producing superficial injury to the skin It is performed using the edge of something, for example the lid of a jam-jar, a coin or a spoon. The edge is used to forcefully scrape the (lubricated) skin thereby producing bruising, which can be very extensive. It has never been shown or proven to work for any ailment or disease and is extremely unlikely to have any physiological benefit. Any perceived benefit is in the mind of the practitioner and/or the victim/customer.
            Performing Gua Sha, whether for financial gain or not, with claims of beneficial effects is not only fraud but constitutes injurious assault as well when performed with enough force to cause injury, which is the sought after effect (the bruising).
            Harmful effects include damage to the skin with microscopic scarring, which will accumulate with repeat injury; GS may cause delay of proper diagnosis and treatment for important health problems and lastly, the bleeding into the skin can prove an adverse load on the kidneys and other systems in certain conditions.

            Somehow I doubt that this will make “jm” happy and content but s(he) asked for it.

          • I do enjoy these discusions though i also know went to take pronouncements with skepticism. Prescientfic is a loaded word. China had many advance technologies when Icelanders where still Beserking the coasts of Europe. Nobody’s science is that pure but we all do the best we can. I’m sure Björn knowledge base includes personal experience he has gained in ER but also includes his own cultural biases. I can labor on to deaf ears…

            Evidence of harm? Chicken contains arsenic. Arsenic is a known carcinogen. But if I were to say chicken causes cancer based on reasoning this would be an abuse of evidence. Is it testable? Yes. Should people avoid chicken waiting for best evidence is a personal choice. I’m sure some wanting to close down chicken farms would use this as case.

            Science Journalism is filled with cultural biases. I’m not saying this should be ignored. Indeed I found these critics useful.
            I also think paywalls suck, peer review is too often a political process. I support Open Science with all it’s problems.

            That is why I raised the question of medical reductionism of what is hemo oxygenase 1. Here I will raise the question on what is micro scaring and it’s sequel. Excerise causes micro breaks in connective tisse, but that is why people do it. No pain, no…no… everybody stop running before we all drop dead!

            OK will be back later… headed to KFC to shut them down.

          • “Because they loose suction.”

            They don’t. You can do better than that.

          • That’s actually a fantastic summary of what you think gua sha is. I should have asked you for it long ago. I think it should be a guest post on this site.

            If you could flesh it out a bit with references to studies of the scarring & accumulation specifically from gua sha, that would be great. Also the studies for bleeding into the skin from gua sha and the effects on the kidneys. I know folks will ask – and I don’t know what studies you’re getting your info from.

            The stigmata thing – those weren’t your words, they were Howard’s. I was hoping for a better explanation from you. You weren’t even trying with the losing vacuum idea.

          • Facts and references can be found in any textbooks of physiology and histopathology. As I said, they allways need to have the last words, however silly. When those words start containing something in the way of supporting their fantasies instead of childish retorts, we can perhaps start taking them seriously.
            The key to understanding is knowledge. Our resident aficionados of ancient medical magic simply lack the knowledge to understand how far their fantasies are from reality.

          • Ok, scrap the references thing then. But you do need to add in the ideomotor part. And please add in the part about cupping marks, and how sometimes the markings appear when the cups are strongest, sometimes after they have lost suction. That should drive the point home.

            You’re also missing the part about pain being part of the requirement (from one of your earlier comments, ““As I have pointed out before, there is a very important prevailing misunderstanding about what constitutes GS. Real GS involves inflicting painful injury. If not it is not GS. Any practitioner who pretends to perform GS without producing painful bruising is only performing massage.”.

            And, add in a part about your qualifications to discuss this. Here are some of your quotes, to get you started:

            – “I am a physician and a surgeon who cares about his fellow humans. I have several degrees and decades of experience that says that I can call myself authority on these matters.”

            – “I know an injury when I see one and I know what it does to the body.”

            – “From what I have read and seen, Gua-Sha is supposed to leave prominent trauma in form of ecchymoses i.e. bleeding into the superficial tissues. If it does not do that, it is not defined as Gua-Sha.”

            – “My knowledge of Gua Sha and for that matter acupuncture and other injury-based quackery as well, is based on both clinical experience of cases as a trauma and emergency surgeon, on an extensive theoretical knowledge and experience of injury and trauma and on perusal of scientific evidence and other non-selective information sources. I have good reasons to sound condescending towards people with stupid and dangerous ideas about health and related matters.”

            And you could end the post with “The key to understanding is knowledge.”

            Write it up as a guest post – people need to know the real story. Edzard could be your first commenter, and cite the systematic review that he recently ran across and posted on this thread.

        • Sorry for distraction. I was replying directly to FC comments launched at me.

          To get back on topic suggest people goggle scholarly articles on “gua sha heme oxygenase 1”

      • Why don’t you come back Howard, when and if this research in Heme oxygenase 1 and Gua Sha results in something interesting. Just now it is not.

        In the meantime you might tell us how research involving injury to the subjects was cleared by the ethics committee.
        Or is it all being done in China where there are practically no functional ethics committees and research for some uncomfortable reason never produces negative results 😉

  • I’ve Googled for the study that one of the posters mentioned from Harvard and Beth Israel Medical Center. This came up: http://www.ncbi.nlm.nih.gov/pubmed/17905355

    • Worthless study.
      “Pilot” study on only 11 patients, uncontrolled. Proves only what was known beforehand that stroking the skin increases the (micro-)circulation in it. Does not say anything about whether GS has any beneficial effect or not.

    • Behind a paywall of a journal that will publish anything as long as it smells of dim sum (this is a joke).
      Written by aficionados of oriental medicine who say they studied 40 patients, half of them neck pain and half back pain. The abstract does not give any information that can be used to evaluate but it says only one of the groups got better with a P value under 5%, which says nothing of the clinical usefulness. The usual conclusion is that GS may be effective and further studies are warranted.
      This paper about a small study of subjective outcomes is also a useless reference, if not for other than the very large potential for bias.

  • And one last study… http://www.ncbi.nlm.nih.gov/pubmed/21276190

    I’ll leave it up to you and your readers to do further searches on that webside for more information.

    • Again a small (anything under n=50 in each arm can be considered small in such settings) pilot study albeit somewhat than the previous but still not giving any useful evidence. The authors admit multiple problems with the study design but the main problem I see with this is they did not standardize the “verbal factor”. There is no controlling what the therapists say or their demeanor/attitude when applying the GS vs. the heat pads. Also no massage was applied in the control group so the skin bruising (yes, the “petechiae” discussed in this paper is superficial, traumatic bruising, no matter what “jm” believes)
      Very large bias potential, poor blinding, inefficient control and small pilot study = no inference can be drawn as to the specific effect of the skin bruising. The effect difference may well be due to the combination of massaging effect of the GS rubbing and verbally enhanced placebo phenomenon.
      This paper does not lend credible support to the (specific) effect of Gua Sha.

    • @Melody

      We have discussed Arya Nielsens science fiction activities before in this thread. I briefly gave you answers to your suggestions above, even if we have been through all of this before.
      Most of us are very well versed in scientific research and finding scientific information so your help is really unnecessary. When I started my medical education and career, the scientific databases consisted of gigantic book volumes of lists, the “Index Medicus” where you searched by indexed keywords and then wrote to the authors to obtain copies of their work. Today, anyone can start a journal and have it indexed in the online databases and it only takes seconds to find references.
      This has led to an unfortunate situation where, in the last decade or two, the scientific databases have been filled with pseudoscientific junk and plain science fiction. The quality of the research has also fallen drastically as there is money in getting and interesting title listed in PubMed and other searchable databases and use the reference to support the sales of mostly questionable supplements and services.
      Today it is not enough to know how to enter words into the search fields, you have to know how to filter out the rubbish and find useful and credible evidence there. And you have to know how to interpret and assess it.
      Fro demonstration, I tried entering “Unicorn” into PubMed and it found 117 references. I entered “homeopathy” and got 5267 hits. That does NOT mean that shaken water and sugar pills help with anything. Or that PubMed says Unicorns exist.
      Even “Pink elephant” came up with all of 6 hits 🙂

      Gua Sha is one of those archaic remnants of prescientific attempts at curing diseases. That it was used in old times does not mean it works. That it is still sold by gullible nitwits to gullible people does not mean it works either. Bloodletting does not work even if it was used extensively and still is as a matter of fact.
      Promotors of GS and other “oriental” antiquities are actually very few relative to the medical and scientific world community so it is a fringe activity, even in the orient even if it is a more common high street operation over there.
      Together with other remnants of old magical medicine like cupping, it does inflict injury to the recipient. We have a very complete knowledge of how the body actually works and this kind of injury can not confer any useful physiological effects and has never been shown to do so. On the contrary, the extra load on the systems of the body from having to clean up the extravasated blood and breakdown products may be harmful in some situations. If the bruising is extensive, it may exert a large load on the kidneys and together with other factors it may promote kidney failure as I have discussed before. I am trained as a trauma and emergency surgeon so it is my job to know this.

      Gua Sha should be strongly discouraged.

      • I’ve made it a habit of asking the MDs that I cup and scrape what they think the marks are. All said they would label them as petechiae, you could use layman’s terms and just call it a bruise, but more accurately it’s probably extravasated blood without any damage to the vessels.

        One said he didn’t give a shit what you call it, you can call it voodoo if you want – he calls it being able to raise his arm above his shoulder again. (I’m not well versed on voodoo, but I don’t think it’s related to cupping or scraping.)

        Then again, these are assessments from people trained in modern medicine, going off of experience and palpation rather than YouTube videos. If you just look at videos without first hand knowledge…it looks horrible. And you’re likely to come to some really weird conclusions.

        But you’re probably right about the promotor thing – gua sha in particular is pretty commonplace. Not so much a fringe thing, as a household thing. One of my teachers said that they don’t teach it in most schools – they assume you already know how to do it. And you probably learned from your mother. It’s a good skill to have – it should be strongly encouraged :).

        • …extravasated blood without any damage to the vessels.

          Nonsense. For blood to get out of the circulation you need to damage a vessel. In this case the damage is to small vessels in the skin. With repeated injury the skin will thicken and harden because of repeated micro-scarification.
          An MD-degree does not guarantee that the person is of a sound and rational mind. I can list several MD’s who are completely off their rockers and engaged in woo of the craziest kinds.
          Just to give an example, this dunce thinks he can prevent and cure ebola and most other disease with sounds delivered via web-pages!! I am not kidding you.
          I actually wrote to the bloke to ask if this was a practical joke. I will not describe the sheer lunacy I was confronted with.
          As to the value of “household” remedies, the last one I learnt about was dusting powdered curry into a bleeding wound. Being “household” does not mean it is sensible or works.

        • “An MD-degree does not guarantee that the person is of a sound and rational mind.”

          Preaching to the choir, Bjorn. Speaking of which, you never gave me an explanation for the moving cup/marking thing.

