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Evidence-Based Complementary and Alternative Medicine
Volume 2012, Article ID 490292, 6 pages
doi:10.1155/2012/490292
Research Article
The Effects of Scraping Therapy on Local Temperature and
Blood Perfusion Volume in Healthy Subjects
Qin-Yan Xu, Jin-Sheng Yang, Bing Zhu, Li Yang, Ying-Ying Wang, and Xin-Yan Gao
Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
Correspondence should be addressed to Jin-Sheng Yang, zml@ibucm.com and Bing Zhu, zhubing@mail.cintcm.ac.cn
Received 11 February 2012; Revised 8 March 2012; Accepted 8 March 2012
Academic Editor: Litscher Gerhard
Copyright © 2012 Qin-Yan Xu et al. This is an open access article distributed under the Creative Commons At tribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the or iginal work is properly cited.
Objective. We aim to study the therapeutic effects of scraping by investigating the changes of temperature and local blood perfusion
volume in healthy subjects after scraping stimulation, and to explore the mechanism of scraping stimulation from the points of
microcirculation and energy metabolism. Methods. Twenty-three health subjects were included in this study. Local blood perfusion
volume and body surface temperature was detected at 5 min before scraping stimulation, 0, 15, 30, 60 and 90 min after scraping
using Laser Doppler imager and infrared thermograph. Results. Significant increase was noted in the blood perfusion volume in the
scraping area within 90 minutes compared to the baseline level and non-scraping area (P<0.001). Compared with non-scraping
area, an increase of body temperature with an average of 1
◦
C was observed after s craping stimulation (P<0.01). Conclusion.
Scraping can sig nificantly improve the blood perfusion volume and increase the temperature in the scraping area, promoting the
local blood circulation and energy metabolism.
1. Introduction
Scraping, called Gua Sha in Tr aditional Chinese medicine
(TCM), is one of the unique non-medicinal external thera-
pies of TCM under the guidance of the theory of meridians
and acupoints. It involves using a smooth-edged instrument
for surface frictioning to intentionally raise transitory pete-
chiae and ecchymosis [1, 2]. To date, scraping has shown
pain-relieving effects on myalgia and chronic pain [2–5], and
can improve blood stasis and inflammation [6]. Although
several reports indicated the effects of scraping therapy in
clinical and experimental practices, the mechanism is still not
clear. Recently, Tian et al. reported blood perfusion volume
increased immediately after skin scraping in rabbits using
laser Doppler imager [7]. In this study, we aim to determine
the changes of the local blood perfusion volume and skin
temperature after scraping in healthy subjects.
2. Methods and Materials
2.1. Laser Doppler Imager. PeriScan PIM II Laser Doppler
Perfusion Imager (LDPI; Perimed AB, Jarfalla, Sweden) was
used to measure skin perfusion volume. A low power 670 nm
wavelength was applied. A medium scanning pattern was
used. The image primitive was set as 0.75 mm
× 0.75 mm.
The image size was set at 40 mm
× 40 mm. The apparatus
was connected to a PC computer to obtain the blood flow
images of the body surface. The laser blood flow image and
visual image of the detected areas were measured via LDPI
2.5 Image Software. The blood flow of the body surface was
measured by Doppler frequency shifts which is proportional
to a blood flow-related var iable and is expressed in arbitrary
perfusion unit (PU) [8]. The blood perfusion volume and
the body position at different time points were analyzed after
comparing the laser blood flow images and direct images
demonstrated by the Laser Doppler Perfusion Imager.
2.2. Infrared Thermograph. WP-1 type of infrared thermo-
graph with a temperature resolution of 0.08
◦
C was applied
for thermal images in our study. Based on the infrared ra-
diation photography, the apparatus was connected to a PC
computer to convert thermo energy into temperature. The
distributions and changes of body temperature were displa-
yedascolorfulimages.A3.41versionimageprocessing
software was used to analyze the data obtained from the
images.
2 Evidence-Based Complementary and Alternative Medicine
Table 1: Blood perfusion volume at different time points in scraping area and non-scraping area (PU) , (n = 23, x ± SD).
