ArticleLiterature Review

The Effect of Gua Sha Treatment on the Microcirculation of Surface Tissue: A Pilot Study in Healthy Subjects

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Abstract

Gua Sha, therapeutic surface frictioning that intentionally raises transitory petechiae and ecchymosis, is a traditional East Asian healing technique also known as cao gio, coining, scraping, and spooning. There are case reports in Western literature but no studies on the physiological effects of Gua Sha. To study the microcirculatory effects of Gua Sha on the skin and subcutis in humans to elucidate physiological mechanisms responsible for the clinically observed pain-relieving effect of this treatment Laser Doppler imaging (LDI) was used to make sequential measurements of the microcirculation of surface tissue before and after Gua Sha treatment in 11 healthy subjects. The effect of Gua Sha treatment on the microcirculation of surface tissue was expressed as changes from baseline in arbitrary perfusion units (PU). The study was conducted at the Department of Nephrology, Unit of Circulation Research, University Hospital of Essen, Germany. Subjects were volunteers from the nursing and physician staff of the Kliniken Essen. A single Gua Sha treatment was applied to an area of each subject's back. Change in microcirculation was measured in PUs. Change in myalgia was subjectively reported and confirmed by manual palpation. Gua Sha caused a fourfold increase in microcirculation PUs at the treated area for the first 7.5 minutes following treatment and a significant increase in surface microcirculation during the entire 25 minutes of the study period following treatment (P < .001). Females showed significantly higher rates of response than males (P = .003). Each subject experienced immediate decrease in myalgia in both the site treated, in the related distal control site, and in some cases, other distal sites. Pain relief persisted to some extent up to the follow-up visit. There were no adverse reactions. 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. Decrease in myalgia at sites distal to a treated area is not due to distal increase in microcirculation. There is an unidentified pain-relieving biomechanism associated with Gua Sha.

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... 10 However, Gua sha has never been trialed specifically in elderly subjects with cLBP. Based on previous published findings, [11][12][13] we hypothesized that Gua sha would exert anti-inflammatory effect in cLBP by upregulating the cytoprotective enzyme of heme oxygenase-1 (HO-1), 13 and increase the local microcirculation 14 by pressing and stretching of the superficial skin as well as the deep muscles. Such effects were proposed to be associated with pain reduction and improved physical mobility. ...
... The self-rated unidimensional Visual Analog Scale (VAS) consists of a 100-mm horizontal line labeled with "no pain" at score 0 and the "worst pain imaginable" at score 100, where a higher score indicates greater pain intensity. 18,19 The Hong Kong Chinese version Roland-Morris Disability Questionnaire (RMDQ) 20 (11)(12)(13)(14)(15), whereas a cut-off value of 8 was specifically established for the Hong Kong Chinese population that depression is of significant needing clinical attention if score equal to or greater than 8. 23 The Chinese version Pittsburgh Sleep Quality Index (PSQI) 24 consists of 19 items covering seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime sleep efficiency. Scale score ranged 0-21 indicating poorer sleep quality with a higher score. ...
... In Western medicine, superficial heating using hot packs and heat wraps are frequently recommended by general practitioners and physiotherapists for instant pain relief in cLBP 29 via the increase of blood flow in deep muscles. 28,30 Nielsen et al. 14 has also reported the increase of the local microcirculation following the Gua sha treatment. 30 According to the theory of Chinese medicine, increasing the flow of blood and Qi would enhance the movement and physical activities. ...
Article
Objective: To address the challenges for trialing with elderly and the lacking of valid sham/placebo control, a randomized crossover pilot study is designed and its feasibility on elderly subjects is evaluated. Design: A pilot randomized crossover study was conducted with hydrocollator-based hot pack therapy as active control. Pain intensity, physical disability, depression, general health status, and salivary biomarkers were assessed as outcome measures. Results: Despite there was no significant difference observed between any outcome measures attained by the two interventions, several important differences were noted during the one-week follow-up period. The magnitudes of pain reduction (21-25% versus 16-18%) and disability improvement (45-52% versus 39-42%) were greater in the Gua sha-treated group than the hot pack group. Both treatments were shown to improve flexion, extension and bending movements of the lower back, whereas areas of improvement varied between the two interventions. Decreasing trends were observed in both tumor necrosis factor-alpha (TNF-α) and heme-oxygenase-1 (HO-1) levels following Gua sha. However, rebounds of the biomarkers were observed one week following hot pack. Furthermore, in response to Gua sha, the decrease of TNF-α was strongly correlated with the improvement of physical disability, whereas the physical disability was correlated with the VAS pain intensity. Conclusion: It demonstrated a feasible clinical trial protocol for evaluating the effectiveness of Gua sha and other therapeutic modalities. Gua sha may exhibit a more long-lasting anti-inflammatory effect relative to hot pack for pain relief and improved mobility in elderly patients with chronic low back pain.
... If the pain resolves from touch or movement, it is referred to as Qi stasis; if the pain persists or returns to a particular location, it is called Qi and blood stasis. Coining is thought to release "heatiness" or "negative energies" from the body, and is thus used as a therapeutic intervention for pain and pathology manifesting Qi and blood stasis [2,3]. ...
... The salient features of this therapeutic alternative are discussed. Additional inquiry of patients in whom coining therapy is suspected should be performed to exclude other 1 2 etiologies such as bleeding disorders, child or elder abuse, hemostasis altering medications, and trauma [2,3]. ...
... Coining has its origins in several different Asian countries. Each location has its own designated nomenclature ( Table 1) [1,2,4,5]. The term gua sha in Chinese translates to "scraping sand" [1]. ...
Article
Coining therapy is a treatment commonly used in complementary and alternative medicine. The practice has its origins in several different Asian countries. It is used to treat numerous conditions, such as chronic pain, fever, flu, headaches, heatstroke, and upper respiratory infections. Coining is performed by vigorously rubbing a rounded instrument following the application of lubricant to the affected area. Hence, patients who have undergone coining therapy frequently present with macular erythema, petechiae, and/or raised ecchymoses at the sites of treatment. The cutaneous sequelae following treatment with coining on a Vietnamese man are described. Ecchymoses caused by coining usually resolve spontaneously within one to two weeks. While coining is generally regarded as a safe practice, mild or - albeit rarely - more severe complications may occur. Therefore, this procedure is contraindicated in certain patients including those with bleeding disorders, Von Willebrand disease, or those taking antiplatelet or anticoagulant medications. Several randomized-control studies suggest coining to be an effective treatment for chronic neck and lower back pain. Immediate pain relief at the treated site may result from increased circulation; thus, the venting of heat may mitigate the effects of the inflammation and pain. However, much remains to be learned about the mechanisms of longer-term pain relief in coining therapy. The use of complementary and alternative medicine techniques such as coining has increased in the United States; therefore, clinicians' evaluation and management of their patients would benefit from an understanding of the individual's sociocultural practices and health beliefs.
... Gua Sha is an instrument-assisted unidirectional "press-stroking" of a lubricated area of the body surface that intentionally creates transitory therapeutic petechiae. These petechiae, which fade within 2-5 days, result from the extravasation of blood into the subcutis (Nielsen et al., 2007;Braun et al., 2011). While they and their accompanying ecchymosis appear remarkable (Fig. 1), Gua Sha therapy is generally well tolerated, with little or no discomfort. ...
... Several modes of action for Gua Sha are described in the literature. Gua Sha therapy increases surface microperfusion in treated areas by 400% following treatment (Nielsen et al., 2007) and the resulting extravasated blood in the capillary bed is associated with an up-regulation of the heme oxygenase-1 (HO-1) gene expression (Kwong et al., 2009;Chan et al., 2011). This effect, which can be measured directly after treatment, is sustained for a minimum of five days in mouse models (Kwong et al., 2009). ...
Conference Paper
Question Permanent nociceptive influx may lead to functional changes in the nervous system, i.e. hyperalgesia and allodynia occur. These processes are suspected to contribute substantially to the ongoing pain process. Reflex therapies, like the Gua Sha, a traditional Chinese massage technique preferentially used in the treatment of back pain, are supposed to affect the transmission and processing of sensory information on receptor and spinal level [1]. If so one could assume that the Gua Sha massage should not only decrease the pain level itself, but also change sensory thresholds in the affected areas. In order to test this, we applied the Gua Sha massage in patients with chronic back pain and evaluated sensory threshold changes. Methods Thirty patients with chronic back pain (mean age 50.3±10.1 years) were randomized to treatment group (TG) or waiting list control group (WLC). At T1 all patients rated their pain on a 0–10 VAS scale. Baseline sensory testing was then conducted, followed by Gua Sha massage for the TG. Seven days later (T2) sensory testing was repeated and the WLC received Gua Sha. Testing included determination of mechanical detection threshold (MDT), pressure pain threshold (PPT) and vibration detection threshold (VDT) as described in the Quantitative Sensory Testing procedure (QST) by Rolke et al. [2] at the site of maximal pain, 10 cm next to the pain maximum and two control areas. In accordance to the QST procedure MDT and PPT scores were logarithmized. For further analysis, differences between T1 and T2 were compared between TG and WLC. Results First results show a significant decrease in mean pain ratings for the TG compared with the WLC (p<.05). Sensory testing at the control areas served as an estimation of measurement reliability (mean correlation 0.74±0.13). t-Tests revealed no differences for VDT. For MDT and PPT group differences were found 10 cm next to the pain maximum, i.e. MDT and PPT increased in the TG, but not in the WLC (p<.05). No such effect could be observed at the site of maximal pain. Conclusions GuaSha not only decreased pain intensity for 35% on average compared with 4.6% increase in the WLC. TG also showed increased MDT and PPT at 10 cm next to the pain maximum. Together with the steady thresholds in both control areas this can be interpreted as the result of functional changes in the sensitized area. It appears that Gua Sha reduced allodynia in the pain surrounding area.
... Additionally, two papers discuss the increase of blood flow post Gua Sha (11,12) and the expression of HO-1 post Gua Sha has been measured and discussed in two case reports. (13,14) No records related to the treatment of RLS with Gua Sha. ...
... Gua Sha has been shown to increase local microcirculation by 400% in the first 7.5 minutes with a continued significant increase (p<0.001) for 25 minutes post-treatment. (11) Another study has shown an increase in tissue temperature. (12) One paper relating to chronic neck and back pain pointedly discusses the increase in blood flow from the type of mechanical irritation that comes with Gua Sha leading to an increase in oxygenation of tissues and a surge of histamine, potassium ions, prostaglandins, bradykinin and interleukins, which may lead to an immediate reduction in pain. ...