  • @Melody on Monday 11 April 2016 at 20:32

    “This article lists many studies to back up their claims. http://www.pacificcollege.edu/news/press-releases/2015/05/05/science-gua-sha

    If you are going to post a link, please ensure it is not complete and utter nonsense. Nielsen is a loon trying to establish a link between bruising people and heme oxygenase which does not exist, except in the minds on some loons who post here.

  • I have just found this systematic review [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0117146]; it looks quite thorough and analyses, amongst other TCM modalities, gua sha. here are the relevant paragraphs:
    Gua sha in CNP

    There were only two studies (n = 69) that had researched the efficacy of gua sha for NP [84,85], both of which were fair-quality RCTs.

    Gua sha versus waitlist/no treatment

    There was only one RCT (n = 21) found [84]. Seven days after treatment, significant differences favoring gua sha were found for CNP with respect to pain (VAS 10 cm, MD-1.6 (-3.0, -0.1)) (S5 Table). The study did not report disability.

    Gua sha versus thermal therapy

    Likewise, only one trial (n = 48) [85] was identified. The pain (VAS 100 mm) showed a statistically and clinically significant reduction in the gua sha group compared with the control group during a 1-week period (MD, -29.9 (-43.3, -16.6)). These differences were also observed for disability (NDI, MD-8.5 (-13.6, -3.5)).

    Side effects

    One trial [85] reported that there may be petechiae, slight muscle aches, and soreness in the application area, with none of these effects being serious.

    Summary

    Small studies showed that there was low evidence with medium to large clinical importance that gua sha was more effective than waitlist and thermal therapy for pain in the immediate term for CNP.

    Gua sha in CLBP

    Only one study was identified [84].

    Gua sha versus waitlist/no treatment

    There was a fair-quality RCT (n = 21) found [84]. At a 7-day follow-up, with respect to pain (VAS 10 cm), significant between-group differences favoring gua sha were observed (MD, -1.1 (-2.0, -0.2)). Nevertheless, the study did not report on disability.

    Side effects

    None reported.

    Summary

    A very small study provided low evidence with medium clinical importance that gua sha was more effective than waitlist in treating pain in the immediate term for CNP.

    84. Lauche R, Wubbeling K, Ludtke R, Cramer H, Choi KE, et al. (2012) Randomized controlled pilot study: pain intensity and pressure pain thresholds in patients with neck and low back pain before and after traditional East Asian “gua sha” therapy. Am J Chin Med 40: 905–917. doi: 10.1142/S0192415X1250067X. pmid:22928824 View Article
    • PubMed/NCBI
    • Google Scholar

    85. Braun M, Schwickert M, Nielsen A, Brunnhuber S, Dobos G, et al. (2011) Effectiveness of traditional Chinese “gua sha” therapy in patients with chronic neck pain: a randomized controlled trial. Pain Med 12: 362–369. doi: 10.1111/j.1526-4637.2011.01053.x. pmid:21276190 View Article
    • PubMed/NCBI
    • Google Scholar

  • I imagine that gua-sha has somewhat of a massage effect, but I don’t buy the whole stagnant blood/lymph business.

  • I am a 51 yo female that has had chronic back pain and migraines since I was 19. I now have osteoarthritis and was just diagnosed with lumbar sponylolisthesis. I have seen orthopedic surgeons, chiropractors, massage therapist, had acupuncture, take epson salt baths, use a tens machine, use lidocaine cream and taken ibuprofen and migraine pills. My PCM that does my acupuncture, which want helping, recommended Gua Sha and I said I will try anything. I have to say it felt like a deep tissue massage, and I have bruising. But I don’t feel any pain. Not from the treatment, my back or my head. This is a first in a long time. Until they can cure my migraines and heal my back, I am all in for this treatment!

    • It is very very important that you jump up and down shouting,”Placebo! Placebo!” until your back pain returns. If that doesn’t restore your suffering seek professional help so you can rejoin a sceptical society.

      • @Howard Wu

        How do you know the cure wasn’t a delayed effect of the acupuncture or the chiropractic or the massage therapist? All of these purport to cure lower back pain and migraines. Just because the pain abated after the gua sha doesn’t prove the gua sha did it: after all, DiAndy might have started wearing new shoes, or eating some new food, or standing for five minutes on one leg in a bucket in addition to the gua sha.

        Please do try to understand why first-person anecdotes don’t constitute evidence of anything: after all, there are loads of people convinced they have seen ghosts, and no amount of mundane explanations for their experiences will un-convince them.

        Or… perhaps you have a marvellous diagnostic technique that can predict when a person’s symptoms will respond to homeopathy rather than chiropractic, or gua sha rather than acupuncture, or crystal healing rather than therapeutic touch. That would have saved DiAndy a lot of trouble exploring different facets of Big Snakoil before finding the one that appeared to cure her complaint. Please do tell.

        • If you are seeing ghosts seek a qualified classical acupuncturist familiar with The twelve Sun Si-Maio ghost points. Antibiotics can also help.
          If you are not seeing ghosts trying needling LI-14 near the deltoid insersion. There has been Soviet Researchers that has tested this point for increasing pyschic ability.

        • Real snake oil that was used by chinese immigrants building the railroads has been shown to be an effective anti-inflamatory. If got a bad reputation by westerners selling counterfeit products. Typically oil came small venomous grass snakes. Never heard of BIg Snake oil however just googled research with Boa constrictors. All of these are enviromentally at risk. I surmise that using emu or ostrich oil might be just as effective. Some controversy about which bird is better. I assume fatty acid composition is effected by diet.
          A Chinese pit viper similar to our rattlesnakes has been used for certain neurological problems but the flesh is used not the oil. Snake gallbladder can be also had fresh from street merchants.
          Shoe therapy is a thing? Why not. However after 31 years I doubt if it was the shoes.
          First person evidence of pain relief is the best evidence of all, if you are that person.

          • “First person evidence of pain relief is the best evidence of all, if you are that person.”
            BUT THE REST OF THE WORLD MUST INSIST ON REAL EVIDENCE!!!

    • Howard,

      Probably a self limiting condition. The timing was pure coincidence. There seems to be a weird pattern of self limiting conditions limiting themselves right about the time of a gua sha treatment.

  • @ Edzard unfortunately publications predates the internet. You may find a copy of “Psychic Research Behind the Iron Curtain” in your public library. No mention of Sun Si Miao by them, however he was the original PI. In English only commentaries on Sun Si Miao are usually available. HIs works were volumnous and not all have yet been translated. Many of his herbal formulas are still best sellers after twelve centuries.

  • I have have This treatment done and It helped me. SO much so I’m trying to find ways to do it for myself. I love the way you all assume you have the answers but have you ever had the treatment? I don’t think you have. Nor do I think you’ve had acupuncture treatments either. Just call it bogus before ever needing relief that Doctors can’t seem to give.

    I’m going Wednesday to have both Acupuncture and Gua sha because It helps me with my content pain. Doctors have done nothing for me but bill me.

    • Hi Suzi? Have you tried Chiropractic? Lots of comments on this blog are from people who’ve found chiropractic works really well with constant pain. Or reiki? There are many people here who testify to its effectiveness.

      • long live THE TESTIMONIAL !!!

      • Hear! Hear! Long live the testimonial indeed. Patient feedback is quite illuminating, don’t you think? Without it, you’re limited only to evidence (which, for massage/bodywork techniques like gua sha, the evidence you’re looking for is change in tissue…which you can palpate).

        • What do you think you are palpating “jm”?

          • It’s not what. It’s who. There is a person in there Björn.

          • @Howard Wu on Tuesday 08 August 2017 at 19:29

            “It’s not what. It’s who. There is a person in there Björn.”

            FFS Wu Wu, everyone knows that. The question is, what on the person is being palpated? It is no wonder non-meds think they are doing something real, when their level of comprehension is so low.

        • Geez Bjorn, you palpate the soil – check for clumping, moisture, rocks… Oh, wait. That’s gardening.

          Gua sha is a massage technique, like kneading, rubbing, rolling, pressing, etc. Generally with massage stuff, you palpate the area of the body you’re working. 🙂

          • Sorry, I thought gua sha was supposed to provide pain relief. What does palpating the massaged/scraped area have to do with assessment of pain relief??

          • @”jm”
            As your input on this blog of lately has been less disagreeable than it used to be, I decided to once again try to you offer you the benefit of first person, courteous discourse and try to have a meaningful discussion with you about your favourite subject. Your immediate response however makes me doubt the judiciousness of this attempt.
            We already know that you are practically ignorant of medical terminology and techniques and anything that has to do with the body and its anatomy and physiology*.
            I did not realise that even if my original question should be crystal clear to the medically trained, you do not have the means to understand what I was asking.

            You said:

            for massage/bodywork techniques like gua sha, the evidence you’re looking for is change in tissue…which you can palpate

            Now let me try to repeat my question regarding this statement of yours in words more likely to be correctly understood also by laypeople:
            When you palpate (feel with your fingers) the tissues (i.e. the skin and underlying fat and muscles) after scraping them (Gua Sha) or sucking them (Cupping) you say you find evidence in that you feel something, some change from before perhaps.
            What do you think it is that represents these changes that you feel? How would you describe them and what, in your mind does it represent in each case? Most importantly, how do you interpret this as evidence (of benefit)?
            You can use whatever terms or paraphrasing you like, just try to describe what it feels like (bumps, thickening, mass, softening…?) and what do you think has happened in the tissues that causes these changes that you are feeling with your fingers.

            *For the recently arrived audience, a bit of explanation:
            “jm” is a well known incognito participant here at professor Ernst’s blog. He or she (“jm” has not revealed its gender so it is simpler to refer to it as “it”, which I hope no one takes as disrespect) has admitted to being a provider of paid services under the promise (pretense?) of “therapy”. These services are based on well known ancient ritualistic, philosophical beliefs, which involve the scraping of the skin with the blunt edge of an instrument to produce blemishes and bruises (“Gua Sha”) or the production of suction injury marks using vacuum cups (“cupping”).
            “jm” uses these exact names to designate its services but stoutly denies that they (in its hands?) involve trauma. That means that either it is only pretending to provide “cupping” and “Gua Sha”, which by definition produce trauma and is instead only performing lighter, non-injurious massage, which of course is by definition neither Gua Sha nor cupping.
            Or “jm” is totally blinded by delusion and really believes that the obvious injuries that classically results from Gua Sha, cupping and similar archaic rituals do not represent trauma

          • Hi Bjorn,

            That’s very big of you to offer the benefit of first person, courteous discourse and meaningful discussion. Although, gua sha is not my favorite subject. It’s just a really simple and straightforward one. Gua sha is a fantastic topic for sussing out just how big of a grain of salt to add to your (or anyone else’s) comments.

