MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The only time we discussed gua sha, it led to one of the most prolonged discussions we ever had on this blog (536 comments so far). It seems to be a topic that excites many. But what precisely is it?

Gua sha, sometimes referred to as “scraping”, “spooning” or “coining”, is a traditional Chinese treatment that has spread to several other Asian countries. It has long been popular in Vietnam and is now also becoming well-known in the West. The treatment consists of scraping the skin with a smooth edge placed against the pre-oiled skin surface, pressed down firmly, and then moved downwards along muscles or meridians. According to its proponents, gua sha stimulates the flow of the vital energy ‘chi’ and releases unhealthy bodily matter from blood stasis within sore, tired, stiff or injured muscle areas.

The technique is practised by TCM practitioners, acupuncturists, massage therapists, physical therapists, physicians and nurses. Practitioners claim that it stimulates blood flow to the treated areas, thus promoting cell metabolism, regeneration and healing. They also assume that it has anti-inflammatory effects and stimulates the immune system.

These effects are said to last for days or weeks after a single treatment. The treatment causes microvascular injuries which are visible as subcutaneous bleeding and redness. Gua sha practitioners make far-reaching therapeutic claims, including that the therapy alleviates pain, prevents infections, treats asthma, detoxifies the body, cures liver problems, reduces stress, and contributes to overall health.

Gua sha is mildly painful, almost invariably leads to unsightly blemishes on the skin which occasionally can become infected and might even be mistaken for physical abuse.

There is little research of gua sha, and the few trials that exist tend to be published in Chinese. But recently, a new paper has emerged that is written in English. The goal of this systematic review was to evaluate the available evidence from randomized controlled trials (RCTs) of gua sha for the treatment of patients with perimenopausal syndrome.

A total of 6 RCTs met the inclusion criteria. Most were of low methodological quality. When compared with Western medicine therapy alone, meta-analysis of 5 RCTs indicated favorable statistically significant effects of gua sha plus Western medicine. Moreover, study participants who received Gua Sha therapy plus Western medicine therapy showed significantly greater improvements in serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) compared to participants in the Western medicine therapy group.

The authors concluded that preliminary evidence supported the hypothesis that Gua Sha therapy effectively improved the treatment efficacy in patients with perimenopausal syndrome. Additional studies will be required to elucidate optimal frequency and dosage of Gua Sha.

This sounds as though gua sha is a reasonable therapy.

Yet, I think this notion is worth being critically analysed. Here are some caveats that spring into my mind:

  • Gua sha lacks biological plausibility.
  • The reviewed trials are too flawed to allow any firm conclusions.
  • As most are published in Chinese, non-Chinese speakers have no possibility to evaluate them.
  • The studies originate from China where close to 100% of TCM trials report positive results.
  • In my view, this means they are less than trustworthy.
  • The authors of the above-cited review are all from China and might not be willing, able or allowed to publish a critical paper on this subject.
  • The review was published in , a journal not known for its high scientific standards or critical stance towards TCM.

So, is gua sha a reasonable therapy?

I let you make this judgement.

69 Responses to Gua sha, a reasonable therapy?

  • I know the answer; it is a form of witchcraft espoused by charlatans or the deluded, both of which have no understanding of even basic science.

  • Given the risks and the lack of biological plausibility – NO!

  • While it doesn’t seem very likely to me, I would not have thought this was completely biologically implausible. I’m sure it is possible to hypothesise mechanisms whereby traumatising the skin in this way can have biological effects. For instance, if it alters blood flow within subcutaeous fat, this may affect oestrogen levels (oestrogen being metabolised in fat) and therefore also LH and FSH. Or perhaps there are systemic effects following on from the local inflammation visible in the photograph, with release of any number of acute phase proteins, growth factors and other chemical signals associated with tissue damage. Such a response might be an interesting area for basic research (probably somebody has already looked into it with regard to burns and other forms or skin trauma). Nature is much more devious that we give her credit for, and our knowledge of physiology is far from complete.

    However, I certainly wouldn’t want to base treatment on such ideas without a lot more evidence.

    • Speculation is not a hypothesis, neither is it a basis for plausibility, I think.

      • I was not putting forward a hypothesis. I was trying to make the point that just because the mechanism of a response is as yet unknown doesn’t mean that it is biologically implausible.

        Over the course of my career I have seen many strange reactions. Some of these are well-characterised, and indeed described in standard textbooks, such as erythema nodosum, clubbing of the fingernails, hypertrophic pulmonary osteoarthropathy, malar flush in mitral stenosis and the wide variety of paraneoplastic syndromes. However, the explanations that I have heard for the mechanisms of these phenomena seem to me to be simply guesswork.

        And indeed I have seen changes in sex hormone levels in relation to trauma in my own patients.

        Of course, if a thing is plausible, that does not mean that it is true. But it seems to me at least plausible that deliberate skin trauma could have other physiological effects, perhaps even changes in gonadotrophin levels as described in the review article in question. Much more plausible than the other therapeutic claims made for Gua Sha. Having said that, the abstract that Edzard links to does not state what is meant by “improvements” in LH and FSH, and although I was unable to read the full paper, Pubmed does helpfully provide a link to another RCT (Chinese) of Gua Sha in perimenopausal syndrome where the authors found no effect on LH and FSH.

        Implausibility implies a contradiction with other established theories. In this case I am not clear what the hypothesis that skin trauma can cause changes in gonadotropohin levels is contrary to.

    • Indeed, it used to be applied – still is, apparently – to horses’ legs – I have seen it mentioned in early 20th century novels, and here is Wikipedia on the subject: https://en.wikipedia.org/wiki/Pin_firing

  • Edzard,

    The “My Gua Sha Session” link isn’t working – here it is: https://www.youtube.com/watch?v=1nnvqqIU5ts

    I’m assuming you meant to link to the video, because the image isn’t actually showing the practitioner doing gua sha. He’s working the side of Heidi Powell’s leg with his thumb. The still is from around 4:15 in the video.

    Good choice of video, though. Pretty standard gua sha treatment.

  • We have previously been taught by you, “jm” that Gua Sha and cup-sucking does not cause injury. Or to partially quote one of your feverish responses in the aforementioned mega-thread:

    jm on Friday 20 June 2014 at 14:53
    […]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.)[..]

    You say that what we are seeing in this film is “pretty standard gua sha treatment”

    I wonder what this rather healthy looking woman was suffering from that the gentleman (with emphasis on “gentle-“?) was sucking and scraping out? Was it some disease, a mental condition perhaps, or previous injury? Perhaps her husband has a habit of beating her??

    I have asked several people, both laymen and health care personnel what they think the marks that are seen on the woman in this film, represent. They all use terms like ‘injury’, ‘trauma’ and ‘bruising’
    Can you explain what we are seeing and why we are wrong? If this is not bruising from trauma, then what on earth is it?

    • Bjorn,

      “You say that what we are seeing in this film is “pretty standard gua sha treatment”

      According to Heidi, it was a superficial scraping, it “didn’t feel like you had done anything that would create that kind of response”, she was laughing and joking during the session, painful areas produced a darker color, the painful areas were more uncomfortable with compression (hand techniques, not gua sha). She showed a pic from her previous session – markings during this session were much less (same area at the base of the neck remained unmarked, too). And she like the results from the session.

      Pretty standard gua sha treatment. (What you keep referring to as bodily assault, and a threat to fellow human beings. And a good example of what Edzard referred to as torture.)

      “Was it some disease, a mental condition perhaps, or previous injury? Perhaps her husband has a habit of beating her??”

      Just a guess, but based on her other posts…exercise.

      “I have asked several people, both laymen and health care personnel…”

      And what was the response from Mount Sinai Beth Israel, child welfare agencies, Stanford University, hospitals – you know, the professionals who did injury assessment, and found none? They were probably looking at actual bodies, though – not pictures. Probably wise when assessing potential injury. I’m sure you could also contact Heidi Powell (the patient in the video). ?

      We could go back and forth another hundred times or so. But it would be more productive if you actually first find a practitioner, talk to them, and get a demo. That would at least put your mind at ease that she probably wasn’t being beaten by her husband. What made you think that in the first place? I’m always a bit leery when that’s where peoples minds go…

      • I take it you don’t know, then.

