Gua
Sha (刮痧), literally "to scrape for
cholera", sometimes given the descriptive French name "tribo-effleurage"
by English speakers,[1]
is an ancient medical treatment that is still widely used by practitioners of Traditional Chinese Medicine. It is
used even more widely as a "folk" technique, by Chinese, as a
preventive or remedial treatment.
Gua
sha is reported almost exclusively in Western literature as 'cao gio';
somewhat equivocally as 'not abuse, pseudo-abuse, or pseudo-battery'. This
being a result of East Asian immigrant population's relocation to the West
during and after the Vietnam war, and the Western medical community's mixed
reaction to that population's use of their traditional medicine.
It is
also widely used in Indonesia. It is a traditional Javanese technique, known as
kerikan (lit., "scraping technique"),[2]
and it is very widely used, as a form of "folk" medicine, upon
members of individual households.
Contents |
In
describing the Gua Sha techniques as a form of "folk" medicine, the
term "folk" is not being used in any pejorative
sense. It is used to emphasize:
Notwithstanding
this, the Gua Sha technique is just as important a part of the legitimate
practice of the specialist practitioners of Traditional Chinese Medicine as is
the use of fire cupping; and it is a highly reputable technique
that is applied just as much by these highly trained experts as it is applied
by the "folk" users.
As
with many of the "folk" methods that are used domestically as a form
of first intervention, the use of Gua Sha often precludes any need for any more
complex medical treatment; and, because its use means that further medical
treatment is unnecessary, the technique, although extremely widespread, is
often hidden from view, and its role as a very significant and very important
participant in the overall health care of a community may not be immediately
apparent.[3]
Therefore,
in the case of Gua Sha,the term "folk" medicine should not be thought
of as separate from the practice of more complex Traditional Chinese Medicine,
but far more as an immediate form of domestic "first-aid"
intervention that serves to prevent any need for further medical intervention
by a medical professional.
Gua
Sha involves repeated
pressured strokes over lubricated skin with a smooth edge. Commonly a ceramic Chinese soup
spoon was used, or a well worn coin, even honed animal bones, water buffalo
horn, or jade. A simple metal cap with a rounded edge is commonly used.
In
cases of fatigue from heavy work a piece of ginger root soaked in rice wine is sometimes
used to rub down the spine from head to tail.
The
smooth edge is placed against the pre-oiled skin surface, pressed down firmly,
and then moved down the muscles -- hence the term "tribo-effleurage"
(i.e., friction-stroking) -- or along the pathway of the acupuncture
meridians, along the surface of the
skin, with each stroke being about 4-6 inches long.
This
causes extravasation of blood from the peripheral capillaries (petechiae)
and may result in sub-cutaneous blemishing (ecchymosis),
which usually takes 2-4 days to fade. Sha rash does not represent capillary
rupture as in bruising, as is evidenced by the immediate fading of petechiae to
echymosis, and the rapid resolution of sha as compared to bruising. The color
of sha varies according to the severity of the patient's blood stasis -- which
may correlate with the nature, severity and type of their disorder --appearing
from a dark blue-black to a light pink, but is most often a shade of red.
Although the marks on the skin look painful, they are not. Patients typically
feel immediate sense of relief and change.
Practitioners
tend to follow the tradition they were taught to obtain sha: typically using
either gua sha or fire cupping. The techniques are not used together.[4]
In
classical Chinese practice, the Gua Sha technique is most commonly used to:
There
is an allied technique, Ba Sha (拔痧), or 'tsien sha' literally "to lift up for
cholera", which has a similar application to Gua Sha. It is performed by
gripping the skin, lifting and then flicking between the fingers until
petechiae appear. It is used more often on the tendons, at the center of the
brow, or than over specific acupuncture points.
A slightly
different form of Gua Sha, using the edges of coins, rather than porcelain, is
practiced as a "folk medicine" technique, by individuals amongst
their own family members, in some Chinese traditional cultures, in Vietnam
(where the coin scraping is known as "cạo gió", scraping
for wind), in Cambodia, and in their immigrant communities abroad.
Cao
Gio was introduced to the USA in 1975, when large numbers of Vietnamese were
airlifted from South Vietnam near the end of the military conflict between North
and South. Well-meaning practitioners of western medicine are sometimes shocked
at the sight of these marks and fear that a child with the marks has been
abused. The practice was observed by military physicians who publicized the
harmless nature of this practice.
In
1980, it was found that many Vietnamese still distrusted US medical
practitioners in part due to fear of being falsely accused of child abuse.
For
professionals in this position, it is helpful to be familiar with the
appearance of Gua Sha marks and to understand its traditional
therapeutic value, and to be able to make the distinction between gua sha
marks and signs of abuse.
Gua
Sha is not known to be
harmful. The technique called cupping also leaves distinctive, petechial marks on the skin,
but is also harmless.
In
2001, a movie called "Gua Sha" (see "The Treatment") was made addressing
this practice and the cultural misunderstandings it causes. The movie stars Tony
Leung Ka-Fai.
1. ^ Huard & Wong (1977), p.126. They also
cite a French romanization for the same set of two Chinese characters:
koua sha.
2. ^ Although most Indonesians would
understand it to have a far more general meaning of something like "to
take out "the wind" by scraping".
3. ^ In a similar fashion, the cleaning and
bandaging of minor cuts and scrapes or, even, the washing of hands before
eating, are extremely significant factors in the overall maintenance of health,
but may not be immediately recognized as components of the overall delivery of health-care.
However, the cleaning and bandaging of minor cuts and scrapes and the washing
of hands before eating are practices that can be observed in every hospital.
4. ^ One of the first to introduce the
technique of Gua Sha to non-Chinese students in the United States was James Tin
Yau So (1911 - ).
5. ^ This includes the reactions to state
altering substances (such as LSD, and psychedelic mushrooms) which are included
under the generic title of food poisoning from a Traditional Chinese Medicine
perspective