            Really, gua sha is a great topic to see which websites, blogs, commenters, etc are full of crap. Cupping’s good, too – but gua sha is the king of crap-cutting in this area*. It’s just that straightforward and simple. And as I’ve told you before, it takes about 10 minutes to demonstrate.

            This isn’t meant to be a put down or insult – I mean this literally. Your understanding of gua sha is fantasy. You’re working with constructs that exist only in your mind. Here’s a direct quote from you:

            “As I have pointed out before, there is a very important prevailing misunderstanding about what constitutes GS. Real GS involves inflicting painful injury. If not it is not GS. Any practitioner who pretends to perform GS without producing painful bruising is only performing massage.”

            My advice would be to step away from Wikipedia, YouTube, and sciencebasedmedine’s website/blog and go talk to actual practitioners. Then have them demo on you. Or, stick with fantasy. Up to you.

            ________________

            *That’s just my opinion. You challenged that one with a video you posted, to illustrate the “painful injury” from cupping. It was a YouTube video, and you either didn’t watch the whole thing before posting, or you didn’t turn up the sound. You seem to have missed the laughter from the person being cupped, despite her partner telling her that it looked painful. Sometimes, you can’t go by looks, eh? 🙂

          • Frank,

            No, gua sha is a massage technique usually used for superficial tissue. Like all other massage techniques, palpating is the best way to check progress. It’s handy in that way.

            But like other massage techniques, pain relief is often a side effect.

          • Is this the best you can do in form of a response “jm”?
            It is really sad if you are unable to discuss and clarify even your own statements let alone the consequences and physical signs of your practice, which you seem to be trying to claim are evidence of its efficacy.

            Please answer the questions put to you “jm” Thereby you might be able to show us that you understand what you are talking about and can justify the sale of Gua Sha and cupping as medically useful services.

            We have asked you this multiple times during the past years and are still waiting for something other than the sort of childish, incoherent babble of which your latest set of responses is a prime example.
            Otherwise we will have to continue considering the alternative (to you being a skilled health care provider) hypothesis to be true, i.e. that you are an ignorant pretender to medical skill who can be disregarded in the discussion on this blog.

          • Bjorn,

            You’ve gone plural again! Or are you referring to the Royal “We”?

            As far as answering your questions, we’ve been there and done that. There’s really no sense in going over the same stuff, yet again. Not until you get some first hand experience. But…

            I could tell you again that cupping and scraping don’t always produce marks – and markings aren’t the goal of scraping or cupping. Or that neither is a “medical service” but simply tools used by most medical systems.

            I could tell you again that “problem areas” will mark less and less with each treatment. I could tell you yet again that like other massage techniques, gua sha and cupping don’t need to be painful – in fact, you’ll get better and faster results if they aren’t. (And since you seem to be hung up on ‘results’ being the marks – I’ll clarify again. These are techniques used to massage the body. ‘Results’ is a change in the soft tissue, not the marks. You don’t always get marks. You almost always get a change in the soft tissue.)

            And again (we’ve covered this before) – it’s pretty tough to actually injure someone with either cups or scraping. It can be done, but you have to really work for it. If markings are going to come up, they’ll come up with really comfortable pressure/vacuum. If injury is the goal (not sure why it would be) you’d be better off with deep compressive or dramatic stretching techniques. Way easier to do damage with those.

            (Except for the choking thing, as we’ve also discussed. Scraping tools are a choking hazard. Especially the jar lids that Arya likes to use, or the coins used in the Vietnamese version of gua sha. So be extra careful in those cases.)

            I’m assuming that once again, you won’t hear any of this. You seem to be pretty fixed on what you think you know. I still think you should write a blog post – I’ve had several fantastic scraping/gua sha teachers (most working in the Chinese Med system, but some others as well), and apparently they haven’t heard about the “painful injury” or “bodily assault” part. Quite the opposite – cupping and scraping are great tools for working painful or injured areas, because they are gentler on the body than most hands-on techniques.

            And, do a follow up post describing how cups lose vacuum as they move along the body. I’m pretty good with cups, yet for the life of me I can’t seem to duplicate the vacuum loss you describe.

            You’ve never answered my question, by the way. Do you have any evidence for your claims of injury? (remembering of course, anecdote is not evidence…) The links Edzard has posted seem to disagree. Unless you consider “minor and transient” or “slight muscle aches” to be painful injury or bodily assault?

          • @jm

            I’m afraid everywhere I look on the web, gua sha is clearly supposed to relieve pain. If it’s only “a massage technique usually used for superficial tissue” that’s an oxymoron: you can only massage superficial tissue, for Pete’s sake!

            “Like all other massage techniques, palpating is the best way to check progress. It’s handy in that way.” Sorry, because I know you try very hard to come over as a reasonable person, but I’m afraid I’m in 100% agreement with Bjorn’s comment on this subject. You need to get a grip on reality and, to be honest, I think your responses on this particular thread have done nothing more than demonstrate you have a way to go in understanding very basic physiology and medicine.

          • Frank,

            “I’m afraid everywhere I look on the web, gua sha is clearly supposed to relieve pain.”
            So there are websites out there claiming that a massage technique relieves pain? Hard to imagine… Or are you reasoning that if it relieves pain, it can’t be massage? Not sure where you’re going with that one.

            “you can only massage superficial tissue, for Pete’s sake!”
            If you aren’t actually joking with that…you should find a different massage therapist.

            “You need to get a grip on reality”
            That’s good advice, Frank. Maybe I should watch more YouTube videos and speculate…

            Sorry, Frank – to be fair, gua sha does look absolutely brutal, and it really is hard to imagine that those markings are not serious injuries. Also hard to imagine that it was done with a ceramic Chinese soup spoon on oiled up skin, with relatively light pressure. Strains the mind, don’t it?

            Then again…maybe imagining isn’t the best plan, if you want to grip reality.

          • “jm” is evidently not interested in answering the question what it is he can palpate after scraping and sucking the skin and underlying tissues, just prattles on as usual, with childish nonsense. Probably has no idea what inflammation and edema are and how they are the result of trauma, which is not helpful in any medical sense.
            One suspects he or she simply lacks the intelligence to understand such matters.

            We can safely return to ignoring this troll. Nothing interesting here folks, please move on.

          • Inflammation and edema? Holy crap, Bjorn – I thought the palpation thing was a smart-ass question.

            Have you ever rubbed your sore shoulder, Bjorn? I would guess that most people have rubbed their shoulder at one point or another? Do the rubbing, feel the tissue. If the rubbing “worked” – the shoulder will feel softer, looser, more pliable, whatever. If not, keep rubbing. Check again – by feeling it. That is checking for evidence by palpating. I really didn’t think you would need that spelled out. But here we are.

            Same with scraping your shoulder. Whether it marks or not – you won’t feel inflammation or edema…because there won’t be any. You’re feeling for softer, looser, more pliable, whatever result you were aiming for.

            When we started this, years ago, I said you could scrape your hands & fingers for your arthritis pain. (If you like, I can give you more detailed instructions…but you seem unnaturally fearful of this.) You wouldn’t need to palpate at all. Just move you fingers. They will feel lovely – more mobile, less pain. If not – scrape some more. As a bonus, I’ve never seen fingers mark up. So you won’t have that worry about bodily assault*!

            ____________

            *Oh, and on the topic of bodily assault – you’ve made some pretty dramatic claims. Many times. Here are some highlights:

            “People like Arya Nielsen are a threat to their fellow humans.”

            “My suggestion is that anyone who comes across a victim of cupping, Gua Sha, bloodletting or other antiquated nonsense that in effect constitutes bodily assault, consider submitting a complaint to the police.”

            “Its practitioners should be prosecuted for harming their misinformed clients.”

            Do you have any evidence for your claims of injury? (remembering of course, anecdote is not evidence…) The links Edzard has posted seem to disagree. Unless you consider “minor and transient” or “slight muscle aches” to be painful injury or bodily assault?

            Do you think making claims like that, without any evidence, is ethical?

          • Björn Geir wrote:

            “jm” is evidently not interested in answering the question what it is he can palpate after scraping and sucking the skin and underlying tissues, just prattles on as usual, with childish nonsense. Probably has no idea what inflammation and edema are and how they are the result of trauma, which is not helpful in any medical sense.

            One suspects he or she simply lacks the intelligence to understand such matters.

            We can safely return to ignoring this troll. Nothing interesting here folks, please move on.

            Yes indeed! The faceless commentator, who hides behind the pseudonym “jm”, has been prattling on, as usual, with childish nonsense for several years.

            Note to the readers who are unfamiliar with the alternative-to-medicine quacks who have vested interests in the promotion of gua sha and/or cupping, please view the following Wikipedia images:
            https://en.wikipedia.org/wiki/Gua_sha#/media/File:Gua_Sha_Massage_Aftermath.jpg
            https://en.wikipedia.org/wiki/Cupping_therapy#/media/File:Fire_Cupping.jpg
            https://en.wikipedia.org/wiki/Cupping_therapy#/media/File:Fire_cupping_in_Haikou_-_02.JPG

            I have little doubt that each ‘patient’ had plenty to ‘palpate’ after receiving their ‘treatment’.

          • Pete,

            If you’re going to make a claim like “Gua sha practitioners deliberately cause injury to their patients”, surely you can back that up with evidence, yes? As you well know, pictures aren’t evidence to support your claim.

            Do you have any evidence for your claims of injury? (remembering of course, anecdote is not evidence…) The links Edzard has posted seem to disagree. Unless you consider “minor and transient” or “slight muscle aches” to be painful injury or bodily assault?

            Do you think making claims like that, without any evidence, is ethical?

          • Oh, and Pete-

            While you contemplate the ethical issue of
            – claiming deliberate injury when the evidence of adverse effects ranges from “none” to “none serious”
            – the ethics of an MD claiming that those side effects are “bodily assault”, or whether practitioners should be prosecuted (what do you suppose the charge would be for minor, transient, slight muscle aches?)

            …I forgot to thank you for posting the links. The file “gua sha massage aftermath” is one that’s been posted before – but I never caught the image label.

            I would have thought you’d find a more dramatic one, though. Same with the cupping ones. I would have thought you’d have gone for more dramatic pics (they’re definitely out there), but the ones you chose are pretty representative of a standard cupping treatment, and clearly illustrate the horrors. Those monsters!

            But the pic of the woman with the cups on her neck – if you look in the lower right hand corner, there are some really nice bamboo cups. The darker ones look quite lovely. Thanks for posting that.

        • I have a poor sense of my physiological balance. The last time I fell downstairs, I used my elbows against the walls as brakes, in the hope that doing so would save injury to my legs and head: it worked.

          There was plenty to ‘palpate’ on my elbows for a few days afterwards. As Björn wrote: What do you think you are palpating “jm”?