PU Scraping area (right) Non scraping area (left) P values
Before scraping 0.469 ± 0.103 0.453 ± 0.105 P>0.05
immediately 0.966
± 0.203 0.465 ± 0.089 P<0.001
15 min 0.685
± 0.158 0.483 ± 0.076 P<0.001
30 min 0.586
± 0.075 0.510 ± 0.080 P<0.001
60 min 0.553
± 0.064 0.504 ± 0.061 P<0.001
90 min 0.558
± 0.066 0.514 ± 0.052 P<0.001
2.3. Scraping Stimulation. Scraping stimulation was per-
formed by trained therapists using a buffalo horn scraper
and a skin lubricant (Jinlongkang, Beijing Jinlong Kang Er
Fu Scraping Cupping Research Institute, Beijing, China) to
decrease friction. Scraping was conducted on the erector
spinal muscle above the back spine (from C7-T10) along the
bladder meridian of the right side. The scraping areas is 6-
7 cm in width and 20 cm in length. Infrared thermal images
were collected at scraping area from C7 to T7. Laser Doppler
images were collected in two areas at the scanning centers
of bilateral sides of the back spine (scraping area and non-
scraping area at the opposite side) respectively. The areas
were 4.5 cm lateral to the spinous process of the 4th thoracic
vertebra.
2.4. Subjects. Twenty-three healthy subjects (12 males, 11 fe-
males) aged from 20 to 40 years old were enrolled after phy-
sical examination. Laboratory room temperature were main-
tained at 24
◦
C−27
◦
C without direct sunlight, infrared ra-
diation, and indoor/outdoor ventilation.
2.5. Experimental Procedure. Thesubjectswereseatedina
square stool in the laboratory with their back exposed. Before
collecting the infrared temperature images, the subjects were
needed to stay calm for 15 min to adapt to the room tem-
perature. Infrared temperature images were collected at a sit-
ting position. Then laser Doppler images of both sides of the
selected areas at a prone position. After scraping for 5 min,
both infrared temperature images and the laser Doppler
images of the above a reas mentioned were collected imme-
diately after scraping (0 min), 15 min, 30 min, 60 min, and
90 min after scraping respectively.
2.6. Data Collection. For infrared thermal images, the subject
sat erectly at a distance of 1.5 m to the infrared thermograph.
Then the detected area was determined and fixed with a ca-
libration circle. The thermographic imaging system was in-
put into a PC computer to save the infrared images and ther-
mal images. For laser Doppler imaging, the blood perfusion
volume of the selected scraping area on the right back and sy-
mmetrical non-scraping area on the left side were collected
by laser Doppler imager. The images were processed by LDPI
2.5 imaging software for offline analysis.
2.7. Statistical Analysis. Data were all presented as mean
±
SD. Statistical analysis was performed using SPSS 17.0 Soft-
ware. A Student’s t test was performed for the analysis of
changes of temperature and blood perfusion volume between
pre- and post-scraping, and scraping and non-scraping at
different time points. P<0.05 was considered as statistical
significance.
3. Results
After scraping, all the 23 subjec ts (100%) reported obviously
warm accompanied by slight pain at the scraping area. They
all felt relax and comfort after scraping. It was observed that
the skin became slightly red, and then subcutaneous hyper-
aemia and subcutaneous bloody spots were found in the local
scraping area.
3.1. Changes of Blood Perfusion Volume before and after Scrap-
ing. Significant increase of blood volume was observed in the
scraping area compared with the baseline level. PU values
were 1.0-fold higher compared with the baseline level
(0.966
± 0.203 versus 0.469 ± 0.103, Tab le 1). Significant dif-
ference was noted in the blood perfusion volume within 90
minutes after scraping compared with the non-scraping area.
(P<0.001; Figures 1 and 2, Table 1).
3.2. Changes of the Local Skin Temperature before and after
Scrapin. As is shown by infrared thermograph, the skin tem-
perature of the scraping area increased significantly with the
average temperature increased more than 1
◦
C. Compared
with the skin temperature obtained in the opposite non-
scraping area and the scraping area before stimulation, sig-
nificant increase of skin temperature was observed within 90
minutes after scraping, respectively (P<0.05, Figures 3,and
4, Tabl e 2 ).
