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CAO GIO (Coin Rubbing or Coining)
by Lan Pich
What is it? Who practices it?
Over the years, there have been mass migrations of Southeast Asians to the United States who have brought along with them their traditional ideas of health and forms of healing. One of the most common folk remedies practiced among the Southeast Asians is cao gio. Regardless of the availability of western biomedicine, cao gio continues to be a popular form of alternative medicine practiced among these ethnic groups.
Cao gio, also called coin rubbing or coining, is a dermabrasive therapy used to relive a variety of illnesses such as aches, pains, fevers, colds, cough, nausea, abdominal pain, chills and symptoms related to changes in the weather (Ostensen).
Christian Ostensen, http://www.ouraim.cnc.net/GuaSha.html
Cao gio involves an oil or ointment and a coin. Balms or oils such as tiger balm or liquid herbal medicines containing camphor, methanol, winter green oil, eucalyptus oil, peppermint oil, and cinnamon oil are most commonly used (Sullivan, 2005). The skin is first lubricated with a balm or oil and the coin is rubbed firmly and repeatedly in a linear pattern until blood appears under the skin. These skin abrasions are usually generated along the spine and ribs (Sullivan, 2005). The technique is considered effective when it produces prominent marks and these marks usually only last a few days.
Tara Sullivan, http://altmed.creighton.edu/coining/default.htm
How does it work?
Cao gio is translated as “catch the wind.” Illnesses are believed to be caused by an excess of “wind,” and coining is believed to release the excess “wind” and restore balance to the body. To better understand this concept of “wind,” an understanding of the Southeast Asian cultural beliefs in health and medicine must be first established. There are a variety of beliefs and practices among the different ethnic groups; however, there is a common theme in their medicinal beliefs and practices that originates from the Chinese concept of yin and yang (Sullivan, 2005). The belief states that the universe consists of opposing elements that are held in balance. Illnesses are interpreted as a disruption of this balance. Thus, health practices attempt to restore balance between these opposing elements. According to Lance Rasbridge, “the imbalance can be a result of physiological state, such as pregnancy or fatigue, or it could be brought on by intrinsic factors like diet or over exposure to ‘wind,’ one of the body forces or ‘humors’.” This excess of wind in the body can cause ailments such aches, pain, colds, etc. and can be treated by “releasing” wind from the body. Cao gio is believed to do just that by pulling the “wind” to the surface of the body and creating a pathway in which it could be released. The amount of “wind” is measured by the degree of redness that appears on the body after coining, which also measures the severity of the illness. If the red marks that appear are mild, the illness is believed to be minor because there is a small amount of excess wind in the body and vice versa.
Tara Sullivan, http://altmed.creighton.edu/coining/default.htm
Lance Rasbridge, http://www3.baylor.edu/~Charles_Kemp/vietnamese_health.htm
Effectiveness and Complications
The effectiveness of coin rubbing is a really complex issue. According to numerous alternative healthcare websites and articles, cao gio is safe and its efficacy is only verified by testimonials of Southeast Asians who practice this form of healing. An extensive search of scientific articles was done by Dr. Tara Sullivan and she found no articles that verified its effectiveness. Sullivan states, “coining is a cultural folk remedy with no basis in scientific evidence (Sullivan, 2005).” Even though coining has no scientific basis, there were numerous articles set up in websites that concern ethnomedicine and cultural relativity because coining has been highly criticized by western doctors.
I also attempted to find scientific articles on the subject of coining. The only articles available deal with complications associated with cao gio and the controversial issue of abuse due the misunderstanding of the red marks found on patients. Because of the lack of understanding and suspicion of its effectiveness among western physicians, there have not been any known attempts to conduct further research and only the failures tend to show up in medical records.
For more information on complications, see:
Amsh Amshel CE, Caruso D. (2002). Vietnamese ‘Coining’: A Burn Report and Literature Review. J Burn Care Rehabil 21(2), 112-114.
Davis R. (2000). Cultural Health Care or Child Abuse? The Southeast Asian Practice of Cao Gio. J Am Acad Nurse Practitioners 12(3), 89-95.
Rampini SK, Schneemann M, Rentsch K, Bachli EB. (2002). Camphor Intoxication After Cao Gio (Coin Rubbing). The Journal of the American Medical Association 288(1), 45. http://jama.ama-assn.org/cgi/content/full/288/1/45
1. Even though there is no evidence for its effectiveness, cao gio can be analyzed through another perspective. Coining uses balms and oils, such as tiger balm or other oils that contain camphor, that are absorbed trandermally when applied or rubbed against the skin with a coin. The effectiveness of cao gio to treat ailments such as aches and pains can be attributed to these balms and oils. Tiger balm is a topical analgesic that is believed to have a soothing action that relives aches and pain and is sold nationwide in pharmacies and health stores (http://www.tigerbalm.co.uk/ )A clinical study was done by Schatter and Randerson to test the efficacy of this product for the treatment of acute tension headaches. The study was a randomized, double blind study with a three-group comparison. Patients were recruited by newspaper advertisement and by general physicians who first subjected these patients to pre-treatment assessments. The three different groups were given either tiger balm, topical placebo, or paracetamol and the outcome was measured by self report on a scale basis. The results showed a statistically significant difference (p<0.05) in headache relief between tiger balm and placebo; however, there was no significant difference between tiger balm and paracetamol (Schatter and Randerson, 1996).
