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Capital source: Second Traditional Chinese Medicine Hospital by: Guangdong Basic and Applied Basic Research Foundation (2023A1515220116); Special Fund for the Transformation of Scientific and Technological Achievements in the Guangdong-Hong Kong-Macao Greater Bay Area Life and Health Innovation Zone (GBALH202309); Guangdong Province Liu Yue Famous Traditional Chinese Medicine Studio (Yue Zhong Yi Ban Han [2023] No. 108).

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	<li>Hou MH, Yu YJ, Liu Y, Bao DX. Study on the application effect of warm-unblocking Gua Sha in hypertension patients with phlegm-stasis internal obstruction. Nurs Rehabil. 2023;22(7):19-22.</li>
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	<li>Gong Y, Guo CF, Wang DM. Observation on the curative effect of scraping the Back-Shu functional zone combined with head scraping in treating chronic fatigue syndrome. Guid J Tradit Chin Med Pharm. 2021;27(4):[pages unavailable].</li>
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The authors declare no competing interests.

The present protocol describes a standardized copper Bian-stone Gua Sha procedure for application in human subjects with chronic fatigue syndrome (CFS). In the execution of this protocol, changes in Fatigue Severity Scale (FSS) scores, TCM syndrome scores, and SF-36 domain scores were recorded between pre- and post-intervention time points in the 20-subject cohort. The observed differences are presented as representative data to illustrate the protocol&#39;s procedural flow and outcome documentation, rather than to estab...

Chronic fatigue syndrome (CFS) is a clinical condition characterized by persistent or recurrent fatigue lasting six months or longer that is not substantially alleviated by rest and cannot be explained by an underlying medical condition1. The global prevalence of CFS has been reported to be increasing, and prolonged fatigue may contribute to functional impairment across multiple physiological systems2.
Current pharmacological interventions for CFS are primarily symptomatic and include anti-fatigue agents and low-dose antidepressants; however, long-term use may be associated with adverse effects such as gastrointestinal discomfort and dependency3. As a result, non-pharmacological approaches, including certain Traditional Chinese Medicine (TCM) external therapies, have been explored as alternative or adjunctive options. Gua Sha is a TCM technique that involves instrument-assisted scraping of the skin along designated meridian pathways. The use of copper Bian-stone scrapers introduces specific material properties, such as thermal conductivity, that differ from traditional tools made of horn or jade.
This protocol describes a standardized copper Bian-stone Gua Sha procedure for application in human subjects with CFS. The aim is to provide a detailed, step-by-step framework covering material preparation, acupoint localization, scraping technique, pressure calibration, and safety monitoring. The protocol emphasizes reproducibility and is intended for use in clinical research settings where a consistent, well-documented external intervention is required.
(Note: This study focused on the relationship between syndrome homogeneity and therapeutic efficacy; the age and gender distribution of individual patients were not systematically recorded or analyzed. All efficacy was based on the entire enrolled population = 20.)

<table><tbody><tr><td>Alcohol,75% medical grade</td><td>Guangdong Province Guangning County Shunning Glucose Pharmaceutical Co., Ltd.</td><td>N/A</td><td>CAS 64-17-5;thanol concentration 75% &amp;plusmn; 1% (v/v); Medical disinfectant grade</td></tr><tr><td>Copper Bian-stone scraper</td><td>Liaoning Province Xiangsha Health Management Consulting Co., Ltd.</td><td>Model:H62(C28000)</td><td>H62 brass alloy (copper content &amp;ge; 61.2035%); Dimensions: 180 mm &amp;times; 40 mm &amp;times; 4 mm; Weight: 160 &amp;plusmn; 5 g; Edge radius: 2 mm; Surface treatment: polished</td></tr><tr><td>Cotton balls,sterile</td><td>Guangzhou Haozheng Medical Devices Co., Ltd.</td><td>N/A</td><td>Medium size (approximately 0.3 g per ball); 100% medical-grade absorbent cotton; Autoclave sterilized</td></tr><tr><td>Examination gloves,disposable</td><td>Guangdong Feiyang Medical Supplies Co., Ltd.</td><td>Type B (Powder-Free Matte Surface)</td><td>Made of natural rubber latex, powder-free; Size: S (small); Non-sterile; Single use only.</td></tr><tr><td>Forceps,medical&amp;nbsp;</td><td>Shanghai Jinzhong Medical Equipment Co., Ltd.</td><td>N/A</td><td>Stainless steel; Length: 12.5 cm; Straight tip with serrated grip</td></tr><tr><td>Gua Sha oil</td><td>Nanjing Tongren Hospital Pharmaceutical Co., Ltd.</td><td>N/A</td><td>Ingredients: Vegetable oil-based (CAS No. 8007-08-7, 8022-37-5), with a mixture of natural essential oils added at no more than 1%;viscosity:approximately 15 mPa&amp;middot;s at 25 &amp;deg;C;dosage per use: Approximately 5 mL</td></tr></tbody></table>

a standardized copper bian-stone gua sha protocol for treating chronic fatigue syndrome in human subjects

A Standardized Copper Bian-Stone Gua Sha Protocol for Treating Chronic Fatigue Syndrome in Human Subjects

Chronic fatigue syndrome (CFS) is characterized by persistent, unexplained fatigue lasting six months or longer. This protocol describes a standardized copper Bian-stone Gua Sha procedure for application in human subjects with CFS. The procedure targets the Governor Vessel (from Dazhui DU14 to Yaoyangguan DU3) and the Bladder Meridian (from Feishu BL13 to Shenshu BL23). A copper Bian-stone scraper is used to apply light scraping along the meridians at approximately 5 cm/s, with moderate pressure applied for 30 s at Back-Shu points (Pishu BL20, Weishu BL21, Shenshu BL23). Scraping continues until uniform petechiae (sha) appear or 10 strokes per segment are completed. Sessions last approximately 20 min and are performed twice weekly for two weeks. Pre- and post-intervention assessments include the Fatigue Severity Scale (FSS), a TCM syndrome score, and the SF-36 Health Survey. Representative changes in these scores are documented to illustrate protocol execution. This protocol emphasizes standardized acupoint localization, pressure calibration, and safety monitoring to facilitate reproducibility in clinical research settings.