        I presume you are referring to Arya Nielsen who is NOT a health care specialist, she is an acupuncturist. Her so called research was the equivalent of building sand castles on the beach, as I have written about before in another thread. Neither is Ted Kaptchuk with whom she decorates a book on GS. Katptchuk studied oriental medicine, which means he is an historian, not a medical doctor.

        That cases of child abuse have been deemed non-criminal by a US child welfare agency or two does not mean that torturing children in the -name of oriental sorcery is alright. I don’t give a hoot what you or other peddlers of pseudomedical abuse think of my views on this matter, they are mine and they are shared with many.

        As is clearly evident in the film, Gua Sha and cupping produce petechial bruising, which has no health benefit whatsoever. That there are people like you who think it does does not constitute evidence.

      • “I take it you don’t know, then.”
        Of course not. It’s a YouTube video. Only a fool would use that to assess someone. I think exercise is a pretty good guess though.

        “I presume you are referring to Arya Nielsen…”
        Never mentioned her. Or Kaptchuk.

        “That cases of child abuse have been deemed non-criminal by a US child welfare agency or two…”
        Quite a bit more than that. It’s pretty common knowledge over here that gua sha/cai gao is not child abuse. It’s been thoroughly examined by professionals. Many of those professionals started receiving treatments, a couple (that I know of) have learned how to do it. At this point, those claiming child abuse have a darker agenda.

        “I don’t give a hoot what you or other peddlers of pseudomedical abuse think of my views on this matter, they are mine and they are shared with many.”
        No sense in discussing it further then. There’s you (and many others, you claim) on one side, and hospitals, universities, child welfare services, law enforcement (and of course patients) on the other.

        “That there are people like you who think it does does not constitute evidence.”
        Not evidence, just common sense. Having a solid opinion on something you haven’t researched or even experienced…that’s not common sense.

        More interesting though – you mentioned possible abuse by Heidi’s husband. Seeing that they are not anonymous, or hypothetical…do you think it’s ethical to imply abuse?

      • jm on Monday 18 June 2018 at 07:56

        Good choice of video, though. Pretty standard gua sha treatment.

        jm on Monday 18 June 2018 at 19:41

        It’s a YouTube video. Only a fool would use that to assess someone.

        “jm” ‘s right, only a fool…

      • Bjorn,

        Just to refresh your memory…you asked “I wonder what this rather healthy looking woman was suffering…”

        I answered “Just a guess, but based on her other posts…exercise.”
        You replied ““I take it you don’t know, then.”

        I hope you’re not in the habit of determining causes of suffering from YouTube videos. For instance, you mentioned possible abuse by Heidi’s husband. Seeing that they are not anonymous, or hypothetical…do you think it’s ethical to imply abuse?

        • You still don’t get it “jm”.
          It is up to you to tell us what it is we are observing in this video, which you claim shows standard Gua Sha. Is it bruising, is it theatrical make-up or is it something else?
          You keep obfuscating and building strawmen trying to deflect the question. Please answer the question: What do these clearly visible marks consist of?

          Let’s put it this way: What would skin biopsies show? Can you show us a report or even better, a peer reviewed article describing a study of properly (i.e blindly and independently by a certified pathologist) performed histological examination of skin biopsies after standard Gua Sha?
          Or would such biopsies perhaps show nothing, because the appearance is only a trompe-l’œil produced by the immeasurable, intangible, invisible, inexplicable life-force “Qi”?
          Your call “jm”, the camera is on you.

        • “It is up to you to tell us what it is we are observing in this video…”
          Markings. We’ve been over this a hundred times.

          “You keep obfuscating…”
          For the fourth time – you mentioned possible abuse by Heidi’s husband. Seeing that they are not anonymous, or hypothetical…do you think it’s ethical to imply abuse?

          • We are observing someone having their skin scraped. Would have thought that was obvious. You and your Strawmen eh Bjorn. Just what is your obsession with them? Obfuscating? Wow a big word Bjorn. Why didn’t you just say “To make unclear, etc haha.

        • Please answer the question “jm”. What do these “markings” consist of and what is it that is causing them? Your attempts at diverting the discussion and try to build a strawman out of my question to you, are not working.

        • On the other gua sha thread (you know, the thread where I answered your marking question 100 times, and explained gua sha to you in a way that is clearly illustrated by Edzard’s video), you repeatedly accuse gua sha practitioners of bodily assault. You mention Arya Nielsen by name (“and others like her”) – as “a threat to their fellow human beings”.

          Those are pretty serious accusations. As is domestic abuse. You claim to be a physician – so you know (as any human being should know) these aren’t joking matters. Serious enough that it’s been thoroughly investigated, and determined to not be assault or abuse.

          So for the fifth time – you mentioned possible abuse by Heidi’s husband. Seeing that they are not anonymous, or hypothetical…do you think it’s ethical to imply abuse?

        • I have am not counting my iterations but you are not answering the question and your diversionary strawman attacks are not relevant to the discussion of efficacy and legitimacy of Gua Sha’s (and cupping)!
          Please answer the question, otherwise we have to conclude that you are ignorant as to medicine and biology and have no idea what the effects of Gua Sha or cupping are.
          Unless you come up with contradicting evidence, we will continue to consider Gua Sha, cupping and acupuncture as being bodily harm under the pretext of health treatment and therefore fraudulent activity.

        • Gua sha (and cupping!) are massage techniques, Bjorn. We’ve gone over that 100 times, too. As far as efficacy goes…you well know that massage is medicine, and works every time!

          “…we will continue to consider Gua Sha, cupping and acupuncture as being bodily harm…”

          Who’s this “we” you’re talking about? Edzard kindly posted a video illustrating what you’re calling (on the previous thread) “bodily assault” and “a threat to fellow human beings”. And of course the legal/medical system says “no evidence of harm”, studies report “no adverse effects”. Maybe you mean the ‘Royal We’.

          So for the sixth time (if you keep dodging, maybe we can break the comment record from the last gua sha post) – you mentioned “Perhaps her (Heidi Powell) husband has a habit of beating her??”. Seeing that they are not anonymous, or hypothetical…do you think it’s ethical to imply abuse?

          That’s a pretty serious accusation. Then again, so is bodily assault – and you seem pretty comfortable throwing that around without any evidence or support. I’m starting to wonder if you have Ethical Tourette’s.

  • Bjorn Geir on Friday 22 June 2018 at 21:37

    “How old are you Barry?”

    Funnily enough I was thinking the same about you. I’m not the one who waffles on about imaginary Straw Men.

  • Dear gentlemen, while doing your best to imply that gua sha is a reasonable therapy, we (it’s plain plural, dear jm), in this community, will be waiting for some robust evidence that it is efficacious as a treatment for anything. Until then, we will choose simple massage, the kind that does not screw the skin, while having the same benefits and demonstrably less risks. And we are going to advocate as such, as “it feels great” is not a dependable scientific piece of advice.

    We don’t care about what “feels great”. We don’t worship science or medicine (though we enjoy and like it quite a lot). We don’t care about alternative explanations of reality, unless accompanied by robust evidence. We care about what robust evidence shows because it simply represents reality and the truth and because truth is (maybe almost) always in the best interest of patients. This is not some “higher sense of altruism”, it’s just the way it is. You can’t turn back time, and you can’t treat anything with gua sha that you couldn’t with plain massage (which is safer to begin with).

    • James,

      Your dedication to robust evidence, reality, and truth sounds admirable. And yet, smells like bullshit. You’re saying that simple, plain massage has demonstrably less risk than gua sha. Prove it.

    • We have long since concluded from her description of her services, that “jm” is not selling real Gua Sha, just over-rated massage.
      She massages her customers gently[sic] with her soft-edged paraphernalia. She advertises it as Gua Sha to give it an esoteric air of oriental magic, which acts on business as sunshine does for an ice-cream parlour.
      When she happens to apply enough pressure for bruises to appear, she tells the customer it’s a feature, not a bug (to paraphrase Micro$oft) and that whatever the customer was complaining about must have been very serious but is magically being drawn out of the system. 😀

      • Instead of just reading Edzard’s post on critical thinking…it seems that you need a class.

