Gua Sha As Counteraction: the Crisis Is the Cure

JOURNAL OF CHINESE MEDICINE NUMBER 50 JANUARY 1996

GUA SHA AS COUNTERACTION The Crisis is the Cure

Arya Nielsen

I wish I could make a petechial fever; that is, I wish I could produce upon the skin that state of counteraction existing when petechial spots are formed. (Boerhave, Dutch physician 1668-1738)

What is Gua Sha? Gua means to scrape or scratch. Sha is a ‘reddish, elevated, millet-like skin rash14’. Gua Sha is a technique that intentionally raises sha rash or petechiae. Sha is the term used to describe stuck surface blood Fig. 2 before or after it is raised as petechiae. See figures 1 Fig. 2 and 2.

When is Gua Sha used? Gua Sha is applied for pain when external factors such as wind or cold have obstructed the blood in the surface tissues. When normal finger pressure on a patient’s skin causes blanching that is slow to fade,

Fig. 2: Gua Sha at neck and shoulder for pain subsequent to whiplash injury.

sha is present. See figures 3 and 4. Gua Sha is applied as treatment and prevention for common cold, 'flu, bronchi- tis and asthma, as well as chronic disorders involving Fig. 1 congestion of qi and blood. Where is Gua Sha applied? Sha is raised primarily at the yang surface of the body: the back, neck, shoulders, buttocks, and limbs. On occasion, Fig. 1 Gua Sha is applied at the chest and abdomen.

How is Gua Sha applied? The area where Gua Sha is to be applied is lubricated with oil. I use Vick’s Vapo-rub because my patients are famil- iar with its smell and are comforted by it, although a thick oil such as peanut oil was traditionally used. The skin is pressured in downward strokes by a round-edged instru- ment such as a coin, spoon, metal jar lid etc. (see figure 5). Strokes are continued along one area until the petechiae that surface are completely raised. If there is no sha, petechiae will not form and the skin will only turn pink.

Fig. 1: Gua Sha at left shoulder and upper back for pain What does the type of sha indicate? due to trauma. The colour of the sha is both diagnostic and prognostic. Very light coloured sha can indicate deficiency of blood. JOURNAL OF CHINESE MEDICINE NUMBER 50 JANUARY 1996

congesting surface tissues and muscles and promotes normal circulation and metabolic processes. It is a valuable treatment for both external and internal pain, and facilitates the resolution of both acute and chronic Fig. 3 disorders. Fig. 3 I have practised Chinese medicine for nearly twenty years. Next to needles, Gua Sha has been the most valuable technique that I know. The results of Gua Sha are visible and the relief it provides for patients immediate. For some disorders it is all that is needed; for others, it opens the way to a deeper process of healing. Why then has Gua Sha been slighted by practitioners in the West? Why do our schools venerate acupuncture and Fig. 3: Palpating painful areas for sha; the practitioner presses her fingers onto the flesh. herbal therapy while de-emphasising techniques integral to the tradition of Chinese medicine like Gua Sha, cupping, bloodletting, moxibustion, plum blossom needling and so on? I believe the answer lies in our own history, and modern Western cultural values that cast shadow status on some therapeutic methods and light on others. The truth is that Fig. 4 techniques like Gua Sha, and the humoural theory that Fig. 4 drives them, are not new to the West. When the Western humoural perception of the body gave way to micro-analysis advanced by technology, therapies like Gua Sha were rejected. It is my hope that they can be revived, to be used when clinically appropriate. In this article I will examine the counteractive techniques of early Western medicine, the humoural theory that in- formed them, and their decline in the West. Lastly, I will Fig. 4: Sha is indicated when finger pressure causes blanching that is distinct and disappears slowly. consider in more detail the clinical relevance of Gua Sha to modern practice.

PART ONE: CHINESE MEDICINE AND EARLY WESTERN MEDICINE Fig. 5 As I was doing research for my book on Gua Sha, I was Fig. 5 surprised to find many of the techniques used in Chinese medicine were a part of early Western medicine. Known as Hippocratic or counteractive, early Western medicine has a language and intent strikingly similar to the theories of Chinese medicine.

