Going Gua Sha: What to Know About This TCM Practice That's Everywhere

Gua sha—the unassuming, more precise cousin of Jade rolling—is having a moment.  Scroll through any social media feed, and you’ll likely come across some celebrity or skinfluencer going ga ga for gua sha. 

Though its foray into mainstream beauty is recent, gua sha has been a staple in Chinese households for centuries.  

If you're wondering whether this buzzy treatment is actually worth the hype and how you can reap its touted benefits, you're in the right place. Let’s dig in.

What Is Gua Sha?

Gua Sha or ‘scraping therapy’ is a technique used in traditional Chinese medicine (TCM) that involves gently scraping the skin with a flat, smooth-edged tool to stimulate the flow of blood, Qi (vital energy), and lymph. 

These minor bruises (petechiae and ecchymoses) are formed when small blood vessels break open and blood leaks into the innermost layer of the skin, aka the subcutis.

The blemishes clear out in 2–5 days, with the symptoms alleviating immediately or after a few hours from treatment.

The practice can be traced back to the Paleolithic Age when it was used for treating various illnesses.

Thousands of years later, “in the 17th century, the upper-class elite in China adapted these tools using precious stones such as jade and began using them for cosmetic benefits. A different technique was developed during the Qing dynasty once these tools went from the body for illness to the face for aesthetics,” Dr. Yang explains.  

As the cosmetic benefits of Chinese facial tools became more widely known, their popularity spread across East Asia. People who did not have access to precious stones would improvise by using readily available objects like soup spoons and lids, even their hands, for massaging their faces and bodies. 

Gua sha techniques were handed down within families and among TCM practitioners. Decades later, the practice made its way to the West, notes Dr. Yang.  

Is Gua Sha Really Effective?

“The benefits of gua sha can be viewed through two lenses, that of East Asian medicine and that of Western medicine,” says Dr. Jason Chong, a traditional East Asian Medicine physician and director of Australian Shiatsu College. 

Studies suggest that gua sha may not only alleviate various aches and pains, like neck pain, plantar fasciitis, and chronic lower back pain, but it might also provide longer-lasting effects compared to other pain-relieving methods, such as heat packs.

It’s also effective in treating chest congestion caused by colds, asthma, bronchitis, and other lung diseases, adds Dr. Tom Ingegno, DACM, MSOM, LAc. 

Moreover, animal studies show that the mechanism of gua sha could strengthen metabolism and improve the immune function of the skin and body.

In addition, a randomized research study published in the journal Menopause found that gua sha may relieve perimenopause symptoms such as hot flashes, insomnia, fatigue, and headache.

The benefits of gua sha extend to aspects of mental well-being as well. For example: 

It May Regulate the Nervous System

Gua sha can help modulate the balance between sympathetic and parasympathetic nervous systems (the fight-or-flight vs. rest-and-digest response), says Caitria Thiele, LAc. This equilibrium allows us to adapt to different situations effectively, keeping us from getting stuck in chronic stress or overstimulation.

An overactive or disordered nervous system, on the other hand, is linked to anxiety, depression, and mood swings.

It Can Relieve Stress

According to Thiele, gua sha can be an excellent tool for self-care and relaxation once you learn the proper technique from a licensed TCM practitioner.  

Thiele recommends performing facial gua sha daily to mitigate the effects of stress on the facial muscles. 

Similarly, body gua sha can also be a nice stress reliever as it tackles the systemic effects of stress by improving circulation, she adds.  

It Promotes Mindfulness

Gua sha is an intentional practice that encourages mindfulness, providing time and space to sit with ourselves and our emotions, notes Dr. Yang.  

It’s an opportunity to acknowledge, validate, and empathize with our emotions and experiences, ultimately softening those areas of our stories that have impacted areas of our faces that could use softening, she says.   

This might involve, for instance, holding less tension or letting go of negative beliefs about our appearances. 

It May Lower Fear Avoidance-Based Anxiety

A case study published in the Global Advances in Health and Medicine journal highlights that gua sha, as a complementary treatment intervention, may ease symptoms of anxiety and depression associated with fear-avoidance beliefs in chronic pain patients.

It May Improve Mood

Techniques like gua sha may help boost our mood by increasing blood flow to the brain and body. 

Poor blood flow has been linked to impaired tissue function in specific regions of the brain that may contribute to mental health conditions such as depression.

Does Gua Sha Actually Change Face Shape?

One of the most touted claims for gua sha is that it can permanently alter the face shape, making it slimmer or more sculpted. 

Gua sha can improve microcirculation and lymphatic drainage to reduce puffiness and enhance skin appearance. “However, I find it difficult to fathom how this can influence the contour of the face,” says Dr. Dev Patel, a certified advanced esthetics practitioner.  

“The only exception would be if someone had a lot of fluid retention in the face, then by improving the lymphatic drainage, one could temporarily see a change to the contour of the face,” adds Dr. Patel.  

“In many cases, the slimming effect or lifted appearance disappears after 24 hours,” notes cosmetic formulator Dr. Vanita Rattan.  

Chinese facial tools such as gua sha have been “vastly (mis)appropriated” by the West and “incorrectly marketed with little understanding or acknowledgment of their origin,” says Dr. Yang.  

