When sales go stale, embrace the romanticism of exoticism.
That is one of the tricks of the wellness industry: selling gadgets and procedures that come from ancient traditions far, far away. There is, after all, an endless supply of folk remedies that can be repackaged for a modern audience suspicious of medicine but desirous of all-natural lotions and potions.
贰苍迟别谤听gua sha. You may have seen it endorsed by the queen of wellness herself,听, or by legions of beauty influencers. Recently, rising star Hudson Williams from听Heated Rivalry听was seen smoothing out his skin with a听gua 蝉丑补听tool in a viral (and delightfully unhinged)听听published by听The Cut.听Looking like a symbolic heart stretched thin, the听gua 蝉丑补听stone most often used is made of jade, and we are told to gently stroke our face and neck with it to get rid of puffiness.
But the version modeled on social media is heavily diluted from true听gua sha, which leaves red-and-purple bruises no Instagram star would want on their face.
How spooning might work
Gua 蝉丑补听hails from China, although the practice has also become popular in Southeast Asia. It has been听, near the end of the Han dynasty. The word听驳耻补听translates to 鈥渟craping鈥� or 鈥渟cratching,鈥� while听蝉丑补听can mean a number of things, including 鈥渟and,鈥� 鈥渟hark-skin,鈥� or a 鈥渞ed, raised rash.鈥� Basically, you听驳耻补听until you see听sha.
This old remedy begins by lubricating the skin鈥攐ften the back, the chest, or stomach鈥攁nd then using a tool with a smooth edge. Some people recommend using the flat side, while others use the edge itself. The tool can be a piece of jade stone, a metal jar cap, a piece of animal horn or bone, or even a thick ginger root. In 2012, a听听of 3,209 adults in Hong Kong revealed that nearly a quarter of them had used听gua 蝉丑补听in the last year and their preferred tool for the technique was a simple spoon.
罢丑别听gua 蝉丑补听tool is used to stroke the oiled-up skin repeatedly, in one direction, with a fair amount of pressure applied to it until blemishes start to appear. The pressure causes blood vessels under the skin to burst, creating ecchymoses that heal after a few days. This process is claimed to heal just about anything, from respiratory problems to fevers, from vomiting to constipation. In Vietnam, it is called听cao gio; in Indonesia,听办别谤颈办听辞谤听kerokan; while English has preferred words like coining or scraping鈥攅ven spooning, not to be confused with what couples do for comfort, which shouldn鈥檛 leave any mark.
To the uninformed eye, the bruises of听gua 蝉丑补听can look like physical abuse, and the medical literature is peppered with warnings to healthcare providers. If the bruises, sometimes described as tiger stripes, are linear and symmetrical (especially if the patient is Asian), think听gua sha. To be honest, though, some of the photos published in the literature s丑辞飞听, where the purplish-red bruising鈥檚 linearity and symmetry are not easy to observe. A听听was seen in the emergency room of an Italian hospital because of abdominal pain, and when the staff noticed the masses of ecchymoses on her back, they got suspicious. But the patient only spoke Chinese and wouldn鈥檛 admit what had happened to her own son. A cultural mediator arrived, and the patient finally confessed to having received听gua 蝉丑补听treatment for her pain.
The reasoning behind听gua 蝉丑补听originally comes from pre-scientific beliefs about how the human body works. Illnesses were ascribed to a stagnation of a life force called听qi. By scraping the skin, the idea was that, like a blocked pipe tended to by a plumber,听. As we learned more about human biology, the explanation had to shift away from unscientific notions of听辩颈听and toward molecular phenomena that might account for the putative benefits of听gua sha. All sorts of ideas have been听: anti-inflammatory effects conjured up by the need to clean up the heme in those bruises; a tweaking of the production of nitric oxide due to blood vessel injuries; and an inhibition of how nerves detect pain.
There鈥檚 also a simpler theory when it comes to how using听gua 蝉丑补听for pain might help. When we hurt our foot, what鈥檚 the first thing we do? We grab it and rub it. The sensation overrides the pain from the injury, at least temporarily. Similarly, ointments like Tiger Balm work by acting as counterirritants. Rubbing a spoon on the area might likewise cause a counterirritation that makes our brain less able to feel the original pain鈥攆or a short period of time.
This simple theory, which demotes听gua 蝉丑补听to a league of run-of-the-mill counterirritants, doesn鈥檛 sound right to some. One of the most preposterous papers I鈥檝e read in a while comes from a Chinese team that performed听gua 蝉丑补听once on听, drawing their blood before and after the procedure and looking at changes in messenger RNA expression. We are talking tens of thousands of mRNA molecules鈥攕hort-lived transcripts from genes鈥攖o see what went up and what went down after听gua sha, a massive fishing expedition. It turns out that the changes they saw were very specific to each woman and hardly anything changed consistently in all of them鈥� except for the transcripts from three histone genes. The proteins encoded by these genes are the rolls around which our DNA is spooled, so they play a role in just about anything our bodies do, including the immune system. And this is where the authors land, claiming that these 鈥渟ubtle鈥� changes in histone expression have something to do with immune function, and this may be 丑辞飞听gua 蝉丑补听works. It鈥檚 anomaly hunting, but because it takes the form of a scientific paper, it can be weaponized by people looking to validate skin-scraping as a health intervention. It鈥檚 nonsense.
None of this hypothesizing on听丑辞飞听it works can answer the real question of听诲辞别蝉听it work.听
Is it the oil? the massage? the bruising?