Article
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The patient in this case presented with chronic shoulder pain and was treated with Gua Sha. While a reduction of shoulder pain was the primary objective, the patient reported an unexpected positive outcome which was an improvement of his restless leg syndrome (RLS). The patient received Gua Sha with no other concurrent therapy. To assess pain, range of movement tests were performed before and after each treatment. Gua Sha was applied in unidirectional linear strokes with a steralised porcelain Asian soup spoon, bilaterally to the spine, over the scapulae and right posterior shoulder. Stroking was repeated in lines of 10-15cm until petechiae was fully expressed before moving onto the next area. The same treatment was given each time for a total of 4 treatments. Pre and post treatment visual analogue scales show an immediate reduction in shoulder pain. Additionally the patient noted a marked reduction in RLS which led to better quality sleep. The literature review reveals that Gua Sha has been shown to increase blood flow, tissue temperature and the expression of heme oxygense-1 (HO-1) which has anti-inflammatory and anti-oxidative actions. Not only has HO-1 been shown to remain elevated for at least 120 hours post treatment, the by-products of the catabolism of free heme molecules are carbon monoxide, bilirubin and iron. Carbon monoxide is a vasodilator and iron has been used in the treatment of RLS for decades. In this case, Gua Sha is shown to give immediate reduction in shoulder pain and we suggest that Gua Sha may have applications beyond musculoskeletal cases, including circulatory conditions such as RLS.
... 'Gua Sha' is an East-Asian traditional healing technique, also known as skin scraping, coining or spooning by English speakers 7 . Gua Sha involves repeated unidirectional pressured strokes over lubricated skin with a smooth edged instrument such as a ceramic Chinese spoon, worn coin, honed animal bones, metal cap, or jade tool (Fig. 1A, B) 8,9 . ...
... It intentionally creates transitory petechiae and ecchymoses which can increase microcirculation and immune function of the skin (Fig. 1C). Although there is little place for Gua Sha in evidence-based medicine, it is widely and regularly used in Asia and Asian immigrant communities for immediate relief from pain, stiffness, fever, chills, cough, wheezing, and nausea, as well as for treating many functional internal organ problems 7 ...
Article
Full-text available
Nontuberculous mycobacteria are ubiquitous environmental organisms that are rare pathogens in immunocompetent individuals. However, cutaneous nontuberculous mycobacteria infections have been increasingly associated with invasive procedures, including surgery, liposuction, filler injection, intramuscular injection, mesotherapy, piercing, acupuncture, and cupping therapy. Herein, we report the first case of cutaneous nontuberculous mycobacteria infection caused by the East-Asian traditional treatment 'Gua Sha', also known as scraping, coining or spooning in English. A 35-year-old healthy female presented with widespread, painful skin nodules and pustules on her upper and lower extremities that had developed after Gua Sha treatment for body contouring. Histopathologic examination of the lesions revealed granulomatous inflammation in the dermis and the culture isolates were identified as Mycobacterium massiliense with molecular identification. The patient was successfully treated with intermittent incision and drainage of persistent nodules and oral clarithromycin based on antimicrobial susceptibility testing. We recommend implementation of a standard safety protocol for Gua Sha practitioners to minimize the risk of infection transmission.
... 263 Gua sha increases circulation and temporarily increases temperature in the treated area. 264,265 One study found gua sha increases superficial blood flow by 400% for over seven minutes, which then slowly tapers for over 25 minutes. 264 This increase in circulation could help remove inflammation such as lumbar subcutaneous edema that is often found in those with discogenic radiculopathy and LSS. ...
... 264,265 One study found gua sha increases superficial blood flow by 400% for over seven minutes, which then slowly tapers for over 25 minutes. 264 This increase in circulation could help remove inflammation such as lumbar subcutaneous edema that is often found in those with discogenic radiculopathy and LSS. ...
Chapter
• The treatment of sciatica differs according to its cause • Most cases warrant a trial of conservative treatment • Integrated programs including manual therapies and exercise may be superior to any single therapy • Surgery is indicated in the presence of red flags and/or a lack of response to conservative treatment
... "GUA" means to scrape or rub; "SHA" means petechiae and ecchymosis as well as the feeling of satisfaction. The physiological mechanism of GUASHA in both healthy people and patients is that it increases surface microperfusion [1]. GUASHA has an immune anti-inflammatory effect due to upregulating the heme oxygenase-1 [2], prolonging the endurance time [3], enhancing the amount of white blood cells and neutrophils [4], and reducing muscle pain and chronic fatigue syndrome [5,6]. ...
... The GUASHA therapy is beneficial for health care and treatment because it effectively improves microcirculation [1] and skin temperature [24], and it upregulates heme oxygenase-1 [2] and reduces muscle pain and chronic fatigue syndrome [5,6]. The previous study demonstrated that GUASHA could reduce fatigue [4,6]. ...
Article
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Objectives. This paper aims at exploring the effects of GUASHA on heart rate variability between healthy volunteers under normal condition and weightlifters after training sessions. Methods. Ten healthy male volunteers under normal condition and 15 male weightlifters after weightlifting training sessions were recruited into two groups. Electrocardiography was recorded before and immediately after 20-minute GUASHA. HRV was calculated in both the time domain and the frequency domain. Results. Stress index was reduced, while standard deviation of N-N intervals (SDNN), proportion derived by dividing the number of interval differences of successive N-N intervals greater than 50 ms, and root mean square of successive differences (RMSSD) were enhanced after GUASHA therapy in the two groups. The changes in SDNN and RMSSD were higher in the healthy men group than in the weightlifters group. In addition, low frequency was decreased whereas high frequency was significantly increased in healthy men after the GUASHA session. Conclusions. GUASHA therapy facilitates the parasympathetic nervous activity and modulates the balance between parasympathetic and sympathetic activities in both healthy men under normal condition and weightlifters after training sessions as indicated. Although the changes of the HRV parameters were similar in both groups, the responsiveness was more pronounced in healthy men than in male weightlifters.
... (4) In the literature, it is possible to find researches about treatments of neck pains, low back pains, headaches, increase of blood circulation in the treated area, improvement in mother's breastfeeding by the better breast engorgement, better hormonal control in hyperthyroidism, showing always the best results in comparison to other control groups. (5,6,7,8,9,10,11) Gua Sha's beneficial effects are because of its simultaneous actions on the skin, in the connective tissues, in the lymphatic system, in the muscles, blood vessels and the internal organs. The simple gesture of scraping has effects as great as massages, moxibustion, lymphatic drainage, oxygenic therapies and stimulation of the immunological system. ...
... The simple gesture of scraping has effects as great as massages, moxibustion, lymphatic drainage, oxygenic therapies and stimulation of the immunological system. (5,7,9,12) During the Gua-Sha treatment, a special oil is placed over the body, on the region to be treated. The skin is scraped until it presents light hyperemia. ...
Article
Introduction: The Gua Sha technique is a method from the traditional Chinese medicine (TCM), having its origins in the prehistory, where they had the habit of rubbing their bodies to relieve symptoms of pain. The term “gua” means to scrape, brush, scratch and the term “Sha” has a more complex meaning such as sand or dirt. In China, this technique was and still is very used by the peasants. Gua Sha’s great effects exist by its simultaneous action on the skin, in the connective tissues, in the lymphatic system, in the muscles, blood vessels and the internal organs. Objectives: To verify the Gua Sha technique’s (western view) use in the flexibility recovering of sedentary men. Methodology: This study had as sample three men with average of 28,66+- years, height of 176cm+=9,29, weight of 100,3kgs+-15,05. At first, the study was conducted through the patient’s anamnesis, besides the checking if the patients didn’t have any limitation to perform the evaluation tests. Then, the individuals were submitted to the gua sha technique’s treatment in all their posterior chain, only in one session. Results: After the treatment session using the Gua Sha, the patient’s improvement was notorious. Analyzing the data that shows one gain in about 330 of the lumbar back’s amplitude evaluated by the goniometry and flexibility, through the fingertip-to-floor test, in a short treatment time. In the fingertip-to-floor test, the patients were classified with reduced flexibility, because they stayed more than 10 cm away from the ground, after the technique’s use all patients were classified as having regular flexibility, since they touched the third finger on the floor. Discussion: The Gua Sha technique is very used in the eastern culture for muscular and breathing pains, so this article demonstrates one more accomplishment of the technique, the flexibility gain with satisfactory results, an important factor was the use of only one series obtaining these results, becoming one more technique to add to a combined treatment, aiming the patient’s improvement. Conclusion: This way we conclude that the Gua Sha technique is an excellent tool for the myofascial induction, for the gain of muscular mobility and flexibility of the posterior chain in a short period of treatment time.
... The need for instrumental application for therapeutic purposes dates back to Greek and Roman antiquity when small metal objects found wide application in therapeutic operations. Furthermore, such tools have also been mentioned by traditional Chinese therapists [4,20]. Instruments have often been used to scrape or squeeze the skin as a means of accelerating blood flow to facilitate the supply and delivery of oxygen and blood to the soft tissues [21]. ...
Article
Instrument-assisted soft-tissue mobilization (IASTM) represents a treatment strategy for soft tissue (skin) and musculoskeletal tissue (myofascia). There are different morphologies of these tools that are used by clinicians and manual therapists for the management of scars, fibrotic formations, muscle-joint pain, and movement limitations. The literature demonstrates the effectiveness of IASTMs in different clinical areas. However, the literature does not consider the use of these tools for the protection of the clinician's hands. The main objective of this article is to draw attention to the fact that IASTM can protect clinicians from professional joint injuries of the hands and can likely become a preventive tool for the operator. Further research is needed to fully determine the positive adaptations in operators who use IASTMs compared to those who do not use them.
... This protocol was followed for 2 weeks before the 8-week study began, and 2 weeks after the study was completed. This protocol involved several warm-up trials being carried out at 40% (3 repetitions, 2 sets), 50% (3, 2), 60% (3, 2), 70% (3, 2), 80% (3,2), and 85% (3,3). Measurement of the RPE scale score in each session was used to rate the intensity of the entire workout by each of the participants. ...
Article
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OBJECTIVE To evaluate the effects of Guasha therapy on the rating of perceived exertion (RPE) scale score, and heart rate variability (HRV). METHODS A randomized controlled trial of Guasha (skin scraping) was compared with a sham scraping group and control group. Sixteen sessions within an 8-week period were completed. Sixty-five male weightlifters who had undergone normal weightlifting training for a mean of 5 years before study commencement were recruited. The RPE scale score of “snatch”, “clean and jerk” maneuvers (85% of one-repetition maximum), and HRV were measured before and after the intervention. RESULTS The RPE scale score for snatch, clean and jerk were reduced significantly after intervention in the Guasha group and sham group. However, there was a significant difference in the low frequency (LF) domain and LF/high frequency (HF) ratio (P < 0.05): the LF domain decreased, and the LF/HF ratio decreased. CONCLUSION Guasha could be used to reduce the RPE scale score, and increase the response to HRV. Guasha could be considered as an alternative to some types of recovery from sports training.
... As East Asians migrated to the West, the appearance of Sha from Gua Sha therapy was misinterpreted as 'dermabrasion' and 'burns' by Western doctors and mistaken as signs of abuse/child abuse, then pseudo-abuse. [16,17,20,28,47]. ...