        Speaking of class, for the seventh time – you mentioned “Perhaps her (Heidi Powell) husband has a habit of beating her??”. Seeing that they are not anonymous, or hypothetical…do you think it’s ethical to imply abuse?

  • You have the rhetoric skills of a rhinoceros dear “jm” 😀

  • My bullshit opinion is that simple massage breaks far less capillaries than gua sha. Now, it’s your turn to prove that it isn’t so… and while at it, I would appreciate some reliable, even partial, proof that it helps with anything, more than simple massage.

    • “We care about what robust evidence shows” is what you claim. Why give me your opinion?

      You claim that simple, plain massage has demonstrably less risk than gua sha. Prove it. It shoudn’t be that hard – it’s been investigated. By people specifically looking for evidence of abuse or injury. People whose area of expertise is looking for evidence of abuse or injury. They found none, but maybe you know better?

      Show me some proof that you care about robust evidence, James.

  • What are these markings on her body after the laughing session, jm? Is it oil painting? Only a fool would use a video to judge…what? That she has markings on her body? What do smart people do? Go have the session and then sit under the microscope?

    Now, try to argue about efficacy, which is the point here. Your trying to showcase that it is not injury and we are overinterpreting/misinterpreting the broken capillaries caused by gua sha, and we should be better educated about ancient, cao-gio style, wisdom, has been completely outside the scope all along. Of course, maybe your insistence stems from persisting on outdated technology, such as spoons and coins, in which case all we have here is a simple clash of paradigms.

    You see, dear jm, we prefer the microscope!

    • James,

      “Only a fool would use a video to judge…what?”

      Bjorn was aking ““I wonder what this rather healthy looking woman was suffering…”. I said only a fool would use a video to figure that one out. You can watch some video of healthy looking people with cancer. Pretty stupid to look at a video and claim someone is healthy, don’t you think?

      Based on experience, training, some things she (Heidi) said in the video, and her other video and blog posts, I speculated that what she was ‘suffering’ from was exercise.

      Bjorn thought “Perhaps her (Heidi Powell) husband has a habit of beating her??”

      You asked “What do smart people do?”

      My guess (and it’s only a guess) would be that ethical people wouldn’t imply domestic abuse without evidence. Smart people would figure that since the markings were coming up in the process of her receiving gua sha…the markings were probably from the gua sha. Not-so-smart people would imply, on a public blog, that someone with 34,000 subcribers to their youtube feed was abusing their spouse.

      “Now, try to argue about efficacy, which is the point here. Your trying to showcase that it is not injury…”

      I have no interest in arguing about efficacy. I’ve never claimed that gua sha was anything more than a massage technique.

      But, every time it comes up I will point out that gua sha/cai gao isn’t injury, abuse, or bodily assault. Anyone claiming otherwise is either unfamiliar with the technique, is ignorant of the investigations (mainly involving immigrant mothers treating their kids), or has an agenda.

      Edzard conveniently posted a video – so you’re familiar with the technique. I’ve posted links to the investigations (or you can take 10 seconds and google it yourself), which conclude with ‘no evidence of abuse’, ‘no harm found’, etc.

      Promoting the completely off base idea that gua sha is “bodily assault” can unintentionally lead to some serious pain and suffering for immigrant mothers. (Or intentionally, if that happens to be the agenda.) So the very least you can do is showcase the fact that claims of “bodily assault” are bullshit. If you’re as interested in “truth” and “reality” as you claim to be.

      • I very rarely use videos as evidence;
        I ~ 13000 posts, I might have posted 2 or 3.

      • Video’s probably only slightly better than photos – at least you get some context. In the one you posted, for instance, you can compare Heidi’s reactions between the hands on work and the gua sha. It’s odd that she used a still with her wincing from the thumb work – but I assume it’s for the visual drama. Her reactions to the actual gua sha were pretty boring. Totally normal and expected…but boring.

  • it’s been investigated. By people specifically looking for evidence of abuse or injury. People whose area of expertise is looking for evidence of abuse or injury. They found none

    You don’t say? How interesting! Who are they? My area of expertise happens to be looking for evidence of injury. (Police detectives and lawyers are experts who determine evidence of abuse so let’s put that term aside for a while), What is your expertise Ms. “jm”?

    I and other experts in the field of trauma, surgery and medicine think the marks look exactly like petechial bruising and hematomas, which is injury caused by traumatic tears of small vessels in the skin. The most obvious explanation seem to be the scraping and sucking, right?

    Please tell us “jm”, who “they” are and how “they” looked for evidence of injury. Did they e.g. examine tissue biopsies from the markings, or…?

    • “You don’t say? How interesting! Who are they?”
      I think you said the same thing a few other times this came up, and we taked about Stanford University Hospital, the National Institute for Health, and a few others. They all seem to agree that health care providers need more education on this, to avoid misinterpretations.

      My favorite is the Annals of Forensic Research and Analysis (“The physical manifestation of these practices may be confused with, or misinterpreted, as child abuse.” folks) because they talk about:

      “…Although most of the complications associated with this practice have been minor burns, a few cases of serious complications from coining have been reported requiring skin grafts when the heated oil on the skin caught fire…”

      So thanks for the reminder. I need to research the heated oil catching fire thing. Not sure what that’s about. Seems like you should be more concerned with heated oil than scraping. There seem to be some minor adverse reactions (including burning) to camphor, as well.

      “Police detectives and lawyers are experts who determine evidence of abuse…”
      Here, the police detectives consult doctors. They don’t make that determination themselves. Neither do lawyers. Maybe it’s different in Iceland.

      “I and other experts in the field of trauma, surgery and medicine think the marks look exactly like petechial bruising and hematomas”

      I do too. The marks look pretty bad. You would really expect them to be painful to the touch, wouldn’t you? Like other injuries. And yet, scraped areas feel better than when you started (we’ve talked about this a bunch of times already…and now you have video, too). I’d also expect them to change color over time, like all other bruising. And yet…they don’t. I’d also expect the tissue to feel damaged. And yet, the tissue feels healthier than before being scraped. I’d also expect the patient’s movement to be affected, like with most injuries (particularly ones that look dramatic like that). And yet, movement is easier and less painful after scraping. Weird, eh?

      What’s your experts’ take on that? I’m curious, especially for their descriptions of what they found with palpation of the marked areas. Please post the methods ’they’ used to determine bodily assault – that’d be quite helpful.

      Doctors I’ve talked to – I’ve had them examine the patients before, during, right after, and for the next few days after treatment. Had them do visual, palpation, and movement assessments. And patients’ subjective assessment. We did this with cupping as well.

      The ‘result’ was that a couple docs now come in for regular treatments. One has learned to do scraping on their patients themselves. And they all refer their patients (even the one that learned how to do it…I think it’s a time thing).

      Not a very scientific study on my part. (Then again, it’s just massage.) So I’d love to hear how you and other experts came to your conclusions – I’ll duplicate your procedure, so we’re on the same page.

      • And around we come, to the same as we´ve been so many circles. “Jm” seems to have a mental block when it comes to her scraping fetish. Now where was that post from Edzard on what evidence is all about? “jm” seems to have missed that bit.
        Ah, well,, we´ve been down that road a couple times before. Let us just say that a degree in one or more of the health sciences does not make you immune to stupidity. I know a doctor who thinks homeopathy is what medicine is lacking and another, an anesthesiologist who thinks we are infested with fungus that causes all ills and goes about injecting people with tiny amounts of Magnesium, for the wonderful, health bringing placebo effect. The last idiot with an MD after his name has not graduated.

        And as for Standord, last time I Googled the terms Stanford and Gua Sha together the first hit was a piece with their official heading that explained the bruiising and injury from a useless, ancient medical practice that is popular among uneducated commoners and may be encountered in oriental immigrant communities. No mention of benefit or healing. Just a heads up for health care personnel to be aware of the phenomenon.

        Call me when someone found some evidence of health benefit from bruising people up.

        I am not in the best mood just now. My wife snatched Edzards new book, SCAM, and I have to wait till she´s finished reading it. 🙂

        • Bjorn said “Call me when someone found some evidence of health benefit from bruising people up.”