          Gua sha practitioners deliberately cause injury to their patients, then proudly proclaim that these injuries can be palpated — “jm” stated “which, for massage/bodywork techniques like gua sha, the evidence you’re looking for is change in tissue…which you can palpate” — and that this counts as evidence of efficacy of the gua sha treatment modality.

          It does indeed count as evidence of injury; it does indeed count as evidence of efficacy [noun: the ability to produce a desired or intended result] of this treatment; but the only way in which it counts as a 21st Century medical treatment would seem to be medical fraud.

          QUOTE from the Wikipedia article entitled Quackery [retrieved 2017-08-08]:

          Quackery is the promotion[1] of fraudulent or ignorant medical practices. A quack is a “fraudulent or ignorant pretender to medical skill” or “a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess; a charlatan or snake oil salesman”.[2] The term quack is a clipped form of the archaic term quacksalver, from Dutch: kwakzalver a “hawker of salve”.[3] In the Middle Ages the term quack meant “shouting”. The quacksalvers sold their wares on the market shouting in a loud voice.[4]

          Common elements of general quackery include questionable diagnoses using questionable diagnostic tests, as well as untested or refuted treatments, especially for serious diseases such as cancer. Quackery is often described as “health fraud” with the salient characteristic of aggressive promotion.[1]

          https://en.wikipedia.org/wiki/Quackery

          • “Gua sha practitioners deliberately cause injury to their patients”

            “ Quackery – a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess”

            If it walks like a duck…well, you know the rest :).

          • @Pete
            Upton Sinclair, a wise man, used to say: “It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”

            “jm” is uneducable. There is no use explaining trauma and injury to an unwise person who makes money from inflicting unnecessary injury albeit mild.
            From what this character has said here, one may hope it is mostly pretending to do Gua Sha, i.e. not producing so much bruising and cupping-edema? A charlatan any which way.

          • Quoting Upton Sinclair isn’t evidence, Bjorn.

            Edzard posted a few links, and according to the research gua sha is really safe. Do you have any evidence for your claims of injury, truama, bodily assault, Arya Neilsen is a threat to her fellow human beings, call the police, etc ? You say “I AM an expert in this matter, I have tons of paper to substantiate my claims…”, but you provide no evidence.

            Do you think making claims like that, without any evidence, is ethical? It’s a simple question.

          • “according to the research gua sha is really safe”
            ARE YOU SURE? WHAT RESEARCH?

          • The links you posted show the side effects as:

            “One trial [85] reported that there may be petechiae, slight muscle aches, and soreness in the application area, with none of these effects being serious.”

            “None reported.”

            “No adverse events were reported.”

            “The treatment was safe and well tolerated.”

            In addition to those studies, you link to a case study of a 72 year old woman “The patient who suffered from chronic headaches, highly profited from Gua Sha during her 14-day inpatient multimodal treatment. This case provides first evidence that Gua Sha is effective in the treatment of headaches.” I think you pointed out that it’s not evidence that gua sha was effective in treating her headache – but I would hope that if she suffered “bodily assault” they would have mentioned it. Maybe she was a really really tough 72 year old…

            Bjorn has repeated and emphatically claimed serious injury, bodily assault, practitioners should be prosecuted. Do you think it’s ethical for a medical practitioner to make statements like that with no evidence?

          • ” petechiae, slight muscle aches, and soreness in the application area”
            this is not ‘really safe’!
            and anyway, to make such a claim you would need something like post-marketing surveillance which does not exist in alt med.

          • Quoting Upton Sinclair isn’t evidence, Bjorn.

            No one was asking “jm” for comment and no one was claiming evidence. “jm” would not know evidence even if bit in the but by it.

          • “” petechiae, slight muscle aches, and soreness in the application area”
            this is not ‘really safe’!”

            Sure it is, and you know that. And actually, you left out the “may be…”. The finding was ““One trial [85] reported that there may be petechiae…”. But let’s say the “may be…” wasn’t there. Do you think petechiae, slight muscle aches, and soreness is “bodily assault”?

            Do you think it’s ethical for a medical professional to call that “bodily assault”, worthy of prosecution? That’s quite a claim.

          • why do you ignore the 2nd part of my post?

          • You mean this part – “and anyway, to make such a claim you would need something like post-marketing surveillance which does not exist in alt med.”

            Really? I think the reported side effects ranging from “none” to “muscle aches/soreness” is fairly easily understood.

            Speaking of ignoring, I’ll ask you (the very straightforward question) again: Bjorn has repeated and emphatically claimed serious injury, bodily assault, practitioners should be prosecuted. Do you think it’s ethical for a medical practitioner to make statements like that with no evidence?

          • How about that then?
            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016097/

            After receiving gua sha for throat pain, the person, having his neck assaulted like this unavoidably produced swelling, which, in turn, increased pressure in significant underlying structures beneath the area. Also, the treatment itself inflicted damage directly to these tissues, directly triggering the inflammatory response.

            I don’t see anything difficult in understanding that when you cause brusing and skin trauma, you open “doors” to infections of all kinds. Gua Sha is very tough massage, with no reason other than a proclivity to sadism/masochism. It does not help the body expel anything, it is the other way round, things get IN more easily. And in terms of effectiveness, it does not have any effects that are more beneficial than those of plain massage. Rationally speaking, the only reason it appears to be effective for pain management is because it causes more pain, thus modulating the nociceptive effects of the original sources of pain. It does NOT cure anything, however, in the process. Also, it would be short-sighted to deny physiological response in case of varying levels of pressure on soft tissue (see mechanotransduction). But beneficial side-effects and level of applied pressure are not connected in a dose-dependent fashion, naturally. Up to a level of pressure, interesting and beneficial side-effects of the physiological response can be elicited… BEYOND this level of pressure, you are obviously causing more harm than good.

            Now, talking about gua sha is, in terms of physics, like talking about pressure and friction. There are skin conditions that might benefit from slight friction. However, gua sha is about some pressure and a LOT of friction. If you are trying to elicit physiological responses to soft tissues OTHER THAN SKIN through friction, you have to cause friction directly on the tissues… skin gets in the way, however, so Gua Sha is relatively useless for that. If you really wanted to elicit friction on other pieces of soft tissue (muscles, tendons, fasciae, etc.) you had better grab handfuls of dimples of skin and pull them around softly for a while, much more efficient than Gua Sha. For what it’s worth, though, friction does not elicit much more of a physiological response, other than that of increased temperature and shear stress on the tissue (cf. damage).

            However, muscles, tendons and ligaments, which may feel sore after, say, a training session of whichever kind, tend to respond more aptly, in a physiological sense, to pressure (i.e. mechanical stimulation of sorts, thank you mechanotransduction!), rather than friction. If you want to have a beneficial effect and your pain originates in the muscles, try pressure, not friction.

            In short:
            -Gua Sha appears to modulate pain by causing more and diffuse pain. However, try cutting off one finger next time you have a strong headache. Acute localized pain is even more effective in distracting attention.

            -Pressure and friction are the means. Tissues have a more suitably exploitable physiological response to pressure than friction and there are well-documented mechanisms for that fact. Better focus on that, take friction out of the equation (unless it is 5 degrees in the room) and resort to a simple and elegant massage with any technique you like to patent. It is understandable that there has to be some friction in massage. Stick with those levels that do not create bruises and damage.

          • The epiglottitis story is on the wikipedia page, too. There was a case of someone being burned pretty badly by cupping, a pneumothorax incident involving a massage therapist performing acupuncture. A friend of mine died (liver failure) after a bad reaction to an antibiotic prescribed by her MD.

            Edzard has posted 3 different links to studies done on gua sha. Two of them no adverse effects were reported. One reported that there may be petechiae, slight muscle aches, and soreness in the application area, with none of these effects being serious.”

            Do you think the people in the studies were outliers – some weird mass coincidence thing? Or possibly “real gua sha” wasn’t used. That could be it. Or maybe they were lying.

            Do you think it’s ethical for a medical practitioner to claim serious injury, bodily assault, practitioners should be prosecuted, etc when the most serious side effect reported in studies was “may be petechie”?

          • Let’s assume (as always) good faith in you not understanding, rather than you not wanting to understand. I will keep it as simple as possible.

            The trials were performed in a controlled environment. It is unethical to expose people to dangerous and potentially harmful conditions for the sake of performing a medical trial. Furthermore, they were carried out in Germany. The living conditions in Germany are fine in most places, even more so in the proximity of an academic teaching hospital in Duisburg. If someone cares to state otherwise by personal experience, by having lived in Duisburg, feel free to correct me. People participating were not going to be exposed to any dangerous conditions anyway, such as dirty and infectious environments. When taken care of, more adverse side-effects can efficiently be avoided. Which is to say, the adverse effects are PRECISELY the ones caused anyway, i.e. the skin trauma.

            This brings us to the conclusion…enough with the word play. You have spoken numerous times about “real” gua sha and stuff. You obviously have personal experience of using gua sha. Why do you insist using the “may be petechiae” citation of some trial time and time again? Share your honest experience. Intensively scratching the skin for a moderate amount of time does or does not create blemishes, petechiae and bruising? CAN you or CAN YOU NOT discern the back of a person that has received “true gua sha” massage, in comparison to someone that has not? What do you think these deep purple bands are? Traces of purple markers? Rock musicians?

            Answer that and we can start from there in trying to decode what exactly it is that you are defending on behalf of gua sha. If you keep writing with an intention to divert the attention etc., there can be absolutely no end to the discussion. I could also keep saying irrelevant stuff, such as “do you think parents that slap or spank their children some times should be prosecuted?”. Let’s stick to the point. Does gua sha traumatize the skin or not?

          • James,

            ” Let’s stick to the point.”*
            I’d love to. The point is that an MD has made some pretty dramatic claims about the nature and safety of gua sha. Many times. Here are some highlights:

            “People like Arya Nielsen are a threat to their fellow humans.”
            “My suggestion is that anyone who comes across a victim of cupping, Gua Sha, bloodletting or other antiquated nonsense that in effect constitutes bodily assault, consider submitting a complaint to the police.”
            “Its practitioners should be prosecuted for harming their misinformed clients.”

            Those claims can’t be backed up with evidence. Is that ethical? You seem to have joined Bjorn, Pete, and Edzard in not answering a simple question.

            The links that Edzard posted aren’t “proof” that gua sha isn’t dangerous. It should be pretty obvious, though – you have to be quite the fundamentalist to look at those and come to the conclusion that gua sha is bodily assault. At the very least, you should scratch your head and wonder how Bjorn came to that conclusion. (Other than looking at pictures – the pictures of gua sha look nasty. In person they look pretty bad, too. You could conjure up quite the fantasy about gua sha from looking at it.)

