Gua Sha (Scraping Therapy) for Spasticity After Stroke: Systematic Review and Meta-Analysis of RCTs with Integrated Preclinical Mechanistic Synthesis.

​Emerging clinical data from Chinese randomized controlled trials (RCTs) suggest Gua Sha (scraping therapy) may deliver adjunct antispastic benefits for spasticity after stroke (SAS) when combined with standard rehabilitation. This study aimed to synthesize clinical efficacy evidence and explore treatment parameters for this intervention. We searched eight electronic databases from database inception to January 1, 2026; two independent reviewers completed study screening, risk-of-bias assessment using Cochrane Risk of Bias 2.0 tool, and data extraction. Meta-analytic effect sizes were calculated using mean difference (MD), and the review protocol was preregistered on PROSPERO. Sixteen eligible RCTs enrolling 1227 stroke survivors were included, all conducted in China, which may limit the external transferability of our results. Pooled random-effects estimates indicated that add-on scraping therapy was associated with reduced Modified Ashworth Scale and Visual Analog Scale for Pain (VAS-P) scores, lower serum hs-CRP and Hcy, as well as improved motor function and activities of daily living. Grading of Recommendations Assessment (GRADE) rated the certainty of evidence for all outcomes as very low due to high heterogeneity, methodological limitations, suspected publication bias and limited cross-regional data. Exploratory subgroup analyses identified numerically larger spasticity relief in regimens with 5-day treatment intervals, 1.5-month treatment duration and intensive scraping stimulation. These cross-study comparisons generate preliminary hypotheses awaiting verification through dedicated head-to-head dosing trials. Proposed mechanistic pathways linking scraping therapy to symptom relief rely largely on preclinical evidence, including enhanced local microcirculation and modulation of inflammatory and neural signaling. Current evidence supports scraping therapy as an investigational adjunctive strategy for SAS. Given the low-certainty evidence base and lack of inclusion in international rehabilitation guidelines, this therapy should be evaluated only in clinical settings with certified practitioners and standardized adverse event monitoring. Further well-designed RCTs are required to clarify its long-term therapeutic benefits and complete safety profile.