Having read dozens of papers on听gua sha, I can say that their failings are exactly what we are used to when it comes to alternative medicine: small studies done at single centres with no long-term follow-up, in which the control group comparison is problematic. Basically, you can鈥檛 blind people to听gua sha. There is no placebo听gua 蝉丑补听that doesn鈥檛 also do what听gua 蝉丑补听does. Experimenters resort to heating pads, standard of care, or wait lists, which means that at best we can say that doing听gua sha听can be better than doing nothing. When a patient dealing with chronic pain gets recruited into a study in which a person strokes their body for 15 minutes after being told that this might help with pain, is it any wonder that they report that their pain has gone down? Placebo effects are common, and these studies do not manage to subtract them from the equation.
Moreover, the oil used to lubricate the skin in these studies is often an ointment called Tumarol, which is medicated with camphor, eucalyptus oil, and menthol. If we compared a group receiving听gua 蝉丑补听with a group being rubbed with Tiger Balm, would they report the same benefit? Or is it the massage itself, regardless of the tool used or the specific motion, that benefits the patient, in which case we can do away with the unnecessary bruising? We simply do not know. A common claim is that听gua 蝉丑补听improves blood circulation in the area being massaged. This much is obvious: it is a type of massage, after all, but the effect on circulation, as seen in听听very small听, is temporary. Does it help in any way? Hard to tell.
Also, the lion鈥檚 share of the studies are done in China. I read too many scientific papers that introduced听gua 蝉丑补听as 鈥済enerally regarded as effective鈥� or as having an 鈥渆ffectiveness rooted in the extensive empirical knowledge dating back to ancient times.鈥� Chinese researchers are proud of听gua sha. A similar nationalistic pride has contaminated the Chinese literature on acupuncture, whereby听听of acupuncture done in China 鈥減roves鈥� it works鈥� but trials done elsewhere are much more muted.
Gua 蝉丑补听has an advocate outside of China, though. Arya Nielsen is part of the faculty at Beth Israel Medical Center in New York City and she has published numerous papers about听gua sha.听She lists a听听in English and Philosophy, a听听in Community Organization and Advocacy, and a听in Interdisciplinary Studies, Integrative Medicine, and Health Research. In her defense, she has published听听to minimize the potential harms of听gua sha鈥攂y teaching practitioners to wear gloves and use a disposable stroking device听听to minimize the transmission of infectious microbes鈥攂ut her use of the phrase听听is quite telling. Among believers in alternative medicine, science can be annoying when it shows these practices don鈥檛 work. Experience and anecdotes are often promoted instead, which are pretty terrible forms of evidence.
The risk of infection Nielsen outlines, though, is real and is not the only possible harm from听gua sha. You can see that reusing the same stone on multiple patients without disinfecting it is not a good idea. The bruises are under the skin, sure, but tiny cuts may result from the treatment and the stone picks up blood-borne microorganisms and delivers them to the next patient who gets accidentally cut. One such patient was听听a few years ago: she developed nodules and pustules on her arms and legs, filled with bacteria called听Mycobacterium massiliense.听She had to be put on antibiotics and have her nodules drained every month for nearly half a year.
Another patient could hardly talk and had听: his epiglottis had enlarged after receiving听gua 蝉丑补听and he had to be injected with steroids to reduce the inflammation. Some will argue that听gua 蝉丑补听should not be performed on the neck, but when a practice is unregulated and becomes popular, you never know how well trained the person caring for you is.
The good news is that serious complications from听gua 蝉丑补听appear to be very rare. The often-repeated warning that the stroking can induce burns is听: it was actually a case of fire cupping gone wrong in Vietnam. But many studies of听gua 蝉丑补听fail to report adverse events, so it鈥檚 possible that complications are underreported.
Gua 蝉丑补听is intense and it leaves you looking bruised. What we see on Instagram has little to do with this ancient practice.
Magic mirror on the wall, youth is the fairest one of all
So, does rubbing your face with a stone remove puffiness?
The closest thing I can think of is manual lymphatic drainage. Lymph is a clear fluid, a derivative from blood, full of immune cells, and some people experience swelling that is due to an abnormal accumulation of lymph somewhere in the body. It can happen, for instance, after treatment for breast cancer. A therapist can use their hands on the swollen body part in an attempt to move this accumulated lymph into a nearby lymph node. The evidence for its effectiveness is听, however, when it comes to using it in the context of breast cancer care. Does it do anything when you think your face is a bit swollen? I have no idea, but if there is an effect, it鈥檚 likely to be minimal and temporary.
Why do influencers swear by running a stone across their face? Probably because they鈥檙e young and they already have really good skin, and it鈥檚 easy to register tiny changes when you want to see them. If these influencers want to keep that supple skin as long as possible, there are more evidence-based things to do than stroking their face with a jade stone: wearing sunscreen to听听and refusing to听.
We may want to refer to the Instagram and TikTok version of the practice as听gua, since there is no听sha. As for the actual, bruise-inducing听gua 蝉丑补听treatments that can seemingly help with everything, the old saying is worth trotting out once again: if something is claimed to treat everything, it probably doesn鈥檛 treat anything.听Gua 蝉丑补听will need more than a spoon or a jar lid to smooth out the many wrinkles in its scientific literature.
Take-home message:
- Gua sha is a popular practice in Asia where an edged tool is used to massage the body until bruises appear, and the technique is claimed to help treat any health problem
- Studies of gua sha鈥檚 alleged health benefits are small and do not manage to exclude placebo effects, since there is no placebo version of gua sha
- One of the main risks is infection if the tool is reused on multiple patients without being properly sanitized, as gua sha can create small cuts and pick up disease-carrying microorganisms
- A softer version of gua sha is popular on social media, where influencers smooth out their face without creating bruises, but the effect of this massage on puffiness is unlikely to be significant