            _______________
            *As you say, let’s stick to the point – is it ethical to claim assault, etc without proof? Then let’s move on to the rest of your comment. But I want to clear up a couple of things:

            – when I mentioned ‘real gua sha’, that was for Bjorn’s enjoyment (he said “As I have pointed out before, there is a very important prevailing misunderstanding about what constitutes GS. Real GS involves inflicting painful injury. If not it is not GS.” That’s humorously inaccurate.

            – “…trying to decode what exactly it is that you are defending on behalf of gua sha.” I have no interest in defending gua sha. Quite the opposite. For a variety of reasons, I hope that there’s never good, western med evidence that gua sha is helpful for anything. I’d love to discuss that – but not in relation to a conjured fantasy of gua sha. There’s really no point to debating fantasy.

            Meanwhile, it’s interesting to see just how serious folks are about making claims without evidence :).

          • Nice, then there is not much sense in creating too much of a debate when there isn’t one. Let me delineate the line of reasoning in steps:

            1) The primary suggestion of the post was that Gua Sha is not an efficacious treatment. The links to the trials were not cited for what they say with respect to adverse effects, but with respect to what they propose regarding the efficacy of the technique.

            2) The premise was established (in the post) that these pieces of work are quite biased in favor of Gua Sha (for some reason) and their reportings were greatly exaggerated. Let me demonstrate what I mean:

            2a) https://www.ncbi.nlm.nih.gov/pubmed/21276190
            i) QUOTE from Discussion:
            “Expert opinion and Chinese literature point to its effectiveness in chronic neck pain [11, 17,20]. However, no studies have been done in a Western population.”

            MY COMMENTS:
            If you follow the citations, 11, 17, 20… they are a doctoral dissertation (too much “opinionation” in these), a pilot study that practically studies the effect of Gua Sha (cf. strong scratching) on microcirculation of surface tissue, as if harming the skin wouldn’t cause changes to skin microcirculation. These are not experts. And just using the expressions “Chinese literature” and “effectiveness” in the same sentence is enough to ring an alarming bell in medicine. They like alternatives. To perform studies on western population is a redundancy. It’s like assuming that since eastern population appears to get better, western population may get better too. This sentence reads (to me, at least) “we had nothing better to do and we picked in random some Chinese method and applied it to some western people”.

            ii) QUOTE from Discussion (EVEN WORSE):
            “Furthermore, Gua sha therapy, as applied in this study and despite producing transitory impressive skin petechiae and ecchymosis, was safe and well tolerated by all treated subjects.”

            MY COMMENT:
            …impressive skin petechiae and ecchymosis… safe? In what sense? As in “nobody died”? Apart from my personal opinion that this is an unfortunate understatement, I think it would be quite objective to say that they don’t even consider that ecchymosis may not be a good thing at all (vs. the indifference with which they make their statement). Why? Because hematomas of any type are visible, perceptible symptoms that doctors (and not only) use quite often to make DIAGNOSES. When they have an underlying cause (e.g. scurvy), they are bad, and when they are the result of intense scraping, they are ok? This is a textbook double standard. Imagine police officers standing above a corpse with a bruised skin band around the neck and inferring it cannot have been strangulation but Gua Sha… Anyway, the objective conclusion I can make of this sentence is that they are QUITE biased in favor of Gua Sha anyway, so they undermine the significance of its effects (I am clear… they are NOT side-effects, they are EFFECTS… the PRIMARY EFFECTS of Gua Sha), which are hematomas of various extents (from petechiae to ecchymoses).

            2b) I would like to comment on the second study but THREE of its authors were the same people, and it was about one year later so they probably didn’t have enough time to change their attitude. Also, it was published in the American Journal of Chinese Medicine, so I feel it will be trivial AND a waste of time to seek examples of bias in favor of Chinese Medicine in the “…Journal of Chinese Medicine”. However, I took a look at the text and I think it is of relatively good quality, with the occasional wishful explanations (“may be” is written all over the place in the article). The only thing I can accept from the study is that Gua Sha modulates pressure pain thresholds, which I would have expected anyway from some intense scraping by any other title. No mention is made whatsoever about adverse effects, other than the patients did not report any, although they have an IMAGE with the back of a person with petechiae all over it during the course of performing Gua Sha.

            3) Since the premises are established in the post of Edzard that Gua Sha is not efficacious and the studies are highly biased in favor of Gua Sha, the obvious not-necessary-to-mention conclusion that they unavoidably disregard the importance of the injuries Gua Sha causes in their rather indiscernible attempt to vindicate the practice, hopefully, becomes now EVIDENT. This should be clear ANYWAY (but, for some reason, you don’t want to understand this simple line of reasoning) and that is why Bjorn, Pete and Edzard (although they should feel free to correct me if I have misunderstood anything) do not insist in stating obvious mid-term conclusions. On the other hand, however, you are trying to USE these studies to provide evidence that Gua Sha does not cause injury. But you missed some of the sentences (see quotes above). The authors do not consider hematomas as injuries (I hope they WILL DO when they diagnose patients in different settings), so you cannot be based on their account of “adverse-effects”. To me, hematomas are quite adverse effects from a treatment that cannot provide anything useful after all. The risk-benefit ratio is simply rather high (approaching infinity actually, regardless of the nominator, since the denominator is zero).

            Your behavior henceforth runs ad hominem. You want to find something wrong with the people (maybe you have a bone to pick with them?) and have so peristently ran along with the same darned question to CREATE an impression to the readers of the comments section. Let me answer this question then: Whichever treatment is not efficacious, in order to be even slightly better than utter trash, it MUST retain a minimum of providing NO HARM WHATSOEVER (cf. do-no-harm). Even the least bit of harm makes it a negative treatment. There is no need for a ghost-chase of evidence of harm. The normal natural physiological condition of the skin is unbruised. Bruised skin is harm and this is why whoever applies this treatment simply DOES HARM AND NO GOOD. Unless you have something serious to say to refute this statement (such as what, in your opinion, constitutes Gua “SHA”, e.g. you believe it should not be so hard as to cause bruising…?), just go straight to your true underlying intention and state what your problem is with Bjorn, Pete, Edzard etc… People applying Gua Sha to someone without telling them that it is QUITE UNPROVEN as a therapy and sums up in making harm to cause pain to distract from other pains are arguably exercising premeditated harm. Whether they should be prosecuted or not is for a different and more solemn and official procedure to determine, preferrably one involving unbiased experts of both medical and legal professions.

            Let me remind you of your other option, of course, which is to move the goalposts (and we will all follow your line of reasoning perfectly well) and say that hematomas of whichever type (ecchymosis, petechia, etc.) are not an indication of harm. If you care to redefine bodily assault in a sense that does not include these, maybe all your contenders will also care to redefine their claims of prosecution. And, of course, we must reeducate forensic pathologists too, to disregard hematomas as signs of ANY form of bodily assault.

          • “[jm replying to James] Those claims can’t be backed up with evidence. Is that ethical? You seem to have joined Bjorn, Pete, and Edzard in not answering a simple question.”

            Stated by the random Internet poster who hides behind the pseudonym “jm”, who has previously stated:

            My advice would be to step away from Wikipedia, YouTube, and sciencebasedmedine’s website/blog and go talk to actual practitioners. Then have them demo on you. Or, stick with fantasy. Up to you.

            To which of us does the Oxford Living Dictionaries definition of the word “fuckwit” apply [rhetorical question].

            QUOTE [https://en.oxforddictionaries.com/definition/us/fuckwit]
            fuckwit noun

            A stupid or contemptible person (often used as a general term of abuse).

            Synonyms
            idiot, ass, halfwit, nincompoop, blockhead, buffoon, dunce, dolt, ignoramus, cretin, imbecile, dullard, moron, simpleton, clod

            scoundrel, villain, rogue, rascal, brute, animal, weasel, snake, monster, ogre, wretch, devil, good-for-nothing, reprobate, wrongdoer, evil-doer
            END of QUOTE

            “jm” revels in issuing personal accusations in his tiresomely-repeated pathetic attempts to defend the branches of sCAM quackery in which he has vested interests — even resorting to the utterly disgraceful depth of accusing Björn and others of posting racist comments. Here is one of the instances:
            http://edzardernst.com/2016/06/an-invitation-resulting-in-a-rare-insight-into-the-acupuncturists-mind-set/#comment-79435

            Those who fear the facts will forever try to discredit the fact-finders.
            — Daniel C. Dennett

          • Bjorn,

            You need evidence for your dramatic claims, not pictures.

            By the way, did you get that one from a study that proved injury? If so, post the link. Or is that a pic of a “no adverse effects”? Could go either way – gua sha pics looks pretty bad. In fact, that could be a pic from someone from the links Edzard posted. You never know. (I doubt it, since it’s a pic illustrating the Vietnamese version of scraping, on a page advertising various scraping and related tools.)

            Did you notice that a couple of rows above that pic is a pretty dramatic one from a page on “gua sha massage”? Looks like the secret’s out (well, it’s been out since the beginning of gua sha…but we can pretend it’s new!).

            Always a pleasure watching you dodge the ethics question. (I particularly liked the Trump-esque “nothing to see here…” one.)

          • @Pete Attkins on Tuesday 15 August 2017 at 02:13

            “To which of us does the Oxford Living Dictionaries definition of the word “fuckwit” apply [rhetorical question].”

            Love your work; nailed the perfect pejorative for the anonymous fool who panders to the worried well, steals their money, claims efficacy for scraping to produce dramatic bruising, has no idea of the ideomotor effect (in its case, the idiotmotor effect), writes as if he knows something, commits one logical fallacy after another, is blind to real science and medicine, suffers cognitive dissonance, and yet, claims intellectual superiority.

            You even deign to converse with it, something for which it should feel grateful.

          • James,

            How do you feel about Wikipedia’s definition of bodily assault? Don’t want to get mired in accusations of goalpost moving, so let’s pick a definition. Wikipedia’s is:

            “Bodily harm is defined as any hurt or injury to a person that interferes with the health or comfort of the person and that is more than merely transient or trifling in nature.”
            https://en.wikipedia.org/wiki/Assault_causing_bodily_harm

            Sound good, or do you prefer a different one?

          • Listen, I will once again refrain from assuming you are trying to be a smartass, but you are asking, maybe because you are worried that it may happen to you one day. Let me make an indicative case for you. This will get a bit tiresome, but bear with me, it may save your wallet in the long run.

            I will take, for example, the German criminal law:
            https://www.gesetze-im-internet.de/stgb/BJNR001270871.html – Das Strafgesetzbuch
            https://www.gesetze-im-internet.de/englisch_stgb/englisch_stgb.html – The english translation for you.

            ——– A FEW NECESSARY PASSAGES ———

            i) SECTION 223: Causing bodily harm
            (1) Whosoever physically assaults or damages the health of another person, shall be liable to imprisonment not exceeding five years or a fine.
            (2) The attempt shall be punishable.

            ii) SECTION 225: Abuse of position of trust
            (1) Whosoever tortures or seriously abuses or by maliciously neglecting his duty of care for a person damages the health of a person under eighteen years of age or a person who is defenceless due to frailty or illness and who…
            1. is in his care or custody;
            ….
            shall be liable to imprisonment from six months to ten years.