3.3. Correlation of Changes of Temperature and Blood Perfu-
sion Volume in the Scraping Area. With regard to the skin
temperature and local blood volume obtained within 90
minutes after scraping, a close correlation was noted between
skin temperature and the local blood volume in the scraping
area (r
= 0.383, P<0.01, Figure 5). Both temperature and
blood flow perfusion values were still higher 90 min after
scraping compared with the baseline level (Tables 1,and2).
4. Discussion
Scraping, called Gua Sha in TCM, is one of the physical stim-
ulating therapies. Previous reports indicated that physical
therapies such as acupuncture, moxibustion, massage, scrap-
ing and cupping basically shared similarities in their func-
tions and mechanisms as they all developed from external
Evidence-Based Complementary and Alternative Medicine 3
Table 2: infrared temperature at different time points in the scraping area and non-scraping area (n = 23, x ± SD),
∗∗
P<0.01.
(
◦
C) Scraping area (right) Non scraping area (left) P values
Before scraping 33.057 ± 1.116 32.989 ± 1.137 P>0.05
Immediately 34.837
± 0.743 33.233 ± 0.851 P<0.001
15 min 34.703
± 0.614 33.633 ± 0.673 P<0.001
30 min 34.343
± 0.855 33.640 ± 0.733 P<0.001
60 min 34.123
± 0.769 33.688 ± 0.674 P<0.001
90 min 34.065
± 0.838 33.771 ± 0.69 P<0.01
The left, control side;
The right, scraping area
a: control; b–f: immediate
moment, 15, 30, 60, and 90 min after
scraping, respectively
(a)
(b)
(c)
(d)
(e)
(f)
(a)
(b)
(c)
(d)
(e)
(f)
Figure 1: Visual image (middle) taken at 5 min after scraping showed that the skin of the scraping area turned apparently red. Laser Doppler
images (left, non-scraping side; right, scraping side) showed the blood perfusion volume. Images (a)–(f) were taken at 5 min before scraping,
0 min, 15 min, 30 min, 60 min and 90 min after scraping stimulation, respectively.
1
0.8
0.6
0.4
0.2
0
Control 0 15 30 60 90
(min)
(PU)
∗
∗
∗
∗
∗
∗
∗
∗
∗
∗
∗
∗
∗
∗
∗
Scraping area
Nonscraping area
Figure 2: Changes of blood perfusion volume in scraping area and
non-scraping area.
∗∗∗
P<0.001, compared with non-scraping area
at the same time point.
stimulating therapies [9]. In the 56th Chapter of Plain Ques-
tions, an ancient works in TCM, it mentioned that “the 12
meridians and collaterals distributed in their relevant cut-
aneous regions”. Zeng (1999) reported that the scraping per-
formed by stimulating the collaterals on the surface of the
body was efficient for the treatment of certain diseases.
Therefore, the author speculated that the efficiency of scrap-
ing therapy is closely related with the function of collaterals
[10]. Though se veral studies reported the effects of scraping
therapy in clinical practices [2–5], its mechanism is still not
well defined. In this study, Laser Doppler imager and infrared
thermograph were used to detect the effects of scraping ther-
apy on local temperature and blood perfusion volume of hu-
man body surface. Macroscopic observations and infrared
images showed apparent changes of the local skin color and
temperature before and after scraping. Furthermore, quan-
titative analysis indicated scr aping could increase the local
microcirculation and metabolism of subcutaneous t issues.
Skin, covering the body surface, contains abundant capi-
llaries functioned as the major organ for temperature regula-
tion and body defense. Under normal conditions, the blood
4 Evidence-Based Complementary and Alternative Medicine
37.3
◦
C
24.5
◦
C
37.3
◦
C
24.5
◦
C
(a)
(b) (c)
(d) (e) (f)
Figure 3: The infrared thermograph images showed the skin temperature of the right body side (scraping) increased significantly after
stimulation. Skin temperature increased in the scraping area and extended onto the opposite side and the neck 15 min after scraping. The
local temperature increase lasted about 1 hour. (a)–(f): image otabined at 5 min before scraping, 0, 15, 30, 60, and 90 min after scraping.