Fig. 5: Gua Sha is applied with a round-edged tool. In China Hippocratic medicine held that sickness resulted when a this may be a soup spoon, or slice of water buffalo horn body humour became impure, out of place or out of bal- specifically made for this purpose. The slice in the foreground ance. Dietary or behavioural indiscretions as well as expo- has an indentation for finger joints. A simple metal lid with a 1 rounded lip is the most comfortable tool I have found. sure to the elements led to illness . Restorative treatment aimed at removing or diminishing the excess offending If the sha is fresh red, it is of recent penetration. If the sha humour by manipulation, purging, bleeding or blistering, is purple or black, the blood stasis is long-standing. If or by inducing vomiting, urination, salivation, or sweating. brown, the blood may be dry. Dark red sha can indicate A deficient humour was restored by manipulation, diet, heat. The sha petechiae should fade in 2-3 days. If it is and herbs or drugs2. Drugs, herbs, food and behaviour were slower to fade, the patient has poor blood circulation. classified according to their warm, cold, moist, or dry qualities. For example, pepper was a heating herb that What are the benefits of Gua Sha? countered cold. Cucumber was a cooling herb that coun- Gua Sha moves stuck qi and blood, releases the exterior tered heat. Speaking in terms of excess and deficiency, and mimicking sweating, moves fluids and metabolic waste applying principles of hot and cold, counteractive medicine

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used discutient3 ‘touch’ to scatter and disperse pathologic accumulation and revive a balanced circulation of hu- mours. Theory of Counteraction It was a maxim of early Western medicine dating to the Hippocratic corpus that "no two diseased actions, affecting the general constitution, can go on at the same time, for any considerable period in the same system4". A patient’s asthma subsided with an attack of gout or was relieved by a discharge of blood from piles. A child’s seizures stopped when an accidental poker burn caused a small infection on his lower leg. It was thought the new disease action created a crisis that ‘counteracted’ the original disease5. Hippocratic method recorded these crises, surmising that artificial crises could be created as intervention, hastening resolution. In fact, the definition of allopathy springs from this approach: "Allopa- thy is a therapeutic system in which a disease is treated by producing a second condition that is incompatible with or antagonistic to the first6". For example, observing that fever resolves in sweating, inducing sweat might cure a fever7. Natural critical haemorrhages preceding the crisis stage in acute disease were thought to have fostered bloodletting as counteraction. Bloodletting was practised by every ancient culture to prevent or reduce pathologic accumulation A seton is the early Western medicine counteractive technique described as ‘heat’, ‘residue’, ‘malevolent spirit’ or just ‘bad closest to acupuncture. Here the skin was pinched at the back of the head and a fibre or hair was threaded into the flesh. The blood’. In the West, bloodletting became venesection; pa- subsequent surface infection, though mild, counteracted a deeper tients were bled until they fainted8. In the East, blood was let infection, in this case of the eye. by drops until its colour changed from dark to light. Sites were bled according to channel theory, time of day, month, cases of cholera. In the West cholera was described as and year. Tracing the chronology and language of the Su congestion of blood and internal heat at the pit of the Wen, Epler argues convincingly that acupuncture descends stomach with excessive coldness at the surface: " ... excite from bloodletting9. counteraction at the surface. We relieve the internal conges- 13 Hippocratic medicine never developed a procedure like tion. Warmth is the counteragent ". Classical Chinese medi- acupuncture but utilised cupping, cautery, setons and is- cine describes cholera as disease from ‘evil water’ with sues10, poultices, and so on. The Western counteractive exterior cold and interior damp. The character for sha is 14 analogue to Gua Sha was called frictioning. The indications sometimes translated as cholera , or loosely ‘sickness from 15 for frictioning share a similar history to Gua Sha. discharge of water’ .