          It would be an idea if you could furnish us with some evidence of peoples skin catching fire Bjorn. I have searched the internet and can find nothing.

      • So, (for the second time) I’d love to hear how you and other experts came to your conclusions – I’ll duplicate your procedure, so we’re on the same page.

  • There is a claim that gua sha improves survival time after heatstroke in rats… combined with bloodletting of course, at the proper meridian points.

    https://www.ncbi.nlm.nih.gov/pubmed/25098257

  • Björn, this is cutting edge science!

    Dr. Ernst, I apologize for the lengthiness of this post, but the opening question of this post is not very easy to deal with, especially in the face of religious persistence put forth by people like jm.

    Now, let’s get to the point. jm is asking whether it’s “ethical to imply abuse”. I don’t know about the others but my personal opinion is that, yes, it is ethical to imply abuse when a young child (or anyone) presents to a doctor with bruises anywhere on their body and not complaining in specific about them. As minors are not in position to make judgement calls on their safety, someone has to make the call. If anyone in here does not agree, I would appreciate it if they would set me straight or point the flaws in my argumentation.

    A doctor “implies” abuse, and performs necessary actions to confirm. What happens at worst is that the doctor will find out that gullible parents with a thing for ancient practices, or potentially misguided by some practitioner of alternative medicine, fell for what is called coining, going around by the fancy name of gua sha, thinking they will treat any problem of their child. Majors (as in “not minors”) will of course be able to make their own minds about whether exposing themselves to this practice or not, but because anyone presenting to the doctor should be treated protectively, abuse, I believe, should also be implied in these cases.

    As jm states:

    Doctors I’ve talked to – I’ve had them examine the patients before, during, right after, and for the next few days after treatment. Had them do visual, palpation, and movement assessments. And patients’ subjective assessment. We did this with cupping as well.

    It appears that that the doctors jm has talked to fall in this (utter parody) and this (completely improper controls, since patients knew that they were receiving gua sha), or this, or this category, and so on. There is an ample amount of doctors that will fall for just about anything, even in genuine honesty. Therefore, supporting arguments are definitely not lacking, although, in their devastating majority, originating in Asian countries (cf. China).

    However, jm will forgo the evidence against gua sha, because, in her practice, people seem to enjoy it. jm should know that just because something doesn’t cause indirect harm in most cases, it doesn’t follow that it is GRAS (Generally Recognized as Safe). There is something jm denies and this is direct harm. Let’s see the immediate statements:

    I do too. The marks look pretty bad. You would really expect them to be painful to the touch, wouldn’t you? Like other injuries. And yet, scraped areas feel better than when you started (we’ve talked about this a bunch of times already…and now you have video, too).

    A lot of things feel better, great etc. but are NOT safe. This is not a very good argument because subjective customer (I don’t like the incorrectly used word “patient” in place of “massage receiver” or stuff like that) experience is not a dependable control factor in clinical research. Also, the placebo effect (after countless suggestions that “it doesn’t hurt in the end” and “it will feel great” and “it helps, really”) will substantially help evoking this pleasure, which has no clinical relevance in terms of safety, of course. Here, have some morphine, it feels great…

    I’d also expect them to change color over time, like all other bruising. And yet…they don’t. I’d also expect the tissue to feel damaged. And yet, the tissue feels healthier than before being scraped. I’d also expect the patient’s movement to be affected, like with most injuries (particularly ones that look dramatic like that). And yet, movement is easier and less painful after scraping. Weird, eh?

    Well, nobody here said that bruises can only come from scraping. We don’t call them bruises, we call them petechiae. To quote an expert in Gua Sha:

    The discoloration caused by gua sha is not a bruise. Bruising occurs when a blow or shear force damages capillaries and causes bleeding into the tissue. In contrast, during gua sha, blood cells are extravasated (or pressed) through the capillary walls without damage to the capillaries or the surrounding tissues […] The medical term for the red dots that gua sha causes is “petechiae”. These petechiae represent blood cells that have been pressed outside of capillaries (tiny blood vessels) as the practitioner repeatedly strokes the skin.

    I am sorry, but, last time I checked, Wikipedia on Petechia, citing a basic pathology textbook states:

    A petechia, plural petechiae, is a small (1–2 mm) red or purple spot on the skin, caused by a minor bleed from broken capillary blood vessels.

    Yes, that’s right. These are broken capillaries, and denying this kind of makes all this discussion pointless.

    Movement is naturally not affected because the trauma is not inflicted in a crushing manner, conservation of range-of-motion is totally expected, no joint soft-tissue is hurt in the process. jm, nobody expected range-of-motion to be altered by scratching, I don’t see why any actual doctor would expect the customer’s movement to be affected, but I can totally understand why you would expect the customer’s movement to be affected by something like scraping.

    In short, visual, palpation and movement assessments don’t imply overall safety in any clinically relevant way. As bold as this argument appears, confer the case of drugs, alcohol, radiation, etc. This is like saying that X-rays are safe, because the patient does not “look”, “feel” (both in palpation and overall condition) or “move” any worse after than before having them, even at large doses (now, try teaching that to a chiropractor).

    Now, let’s move on to jm’s favourite! Evidence! It can get a bit tiring but there are lots of recorded cases and reports of harm by coining (which is gua sha). Let’s start with this report:

    That there have been scattered case reports of more serious complications associated with cao gio. These included full thickness skin burns necessitating skin grafting, cerebellar hemorrhage thought to be mediated by the pain-activated sympathetic response to coining, and altered medical status as a result of the systemic absorption of camphor (an ingredient commonly found in balms and oils). The true incidence of these more serious implications is unknown and likely underreported to Western-trained healthcare providers for fear that this cultural practice could be misinterpreted as a form of abuse.

    For those that wonder where the text comes from, the complete issue where this short paper is published in is here, in pages 145-146. It is a small one-page report, but very clear, concise and to the point. It is totally worth the few minute read, in my opinion!

    Moving on to this report:

    Coining is associated with serious complications, and has been confused with child abuse by physicians unfamiliar to Asian cultures. Despite the availability of more simple and effective treatment for fever, coining is still widely practiced among Asians.

    Yes, that’s right! And further below:

    The boy underwent traditional treatment of “coining” prior to presentation. He was diagnosed of bacterial tonsillitis and his illness resolved after three days with oral amoxicillin 500 mg four times daily.

    Understanding the socio-cultural dimension of a patient’s health beliefs will enhance relationship of trust and proper communication, avoid cultural blind spots and hence critical to a successful clinical encounter.

    For those that wonder as to the relevance of these statements, that is to say that gua sha practiced by Asian immigrant mothers can and will lead to delaying proper treatment for minor or major cases. And, of course, that there is no “doctorwise” agenda to cause pain and suffering to those mothers, it is all a matter of protecting the children from incompetent medical decisions (and I hope we can all agree that it is also important to educate those mothers with respect to those issues, and not feed their delusions. We don’t have an agenda to cause pain to immigrant Asian mothers, dear jm, as you imply. We’re the good guys and we take an awfully large amount of time to prove it to you, an amount you are quite undeserving of, I am afraid, in the face of your religious persistence to irrelevant details.

    Coining is perceived to be safe despite reports of serious complications associated with the technique [refs]. Camphor toxicity is potentially fatal and may mask the presentation of underlying disease. This treatment is not advisable for those with blood dyscrasias and those taking antiplatelets or anticoagulants medication.

    In countries where dengue haemorrhagic fever is endemic, the ecchymoses can be a source of diagnostic confusion.

    Well, this makes things even worse, not only there are confirmed reports of complications, it can also be a source of diagnostic confusion, once again delaying medical services for no apparent reason.
    All in all, this is a very significant article, once again worth the few minute read, in my opinion.

    I would, then, move on to this report:

    “Coining,” “coin rubbing,” or çao gio, is an ancient Vietnamese folk remedy that is practiced by many Vietnamese-Americans to treat minor ailments. There are few reported cases of serious complications of çao gio; most of the complications have been minor burns. We present a case report of a 45-year-old woman who sustained 22% partial-thickness and full-thickness burns after she caught on fire during a coining treatment. She underwent fluid resuscitation, wound care management, and, eventually, burn debridement and autografting. She was discharged 10 days after the operation, with excellent take of all of her grafts. However, a contracture of her right axilla did develop and will require surgical release. This case represents a serious injury that can result from traditional cultural forms of medicine.

