Wash your hands and cleanse the face. Pat dry, and leave the skin slightly damp.
TCM beauty · Practice
Gua sha for the face
面部刮痧
What it is
In Chinese medicine, gua sha for the face is a self-care technique in which a smooth-edged tool is drawn across lightly oiled skin in set directions to move Qi and Blood in the facial channels. The tool is a polished stone, jade, horn or metal plate with a rounded edge, and the pressure is much lighter than in the body version of the technique.
The name is two words: gua (刮), to scrape, and sha (痧), the petechial rash that body gua sha deliberately raises. That gives the technique its reputation and its main point of confusion. On the body, the appearance of sha is part of the treatment. On the face it is not, and a facial routine that leaves bruising has been done too hard.
Gua sha is documented as a named practice in the Qing-era literature on sha conditions, of which Sha Zhang Yu Heng (痧胀玉衡, Guo Zhisu) is the best known text; the chapter reference is not confirmed. The facial version, worked lightly along the channels for appearance rather than for sha, is a modern cosmetic adaptation of that tradition rather than a classical procedure.
Facial gua sha is not a treatment for a skin disease. It is traditionally used to support the movement of Blood in the face, which the tradition connects with a dull, dusky or heavy complexion, a picture it classifies as Blood Stagnation.
How TCM explains it
The reasoning starts with the channels. The face is where several of them surface: the Stomach channel (足阳明胃经) crosses the cheek, the side of the nose and the forehead; the Large Intestine channel reaches the side of the nose; the Gallbladder channel runs through the temple and the side of the head; the Bladder channel begins at the inner corner of the eye and runs over the head. Facial gua sha follows those lines, which is why the direction of a stroke is fixed rather than arbitrary.
Where movement is sluggish, the tradition reads it from the surface: a complexion that looks dull or slightly dusky rather than clear, a face that feels heavy or puffy, a fixed discolouration that does not shift. The pattern named for that is Qi And Blood Stagnation, and it is the one most often given as the reason for working the face.
Two other patterns matter. Liver Qi Stagnation is read in jaw and brow tension, in a face that grows tense under stress and flares before a period or an examination. Damp-Heat is read in oiliness, puffiness and a heavy, sticky feeling, and it is a pattern in which less pressure and fewer strokes are used, not more.
The points that sit on the worked lines are named on the page for that reason. Yangbai (GB-14) and Touwei (ST-8) sit on the forehead, Jiache (ST-6) on the angle of the jaw, Yingxiang (LI-20) beside the nose. Practitioners pair the local work with distal points, most often Hegu (LI-4) and Sanyinjiao (SP-6), and sometimes Jianjing (GB-21) in the shoulder. All three of those are classically avoided in pregnancy and should not be pressed by anyone who is pregnant. The internal counterpart to the Liver picture is a formula such as Xiao Yao San.
One honest note belongs here rather than at the end. This theory explains why the practice is done and how it is meant to work. It does not show that it works, and the evidence section below sets out what has actually been tested.
Which skin pictures it is used for
The table sets out the pictures a practitioner would treat with facial gua sha, the pattern each belongs to, and how the stroke changes. Where a picture is listed as unsuitable, the reason is given rather than a modified technique, because there is no safe version of the practice over inflamed skin.
| What you see | TCM pattern | How the practice is adapted |
|---|---|---|
| Dull or slightly dusky complexion, a fixed discolouration, a face that looks tired rather than thin | Blood Stagnation | Short, slow strokes, very light pressure, each line worked once rather than repeatedly |
| Jaw and brow tension, a face that grows tense under stress, flares before a period or an examination | Liver Qi Stagnation | Slower passes along the jaw and brow, and the neck worked first to settle the shoulders |
| Oily, puffy, heavy-feeling face with a sticky sensation | Damp-Heat | Work from the centre outwards, keep pressure light, skip any inflamed or weeping spot |
| Dry, fine, thin-looking skin that marks easily, as in Skin dryness | Blood Deficiency | More oil, fewer strokes, stop while the skin still feels comfortable |
| Active Acne lesions, a Rosacea flare, eczema or dermatitis | Not suitable | No gua sha over the lesions or the flare; see the safety section |
Before you start: who should not do this
Before you start: who should not do this
Read this before the steps. The exclusions are not formalities.
