Ecchymoses From Spoon Scratching

A 7-year-old Chinese boy presented with fever, cough, and sore throat of 2 days’ duration. His temperature was 38.3^°C (101^°F); heart rate, 85 beats per minute; and respiration rate, 26 breaths per minute. The throat was erythematous but without any exudate. There were small cervical lymph nodes bilaterally. The chest was clear. Extensive ecchymoses were evident on his back and along his spine. The boy’s mother acknowledged that the bruises were a result of spoon scratching, a Chinese folk remedy. An antipyretic medication was prescribed for the child. The fever subsided in 3 days and the sore throat in 5 days. Culture of a throat swab was negative for bacteria. Spoon scratching (quat sha) is a Chinese folk dermabrasion therapy used to “scratch the wind” (to rid the body of “bad winds”) and to relieve symptoms, such as fever and headache.¹ Water or saline is applied to the site of scratching, which is usually the back. The area is then patted, pinched, or massaged until the skin turns red.^1,2 The skin is then scratched with a porcelain spoon until bruises appear. The resulting ecchymoses often have a Christmas tree appearance. A similar procedure— coin rubbing (cao gio)—is popular in Vietnam, Cambodia, Thailand, Malaysia, and Indonesia.^1,3 With coin rubbing, balsamic or mentholated oil replaces water or saline and a coin replaces a spoon.¹ Spoon scratching is believed to improve health by blocking synaptic networks or by increasing circulation and relieving inflammation within the soft tissue.⁴ Regardless of whether spoon scratching has a scientific rationale, the procedure is practiced by caring families with good intentions; it has a low incidence of adverse events. As such, the practice is likely to continue.^1,4 Failure to recognize the cultural origins of spoon scratching or coin rubbing may result in a false accusation of child abuse.^1,4 Suicide was reported when a falsely accused Vietnamese father was jailed for child abuse.⁵5 Awareness of folk medicine is essential for health care professionals who practice in a multicultural setting.²