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In the last decade, research has begun to clarify how gua sha works. Gua sha’s therapeutic petechiae represents blood cells that have extravasated in the capillary bed, and measure as a significant increase in surface microperfusion. As this blood is reabsorbed, the breakdown of hemoglobin upregulates HO-1, CO, biliverdin and bilirubin, which are anti-inflammatory and cytoprotective. Studies show the anti-inflammatory effect of gua sha has a therapeutic impact in inflammatory conditions, such as active chronic hepatitis, where liver inflammation indicates organ breakdown that over time can lead to premature death [8]. The physiology of HO-1 may also explain gua sha’s anti-inflammatory effect in other responsive clinical conditions, such as fever, cough, asthma, bronchitis, emphysema, mastitis , gastritis, musculoskeletal and other painful conditions presenting as neck pain [13], back pain, migraine, postherpetic neuralgia, and others. That gua sha has anti-inflammatory and immune stimulation properties is important for providers to understand and to be able to communicate to their patients as well as other health care providers.