32
33
34
35
(
◦
C)
Control
0 15306090
(min)
Scraping area
Nonscraping area
∗
∗
∗
∗
∗
∗
∗
∗
∗
∗
∗
∗
∗
∗
Figure 4: Changes of temperature in the scraping area and non-
scraping area.
∗∗
P<0.01,
∗∗∗
P<0.001, compared with non-
scraping area at the same time point.
volume of microcirculation is in accordance with the meta-
bolism level of the tissues and organs to keep a dynamic
balance. The capacity and rate of substance exchange of ex-
ternal and internal capillary mainly depended on the open
volume and permeability of the true capillar y. The present
study showed that the the blood flow volume in the scr ap-
ing area significantly increased, especially immediately after
scraping. The values of the blood flow increased 1.0-fold
higher in the scraping area than those of the non-scraping
area (Table 1). Our study is in accordance with the previous
report which indicated that Gua Sha caused a 4.0-fold
1.5
1
0.5
0
30 31 32 3 34 35 36 37
(PU)
(
◦
C)
Figure 5: Correlation analysis between temperature and blood
perfusion volume in the scraping area.
increase in microcirculation PUs at the scraping area for the
first 7.5 minutes together with a significant increase in
surface microcirculation during the entire 25 minutes of the
study period following scraping stimulation (P<0.001) [2].
The obvious increase of blood perfusion volume indicated
that scraping stimulation could reflexively regulate the sym-
pathetic vasodilator nerves to relax the precapillar y sphincter,
increase the local volume of blood flow and the amount of
the opening capillaries directly, and promote local blood cir-
culation. Scraping stimulation was possible to cause partial
subcutaneous bleeding of the capillaries, resulted in hyper-
aemia or blood stasis [7], which can otherwise promote the
metabolism of the tissues and improve local microcirculation
[11–14]. According to the infrared thermograph images, a
significant increase was noted in the scraping area. As is
shown in Ta ble 2,anaverageof1
◦
C was noted after scra ping
Evidence-Based Complementary and Alternative Medicine 5
stimulation. Under normal conditions, temperatures a t both
sides of the body back are nearly the same and sy mmetrical
[15]. Our results also indicated that scraping could lead to a
long-lasting (60 min) increase of temperature in the adjacent
tissues and even further (Figure 3). It could affect these func-
tions of the surrounding tissues. The effects of scraping to an
extended area lies in that it causes more vessel dilation and
increase of blood flow volume in the adjacent tissues as the
cutaneous arteries trunk on the back are interconnected with
each other to form a vessel network [16].
Generally, the blood circulations in human body surface
were stable. Once the pressure and muscle relaxation of
scraping extruded subcutaneous capillary, capillary network
reconstruction and expansion was induced, which resulted
in changes of cutaneous blood volume and skin temperature
[12, 17]. This phenomenon indicated that scraping could
change the subcutaneous micro-vascular pressure, leading to
vascular dilation and increase of local temperature and the
volume of blood flow of the scraping area. Previous study
showed that heat could increase the temperature of the tis-
sues, dilate the capillaries, increase local blood circulation,
promote blood and oxygen supply, and strengthen the me-
tabolism of the local tissues [13]. Based on our results, a strict
correlation was detected between the blood perfusion vol-
ume and skin temperature (r
= 0.383, P<0.01, Figure 5)
Scraping is performed according to the location of acup-
uncture points along meridians [18]. According to the pre-
vious report, thermal conductivity along meridians and be-
neath tissues was more remarkable than other parts of the
body [19]. In addition, a positive correlation between the
therapeutic effects and microcirculatory changes of the suf-
fered areas or relevant points was found [20]. Moreover, a
remarkable increase was noted in microcirculation and blood
perfusion volume after scraping stimulation in the meridian
and points [21]. Our study indicated that the responsive
areas of scraping extended to the bladder meridian on both
sides of the back spine. embodied by mainly by capillary dil-
ation, obvious temperature change and expanded blood per-
fusion volume of the scraping areas. Generally, scraping of a
tolerable intensity is a p ositive stimulation on the skin, and
can helps to increase the metabolism of the local and adj-
acent t issues as well as activate physiological functions of the
body. The increased temperature and microcirculation could
reversely remove the microcirculatory obstruction, especially
for arteriole angiectasis and spasm [ 22 ]. Scraping, stain
stimulation mode, could change the skin color of the local
scraped area and produce warming or even slightly pain.