“Gua sha is not about erasing anything, but actually about embracing everything,” she says. 

According to Dr. Yang, the practice encourages us to form a deeper relationship with ourselves by accepting the features that make us uniquely beautiful.

“When you shift your intentions from erasing your face to embracing your face, the aesthetic benefits become even greater because you are no longer in opposition with the self,” she explains.  

Dr. Yang adds, “when applied in the context of Chinese history, culture, and medicine, these tools are so much more than a stone that makes you look good.”

Do Dermatologists Recommend Gua Sha?

“Gua sha can stimulate blood circulation and improve lymphatic drainage, which can increase the delivery of antioxidants to skin cells and reduce puffiness and swelling,” says Brendan Camp, MD, double board-certified in dermatology and dermatopathology. 

“Most can benefit from gua sha, especially those concerned about facial tension and swelling related to vascular congestion on the face,” adds Dr. Camp.

“If individuals experience improvements in the appearance of their skin after using gua sha, it could be due to increased blood flow, reduced muscle tension, or enhanced lymphatic drainage, rather than a direct effect on collagen production,” she explains. 

“Typically, gua sha is considered safe. However, individuals with damaged skin barrier due to conditions such as eczema or psoriasis should avoid gua sha as it could cause further irritation,” says Dr. El Mouhebb. 

How to Perform Gua Sha At Home

It’s highly recommended to learn the technique from a licensed TCM practitioner first before trying gua sha at home. “It can be at worst harmful or at best ineffective if done incorrectly,” says Thiele. 

Next, choose a gua sha tool of your choice.  

Contrary to popular belief, you don’t need a vanity-worthy tool made from polished crystal to reap the benefits of this ancient healing practice.  

“Any gua sha board that resonates with you is a good place to start,” says Dr. Yang. “There is more emphasis on technique than the tool itself,” she adds.  

Techniques and Tips for Effective Gua Sha

Here are other quick tips to keep in mind to get the most out of your gua sha practice:

• Always perform gua sha on clean skin with a clean tool to avoid pushing impurities into the skin. 
• After cleansing, Dr. Ingegno recommends moisturizing the skin with a face or body oil, lotion, or cream to help the tool glide easily over the skin.  
• For best results, keep the tool at a 45-degree angle from the skin, suggests Thiele. 
• Apply mild to moderate pressure if using gua sha for facial rejuvenation. For pain or stress relief, keep the pressure medium to firm, recommends the American Institute of Alternative Medicine (AIAM). 
• Stop massaging when the skin begins to redden."Overdoing it can damage the skin and possibly cause an abrasion," cautions Dr. Ingegno. It should not be a “no pain, no gain” situation.  
• Use even strokes following the lymphatic pathways to prevent fluids from pooling in your skin, causing swelling and discomfort.  
• Allow any scraping marks or 'sha' left by the treatment to fully clear out before treating the same area again, says Thiele.

For Neck & Throat

• Place the long edge of the tool on the skin and massage in an upward motion, moving from your collarbone to your earlobe. 
• Apply medium pressure. 
• Repeat the movement 3-5 times before moving to the opposite side. 
• For the throat, place the tool's edge between your collarbones and move it up to your chin.
• Keep the pressure light. 
• Next, move the tool in long, even strokes from the center of your chin and along the jawline until the base of your ear.  
• Repeat 3-5 times before switching to the other side.

For Cheeks

• Place the long edge of the tool on the skin and slowly drag it upward past your cheekbone to your ear. 
• Use mild to moderate pressure. 
• Repeat the movement 3-5 times, then do the same on your other cheek.  

For Eyes & Eyebrows

• Place the edge of the gua sha tool on the middle of your eyebrow. 
• Move along the brow until you reach your hairline. 
• Repeat the movement 3-5 times, then do the same on the other eyebrow.
• Next, place the curved edge of the tool flat against the inner corner of the eye. 
• Use light sweeping motions to massage outwards to the hairline. 
• Do this 3-5 times, then repeat on the other side.

For Forehead

• Place the edge of the tool on top of your eyebrow. 
• Slowly drag the tool towards the top of the forehead. 
• Repeat 3-5 times, then switch to the other side.

Is it OK to Use Gua Sha Every Day?

It’s relatively safe to perform gua sha every day, provided you follow the correct technique learned from a trusted source and don’t overdo it, says Dr. Yang. 

To further minimize any potential side effects, it’s important to avoid performing gua sha on certain areas of the body. For example, skin with lesions, cuts, large visible veins, or infections, says Dr. Ingegno. 

Gua Sha for Specific Conditions

While it's unclear if it is unsafe for pregnancy, Dr. Ingegno also advises against this massage technique if you’re pregnant. 

How Long Does It Take to See Results From Gua Sha?

Some people can feel relief immediately after the treatment, provided the condition is mild to moderate, says Dr. Ingegno.  

However, more than one session may be needed to see any significant improvement if the condition is more serious, depending on its severity, he adds. 

Keep in Mind

If you’re new to gua sha, working with a licensed TCM practitioner to determine which technique and tool is best for your specific goal is a good place to start.  

Gua sha is typically safe and effective for most people. However, as with any new treatment or procedure, it’s advisable to check in with your healthcare provider first to see whether it’s right for you.