Do not use facial gua sha at all if you have:
- broken, cut, sunburnt, peeling or recently shaved skin, or skin that is bruised already;
- active acne lesions, cysts or nodules on the area you would work;
- a rosacea flare, or a flare of eczema, dermatitis or urticaria;
- a cold sore, an active infection, or a feverish illness;
- had fillers, botulinum toxin, a chemical peel, laser treatment or microneedling in the past two weeks, or until the practitioner who did it says the skin has settled;
- a bleeding disorder, or you take warfarin, a direct oral anticoagulant, aspirin or clopidogrel, or you bruise very easily;
- a skin cancer or an unexplained mole. Do not work over it, and have it assessed;
- poor wound healing, as in uncontrolled diabetes or immunosuppression;
- a tendency to keloid scarring.
Pregnancy. Facial gua sha is not one of the practices classically avoided in pregnancy, but the points used alongside it are. Hegu (LI-4), Sanyinjiao (SP-6) and Jianjing (GB-21) are classically avoided, so do not press them if you are pregnant, and check with your practitioner before starting any facial routine.
Patch test any oil or preparation on the inner forearm and wait 24 hours before using it on the face.
Stop at once and see a doctor if you get spreading redness, pain, swelling, blistering, hives, dizziness or faintness, any eye pain or change in vision, or bruising that has not faded after a week. A mole that changes shape, colour or size needs a dermatology review, not another routine.
Two areas are off limits at any pressure: the eyeball itself, and the front of the throat over the thyroid. Work around the eye on the orbital bone, never into it, and keep the neck work at the sides.
How it is done
Five to ten minutes, two or three times a week, on skin that is calm. Work in one direction per stroke: the tool travels one way and is lifted back, rather than scrubbed back and forth.
Skip today if…
- the skin is broken, sunburnt, peeling, recently shaved or already bruised;
- there is active acne, a rosacea flare, or a flare of eczema or dermatitis;
- you have had fillers, botulinum toxin, a peel, laser or microneedling in the past two weeks;
- you take a blood thinner or bruise very easily;
- you are pregnant and would be working the points the tradition avoids.
Read the full exclusion list.
The under-eye stroke is placed while the tool is still at the top of the cheek, because it is the lightest stroke of the routine and the tool should never travel back down over the eye; the forehead finishes the face work and the closing neck sweep finishes the routine.
Step by step
Apply oil or a light balm, three or four drops for the whole face. There should be enough that the tool glides without dragging.
Hold the tool at about 15 degrees to the skin, flat against it, with the rounded edge leading. Too upright and it digs in.
Neck first, on each side: stroke downward from the jawline towards the collarbone, five to eight passes. Do not press on the front of the throat.
Jaw: from the chin along the jawline towards the ear, five to eight passes on each side, over Jiache (ST-6).
Points: Jiache (ST-6)
Cheek: from the side of the nose outward towards the ear, five to eight passes, passing beside Yingxiang (LI-20) and staying clear of the eye.
Points: Yingxiang (LI-20)
Under the eye: the lightest pressure of the routine, from the inner corner outward along the orbital bone, three to five passes. Never press into the eye socket.
Brow: from between the eyebrows outward to the temple, five to eight passes, over Yangbai (GB-14) and towards the hairline at Touwei (ST-8).
Points: Yangbai (GB-14) Touwei (ST-8)
Forehead: from the centre outward to the hairline, five to eight passes.
Closing sweep: from behind the ear, stroke down the side of the neck towards the collarbone, three to five passes on each side, to finish the routine.
Wipe off the excess oil and apply a simple moisturiser. Wash the tool with soap and warm water and dry it.
Pressure scale
1
Feather-light
The tool barely rests on the skin; the skin does not move.
