What are these Hickey marks, and why do they make the pain go away?

Leta Herman with Gua Sha spoon by Leta Herman


Cupping Therapy has been in the news for the past year, since Michael Phelps sported his “Circles of Red” marks on his back from an ancient technique that is supposed to relieve pain and promote overall health. Celebrities, like Katy Perry, had already embraced Cupping for treating pain, weight loss, and even the removal of cellulite.

With all this attention on Cupping, its sister, and in my opinion, more powerful pain-relieving technique has been a bit neglected! Most Chinese Medicine practitioners don’t just use Cupping to relieve pain. They use Cupping and another ancient technique called Gua Sha. The two together are a one-two punch against pain!

Gua Sha on the back of the neck

What is Gua Sha?

Gua Sha is thousands of years old, but no one knows exactly how old or exactly where it was created. It’s believed to have been invented in southern China, what is now Vietnam. It began as folk medicine by family members and was handed down generation to generation. Eventually, it was adopted into Traditional Chinese Medicine, and itinerant traveling Chinese Medicine doctors would frequently use it. Today it’s considered an integral part of a typical Chinese Medicine practice.

Using a Gua Sha tool, such as a simple ceramic soup spoon, large coin, or even an animal horn (a common tool in ancient times that is still used today in many parts of the world), you lightly scrape the surface of the skin using a simple technique for about 30 seconds (or more). This scraping of the skin may cause splotchy red marks to appear as the blood rises to the surface of the skin. These splotchy spots, that oddly look like hickeys, are known as Sha.

The amazing thing about Gua Sha is these strange red marks only appear where a person has stuck, stagnated energy. If you’re having pain in your arm, and you do Gua Sha on an area that feels just fine, let’s say your leg, those red marks won’t appear at all. That’s because you’re leg is doing just fine, thank you very much. Now if you do Gua Sha scraping on your arm, especially near where it hurts. Bingo! The red Sha marks emerge within about 30 seconds.

Gua Sha is easy to perform but has a profoundly effective healing technique. It’s true Folk Medicine. Today, millions of people around the world use Gua Sha for healing.  More and more research is being done to understand all the healing effects Gua Sha has.

Getting Gua Sha done in most cases doesn’t hurt at all! In fact, people come to love the feeling of Gua Sha and often times they say it feels like a massage.Leta-Herman-Gua-ShaThe petechiae or red marks that come out with Gua Sha can look alarming at first. I often take a picture of a client’s back to show them what it looks like before they surprise their loved ones that evening. 

Why Red?

When redness appears it means that tension and toxic energy is being released through the surface of the skin when you apply the Gua Sha technique. As the blood rushes up to the surface, the fascia and muscles get renewed with what is called, “microcirculatory effects.” This particular study explains that as these microcirculatory effects are increased (by as much as 4 times in an area where Gua Sha is applied), the person’s pain is immediately reduced. The idea discussed in this study is that as all the blood and qi flow stimulated in the area, causes the tension and resistance in that area to be released. Thus the person feels relief immediately.

As a Chinese Medicine practitioner, I’ve been using Gua Sha in my practice for over 15 years. And I’ve seen the amazing results of Gua Sha over and over again. I have personally experienced this relief many times, when, in my Kung Fu practice, as soon as I pull a muscle or strain something, I take out my spoon and simply vanish the pain.

What is Gua Sha good for?

Okay, so you’re probably wondering… why would I use Gua Sha? Gua Sha has amazing applications that can be so beneficial to many people. Some common uses are:

Pulled Muscles

In my opinion, Gua Sha is one of the best modalities out there for pain in the muscles and tendons. Gua Sha is incredibly useful for all sorts of pulled and strained muscles. Massage and Gua Sha together are especially powerful for pain from pulled muscles.

Neck Pain

Those pains in the neck need not put you out of sorts for several days. Another area that Gua Sha is great for is on the neck. Neck pain is probably one of the most common complaints I see, and Gua Sha is incredibly effective for all sorts of neck pain. whether it’s on the back of the neck, the sides of the neck, or even the SCM muscles on the front of the neck. Even the most entrenched neck pain from old whiplash injuries can be helped with Gua Sha. My gardener client tried everything after a car accident to heal her neck and was at her wits end, unable to do the thing she loves most. Gua Sha did the trick, and she’s back to her gardening again.

Shoulder Pain

We all “shoulder” a bit too much in our lives. Gua Sha is very useful for shoulder pain because it can really get around the entire rotator cuff. Even frozen shoulders, which are so mysterious to the medical field, can be helped with Gua Sha. 

Back Pain

Gua Sha can help heal all sorts of back pain, whether it’s in the upper, middle, or lower back. I remember years ago, when I was just starting out, a police officer came to me for one treatment. She couldn’t go to work that day because her back was out. I did Gua Sha on her low back and scheduled several more appointments with her. Later that day she called me back to say that she was already all better and back to work!


