A therapist is shown practicing gua sha (scraping) on a client.

The Chinese scraping method of gua sha is rooted in traditional Chinese medicine, and is becoming better known and utilized by Western health care practitioners. There are many uses for this method, including benefiting the skin, muscles, fascia and various body systems. This article will explore gua sha’s impact upon the lymphatic system and provide suggestions on its usage.

The term gua sha is a Chinese term translated as “scraping sand,” interpreted as moving heat or wind through the body. In Chinese medicine, diseases and conditions are characterized in six categories: heat, summer heat, wind, cold, dampness and dryness. Gua sha is said to help alleviate conditions related to heat, summer heat and wind.

“The Yellow Emperor’s Classic of Internal Medicine,” published during the Chinese Ming Dynasty approximately 700 years ago, provides the earliest written recording of the practice of gua sha. This classic work describes the use of gua sha techniques to move heat, summer heat and wind conditions.

Heat conditions include diseases and conditions that manifest with inflamed tissues, fever, warm skin, swelling, sweating or acute pain. If congestion of fluids is present, the term damp-heat may be used. Examples of heat-based conditions include sinusitis, nasal polyps, eczema and oliguria.

Summer heat conditions include diseases and conditions showing more intense manifestations of normal heat conditions.

Wind conditions include diseases and conditions that manifest restlessness, headaches, tremors or respiratory difficulties. If warmth is present with a wind condition, the term wind-heat may be used. Examples of wind-based conditions include tremors, headaches, hay fever, and asthma and related respiratory challenges.

James Tin Yau So, ND, LAc (1911-2000), was among the first acupuncturists in the U.S. to popularize gua sha. He opened one of the first U.S. acupuncture schools in 1974. He commonly presented acupuncture and gua sha as two primary means toward curing many types of diseases.

Massage and Gua Sha

Gua sha can be used in a myriad of ways in therapeutic massage sessions. Scraping methods can be used as primary myofascial release techniques to free bound tissue layers. As superficial fascial tissue softens, underlying lymphatic tissue can be mobilized.

The journal Explore published an article by Arya Nielsen, PhD, in 2007 highlighting how gua sha increases microcirculation of surface tissues at treated areas as much as fourfold. Females witnessed greater relief than males with increased microcirculation. Pain relief and a decrease in myalgia were also experienced.

Nielsen translated hundreds of articles within the Kelley Library of the New England School of Acupuncture, confirming the initial findings. In 2009, Nielson’s research indicated a physiological immune response when performing gua sha with hepatitis patients.

Gua sha techniques upon the superficial body tissues initiated an immune response resulting in an increased activation of heme oxygenase-1 (HO-1) at “multiple internal organ sites immediately after treatments and over a period of days following gua sha treatment.” This immune response will then be modulated by the workings of both the immune system and lymphatic system.

In my private practice, I will often use gua sha techniques to accomplish many goals, and I often incorporate gua sha into sessions focusing upon improving the function of the lymphatic system. Several years ago, I began seeing more clients after their cosmetic procedures. Gua sha became an effective tool to both aid in releasing scar tissue buildup post-surgery with these patients, as well as to aid lymphatic flow, which resulted in expediting healing for the client.

Proponents of Chinese medicine have long considered jade a powerful stone to include in healing practices. (I use jade stone tools within my gua sha practice.) Jade is a stone anecdotally thought to aid a myriad of conditions, including strengthening the heart and circulatory system, aiding kidney diseases, modulating moods, revitalizing skin, warming the body, promoting peace and providing comfort.

Benefits of Gua Sha

In the gua sha class I present, I share many benefits of gua sha treatments. Many of the anecdotal benefits shared by clients include:

• Improved local circulation

• Reduced appearance of scar tissue

• Relieved muscle tension

• Alleviated arthritic pain

• Reduced chronic inflammation

• Aided postpartum breast health

• Reduced headaches

• Improved lymphatic movement

A search of the National Library of Medicine’s database returns studies that indicate gua sha effective for relieving low-back pain and improving immune function, although researchers note that additional studies are needed.

Gua Sha for the Lymphatic System

The last general benefit of aiding lymphatic movement will be the emphasis of this article. The lymphatic system is our body’s waste-management system. Pulling metabolic waste, pathogenic agents and fluid from interstitial tissues, the lymphatic system ensures our bodies remain healthy.