2
Light
The skin moves gently under the edge; no dragging, no heat.
3
Firm
Not used on the face except on the jaw muscle, and never on bone.
| Area | Most pressure allowed |
|---|---|
| Under the eye | Feather-light |
| Cheek | Light |
| Jaw and neck | Light |
Afterwards. Two or three times a week is the usual routine, and the day is skipped entirely if the skin is red, irritated or sunburnt. The skin may be mildly pink for a few minutes; it should not be bruised. Any product used after the routine should be one the skin already tolerates, and sun protection is sensible after any facial routine.
If a stroke feels sharp, hot or stinging, stop. That is the skin saying the pressure or the product is wrong, not a stage to work through.
The tool and its edges
A gua sha tool is a smooth plate with at least one edge that runs over the back of your hand without catching. The shape decides which part of the face it suits, and the material decides how it feels and how it is cleaned. There is no need for a branded tool: an un-chipped stone or a smooth metal plate is enough.
The shapes and their edges
Heart
The commonest shape: one long flat edge, two curves and a pointed tip, so it covers most of the face in one tool.
Wing
A longer flat edge with a deeper concave curve, useful for the jaw and the side of the neck.
Comb
A row of notches on one edge, for working along the jawbone where a flat edge would slip.
S
A double curve that follows the cheek and the brow and reaches the side of the nose.
Which edge goes where
| Edge | Where it goes | How |
|---|---|---|
| Long flat edge | Cheeks and forehead | The basic edge; keep it almost flat to the skin. |
| Concave curve | Jaw and neck | The curve hugs the line of the jaw and the side of the neck. |
| Notched or comb edge | Along the jawbone | Used lightly, over the muscle, never on bone. |
| Pointed corner or small curve | Pressing points and the side of the nose | For static pressure, not for gliding. |
| Rounded tip | Under the eye | The gentlest contact; the pressure of the whole routine is lowest here. |
Materials
| Material | Note |
|---|---|
| Jade 玉 | Smooth and cool; the traditional cosmetic stone, and the easiest to keep clean. |
| Rose quartz 玫瑰石英 | Slightly softer than jade; check the edges for chips more often. |
| Bian stone 砧石 | The traditional scraping stone (bian shi); heavier, and it holds warmth. |
| Horn 牛角 | The classical material for scraping; light, warm to the touch, and it must not be soaked. |
| Stainless steel 不锈钢 | The easiest to disinfect and the least likely to chip. |
Cleaning and checking the tool
- Wash the tool with soap and warm water before and after each use, then dry it fully.
- Wipe it with alcohol between people, and never share an unwashed tool.
- Check the whole edge with a fingertip before every use: a chip or a rough spot will scratch the skin.
- Store it so the edge is not knocked against anything hard.
The moves
Every stroke on the face is one of six moves. They are the vocabulary the routines are built from, and each one is gentle: the pressure stays at the level of a light stroke, and the tool is lifted at the end rather than dragged back.
Long glide 面刮
The basic stroke: the flat edge travels one way along a line, then is lifted off the skin.
Corner stroke 角刮
The pointed corner works the side of the nose and the brow notch in short passes.
Press and hold 点按
The tool tip rests on a point and stays still for three to five slow breaths.
Small circles 按揉
The tip makes slow circles about the width of a pea at a tense spot such as the jaw.
Wiggle and glide
A modern technique: a small side-to-side wiggle while gliding along the jaw, for jaw tension.
Lift-off
Every stroke ends with the tool lifted away at the hairline or the ear, never dragged back.
Choose your routine
Three short routines, each built from the stroke-map numbers above. Use the numbers to follow the same diagram, and keep to the pressure the routine names. They follow the pictures in the table higher up the page; no new claim is made here.
Morning, puffy or heavy face
- 1Neck down towards the collarbone, both sides.
- 3 to 4Cheek, from the nose outward to the ear.
- 5Under the eye, rounded tip, feather-light.
- 8Close with the neck sweep from behind the ear.