Article
Objective In East Asia, Gua Sha therapy is widely used in patients with perimenopausal syndrome. The goal of this systematic review was to evaluate the available evidence from randomized controlled trials (RCTs) of Gua Sha therapy for the treatment of patients with perimenopausal syndrome. Methods Databases searched from inception until June 2017 included: PubMed, Embase, the Cochrane Central Register of Controlled Trials and four Chinese databases [WanFang Med Database, Chinese BioMedical Database, Chinese WeiPu Database, and the China National Knowledge Infrastructure (CNKI)]. Only the RCTs related to the effects of Gua Sha therapy on perimenopausal syndrome were included in this systematic review. A quantitative analysis of RCTs was employed using RevMan 5.3 software. Study selection, data extraction, and validation were performed by two independent reviewers. Cochrane criteria for risk-of-bias were used to evaluate the methodological quality of the trials. Results A total of 6 RCTs met the inclusion criteria, and most were of low methodological quality. When compared with Western medicine therapy alone, meta-analysis of 5 RCTs indicated favorable statistically significant effects of Gua Sha therapy plus Western medicine on the Kupperman Menopausal Index (KMI) Score [mean difference (MD) = -4.57, 95% confidence interval (CI) (−5.37, −3.77), p < 0.01; heterogeneity: Chi² = 29.57 p < 0.01, I² = 86%]. Moreover, study participants who received Gua Sha therapy plus Western medicine therapy showed significantly greater improvements in serum levels of follicle-stimulating hormone (FSH) [MD = −5.00, 95% CI (−9.60, −0.40), p = 0.03], luteinizing hormone (LH) [MD = −4.00, 95% CI (−7.67, −0.33), p = 0.03], and E2 [MD = −6.60, 95% CI (−12.32, −0.88), p = 0.02] compared to participants in the Western medicine therapy group, with a low heterogeneity (Chi² = 0.12, p = 0.94, I² = 0% in FSH; Chi² = 0.19 p = 0.91, I² = 0% in LH; Chi² = 0.93, p = 0.63, I² = 0% in E2). In addition, the pooled results displayed favorable significant effects of Gua Sha therapy plus the Western medicine therapy on the MENQOL scale when compared with the Western medicine therapy alone [MD = −5.13, 95% CI (−7.45, −2.81), p < 0.01] with low heterogeneity (Chi² = 0.66, p = 0.42, I² = 0%). Conclusion Preliminary evidence supported the hypothesis that Gua Sha therapy effectively improved the treatment efficacy in patients with perimenopausal syndrome. Additional studies will be required to elucidate optimal frequency and dosage of Gua Sha.
... The effect of Gua Sha on immunity may be a synergistic result attributed to the following factors. First, the mechanical press-stroke movement enhances surface microcirculation in the skin tissue and induces the expansion of capillaries, including the blood vessels and lymphatic vasculature (Nielsen et al., 2007). The increased blood and lymphatic flow leads to more rapid substance and cell exchange among blood, interstitial fluid, and lymphatic fluid. ...
Article
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Objective The skin is an important immunological barrier of the body as well as an optimal route for vaccine administration. Gua Sha, which involves press-stroke treatment of the skin, is an effective folk therapy, widely accepted in East Asia, for various symptoms; however, the mechanisms underlying its therapeutic effects have not been clarified. We investigated the influence of Gua Sha on the immunological features of the skin. Methods Gua Sha was performed on BALB/c mice and the effects were evaluated using anatomical, histological, and cytometric methods as well as cytokine determination locally and systemically. The effect on intradermal vaccination was assessed with antigen-specific subtype antibody responses. Results Blood vessel expansion, erythrocyte extravasation, and increased ratios of immune active cells were observed in the skin tissue following the treatment. Pro-inflammatory cytokines were up-regulated, and immunosuppressive cytokines, down-regulated, in the treated and untreated skin and systemic circulation; no obvious variations were detected in case of anti-inflammatory cytokines. Interestingly, intradermal delivery of a model vaccine following Gua Sha induced about three-fold higher IgG titers with a more Th1-biased antibody subtype profile. Conclusion Gua Sha treatment can up-regulate the innate and adaptive immune functions of the skin and boost the response against intradermal antigens. Thus, Gua Sha may serve as a safe, inexpensive, and independent physical adjuvant for intradermal vaccination.
... In ancient Greece and Rome, a small metallic instrument known as a "strigil" was used in bathhouses for therapeutic purposes (Hammer, 2008), and such an instrument has led to today's IASTM. Another origin of IASTM is a traditional Chinese therapy known as "gua sha" (Nielsen et al., 2007). The word "gua sha" refers to the red spot that appears on the skin when an instrument is used to push or scrape the skin, increasing the blood flow to facilitate the supply of blood and oxygen to the soft tissues (Chiu et al., 2010;Hammer, 2008). ...
Article
Full-text available
This article reviews the mechanism and effects of instrument-assisted soft tissue mobilization (IASTM), along with guidelines for its practical application. IASTM refers to a technique that uses instruments to remove scar tissues from injured soft tissues and facilitate healing process through formation of new extracellular matrix proteins such as collagen. Recently, frequent use of this instrument has increased in the fields of sports rehabilitation and athlete training. Some experimental studies and case reports have reported that IASTM can significantly improve soft tissue function and range of motion following sports injury, while also reducing pain. Based on the previous studies, it is thought that IASTM can help shorten the rehabilitation period and time to return to sports among athletes and ordinary people who have suffered sports injuries. However, few experimental studies of the mechanisms and effects of IASTM have examined, while case reports have accounted for the majority of articles. In the future, the scientific basis of IASTM and its reliability should be provided through well-designed experimental studies on humans. Moreover, IASTM studies that have mostly focused on tendons need to broaden their scope toward other soft tissues such as muscles and ligaments.
... 4 It was shown from the result that SD rats can be selected as experimental subjects for observation of histomorphological changes after Guasha. Studies on Guasha at home and abroad study in recent years mainly focus on the biochemical index of blood, skin microcirculation, and etc., [5][6][7][8][9] but pay less attention to morphology and conjunction with morphological methods. According to HE staining, we could observe the infrastructure changes in skin tissues in Guasha area before and after Guasha at different time points, especially hair follicle, glands and stratification of skin. ...
Article
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OBJECTIVE To reveal the effects of Guasha (scraping therapy) on the histomorphology of scraped skins and on the expressions of calcitonin gene-related peptide (CGRP) and substance P (SP). METHODS 50 rats, as experimental subjects, were randomly divided into 5 groups according to different observation time points. Dorsal setae were shaved for the exposure of skin on both sides of the spine. Even reinforcing and reducing method was applied to the rats in Guasha groups on the site equivalent to bladder meridian of human body on one side of the spine, and the skin was scraped from top to bottom until rash of measles occurred. The skin tissues with rash of measles were taken down after perfusion. The corresponding sites of rats in group A were also taken down as control. The tissues were made to sections and used for immunofluorescence histochemical staining and HE staining of antibodies such as SP and CGRP. RESULTS After Guasha, there were significant differences in appearance, hair follicle and blood vessel on local skin scraped on the back of rats when compared with control; In different time points, the differences reduced. There was no significant difference in expression of CGRP and SP when compared local skin scraped on the back of rats in different time points. CONCLUSION Guasha didn't significantly change the morphology of nerve fibers inside local skin, and the histomorphology of hair follicle, blood vessel and etc. However, after Guasha they basically returned to normal level within five days.
... The systemic effect of the massage is connected with the haemangiectasia and enlargement of blood flow in all tissues and organs of the organism, what translates into effort tolerance of the organism [4,5]. Externally observable effect of the massage should be heating of tissues, as the result of mentioned enlarged flow of blood [6]. The qualification of best massage in the range of power, duration or techniques can be the potential problem. ...
Article
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Introduction. Thermography is a one of new non-invasive method using to assess the impact of physiotherapeutic treatment for the human body. Aim of Study. The purpose of this study was the qualification of dependence between application of classical massage of hand and forearm and the temperature of muscles surface of the upper limb and the strength of hand and the range of motion in radio-carpal joint. Material and Methods. The research embraced 12 men aged 19-23 years. The Flir A325 camera was used for thermal imaging. The measurement of hand strength was made by means of analog dynamometer, and the range of motion in radio-carpal joint – was measured with the goniometer. All tests and measurements were performed twice – directly before and after the massage of hand and forearm (the right limb). Classical massage was performed on the dorsal and palmar surface of the hand and on front and back of the forearm. Results. After the massage the superficial temperature of massaged (studied) limb significantly rose. There was also noted some essential difference of temperature of the back surface of the limb not being massaged (control). One did not, however, observe any differences of temperature of the front surface of the left forearm and shoulder. The broadening of the range of motion in radio-carpal joint of the right limb (in all surfaces) was shown. There were no characteristic differences in the hand strength measured with the dynamometer before and after applied massage. Conclusions. The classical massage, though it increases the temperature of muscles and affects the enlargement of effort tolerance, is not a sufficient means for preparation to physical effort. Due to massage, the range of motion in the joint of massaged limb broadened, therefore, the effect of applied treatment is mostly loosening.
... Physically, microcirculation of the scraping surface was shown to be enhanced by gua sha through increasing the local temperature and blood perfusion. 2,3 The occurrence of skin sha blemishing following gua sha implicates the destruction of erythrocytes that releases multiple haemoglobin products to stimulate the expression of stressinducible heme oxygenase-1 (HO-1). The up-regulation of HO-1 gene expression in response to gua sha has been demonstrated in HO-1-luciferase transgenic mice using bioluminescent optical imaging technique. ...
Article
To conduct a community-based survey to describe the demographics, experience, and utilization variables among the users of gua sha living in Hong Kong. A total of 3209 adult respondents were surveyed by using a short Chinese questionnaire. Gua sha was found to have a one-year prevalence of 22.7% and four-week prevalence of 6.6%. The users were seen to be old of age and less educated. The majority believed that gua sha is beneficial to health, practiced in non-regular basis, and mainly employed for treating illnesses. For both male and female, the top two common illnesses to be treated were the respiratory and pain problems, which accounting for 74% of all users. Other illnesses included nervousness, heat stroke, fever, infection, dizziness, diarrhoea and vomiting, oedema, and constipation. As practiced by most respondents, unidirectional pressured stroking was applied repeatedly on the lubricated skin surface at the back region using various smooth-edged tools typically spoons. Almost all users reported the occurrence of skin blemishing and subsequently faded within 7 days after the gua sha treatment. The general population of Hong Kong was found to have high prevalence of gua sha usage. The utilization characteristics as reported by the users were generally aligned with the current scientific knowledge, in particular the treatment procedures and response. Copyright © 2014 Elsevier Ltd. All rights reserved.