            (2) The attempt shall be punishable.

            (4) In less serious cases under subsection (1) above the penalty shall be imprisonment from three months to five years […].

            iii) SECTION 226: Causing grievous bodily harm
            (1) If the injury results in the victim
            3. […] contracting a lingering illness […]
            the penalty shall be imprisonment from one to ten years.

            (2) If the offender intentionally or knowingly causes one of the results indicated in subsection (1) above the penalty shall be imprisonment of not less than three years.

            (3) In less serious cases under subsection (1) above the penalty shall be imprisonment from six months to five years, in less serious cases under subsection (2) above imprisonment from one to ten years.

            iv) SECTION 228: Consent
            Whosoever causes bodily harm with the consent of the victim shall be deemed to act lawfully unless the act violates public policy, the consent notwithstanding.

            v) SECTION 229: Causing bodily harm by negligence
            Whosoever by negligence causes bodily harm to another shall be liable to imprisonment not exceeding three years or a fine.

            vi) SECTION 230: Request to prosecute
            (1) Causing bodily harm intentionally under section 223 and negligently under section 229 may only be prosecuted upon request unless the prosecuting authority considers propio motu that prosecution is required because of special public interest. If the victim dies the right to file a request in cases of intentional bodily harm shall pass to the relatives pursuant to section 77(2).

            ———- END OF NECESSARY PASSAGES ————–

            Now, let’s check the facts. You insist that petechiae and ecchymoses are not significant injuries. This is a strong indication that you are IRREVERSIBLY ignorant of ANY medically significant piece of scientific knowledge. I cannot present you with the mechanisms or point you to a book or something (you wouldn’t understand anyway), but maybe a case can clarify this for you: https://www.ncbi.nlm.nih.gov/pubmed/25671451
            To state it in super-simple words, a gastric adenocarcinoma neoplasm migrated to the skin at the site of an ecchymosis. To quote from the case: “The skin metastasis was the first sign of relapse and was followed by alteration of the general status and death”.

            Yes, dear “jm”. VERY SERIOUS complications may also arise from as simple and “harmless” (according to you) things as bruises of various kinds. It would be totally ethical to make a serious NOT-CLAIM but WARNING that ecchymoses (bruises in general) can mediate mechanisms of further harm to a body. Ok, so let’s go on to the case:

            -Adhering to Section 223, physically damaging the health of another person is something that can clearly be the case for producing hematomas of any extent.

            -Perfectly adhering to Section 225, the person receiving Gua Sha IS in the care of a practitioner AND is defenceless due to frailty or illness, since he is “in pain” and trying to relieve it by believing the practitioner’s claims and left in his/her hands.

            -Section 226 (1),3 is one that can be made for cases such as the one cited above for a metastasis because of severe subcutaneous bleeding. All that is necessary to claim adherence to this section is that a serious illness was caused as a result of the subcutaneous bleeding. There are “lighter” cases, but I feel this case of metastasis cited above is grave enough to make a strong point.

            -You can only save yourself using the passage of Section 228 regarding consent. For THIS, however, you have to have informed your clients that you are going to physically cause harm through BATTERY (and not “assault” that you are consistently stuck with, which may also, legally, not amount to physical contact).

            -Adhering to Section 229, Gua Sha practitioners USE the word “SHA” in the title of their services, so they cannot claim negligence. They know it is about bruising. What they may NOT know is how significant things can happen BECAUSE of this type of harm, even though rarely. Still, they do not belong to Section 229 because they purposely cause the harm in an “effort to heal” (I don’t know how else to put it).

            -Usually, the clients will not prosecute and the practitioners will not be held liable for anything, because of Section 230. This is why Edzard is trying to raise awareness in his statements. An unproven treatment that causes harm of any level and no benefit whatsoever should be legally prosecuted without special notice. Of course, the state cannot run behind practitioners of alternative treatments and follow-up on their clients, so I think this passage is relatively justified. But general awareness is low, and should be raised.

            So, you can stick with your irrelevant ethics questions on any matter you like, as you are persevering in here. You’re still looking at a good fine or/and a couple of years in prison if you don’t tell people that you will harm them more to inflict pain in order to ATTEMPT to relieve other pain, given that they know they can prosecute you of course… and you are in Germany (not that it matters, the same would hold in most countries).

            DISCLAIMER: Don’t take things lightly. The above is not the result of some random concoction. You are looking at serious indictments as a Gua Sha practitioner if an unknowing client of yours is well aware of his rights and has the support of a lawyer and a good case to make (and is in Germany, for the present example). The more aggressive their lawyers, the more the years in prison for you. Oh, and criminal laws of most countries DO have provisions relevant to battery and physical damage that does not involve skin-penetrating trauma. Just have fun with what you can mumble around in commentaries of posts of online blogs, but be careful of what you do in real life. That goes for pretty much ANYONE practicing Gua Sha.

          • James,

            This incident happened quite a while ago, and it’s been some years since I heard the first hand account…so details may be fuzzy. But, authorities were called to investigate a Vietnamese woman who performed a version of gua sha (the term is cạo gió) on her kid. Her kid was coming down with a cold, so she scraped them. The markings probably looked like the pic Pete posted. The kid’s school thought it was child abuse, so they (rightly so) contacted the proper authorities.

            Agencies like that one (and some schools and hospitals) are now trained to recognize the difference between scraping (and cupping) marks, and actual bruising. (At first glance, or in pictures, they can look very similar. In person, it doesn’t take much training to be able to tell the difference.)

            Employees at that particular agency started receiving gua sha on a regular basis. One has gone on to study the particular technique with one of my teachers.

            On a sidenote, you said “Gua Sha practitioners USE the word “SHA” in the title of their services, so they cannot claim negligence. They know it is about bruising.” That’s sort of true. The term “bruise” is usually used as an inaccurate shorthand. “Sha” is a very specific Chinese med term, and does not mean ‘bruise’ or any other injury/trauma. ‘Bruise’ is a different word in Chinese. And of course like every other language, there are specific terms for specific types of injury (different word for hematoma, etc).

            Many practitioners are starting to stick to the (accurate) term ‘sha’. Others are using the term ‘marking’. Because bruise, hematoma, etc are not accurate. And they lead to confusion (this blog post, for instance). One obvious (obvious if you’ve ever received scraping) is that bruises hurt, particularly when touched. Scraping marks don’t.

            So if you don’t know any better, you’re likely to conjure up the fantasy that scraping produces injury. And that can lead to other inaccurate speculation like “…essentially the accident (a scrape and resulting infection from falling off your bike) and the treatment (gua sha) work via similar mechanisms, namely distraction and counter-irritation.”

            One dog barks a fantasy, 100 more repeat it as the truth…so to speak.

            What are Germany’s libel laws like?

          • Let’s start with your smartass comment about German libel laws… It appears you have not taken a moment to read http://edzardernst.com/rules/ so you do not really know that:

            1) as per Edzard’s layout, everything posted in here by Edzard is a comment in a legal sense (this includes the comments, which would, otherwise be called elsewise, but they are called COMMENTS). This is, regardless of country (though there are a couple of countries where freedom of speech is quite limited), a fair disclaimer.

            2) Libellous statements are not allowed, so things posted here are, at least to a fair extent, checked for libel. I really don’t see anything libellous in here however, so, if one wears a different pair of glasses, your one-line aphorism may begin looking more like a THREAT, which amounts to premeditated assault. In contrast (because I already foresee you making the comment), my full-blown analysis has nothing to do with threat, it is a consultation and conveyance of important information to help protect both sides of a Gua Sha treatment session from potential trouble with the law.

            3) If you are too tired to check the website with the German criminal code, I cannot bother making a full analysis for you, but it will be totally sufficient to cite just Section 193 – Fair comment; defence
            QUOTE
            “Critical opinions about scientific, artistic or commercial achievements, utterances made in order to exercise or protect rights or to safeguard legitimate interests, as well as remonstrations and reprimands by superiors to their subordinates, official reports or judgments by a civil servant, and similar cases shall only entail liability to the extent that the existence of an insult results from the form of the utterance of the circumstances under which it was made.”

            Now that we are done with irrelevancies, we can focus on the core of the matter at hand, as it appears to manifest through your comments. Some simple questions will help put things into perspective.

            -You don’t think ecchymosis, petechia and hematoma in general (as in “subcutaneous bleeding”) is a type of injury? If not, why is that? Because it resolves within a few days to weeks?

            Let me also attempt to rephrase your course of reasoning on that. Gua Sha produces intense scraping marks (it does, there is no denying it). But the Chinese call it “Sha”, which is a medical term for something else. As long as it does not mean “bruise”, the marks are not bruises (or petechiae or ecchymoses for that matter). And calling it something else makes it not-an-injury. So these marks are not signs of subcutaneous hematoma? What is it then? And what does “sha” mean precisely?

          • You need evidence for your dramatic claims, not pictures

            Interesting. How does “jm” think these marks were produced? Using Photoshop perhaps? Rather unlikely.

            What does one call someone who tries to convince others that these images do not represent intentional injuries.
            Delusional perhaps?

          • Bjorn,

            Photoshop? No, I think it was from a smooth edged coin. Sorry I didn’t spell that out more clearly. I would also suspect she wasn’t injured. I have to suspect, though. It’s pretty stupid to judge injury from a picture.

          • James,

            “Gua Sha produces intense scraping marks (it does, there is no denying it).”
            It certainly does. Unless there’s nothing to bring up. Then it won’t. Scrape an area that marks dramatically – then scrape it again a week later and marking will be less (quantity and drama). Another week later, even less. After not too long, no marks. That’s just the way it works.

            “And what does “sha” mean precisely?”
            Google translates it as ‘fever’. One dictionary has it as ‘acute diseases such as cholera and sunstroke’. Neilsen breaks down the character nicely in her book and gives a great explanation.

            But if you want ‘precisely’…you’ll need to find a good practitioner and have them show you, and you’ll need to feel it. Both from the outside (feel sha on someone else) and from the inside (have the practitioner bring some up on you).

            Until then, you won’t really understand why “…there may be petechiae…” showed up under side effects. Or why MDs who have been scraped and asked about the marks take some time to answer, and the answer includes things like “might be”, “could be”, “kind of looks like”, and “not really sure”.

          • Photoshop? No, I think it was from a smooth edged coin. Sorry I didn’t spell that out more clearly. I would also suspect she wasn’t injured. I have to suspect, though. It’s pretty stupid to judge injury from a picture.

