Gua Sha Therapy Guidelines: Duration, Frequency, and Safety Tips

A. Duration of Gua Sha

1. Perform Gua Sha using purging scraping or even-replenishing and even-reducing techniques, with each area generally scraped for no more than 3 to 5 minutes.

2. For the supplementary scraping technique, each area should be scraped for 5 to 10 minutes.

3. Typically, select 3 to 5 areas for supports in one patient. For patients who do not exhibit sha (petechiae) or show minimal sha, do not force its appearance.

4. The scraping duration should also be flexibly adjusted according to the patient’s age, constitution, condition, wellness course, and the specific area where Gua Sha is applied.

B. Frequency of Gua Sha

The interval between two Gua Sha sessions should be 3 to 6 days, determined by the complete disappearance of Sha marks on the skin. Generally, 3 to 5 sessions constitute one supports course.

C. Post-Gua Sha care.

Generally, no special supports is required after Gua Sha. Simply use clean tissue paper or a towel to wipe off the Gua Sha blood-activating and meridian-dredging agent from the scraped area. Alternatively, massage the scraped area with the palm to allow the blood-activating agent to be fully absorbed by the skin, which can enhance the therapeutic effect. After Sha appears, it is advisable for the patient to drink a glass of warm water (preferably lightly sweetened saline water) and rest for 15 to 20 minutes before leaving.

D. Normal Reactions to Gua Sha and Management of Adverse Conditions (Fainting During Gua Sha)

(I) Normal Reactions The appearance of red, purple, or black spots or blisters on the skin surface after Gua Sha is clinically referred to as “Sha emergence,” representing a normal therapeutic effect of Gua Sha. These manifestations typically resolve spontaneously within a few days without requiring special intervention. Mild pain, itching, crawling sensations (like insects moving), perceived cold or heat emissions from the body surface, or urticaria-like changes on the skin in the scraped area 1–2 days after Gua Sha—especially following Sha emergence—are all considered normal phenomena.

(II) Abnormal Reactions (Fainting During Gua Sha) and Management If a patient experiences signs of imbalance such as dizziness, blurred vision, palpitations, cold sweats, pallor, cold extremities, nausea with a tendency to vomit, or loss of consciousness and collapse during Gua Sha supports, immediately stop scraping and promptly have the patient lie flat in a head-down, feet-elevated position. Provide a cup of warm sugar water for the patient to drink and ensure they are kept warm. Quickly use the Gua Sha tool to scrape the following acupoints: GV20 (Baihui, heavy scraping), GV26 (Renzhong, light scraping at the corners), PC6 (Neiguan, heavy scraping), ST36 (Zusanli, heavy scraping), and KI1 (Yongquan, heavy scraping). Resting quietly for a short period will typically lead to recovery.

Attention should be paid to helps maintain syncope during guasha therapy. For individuals receiving guasha supports for the first time, those who are excessively nervous, or those with a weak constitution, explanations should be provided to helps with occasional their concerns about guasha, while simultaneously

The manipulation should be gentle, that is, use the tonifying method. If the patient is hungry, fatigued, or extremely thirsty, do not perform Gua Sha. Instead, instruct the patient to eat, rest, and drink water before proceeding with Gua Sha. During the Gua Sha process, the practitioner should remain focused, continuously observe the patient’s complexion, and inquire about the patient’s sensations. If any discomfort arises, promptly make corrections or take early measures to helps maintain potential issues.

E. Precautions for Gua Sha (Scraping Therapy)

1. During guasha supports, ensure indoor warmth, especially avoiding cold and drafts in winter. When performing guasha in summer, avoid direct exposure of the scraped area to fans.

Avoid taking a cold shower within 30 minutes after scraping therapy induces sha (petechiae).

3. For patients who are physically weak, elderly, children, or those who are particularly nervous and fear pain, the tonifying scraping method should be used. Continuously observe the patient’s facial expressions and overall condition to promptly identify and address any unexpected situations.

4. For patients with severe conditions, deep-seated lesions, but robust constitution or those with painful conditions, scraping therapy should employ the purgation method or the even reinforcing-reducing method. For patients with mild conditions, superficial lesions, but poor constitution, the reinforcing method should be used. In winter or cold weather, the scraping duration should be slightly longer, while in summer or hot weather, the scraping duration should be shortened.

5. Before the petechiae from the previous Gua Sha session fade, it is not advisable to perform Gua Sha again at the same location. The interval between subsequent Gua Sha sessions should be 3 to 6 days, with the fading of petechiae on the skin as the criterion.

6. For areas with abundant muscles (such as the back, buttocks, chest, abdomen, and limbs), it is advisable to use the transverse surface (either the thin or thick side) of the gua sha tool for scraping. For areas with less muscle and more irregularities, such as joints, fingers and toes, and the head and face, it is appropriate to use the edges and corners of the gua sha tool for scraping.

F. Contraindications and Precautions for Gua Sha

1. Avoid scraping the abdomen and lumbosacral region of pregnant women, as well as the nipples of women.

2. For wellness with a tendency to bleed, such as leukemia and thrombocytopenia, scraping should be performed with caution (i.e., only light scraping techniques should be used, and the emergence of sha is not required).

3. Scraping is contraindicated in cases of severe skin hypersensitivity, skin conditions such as broken skin, ulcers, sores with exposed heads, fresh or unhealed wounds, or areas of traumatic fracture.

4. Patients with chronic wellness, the elderly, those who are extremely weak, or emaciated individuals should use scraping with caution (i.e., only light-technique health-preserving scraping is allowed).

5. Gua sha is contraindicated for patients with severe Heart wellness accompanied by Heart failure, Kidney wellness accompanied by renal failure, abdominal areas of patients with Liver cirrhosis with ascites, and individuals with severe generalized edema.

6. Heavy scraping is prohibited at areas where major blood vessels are visible. Instead, use the edges to avoid the blood vessels and apply light pressing techniques for scraping. For patients with varicose veins or edema in the lower extremities, scrape from the bottom upward using light techniques.

7. Scraping is prohibited on the five sense organs including the eyes, ear canals, nostrils, tongue, and lips, as well as on the anterior and posterior orifices, and the umbilicus (Shenque acupoint, GV8).

Individuals who are intoxicated, excessively hungry, excessively full, excessively thirsty, or excessively fatigued are prohibited from undergoing scraping therapy to avoid the occurrence of scraping-induced syncope.

9. When a child’s fontanelle has not closed, scraping therapy is contraindicated on the head and neck.

10. For patients with urinary retention, heavy-force Gua Sha on the lower abdomen should be used with caution, and gentle rubbing and pressing are recommended instead.