The area to be Gua Sha-ed is lubricated with oil. The skin is then rubbed with a round-edged instrument in downward strokes. One area is stroked until the petechiae that surface are completely raised. If there is no Blood stasis the petechiae will not form and the skin will only turn pink. Sha is raised primarily at the Yang surface of the body: the back, neck, shoulders, buttocks and limbs. On occasion, Gua Sha is applied at the chest and abdomen. In Asia a soupspoon, coin, or slice of water buffalo horn is normally used for Gua Sha. I have found that a simple metal cap with a rounded lip works best and is by far more comfortable for the patient.
The colour of the Sha is both diagnostic and prognostic. Very light colored Sha can indicate Deficiency of Blood. If the Sha is fresh red, it is of recent penetration. If the Sha is purple or black, the Blood stasis is long-standing. If brown, the Blood may be dry. Dark red Sha can indicate heat. The Sha petechiae should fade in 2-4 days. If it is slower to fade, indicating poor Blood circulation, the practitioner must ascertain whether it is deficiency of Blood, Qi or Yang, a deeper stagnation or organ deficiency at the root.
Gua Sha is a completely safe technique, but it is serious medicine. Knowing when to use it and what to expect from treatment is as important as good technique. People who live in chronic pain often erect emotional defenses to cope with it or can feel completely hopeless. Having that pain ‘touched’ and relieved can be unsettling, even shocking. It is good to be moderate in activity after treatment, even rest. I have always told my patients after treatment: no drugs, alcohol, sex, fasting, feasting or hard labour (including working out) for the rest of the day. In other words, mellow mode.