Moxibustion - 1

8/10/2019 Moxibustion - 1

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MOXIBUSTIONPractical Considerations for Modern Use of an Ancient

Techniqueby Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

BACKGROUNDPractitioners of Chinese medicine usually receive limited training inmoxibustion therapy. The training is mainly comprised of presentation of a few

basic moxa techniques and a listing of some indications for use of moxibustion(e.g., to treat cold syndromes) and contraindications (e.g., in heat syndromes).The actual experience of utili ing moxibustion therapy is often confusing.Practitioners, patients, and others wonder about the smo!e emanating from themoxa in terms of safety as well as other impacts. Practitioners are left withoutmuch instruction as to how intensively to apply moxa to get the desired results."ometimes they are instructed to use moxa very mildly, with short duration,and infrequent administration in contrast to its actual use in China# and thereremain questions about its mechanism of action and how effective it is. Thisarticle reports on an exploration of the literature on moxibustion to help clarifysome of these matters. $t is an expansion on a section of a previous "T%&Tarticle from ' , Borneol, Artemisia, and Moxa . That article ma!es referenceto the herb material used for moxa (artemisia, also called mugwort) and one of its active components, borneol, which is isolated (provided in the form of crystals, called bingpian ) and commonly used in topical therapies for itsantiseptic and analgesic effects.

% primary source used for this literature survey was the *ournal of Traditional Chinese +edicine, published since ' in -nglish and reviewedthrough /. This 0ournal presents numerous articles on the various forms of traditional Chinese medicine practice, including a variety of techniques for acupuncture, moxibustion, cupping, blood1letting, therapeutic massage, as wellas internal medicine (herb prescriptions) and topical applications of herbs. The

0ournal includes articles that review techniques generally, as well as articles ontreatment of specific diseases, or uses of specific acupuncture points or herbs. %limitation of this review is reliance on -nglish language publications(translations from the Chinese), but an advantage is that readers will be able toexamine most of the referenced texts and articles.

RELATIVE POSITION OF MOXIBUSTION IN ACU-MOXIBUSTION
http://www.itmonline.org/arts/borneol.htmhttp://www.itmonline.org/arts/borneol.htm


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$n the case of harm caused by food, one should use moxa. $f the disease does not come to an end, it is essential to watchfor those conduits excessively filled with yang qi4 pierce therespective transporters several times and give herbs.

The situation where moxa fails, as described here, reveals some of thethin!ing about its effects. The harm caused by food is an accumulation, whichshould be dispersed by the warm moxa. The yang qi that the moxa treatment

bestows is the basis of the dispersing effect. 7owever, if the moxa fails todisperse the stagnation, then it has simply added a new excess, the yang qi, tothe former excess of yin. Therefore, the response must be to drain the channels

by blood1letting, so as to get rid of all the excesses.

The case of treating accumulation associated with food stagnation and coldenvironment is one of the few instances in the ancient literature where moxa is

recommended as the first therapy to try# in most instances, it is the resortshould acupuncture fail. This fact is mentioned in the boo! ChineseAcupuncture and Moxibustion ( ), with reference to the Neijing Lingshu aswell as a later text4

Chapter ;/ of the Lingshu states4 8% disease that may not betreated .), moxibustion goes unmentioned, even in the chapterson diseases of cold (' ). % monograph on the herb relied upon for moxibustion,artemisia ( Aiye Chuan ), published around '9 %.>. by @i Aenwen, was lost.$ts title is recorded, but nothing is quoted from it, not even in the BencaoGangmu , published later that century by @i8s son @i "hi hen, which carriedquotations from his other monograph on ginseng (/).

%fter the Chinese revolution in ' ? , a great reorgani ation of traditionalChinese medicine was underta!en. :ne of the first steps was to investigate andevaluate the traditional methods of acupuncture and moxibustion therapy. Theresults of such studies were published in a series of reports in the -nglishlanguage *ournal of Traditional Chinese +edicine in ' ?. $n the first article of


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the series (?), devoted to history of the practices, only the following was notedspecifically about moxibustion4

"ome fifty !inds of moxibustion methods have beensummari ed through research into ancient literature on

moxibustion. $n these


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long1term effective rate on follow1up examination for threeyears. :ther reports claim that scarring moxibustion maymar!edly lower blood pressure, reduce blood viscosity, anddilate various vessels.

These reports indicate that scarring moxibustion decreasesthe incidence of fulminant apoplexy by lowering blood pressure. :bservation over '; years of 9? cases of high blood pressure revealed that only 9 suffered from fulminantapoplexy after receiving scarring moxibustion, while ? out of ' in the control group did. These results of the therapy areobvious. -xperimental and clinical studies have pointed tofurther health benefits of scarring moxibustion. %n exampleis cases of asthma treated by purulent moxibustion inwhich ; . D were effective and .'D mar!edly effective.

%bnormal 5EC count in cases before treatment werecorrected in ' casesF.%nimal experiments have showedmoxibustion to mar!edly strengthen the immunity of theorganism.