... Acupuncture therapy displayed the effects of increasing speed-strength ability, reducing blood urea, and relieving acute muscular fatigue after training. [28][29][30][31] The scraping therapy is beneficial for health care because it effectively improves microcirculation, 8 and up-regulates heme oxygenase-1. 32 However, to our knowledge, the effects of scraping therapy on the athlete training has never been studied before. ...
Article
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Objective To verify the effects of scraping therapy on the weightlifting ability by measuring the subjective sensation, and changes of biomarkers. Methods Five students, who have been trained for 3 years in a sport school in China were participated in this study. A course of scraping therapy was applied to intervene during the normal 7-week of weightlifting training programme. The ability of weightlifting, the scale of rating perceived exertion and serum biochemical markers were measured before and after the intervention. Results Scraping therapy caused a significant increase in weightlifting ability (P<0.05). The level of rating perceived exertion remained stable with the increase in the training volume. Immuno-globulin A was significantly increased (P<0.05), and creatine kinase and blood urea nitrogen were significantly decreased (P<0.05). No significant changes were observed in white blood cell, neutrophil, and testosterone. Conclusion Scraping therapy may facilitate weightlifting ability mainly by decreasing weight sensation and improving serum biochemical parameters.
... The mechanisms of action of Gua Sha are still under debate. It has been demonstrated that Gua Sha treatment increases surface microperfusion in the treated areas by 400% [38] and that the resulting extravasated blood in the capillary bed is associated with an up-regulation of the heme oxygenase-1 (HO-1) gene expression [39,40]. In a mouse model, this immediate effect is sustained for at least five days [39]. ...
Article
Objective: To test the efficacy of Gua Sha therapy in patients with chronic low back pain. Methods: 50 patients with chronic low back pain (78% female, 49.7 ± 10.0 years) were randomized to two Gua Sha treatments (n = 25) or waitlist control (n = 25). Primary outcome was current pain intensity (100-mm visual analog scale); secondary outcome measures included function (Oswestry Disability Index), pain on movement (Pain on Movement Questionnaire), perceived change in health status, pressure pain threshold, mechanical detection threshold, and vibration detection threshold. Results: After treatment, patients in the Gua Sha group reported lower pain intensity (p < 0.001) and better overall health status (p = 0.002) compared to the waitlist group. No further group differences were found. No serious adverse events occurred. Conclusions: Gua Sha appears to be an acceptable, safe, and effective treatment for patients with chronic low back pain. Further rigorous studies are needed to confirm and extend these results.
... MTrP's may develop anywhere in the body as a response to overload, injury or repetitive microtrauma (Nice et al., 1992). Various studies have shown that MTrP's were the primary source of pain in 30%e85% of patients presenting in a primary care or pain clinic because of pain (Fishbain et al., 1986;Fricton et al., 1985;Gerwin, 1995;Nielsen et al., 2007;Skootsky et al., 1989). MTrP's were the primary source of pain in 74% of 96 patients with musculoskeletal pain seen by a neurologist in a community pain medical center (Gerwin, 1995). ...
Article
Background Myofascial trigger points (MTrP’s) are a primary source of pain in patients with musculoskeletal disorders. Nevertheless, they are frequently underdiagnosed. Reliable MTrP palpation is the necessary for their diagnosis and treatment. The few studies that have looked for intra-tester reliability of MTrPs detection in upper body, provide preliminary evidence that MTrP palpation is reliable. Reliability tests for MTrP palpation on the lower limb have not yet been performed. Objective To evaluate inter- and intra-tester reliability of MTrP recognition in hip and thigh muscles. Design Reliability study. Subjects 21 patients (15 males and 6 females, mean age 21.1 years) referred to the physical therapy clinic, 10 with knee or hip pain and 11 with pain in an upper limb, low back, shin or ankle. Methods Two experienced physical therapists performed the examinations, blinded to the subjects’ identity, medical condition and results of the previous MTrP evaluation. Each subject was evaluated four times, twice by each examiner in a random order. Dichotomous findings included a palpable taut band, tenderness, referred pain, and relevance of referred pain to patient’s complaint. Based on these, diagnosis of latent MTrP’s or active MTrP’s was established. The evaluation was performed on both legs and included a total of 16 locations in the following muscles: rectus femoris (proximal), vastus medialis (middle and distal), vastus lateralis (middle and distal) and gluteus medius (anterior, posterior and distal). Results Inter- and intra-tester reliability (Cohen’s kappa (κ)) values for single sites ranged from -0.25 to 0.77. Median intra-tester reliability was 0.45 and 0.46 for latent and active MTrP’s, and median inter-tester reliability was 0.51 and 0.64 for latent and active MTrPs, respectively. The examination of the distal vastus medialis was most reliable for latent and active MTrP’s (intra-tester k=0.27-0.77, inter-tester k=0.77 and intra-tester k=0.53-0.72, inter-tester k=0.72, correspondingly). Conclusions Inter- and intra-tester reliability of active and latent MTrP evaluation was moderate to substantial. Palpation evaluation can be used for clinical diagnosis of MTrP’s in the hip and thigh muscles. Significance This study provides evidence that MTrP palpation is a moderately reliable diagnostic tool in the hip and thigh muscles and can be used in clinical practice and research
... The theory of Traditional Chinese Medicine (TCM) believes Gua Sha is responsible for opening Couli (striae of the skin and muscles), promoting the flow of Qi and blood, dredging meridians and removing pathogenic toxin. Clinical trials and experimental studies have demonstrated that Gua Sha could alleviate pains, 12,13 stimulate an unidentified pain-relieving biochemical pathway 14 and modulate cytokines. 15 However, the clinical significance and biomechanism of Gua Sha have not been empirically established. ...
Article
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OBJECTIVE To investigate the analgesic effect of Gua Sha and its underlying mechanism in rats with noncompressive lumbar disk herniation induced by autologous nucleus pulposus. METHODS A rat model of noncompressive lumbar disk herniation was established and rats were randomly divided into model group, sham group, and Gua Sha group (24 in each group). Gua Sha was performed from the 5th day after the surgery, once every other day, 3 times for a course of treatment, and totally 3 courses. The thermal withdrawal latency was evaluated using the intelligent hot plate one day before the surgery, and on days 4 (the day before the treatment), 10 (the end of the first course), 16 (the end of the second course) and 22 (the end of the third course). On days 4, 10, 16 and 22, six rats in each group were picked randomly and their blood samples were drawn to assess the expression of interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). RESULTS Compared to rats in the sham group, the application of nucleus pulposus to right L5 dorsal root ganglion induced prolonged thermal hyperalgesia, and up-regulated the expression of IL-1β, IL-6 and TNF-α in serum (P < 0.01). The therapy of Gua Sha attenuated thermal hyperalgesia potently, inhibited the expression of IL-1β, IL-6 and TNF-α in a time-dependent manner (P < 0.01). There were no significant differences in the thermal withdrawal latency and the expression of inflammatory cytokines between the sham and Gua Sha groups at the end of the treatment (P > 0.01). CONCLUSION The current study showed that Gua Sha might alleviate thermal hyperalgesia in rats with lumbar disc herniation induced by autologous nucleus pulposus via inhibiting the expression of proinflammatory cytokins.
... This kind of therapy is supposed to increase range of motion and functionality because of improved blood flow accompanied by increased tissue temperature, pain reduction as well as generated pressure, tensile, and shear forces. However, the underlying mechanisms behind these processes are still unknown, but increased microcirculation and altered expression of cytokines in the ground substance, particularly growth factors and inflammatory mediators that enhance regeneration and wound healing, are discussed [21,[30][31][32]. ...
Article
Full-text available
Background: Myofascial (self-)treatments, such as foam rollers to therapeutic instruments in manual therapy, are utilized increasingly in prevention and therapy in healthy people, athletes, and patients suffering from chronic back pain. However, there is limited knowledge about the effectiveness of treatment and the underlying mechanisms of myofascial therapies, especially for instrument-assisted manual therapy (IAMT). Therefore, this pilot study will investigate the feasibility and impact of IAMT for the lumbar area compared with heat application and placebo treatment as a basis for calculating the sample size for further full studies. The primary outcomes will be a critical analysis of the feasibility of the measurement protocol in terms of time economy and expressiveness and of the short- and long-term effects on shear motion of the single tissue layers of the lower back obtained through ultrasound imaging. Secondary outcomes will include thickness and compressibility of the lumbar structures and flexibility of the dorsal structures, indentometry, and superficial skin temperature. Methods: A minimum of 60 healthy, competitive 15-35-year-old female soccer players will be recruited and randomised into three groups. Short-term effects of IAMT on thoracolumbar structures will be compared with heat application and pressure-less placebo treatment. Long-term effects in the IAMT group will be tested after nine further interventions over a 5-week period (2×/week) and compared with the placebo group, which will not receive further treatments but will serve as a control. Intermediate and final testing of both groups will occur in weeks three and five. Discussion: This pilot study will assess the feasibility and the impact of IAMT for the lower back particularly by examining the structural and functional properties of myofascial tissue using diagnostic ultrasound. These outcomes could evaluate the feasibility of the measurements used, shall build a basis for sample size calculation of further full studies, and might generate a greater understanding of myofascial therapies, especially IAMT, for the lower back and its benefits. If this approach proves to be practicable, next steps will be further full studies with soccer players, other sports, and patients with low back pain. Trial registration: German Clinical Trials Register (DRKS00012252) 20.06.2018; retrospectively registered.
... It is often used to treat nuchal pain, shoulder tension, myalgia, chronic pain, and other muscle issues. [4] Traditional healings were often embedded in the culture in which they were practiced. Gua Sha involves scraping the body surface with a tool (e.g. a buffalo horn scrape) with or without a skin lubricant to intentionally create petechiae, which is traditionally called Sha and can be loosely translated as stagnant blood. ...
Article
Full-text available
Gua sha is a traditional healing technique that aims to create petechiae on the skin for a believed therapeutic benefit. Natural healings are mostly based on repeated observations and anecdotal information. Hypothetical model for healing does not always fit the modern understanding. Yet, the mechanisms underlying Gua Sha have not been empirically established. Contemporary scientific research can now explain some events of traditional therapies that were once a mystery. It is assumed that Gua Sha therapy can serve as a mechanical signal to enhance the immune surveillance function of the skin during the natural resolving of the petechiae, through which scraping may result in therapeutic benefits. The current review, without judging the past hypothetical model, attempts to interpret the experience of the ancient healings in terms of contemporary views and concepts.
... 11,19,27 Consequently, functionality and pain improvement could be explained by this hypothesis. However, although these muscle properties have already been studied in other instrumental techniques for mobilizing soft tissues, such as gua-sha, 28,29 the Grastron technique 30,31 or Astym technique 32 its effects have not been studied on diacutaneous fibrolysis yet. ...