    This is gua sha in all its majesty, (un)safe as ever.

    An even worse case of promoting medical neglect is reported in this paper:

    A 43-year-old Chinese woman presented at the Emergency Department complaining of abdominal pain; a diagnosis of acute appendicitis was promptly made, and an appendectomy was performed. Clinical examination showed clearly visible reddish ecchymoses on the back, arranged in an almost symmetrical fashion on both sides ofthe spine. […] During the current hospitalization for appendectomy, the previous history and the clinical examination of the patient led
    physicians to suspect physical abuse. […] When the interview took place in a supportive and safe environment the patient stated that there was not any physical abuse and that a Chinese practitioner applied a balsam to the skin of her back, and then pressstroked repeatedly with an unidentified tool in an attempt to treat her abdominal pain

    Just, WOW. This is another case of delaying medical treatment for what I would not call a minor ailment. I hope you don’t treat abdominal pain with your gua sha dear jm.

    Before I finish with this endless post, bear with me in a quite significant case report:

    On the morning of admission, the patient developed a headache and took an over-the-counter analgesic. She experienced no relief. Her boyfriend then applied a hot Chinese oil to her chest and back and scratched the edge of a hot coin against the bony prominence producing a superficial burn in a linear pattern resembling a pine tree (figure). The procedure seemed to be excruciatingly painful and lasted 30 minutes before the patient became drowsy and unresponsive. She had no contributory medical history, including hypertension, and had no relevant neurologic or surgical disorders. She used no medications or illicit drugs.

    Yes, this is the case of the cerebellar hematoma discussed and it is totally worth the read. Adherence to these oriental practices can give you various things, although, in my opinion, one of the worst is the sense of false security and feeling that you can treat anything with them, even when anything is actually nothing.

    I think that’s enough for one shot, but I felt it is necessary to provide the actual argumentation to anyone following this thread that we are not joking here and this blog is all about actual research and rational critical thinking, the stuff that smells like bullshit to dear jm.

    Dear jm, your making (epically failing) fun of Björn’s opions does not help your position. It is true, you are not performing proper gua-sha, only a watered-down version that you like to peddle, just to err on the safe side… which is good for you (and your clients, of course). Asian people endanger their fellows in all sorts of ways, so education has to prevail, at least that’s if we want to minimize the dangers and coexist in harmony, while properly catering for everyone’s health problems (which we do!). If you bother to post anything, better make it worth the time and effort, this is not kindergarten (although we’re all for proper child-care!).

    To close, as a direct response to the opening post question set by Dr. Ernst, my (obvious by now) opinion, based on the aforementioned analysis and references, is that Gua Sha is not a reasonable treatment (unless one wants to make some easy money), and definitely not worth the risks or the time involved, unless employed as a fetish, which, of course, overrules all concerns, though I would go with a courtesy Miranda warning “perform at your own risk”.

    • This is my first comment on GS, from 2013 It chimes well with James´ reasoning above. I believe it is what set poor “jm” off on a raging rampage trying desperately to defend her fetishistic conviction that the scraping and succing that out bread on her table are bona fide, honest health care.
      I admit that I have been all too often tempted through these years, to heckle at her naive devotion.
      I propose we turn our attention to more important matters, e.g. the true nature of ´Qi´ 😀

    • James,

      ” I would appreciate it if they would set me straight or point the flaws in my argumentation.”

      Ok.

      For this blog, your argumentation is fantastic. However, if you ever use this anywhere else…you should consider some edits.

      First off, you should get clear about the difference between evidence of efficacy and injury assessment. You’re kind of hung up on the efficacy thing. We’ve been over that – not what we’re talking about. There is no evidence that gua sha is bodily assault, abuse, or “a threat to fellow humans”. “Safe and well tolerated” is pretty standard if you look at study stuff. (and you did – you actually linked to it)

      Second, read all the words of previous comments, and be mindful of context. You said “Movement is naturally not affected because the trauma is not inflicted in a crushing manner, conservation of range-of-motion is totally expected, no joint soft-tissue is hurt in the process. jm, nobody expected range-of-motion to be altered by scratching, I don’t see why any actual doctor would expect the customer’s movement to be affected,”.

      As I said, the weird thing is that with gua sha, range of motion increased (in other words, movement was affected). With injury, you would expect a decrease in movement. You had it backwards in your comment. Easy to do, if you have strong preconceptions.

      Third, you should get an understanding of why someone would choose to perform gua sha or cao gio. Neither gua sha nor cao gio would be thought to treat every problem (if that’s what you meant by “treat any problem of their child”). Gua sha wouldn’t be a choice with appendicitis, for instance. (Neither would cai gao.)

      On a related note, in a previous comment you said “you can’t treat anything with gua sha that you couldn’t with plain massage (which is safer to begin with)”. Neither of those things are true…you should probably avoid repeating that.

      And, “in my opinion, one of the worst is the sense of false security and feeling that you can treat anything with them…”. Again, the idea that you can ‘treat anything’ with gua sha is a misunderstanding on your part.

      Fourth, you should get clear on gua sha vs cao gio. They’re similar, but different. You need to understand both – sometimes it makes sense to use them interchangeably, sometimes not.

      For instance, you should probably avoid saying things like “…fell for what is called coining, going around by the fancy name of gua sha, thinking they will treat any problem of their child.”. A statement like that makes it blatently obvious that you’re not really familiar with the subject. Simply avoid things like that, and no one will be the wiser.

      Same with the big chunk of your comment that starts with “Now, let’s move on to jm’s favourite! Evidence! It can get a bit tiring but there are lots of recorded cases and reports of harm by coining (which is gua sha).” Again, coining and gua sha are different – so it’s a bit weird that you quote a handful of case reports about cao gio, and add a few paragraphs of your own two cents. Then end with “”This is gua sha in all its majesty, (un)safe as ever.”

      But confusing gua sha and cao gio isn’t the weirdest part of that chunk of your comment – it’s the “(un)safe as ever” part. You start with some links that clearly state that the injuries weren’t from cao gio. They were from camphor, and heated oil. Camphor is an herb, not scraping. Heated oil isn’t scraping either. It’s oil. That’s heated.

      The part you quoted “Coining is associated with serious complications…” – again, camphor. Not coining.

      And don’t quote this part- “…and has been confused with child abuse…” . If there was injury, there would be no confusion. Best just to ignore that part, if you’re trying to make the case for bodily assault.

      Fifth, “…in the face of your religious persistence to irrelevant details.”
      Accusations of bodily assault and abuse isn’t irrelevant. Bodily assault is illegal, and unsustatiated claims of bodily assault are unethical. Best to avoid that part.

      Sixth, “We’re the good guys and we take an awfully large amount of time to prove it to you…”. You still haven’t. You’ve shown camphor burns, that gua sha is confused with child abuse, and that in studies scraping is safe and well tolerated. And, you still haven’t proved that gua sha carries more risk than ‘simple massage’. You should really look at the dangers of ‘simple massage’…

      Seventh, “Asian people endanger their fellows in all sorts of ways, so education has to prevail…”. I think your comment speaks for itself. Obviously not a problem on this particular blog (or I wouldn’t be the one pointing it out to you), but you shouldn’t use it elsewhere.

      And finally, “my (obvious by now) opinion, based on the aforementioned analysis and references, is that Gua Sha is not a reasonable treatment…”. If I were you, I’d avoid that completely. What’s obvious (by now) is the quality of your analysis.

      There’s more…but that should get you started.

      • Looks like “jm” doesn´t like James either. Interesting how she keeps ranting about how we are wrong in this and that but never elaborates on why or how and never gives straight answers to simple questions. For example her ranting about some difference between GS and CG, which her idol GS expert seems to consider the same.

      • Sorry Bjorn, I tried but I can’t crack you ‘idol’ code.