            Now that we have established the common understanding that these photos are genuine and not manipulated, Let’s contemplate what it is they are showing.
            “jm” seems to be referring to one image, there are thousands to be seen if you scroll up and down following the link, which simply shows a search on Google for the words “Gua sha”.
            “jm” is trying to chant a magic spell, making the notion that what we are looking at is not injury. How many in here agree with “jm”?

          • How should she be treating those injuries, Bjorn?

          • Is it possible that a tiny flicker of light is getting through the dark clouds of cognitive dissonance?
            “Jm” has finally accepted the term “injury” for the consequences of applying excessive scraping force to the skin, aka “gua sha”.

            “Jm asks how the victim should treat such injuries.
            This “jm” can look up in any handbook of first aid for the public.
            Why not ask: How should such injuries be prevented?
            Injury prevention is a much more important public health measure than first-aid education. Information is the keyword here, that is the whole purpose of this blog and this almost four hundred comment long thread, of which “jm” has written over one fourth trying to convince itself and others that injuring the skin helps for anything from sore muscles to hepatitis B (See Arya Nielsen’s “research”). That is just about as daft as dropping a fire extinguisher on your toe to help cure a sprained ankle.
            Teach a sufferer of sprained ankle to wear supportive shoes on the next hike… teach the sufferer of “gua sha” to avoid high street performers of pretentious practices.

          • Bjorn,

            A tiny flicker? I’m totally on board. I took your advice and looked at every first aid handbook I could find…no useful advice. There’s no mention of how to treat an injury that doesn’t hurt, no swelling, better movement – and the victims usually complaining about how good the assault feels while you’re doing it.

            (I guess I shouldn’t say ‘assault’ – over the years you gradually stepped it back from torture to assault to serious injury….and your latest is “inflicting unnecessary injury albeit mild”.)

            As far as your public health measure/information idea – I still think your first step is to do a guest post on this blog. Like I said, I will gladly help you spread it far and wide. Too many people are being conned by reality and need to be informed of the fantasy dangers conjured up by Wikipedia pages and YouTube videos.

            Before you do that, though – I never mentioned anything about Hepatitis B. But on that topic, have you voiced your concerns yet to Mount Sinai? What was their response? You’d think they would be fairly well versed in identifying bodily assault…and wouldn’t be allowed to use it in research. Odd.

            On a sidenote, you never answered my ethics question. Maybe I should rephrase. You need evidence to claim benefit, yes? But you don’t need evidence to claim injury? Is that accurate? Is it ethical? Could I pull up some pics from google and proclaim this that or the other is willful injury? I would have thought you’d need more than just a picture and some speculation. I’m learning so much from this blog…

          • Nope, the cloud-cover is permanently closing out any . No hope left. 🙁

          • Does that mean you’re not really serious about the whole information/injury prevention thing? And you keep dodging the evidence for claims of injury question. I didn’t think it would be so befuddling…

          • So, we have our fact-sheet:

            1) Seeing the scratches and scraping marks of Gua Sha is not enough evidence of their existence.
            2) The fact that scratches, scraping marks, petechiae and ecchymoses from Gua Sha are not given enough attention (cf. disregarded) in a couple of strongly biased (in favour of Gua Sha) papers (by the same people no less) constitutes evidence of their absence.
            3) Scratches and scraping marks of any severity, are not injuries.
            4) Repeatedly performing Gua Sha every week leads, over time, to the scraping marks not showing up any more. This is probably because “illness” is getting out, and, in the end, health has been restored.
            5) Wikipedia pages are very misleading sources of information.

            I think this constitutes a sound account of take-home points, as per “jm”, after so many comments.

            (A): Gua Sha is not ethical because, as a practitioner or advocate, you have people believe you will improve their health through Gua Sha, you get their money for that, and, in fact, you make their health worse.

            Sentence (A) is what ALL the fuss in here is about. All attempts in here to dispute sentence (A) can be summed up as:

            6) Gua Sha actually does improve their health.
            7) Sometimes, practitioners don’t get money (mother-to-child and similar treatments excluded).
            8) Gua Sha does not make the health of the people worse (no injuries show up).
            9) Injuries are not what medicine knows them to be (and various wordplays in support of that).
            10) (Of course,) completely irrelevant points about conventional medicine.

            So, for a Gua Sha practitioner, supporter or believer, sentence (A) is completely wrong and sentence (B) below is far closer to reality.

            (B): Gua Sha helps improve the health of people in multiple significant ways, is totally safe and does not damage even a single molecule of the person under treatment, and practitioners are often philanthropists with a keen interest in the common good and well-being of the public and their clients only give them money in return for the evident benefits of the treatment.

            Didn’t miss anything, now did I?

          • James,

            “Didn’t miss anything, now did I?”

            You missed a lot.
            1) You can’t asses torture, bodily assault, or even necessarily injury from visual marks. Injury assessment is more involved than looking at pictures.
            2) No, I doubt any markings were disregarded.
            3) No. You can certainly perform bad scraping. Just like anything else.
            4) For whatever reason, “illness getting out” etc – the fact of the matter is that repeated treatments results in less marking. Eventually no marking. Until you re-injure, re-overuse, etc. That’s not theoretical, that’s actually what happens.
            5) Wikipedia is usually a great starting point – but it’s not accepted as a research source for high school term papers. If you want to come to more accurate understandings…you need to venture forth.

            Your A and B sentences are both wrong. I love the “practitioners are often philanthropists” though – that’s funny. I assume you got that from some back and forths in the comments about not charging for gua sha? I personally don’t know anyone that does (I’ve seen some spas that advertise it as a separate charge, though).

            That’s a great example of how people read what they want to read, though. If you go back, what I actually said was that gua sha is a tool used in treatments in many different medical and bodywork systems. Everyone I know charges for the treatment, and uses gua sha when it’s called for. I also don’t charge extra for kneading or stretching. But I’ll use them in a session if that’s what’s called for. If you don’t understand that, just stick with “philanthropy”. I honestly don’t care.

            The results of gua sha have actually been assessed for injury. If you really think that Mount Sinai, child welfare agencies, Stanford University, hospitals, etc etc etc missed something – I’m going to call bullshit on that. You’re off your rocker.

            (Speaking of rockers and bullshit, we could go back to your assessment that the lack of side effects had something to do with the trials being performed in Germany. Good grief. I’m hoping you were kidding with that.)

            After your first comment, I was hoping we’d be able to get to the actual dangers (albeit mild, as Bjorn would now say) of gua sha. But it seems that we’ll be forever stuck in the mire of markings, conjured fantasy, and semantics.

          • Fashionable! So one functional use of Gua Sha would be to train the skin to be resistant to scraping marks. Mount Sinai? Stanford? Well, people vote as well. They don’t miss something when it comes to that, do they? Not in the USA of course.

            Frankly, I don’t know why some specific alternative forms of treatment, including Gua Sha, are being offered officially. Maybe it’s politics. Maybe it’s money. Maybe it’s customary (patient satisfaction, cf. “we treat you as your grandmothers”). Evidence is usually an enemy of these sectors.

            The primary disagreement of mine is that Gua Sha is “supposed” to be special when done by someone “who knows”. Knows what? Where, specifically, to scrape? How, specifically, to scrape? To evoke what effect? The scraping marks?

            Take gardening, or plowing, for example. There aren’t many ways to plow the soil, and there are no super-special secrets about it. Regardless of how exquisitely complex or tough the plowing is, subsequent plant growth can only be affected so much (and that’s not very discernible in distant temporal endpoints). Gua Sha techniques would like to have people believe there is a special way to scrape, so you can overcome illness or something (what??). Nope, there is nothing super special in scraping with a tool on lubricated skin. It is a false dichotomy to have someone claim there is a “correct” way and many “wrong” ways to do it, because, in the end, all there is is scraping marks. Does Gua Sha provably help with anything after all?

            Anyway, let’s get to the important points.
            When is Gua Sha called-for?
            What does it help with?
            And, most importantly, what are the real dangers of Gua Sha that you are referring to?

          • James

            “The primary disagreement of mine is that Gua Sha is “supposed” to be special when done by someone “who knows”. Knows what?”

            If that’s your primary disagreement, then problem solved. You can relax. Gua sha isn’t, and isn’t “supposed” to be, special. It’s very basic and simple. Opinions vary, but most of the time gua sha falls into the ‘kitchen medicine’ or ‘folk medicine’ category. You can learn to do it in about 10 minutes, with tools you already have (the side of your finger or thumb, if nothing else). It’s easy, feels great, and doesn’t take a lot of time. If you work on yourself or have a friend or family member do it – it’s free. Or you spend the big bucks (less than $5) and get a fancy gua sha tool. Or $1 and get a ceramic soup spoon.

            But like your plowing example, you should learn the basics. There aren’t many…way easier than learning to manipulate a plow. And way safer – plows are dangerous. (although plows are rarely choking hazards)

          • “jm”never answers questions, doesn’t seem to know the answers or understand the difficult words so ignores them and repeats its own inanities 🙂

            390 comments and counting. Let’s get this silly thread over 400. Would that be a record?

          • Wow Bjorn – that was weird. Pete just posted a bunch of my answers to your questions. Odd timing, eh? Oh, and it’s on the new thread you started, right after the comment where I answer your question. You know, the latest question you’re using to dodge my question :).

            So far, I asked you 8 times (in this latest round anyway) about evidence for willful injury, bodily assault, and all of your other dramatic claims. Got any? Or should I wait for dodge #9?

    • @Suzi on Monday 07 August 2017 at 14:53

      Why not,
      energy healing,
      therapeutic touch,
      osteopathy,
      Bowen therapy,
      naturopathy,
      acupressure,
      aromatherapy,
      ayurvedic,
      balneotherapy,
      homeopathy,
      reflexology,
      phytotherapy,
      shamanism,
      Gerson therapy,
      and dozens of others? Does everyone need to try each and every one of them in order to dismiss them, or is it enough that they fail to obey the laws of nature?

      Unthinking, dopey relativists like you are a scourge on this planet. While real science is done by real scientists to improve all aspects of your life, you have the temerity to dismiss some of it only because you have a baseless opinion of it. Crawl back under your rock.

  • The ‘pragmatic fallacy’ and the arrogance of the ‘individual’….THAT you say and believe something ‘works’ then it must be true since YOU couldn’t possibly be mistaken, confused or biased….simply because you are you, and that’s good enough for you.
    You’re “innocent until proven guilty” is THE rational rule-of-law precisely because only positive-claims need be proven. One isn’t required to dis-prove a claim or prove their innocence against no facts.
    Those who can offer no proof always get the most aggressive and contentious against those who ask for it.

  • jm wrote on Friday 18 August 2017 at 20:14

    1) You can’t asses torture, bodily assault, or even necessarily injury from visual marks. Injury assessment is more involved than looking at pictures.