A v ariety of scraping stimulation performed on body surface
would help to relieve the muscular spasm and improve the
local metabolism of tissues, reduce the tension of blood ves-
sels and nerves, and eliminate or reduce the negative impact
of somatic disorders on visceral functions [23]. Therefore, it
is an effective way for removing the microcirculatory ob-
struction.
In our study, Laser Doppler and infrared thermal imag-
ing techniques were used for the first time for the detection of
the skin temperature and blood volume in healthy subjects.
The effect of scraping therapy was analyzed to clarify the
mechanism of scraping from microcirculation and energ y
metabolism. Our study provided theoretical and clinical
guidances on the research of meridians and collaterals for
further studies. Further s tudies about the effects of the dif-
ferent scraping techniques on pressure changes of subcu-
taneous microcirculatory system, and the influences of scrap-
ing stimulation on meridians and collaterals should be per-
formed in the near future.
Acknowledgments
The scientific investigations were supported by funds from
national program of the “Eleventh Five-Year Plan” from the
Ministr y of Science and Technology (2008BAI53B063) to
J.-S. Yang. Of the two corresponding authors, B. Zhu de-
signed the experiment and J.-S. Yang has founding support to
conduct the study. Q.-Y. Xu performed the experiment, Q.-
Y. Xu and X.-Y. Gao constructed the manuscript and L. Yang
and Y.-Y. Wang do data analysis and figure managing.
References
[1] J. S. Yang, Practitioner of scraping therapy of TCM, China Pub-
lishing House of Traditional Chinese Medicine and Pharma-
cology, Beijng , China, 2011.
[2] A.Nielsen,N.T.M.Knoblauch,G.J.Dobos,A.Michalsen,and
T. J. Kaptchuk, “ The effect of Gua Sha treatment on the mi-
crocirculation of surface tissue: a pilot study in healthy
subjects,” Explore, vol. 3, no. 5, pp. 456–466, 2007.
[3] M.E.Schwickert,F.J.Saha,M.Braun,andG.J.Dobos,“Gua
Sha for migraine in inpatient withdrawal therapy of headache
due to medication overu se,” Forschende Komplementarmedi-
zin, vol. 14, no. 5, pp. 297–300, 2007.
[4] M. Braun, M. Schwickert, A. Nielsen et al., “Effectiveness of
traditional Chinese “gua sha” therapy in patients with chronic
neck pain: a randomized controlled t rial,” Pain Medicine, vol.
12, no. 3, pp. 362–369, 2011.
[5] M. S. Lee, T. Y. Choi, J. I. Kim, and S. M. Choi, “Using Guasha
to treat musculoskeletal pain: a systematic review of controlled
clinical trials,” Chinese Medicine, vol. 5, article no. 5, 2010.
[6] A. Nielsen, “Gua sha research and the language of integrative
medicine,” Journal of Bodywor k and Movement Therapies, vol.
13, no. 1, pp. 63–72, 2009.
[7] Y. Y. Tian, Y. Y. Wang, M. F. Luo et al., “Effects of scraping on
blood perfusion volume and histomorphology of rabbit skin,”
Journal of External Therapies of TCM, vol. 18, no. 6, pp. 8–9,
2009.
[8] D.Zhang,S.Y.Wang,andH.M.Ma,“Observationontheef-
ficacy of acupuncture by laser D oppler imaging techniques,”
Shanghai Journal of Acupuncture and Moxibustion, vol. 23, no.
5, pp. 37–40, 2004.
