No Fear! It’s just Sha!

I love using gua sha and cupping on my patients. These Chinese Medicine modalities satisfy me personally because they are highly effective and efficient, yet elegantly simple...they are modalities that I can even teach my patients how to do on their own. My patients love these modalities for their non-invasiveness, often pleasureable application, and amazing feel-good results.

However, the one thing most patients have to contend with is explaining to others after a treatment that, no, they have not been in an accident or a fight. Why? Well, many of us remember the U.S. Olympic swimmer, Michael Phelps, and his very obvious temporary skin discoloration after his cupping sessions . This is often what we can expect after a gua sha or cupping treatment, sometimes with more discoloration, sometimes with less. So I thought it might be useful to demystify these ‘bruises’, or what we call in Chinese Medicine, sha.

Sha is the red, brown or purplish spots or patches on the surface of the skin brought about by the suctioning of cupping or the scraping of gua sha. We often hear of it being called petuchiae from western medicine terminology. That would imply that the spots on the skin are a result of blood leaking into the skin due to breaking of blood vessels.

I believe this is not only a misnomer but a misconception, because this isn’t really an accurate description of the process that is occuring. Rather, as indicated by current research, what we are really witnessing is blood vessel expansion with erythrocyte extravasation, followed by an increased ratio of immune active cells locally. Simply stated, blood cells move out of the temporarily expanded capillaries - which are the thinnest of all blood vessels, having only one layer of endothelial cells and are permeable - into the capillary bed or surrounding tissues. An increased immune function of the skin follows.

We could further simplify our understanding of sha as an indication that skin microcirculation has been enhanced. (It has been demonstrated, for example, that there is a 400% increase of surface circulation of blood for 7.5 minutes after gua sha.) We can, therefore, expect to see improved skin homeostasis allowing for improved transportation of gases, nutrients, & waste, improved synthesis of vitamins and hormones, improved blood pressure regulation, improved inflammatory response, improved body temperature regulation and improved sensory reception as by-products of improved skin microperfusion.

The skin remains completely undamaged, and ‘bleeding’ is absent, contrary to popular opinion, as new sha continues to appear only so long as the scraping or suctioning is in progress. Chinese Medicine Pratitioners proficient in the use of gua sha therapeutically recognize that sha will often not appear at all in a person void of health issues or injury.

I always warn patients prior to treating them with cupping or gua sha that they might not look so pretty afterwards. However, most see the benefits far outweigh any minor temporary aesthetic inconveniences. They also appreciate that sha is very helpful to me diagnostically, pointing to location, nature as well as the severity of the issue presented. And, of course, the sha that appears doesn’t last forever. It normally disappears in 3-5 days, sometimes in a week. We can even be happy to know that as the extravasated blood cells get reabsorbed, the breakdown of hemoglobin (a protein in red blood cells that carries oxygen throughout the body)

upregulates HO-1, CO, biliverdin and bilirubin, leading to an anti-inflammatory and cell protective effect that is powerfully therapeutic.

I want to close with an encouragement to those who have wanted to try cupping and gua sha but have avoided doing so due to the myths and misconceptions about the mechanisms by which these modalities operate, to find your nearest Acupuncturist or Chinese Medicine Practitioner and experience the extraordinary health-supporting benefits of such elegant therapies.

For Further Reading:

Chen, Tingting et al. “Gua Sha, a press-stroke treatment of the skin, boosts the immune response to intradermal vaccination.” PeerJ vol. 4 e2451. 14 Sep. 2016, doi:10.7717/peerj.2451

Kwong, Kenneth K et al. “Bioluminescence imaging of heme oxygenase-1 upregulation in the Gua Sha procedure.” Journal of visualized experiments : JoVE ,30 1385. 28 Aug. 2009, doi:10.3791/1385

Neubauer-Geryk, Jolanta et al. “Current methods for the assessment of skin microcirculation: Part 1.” Postepy dermatologii i alergologii vol. 36,3 (2019): 247-254. doi:10.5114/ada.2019.83656

Nielsen, Arya et al. “The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects.” Explore (New York, N.Y.) vol. 3,5 (2007): 456-66. doi:10.1016/j.explore.2007.06.001

Nielsen, Arya. “Gua sha: A Traditional Technique for Modern Practice.” (1995).

Wu, Zhongchao. 'Gua Sha Scraping Massage Techniques: A Natural Way of Prevention and Treatment Through Traditional Chinese Medicine.' (2018). Print.