Gua Sha and Frictioning = + Frictioning applies rough pressure to chafe, stress or irritate the surface, counterirritating and counteracting a deeper Sha or Chi Sha condition. Kaim describes “The part vexed by friction be- cholera to lie on a bed Sediment, gravel or sand gins to be red, to swell, to be warm11” Broussais (1772-1838), Sick/Sickness deposed by water, or sandlike rash from severe surgeon to the French army explains: dehydration The theory of disease took irritation to be at the bottom of every morbid condition, and held that this irritation Cholera is characterised by diarrhoea, vomiting, cramps, always resulted in an increased flow of blood to the part. suppression of urine, and collapse. It quickly dehydrates its This was inflammation, and the seemingly reasonable victims. An end stage of choleric dehydration is rashlike petechiae way to act in such a case was, if possible, prevent that flow and ecchymosis from ruptured blood vessels at the surface (italics 16 of blood and that Inflammation. An External irritant mine) . As seen in figures 1 and 2, application of Gua Sha would serve this purpose. It would determine the flow of results in the surfacing of sha petechiae that can range in blood outwards and away from the diseased direction in colour from red to dark purple. The petechial or ecchymotic which it might be going. It would stop the inflammation. stage of cholera is naturally occurring sha. By raising the This is called counterirritant12. petechiae, Gua Sha counteracts the action of cholera; it Frictioning in the West and Gua Sha in Asia were applied in artificially induces ‘the crisis that is the cure’. JOURNAL OF CHINESE MEDICINE NUMBER 50 JANUARY 1996

Into the Shadows There are three significant points to this definition. The first Counteractive therapies of early Western medicine were is the notion, shared by early Western medicine, that dis- abandoned over time. As the West industrialised, it devel- ease can be caused by exposure to the elements or climatic oped a micro-analysis of disease. Humoural theory was factors. replaced with the view that inflammation was caused by micro-organisms that could not be ‘rubbed away’ or flushed 1. Climatic elements act in the body like by letting blood17. With some exception, the West focused they act outside on smaller and smaller body units, refining an ‘attack the If a climatic element is able to penetrate the body’s resist- pathogen’ approach to cure, and a ‘win lose’ military model ance, it is the ‘character’ or ‘nature’ of the element that of immunity. The East continued to view health and disease invades the body. The inner qi is disturbed in a manner as a play of natural forces; yin and yang, hot and cold, excess characteristic of that factor. and deficiency, operating within and without. Chinese Cold medicine included the ‘attack the pathogen’ approach, but Penetration by cold causes the body to contract, slowing emphasised ‘supporting the body’s natural resistance’. The things down just like a stream freezing over. ‘Just as cold Eastern disease model included metaphors of war, but also causes the water in rivers to freeze so it is said to cause the of peace in abiding observable laws of nature. blood in the vessels to congeal20.’ Cold inhibits circulation On the positive side, modern science dashed the religious causing stagnation and hence pain characterised by chilli- and superstitious bias that saw illness as a cause for re- ness, contraction, cramps and spasms. proach. On the downside, technology separated mind from Damp body, patient from context and distanced the physician Penetration by dampness gives rise to wetness and slug- from the patient. The patient became a passive recipient and gishness, which may collect as oedema or pour down as rarely an agent to his or her own condition. diarrhoea or discharge. Pain due to dampness is character- The humoural approach, which tends to view the patient ised by a steady heavy aching that is fixed in location. as a whole in a larger context, came to be viewed as unso- Dryness phisticated and unscientific. The therapeutic techniques, Dryness deprives the body of moisture, injuring all func- even when useful, were discouraged as archaic. It is no tions dependent upon fluid. Fluids conduct body nourish- coincidence that many physical therapy departments are ment and elimination, and even facilitate movement itself. housed in hospital basements. Fever, fluid loss or inability to drink create internal dryness There is a modern expectation, held even by acupunctur- that can be life threatening. External dryness injures the ists that science, medicine, even acupuncture or herbs can skin and the Lungs first, causing dry skin, dry cough, and intervene and cure. And when a cure is obtainable, who thirst. As dryness persists, it’s effects deepen in the body would not want it? However, "In many cases, medical causing dry stool, dark infrequent urine, fatigue, and stiff- science prevents the patient from dying, without restoring ness. Dryness as yin deficiency can also lead to internal him to health. It is thus a primary cause of chronic illness18." wind that appears as dizziness or spasms. Chinese medicine practised with its traditional percep- Heat tions, techniques and recommendations, can restore many Heat causes things to stir and agitate. Heat raises body patients to health. It is up to acupuncturists to utilise all of temperature systemically or locally, and dries fluids. Pain Chinese medicine even in a cultural setting that has aban- due to heat is characterised by a subjective sensation of heat doned much of its own hands-on interventions and and irritability. Hippocrates understood fever to arise from humoural outlook. excessive internal motion. He believed frictioning could augment the vital force and excite a warm fever in even the PART TWO: OUT OF THE SHADOWS most ‘frigid dropsical person21’ . The Clinical Use of Gua Sha in the Context Wind of Chinese Medicine Wind moves. It can blow through openings carrying other Gua Sha is effective for any condition that involves pain. It factors into the body. External wind affects the skin, head, is practised throughout Asia as popular medicine, not throat, and Lungs first. Wind can advance itself as well as limited to the professional sector. Acupuncturists generally other factors inward, to the body interior. Wind acts inter- use Gua Sha after acupuncture needling, but it can be used nally in the same way it acts externally. Pain due to wind outside of acupuncture practice. can be of sudden onset and tends to move around or shoot. Modern TCM describes Gua Sha as treatment for ‘sha Wind pain can cause rigidity like a tree strained against a syndrome’: steady gale. A disease caused by the exposure of wind, cold, summer- The common effect of the penetrating nature of cold, heat or wetness evil in summer or autumn leading to damp, wind, and sometimes heat is ‘blockage to the merid- blockage to meridians; manifested as chilliness, fever, ians’ or channels. This is the second significant point of the distension and pain of the body, or vomiting and diar- sha syndrome definition. External factors obstruct the sur- rhoea, or rigidity and numbness of extremities19 . face qi.