Schattner P, Randerson D. (1996). Tiger Balm as a Treatment of Tension Headache. A Clinical Trail in General Practice. Aust Fam Physician 25 (2), 216, 218, 220.
2. In addition, Hempel B, Kroll M, and Schneider did a study that involved the efficacy of camphor in hypotension and orthostatic circulatory disorders. Korodin Herz-Kreislauf, a herbal drug containing D-camphor, and an extract of hawthorn berries were tested against a placebo using a retrospective cohort study, which was performed in 46 medical practices in Germany. Four hundred and ninety healthy volunteers and patients between 11 and 102 years of age were recruited for this study. Three hundred and ninety-nine patients were treated with the test drug and 91 patients were treated with a control drug. Their files were later reviewed by physicians who assessed the improvement in symptoms. The data was controlled by using anonymous copies of the files and the heterogeneities in baseline conditions were adjusted. In conclusion, the test drug proved to be an effective form of treatment for orthostatic hypotension (Hempel, Kroll, and Schneider, 2005).
Hempel B, Kroll M, Schneider B. (2005). [Efficacy and safety of a herbal drug containing hawthorn berries and D-camphor in hypotension and orthostatic circulatory disorders/results of a retrospective epidemiologic cohort study.] Arzneimittelforschung, 55 (8), 443-50. German.
Camphor’s ability to improve blood pressures, as the study above shows, relates back to the belief that by releasing the excess wind, cao gio can improve circulation in the body.
3. Another perspective that can shed light on the effectiveness of coining is the placebo effect. Cao gio has been one of the most common forms of healing among Southeast Asians for a long time. Its effectiveness is firmly established among these cultural groups. Thus, the strong belief in its ability to heal and the outcome can be explained as a placebo effect. In addition, some of the illnesses that cao gio seeks to treat are minor ailments, such as colds and coughs, that are usually treated by the body’s natural defenses and the symptoms will eventually disappear if left untreated.
4. Another factor that affects the efficacy of cao gio is the combined use of western medicine. In particular, Vietnamese people view illnesses from a variety of perspective. Because they also recognize more “western” forms of disease causations, it is common for them to interpret their illness as an imbalance in the body in addition to an infective process (Rasbridge). Thus, cao gio is performed in addition to taking pain medications such as Tylenol or Aspirin and other western drugs according to the illness they wish to treat. (http://www3.baylor.edu/~Charles_Kemp/vietnamese_health.htm )
With all this said, is cao gio an effective form of healing? Unfortunately, there is not an answer to this question. Although the tiger balm and camphor oil studies provide some evidence on its effectiveness, there are too many external variables that prevent any conclusions from being drawn. On the other hand, the efficacy of cao gio cannot be denied because there is no solid evidence to dispute its curing powers. Through the alternative perspectives mentioned above, we can gain a better understanding of this cultural treatment and make our own assessments on its efficacy.
1. Amshel CE, Caruso D. (2002). Vietnamese ‘Coining’: A Burn Report and Literature Review. J Burn Care Rehabil 21(2), 112-114.
2. Davis R. (2000). Cultural Health Care or Child Abuse? The Southeast Asian Practice of Cao Gio. J Am Acad Nurse Practitioners 12(3), 89-95.
3. Hempel B, Kroll M, Schneider B. (2005). [Efficacy and safety of a herbal drug containing hawthorn berries and D-camphor in hypotension and orthostatic circulatory disorders/results of a retrospective epidemiologic cohort study.] Arzneimittelforschung, 55 (8), 443-50. German.
4. Ostensen, Christian http://www.ouraim.cnc.net/GuaSha.html
5. Rampini SK, Schneemann M, Rentsch K, Bachli EB. (2002). Camphor Intoxication After Cao Gio (Coin Rubbing). The Journal of the American Medical Association 288(1), 45. http://jama.ama-assn.org/cgi/content/full/288/1/45
6. Rasbridge, Lance http://www3.baylor.edu/~Charles_Kemp/vietnamese_health.htm
7. Sullivan, Tara http://altmed.creighton.edu/coining/default.htm
8. Schattner P, Randerson D. (1996). Tiger Balm as a Treatment of Tension Headache. A Clinical Trail in General Practice. Aust Fam Physician 25 (2), 216, 218, 220.
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