Gua Sha
Gua sha, sometimes referred to as “scraping”, “spooning” or “coining”, is a traditional Chinese treatment that has also been adopted in 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, the assumed ‘energy’ channels of traditional Chinese medicine. According to its proponents, gua sha stimulates the flow of the vital energy ‘chi’ and releases unhealthy bodily matter from blood stasis within sored, tired, stiff or injured areas.
An international team of authors has revisited gua sha, a therapy that we have discussed repeatedly on this blog (see here and here). The authors offer the following summary:
Gua sha is a traditional healing technique that aims to create petechiae on the skin for a believed therapeutic benefit. Natural healings are mostly based on repeated observations and anecdotal information. Hypothetical model for healing does not always fit the modern understanding. Yet, the mechanisms underlying Gua Sha have not been empirically established. Contemporary scientific research can now explain some events of traditional therapies that were once a mystery. It is assumed that Gua Sha therapy can serve as a mechanical signal to enhance the immune surveillance function of the skin during the natural resolving of the petechiae, through which scraping may result in therapeutic benefits. The current review, without judging the past hypothetical model, attempts to interpret the experience of the ancient healings in terms of contemporary views and concepts.
The authors conclude that this narrative review draws up a survey of scientific sources on an ancient healing, scraping therapy. It is hypothesized that the skin, the nervous system and immune system interact with one another to generate a cascade of physiological responses to the scraping, through which scraping may result in therapeutic benefits. Within the scope and limitations of this review, only a brief overview could be given of the potential relationship between the observed outcomes and scraping therapy. Implementing effective traditional healings within health systems will require appropriate knowledge translations and future prospective studies.
And they add the following ket points:
- The observed therapeutic effects following scraping therapy may be a physiological response to the minor bruising.
- Scraping is assumed to be a mechanical signal to elicit the immune function of the skin.
- Through natural resolving of the scraping marks (petechiae) a cascade of physiological responses are generated.
- Counterirritation and placebo effect can also contribute to positive effects for symptom relief.
I think that this paper is a good example for highlighting a common misunderstanding in so-called alternative medicine (SCAM): the confusion about how and whether any given therapy might work.
It is in my view utterly irrelevant, to consider or investigate the mechanisms of action of a SCAM that has not been proven to be an effective treatment of a disease or symptom. Such an approach can only lead to confusion about the value of the SCAM in question. In the present case, it makes gua sha look almost like a reasonable therapy, and consumers who read the paper might conclude that gua sha is worth trying.
A deliberately exaggerated example might make this clearer: If I fall down the staircase, a multitude of physiological effects of the fall could easily be verified on my body. Yet, nobody would claim that throwing patients down the stairs is of therapeutic value. Likewise, the forceful scratching of the skin is bound to have all sorts of physiological effects. These are, however, totally irrelevant until someone has shown that the procedure also has therapeutic value.
To put it bluntly: who cares how a SCAM works when it is unproven that it works?
Yesterday, I had the honour and pleasure to present to the UK press my new book entitled ‘ALTERNATIVE MEDICINE, A CRITICAL ASSESSMENT OF 150 MODALITIES’ (see also my previous post). The SCIENCE MEDIA CENTRE had invited me to do a ‘media briefing’ on the occasion of its publication. I did this by outlining the background around so-called alternative medicine (SCAM) and explaining the concept of the new book which essentially is – as its title indicates – to provide concise and critical assessments of 150 modalities.
In the course of my short presentation, I mentioned the following exotic modalities in order to show that my book goes beyond the ‘usual suspects’ of acupuncture, chiropractic, etc.:
- BERLIN WALL
- COLLOIDAL SILVER
- PALEO DIET
- PLACENTOPHAGY
- URINE THERAPY
- CUPPING
- GUA SHA
- LYMPH DRAINAGE
- SLAPPING THERAPY
- VISCERAL OSTEOPATHY
- JOHREI HEALING
- LEECH THERAPY
- NEURAL THERAPY
- ZERO BALANCE
- APPLIED KINESIOLOGY
- IRIDOLOGY
- LIVE BLOOD ANALYSIS
- PULSE DIAGNOSIS
- RADIONICS
As it turned out, the journalists present found the BERLIN WALL remedy the most fascinating aspect of my talk. And this is clearly reflected in today’s articles covering the event:
The DAILY TELEGRAPH published an article much in the same vein, and so did THE SUN and the EXPRESS (not available on line). The only UK newspaper I have seen so far going beyond the Berlin Wall topic is THE DAILY MAIL. The paper mentions several other so-called alternative medicines (SCAMs) that consumers need to be protected from, in my view.
Interestingly, none of the articles mentioned that my new book is not an exercise in debunking. During my presentation, I made the point that several of my assessments of 150 modalities do arrive at positive conclusions for therapies that demonstrably generate more good than harm.
I also tried to point out to the journalists that SCAM includes a range of diagnostic techniques. None of them are valid which means that they present a real danger to consumers through false-positive and false-negative diagnoses. In particular the latter scenario can cost lives.
All in all, I did enjoy yesterday’s press briefing very much. I am aware of the fact that, in the realm of SCAM, the press have a most important role to play. Consumers rarely consult their doctor when deciding to use SCAM; frequently they go by what they read in the papers.
In this context, I find it noteworthy that, during the last years, the UK press have become considerably more sceptical. Not so long ago, most UK journalists used to praise SCAM like the best thing since sliced bread; today this attitude has laudably shifted towards a more rational stance. I am sure that the excellent work of the SCIENCE MEDIA CENTRE has played a crucial part in this positive development.
Alternative practitioners practise highly diverse therapies. They seem to have nothing in common – except perhaps that ALL of them are allegedly stimulating our self-healing powers (and except that most proponents are latently or openly against vaccinations). And it is through these self-healing powers that the treatments in question cure anything and become a true panacea. When questioned what these incredible powers really are, most practitioners would (somewhat vaguely) name the immune system as the responsible mechanism. With this post, I intend to provide a short summary of the evidence on this issue:
Acupuncture: no good evidence to show stimulation of self-healing powers.
Aromatherapy: no good evidence to show stimulation of self-healing powers.
Bioresonance: no good evidence to show stimulation of self-healing powers.
Chiropractic: no good evidence to show stimulation of self-healing powers.
Detox: no good evidence to show stimulation of self-healing powers.
Energy healing: no good evidence to show stimulation of self-healing powers.
Feldenkrais: no good evidence to show stimulation of self-healing powers.
Gua sha: no good evidence to show stimulation of self-healing powers.
Herbal medicine: no good evidence to show stimulation of self-healing powers.
Homeopathy: no good evidence to show stimulation of self-healing powers.
Macrobiotics: no good evidence to show stimulation of self-healing powers.
Naturopathy: no good evidence to show stimulation of self-healing powers.
Osteopathy: no good evidence to show stimulation of self-healing powers.
Power bands: no good evidence to show stimulation of self-healing powers.
Reiki: no good evidence to show stimulation of self-healing powers.
Reflexology: no good evidence to show stimulation of self-healing powers.
Shiatsu: no good evidence to show stimulation of self-healing powers.
Tai chi: no good evidence to show stimulation of self-healing powers.
TCM: no good evidence to show stimulation of self-healing powers.
Vibrational therapy: no good evidence to show stimulation of self-healing powers.
Vaccinations: very good evidence to show stimulation of self-healing powers.
THE END
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.