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2. Pain means obstruction: consider Gua Sha may be deficient. If the sha itself clears slowly, the circula- The ‘ceaseless flow of qi’ is a body concept analogous to the tion is poor, reflecting a deficiency in qi or yang. ceaseless flow of water in nature. Obstruction causes prob- Hence Gua Sha is relevant to almost any presenting disor- lems reflected by the maxim: Bu tong ze tong, tong ze bu tong der. Decongesting blood at the surface moves blood inter- which means no free flow, pain; free flow, no pain. Pain means nally, promotes blood production and improves dissemi- obstruction; intervention is aimed at freeing the flow. nation of fluids throughout the body. When the pain is at the surface, in the muscles, it can The following cases illustrate that Gua Sha is able to indicate obstruction by external factors or climates, as de- counteract long standing problems deep to the surface and scribed above. If only the qi is obstructed, massage will hasten resolution. disperse the pain. If the blood becomes obstructed, massage will not resolve it. Cases Obstructed surface blood, sha, can be verified by palpa- tion. When finger pressure causes blanching that is distinct 1. Male, 55 and disappears slowly, there is sha (see Figures 3 and 4). Presenting Complaint Intervention is aimed at freeing the flow by ‘releasing the This patient complained of a lifetime chronic infection in exterior’, and by removing stagnant blood. I palpate every the right ear subsequent to a punctured ear drum as a child. patient I see for the presence of sha. He has earaches and drainage, some headaches at the back of the head, sinus drainage and a peculiar taste in the 3. Gua Sha releases the Exterior mouth. Gua Sha not only treats pain but treats and prevents acute Tongue: red with thick white coating, dry and sticky. illness by releasing the exterior. Gua Sha extravasates stag- Pulse: 64, clear*, even but for a moving Lung pulse. nant fluid and blood, mimicking sweat. This stabilises the Other signs and symptoms ‘pores’ and halts further penetration of wind, cold, and His appetite and stools are normal. Urination is normal damp. The pathogenic factor is said to be weakened, allow- with some night-time urination. His sleep is good. He has a ing the body’s wei, or anti-pathogenic qi, to resolve the history of back problems and occasional haemorrhoids. He acute illness. If already sick the patient may get sicker for a has 2 martinis each evening. He works outside most of the day and then recover rather quickly. Release of the exterior day. promotes a speedy resolution and rebound to health. Gua Treatment Sha prevents protraction of illness to chronic unresolved Back: Dazhui DU-14, Tianyou SJ-16, Fengchi GB-20, Jianjing syndromes like chronic fatigue, cough, sinusitis, diarrhoea, GB-21, Gua Sha right neck, shoulder and upper back. and so on. Front: Zhongzhu SJ-3, Tianyou SJ-16, Yifeng SJ-17, Ermen ‘When you come in the house, close the door’. Aside from SJ-21, Tinghui GB-2, Tinggong SI-19 all right side. Indirect acute pain, acupuncturists are most often asked to treat moxa around ear, (at the third session left Quchi L.I.-11 and chronic disorders. The Jinkui yaolue fanglun warns that Hegu L.I.-4 were added), Gua Sha in front of ear, along right treatment directed toward the interior can drive external sternocleidomastoid and scalenes. factors deeper into the body, making a patient sicker22. This Course of treatment: 9 sessions, 8 of them one week apart, is reflected in the maxim Xian biao hou li: first treat the exterior, with the ninth 5 weeks later. then the interior. Treatment of a chronic condition is post- Recommendations: Avoid cold and sour foods and drinks, poned until any acute illness is resolved. keep the ear covered and warm, even to the point of Palpating for sha can help elucidate whether there are in wearing a light hat indoors. fact external pathogens present and help the practitioner Results: The day after the first treatment he had a rush of avoid deepening them when they have not yet expressed as brown and red fluid from the right ear which abated. The an acute illness. The surface becomes stabilised, the door to ear was less sensitive and hearing improved. By the third the outside is closed, the patient’s interior chronic condition session he had some pain in the ear with clear fluid drain- can be safely treated. ing. By the fourth the fluid was once again brown, bad smelling and his ear really hurt. By the fifth treatment the Gua Sha resolves stagnation of blood ear stopped draining completely for the first time, but at the surface remained sensitive to cold and noise. By the sixth session he Sha petechiae verify stagnation of blood at the surface. If had no pain or draining, and his hearing was much im- there were no stagnation of blood, Gua Sha or any other proved. His neck was now feeling warm. The last three surface frictioning would only be rubifacient, causing a sessions treated his back, haemorrhoids and his ears sec- pink blush. ondarily. During this time he had one more episode of clear Practitioners can diagnose and prognose by the colour fluid from the ear. He presented five years later for a hand and nature of sha, and by how fast it disappears. The darker injury. His ear remained completely healed. the sha, the older the blood stasis. If the sha surfaces quickly, *This is a pulse quality taught by Dr. James So meaning a pulse it is a more recent penetration. If the sha is pale, the blood that has clear edges and is firm but not wiry. JOURNAL OF CHINESE MEDICINE NUMBER 50 JANUARY 1996