Article
Objective To assess the effectiveness of diacutaneous fibrolysis in reducing musculoskeletal disorders symptoms such as pain, range of motion and functionality. Data sources A systematic review of MEDLINE, Cochrane, PEDro and Science Direct was conducted until September 2020. Review methods Computerized search strategy was performed to identify randomized controlled trials applying diacutaneous fibrolysis, on subjects with musculoskeletal disorders. Eligible articles and data extraction were conducted independently by two reviewers. Methodology quality and risk of bias were assessed by Risk of Bias 2 tool from the Cochrane Collaboration and Physiotherapy Evidence Database. Outcomes assessed were pain intensity, range of motion and functionality. Results Search strategy identified 98 potential randomized control trials and six studies involving 386 participants, were finally included. Diacutaneous fibrolysis intervention added to usual physiotherapy treatment was compared to control group. Pain intensity immediately after treatment showed a pooled Standard Mean Difference (SMD) of –0.58 with 95% confidence interval (CI) from –1.12 to –0.04, and in the longest follow-up SMD was –0.63 with 95% CI (–1.21 to –0.05). Functionality showed a pooled SMD of –1.02 with 95% CI (–1.67 to –0.36) immediately after intervention and a SMD of –0.84 with 95% CI (–1.54 to –0.14). Range of motion could not be included in the quantitative synthesis. Conclusion Diacutaneous fibrolysis is an effective treatment, when combined with conventional physiotheraphy, reducing pain immediately after treatment and long term follow-up and improving function in both, short and long term in musculoskeletal disorders.
... Original edition, 350 BC. 150. Arya Nielsen et al. (2007). "The effect of gua sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects." ...
Article
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Global health champions modernism and biomedical knowledge but tends to neglect knowledge, beliefs and identities of rural communities in low-income and middle-income countries. The topic of antimicrobial resistance represents these common challenges, wherein the growing emphasis on public engagement offers a yet underdeveloped opportunity to generate perspectives and forms of knowledge that are not typically incorporated into research and policy. The medical humanities as an interdisciplinary approach to illness and health behaviour play a central role in cultivating this potential—in particular, through the field’s emphasis on phenomenological and intersubjective approaches to knowledge generation and its interest in dialogue between medicine, the humanities and the broader public. We present a case study of public engagement that incorporates three medical humanities methods: participatory co-production, photographic storytelling and dialogue between researchers and the public. Situated in the context of northern Thailand, we explore subcases on co-production workshops with villagers, tales of treatment shared by traditional healers and dialogue surrounding artistic display in an international photo exhibition. Our starting assumption for the case study analysis was that co-produced local inputs can (and should) broaden the understanding of the sociocultural context of antimicrobial resistance. Our case study illustrates the potential of medical humanities methods in public engagement to foreground cultural knowledge, personal experience and ‘lay’ sensemaking surrounding health systems and healing (including medicine use). Among others, the engagement activities enabled us to formulate and test locally grounded hypotheses, gain new insights into the social configuration of treatment seeking and reflect on the relationship between traditional healing and modern medicine in the context of antimicrobial resistance. We conclude that medical-humanities-informed forms of public engagement should become a standard component of global health research, but they require extensive evaluation to assess benefits and risks comprehensively.
... When the skin does not rapidly return to its normal color this is thought to indicate poor blood flow. 30 This sign is called blood stasis or sha stasis in the gua sha literature, and is Figure 116: Lyme and disc lesions. This 49-year-old woman presented with chronic aching pain in the low back, and R gluteal region, and thigh. ...
Chapter
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• Combinations of tests help rule the spine and nerve root involvement in or out • Deficits are more pronounced in those with radicular sciatica compared to extraspinal or myofascial sciatica • Red flag signs may prompt urgent or emergent referral
... Previous studies have thoroughly shown that Gua Sha therapy produces effects related to the physiological state in humans or rats. 17,21,32,33 Gua Sha therapy stimulates a change in conduction velocity due to different fibers having different conduction velocities, 20, 34 and facilitates parasympathetic nervous activity and modulates the balance between parasympathetic and sympathetic activity by changes in heart rate variability parameters. 3 Therefore, a reduction in RPE values may have resulted from the increasing function and skills of subjects due to Gua Sha intervention. ...
Article
Objective: To evaluate the effect of Gua Sha therapy on weightlifting training. Methods: The sample size was calculated by conducting a pilot study. A total of 44 male weightlifters were randomly assigned to either the Gua Sha group (n = 15), sham scraping group (n = 14), or control group (n = 14). The participants in the Gua Sha group and sham scraping group received 16 sessions of Gua Sha therapy during normal weightlifting training for 8 weeks. No treatment was applied to participants in the control group. The effectiveness of Gua Sha therapy was evaluated by measuring weightlifting ability, the rating of perceived exertion (RPE) of snatch and clean and jerk (85% of 1 repetition maximum), and creatinine kinase (CK), blood urea nitrogen (BUN), and immunoglobulin A levels. Results: Gua Sha therapy treatment significantly increased weightlifting ability in participants in the Gua Sha group (P < 0.01). The RPE values of snatch and clean and jerk were significantly lower in the Gua Sha group and sham scraping groups compared with the control group (P < 0.05). CK levels were lower and immunoglobulin A levels were significantly higher in the Gua Sha group compared with sham scraping group and control group (both P < 0.05). BUN levels tended to be reduced only in the Gua Sha group. A close correlation between CK levels and the RPE was found in the Gua Sha group. Conclusion: Gua Sha therapy can facilitate weightlifting ability, reduce the RPE, and inhibit muscle injury by promoting recovery from fatigue caused by normal weightlifting training. Gua Sha therapy could be an effective treatment to complement normal weightlifting training.
... A C C E P T E D ACCEPTED MANUSCRIPT 12 However, the possible mechanisms of how Gua Sha therapy exerts positive effects on different disease conditions are under ongoing investigations. According to preclinical studies, Gua Sha is shown to increase microperfusion [17], produce an antiinflammatory and an immune protective effect due to up-regulating the heme oxygenase-1 (HO-1) [18,19], which has both cytoprotective and anti-nociceptive effects [20,21], as well as anti-inflammatory and immunoregulatory properties [20][21][22]. Based on these animal study findings, it could be inferred that Gua Sha can reduce DPN symptoms, which is attributable to an antinociceptive and antiinflammatory effect via HO-1 gene up-regulation. ...
Article
Objective: To examine the effect of Gua Sha therapy in the treatment of diabetic peripheral neuropathy (DNP). Design: An open-label randomized controlled study was conducted with usual care as the control (60 subjects in Gua Sha group and 59 subjects in usual care group). Outcome measures included Toronto Clinical Scoring System (TCSS), Vibration Perception Threshold (VPT), Ankle Brachial Index (ABI), and fasting plasma glucose (FPG). There were 12 consecutive sessions of Gua Sha, one session per week. Results: After the first cycle of Gua Sha intervention, only performance of sensory function measured by the VPT, and peripheral artery disease symptoms by the ABI were statistically significant differences between the two groups (both P values < 0.01), and the total TCSS score and the FPG level were no group differences (P = 0.14, and 0.25, respectively). At the eight-week and 12-week post intervention assessment, Gua Sha therapy significantly reduced severity of neuropathy symptoms, improved performance of sensory function, reduced peripheral artery disease, and better controlled plasma glucose by comparing with the control group (all P values < 0.01). The changes of mean scores of TCSS, VPT, ABI and the plasma glucose levels in the Gua Sha group showed a significant change from baseline to week 12, indicating that Gua Sha therapy induced progressive improvement in the management of DPN symptoms, sensory function, peripheral artery disease and glucose levels. No serious adverse events were reported in either arm. Gua Sha therapy in this study was effective, safe and well tolerated by patients. Conclusion: Gua Sha therapy appears to be effective at reducing the severity of DPN in a clinically relevant dimension, and at improving other health outcomes in patients with DPN. While this study found that Gua Sha therapy is a promising treatment in reducing the symptoms of patients with DPN, further, larger sample studies are required to confirm the effects of Gua Sha therapy in patients with DPN.
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To explore factors influencing the curative effect of scraping therapies (at acupoints or along channels) and to determine the relationship of scraping site and strength to curative effect. Two hundred and ten patients with lumbar muscle strain were divided into five groups with 42 patients each. The "scraping therapy at acupoint until appearance of skin eruptions" and "scraping therapy along channel until apperance of skin eruptions" groups were treated with a 4-day course. The "scraping therapy at acupoint without appearance of skin eruptions", "scraping therapy along channel without appearance of skin eruptions", and acupuncture groups were treated with a 2-day course. The five groups were treated with seven courses. The visual analog scale (VAS), oswestry disability index (ODI), and lumbago scores were recorded in the five groups before treatment, after each treatment, and in follow-up visits one month and three months after treatment. VAS, ODI, and lumbago scores after treat ment improved in the five groups (P < 0.01). There was a statistical difference (P < 0.01) in the change of VAS scores by appearance of skin eruptions and scraping site. Scraping therapy can effectively alleviate lumbago symptoms. The appearance of skin eruptions and scraping therapy along channels can enhance the curative effect of scraping therapy.
Article
Gua Sha is a traditional Asian medicine with different names in many Asian countries. It is a treatment to scrape the petechiae of the skin with ointment. It has generally been administered to patients with upper respiratory infections, heat syndrome, and pain. Herein, we report the case of a 31-year-old Cambodian man who was found dead at a farm accommodation. During the autopsy, multiple linear intradermal hemorrhages without subcutaneous damage were observed in the upper chest and both shoulders. The cause of death was sudden unexpected nocturnal death syndrome because he was a young Asian man who died while sleeping without specific findings. Since it is an unfamiliar traditional medicine in Korea compared to other Asian countries, forensic officers without background knowledge about Gua Sha initially suspected that he was severely assaulted or pressed against a particular object enough to cause crush asphyxia. Because of the difficulty of going to the hospital during the coronavirus disease 2019 pandemic, Gua Sha was used to treat headaches and mild fever. Therefore, this case shows that understanding the culture of other countries could be helpful for investigations especially with the increase of multicultural families in Korea.
Article
The purpose of this case study was to raise awareness among forensic pathologists and medicolegal death investigators regarding two unique socioethnic practices and regional customs that have significant forensic implications. We present two cases involving coining (gua sha) and bloodletting (sapi) that represent two forms of traditional customs that involve the use of blunt force and sharp force trauma, respectively. In coining, the skin lesions are produced as a result of dermabrasion with oils and oval objects such as coin. In sapi, multiple superficial linear scrapes are made in the skin as part of a bloodletting ceremony. The identification of these lesions will prevent the interpretation of them as non-voluntary-inflicted trauma.