This study describes a copper Bian-gua-sha scraping treatment protocol for chronic fatigue syndrome with a Phlegm-Dampness and Blood Stasis pattern(Figure 5). A total of 20 patients who met the inclusion criteria were enrolled and completed the trial. All patients were diagnosed using uniform criteria the identical Gua Sha therapy protocol was performed by the same practitioner. Evaluations using the Fatigue Severity Scale SF-36 Health Survey the TCM Syndrome Score were conducted for all pat...

This protocol describes a standardized, step-by-step procedure for performing copper Bian-stone Gua Sha in human subjects diagnosed with chronic fatigue syndrome. The technique involves the application of a copper alloy scraper to specific meridian pathways (Governor Vessel and Bladder Meridian) and designated acupoints. Representative pre- and post-intervention observational data are included to illustrate the procedural workflow and data collection methods.

Chronic fatigue syndrome (CFS) is characterized by persistent, unexplained fatigue lasting six months or longer. This protocol describes a standardized ...

This protocols describe a standardized step-by-step procedure for performing copper Bian-Stone Gua Sha in human subjects diagnosed with chronic fatigue syndrome. This protocol offers a non-pharmacological procedure alternative that may avoid certain limitations associated with long-term pharmacotherapy. To begin, explain the procedure, expected sensations, and potential skin changes to the participant with a clinical diagnosis of chronic fatigue syndrome.Confirm that they are not excessively hungry, full, fatigued, or stressed, and schedule the procedure one to two hours after a meal. Inspect the treatment site and exclude any areas with ulceration, infection, active dermatitis, open wounds, bleeding, severe bruising, or other unsafe skin findings. Position the participant in a seated posture with an approximately 15 degree forward lean, and place the participant's arms on a padded support.Expose the posterior trunk region selected for scraping and drape all other areas with a blanket to maintain warmth and privacy. Determine the acupoint locations according to the Chinese national standard for nomenclature and location of meridian points. Select and measure the Governor Vessel and bilateral Bladder Meridian acupoints using the finger con method and vertebral landmarks.Using medical forceps, hold a sterile cotton ball and disinfect the skin three times from Dazhui to Yaoyangguan and along the bilateral Bladder Meridian lines with 75%alcohol. After the skin dries, apply approximately five milliliters of Gua Sha oil evenly over the target area. Hold the sterilized copper Bian-Stone scraper at a 45 degree angle to the skin surface.Begin at Dazhui and apply the light scraping technique along the spinal midline toward Yaoyangguan at approximately five centimeters per second. Repeat the downward scraping motion 10 times along the Governor Vessel. Increase pressure briefly to a moderate level at the Dazhui for 30 seconds, and then at the Yaoyangguan for 30 seconds.Monitor participant discomfort continuously using a 0 to 10 visual analog scale, and do not exceed a participant reported pain score of 4. Reduce the pressure immediately when the pain score exceeds 4. Proceed to the bilateral bladder meridian lines.Begin at Feishu, and scrape downward from Feishu to Shenshu, applying the light scraping technique along the meridian. Then apply moderate pressure for 30 seconds each at Feishu, Weishu, and Shenshu. Repeat the scraping sequence 10 times on each side of the spine.Continue scraping until uniform petechiae or sha appear at a density of 10 to 15 petechiae per square centimeter or until 10 strokes per segment are completed. And check the skin to avoid excessive sha formation. Discontinue scraping once the defined endpoint is reached, and limit the total session duration to approximately 20 minutes.Perform the procedure two times per week for two consecutive weeks. If the participant develops any concerning symptoms, stop the procedure immediately and position the participant supine on a bed. Assess the participant's breathing, level of consciousness, and vital signs if an adverse reaction occurs.And confirm that oral intake is safe before administering fluids. Offer 200 milliliters of warm water containing 10 grams of glucose when the participant is conscious, able to swallow safely, and has no glucose-related contraindication. After completion, gently wipe the residual oil from the skin with a soft cloth and inspect the treated skin for excessive irritation, bleeding, blistering, or other abnormal findings.Advise the participant to keep the scraped area warm and avoid exposure to wind or cold water for four to six hours. Finally, document the treatment details, participant response, adverse events, and post-treatment instructions. 20 participants meeting the inclusion criteria completed the intervention protocol.Uniform light red to purplish petechiae were visible along the Bladder Meridian lines after the treatment. After the two-week protocol, the Fatigue Severity Scale score and the Traditional Chinese Medicine Syndrome score decreased significantly. The short form 36 health survey scores changed significantly after the treatment.Key considerations during the procedure include accurate acupoint location, pressure calibration, and safety monitoring to ensure reproducibility and patient safety in clinical research settings. This study may provide a framework for investigating interventions, then address both physical and mental dimensions of fatigue related conditions.

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Research

JoVE Journal

Medicine

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The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine.  This protocol describes a standardized, step-by-step procedure for performing copper Bian-stone Gua Sha in human subjects diagnosed with chronic fatigue syndrome. The technique involves the application of a copper alloy scraper to specific meridian pathways (Governor Vessel and Bladder Meridian) and designated acupoints. Representative pre- and post-intervention observational data are included to illustrate the procedural workflow and data collection methods.

A Standardized Copper Bian-Stone Gua Sha Protocol for Treating Chronic Fatigue Syndrome in Human Subjects

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