What is Cupping and Gua Sha, where do they come from?

Cupping is a therapeutic technique based on applying negative pressure (suction) to gently manipulate soft tissues in the body, specifically muscles and the connective tissue (Fascia) that surround them. It can be helpful to think of it as a “massage-in-reverse” where suction is used to apply forces of tension, compared to the compression applied in massage and acupressure.

Cupping as a therapeutic modality is very old and has been practiced, and seemingly independently discovered, by disparate groups of people throughout the world. The oldest written account of its therapeutic use comes from a more than 3500 year old treatise on ancient Egyptian medicine known as the “Ebers papyrus”. Other ancient proponents of the practice include famous Greek writers like Hippocrates and Herodotus, the Arabic prophet Muhammad, and of course the classical scholars of Chinese medicine.

Gua sha, is a simple and safe technique used to restore energy flow in areas of the body blocked by the invasion of external pathogens. It is a traditional Chinese medicine (TCM) practice ultilizing a smooth-edged tool to stroke your skin while they press on it. This motion raises small, red/purple dots that show under your skin called petechiae.

Practitioners believe that gua sha recirculates stagnant, unhealthy bodily matter from blood stasis within sore, tired, stiff, or injured muscle areas to stimulate new oxygenated blood flow to the areas, thus promoting metabolic cell repair, regeneration, healing, and recovery. We often refer to the use of gua sha on the upper back and neck “relieving/releasing the exterior”, that the mechanism of the scraping opens pores and restores the circulation of our Wei Qi.

Gua sha, the literal translation being “to scrape petechia” which refers to the sand-like bruising after the treatment, spread from China to Vietnam, where it became very popular. It is known as “cạo gió”, which roughly means “to scrape wind”, as in Vietnamese culture “catching a cold” or fever is often referred to as rúng gió, “to catch wind”.

Gua sha, a related technique to cupping, is sometimes referred to as “scraping”, “spooning” or “coining” by English speakers.

What conditions do you treat with Cupping and Gua Sha at Heart & Hands?

Mostly pain, Cupping is most effective at relieving pain originating in the soft tissues (myofascial pain), but is still helpful for the management of pain stemming from joints (arthritis/arthralgia) and in some cases of pain without a clear cause (idiopathic).

Gua sha likewise can treat pain, with a particular focus on breaking up adhesions within the fascial layer of tissue. This technique is also useful bolstering the body’s protection against early stage external pathogenic invasion (EPI) – which in Western medicine we think of as the common cold or flu-type illnesses and acute lung pathologies.

Common conditions treated

  • Tension headaches
  • Lower back pain
  • Shoulder and neck pain
  • Osteoarthritis (of the knee, hip, shoulder, etc)
  • Fibromyalgia
  • Sciatica
  • Tennis elbow
  • Shin splints
  • Lymphatic drainage issues
  • Pelvic alignment
  • Carpal tunnel syndrome
  • Hip tension & pain
  • Asthma
  • Edema
  • Breaking up scar tissue
  • If you’re wondering if Cupping and Gua Sha can treat your particular condition, contact us

Does Cupping or Gua Sha hurt?

It can, but pretty rarely with the version we practice.

At Heart & Hands we use silicone cups to create the suction. We have previously used glass cups with fire, but they take more effort to use and don’t allow for as much control over the pressure exerted. When you create suction with fire, it is very all or nothing. So if you want maximum suction all the time it’s great, but lots of folks need less suction in order to relax and derive full therapeutic benefit from the treatment.

Using less suction and making sure to properly lubricate the skin before moving the cups (slide cupping) generally makes for a low-pain to no-pain experience.

The pressure and friction experienced during gua sha can be adjusted to your comfort, though generally does not feel more intense than a moderately vigorous massage. Often when treating fascial adhesions we will use a surprisingly light touch to impact that superficial tissue.

Are there any contraindications?


Cupping and gua sha should not be performed over: burns and other large or recent injuries to the skin, varicose veins or any sensitive major blood vessel (such as those on the inner thigh), and on infected body parts like abscesses. Rashes are usually avoided, although it can be okay for folks with eczema depending on the severity. Cupping over the abdomen is generally avoided because of the small chance of a hernia from excessive suction. Folks with clotting disorders like Deep-vein Thrombosis should avoid cupping unless cleared with their primary care provider.

Folks who are taking blood thinners or who bruise very easily, we recommend our Community Acupuncture service, which is less invasive. But if interested can still try with less suction.

PREGNANCY: Pregnant people can still get cupping and gua sha, just not on the lower back or abdomen areas. Stiff necks, shoulders, upper backs and limbs are usually fine.

Are there any side effects?

Only one common one: cupping and gua sha marks and/or bruising

After a cupping session there will usually be hickey-style discolouration over the treated areas. Gua sha results in the same markings, though usually in lines or patches, corresponding to treatment. Darker shades of marks are traditionally thought to indicate more “stasis” or impairments in the smooth flow of blood to and from the tissues it nourishes. These marks usually fade in a few days, but may occasionally last up to several weeks.

After any session make sure to keep the area treated with cupping or gua sha covered for the next 24-48 hours. Both of these treatments open the superficial channels and can leave us vulnerable to EPIs.

How frequently should I get treatment?

Depends on the issue and what else you’re doing for it. As a general rule, cupping and gua sha pair well other manual therapies like massage and acupuncture. If cupping or gua sha is the only form of manual therapy employed for your issue, then once a week tends to be optimal. If you’re also receiving acupuncture or other therapies as well, then less frequently is okay and once every 2-3 weeks with your other treatments in between can spread the appointments out as needed to maximize the benefits.

Can I exercise soon after my treatments?

For gentle or low-impact exercise, yes almost always. I have previously had success with an older patient who used cupping as a way to “limber up” before attending an aquafit class later that day. For more strenuous exercise like heavy weightlifting or high-impact sports, it is better to wait at least a day or two after the treatment. This is even more important for those recovering from an injury. Cupping and gua sha, like acupuncture, may relieve pain and lead someone to overexertion too soon causing re-injury. To avoid this: keep it gentle or work out another non-injured part of the body.