Article
Objective: Gua Sha and Blood-letting at the acupoints were Chinese traditional therapies for heatstroke. The purpose of present study was to assess the therapeutic effect of Gua Sha on the DU Meridian and Bladder Meridian combined with Blood-letting acupoints at Shixuan (EX-UE 11) and Weizhong (BL 40) on heatstroke. Methods: Anesthetized rats, immediately after the onset of heatstroke, were divided into four major groups: Gua Sha group, Blood-letting group, Gua Sha combined with Blood-letting group and model group. They were exposed to ambient temperature of 43 °C to induce heatstroke. Another group of rats were exposed to room temperature (26 °C) and used as normal control group. Their survival times were measured. In addition, their physiological and biochemical parameters were continuously monitored. Results: When rats underwent heatstroke, their survival time values were found to be 21-25 min. Treatment of Gua Sha combined with Bloodletting greatly improved the survival time (230±22 min) during heatstroke. All heatstoke animals displayed and activated coagulation evidenced by increased prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer, and decreased platelet count, protein C. Furthermore, the animals displayed systemic inflammation evidenced by increased the serum levels of cytokines interleukin-1ß (IL-1ß), tumor necrosis factor α (TNF-α) and malondialdehyde (MDA). Biochemical markers evidenced by cellular ischemia and injury/dysfunction included increased plasma levels of blood urea nitrogen (BUN), creatinine, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and alkaline phosphatase (ALP) were all elevated during heatstroke. Core temperatures (Tco) were also increased during heatstroke. In contrast, the values of mean arterial pressure were signifificantly lower during heatstroke. These heatstroke reactions were all signifificantly suppressed by treatment of Gua Sha and Blood-letting, especially the combination therapy. Conclusion: Gua Sha combined with Blood-letting after heatstroke may improve survival by ameliorating systemic inflflammation, hypercoagulable state, and tissue ischemia and injury in multiple organs.
Article
Naturopathic reflex therapies such as massage, Gua Sha massage, cupping, wet packs etc. are likely able to influence chronic pain at different levels of the nociceptive system. Since naturopathic reflex therapies have been shown to reduce symptoms of chronic pain and often utilize intense manipulation of the environment of the nociceptor (e.g. Gua Sha massage or cupping), it can be hypothesized that they unfold part of their effect at the level of the peripheral nociceptor and the spinal cord. However, these hypotheses have to date not been tested systematically. Standardized sensory testing, e.g., as performed by 'quantitative sensory testing' (QST), a comprehensive battery of tests for clinical trials, may offer additional information about the mechanisms of naturopathic reflex therapies since it provides a measure for the mechanisms of nociceptive pain on all levels of the pain processing system. This method paper describes the potential role of QST in research on the neurobiological mechanisms of naturopathic reflex therapies. © 2013 S. Karger GmbH, Freiburg.
Article
Laser Doppler flowmetry (LDF) is commonly used in combination with reactivity tests to noninvasively evaluate skin sympathetic nerve activity and skin microvascular function. In manual medicine research, LDF has been used as a marker for global peripheral sympathetic nervous system function, but these results should be considered with caution because skin sympathetic nerve activity physiology is often overlooked. Another limitation of LDF in manual medicine research is the processing of LDF recordings. Two methods have been suggested: the time-domain analysis and the frequency-domain analysis. Standardization is required for data collection and processing in either domain to accurately interpret these changes in skin blood flow that occur after manual procedures. For physiologic studies using LDF, the authors recommend the use of noninvasive reactivity tests (positive controls) to evaluate the different mechanisms involved in overall skin blood flow changes and to compare the magnitude of these changes with those specifically elicited by manual procedures. © 2014 The American Osteopathic Association.
Article
Gua Sha (press-stroking) is a traditional Chinese healing technique utilized to combat pain, common cold, heatstroke, and respiratory problems. Patterned ecchymoses may appear due to the action of scraping and scratching repeatedly in a unidirectional manner, with a smooth edge over a lubricated area. They may be very informative, since they, generally, reproduce the shape of the injurious agent. However, many confounding factors can make the identification of the lesions difficult. A case of a 43 year-old Chinese woman, hospitalized for abdominal pain, is reported. An unusual pattern of reddish ecchymoses on the back was present. After a careful investigation, ecchymoses were attributed to Gua Sha. The case demonstrated that clinicians and forensic pathologists should also consider press-stroking, and other similar techniques in adults who present scratch-like marks or ecchymoses on various body districts, even if they have an unusual pattern. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Article
To observe the antihypertensive efficacy of guasha for essential hypertension.
Article
Gua sha is a traditional East Asian treatment that involves press-stroking with a rigid instrument along muscular lines with the intent of generating petechiae, helping to alleviate a wide range of pathologies. Despite regular practice in some communities and a rebranding as instrument-assisted soft tissue mobilization in Western physiotherapy and chiropractic medicine, there remains a paucity of scientific literature on the practice. This narrative reviews aims to provide an overview on gua sha and similar scraping practices, including the proposed physiological mechanism behind its purported benefits, while examining the literature for validated studies of the efficacy of gua sha. At present, there is weak evidence supporting the benefits of the therapy in isolation, with potential value as an additional treatment modality complementing conventional manual therapies.
Article
Objective The purpose of this study was to review the literature on the effect of scraping therapy on chronic low back pain (LBP) from randomized controlled trials (RCTs). Methods Three English medical electronic databases (PubMed, Embase, and the Cochrane Library) and 2 Chinese databases (China National Knowledge Infrastructure and Wanfang) were searched. Only randomized controlled trials related to the effects of scraping therapy on chronic LBP were included in this systematic review. Study selection, data extraction, and validation were conducted independently by 2 reviewers. The methodological quality of the studies was evaluated by the Cochrane risk-of-bias tool. RevMan 5.3 software was applied to perform meta-analysis of the data. Results Ten studies comprising 627 participants were included. Overall, the quality of evidence was moderate owing to a lack of blinding and allocation concealment in some studies and unclear risk of selective reporting. Meta-analysis of 9 RCTs indicated that scraping therapy had a statistically significant effect on pain reduction (standard mean difference = −0.66, 95% confidence interval [CI], −0.83 to −0.49, P < .001). However, if only a single scrape treatment was carried out, the results did not show that scraping was superior to the control group regarding pain relief (mean difference = −0.35, 95% CI, −1.23 to 0.53, P = .44). Moreover, the results of 6 RCTs involving 468 participants showed significantly greater improvement in lumbar dysfunction (mean difference = −10.05, 95% CI, −13.52 to −2.32, P < .001). In addition, the results of 5 RCTs involving 393 participants showed a favorably significant effect on the overall efficacy (odds ratio = 4.74, 95% CI, 2.34-9.62, P < .001). As for follow-up effects, meta-analysis of 3 RCTs involving 241 participants showed a promising effect on pain reduction and lumbar function improvement at 1 month and 3 months after the end of treatment, respectively. Only 1 study reported adverse effects, and none were serious. Conclusion Scraping therapy may have a therapeutic effect for some individuals with chronic LBP. However, due to the limited amount of research and the low methodological quality of the included studies, additional large-scale, multicenter, high-quality RCTs on relieving pain intensity and improving lumbar dysfunction are still necessary.
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Objectives: Little is known about Traditional Vietnamese Medicine (TVM) and its use among Vietnamese immigrants in the United States. This study aimed to characterize TVM and improve understanding of its use among Vietnamese outpatients attending an urban clinic. Methods: This cross-sectional observation study was performed by mailing bilingual surveys to a stratified random sample of 400 Vietnamese adult patients (≥18 years of age) who had visited a community health center in Boston, Massachusetts, at least once in the prior 12 months. The data were analyzed by using descriptive and multivariable regression statistics. The use of TVM and the factors influencing their use were reported. Results: Among the 216 respondents, 68% reported using TVM. Of those users, the median age was 56 years and 68% were female, 51% had lived in the United States for less than 13 years, and 91% spoke English "not well or not at all." Among the 89% who reported using TVM of indigenous origin, 62% used "wind scraping," 35% used herbal pills/products, and 30% used "wind snatching." Sixty-one percent used therapies of foreign origin; of those, 51% used Asian-originated TVM (herbs, 25%; Eastern massage, 23%) and 38% used Western-influenced TVM (diet supplements, 28%; Western massage, 8%). TVM was mostly used for pain conditions (57%), "staying well" (38%), and cough/colds (27%). Forty-five percent ignored the question on revealing TVM use to providers; of those who answered, 57% said "no." Fifty-one percent of TVM users reported using Western medicine for the same problem, while 46% used TVM and Western medicine within 2 days of each other. Self-rated health (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.34-5.06), household size (OR, 2.09; 95% CI, 1.04-4.22), and education (OR, 2.65; 95% CI, 1.03-6.80) were associated with TVM use. Conclusion: TVM is an important component of the healthcare of urban Vietnamese and needs to be further investigated. Healthcare providers need to encourage open discussion to better care for this population.
Article
"Sometimes called coining, spooning or scraping, Gua sha is defined as instrument-assisted unidirectional press stroking of a lubricated area of the body surface that intentionally creates "transitory therapeutic petechiae" representing extravasation of blood in the subcutis." Gua sha has been used for centuries in Asia, in Asian immigrant communities and by acupuncturists and practitioners of traditional East Asian medicine worldwide. With the expansion of traditional East Asian medicine, Gua sha has been used over broad geographic areas and by millions of people. It is valuable in the treatment of pain and for functional problems with impaired movement, the prevention and treatment of acute infectious illness, upper respiratory and digestive problems, and many acute or chronic disorders. Research has demonstrated Gua sha radically increases surface microperfusion that stimulates immune and anti-inflammatory responses that persist for days after treatment. The second edition expands on the history of Gua sha and similar techniques used in early Western Medicine, detailing traditional theory, purpose and application and illuminated by science that focuses its relevance to modern clinical practice as well as scholarly inquiry. This book brings the technique alive for practitioners, with clear discussion of how to do it -including correct technique, appropriate application, individualization of treatment - and when to use it, with over 50 case examples, and superb color photographs and line drawings that demonstrate the technique.
Chapter
The medical literature regarding refugee populations in developed countries has predominantly focused on infectious communicable diseases and mental health; however, with changing lifestyles in developing countries and the process of acculturation within developed countries, refugees are facing an increased risk of non communicable diseases either by having a pre existing condition or acquiring it once in a developed country. Amongst industrialized countries, the United States accounts for nearly 75% of all permanently settled refugees. Most recently, sixty-five percent of refugees resettling in the USA originate from Iraq, Burma and Bhutan. Of the refugees being tested within the first eight months of arrival, 51.1% had some chronic disease and 18.4% had two or more. Such prevalence rates support the need to address chronic conditions in refugees, but the literature provides little guidance for care of common non-communicable disorders in refugees. The objectives of this chapter are to synthesize the medical literature so as to offer clinicians an evidence-based approach for the care of common non communicable disorders in adult refugees and cite the systems challenges that caregivers face when providing chronic care to refugees.
