Gua Sha and Cupping: How to Use Chinese Medicine’s Hands-On Traditions

Gua sha is the Chinese art of scraping oiled skin with a smooth-edged tool, and, with cupping and moxibustion, it forms the hands-on family of the Chinese tradition. In the tradition's view, each works at the surface of the body to move qi and blood and to warm what is cool. Here is how each is done, where it comes from and how to begin at home.

What is gua sha?

Gua sha is a scraping practice [2]. A smooth edge passes over the skin again and again, and a passing red flush rises where it has worked [1]. The tool can be an ox-horn board [4], a smooth coin [2] or a spoon [1], and the skin is usually eased first with oil [2] [4].

The practice travels under many names across East Asia: coining, spooning, scraping and cao gio [1]. In the language of the Chinese medicine tradition, gua sha frees the flow of qi and blood in the channels near the surface. The red stripes are temporary and fade with time.

A woodblock chart printed in 1918, in an appendix to the text Fangyi chuyan, gives the classical method in a few lines. Prepare a smooth copper coin, wet it with sesame oil, salt water or vinegar, begin at the hollow at the back of the neck, then scrape along the long muscles on either side of the spine and finish behind the knee [2].

How do you use gua sha on the face?

Facial gua sha is the gentlest form of the practice: a slow, oiled massage that is not meant to raise a flush. A 2025 study taught a set sequence of six movements to a group of women, who then used it at home for ten minutes, five times a week, for eight weeks [3]. Here is that sequence, a simple guide for how to use gua sha at home.

Before you begin, wash your face and smooth on a few drops of a pure facial oil, so the tool glides without pulling [3]. Hold the tool with its smooth edge against the skin, and press firmly enough to move the surface of the skin with the stroke, yet softly enough that it always feels comfortable [3]. Then follow the six movements in order [3].

1. Neck and shoulders. A few slow strokes over the sides of the neck and across the tops of the shoulders.
2. Near the ears. Small, slow strokes just in front of and below each ear.
3. Along the jaw. Glide from the chin up along the jawline toward each ear.
4. Down the neck. Glide from the chin to the ear once more, then carry the stroke down the side of the neck toward the collarbone.
5. Across the cheeks. Glide from the cheek out to the temple, on each side in turn.
6. Forehead and brows. Glide from the centre of the forehead outward, then along the line of each brow.

Close by resting the tool lightly on each temple for a breath or two. The whole sequence takes about ten minutes [3].

How is gua sha done on the body?

On the body, the practice is fuller and slower, and it is usually received from a trained hand. In a 2025 study of the method, the skin of the back was eased with olive oil and a smooth ox-horn board was drawn in one direction along the long muscles on both sides of the spine [4]. Each area was worked for two to three minutes, the pressure stayed within the receiver's comfort, and the whole session lasted fifteen minutes [4].

Afterwards the remaining oil was wiped away and a cup of warm water was offered, so the body kept its warmth [4]. The old texts follow the same path: from the back of the neck, down both sides of the spine and on to the back of the knee [2]. Let the flush come and go in its own time, and let it fade fully before the next session.

What is cupping therapy?

Cupping therapy places a cup on the skin and creates a gentle vacuum inside it, so the skin and the muscle beneath are drawn up into the cup. The practice has a long history in China, Greece, Egypt and the Middle East. The ancient Chinese used animal horns as cups; today the choice ranges from bamboo to glass [5].

Chinese teaching describes three main ways of making the suction: fire cupping, liquid cupping and vacuum cupping with a small pump [5]. It then describes five ways of working with the cups. Flash cupping lifts a cup on and off quickly, retained cupping leaves it in place for some minutes, and moving cupping slides an oiled cup across the back. The two remaining methods combine the cups with other techniques and belong to trained hands alone [5]. Round marks the colour of plums are left behind, and like the stripes of scraping they are temporary.

In the tradition's reading, cupping, like scraping, draws stagnant qi and blood toward the surface, where the flow can renew itself.

Each of these arts begins at the skin, the meeting place of the person and the world.

What is moxibustion?

Moxibustion warms chosen points on the body with smouldering moxa. Moxa is made from the dried, ground leaves of mugwort, Artemisia argyi, which turn into a soft, woolly fluff [6]. The moxa can be rolled into a stick and held near the skin, or shaped into small cones; a slice of ginger, garlic or a layer of salt can sit between the cone and the skin [6].

It is one of the oldest documented practices of the tradition. A chronicle of the pre-Qin era, the Zuo zhuan, records a discussion from 581 BCE that scholars count as the earliest written mention of moxibustion. The silk books buried at Mawangdui around 168 BCE already record its use [6]. The Huangdi Neijing links its origin to the ways of life of the peoples of the high, cold north [6].