        I understand your “never answer” code means that you don’t like the answer…”doesn’t like” means that I’m not going along with your fiction, “bodily assault” apparently means superficial massage…but I’m not sure if “idol” is supposed to mean Howard, Nielsen, or someone else?

        Meanwhile, (for the third time) I’d love to hear how you and other experts came to your conclusions – I’ll duplicate your procedure, so we’re on the same page.

        And for the eighth time – you mentioned “Perhaps her (Heidi Powell) husband has a habit of beating her??”. Seeing that they are not anonymous, or hypothetical…do you think it’s ethical to imply abuse?

        • Just think how nice it would be if you could use a relevant comment. Any port in a storm, I guess. 🙂

          I understand why you dodge the ethics question (ethics doesn’t really seem to be your ‘thing’ – and the answer is pretty obvious anyway). I also understand why you dodge the ‘idol’ question. I’m assuming you were talking about Howard, and our discussion on the differences between gs & cg. Could have been Nielsen, I guess, (although she talks about the differences too). Who knows. Sometimes it takes a bit to crack your code.

          But for the fourth time) I’d love to hear how you and other experts came to your conclusions – I’ll duplicate your procedure, so we’re on the same page. Why keep your methods a secret? Unless you’re making that up, too.

      • You like to go on forever, obviously. Ok, we’re with you!

        There is no evidence that gua sha is bodily assault, abuse, or “a threat to fellow humans”. “Safe and well tolerated” is pretty standard if you look at study stuff. (and you did – you actually linked to it)

        I don’t see anything in what I quoted that implies general safety. Maybe you would like to quote something specific that positively implies safety from the sources I linked to, this would help a bit.

        Unless, of course, you mean:

        Coining is perceived to be safe despite reports of serious complications associated with the technique

        where perceived has no implications as to what really is the case.

        As I said, the weird thing is that with gua sha, range of motion increased (in other words, movement was affected). With injury, you would expect a decrease in movement. You had it backwards in your comment. Easy to do, if you have strong preconceptions.

        Take-home point: I have strong preconceptions! Why should I have strong preconceptions, and of what kind, jm?

        Let’s see what I said:

        Movement is naturally not affected because the trauma is not inflicted in a crushing manner, conservation of range-of-motion is totally expected, no joint soft-tissue is hurt in the process. jm, nobody expected range-of-motion to be altered by scratching, I don’t see why any actual doctor would expect the customer’s movement to be affected, but I can totally understand why you would expect the customer’s movement to be affected by something like scraping.

        I didn’t mention anything with respect to “increase” or “decrease”, I said “affected. I didn’t get anything backwards (what is this supposed to mean anyway?). You are not reading too fast, of course, you just have to say something that conflicts, so I understand you, no worries. In any case, movement is not significantly affected, of course, and you don’t expect any type of injury to affect movement. This kind of injury does not affect movement, because it doesn’t have any far-reaching effect in the soft-tissue. It only harms the superficial layers of the skin.

        Now, look, I’m there with you. A small and short-lived increase in the range of motion is something I would definitely expect. In the process, the rubbing causes an increase in temperature and blood flow on the areas. Unfortunately, this temporary range-of-motion increase mechanism is the same mechanism that causes an increase in range-of-motion when warming-up prior to doing whichever type of training/exercise. You get a temporary range-of-motion boost because of the increased temperature and blood flow. This, unfortunately, goes away after a while. Be sure to warn your customers that it is only temporary, whenever you are luring them using this as a supposed benefit.

        Now, if you disagree on this, instead of asking me for evidence (which is plenty, so don’t bother), I’d suggest trying to disprove it yourself. At worst, you might manage to convince yourself about something relevant to reality after all. So, try performing gua sha on someone’s thighs (all over, I guess) systematically, until they can perform side-splits! After a lifetime, you will understand that it’s simply a temporary, insignificant increase in range-of-motion that (a) is good for business, and (b) is something you could evoke with simple massage, or, even better, some actual warming-up and performing of mild to moderate exercise. I do not see any need for the scratching and scraping, but I will not have any problem if you would be so kind as to point its usefulness to me. Also, if you really want significant and permanent increase in range of motion, you have to perform actual passive stretching, the proper “exercise” type.

        Gua sha wouldn’t be a choice with appendicitis, for instance. (Neither would cai gao.)

        Ummm.. so, how would you like to call what the person in the corresponding case had? Something else? Or, let me guess… they were incompetent, they had to do something else (or call it somewhat else instead). Right…

        On a related note, in a previous comment you said “you can’t treat anything with gua sha that you couldn’t with plain massage (which is safer to begin with)”. Neither of those things are true…you should probably avoid repeating that.

        Nice to know these things are not true… and now it is your turn to play with evidence. Keep it simple, I propose. Just indicate what you can treat with gua sha that you can’t with plain massage, for starters. In the process, please, also produce some case reports of massage-induced injuries. This should be the minimum courtesy to respond to my comments henceforth. Your arguments from (sorority) authority will no longer suffice in anyone’s eyes… in this and other places.

        For instance, you should probably avoid saying things like “…fell for what is called coining, going around by the fancy name of gua sha, thinking they will treat any problem of their child.”. A statement like that makes it blatently obvious that you’re not really familiar with the subject. Simply avoid things like that, and no one will be the wiser.

        You would call this sooner or later, after everything else would fail. I understand that this has become your favourite argument against Bjorn, so it was only a matter of time. From now on, I expect your sole argument to be that I don’t know enough. Yes, I understand the suggestion that I should waste even more time trying to learn the subtle differences. I take it that these subtle differences have profound impact on when to use one over the other, how each is used for a specific range of conditions, and neither one is coining of course. The stuff accompanied by complications is never gua sha or cao gio, or however you like to call it. I have a better idea, just to be on the same page. Let’s call it scraping and scratching! Does that capture the essence?

        But confusing gua sha and cao gio isn’t the weirdest part of that chunk of your comment – it’s the “(un)safe as ever” part. You start with some links that clearly state that the injuries weren’t from cao gio. They were from camphor, and heated oil. Camphor is an herb, not scraping. Heated oil isn’t scraping either. It’s oil. That’s heated.

        The part you quoted “Coining is associated with serious complications…” – again, camphor. Not coining.

        Oh, so you perform it without camphor or heated oil? Please, let us know what you use in your sessions, maybe this can be addressed in the next FDA manual therapy best practices publication.

        And don’t quote this part- “…and has been confused with child abuse…” . If there was injury, there would be no confusion. Best just to ignore that part, if you’re trying to make the case for bodily assault.

        I will reluctantly overcome the part where your authority is superior to that of two doctors and university professors and their citing the practice of many physicians. Why ignore that part? Because it is the case? Once again, jm, scratching one’s child in a misguided attempt to alleviate anything is negligent practice, from which minors cannot protect themselves. There is nothing wrong with the parents, they were also brainwashed into those practices. All I am saying is that it would be much better if they were educated and taught that those fancy practices, beyond the skin injuries that they evoke, do nothing against the conditions they are employed for. If you have any evidence, please, procure it of course! I would be willing to accept some clinical trials with enough participants and proper randomization and blinding.

        Accusations of bodily assault and abuse isn’t irrelevant. Bodily assault is illegal, and unsustatiated claims of bodily assault are unethical. Best to avoid that part.

        I was primarily talking about negligence and delaying proper treatment. But, speaking of bodily assault, precisely what is unsubstantiatied in the consideration that a person goes for help, receives scratches and definitive skin damage on their body through a procedure that is not efficacious for anything (therefore, not for whatever it is that they sought help for all along) and which may also delay necessary efficacious treatment in the process? How about replacing “person goes for help” with “minor needs help”? What is unsubstantiated then? Remember, the part where you do not agree with skin damage being injury is irrelevant. Biopsies show definitive damage, as did the examinations in the case reports I referenced in my previous comment. When is it bodily assault? Please, be clear as to your definition of when it constitutes bodily assault, and how is this different in these cases and don’t end up with the “culture” argument, the human skin doesn’t care about cultures.

