Ecchymoses From Spoon Scratching

February 2, 2005
Alexander K. C. Leung, MD
Alexander K. C. Leung, MD

A 7-year-old Chinese boy presented with fever, cough,and sore throat of 2 days’ duration. His temperature was38.3°C (101°F); heart rate, 85 beats per minute; andrespiration rate, 26 breaths per minute. The throat waserythematous but without any exudate. There weresmall cervical lymph nodes bilaterally. The chest wasclear.

A 7-year-old Chinese boy presented with fever, cough,and sore throat of 2 days' duration. His temperature was38.3C (101F); heart rate, 85 beats per minute; andrespiration rate, 26 breaths per minute. The throat waserythematous but without any exudate. There weresmall cervical lymph nodes bilaterally. The chest wasclear.Extensive ecchymoses were evident on his backand along his spine. The boy's mother acknowledgedthat the bruises were a result of spoon scratching, aChinese folk remedy. An antipyretic medication was prescribedfor the child. The fever subsided in 3 days andthe sore throat in 5 days. Culture of a throat swab wasnegative for bacteria.Spoon scratching (quat sha) is a Chinese folk dermabrasiontherapy used to "scratch the wind" (to rid thebody of "bad winds") and to relieve symptoms, such asfever and headache.1 Water or saline is applied to thesite of scratching, which is usually the back. The area isthen patted, pinched, or massaged until the skin turnsred.1,2 The skin is then scratched with a porcelainspoon until bruises appear. The resulting ecchymosesoften have a Christmas tree appearance. A similar procedure--coin rubbing (cao gio)--is popular in Vietnam,Cambodia, Thailand, Malaysia, and Indonesia.1,3 Withcoin rubbing, balsamic or mentholated oil replaceswater or saline and a coin replaces a spoon.1Spoon scratching is believed to improve health byblocking synaptic networks or by increasing circulationand relieving inflammation within the soft tissue.4 Regardlessof whether spoon scratching has a scientificrationale, the procedure is practiced by caring familieswith good intentions; it has a low incidence of adverseevents. As such, the practice is likely to continue.1,4Failure to recognize the cultural origins of spoonscratching or coin rubbing may result in a false accusationof child abuse.1,4 Suicide was reported when afalsely accused Vietnamese father was jailed for childabuse.55 Awareness of folk medicine is essential forhealth care professionals who practice in a multiculturalsetting.2

References:

REFERENCES:
1.

Leung AK. Ecchymoses from spoon scratching simulating child abuse. ClinPediatr (Phila). 1986;25:98.

2

. Leung AK. Ecchymosis from spoon scratching. Consultant. 1990;30:69.

3

. Hulewicz BS. Coin-rubbing injuries. Am J Forensic Med Pathol. 1994;15:257-260.

4

. Look KM, Look RM. Skin scraping, cupping, and moxibustion that may mimic