Moxibustion leans toward warming and nourishing. Chinese teaching groups its gifts as warming that nourishes, warming that frees the channels and warming that melts what has gathered [6]. It is chosen most often for a cool, depleted pattern, the same pattern that welcomes ginger soup and long, slow cooking on a winter evening.

How do the hands-on traditions fit together?

Scraping and cupping move what has gathered; moxa warms what is cool; massage and slow movement keep the whole river flowing.

How can you begin with the hands-on traditions?

1. Start with your face. A smooth facial tool and a few drops of oil are all you need for the six movements above.
2. Keep the pressure kind. Move the skin, never drag it, and let comfort set the limit.
3. Receive the fuller arts. Let a trained hand first show you body scraping, cupping and moxa.
4. Join them to the day. Pair the practice with a warm drink, an early night or a short round of qigong, so the day keeps its gentle rhythm.

Frequently asked questions

What is gua sha?

Gua sha is a Chinese scraping practice. A smooth edge, such as a horn board, a coin or a spoon, passes over oiled skin and raises a passing red flush; the gentler facial form is an oiled massage that raises no flush.

How often can you use gua sha on your face?

It is gentle enough for regular use. In one study, women used a ten-minute sequence five times a week for eight weeks.

What is the difference between gua sha and cupping?

Gua sha presses and scrapes the skin with a smooth edge, leaving stripes of colour. Cupping lifts the skin into a cup by suction, leaving round marks. The tradition reads both as ways of moving qi and blood that have gathered near the surface.

Why do scraping and cupping leave marks?

The flush is the colour of blood brought close to the surface of the skin. The marks are temporary, and they fade from red or purple to pale with time.

What is moxa made from?

Moxa is made from the dried, ground leaves of mugwort, Artemisia argyi. The soft wool is rolled into sticks or shaped into cones and burned close to chosen points to warm them.

Sources

1. Nielsen A, Knoblauch NT, Dobos GJ, Michalsen A, Kaptchuk TJ. The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects. Explore (NY) 2007;3(5):456-466.
2. Wellcome Collection. TCM for epidemics: Guasha treatment, back view. From Fangyi chuyan, appendix Guasha tushuo, edition printed in 1918. Catalogue record, Wellcome Collection, London.
3. Ahn SH, Hwang UJ, Han HS, Kim JH, Lee HJ, Jeon YR, Lee HH, Hwang AH. Comparative effects of facial roller and gua sha massage on facial contour, muscle tone, and skin elasticity: randomized controlled trial. J Cosmet Dermatol 2025;24(6):e70236.
4. Wang B, Hu Y, Lai D, Eungpinichpong W. Effects of Gua Sha therapy on thoracolumbar fascia thickness and clinical outcomes of patients with chronic nonspecific low back pain: a randomized controlled trial. Medicine (Baltimore) 2025;104(36):e44233.
5. Lin X, Wong HF, Ng SC. Cupping, the past and present application. Chinese Medicine and Culture 2018;1(3):121-126.
6. Deng H, Shen X. The mechanism of moxibustion: ancient theory and modern research. Evid Based Complement Alternat Med 2013;2013:379291.

This article is for educational purposes only and is not medical advice. Nothing here is intended to diagnose, treat, cure, or prevent any disease, or to replace care from a licensed healthcare provider. Gua sha, cupping and moxibustion are not suited to everyone; please consult a qualified professional before trying them, especially in pregnancy, on broken or fragile skin, or if you take blood-thinning medicines.

Images: featured image, gua sha on the back, a woodblock chart from Fangyi chuyan, edition printed in 1918, Wellcome Collection, CC BY 4.0, via Wikimedia Commons. In-article photographs credited in their captions.

Written by

Dr. Carina Lopez

Naturopathic Doctor, Licensed Acupuncturist, Classical Homeopath, Master Herbalist, Certified Iridologist & Sclerologist

Dr. Carina Lopez is a naturopathic doctor, licensed acupuncturist, classical homeopath, master herbalist, certified iridologist and sclerologist, energy healing practitioner, QHHT hypnosis practitioner, and NOVA Non-Ocular Vision instructor. As co-founder of Vitalist Healing Traditions, she brings together traditional healing wisdom, energetic practices, and consciousness exploration to help individuals reconnect with their innate capacity for healing and transformation. Her philosophy rests on one quietly radical idea: Within every human being exists an innate intelligence, a healing potential, and a light waiting to be awakened.