Table of Contents

CONTENTS
Chapter 1 Literature Review of GUASHA 1
1.1 Know the GUASHA Therapy 2
1.2 Possible Physiological Mechanisms of Changes in Musculoskeletal， Cardiovascular，Neurological， Hormonal， and Immune Systems During Weightlifting Training 11
1.3 The Possible Physiological and Biochemical Mechanisms by Which GUASHA Therapy Treats the Diseases 18
1.4 GUASHA May Help Weightlifting Training in Neural and Psychological Mechanisms 25
1.5 RPE and HRV 28
Chapter 2 GUASHA Background and Rationale for Improving the Recovery of Weightlifting 30
2.1 Background and Rationale 31
2.2 Scope of the Study 32
2.3 Research Questions 33
2.4 Objective of This Study 33
2.5 Definition of Terms 33
2.6 Significance of the Study 34
2.7 Conceptual Framework of the Study 34
Chapter 3 Methodology on GUASHA Intervention: A Randomized Controlled Trial About Improving the Recovery of Weightlifting Training 35
3.1 Standardization of GUASHA Therapy 36
3.2 Main Study 38
Chapter 4 Study Results and Discussion on GUASHA Intervention 51
4.1 Main Study Results 52
4.2 Discussion 61
Chapter 5 Summary on the Effects of GUASHA Improving the Recovery of Weightlifting Training 69
5.1 Summary 69
5.2 Conclusion 69
References 70
Appendix A Questionnaire 78
Appendix B Certificate of Guasha Therapist 79
Appendix C Certificate of Ethical Approval of the Khon Kaen University Ethics Committee for Human Research 80
Appendix D Data Collection Form， Subject Information Form and Consent Form 83
Appendix E Additional Form 92
Appendix F Additional Data 96
Appendix G Preliminary Study 103
1. Methodology of Preliminary Study 104
2. Results of Preliminary Study 107
3. Discussion for Preliminary Study 111
4. Summary 112
Appendix H Research Publications 114
Effect of scraping therapy on weightlifting ability 116
Effects of GUASHA on heart rate variability in healthy male volunteers under normal condition and weightlifters after weightlifting training sessions 125
1. Introduction 126
2. Materials and Design 126
3. Results 128
4. Discussions 129
5. Conclusions 132
Guasha improves the rating of perceived exertion scale score and reduces heart rate variability in male weightlifters: a randomized controlled trial 136
List of Tables 149
List of Figures 151
List of Abbreviations 153

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Chapter 1 Literature Review of GUASHA
In this chapter， relevant research topics have been reviewed.
1.1 Know the GUASHA Therapy
1.1.1 What is GUA?
1.1.2 What is SHA?
1.1.3 What are the instruments for applying GUASHA?
1.1.4 Theory of GUASHA therapy
1.1.5 Principles and process of GUASHA
1.1.6 Curative effects of GUASHA
1.1.7 Contraindications of GUASHA therapy
1.2 Possible Physiological Mechanisms of Changes in Musculoskeletal， Cardiovascular，Neurological， Hormonal， and Immune Systems During Weightlifting Training
1.2.1 Normal weightlifting training
1.2.2 Musculoskeletal system
1.2.3 Cardiovascular system
1.2.4 Neurological system
1.2.5 Hormonal system
1.2.6 Immune system
1.3 The Possible Physiological and Biochemical Mechanisms by Which GUASHA Therapy Treats the Diseases
1.3.1 The GUA
1.3.2 Gua can translate information by Jing Luo in the vitro-vivo in the body based on TCM
1.3.3 The liniment
1.4 GUASHA May Help Weightlifting Training in Neural and Psychological Mechanisms
1.4.1 Neural mechanisms of GUASHA therapy may help weightlifting training
1.4.2 Psychological mechanisms of GUASHA therapy may help weightlifting training
1.5 RPE and HRV
1.5.1 RPE as a marker on monitoring training
1.5.2 HRV as a marker to monitor the physical conditions
1.1 Know the GUASHA Therapy
1.1.1 What is GUA?
The GUA means scraping. There are three types of scraping in TCM (traditional Chinese medicine) based on the amount of pressure applied on the skin: mild， moderate， and severe. Correct scraping methods can enhance the therapeutic effect and shorten the healing time. Mild and moderate scraping techniques are often used for health promotion. Whereas mild， moderate and severe scraping are often combined for treatment of many kinds of diseases. The direction of scraping technique in GUA is based on different patient’s needs. In general， the direction and sequence of scraping is always from top to down， from back and waist to the chest and abdomen， and from the body to the limbs. Definitive scraping technique in GUA covers the head， neck， shoulder， back， waist， chest， abdomen， upper limbs， and lower limbs (Yang and Wang， 2011; Zhang and Hao， 2000; Chinese Labor Laws and Social Insurance， 2009). In order to get effective treatment， the proper method of holding the scraping plate requires that the plate angle should be less than or equal to 45 degrees， as demonstrated in Figure 1.1-Figure 1.3 (Yang and Wang， 2011).
Figure 1.1 Method of Holding Plate (Yang and Wang， 2011)
Figure 1.2 Angle of the Scraping (Yang and Wang， 2011)
Figure 1.3 Direction of the Scraping (Yang and Wang， 2011)
1.1.2 What is SHA?
The SHA is the skin reaction resulted from the dilation of capillaries due to the pressure of the scraping plate. However， there are differences between the SHA and the normal bleeding wound， since there is no blood coming out of the skin for the SHA (Figure 1.4) (Zhang， 2009). It is believed that miliary cutaneous bleeding with different colors and shapes may appear at the treated location after scraping due to different conditions of disease. The colors can be flush-red， crimson-red， purplish-red， purple or purplish-black; the bleeding may be sparse， dense or spotty， even phlyctenoid if there is heavy dampness; and the patient will have an obvious feverish feeling on the skin during the scraping (Figure 1.5) (Yang and Wang， 2011).
Figure 1.4 Normal SHA (Yang and Wang， 2011)
Figure 1.5 SHA as Seen in Electron Microscope (Zhang and He， 2000)
How to get the SHA with the scraper? During the scraping， the gap junction is bigger between the cells of the vascular wall due to extrusion of scraping. This could make the erythrocytes come out of the vessels when the skin is scraped. The vascular wall then gradually gets back to the original condition while no scraping applied for a few days. Therefore it is thought that the SHA is a kind of blood with some endotoxins that come out of the blood vessel. The metabolites that accumulate in the capillaries when the person is ill are known as endotoxins. These endotoxins may reduce the normal capability of tissue in the exchange of substance， blood circulation， and cause vasopermeability dysfunction. The microcirculation， vasopermeability， and blood circulation could be improved when the endotoxins are eliminated by scraping (Figure 1.6).
Figure 1.6 A Model of SHA (Zhang and He， 2000)
1.1.3 What are the instruments for applying GUASHA?
The instruments for scraping could be special plates and combs made of buffalo horn， jade， or stone (Figure