Gua Sha: What the Evidence Says for Pain and Your Face

Last verified November 2, 2026. Every grade and study figure on this page links to the source we checked. Where we couldn't confirm something, we say so.

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The short answer

Gua sha is a traditional East Asian practice of stroking the skin with a smooth-edged tool. For chronic neck pain, one small trial found a single session reduced pain for about a week compared with a heat pad,² but a review of the wider evidence for muscle and joint pain called it insufficient.¹ Facial gua sha may reduce puffiness for a short time; claims that it sculpts the face, builds collagen or "detoxes" are not supported.⁸ Body gua sha is meant to leave red spots and bruise-like marks, so skip it or ask a doctor first if you take blood thinners or bruise easily.⁹

What gua sha is

In traditional body gua sha, a practitioner applies oil and then presses and strokes a smooth edge, such as a ceramic spoon, a coin, horn or a shaped stone, over the back, neck, shoulders or limbs. The strokes are repeated until small red or purple spots (petechiae) or bruise-like marks appear; those marks are the point of the traditional technique, not a side effect.^{6, 9}

Facial gua sha is a much gentler, newer use: a flat stone or metal tool glided over oiled facial skin with light pressure, usually outward and upward. It is not meant to leave marks.⁸

Clinicians who use steel tools on muscles call a similar technique instrument-assisted soft tissue mobilization. See our guides to muscle scraping and the Graston Technique.

What the evidence says

A = consistent meta-analyses of randomized trials. B = a meta-analysis or several good trials with a moderate effect, in a narrower group. C = small effects, or small or few trials. D = too little evidence. X = tested, and the claimed effect did not show up. These grades match the ones in our muscle scraping guide.

Claim	Grade	What the best evidence found	Caveat
Less chronic neck pain	C	An open-label trial of 48 people: one gua sha session cut pain by about 30 mm on a 100 mm scale at one week, more than a heat pad.2 A pilot of 39 people with neck or low back pain found less pain than a waiting list.3	Small, unblinded, short follow-up
Less chronic low back pain	C	The same pilot was positive;3 a crossover pilot in older adults found no significant difference from a hot pack.4	Two small pilots, mixed
Musculoskeletal pain in general	D	A 2010 review of 7 controlled trials found most were poor quality and concluded that "current evidence is insufficient to show that Guasha is effective in pain management."1	Older review
Increases blood flow	C	In 11 healthy volunteers, surface blood flow at the treated spot rose about fourfold for the first 7.5 minutes and stayed raised for the 25-minute study.5	Skin surface, minutes, no control group
"Anti-inflammatory" or "detox" effects	D	Gua sha raised an antioxidant enzyme (heme oxygenase-1) in mice.6 Inflammatory markers trended down in one small human pilot, without a significant difference from hot packs.4 "Detox" has no physiological basis.8	Mouse study; pilot data
Facial gua sha reduces puffiness	D	Dermatology Times calls the effect real but short-lived: a fluid shift, not a lasting change.8 We found no controlled trial.	Expert opinion
Facial gua sha sculpts or lifts the face	D	An 8-week trial in 34 women compared gua sha with a facial roller, 10 minutes five times a week, and reported 2.2 to 2.4 mm changes in facial measurements with gua sha.7 There was no untreated group, and the changes are thought to reflect fluid and muscle tone, not bone.8	No control group
Facial gua sha builds collagen or reduces wrinkles	D	Not supported; reviews of facial massage tools describe small, short, poorly controlled studies.8
Treats migraine, TMJ, plantar fasciitis or shin splints	D	We found no good trial for these. An older version of this page claimed they "have been shown to be improved"; we removed that.

The "400% more blood flow" figure some scraping-tool brands use appears to trace back to the fourfold increase in that 11-person study.⁵ It lasted minutes, was measured at the skin surface, and the authors concluded that the pain relief people felt further away from the treated spot wasn't explained by blood flow.⁵

Gua sha sits inside the wider instrument-assisted soft tissue research, where the most recent meta-analysis of 46 trials found no meaningful added benefit for pain, function or range of motion.¹⁰

How to do body gua sha gently

If you want to try it on yourself, on muscles you can reach such as calves, thighs, forearms or the top of the shoulders:

1. Apply oil or lotion so the tool glides.
2. Hold the tool at a shallow angle and stroke in one direction, a few inches at a time, with light to moderate pressure.
3. Start light. You don't need to raise spots or bruises; nothing on this page shows that marks mean a better result.
4. Keep to a few minutes per area, and give the area time to settle before you do it again.
5. Wash the tool with warm soapy water after each use, and don't share it.⁹

Avoid the front of the neck, the spine itself, bony points, and any area that is broken, inflamed, infected or recently injured.

