Safety for Gua sha (press-stroking) and Baguan (cupping)

With Gua sha and Baguan there is risk of exposure to and transfer of blood borne pathogens for the patient and practitioner. Currently there are no reports of complications related to Gua sha other than the risk of misdiagnosis by physicians. There are reports in the literature of transfer of herpes simplex to a patient treated with acupuncture and dry cupping. Blood cells are extravasated with both Gua sha and Baguan, and therefore standards for disinfection must follow. It is recommended to consider decontamination staging, sequencing of procedure and decontamination/sterilization process itself. If intending to re use instruments high level disinfection is necessary where there has been incidental exposure to fluids or blood; sterilization is required for instruments with apparent blood and fluids as in wet-cupping. Alcohol, chlorine bleach or 'washing in a dishwasher' are not sufficient.

Decontamination Staging

Set up an area to disinfect or sterilize in a practice or school:

  • Create a staging area for disinfection away from patients so soiled instruments are not mixed with patient-ready instruments.
  • Keep the area decontaminated with a hospital grade surface decontaminant.

Sequencing steps for Gua sha in practice

Wash hands before touching patient to palpate or needle

  • Glove to remove needles
  • Separate a portion of lubricant for a patient or use a pump dispenser
  • Apply lubricant and perform Gua sha preferably with a disposable metal cap*
  • Use paper towel to remove excess oils
  • Remove and dispose of gloves
  • Always provide a Gua sha handout

Procedure to disinfect or sterilize

  • Wash instruments with soap and water in staging area
  • Immerse instruments in 7.5 % Hydrogen peroxide solution: Sporox® II Sterilizing and

Disinfecting Solution

· 30 minutes: high level disinfection

· 6 hours: complete sterilization

[Note: hydrogen peroxide sold in pharmacies is not strong enough at 3%]

*Cow or water buffalo horn instruments will degrade from disinfection and should not be re used.
Plastic instruments may also pit and degrade and are not recommended for reuse.


For Gua sha, you can also dispose of instruments (caps) after one use. One would still

  • Glove during procedure
  • Wash instrument with soap and water immediately after use
  • Dispose of Gua sha instrument

Click here for a PDF of this information.

Click here for a Gua sha Patient Handout in English. (PDF)

Jung Y-J, Kim J-H, Lee H-J et al. A herpes simplex virus infection secondary to acupuncture and cupping. Ann Dermatol. 2011;23(1) (February):67-69.

Nielsen A. Gua sha, A Traditional Technique for Modern Practice. 2nd edition. Churchill Livingstone, Elsevier. Edinburgh, 2012.

Nielsen A, Kligler B, Koll BS. Safety protocols for Gua sha (press-stroking) and Baguan (cupping). Complement Ther Med. 2012;20(5) (October):340-344.