2. Male, 36 References Presenting Complaint: Patient complained of sharp epigastric • The Apothecary in Eighteenth-Century Williamsburg, pain, more pronounced after eating, with a dislike of touch Williamsburg Craft Series, pub. Colonial Williamsburg MCMLXX. or pressure. He had been medically diagnosed as suffering • 1987 Jinkui yaolue fanglun, Synopsis of the Golden Chamber, from a stomach ulcer, and had refused medication. New World Press, Beijing, first published c.AD 220. Tongue: red with a crack in the stomach region; yellow • 1988 Chinese-English Dictionary of Traditional Chinese Medicine, greasy coating thicker in the central stomach region. Ou Ming (ed), Guandong Science and Technology Publishing Pulse: wiry and full, especially at both middle jiao posi- House, Hong Kong. • 1988 Chinese-English Dictionary of Traditional Chinese Medicine, tions. Joint Publishing, Hong Kong. Other signs and symptoms • Brockbank, W. 1954 Ancient Therapeutic Arts, In: Fitzpatrick The patient works as a contractor; his job involves physical Lectures, Royal College of Physicians, William Heineman and mental stress. Medical Books, London. • Castiglione, A. 1941 A History of Medicine, Krumbhaar E B Treatment (trans. and ed.) Knopf, New York. Back: Feishu BL-13, Ganshu BL-18, Weishu BL-21; Gua Sha • Epler, D.C .1980 Bloodletting in Early Chinese Medicine and its middle back. Relation to the Origin of Acupuncture, Bulletin of the History of Front: Medicine 54:337-367. Zusanli ST-36, Neiguan P-6, Zhongwan REN-12, Liangmen • Epps, J. Counteraction, Viewed as a Means of Cure with Remarks of the Use of the Issue, Renshaw and Rush, London 1832. ST-21, ahshi on the left side, lateral to Jianli REN-11. • Gilles, C .1895 The Theory and Practice of Counter Irritation, Recommendations: Avoid overheating foods: spicy, greasy Macmillan and Company, London . and roasted. Avoid alcohol and coffee. • Jackson, H. 1806 On Efficacy of Certain External Applications, Course of treatment: 6 sessions. Inaugural Dissertation printed in Medical Theses, University of Pennsylvania, TW Bradford, Philadelphia. Results: This patient experienced steady improvement over • Kaim, S. 1756 Dissertatio Inauguralis Medica de Frictionibus, the 6 sessions and his symptoms resolved completely. Kaliwodian Press, University of Vienna. translated for Arya There has been no recurrence in the ten years since. Nielsen by Chipok R 1994. 3. Female, 33 • Kluger, M. 1978 The History of Bloodletting, Natural History Presenting Complaint Vol 87 No11 p78-83. • Mathews, R.H. 1931 Mathews’ Chinese-English Dictionary, A Patient feels very cold, has knee pain and swelling, and Chinese-English dictionary compiled for the China inland mild low back pain. mission and Presbyterian Mission Press, Harvard University Tongue: flat, pale pink, slightly pinker at the tip; coating at Press, Cambridge MA. the rear of the tongue is slightly yellow. • McNeill, W. 1989 Plagues and Peoples, Anchor Press New York. Pulse: slow, overall weak with middle jiao showing more • Nielsen, A. 1995 Gua Sha, A Traditional Technique for Modern strength. Practice, Churchill Livingstone Edinburgh. Treatment • O’Connor, J., Bensky, D. 1981 Acupuncture, a Comprehensive Back: Kunlun BL-60, Weizhong BL-40, Dachangshu BL-25, Text, Eastland Press Seattle. Shenshu BL-23, ahshi (lateral gluteus medius trigger point • Porket, M., Ullman, C. 1982 Chinese Medicine as a Scientific System: its History, Philosophy, and Practice, and How it Fits with for knee). Gua Sha whole back and lateral gluteus medius. the Medicine of the West. Henry Holt, NY. Front: Zusanli ST-36, Xuehai SP-10, ST-34, Xiyan (Extra), • Stedman’s Medical Dictionary, 1987 Williams and Wilkins, medial Wing of Knee (Extra)*. Baltimore MD. Course of treatment: 2 sessions 8 days apart. • Weiger, L. 1965 Chinese Characters: Their Origin, Etymology, Results: After the first session she felt warm all over. Her History, Classification and Signification. A Thorough Study from Chinese Documents, Dover, New York first published 1915. knees were no longer swollen or painful, but weak. 4 months later she asked to be treated again for knee weak- Notes ness. She reported that the sensation of warmth had re- 1. Castiglione, 1941, "Hippocrates’ ...On Airs, Waters and Places mained. ... constitutes the first example known to us of a rational It is satisfying for practitioners to be able to deepen their attempt by a man of genius to put the phenomena of the reach into the body and quicken the process of healing. The macrocosm and the microcosm in direct causal relations ... The first part of the book is a true work on climatology. It considers Hippocratic physician Boerhave had a vision, a sense of the diseases that occur in a given locality in relation to its what petechial counteraction could do. The answer to his climatic position and to the seasons. The second part treats of prayer is Gua Sha and next to needles, it is the most valuable the difference between Europe and Asia and without doubt technique I know. Practitioners or patients interested in constitutes one of the most interesting books that classical learning exactly how and when to use Gua Sha can refer to antiquity has transmitted to us. It is the first attempt to put external causes in direct connection with the origin of diseases, the book below. but also with the constitution of man and with the ethnic characteristics of nations". Quoted in: 2. The Apothecary in Eighteenth-Century Williamsburg, Williamsburg Craft Series, publ: Colonial Williamsburg MCMLXX. *An extra point used by Dr. James So.