Neck first and last, as in the table for the Damp-Heat picture.
Evening, tense jaw and brow
- 1Neck down, both sides, slowly.
- 2Jaw from the chin to the ear, with the comb edge.
- 6Brow out to the temple, pointed corner.
- 8Close with the neck sweep from behind the ear.
Press and hold at Jiache (ST-6) and at the brow when the jaw or brow is tight.
Dry or thin skin
- 1Neck down, both sides.
- 3 to 4Cheek, flat edge, one pass per line.
- 7Forehead up to the hairline.
- 8Close with the neck sweep from behind the ear.
More oil and fewer strokes, and stop while the skin still feels comfortable.
Herbs and preparations used with it
Most facial gua sha is done with a plain carrier oil. Traditional preparations do exist, and each carries its own caution.
A simple oil is the safest base: jojoba, sweet almond (not if you have a nut allergy) or a fragrance-free balm, patch tested first. Essential oils are best left out on reactive skin, and anything with a strong scent should be tested before it goes near the eye area.
Hong Hua (红花, safflower) is the classical red oil of the tradition, used on the body for bruises and dusky, cold patches. It is not a routine facial oil: Hong Hua is a blood-moving herb, and it is not used by anyone on anticoagulants, with a bleeding disorder, or in pregnancy. It is kept to small areas of intact skin.
Bai Zhi (白芷, Dahurian angelica root) has a long record as a facial powder, and its furanocoumarins make skin react to ultraviolet light. When it is used on the face at all, it is used at night and kept out of the sun while it is on the skin and for a day or two afterwards.
Gan Cao (甘草, licorice root) is used as a cooled decoction, as a compress for skin that is hot and itchy rather than for the routine described here. For the internal treatment of a Blood stasis picture, the classical formula is Tao Hong Si Wu Tang, which is taken by mouth and is not applied to the skin.
What the evidence says
At least one verified human study for the condition on this page, with limited or low-quality evidence. Editorial policy
Limited studies. One small randomised trial has tested facial gua sha against another facial massage tool, and no trial has tested it against doing nothing.
The trial enrolled 34 women aged 20 to 50 and randomised them to gua sha or to a facial roller. Both groups massaged for ten minutes, five times a week, for eight weeks. Both changed facial surface measurements by two to three millimetres. The gua sha group showed a reduction in muscle tone measures, and the roller group showed improvement in skin elasticity indices. There was no untreated control group, so the trial cannot separate the effect of the technique from the effect of eight weeks of daily massage and attention, and the outcomes were instrument readings rather than how the face looked to anyone. Ahn SH et al., Journal of Cosmetic Dermatology, 2025, PMID 40439289.
The physiological study behind the technique is older and was not done on the face. Eleven healthy volunteers received a single gua sha treatment on the back, and laser Doppler imaging showed roughly a fourfold rise in local microcirculation for the first seven and a half minutes, with the increase sustained across the 25 minutes of measurement. There was no clinical outcome and the subjects were staff volunteers. Nielsen A et al., Explore, 2007, PMID 17905355.
The rest of the literature is commentary and review rather than trial evidence. A dermatology letter discusses whether gua sha, jade rollers and facial massage have a place in dermatology; a short overview in JAMA Dermatology describes the practice and the marks it can leave; a 2026 review reinterprets the mechanisms of scraping therapy without presenting new data. All three are useful for context and none of them is a test of the facial routine.
These are the human studies we found on PubMed (searched October 2026). One small comparative trial, one small physiological study on the back, and commentary. It is why this page carries the badge it does, and it is why nothing on it is described as a result.
Common mistakes
- Pressing hard because light pressure feels like nothing. The face does not need force, and bruising means the routine was done too hard.
- Working over active spots. Gua sha is not for acne lesions, and dragging a tool across an inflamed follicle can spread irritation.
- Going back and forth. Each stroke travels one way. Scrubbing back and forth irritates the skin and works against the direction the routine is built on.
- Skipping the neck. The neck and shoulders are where the tension usually sits, and working only the face leaves the lower end of the line untouched.
