THERAPIES & TRADITIONS · GUIDE
Cupping, Gua Sha and Tui Na Compared
How cupping, gua sha and tui na differ in what a practitioner does, what research found for each, and the skin and injury risks to know before booking.
Content last updated . This page has not been medically reviewed.
Back to Traditional Chinese MedicineThree hands-on methods from Chinese medicine
Cupping, gua sha and tui na are listed together as non-drug approaches in Chinese medicine, alongside acupuncture and moxibustion. [1] They are different treatments with different risks. This page compares them in general terms. It does not teach how to do them, and none of them should be tried at home without training. For each one see Cupping Therapy, Gua Sha and Tui Na.What a practitioner does
| Cupping | Gua sha | Tui na | |
|---|---|---|---|
| In brief | Suction on the skin using a cup of glass, ceramic, bamboo or plastic [2] | The body surface is press-stroked with a smooth-edged instrument to intentionally raise petechiae (tiny red marks) [3] | Tuina, a form of manual therapy (massage) [4][1] |
| Marks on the skin | Temporary marks [2] | Petechiae are intended, as above [3] | Not described in the sources read |
| Variants | Dry cupping does not pierce the skin; in wet cupping the skin is pierced and blood flows into the cup [2] | Not described in the sources read | Not described in the sources read |
What research found
| Method | What the source found | Strength |
|---|---|---|
| Cupping | NCCIH: some research, most of low quality; may help reduce pain but evidence is not very strong; not enough to draw conclusions for other conditions [2] | Insufficient to limited |
| Gua sha | A German open randomized trial of 48 people with chronic neck pain compared one gua sha treatment with a heat pad; neck pain was lower after one week with gua sha; the authors said long-term value was unclear [3]. A 2026 meta-analysis of 16 trials (1,227 stroke survivors, all in China) of add-on scraping for spasticity rated certainty of evidence as very low [5] | Promising but limited (small, short, unblinded); very low certainty for stroke |
| Tui na | A 2023 meta-analysis of 15 randomized trials (1,390 people) for chronic low back pain found significant effects on pain and physical function, but not on quality of life; quality of evidence was low and only six studies reported adverse events, none serious [4] | Low-certainty, promising for back pain |
Because a hands-on treatment cannot be hidden from the person receiving it, expectation can raise results. The gua sha trial was open (not blinded). [3] Proper evidence for many other claimed uses was not found in the sources checked (NCCIH, PubMed reviews).
Choosing between them
There is no evidence-based ranking. Practical questions matter more: what is the problem, does the practitioner explain what marks or soreness to expect, is equipment single-use or sterilized, and is the practitioner trained and credentialed where you live?Frequently asked questions
Which is best for back or neck pain?
No head-to-head ranking was found. Tui na has low-certainty trial support for chronic low back pain; a small gua sha trial showed short-term neck-pain benefit; cupping evidence is weak. [4][3][2]
Why does cupping leave marks?
Cupping leaves temporary marks on the skin; they are not a measure of whether it worked. [2]
Is gua sha the same as cupping?
No. Cupping uses suction; gua sha uses stroking with a smooth-edged tool. [2][3]
Is tui na painful or risky?
This page found limited safety data: some trials reported adverse events, none serious in the review. [4]
Can I do these at home?
Training matters, particularly for cupping, where burns and infection are documented. [2]
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Risks compared
- Cupping: NCCIH lists persistent skin discoloration, scars, burns and infections, possible worsening of eczema or psoriasis, and rare severe events such as bleeding inside the skull after scalp cupping and anemia after repeated wet cupping. Equipment used on more than one person without sterilization can spread hepatitis B and C. [2] See Moxibustion and Cupping Risks.
- Gua sha: in the neck-pain trial it was safe and well tolerated, but the bruise-like marks are part of the treatment. [3] Facial tools and skin issues are covered at Facial Gua Sha and Gua Sha Tools.
- Tui na: adverse events were reported in only some trials and none were serious in that review. [4]
- Marks look like injury: tell any health care provider the origin of cupping marks so they are not mistaken for signs of physical abuse. [2]
Who should check first
Anyone with skin conditions, a bleeding disorder, pregnancy, or a medical problem in the area to be treated should talk with their clinician before any of these. See Who Should Avoid Moxibustion, Cupping and Gua Sha. Do not use hands-on therapy to delay care for new or worsening pain, numbness or weakness.
References
- National Health Commission of the People's Republic of China. White paper on traditional Chinese medicine in China: characteristics. Read 2026-10-22.
- NCCIH (US). Cupping. Read 2026-10-22.
- Lauche R, et al. Effectiveness of traditional Chinese gua sha therapy in patients with chronic neck pain: a randomized controlled trial. Pain Medicine 2011. PubMed 21276190. Read 2026-10-22.
- Efficacy and safety of Tuina for chronic nonspecific low back pain: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2023. PubMed 36862888. Read 2026-10-22.
- Gua Sha (scraping therapy) for spasticity after stroke: systematic review and meta-analysis of RCTs. Journal of Visualized Experiments 2026. PubMed 42858090. Read 2026-10-22.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.