Gua Sha As Counteraction: the Crisis Is the Cure
Total Page：16
File Type：pdf, Size：1020Kb
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 tech- nique 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-analy- sis 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 6 JOURNAL OF CHINESE MEDICINE NUMBER 50 JANUARY 1996 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 an- cient 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.