Gua Sha is great for helping a person who has overdone it, like running that 5k race without any training! It’s also helpful for people who continuously overuse a particular part of their body at work or in a hobby. Whether it’s an avid cross-fitter, runner, or even a knitter, people put stress on their bodies, and Gua Sha can help you do what need to do or love to do without pain. 

Carpal Tunnel

Many an office worker, programmer, or gamer has come to me, arms held up in front of them, asking for help. After years of seeing many people avoid carpal tunnel surgery, I am convinced such surgery could be avoided entirely if we would only use Gua Sha more.


Gua Sha is excellent for recovering from all sorts of recent or old injuries. Recovery time is faster when you use Gua Sha, although Gua Sha should never be done over an open wound or too soon after serious injury. Some healing may need to occur before you can apply even light Gua Sha pressure to an injury.

Shin Splints

A common runner’s problem is Shin Splints. One woman, looking to lose weight, started a walking program to get back into shape and immediately suffered from Shin Splints. She was so surprised when she got up off the treatment table and could walk! Even a single application of Gua Sha can often fix shin splints!

Plantar Fasciitis

Gua Sha can be one of the best things that can help plantar fasciitis or foot injuries. It takes a little practice to do the feet, and some people are very ticklish, but it works!


Gua Sha can be used to help with all kinds of headaches. I’ve had many people come to me after trying everything else for their recurring headaches and Gua Sha makes all the difference.

Itchy Skin

Ever feel like you have that itch that just won’t scratch? Doing Gua Sha circularly away from an itchy skin problem immediately relieves that itch. While you must never do Gua Sha over a rash or open skin, doing Gua Sha near a rash often stops the itch and also heals the rash faster.

Stress Reduction

Most importantly, everyone who receives Gua Sha benefits from its stress-relieving abilities. When you receive Gua Sha, you often feel an immediate sense of relief and calm. It’s great for the tops of the shoulders, back of the neck, and mid-back.

Preventing the Common Cold

Gua Sha applied to the back of the neck at the first sign of a cold stops the cold in its tracks. I haven’t been sick in over 10 years thanks to Gua Sha!


Facial Gua Sha is extremely popular all throughout Asia–the spoon is considered a woman’s best friend. This is the area where Gua Sha has received the most attention, especially among estheticians. Facial Gua Sha promotes circulation in the skin and makes skin more youthful looking.

Case Studies

Here are a few case studies from my clinic:

Client #1: About year ago, a construction worker named Pete came to see me because he was having shoulder pain. Pete is also a musician, which is his passion. He came to see me with neck, shoulder, and hand pain. He had tried going to several doctors and physical therapists to no avail. He had just about given up on playing his guitar again. He was in a band, and this was really a challenge for him, both emotionally and physically. After just one session of Gua Sha, he felt immediate relief on the back of his shoulder blade and down his arm. His hand freed up, and he could start to play again. It took about 4 sessions to really see him get back to normal guitar playing. He experienced such relief that he was able to play guitar again on a regular basis. He is still coming to me today on an as needed basis for tune ups. He’ll often say when he leaves, “I’m going to be feeling good tonight at band practice!”

Client #2: This young soccer player came to me at the beginning of his Senior year. He was the captain of his college team but during the previous season, he had a debilitating injury–a kick to the thigh from another player. Devastating to some soccer players, it happens far too often. Over the Winter, the pain worsened and by next Summer, the pain was keeping him from sleeping and enjoying life in general, never mind not being able to play soccer! He even had trouble sitting and concentrating in his classes from the pain. He’d never heard of Gua Sha before, but after seeing so many specialists with no help or relief, he thought he’d give it a try. (At this point the pain was so chronic, it involved many muscle groups, and it required some intense work.) I had to Gua Sha his hip, his glutes, and his thigh down to his knee. Guess what happened? After about a month of coming in twice a week, he was able to start playing again. By the end of the semester, he was back in business and able to play in the playoffs!

Client #3 Several years ago, a professor came to me with severe pain in the arm around her bicep. She couldn’t even lift her arm to write on the blackboard in the classroom and had difficulty doing her work on the computer for more than a few minutes. She was extremely stressed out about her work and her pain. After doing Gua Sha with me, she was amazed to find out that her entire neck, back, and shoulders had tons of Sha coming out. After several sessions, her arm began to improve and she was able to do her work. To this day, many years later, she sees me weekly for Gua Sha because she finds it reduces her stress overall, which then prevents any further arm issues.



Gua Sha is not for everyone. There are some considerations to think about. For example, you don’t want to do Gua Sha with certain medical conditions or for people taking certain medications, like blood thinners. For this reason, it is important to receive Gua Sha from a trained professional. While Gua Sha is considered folk medicine in Asia, the principles of Gua Sha were passed down generation to generation along with all of the known precautions. For this reason, if you wish to do Gua Sha yourself, it’s important to take a formal class in it and not just mimic the first Youtube video you see.