    Good. We can agree then, that gua sha involves torture, bodily assault and injury, right?
    Now, what does “jm” suggest, apart from palpation, which we have previously agreed upon, is needed to assess torture, bodily assault and injury?
    Do we perhaps need to biopsy the skin and look at it under the microscope? That would be a good idea for research on the subject. What would we expect to find, apart from extravasated blood, edema and inflammatory reaction? Any forensic pathologist in the audience who would care to tell us what we see in skin biopsies form factitious injury? That is standard stuff for them.

    4) For whatever reason, “illness getting out” etc – the fact of the matter is that repeated treatments results in less marking. Eventually no marking. Until you re-injure, re-overuse, etc. That’s not theoretical, that’s actually what happens.

    Note that the emphasis is added by me. These are “jm”‘s own words!

    Interesting phenomenon this “illness getting out”. What exactly is it that is getting out and stops getting out when the scraping is no longer producing more “illness getting out”?

    What does “illness getting out” look like under the microscope? Or in the lab-tube? Or is it that mysterious nothing called “Qi” that no one can find and no one knows how to describe??

    Can “jm” please refer us to research using histopathological (blinded of course) and/or biochemical assessment of skin biopsies, that shows how scraping produces different changes in different situations of “illness getting out”
    Of course such research would need to be standardised with exactly the same mechanical pressure and angle results in different degrees of injury? Easy today with robot technology. My sons are both engineers and I know from them it would be very easy to produce exactly standardised scrapings.
    This is very important in order to eliminate the possibility of bias, i.e. the scraper (is that the correct term?) subliminally applying different manual pressure and angle of instrument in different situations (the ideomotor phenomenon) affected by his/her expectations and fantasies. Omitting such an obvious error elimination would totally ruin the validity of the research, right?

    5) Wikipedia is usually a great starting point – but it’s not accepted as a research source for high school term papers. If you want to come to more accurate understandings…you need to venture forth.

    So let’s venture forth and go above the level of high-school papers. Actually some very bright research has been performed in sub-academic schools, the name Emily Rosa comes to mind in this context… but that is another story 🙂

    Anyway, Arya Nielsen PhD, an american acupuncturist, is to my knowledge the best known gua sha researcher and perhaps the only person who has tried to seriously apply modern academic science to Gua Sha. She wrote a thesis on the subject based mostly on a series of non-invasive measuring of surface blood flow in the skin after non-standardised manual scraping.
    I have previously shown how we can safely disregard her work as proof of gua sha’s efficacy. It regretfully does not substantiate an efficacy of gua sha for anything. It is not even designed to do so. She has only show what any student of histopathology would have expected to find after scraping injury, i.e. increased microperfusion (aka blushing) and the release of substances into the bloodstream. The same happens after dropping a fire extinguisher on your toe, and I have never heard that is likely to help for any medical problem.
    Her writings usually contain a set of unsupported speculation[sic] about physiological effects of substances known to be released by injury such as heme-oxygenase-1.
    A commonly referred to speculation of hers is that the release of substances like heme-oxygenase-1 will beneficially affect, even possibly cure Hepatitis B. This is pure fantasy if I ever saw one. But I can well imagine laypeople may be impressed by the sciency look of all this. And not the least by the reference to Mount Sinai where Arya Nielsen is employed in the “Department of integrative medicine”. If you ask me what role this department plays, I would answer: patient entertainment services, but I am only a tired, old, grumpy surgeon who does not understand this new, mystical approach to medicine. For example, I cannot understand, based on what we have learned about gua sha, why their “preparation for surgery” program does not include this supposedly wonderful facilitator of healing?
    Instead it only includes the following dramaturgical varieties:

    Centering and Grounding
    Aromatherapy
    Guided Imagery
    Biofeedback
    Energy Healing (Therapeutic Touch, Reiki)

    There is a lot of interesting aspects to this Mt. Sinai-Beth Israel department and its appearance. For example the web representing it is not served under the main domain of MS-BI (mountsinai.org) but under wehealny.org. I guess the domain name is shorthand for something very important but it sure looks like one of those flashy commercial soundbites: “We Heal New York!”
    Clicking on the Mount Sinai – Beth Israel heading on the “wehealny” site, strangely does not lead to the mother-institution.
    And if you use Mount Sinai’s search-for-a-doctor page, the specialties of gua sha or acupuncture or cupping are not listed (nor is any of the integrative medicine services) Searching for Arya Nielsen by name is no good either even if the wehealny site (With MS-BI heading) lists her as one of the acupuncturists.
    If you try to find acupuncture gua sha cupping or just “integrative medicine” in MS-BI’s list of care provided by MS-BI, you are out of luck.
    I thought “jm” told us Arya Nielsen was an eminent member of faculty at MS and this corroborated the importance of gua sha?
    Can it be that the eminent institution wants to keep this embarrasing member of the family at a safe distance?
    Well, you never know?

    We are still waiting for “jm” to lead us to an “accurate understanding” as (s)he calls it, of gua sha .
    The prerequisites for such an understanding (at least an understanding to “jm”‘s liking?), seem to be deeply buried somewhere. We need something a bit more persuasive than the shoddily supported speculations of acupuncturist Arya Nielsen PhD.

    • That’s a lot of typing, Bjorn. I was hoping you’d provide some evidence for your claims of bodily assault, threat to fellow human beings, and all that. Alas, all hat and no cattle :).

      Do you honestly think gua sha is bodily assault, serious trauma, Neilsen is a threat to her fellow human beings? Or maybe you were exaggerating a bit. A touch of hyperbole?

      (Oh, and “illness getting out” actually aren’t my words. They’re from James’ comment.)

      • 😀

        Nielsen, not Neilsen. And the claims of illness getting out and so on are those of “jm” and other scrapers and suckers[sic].

        We are eagerly waiting for proof of gua sha benefits. The onus is theirs to prove their services are worth the money.

      • If by “we” you mean you & I (I doubt anyone else would be silly enough to be following this nonsense) – I’m actually waiting for your evidence of painful injury, trauma, bodily assault. Either evidence, or an explanation as to why you don’t need evidence for serious claims like that.

        But to humor you, I’ll go first since I don’t believe you actually have any proof of painful injury – I think you got caught up in your own hyperbole. I don’t see why, if you can back up your claims with more than anecdote, you wouldn’t share the proof.

        Anyway, as you know by now gua sha is a massage technique, according to Chinese Med textbooks, Traditional Med teachers, some dictionaries (“…a traditional massage technique using a tool with a blunted edge to gently and repeatedly friction…”). And as we also know:

        Massage is medicine.
        It can be soothing and healing.
        It works every time!

        So there you go. Your turn. And, thanks for catching the typo on Nielsen’s name. And the “illness getting out” actually are James’ words, from a few comments above ↑.

        • [jm] And the “illness getting out” actually are James’ [sic] words, from a few comments above ↑.

          No, jm, you did not state those exact words, you actually stated the following amongst your, thus far, 105 comments:

          [jm replying to himself] Gua sha is probably the easiest, most straight forward therapy to gather proof/evidence for.

          – scape [sic]
          – where there’s illness or injury, markings will come to the surface
          – where there’s no illness or injury, there will be no markings

          The proof is (relatively) instant. If you’re not producing marks after 30 – 50 strokes…there won’t be any. This is repeatable and predictable.
          http://edzardernst.com/2013/01/gua-sha-torture-or-treatment/#comment-59736

          [jm to Björn] At least you got the definition of “bruise” in the realm of reality. A bruise is caused by trauma. Gua sha does not produce trauma. Gua sha removes the effects of trauma. Scrape an area with previous trauma from injury or illness – marks will appear. No previous illness or injury – no marks. Simple, straightforward, immediate, consistent. It’s so simple you could teach a 12 year old to do it. (Probably younger, but 12 is the youngest I’ve personally seen.)

          I want you to read this again, since you seem to miss it every time I post it. I’ll type it slower this time: Scrape an area with previous trauma from injury or illness – marks will appear. No previous illness or injury – no marks.
          http://edzardernst.com/2013/01/gua-sha-torture-or-treatment/#comment-60003

          Bjorn – somewhere up there in the mess of comments, I told you that gua sha will only produce markings where there is illness or injury. Otherwise, there will be no markings. I also told you that with repeated treatments, the markings will be less and less each time.
          http://edzardernst.com/2013/01/gua-sha-torture-or-treatment/#comment-76299

          [jm to James] 4) For whatever reason, “illness getting out” etc – the fact of the matter is that repeated treatments results in less marking. Eventually no marking. Until you re-injure, re-overuse, etc. That’s not theoretical, that’s actually what happens.
          http://edzardernst.com/2013/01/gua-sha-torture-or-treatment/#comment-93671

          • @Pete
            Strangely, “jm” seems to read your comment as you answering my questions (See jm on Sunday 20 August 2017 at 08:56). Of course this thread is getting far to complex but the “jm” person seems increasingly incoherent. I hope it’s nothing serious?
            Maybe we should stop playing cat with this mouse?

          • I think you understand perfectly fine, Bjorn. You could say I’m speaking your language :). But, that’s dodge #9.

            Shall we go for 10, or wait until next time?

      • Ok jm… I’ll skate over the “massage is medicine” statement, but I definitely need to know if this course of reasoning you laid out is a serious argument, or you are just making an attempt at humour (Poe should know, though 😉 ).

        And, ok, “illness getting out” is one of my wordings. We got it (I am included in those “we” apparently). Now, instead of fervently citing it time and time again, move on, do you agree with it or not? Does Gua Sha get anything out? Does it help with anything?

        And, to put an end to your persistent questions that distract from the important points, ok, thousands of people are subjected to it, and, USUALLY, there is no life-threatening outcome from Gua Sha massage. But underlying problems can be aggravated through mechanisms you don’t want to believe in, because you probably don’t have a working knowledge of medicine, physiology, biology, chemistry etc. If your medical knowledge stems from Chinese and traditional medicine, “mechanism” is a very distant and complicated concept for you. The scraping marks are a result of injuries, in a strict medical sense. Tissue is damaged, blood perfuses the area, inflammation ensues, medical stuff. Do you believe in that, or you think the scraping marks are an indicator of how unwell the person was, and because after repeated sessions their intensity decays in some way, their not coming out so much indicates that the person is getting better?

        That’s all. These very simple questions will let us know what you believe and think about Gua Sha. Then we’ll tell you what we also believe and think about Gua Sha, based on scientific medical (and biological, chemical etc.) knowledge (though we have already done so), and we can see about the conflicting issues in a more concentrated and productive manner.

        • James,

          The whole “massage is medicine…”, definitely not an attempt at humor. Bjorn wanted proof of gua sha benefits. I would hope that what I answered will be plenty fine.

          As to the rest of your comment – gua sha is a massage technique…just leave it at that. It’s good for massage. We’ve talked about child services, hospitals, etc looking into gua sha. They didn’t find any evidence of injury. If you disagree with their assessment, prove it. Show some evidence. And definitely let them know :).

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