- Doing it every day. Two or three times a week is the routine; daily work on the same lines tends to leave the skin sore rather than settled.
- Using a chipped, rough or improvised tool. A cracked stone or the edge of a spoon scratches skin. The tool should be smooth enough to run over the back of your hand without catching.
- Too little oil. A draggy tool tugs the skin, which is the opposite of what the light technique is for.
- Doing it on sunburnt skin, or straight after a peel or a laser appointment. The skin is already repairing.
- Pressing on the throat or into the eye socket. Both are off limits at any pressure.
Common questions
How often should I gua sha my face?
Two or three times a week, for five to ten minutes, is the usual routine. The traditional reasoning is that the face needs regular gentle movement rather than a single long session. Working the same lines every day tends to leave the skin sore, and skipping days when the skin is red or irritated matters more than the count.
Which direction should I go?
Down the neck towards the collarbone, from the chin along the jaw towards the ear, from the nose outward to the ear, and from the centre of the forehead outward. Each stroke goes one way and the tool is lifted back. The directions follow the channel lines the practice is based on.
Should my face go red or bruise?
A little pink for a few minutes is normal. Bruising is not, and it is not a sign that the routine worked. The petechiae that body gua sha deliberately raises are not the aim on the face, where the pressure is much lighter.
Can I gua sha over acne?
Not over active lesions. The tool drags across the skin, and on an inflamed follicle that can spread irritation and slow healing. Calm areas can be worked gently, but if the acne is widespread or active, the routine should wait, and the acne page in this compendium is the place to start.
Is gua sha safe in pregnancy?
Facial gua sha itself is not one of the practices the tradition avoids in pregnancy, but the points used alongside it are. Hegu (LI-4), Sanyinjiao (SP-6) and Jianjing (GB-21) are classically avoided, so they should not be pressed, and it is worth checking with your practitioner before starting a routine.
Can I do it after fillers or botulinum toxin?
Wait until the practitioner who did the treatment says the skin has settled, and expect that to be at least two weeks. Pressing and dragging over freshly treated tissue is not a good idea, and it is one of the few situations where the answer is simply to wait.
Sources
Classical record
Sha Zhang Yu Heng - chapter not confirmed
The best known of the Qing-era texts on sha conditions, the literature in which scraping as a named practice is documented. The work is organised by sha presentation rather than by numbered chapters, and the chapter reference could not be confirmed for this page; it is cited for the origin of the practice, not for any facial cosmetic use.
Clinical studies
- Ahn SH, Hwang UJ, Han HS, et al. 2025. Comparative Effects of Facial Roller and Gua Sha Massage on Facial Contour, Muscle Tone, and Skin Elasticity: Randomized Controlled Trial.. Journal of Cosmetic Dermatology. PMID: 40439289. Randomised controlled trial, gua sha versus facial roller, 8 weeks; 34 women aged 20 to 50; limits: No untreated control group; instrumental outcomes; 8-week follow-up only
- Nielsen A, Knoblauch NT, Dobos GJ, et al. 2007. The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects.. Explore. PMID: 17905355. Pilot study, single treatment, laser Doppler imaging; 11 healthy adults; limits: Treatment on the back, not the face; no clinical outcome; staff volunteers
- Hamp A, Anderson J, Laughter MR, et al. 2023. Gua-sha, Jade Roller, and Facial Massage: Are there benefits within dermatology?. Journal of Cosmetic Dermatology. PMID: 36170573. Letter; not applicable; limits: Opinion piece, no data
- Marion T, Cao K, Roman J. 2018. Gua Sha, or Coining Therapy.. JAMA Dermatology. PMID: 29998311. Dermatology overview; not applicable; limits: Not a study; describes the practice and the marks it can leave
- Chu YD, Chu EC. 2026. Mechanisms Underlying the Beneficial Effects of Scraping Therapy: A Review of Articles.. Cureus. PMID: 42729907. Narrative review; not applicable; limits: No primary data; not facial