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3. Stedman’s 1987 Discutient: Scattering or Dispersing a Pathologic seasons. The second part treats of the difference between Accumulation, refers to early medicine's humoural view. Europe and Asia and without doubt constitutes one of 4. Epps 1832. 5. Ibid. the most interesting books that classical antiquity has 6. Stedmans 1987. transmitted to us. It is the first attempt to put external 7. This approach has survived its humoural context. For exam- causes in direct connection with the origin of diseases, ple, until the mid 1970’s malaria was used to treat syphilis, and but also with the constitution of man and with the ethnic is currently being researched as a treatment for AIDS. The body characteristics of nations. quoted in can also create its own antagonistic condition to a disease as seen in sickle cell trait as defense against malaria. 8. Kluger 1978. 2 The Apothecary in Eighteenth-Century Williamsburg, 9. Epler 1980. Williamsburg Craft Series, publ: Colonial Williamsburg 10. Cautery is like direct moxibustion. Setons and Issues intro- MCMLXX duce a thread or piece of metal posterior to an infection. The 3 Stedman’s 1987 ‘Discutient: Scattering or dispersing a thread or metal is left in place, causing a small surface infection which counters the deeper one. See Nielsen 1995, Brockbank pathologic accumulation.’ refers to early medicines 1954, and O’Connor & Bensky 1981 (threading). humoural view. 11. Kaim 1756. 4 Epps 1832 12. Gilles 1985. 5 Ibid 13. Jackson 1806. 6 14. Mathews 1931, The character for sha has several transla- Stedmans 1987 tions: ‘reddish elevated millet-like skin rash’, (Ou Ming 1988); 7 This approach has survived its humoural context. For Dr.So translated sha as sand or sharkskin. (So, lecture notes example, until the mid 1970’s malaria was used to treat 1976). syphilis, and is currently being researched as a treatment 15. Weiger 1965. for Aids. 16. McNeil 1989. 17. Kluger, 1978. Bloodletting may be therapeutic in cases of The body can also create its own antagonistic condition infection from bacteria. Bacteria are dependent upon trace to a disease as seen in sickle cell trait as defense against amounts of iron for growth. "At elevated temperatures, bacte- malaria. ria appear to be even more sensitive to reduced levels of iron". 18. Porkert 1982 quoting Dr. Arthur Jores. 8 19. Ou Ming 1988. Kluger 1978 20. Epler 1980. 9 Epler 1980 21. Kaim 1756. 10 Cautery is like direct moxibustion. Setons and Issues 22. Jinkue yaolue fanglun, 220 Clause 1-15. introduce a thread or piece of metal posterior to an infection. The thread or metal is left in place, causing a All illustrations and cases are taken from Gua Sha, A Traditional small surface infection which counters the deeper one. Technique for Modern Practice. The book gives details on how to use Gua Sha in clinical practice, includes over 40 cases and gives See Nielsen 1995, Brockbank 1954, and O’Connor & classical point prescriptions used with Gua Sha for treatment of Bensky 1981 (threading) common disorders. The book can be purchased from Customer 11 Kaim 1756 Services, Churchill Livingstone, Robert Stevenson House, 1-3 12 Gilles 1985 Baxter Place, Leith Walk, Edinburgh EH1 3AF, United King- 13 Jackson 1806 dom. Tel: within UK toll free: 0500 556 242, outside UK: 0131- 14 Mathews 1931, 535-1022, Fax: 031-535-1022. The book can be ordered in the US through: Redwing Book Company, 44 Linden Street, Brookline The character for sha has several translations. ‘reddish MA 02146, Tel: 1-800-873-3946; or Churchill Livingstone, 650 elevated millet-like skin rash’, (Ou Ming 1988). Dr.So Avenue of the America’s, New York, NY 10114, Tel: 1-800-553- translated sha as sand or sharkskin. (So, lecture notes 5426. 1976) 15 Weiger 1965 Biography 16 McNeil 1989 Arya Nielsen is National Board Certified in Acupuncture and 17 Kluger 1978 Bloodletting may be therapeutic in cases Chinese Herbal Medicine, a Fellow of the National Academy of of infection from bacteria. Bacteria are dependent upon Acupuncture and Oriental Medicine, and Chair of the New trace amounts of iron for growth. ‘At elevated tempera- York State Board for Acupuncture. She has been in private practice for nearly 20 years and is a Senior Faculty member at tures, bacteria appear to be even more sensitive to the Tri-State Institute of Traditional Chinese Acupuncture in reduced levels of iron.’ New York City. 18 Porket 1982 quoting Dr. Arthur Jores 19 Ou Ming 1988 1 irs, Waters and Places. ..constitutes the first example known 20 Epler 1980 to us of a rational attempt by a man of genius to put the 21 Kaim 1756 phenomena of the marcrocosm and the microcosm in direct 22 Jinkue yaolue fanglun. 220 Clause 1-15 causal relations...The first part of the book is a true work on climatology. It considers the diseases that occur in a given locality in relation to its climatic position and to the