Chapter
Careful examination of the child’s skin is an essential component of the abuse evaluation. Injuries to the skin are common findings in maltreated children and may include (a) contusions (bruises), abrasions, and lacerations; (b) burns from scalding, direct contact with flame or hot objects, and electricity; (c) frostbite (O’Neill et al., J Trauma 13: 332–339, 1973); and (d) scars resulting from these injuries (Richardson, Cutaneous manifestations of abuse. In: Reece RM (ed) Child abuse: medical diagnosis and management. Lea & Febiger, Philadelphia, pp 167–184, 1994). In one study examining the injuries of 616 children suspected of having been abused, at least 80% of the 775 primary injuries involved the skin, including (a) bruises/ecchymoses/hematomas (56%), (b) erythema/marks (9%), (c) burns (8%), and (d) abrasions/scratches (7%) (Johnson and Showers, Child Abuse Negl 9, 207–215, 1985). Ellerstein (J Dis Child 133, 906–909, 1979, Dermatologic manifestations of child abuse and neglect. In: Ellerstein NS (ed), Child abuse and neglect: a medical reference. Wiley, New York, 1981) noted the importance of cutaneous findings in maltreated children, because the recognition of these easily observed injuries by the child’s relatives, neighbors, and schoolteachers may trigger contact with the healthcare provider. Healthcare providers evaluating children with suspicious skin findings need to consider physical abuse and/or neglect as a potential etiology and pursue a thorough evaluation.
Chapter
The medical literature regarding refugee populations in developed countries has predominantly focused on infectious communicable diseases and mental health; however, with changing lifestyles in developing countries and the process of acculturation within developed countries, refugees are facing an increased risk of noncommunicable diseases by either having a preexisting condition or acquiring it once in a developed country. Studies of resettled refugees in the initial months of resettlement in the United States show that more than 50% of refugees have at least one chronic disease. Such prevalence rates support the need to address chronic conditions in refugees. This chapter synthesizes the medical literature to offer clinicians an evidence-based approach for the care of common noncommunicable diseases in adult refugees and outlines the systems challenges that caregivers face when providing chronic care to refugees.
Article
Objective: This study aims to evaluate the effectiveness and safety of Gua sha therapy on perimenopausal symptoms, quality of life, and serum female hormones in participants with perimenopausal syndrome. Methods: A prospective, randomized, controlled clinical trial was conducted at the First Affiliated Hospital of Nanjing University of Chinese Medicine in China. Eighty women with perimenopausal syndrome were recruited and randomized into an intervention group or a control group. Participants in the intervention group received 15-minute Gua sha treatment sessions once a week plus conventional treatment for 8 weeks, whereas participants in the control group received conventional treatment alone. The primary outcome was the change in perimenopausal symptoms and quality of life as obtained through the modified Kupperman Index (KI) and the Menopause-Specific Quality of Life. The secondary outcome was the change of serum female hormones including estrogen, follicle-stimulating hormone, and luteinizing hormone. Results: Seventy-five out of 80 participants (93.8%) completed the study-38 in the intervention group and 37 in the control group. The baseline levels of demographic and outcome measurements were comparable between the two groups. After eight sessions of intervention, the reduction in the total modified KI score was, however, 16.32 ± 4.38 in the intervention group and 11.46 ± 5.96 in the control group, with a difference of 4.86 ± 6.15 (P < 0.01) between the two groups. Also the reductions of hot flash/sweating, paresthesia, insomnia, nervousness, melancholia, fatigue, and headache were greater in the intervention group than in the control group (P < 0.05). The reduction in the total Menopause-Specific Quality of Life score was 17.87 ± 3.84 in the intervention group and 13.62 ± 7.40 in the control group, with a difference of 4.46 ± 7.52 (P < 0.01) between the two groups. And the scores for vasomotor, psychosocial, and physical domains in the intervention group were significantly lower than those in the control group (P < 0.05). There were no significant differences in serum estrogen, follicle-stimulating hormone, and luteinizing hormone between the two groups. Conclusions: The results of this study suggest that Gua sha therapy was effective and safe in relieving perimenopausal symptoms and improving the quality of life in participants with perimenopausal syndrome. The therapy may serve as a promising, effective, nondrug treatment for perimenopausal syndrome in clinical work. Additional research is needed to better understand its effectiveness and examine its mechanism for treating perimenopausal syndrome.
Article
Objectives Our goal was to review literatures on tool-based manipulation for musculoskeletal diseases with emphasis on guasha and IASTM (Instrument Assisted Soft Tissue Manipulation) by searching foreign and domestic controlled trials. Methods We found literatures published up to August 2016 in electronic databases (OASIS, KoreaMed, KMbase, NDSL, RISS, KISS, MEDLINE/PubMed, EMBASE, Cochrane Central Register of Controlled Trials) without any limitations on language. Results 17 studies were included in the review. 13 out of 17 articles were published within this decade. VAS was the main evaluation tool for most of the articles (14 out of 17). 10 studies showed statistically significant difference between the experimental group and the control group. In terms of materials used for treatment, 6 out of 17 studies used stainless steel. Considering anatomical locations for treatment, trunk area was treated the most, accounting for 7 out of 17 studies. Conclusions Our results show that recently, research on tool-based manipulation treatments for musculoskeletal diseases are actively being performed. Diseases of the vertebral column were the main target for tool-based manipulation treatments, and stainless steel was the most popular and safe material used. Further research should be performed for more accurate data.
Article
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Background: Attention deficit hyperactivity disorder (ADHD) is the most common childhood behavior disorder characterized by three behavior namely inattention, impulsivity and hyperactivity. The influence of exercise on behavior is one of the alternative treatment and also examined on behavior of children which is generally and specially in individuals with behavioral disabilities such as attention deficit hyperactivity disorder (ADHD). Objective: To find the effect of exercise programme on the behaviour of children with attention deficit hyperactivity disorder. Study Design: Quasi experimental. Procedure: 20 subjects were selected based on inclusion and exclusion criteria and divided into 2 groups, Group A-experimental group and Group B-control group. Each group consist of 10 subjects. And group A has followed the warm up phase, exercise phase and relaxation phase. And there was no intervention for group B. Before the commencement of exercise program a children and their parents/guardian WAS attended an information session and parents are told how to complete a Conners Parent Rating Scale. Result: There is no statistical significant changes in the behaviour of both the exercise and control group after the completion of the exercise programme there by (p= 0.01). Conclusion: The behavior of the children with attention deficit hyperactivity ADHD in the study has improved clinically over the 5 weeks exercise programme and there are no statistical significant changes in both the exercise group and control group.
Article
The US Department of Defense (DoD) and the Department of Veterans Affairs (VA) actively address care needs for a subset of service members (SMs) who experience prolonged symptoms and adverse sequelae interfering with their usual level of function after sustaining mild traumatic brain injury. The development of multidisciplinary concussion clinics and implementation of several reinforcing policies within the DoD and the VA address this unique patient population. A network known as the National Intrepid Center of Excellence and Intrepid Spirit Centers and the VA, primarily support these patients through intensive outpatient programs. The VA also has an inpatient program that utilizes specialized capabilities. The features unique to several of these centers are described in this article. While providing for similar patient care needs, each clinical setting implements unique evaluation and treatment modalities to target analogous goals of return to the highest functional level possible and develop life skills to enhance health, quality of life, and readiness to perform military duties. Currently, patient-reported outcomes are being collected.
Article
Evidence from recent RCT's has shown that naturopathic reflex therapies such as massage, Gua Sha massage, cupping, wet packs, or rhythmic embrocation etc. are helpful in reducing symptoms of chronic pain. These bodily oriented therapies are likely able to influence chronic pain not only through brain mechanisms such as expectation or the feeling of well-being, but also through mechanisms at the level of the peripheral nociceptor and the spinal cord. However, the neurobiological basis of these effects has rarely been investigated even though the accumulating knowledge of the pathophysiology of chronic pain syndromes allows for developing specific hypotheses. This essay discusses specific reflex therapies (cupping, Gua Sha massage, classical massage, and rhythmic embrocation) and their possible mechanisms of action via ascending pathways to the brain. © 2013 S. Karger GmbH, Freiburg.
Article
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The findings of studies on the frequency of violence against children imply that many cases go undetected. Selective literature review based on a search of different databases for publications on all types of violence against children, except sexual abuse. The physical abuse of children can involve blunt trauma, thermal injury, and the so-called shaking trauma syndrome (STS). Physical and psychological child neglect have very serious long-term effects. It can be difficult to draw a clear distinction of child abuse and neglect on the one hand, and acceptable behavior on the other, because of the varying social acceptance of certain child-raising practices. Münchhausen's syndrome by proxy (MSbP) is a rare, special type of child abuse. At the beginning of the 21(st) century, well-established normative structures are in place to protect children against abuse and neglect, and the available help from social organizations can also have a preventive effect. Further improvements will depend on interdisciplinary coordination and better training of specialists in all of the involved disciplines.
Article
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Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/68425/2/10.1177_019394598700900205.pdf
Article
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To determine the prevalence of use of traditional health practices among different ethnic groups of Southeast Asian refugees after their arrival in the United States, we conducted a convenience sample of 80 Cambodian, Lao, Mien, and ethnic Chinese patients (20 each) attending the University of Washington Refugee Clinic for a new or follow-up visit. Interpreters administered a questionnaire that dealt with demographics, medical complaints, traditional health practices, health beliefs, and attitudes toward Western practitioners. In all, 46 (58%) patients had used one or more traditional health practices, but the prevalence varied by ethnic group. Coining and massage were used by all groups except the Mien, whereas moxibustion and healing ceremonies were performed almost exclusively by the Mien. Traditional health practices were used for a variety of symptoms and, in 78% of reported uses, patients reported alleviation of symptoms. The use of traditional health practices is common among Southeast Asian refugees. Clinicians who care for this population should be aware of these practices because they may supersede treatments prescribed by physicians or leave cutaneous stigmata that may be confused with disease or physical abuse. Good patient care may necessitate the use or tolerance of both Western and traditional modalities in many Southeast Asian refugees.
Article
Until recently the presence of linear bruising on children in America was synonymous with child abuse.1 With the large influx of Vietnamese children, physicians should be aware of the practice of coin-rubbing.2 While providing medical care for Vietnamese children at Fort Indiantown Gap, Pennsylvania, we commonly saw petechiae and frank purpura of the chest and back. These lesions were often linear and resembled trauma. Indeed, we received one report of alleged trauma from an outside physician who was not familiar with the condition. The lay practice of Cäo Gió is quite commonly used among the Vietnamese for several symptoms including fever, chills, and headaches.