        You’ve shown camphor burns, that gua sha is confused with child abuse, and that in studies scraping is safe and well tolerated. And, you still haven’t proved that gua sha carries more risk than ‘simple massage’. You should really look at the dangers of ‘simple massage’…

        Well, if delaying vital treatment, or cerebellar hemorrhage is safe for you, you may as well say I did. I am still waiting to know what you use for gua sha. Or you perform it on dry skin? I guess you don’t, though I suggest you try it, just so your customers have the chance to find out what you have been hiding from them all along. Also, I am sorry but… did I miss the part where you proved that gua sha is safe? Oh, I remembered, your personal case reports where people feel great after gua sha, right. Did I mention that you can feel great after X-Rays too? Chiropractors beware!

        Seventh, “Asian people endanger their fellows in all sorts of ways, so education has to prevail…”. I think your comment speaks for itself. Obviously not a problem on this particular blog (or I wouldn’t be the one pointing it out to you), but you shouldn’t use it elsewhere.

        I agree, it would take another large amount of time gathering and referencing recorded adverse reactions, case reports, confirmed toxicology reports and analyses and indirect fatalities by delaying proper treatment. This would be a waste of time when someone is in denial. Your specific comment, however, shows that you seem to be taking things personally. Why are you suggesting I shouldn’t use it elsewhere? It would be impolite, improper, unkind, insulting? Once again, I have nothing personal against anyone, Asian people included. I would oppose coining-like practices wherever I would find out they are taking place….or any other irrational treatment for that matter. Your implication, however, shows how “style over substance” easily leads to emotional involvement. I don’t foster double standards, dear jm. I would say the same things for any nationality, Asian people are not the only ones entitled to employing ineffective practices that occasionally endanger health. The Western world has its own share of cases as well.

        And finally, “my (obvious by now) opinion, based on the aforementioned analysis and references, is that Gua Sha is not a reasonable treatment…”. If I were you, I’d avoid that completely. What’s obvious (by now) is the quality of your analysis.

        No, what is obvious by now is how strong unimportant gua sha is to you, and how important is, instead, to reach your very own conclusions. Read your own text again, dear jm. Do you see any well-worded and supported argument? Ask for help, if you wish, I like well-structured arguments, point them to me if I missed something.

        Well… Notwithstanding your truly ex culo argumentation, which deeply saddens me because you have not even made an attempt to directly point me to some source, where I could actually extract some piece of information to support your opinions (whereas I have been as meticulous as possible in gathering information and data), I nevertheless understand that wasting your time with proper argumentations might not be good for your business. I guess the average reader already has all the information necessary to judge for themselves. From here on, we are not really producing anything new, just piling more and more arguments versus a stationary Courtier’s reply.

        I would appreciate it if anyone reading this would give some feedback (in the informal peer-reviewing sense) with respect to my earlier argumentation. Can I be so deluded, as to get everything wrong? Is the quality of my analysis “obvious”…? I guess I’ll have to wait until the next episode 😉

        TL;DR: It is a good thing that jm is not involved into official peer-reviewing… it would be such a disaster for science.

        • “You like to go on forever, obviously.”
          You know that your comment I was responding to was longer. And so is this latest one :). This latest one is way funnier, though. Did you actually read it before posting?

          “I don’t see anything in what I quoted that implies general safety. Maybe you would like to quote something specific…”
          You don’t see anything in “safe and well tolerated” that implies safety? It’s from the second link you posted in your comment. Here’s the context:

          “RESULTS:
          Neck pain severity after 1 week improved significantly better in the Gua sha group compared with the control group (group difference -29.9 mm, 95% confidence interval: -43.3; -16.6 mm; P<0.001). Significant treatment effects were also found for pain at motion, scores on the NDI, and dimensions of quality-of-life. The treatment was safe and well tolerated.

          CONCLUSION:
          Gua sha has beneficial short-term effects on pain and functional status in patients with chronic neck pain. The value of Gua sha in the long-term management of neck pain and related mechanisms remains to be clarified."

          It seems like the same study Edzard linked to in the other thread. I didn’t check, though. Just went to the one you posted. And, I'm not including that as evidence of efficacy. You asked for a quote – so I gave you one that you linked to.

          "Let’s see what I said:
          Movement is naturally not affected…”

          And then…

          "I didn’t mention anything with respect to “increase” or “decrease”, I said “affected. I didn’t get anything backwards (what is this supposed to mean anyway?).”

          You did it again (the backwards part). You actually quoted yourself…then immediately claim you said the opposite.

          "Also, if you really want significant and permanent increase in range of motion, you have to perform actual passive stretching, the proper “exercise” type.”
          Permanent, you say? Gotta get me some of that.

          "Ummm.. so, how would you like to call what the person in the corresponding case had?”
          Appendicitis. I’d bet if they knew it was appendicitis, they would have gone to the hospital sooner. Because you don't treat appendicitis with gua sha or cao gio.

          "Nice to know these things are not true…”
          It was never a secret. Gua sha is used a lot when compressive massage is too painful. Or could easily cause an injury. Gua sha is way safer. And less painful on injured areas. If you don’t believe me, simply watch the video Edzard posted.

          "please, also produce some case reports of massage-induced injuries.”
          You made the claim that massage is demonstrably safer than gua sha. Show the proof. Then I’ll reply with case reports of dislocated joints, severe (and actual) bruising, broken bones, whiplash, nerve damage… But seriously, I’d love some proof that massage is safer. Compared to gua sha…massage is crazy dangerous. (As I’ve told Bjorn, there certainly is the possibility of choking on a coin or spoon. That would be pretty bad.)

          "From now on, I expect your sole argument to be that I don’t know enough.”
          That’s pretty much been my argument the whole time. You’re arguing that superficial massage is bodily assault. You’ve got to be kidding.

          "Yes, I understand the suggestion that I should waste even more time trying to learn the subtle differences.”
          They actually aren’t that subtle. The whole concept is different. It's even in the names.

          "The stuff accompanied by complications is never gua sha or cao gio, or however you like to call it.”
          That would be true, according to the links you posted, and the quotes you pulled. You should read them.

          "Oh, so you perform it without camphor or heated oil?”
          All the time. You avoid burns that way. Why, what do you use?

          “..from which minors cannot protect themselves.”
          Protect themselves from what? If there was evidence of abuse or injury, there would be no confusion, no need for physician education. It would just be called child abuse.

          "I would be willing to accept some clinical trials with enough participants and proper randomization and blinding.”
          Me too. You’re making the claim (abuse). Prove it.

          "Biopsies show definitive damage”
          Really? Proof please. I’d actually love to see biopsies.

          "Well, if delaying vital treatment, or cerebellar hemorrhage is safe for you…"
          Cerebellar hemorrhage, eh? That’s a new one to add to the mix.

          "I am still waiting to know what you use for gua sha.”
          You’re really not. It’s used for massage.

          "Why are you suggesting I shouldn’t use it elsewhere?”
          Can’t say you weren’t warned.

          "I don’t foster double standard. I would say the same things for any nationality,”
          You should delete your Twitter account, then.

          "I guess the average reader already has all the information necessary to judge for themselves.”
          I expect that Edzard’s video says it all.

          "Can I be so deluded, as to get everything wrong?"
          You wouldn’t think so. And yet…here we are.

  • Yes, I remembered that precise comment of yours and that you had also experienced such a specific incident in the past, as I discovered this specific appendicitis case report I referenced above.

    I must admit I have also had occasional shortages of temper every now and then, especially whenever the word “ethical” comes up in her posts. I am not yet fully convinced as to whether it is naive devotion or full-fledged hypocrisy. Though…I guess it doesn’t make much of a difference either way.

  • Compared to gua sha…massage is crazy dangerous.

    And this sums up perfectly what is going on in jm’s mind.

    • Still waiting on your “robust evidence”, James. Good luck with that. 🙂

      • Massage does not produce physical marks, my dear. Massage sessions that do cause intense physical marks, should also be classified as physical harm, of course. And all gua sha/cao gio/cupping, etc. Of course. Especially when performed on minors, but also when performed on uninformed adults (negligence).

        I’m sorry, jm, it’s the CDC’s definitions. You know, we respect the CDC. If you don’t, you’ll have to stay away from wherever the law follows their definitions. It’s really unfortunate that they consider your favourite practices as abuse in the form of maltreatment when performed on minors, so I understand your sense of injustice. Unfortunately, their opinion is much more relevant to justice than yours.