Supporting lymphatic flow in the proper direction is a major focus of any lymphatic work. Lymph fluid will travel from the limbs towards the major drainage regions (areas with a large number of nodes), such as the axilla, groin and abdomen. From the abdomen / lower body, lymph passes through the cisterna chyli (the largest lymph node, located behind the umbilicus) superiorly anterior to the spine toward the subclavian terminal trunks.

At this point, lymphatic fluid has been thoroughly cleaned and re-enters the circulatory system at the superior vena cava leading into the heart. It is interesting to note that much of our blood’s plasma (fluid) content is actually cleansed lymphatic fluid.

According to the Cleveland Clinic, there are approximately 20 liters of plasma flowing through our circulatory system daily. As this fluid loops through the body, 17 liters is returned to the heart while three liters seep through capillaries into interstitial spaces. The lymphatic system is designed to clean these three liters of fluid and return it to the circulatory system.

There are superficial and deep channels of lymph flow within the body. Approximately 70% of lymphatic vessels lie superficial, meaning they are located within subcutaneous tissue. This is why a lighter touch is presented in classes that teach bodywork to move lymphatic fluid. Deeper lymphatic channels tend to surround organs and mobilize the remaining 30% of lymphatic fluid.

With any session in which lymphatic flow is emphasized, I always begin and end sessions at the subclavius terminals located superior to the clavicle and lateral to the sternocleidomastoid attachment sites. This is the main junction at which to guide lymphatic fluid to the heart.

There are other significant lymph nodes I stimulate during sessions. Major lymph node centers to clear include the parotid, submandibular, axillary, groin and popliteal nodes. When I approach a new region of the body, I will clear the neighboring nodes first, then apply lymphatic-specific work. Utilizing gua sha techniques in addition to manual touch has worked wonders for me in practice.

Gua sha generally supports superficial lymphatic flow, as softening myofascial tissues will impact the superficial lymphatic vessels. A practitioner can guide fluids through the body based on the direction of stroke application.

To support lymphatic flow, we generally guide lymph from distal to proximal, posterior to anterior, lateral to medial, all toward major lymphatic watersheds, regions where superficial lymph flow can be diverted from one region to a subsequent pathway region.

Gua Sha Strokes

When I present gua sha classes in my classroom, I present five methods to utilizing the tool:

• Short, quick strokes

• Longer, slower strokes

• Flicking motion off body landmarks

• Tapping upon stubborn muscle knots

• Turning into stubborn muscle knots

Of these techniques, short, quick and longer slower strokes will best support lymphatic flow. In a myofascial-based gua sha class, I will demonstrate applying these strokes in multiple directions upon an area. This is because fascial fibers are generally irregular in layout.

In a lymphatic-specific session, I would apply the strokes in a singular manner, moving the tool along the body in the direction of lymphatic flow, then remove the tool, reset at original spot and repeat this application several times. I apply this method until I feel tissue soften and/or witness skin color change.

Gua Sha Safety

I present these general safety guidelines for gua sha tool usage in my classes:

• If either mild ecchymosis or petechiae are witnessed, scraping was taken to a healthy edge of intensity. Ecchymosis results in mild discoloration of the skin due to increased microcirculation.

• Petechiae results in a speckled or spotted appearance upon the skin due to capillary rupture.

• Hematomas (blood blisters) are a sign scraping was done very intensely.

Ideally a pink/red discoloration is seen with no intense bruising after session.

At times, gua sha may not cause much skin color change. Remember, the goal of gua sha is not necessarily to induce great color change; rather, the goal is to guide heat and wind through the body; that is, move fluids through the body. If skin color does not change much locally, this can mean there is not a need to break up much myofascial tissue in a certain area.

Local circulation can improve even without great skin color change. For excessively stiff myofascial tissue, I may also include cupping and other tools to further assist in loosening superficial tissues.

Tissue healing is expedited when our lymphatic system improves in functionality. As a massage therapist, it will be important for me to share with a client a potential lymphatic or inflammatory response to the work. Such responses lasting one to three days can be a normal occurrence as metabolic waste is expedited from the body.

Jimmy Gialelis

About the Author

Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches “Gua Sha: Chinese Scraping Method” and many other CE classes. His many articles written for this publication including “Clients with COVID Trauma Could be on Your Table.”