Article
Ca̧o gío is the Vietnamese practice of rubbing the skin with a coin to alleviate various common symptoms of illness. The back, neck, head, shoulders, and chest are common sites of application. Although mimicking the lesions of trauma, it is not a harmful procedure, and no complications are known. A survey of 50 Vietnamese living in the United States since 1975 and 1976 has shown marked distrust of American physicians, owing largely to actual or perceived criticism of ca̧o gío. Acceptance of ca̧o gío as a valid cultural practice will facilitate compliance and adequate medical follow-up. (JAMA 1980;244:2748-2749)
Article
Two cases of injuries caused by "coin rubbing" (Kuasha) are presented. In one case these injuries were confined to the neck, raising the possibility of strangulation, and in the other to the trunk and limbs, suggesting torture. Coin rubbing is practiced by most South-East Asian cultures, which believe that it relieves the symptoms of headache, fever, and flu. The causation and characteristics of these injuries and their medicolegal importance are discussed. Language: en
Article
"Sometimes called coining, spooning or scraping, Gua sha is defined as instrument-assisted unidirectional press stroking of a lubricated area of the body surface that intentionally creates "transitory therapeutic petechiae" representing extravasation of blood in the subcutis." Gua sha has been used for centuries in Asia, in Asian immigrant communities and by acupuncturists and practitioners of traditional East Asian medicine worldwide. With the expansion of traditional East Asian medicine, Gua sha has been used over broad geographic areas and by millions of people. It is valuable in the treatment of pain and for functional problems with impaired movement, the prevention and treatment of acute infectious illness, upper respiratory and digestive problems, and many acute or chronic disorders. Research has demonstrated Gua sha radically increases surface microperfusion that stimulates immune and anti-inflammatory responses that persist for days after treatment. The second edition expands on the history of Gua sha and similar techniques used in early Western Medicine, detailing traditional theory, purpose and application and illuminated by science that focuses its relevance to modern clinical practice as well as scholarly inquiry. This book brings the technique alive for practitioners, with clear discussion of how to do it -including correct technique, appropriate application, individualization of treatment - and when to use it, with over 50 case examples, and superb color photographs and line drawings that demonstrate the technique.
Article
To the Editor.— An article that appeared in the Vietnamese weekly magazine Trang Den (20:32, July 1976) causes me concern. Apparently, a Vietnamese father took his 3-year-old son to the hospital to be seen for possible influenza. The child died, and because of ecchymoses on his chest and back, the father was suspected of child abuse. Although he explained to the authorities that the ecchymoses represented cao gio, a home treatment, he was jailed and subsequently committed suicide. Since what happened has some medical relevance, I would like to call the attention of the medical profession in this country to a Vietnamese folklore medical practice.Cao Gio (ie, "scratch the wind") is a common practice in Vietnam. It consists of using a boiled egg covered with hair, a coin, or a similar object to scratch the balsamed or menthol-oiled skin along the spine, back, base of the neck, or in
Sir.—Yeatman et al1 defined the Vietnamese folk practice of c[unk]o gío as pseudobattering. Inflicted trauma is classically defined as any injury caused by other than accidental means. The battered child syndrome is often defined as repeated inflicted trauma, but a single incident of such trauma may be the first of a series of abuses if intervention is not obtained. Either single or repeated applications of vigorous rubbing or mentholated compounds into the skin with a metal object (c[unk]o gío) and its resultant petechiae and ecchymoses2,3 may be definable as inflicted trauma. Some might exclude this Vietnamese folk practice from the battered child syndrome on the basis of the lack of serious resultant symptoms. However, as it is seen from the child photographed in both Yeatman's and co-workers' article1 and in The Journal's "Picture of The Month," the degree of skin injury may be extensive. The definition of
Article
To the Editor.— Regarding the article by LTC Gentry W. Yeatman, MC, USA (1980;244:2748), about ca̧o gío among the Vietnamese immigrants, as a matter of interest, this procedure is also popular in Indonesia as part of traditional medicine. It is known under several names, including kerok and kerik. There is a definite Chinese influence, it being much practiced by the Chinese and those of Chinese ancestry, especially among the older generations.Coconut oil or cajuput oil is usually used as a skin lubricant. Parts of the body frequently used as the site of application are the same, mostly the back and neck, and less frequently, the chest. It seems to give a fast subjective sense of well-being if applied to patients with colds and other flu-like diseases, especially with fever and malaise, and is used in children as well as in adults as a home remedy. The darker the color
Article
PREVIEWSince the end of the Vietnam War, tens of thousands of Hmong refugees have resettled in the United States. This ever-increasing population presents specific challenges to the US healthcare system as Hmong seek to preserve their cultural identity while acclimating to American society. Primary care physicians can enhance their interactions with these patients by seeking to understand various elements of Hmong culture, particularly its approach to medicine and healing. By extension, such knowledge and skills will aid physicians in all encounters with patients who belong to minority cultural groups.
Article
Recent developments in intravital microscopy make this technique an attractive approach to studying microvascular, cellular, and molecular mechanisms of distinct surgical diseases. We investigated the value of this technique in surgical research laboratories by analyzing the studies presented during the past 26 years (1972–1997) at the Surgical Forum of the Annual Congress of the German Society of Surgery. From a total of 2279 papers 188 contributions (8.3%) presented data which derived from the analysis of the microcirculation using techniques, such as H2 and 133Xe clearance, autoradiography, thermodiffusion, laser Doppler fluxmetry, laser speckle, radioactive and fluorescent microspheres, polarographic oximetry, and intravital microscopy. There were 72 presentations (3.2% of all contributions) reporting the use of intravital microscopy, thus reflecting 38.3% of all microcirculatory analyses. Although these numbers may be considered quite small, analysis over time revealed a significant (P<0.05) increase in the number of microcirculatory studies (11.4%) and in particular of those using intravital microscopy (6.3%) in the 1990s when compared to the 1970s (5.3%; 0.1%) and 80th (7.1%; 1.3%). In 1997, 27 of 165 contributions (16.4%) included microcirculatory analyses, and 18 of the 165 contributions (10.9%) reported results analyzed by intravital microscopy. Thus our analysis reflects an increasing interest of surgical researchers to study in vivo the microcirculation, and by doing so to use intravital microscopy for the elucidation of mechanisms of surgical disease.
Article
There were two objectives: first, to make the reader familiar with folk remedies that might be confused with child abuse; second, to challenge the idea existing in the literature that treatment for the Hispanic folk illness caida de mollera can cause the injuries seen in the shaken baby syndrome. Literature review and analysis with case application were used. A wide variety of folk remedies with potential for confusion with child abuse were found to exist, and were described. Treatment for caida de mollera was found to consist of a number of gentle, nonviolent maneuvers quite different from the violent shaking believed to cause shaken baby syndrome. Familiarity with folk remedies will help differentiate them from child abuse. The child protection community would benefit from realizing that treatment for caida de mollera is an improbable cause of shaken baby syndrome injuries.
Article
Film 633 reel 55 is part of Research Publications Early American Medical Imprints collection (RP reel 55, no. 1033). Thesis - University of Pennsylvania. Microfilmed for preservation
Article
For the last decade, death investigators have been aware of an unexplained syndrome of sudden death occurring among young adult Southeast Asian refugees. Presented here is a rare instance of fatal hypokalemic periodic paralysis associated with thyrotoxicosis masquerading as the sudden, unexplained death of a Cambodian refugee. The usual features of this syndrome were present, including relatively occult thyrotoxicosis, paralysis upon awakening following a high-carbohydrate meal, and hypokalemia. This case illustrates the value of thorough background death investigation and also illustrates the potential of misinterpreting traditional folk medicine coin rubbing (Cao Gio) as signs of physical abuse.
Approximately 850,000 Vietnamese, Cambodian, and Laotian refugees have come to the United States since the end of the war in Vietnam. Because of language, religious, and cultural differences, these refugees present a challenge for health care providers. Nurses who work with Southeast Asians must understand how their beliefs about illness causation and treatment affect their response to health care.
Article
Finger-skin microcirculation and its reactions to sympathetic stimuli were investigated in 12 patients with sympathetic dystrophies, secondary to trauma or other diseases. Nailfold-skin capillary blood cell velocity (CBV) was measured by videophotometric capillaroscopy. Laser Doppler fluxmetry was used to provide an index of skin circulation in vessels in addition to the superficial capillaries. Both CBV and laser Doppler flux (LDF) values were significantly lower in the patients, compared with the healthy controls (P less than 0.05), despite the fact that skin temperature was the same in both groups. During cooling of the contralateral hand, CBV and LDF decreased markedly (22-60%) in the control group but not in the patients (0-13%). The decrease in skin perfusion normally seen upon lowering of the hand was also impaired in the patient group (7%) compared with controls (42%) (P less than 0.05). These impaired vasomotor reflex responses are consistent with sympathetic dysfunction and may well explain some of the typical features of the syndrome, e.g. limb oedema.
Article
In Third World countries today one must have a knowledge of and appreciation for traditional medical beliefs and practices if one is to understand each nation's particular adaptation to a modern health care system. Taking the particular example of Vietnam, we discuss the current formal health care system and the traditional herbal medicines, dietary regulations and dermal techniques which are still important elements in the peoples' choice and perception of health care. There is then a discussion of how traditional medical beliefs and practices have shaped the practice of health care in Vietnam today.
Article
Camphor is a cyclic terpine compound that is a constituent of several medications. Historically, it has been used as an aphrodisiac, antiaphrodisiac, contraceptive, abortifacient, and suppressor of lactation. Nowadays, it is synthesized and used as an antiseptic and rubefacient. In cold remedies, it is used either by application to the chest or via a vaporizer. It is also used as a topical analgesic for 'fever blisters' and cold sores. Although medical experts and committees have discussed its questionable medical benefits and warned about its potential toxicity, several over-the-counter camphor compounds continue to be manufactured and marketed.
Article
When a patient's problem is judged to be the result of child abuse and it is not, considerable harm may be done to the child, his parents, and the doctor-parent relationship. The case histories of 15 children who were thought to be abused are reviewed and their correct diagnoses are presented. Overdiagnosing the battered child syndrome can be as harmful as failing to consider it.
Article
Knowledge of the cutaneous manifestations of child abuse is critical to the accurate identification and reporting of abusive injuries. Physicians must also be aware of cutaneous abnormalities which mimic abusive injuries in order to avoid unnecessary reporting of abuse. We report two children with cutaneous abnormalities which mimicked child abuse and review other skin conditions reported in the literature which have been mistaken for child abuse.
Article
Vietnamese health beliefs may seem strange to western nurses. Basic to working with this or any immigrant culture is to have an understanding of and respect for cultural values. This paper presents an overview of a number of health beliefs held by a population of Vietnamese immigrants living in Texas.
Article
Since 1975, over 600,000 Indochinese refugees have resettled in the United States. This patient population has significant personal health problems in need of medical treatment. However, Indochinese refugees frequently underutilize existing health care services. This, in part, results from major cultural barriers between patient and provider. A review is provided of the history of the recent Indochinese immigration and the cultural traits, religious beliefs, and health care practices of this refugee population. This information is provided in the hope that health care providers will learn to understand the Indochinese refugee as a patient and reduce those cultural barriers that appear to limit their access to medical care in this country.