How to do facial gua sha

• Start with a clean face and a few drops of facial oil.
• Hold the flat edge almost flat against the skin and glide it with light pressure, outward from the centre of the face and up toward the hairline.
• In the trial above, people did 10 minutes, five times a week, for 8 weeks.⁷ That is what was studied, not a recommendation.
• Stop if you see redness that lasts, tiny red spots or broken veins. Facial skin is thin and marks more easily.⁸

Safety and who should avoid it

Body gua sha is designed to cause petechiae and bruise-like marks, which means small amounts of blood leave the capillaries. Safety reviewers point out that blood can be drawn through the skin, so tools used on more than one person can carry bloodborne infections unless they are cleaned or disposed of properly.⁹ In a clinic, ask how tools are cleaned.

We didn't find a standard contraindication list, so these are precautions, not rules:

• Blood thinners, bleeding or clotting disorders, or easy bruising. Ask your doctor first, and avoid the firm, mark-raising style.
• Skin problems. Don't use it over broken skin, rashes, burns, infections, moles or varicose veins.
• Facial gua sha. People with rosacea, visible broken veins or fragile capillaries are most prone to marks, and vigorous use can leave dark patches on some skin. Don't press on areas recently treated with fillers or anti-wrinkle injections.⁸
• Pain that is severe, new after an injury, or getting worse. See a clinician rather than treating it yourself.

Choosing a tool

This page has no product picks. Tools range from cheap stainless steel or plastic to jade, rose quartz and other stones. We found no study comparing materials, and none showing that stone type matters. What matters is that the edge is smooth and rounded, the tool is easy to clean, and it fits your hand. Smooth, non-porous materials such as steel are simple to clean. For body work, the tools in our muscle scraping guide do the same job.

Gua sha, muscle scraping and Graston

	Gua sha	Muscle scraping	Graston Technique
Origin	Traditional East Asian practice	Home version of clinical IASTM	Branded clinical IASTM method
Aim of the strokes	Traditionally, to raise petechiae	Make a tight area feel looser	Treat a specific problem alongside exercise
Who does it	Practitioners, massage therapists or yourself	Yourself or a clinician	Licensed clinicians with Graston training
Our guide	This page	Muscle scraping	Graston Technique

FAQ

Does gua sha actually work?

For chronic neck pain, one small trial found short-term benefit.² For muscle and joint pain in general, the evidence is thin and mostly low quality.¹

Does facial gua sha work?

It may make your face look less puffy for a short time. There is no good evidence that it lifts, sculpts or builds collagen.⁸

Why does gua sha leave red marks?

The firm strokes of body gua sha make small amounts of blood leak from capillaries under the skin, which shows as red or purple spots.^{6, 9} Facial gua sha should not leave marks.

How often should I do gua sha?

There is no evidence-based schedule. The neck pain trial used a single session.² For body gua sha, let marks fade before treating the same spot again.

Is gua sha safe on blood thinners?

Ask your doctor first. Body gua sha deliberately causes bleeding under the skin,⁹ so anything that makes you bleed or bruise more easily is a reason for caution.

Is gua sha the same as muscle scraping?

They are close relatives. See our muscle scraping and Graston guides.

Related: muscle scraping, Graston Technique, foam rolling guide, which recovery tools have evidence, derma roller guide.

Featured photo by Content Pixie on Unsplash.

References

1. Lee MS, Choi TY, Kim JI, Choi SM. Using Guasha to treat musculoskeletal pain: a systematic review of controlled clinical trials. Chin Med 2010;5:5. doi:10.1186/1749-8546-5-5. Source
2. Braun M, Schwickert M, Nielsen A et al. Effectiveness of traditional Chinese "gua sha" therapy in patients with chronic neck pain: a randomized controlled trial. Pain Med 2011;12(3):362-369. doi:10.1111/j.1526-4637.2011.01053.x. Source
3. Lauche R, Wübbeling K, Lüdtke R et al. 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. Am J Chin Med 2012;40(5):905-917 (PEDro record). Source
4. Yuen JWM, Tsang WWN, Tse SHM et al. The effects of Gua sha on symptoms and inflammatory biomarkers associated with chronic low back pain: a randomized active-controlled crossover pilot study in elderly. Complement Ther Med 2017;32:25-32 (PEDro record). Source
5. Nielsen A, Knoblauch NTM, 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. Source
6. Kwong KK, Kloetzer L, Wong KK et al. Bioluminescence imaging of heme oxygenase-1 upregulation in the Gua Sha procedure. J Vis Exp 2009;(30):e1385. Source
7. Ahn SH, Hwang UJ, Han HS et al. 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. doi:10.1111/jocd.70236. Source
8. Bosslett M. Social media mythbusters: at-home facial gua sha. Dermatology Times, 8 August 2026. Source
9. Nielsen A, Kligler B, Koll BS. Safety protocols for gua sha (press-stroking) and baguan (cupping). Complement Ther Med 2012;20(5):340-344. doi:10.1016/j.ctim.2012.05.004. Source
10. Nazari G, Bobos P, Lu S et al. Effectiveness of instrument-assisted soft tissue mobilization for the management of upper body, lower body, and spinal conditions: an updated systematic review with meta-analyses. Disabil Rehabil 2023;45(10):1608-1618. Source