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ANCIENT CHINESE SECRET
Gua sha is an ancient healing technique used by many clinicians of traditional Chinese Medicine (TCM). In this procedure, a lubricating medium, such as massage oil, is applied to the skin of the area to be treated. A smooth-edged instrument is used by the acupuncturist to apply short or long strokes on the skin, typically in the area of pain or on the back parallel to the spine. This stroking motion creates raised redness (petechiae) or bruising (ecchymosis). Manual therapies like gua sha may be useful for many conditions, but may become essential clinical options particularly for what are called ‘gaps in care’, i.e. when patients cannot or prefer not to take medicines for a problem, or when those medicines fail or are not available.
It is well known that chronic hepatitis is a difficult condition because of the inflammatory breakdown of the liver over time that can cause illness and even premature death. Medications for the treatment of hepatitis are limited in scope and carry uncomfortable or intolerable side effects. Back in the U.S., at Harvard/Mass General in 2011, Chan et al. described a case where a single gua sha treatment in a patient with active chronic hepatitis B reduced levels of liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST), modulated T-helper Th1/Th2 balance and enhanced HO-1, which they suggest is responsible for the hepatoprotective effect . In this case, and in general, Gua sha may be effective in transiently reducing the inflammatory injury to the liver when chronic hepatitis B moves into the immune active phase indicated by a liver function test. While Chan et al. represents one case, it coincides with both evidence from China and with what is already known about the effect of upregulation of HO-1, and that HO-1 is upregulated from gua sha. Larger trials are needed to establish to what degree and at what dosage/frequency gua sha may be hepatoprotective in patients with active hepatitis. Is it the case that treatment every week or every other week, with other liver sparing dietary cautions, will reduce inflammatory injury to the liver and return a patient to ‘inactive’ status? If the research bears out, gua sha will have an essential role in managing chronic active hepatitis. One could say if it were a drug, establishing this effect would be considered a medical breakthrough.
(A) The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects. Nielsen A, Knoblauch NT, Dobos GJ, Michalsen A, Kaptchuk TJ. In vivo upregulation of HO-1 in response to Gua Sha.Bioluminescence Imaging of Heme Oxygenase-1 Upregulation in the Gua Sha Procedure Kenneth K. Kwong, Lenuta Kloetzer, Kelvin K. Wong, Jia-Qian Ren, Braden Kuo, Yan Jiang, Y. Iris Chen, Suk-Tak Chan, Geoffrey S. Young, and Stephen T.C. Wong
Gua Sha increases microcirculation local to a treated area, and that increase in circulation may play a role in local and distal decrease in myalgia. There is an unidentified pain-relieving biomechanism associated with Gua Sha.
(B) Effectiveness of Traditional Chinese “Gua Sha” Therapy in Patients with Chronic Neck Pain: A Randomized Controlled Trial Maximilian Braun, MD Miriam Schwickert, MD Arya Nielsen, PhD Stefan Brunnhuber, PhD Gustav Dobos, MD Frauke Musial, PhD Rainer Lüdtke, MSc Andreas Michalsen, MD
Gua sha has beneficial short-term effects on pain and functional status in patients with chronic neck pain.
(C) Randomized controlled pilot study: pain intensity and pressure pain thresholds in patients with neck and low back pain before and after traditional East Asian "gua sha" therapy. Lauche R1, Wübbeling K, Lüdtke R, Cramer H, Choi KE, Rampp T, Michalsen A, Langhorst J, Dobos GJ.
These results suggest that Gua Sha may be an effective treatment for patients with chronic neck and low back pain.
(D) Gua Sha for migraine in inpatient withdrawal therapy of headache due to medication overuse. Schwickert ME1, Saha FJ, Braun M, Dobos GJ.
This case provides first evidence that Gua Sha is effective in the treatment of headaches.
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