[9] Y. Y. Wang and J. S. Yang, “Study and prospects for clinical dis-
eases treated with scraping therapy,” Chinese Acupuncture &
Moxibustion, vol. 29, no. 2, pp. 167–171, 2009.
[10] S. J. Zeng, “Preliminary Study on the TCM principles of scrap-
ing therapy along the meridians,” Sichuan Traditional Chinese
Medicine, vol. 17, no. 4, p. 54, 1999.
[11] S. H. Hong, F. Wu, X. Lu, Q. Cai, and Y. Guo, “Study on the
mechanisms of cupping therapy,” Chinese Acupuncture & Mo-
xibustion, no. 31, pp. 932–934, 2011.
[12] X. Y. Liu and Y. N. Lv, “Measurement for skin surface tem-
perature after massage therapy,” Sichuan Traditional Chinese
Medicine, vol. 25, no. 2, pp. 101–103, 2007.
6 Evidence-Based Complementary and Alternative Medicine
[13] Z. H. Guan and J. Xu, “Effects of thermal needling on the nail
fold microcirculation of protrusion of lumbar inter vertebral
disc,” Chinese Acupuncture & Moxibustion, vol. 26, pp. 233–
235, 1996.
[14] L. Zhang, L. T. Tang, X. L. Tong, H. Jia, Z. Y. Zhang, and G. X.
Jiu, “Effect of cupping therapy on local hemoglobin in human
body,” Chinese Acupuncture & Moxibustion, vol. 21, pp. 619–
621, 2001.
[15] H. M. Ma, D. Zhang, S. Y. Li, S. Y. Wang, and Z. B. Sun, “Anal-
ysis on distribution of healthy subjects’ back temperature and
infrared thermal images,” Biomedical Engineering and Clini-
cal Medicine, vol. 10, no. 4, pp. 238–241, 2006.
[16] R. T Yu, X. F. Lou, M. L. Tang, S. H. Jiang, and W. H. Zhou,
“Effects of scraping on vascular anatomy of the back of the
trunk,” Wenzhou Medical College, vol. 38, no. 2, pp. 151–153,
2008.
[17] D. Zhang, H. M. Ma, S. Y. Wang, and S. Y. Li, “Preliminary
study on microcirculatory images of different parts of the body
surface by Laser Doppler imaging techniques,” China Mi-
crocirculation, vol. 8, no. 5, pp. 283–285, 2004.
[18] Y. Y. Wang, W. J. Yi, and W. L. Liu, “Brief introduction to the
functions of points in scraping therapy. Report at 2009 Annual
Conference sponsored by China Association of Acupuncture
and Moxibustion,” Bian stone Forum, pp. 138–139, 2009.
[19] P. M. Qin and J. S. Xu, “Research on the correlation between
meridians and microcirculation,” Henan Traditional Chinese
Medicine, vol. 25, no. 1, pp. 81–83, 2005.
[20] H. Q. Wang, “General introduction to the relationship be-
tween meridians and microcirculation,” Shanghai Journal of
Acupuncture and moxibustion, vol. 15, no. 3, pp. 35–36, 1996.
[21]J.S.Xu,S.X.Zheng,X.H.Pan,X.L.Hu,andZ.Y.Sa,
“Effects of electroacupuncture on microcirculation perfusion
and infrared radiation track of the body surface,” Fujian TCM
College, vol. 20, no. 1, pp. 13–15, 2010.
[22] B. J. Zhu, S. Y. Liang, C. J. Li, L. G. Bi, and S. L. Wang,
“The effects of moxibustion on microcirculation of bulbar
conjunctiva for patients with angina pectoris,” Chinese Acu-
puncture & Moxibustion, vol. 6, no. 5, pp. 19–21, 1986.
[23] H. Y. Fan, J. Y. Cao, A. G. Yang, and J. L. Luo, “C. G. Study
on the mechanism of chronic fatigue syndrome treated by
Plucking technique along the bladder meridian,” Guiyang In-
stitute of Traditional Chinese Medicine, vol. 32, no. 2, pp. 3–5,
2010.