        I wish your opinion would matter, unfortunately, it doesn’t.

      • “Massage does not produce physical marks”

        That’s pretty robust evidence, in an avant garde kind of way.

  • Jm seems to be totally incapable of getting things right when they conflict with its personal opinions. Because jm seems to have problems with reading comprehension, especially when it’s bad for business, it is time for some hard facts.

    First of all, let’s see, for example in the U.S., what the Children’s Bureau – Child Welfare says:

    All States, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico,
    and the U.S. Virgin Islands have statutes identifying persons who are required to report suspected child maltreatment to an appropriate agency, such as child protective services, a law enforcement agency, or a State’s toll-free child abuse reporting hotline.

    The document contains a list of the specific professions required to report. But let’s see what it is that they must report!

    Behold, the CDC:
    From page 12 of chapter Child Maltreatment and Associated Terms
    Definition of Harm:

    Any acute disruption caused by the threatened or actual acts of commission or omission to a child’s physical or emotional health (ISPCAN 2003). Disruptions can affect the child’s physical, cognitive, or emotional development.

    Threat of harm occurs when a parent or caregiver expresses an intention or gives signs or warnings through the use of words, gestures, or weapons to communicate the likelihood of inflicting harm to the child. Threat of harm can be explicit or implicit. Explicit threats would include such acts as pointing a gun at the child or raising a hand as if to strike the child. Implicit threats would include such acts as kicking holes in walls or breaking down doors. Disruption of physical health includes, but is not exclusive to, physical injuries, avoidable illnesses, and inadequate nutrition.

    Of course treating children with gua sha is negligent when you delay proper treatment, but, what does this “physical injuries” mean? Quoting from directly below:

    Physical Injuries:

    Physical injuries are physical harm, including death, occurring to the body from exposure to thermal, mechanical, electrical, or chemical energy interacting with the body in amounts or rates that exceed the threshold of physiological tolerance, or from the absence of such essentials as oxygen or heat (Holder et al. 2001). Physical injuries can include physical marks, burns, lacerations, contusions, abrasions, broken bones, internal injuries, organ damage, poisoning, asphyxiation, or death because of physical injuries sustained.

    Physical marks produced for no reason, such as in gua sha/cao gio/cupping etc. are of course included in the above definition. Unless you wish to imply there is a reason, in which case you would need to talk about efficacy, which is something you have repeatedly and clearly indicated you do not wish to discuss (which is good for you as these techniques lack efficacy).

    Another useful definition from page 13:

    For the purposes of this document the following are irrelevant to determining whether child
    maltreatment has occurred:
    • Caregiver’s intent to harm the child.
    • Caregiver’s legal liability for the maltreatment.
    • Caregiver’s economic means.
    • Caregiver’s religious or cultural norms.

    That’s right, cultural norms and lack of intent do not matter. Gua sha, cao gio etc. performed on minors is harm by maltreatment, by definition of the CDC.

    DO read the document through dear jm, unless you do not reside in the United States, of course. Don’t expect, however, that other countries might be using more lenient definitions, though there certainly are countries where such treatment might even be promoted, which is, also, their business.

    Also, you do not need to discuss or duplicate any procedures with Björn, of course. Your opinion is completely irrelevant, as is that of your customers, if you have any (as you will also have a conflict of interest in this case).

    This is the law, dear jm. You must abstain from treating minors with massage that causes such marks on their bodies. If you have any objections from here on, you, or whoever you know is concerned, should talk to the CDC. If you need to use or promote such maltreatment on minors (as in “teach parents how to do it on their children”), you will have to stay away from countries such as the U.S., where this is illegal. Doctors that find out such marks are obliged to report them to the respective (usually police) authorities, so you can always have a second chance to have your way with those, but that’s your own business.

    So, once again, causing marks of whichever type/colour/intensity on children for no reason is not “culture” and is not tolerated when the caregiver is the “parent”. It is classified as harm in the form of maltreatment, manifesting as physical injuries from the CDC.

    Remember, jm, the fact that I mostly agree with the CDC’s definitions is irrelevant. The fact that you disagree is also irrelevant. If you have any objections, you should talk to the CDC. And this goes, of course, for anyone else beyond you.

    • As James said, maltreatment and abuse of children is nothing anyone or anything can justify. It is punishable by law anywhere in the world.
      An uneducated, culturally conditioned immigrant parent can be forgiven and given amnesty based on circumstances but a peddler of archaic magical healing rites who made it through primary school and can read and write and should know better than to inflict injury on her clients will not be forgiven and excused from liability if it comes to a court of law in any normal society.

    • “Also, you do not need to discuss or duplicate any procedures with Björn, of course.”

      I completely agree. But I’d like to, so we’re on the same page. Why do you suppose Bjorn is keeping his methodology a secret?

    • “As James said, maltreatment and abuse of children is nothing anyone or anything can justify. It is punishable by law anywhere in the world.”

      Yup. So why do you suppose gua sha isn’t considered child abuse, after all the investigation?

  • Please explore graston technique a westernization of a very similar and valuable therapeutic practice often used for plantar fasciitis and other disorders.

    And at least attempt to appear non judgmental if you claim to logical and or scientific.

    • OK; I explored. I found this systematic review of Graston technique efficacy. From the abstract…

      Results:
      A total of 7 randomized controlled trials were appraised. Five of the studies measured an IASTM intervention versus a control or alternate intervention group for a musculoskeletal pathology. The results of the studies were insignificant (p>.05) with both groups displaying equal outcomes. Two studies measured an IASTM intervention versus a control or alternate intervention group on the effects of joint ROM. The IASTM intervention produced significant (P<.05) short term gains up to 24 hours.

      Conclusion:
      The literature measuring the effects of IASTM is still emerging. The current research has indicated insignificant results which challenges the efficacy of IASTM as a treatment for common musculoskeletal pathology, which may be due to the methodological variability among studies. There appears to be some evidence supporting its ability to increase short term joint ROM.

      The Graston technique was also discussed previously on this blog. The post linked to a trial where Graston technique was compared to sham therapy for the treatment of non-specific thoracic spine pain. “The authors concluded that this study indicates that there is no difference in outcome at any time point for pain or disability when comparing SMT, Graston Technique® or sham therapy for thoracic spine pain, however all groups improved with time. These results constitute the first from a fully powered randomised controlled trial comparing SMT, Graston technique® and a placebo.”

      Much as I would like to “appear non judgemental”, these two studies do not lead me to a logical conclusion that the Graston technique is greatly different from a theatrical placebo. People often respond to any form of apparent care and attention, but people often fool themselves, too.

  • Gua Sha is just a kind of IASTM (Instrument Assisted Soft Tissue Mobilization). There is definitely not enought scientific information, but that don’t means that it don’t work. I am really sceptic about non-scientific treatments, but after trying almost everything, I’ve tried gua sha and IASTM to recover from Musculoskeletal Pain, and both really helped.
    It seems to be that gua sha and iastm works by stimulating your fascia and removing a fibrosis/scars in soft tissues caused by long-term inflammation, wich leads to an excessive amount of collagen in tissues, wich also causes muscle shortening and nerve adhesions…
    You also need to consider the “supercompensation” (google it), as gua sha damages tissues, they needs to recover and then use gua sha again.. otherwise you’ll be just damaging tissues.
    So I think you can’t say it don’t work because there is no scientific information… sure, there is almost not information, but it just means that, No information, but doesn’t means that it don’t works.

    I invite you to view this video from Dr. Helene Langevine, an expert in soft tissue.
    https://www.youtube.com/watch?v=cnGWNQu_rRg (Really, watch it, you won’t lose your time)

    Some quick-search papers:
    https://academic.oup.com/painmedicine/article/12/3/362/1829149
    https://www.sciencedirect.com/science/article/pii/S0009898111002658

    • “There is definitely not enought scientific information, but that don’t means that it don’t work”
      BUT IT MEANS IT IS UNPROVEN!
      responsible healthcare practitioners employ treatments that are proven and avoid the rest.

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