6inally, it should be pointed out that although moxibustionhas been extensively used clinically, it has received far lessattention than acupuncture, a point deserving some thought.

:ne can ta!e note of the shift in therapeutic indications for moxibustionfrom accumulation (a type of excess) with cold to deficiency cold, wheremoxibustion is considered a means to tonify the deficiency. This shift mayreflect a change from using moxibustion as a one1time treatment for dispersionto use of it in repeated daily treatments, since tonification of deficiency oftenrequires prolonged therapy. "carring moxa, also called purulent moxa, is wheresevere blistering and ulceration of the site occurs (sometimes with unintendedinfection of the sore), resulting in formation of a scar. This method reflects thedominant form of moxibustion until very recently# for this reason, many writerstranslate moxibustion as Gcauteri ation.G $nstructions for moxa application inthe Chinese literature would typically involve repeated burning of numeroussmall moxa cones on the s!in directly, causing blistering or further damage.This type of moxa therapy is not discussed in any detail as part of 5esternacupuncture training because it is not allowable in 5estern practice.

The production of useful moxa rolls for indirect heating is a moderntechnological development, compared to the simple practice of forming moxawool into small cones by hand. +oxa rolls for indirect treatment wereintroduced at the end of the +ing >ynasty, but did not become common place


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until after ' 9 when factories were established that could turn out thousandsof them daily. "till, traditional doctors were used to employing the standardcones for direct moxa and many of them did not easily ma!e the transition tothis other method.

$n a report on scarring moxibustion presented at a conference in Eei0ing in, 5ang Henliang ( ') points out that4

+oxibustion sore paste must be applied immediately after the moxibustion in order to protect the in0ured s!in and

promote non1bacterial suppuration. $n one wee! after themoxibustion treatment, the exudate becomes more and thesore will suppurate graduallyFafter more than one month,the pus will disappear and the new flesh will grow, thein0ured s!in will get recovered with only slight scar

remaining. The patient must ta!e good rest after suppurativemoxibustion treatment and avoid heavy labor and abnormalemotions such as sadness and anger# the patient should alsota!e proper food, limit sexual life, and prevent exposure to

pathogenic cold or heat. +ore nutritious food should beta!en such as fresh meat, beans, and fresh vegetables# allthese foods help the recovery of the moxibustion sore andremove pathogenic factorsF.This therapy can treattuberculosis, bronchial asthma, arthritis, hiccup, facial

paralysis, and tuberculosis of the nec! lymph.

The author of the *ournal of Traditional Chinese +edicine review article brings up point that moxa is used extensively in Chinese clinics but receives far less attention than acupuncture. This comment no doubt refers to limitedreports of its use as a primary therapy and one can see from 5ang8s descriptionthat moxa treatment can sometimes be a rather serious ordeal, limiting its use inthe large hospitals from which most medical reports are generated. :ne canspeculate about other reasons for its infrequent mention in the literature. +ostarticles on acupuncture therapy report on complex treatment patterns involvingnumerous acupuncture points. 2eedles can be inserted one by one and then the

practitioner can perform manipulations on each, leaving them in place for 1/ minutes. +oxibustion is usually done on only one or two of the points in acomplex treatment pattern including acupuncture. %s a result, the main part of therapy is the needling, with moxa as a small portion of the treatment. $t isdifficult for the authors of reports on these treatments to ma!e the proclamationthat the therapy is based on moxibustion or that the outcome was reliant on themoxibustion portion of treatment.


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&elatively few diseases are treated by moxa alone or with it as the primarytherapy. Thus, little attention is given to this technique, in part, because itaccompanies acupuncture where the latter is used with more points and withmore specific manipulation. %rticles on moxibustion as the primary techniquetend to be short, and little is said about the point selection or method of applying the moxa. $n an article purporting to describe diseases effectivelytreated by moxibustion (??), three cases are singled out and only one of them(treatment of pterygium) involved moxa alone, the others (carpal tunnelsyndrome and throat neuralgia) involved moxa plus acupuncture.

$n fact, a search for clinical research on moxibustion in the *ournal of Traditional Chinese +edicine (in publication for more than years) revealedfew articles on moxibustion, and the ma0ority of the articles that mention thistechnique made use of it as a seemingly minor ad0unct to acupuncture therapy.%rticles that mention acupuncture and moxibustion in the title often are merelygiving the translation of zhenjiu , while the treatments described involveneedling only.

$n part / of the series reviewing acupuncture and moxibustion ( ), withfocus on the disorders the various techniques are considered useful in treating,moxibustion is specifically mentioned as successful for one application1correcting abnormal fetal position4

The success rate of moxibustion on zhiyin (E@1 ;) inchec!ing abnormal fetal position mar!edly exceeds the

figure for manual restoration reported abroad. Two to ?sessions sufficed, though cases with very loose or very tenseabdominal wall, with fixing of the fetal head below thesubcostal region, and with partial descent of the fetus into the

pelvic cavity were less successful or even ineffective.

The other reports summari ed in that review involve either acupuncturealone or Gacu1moxibustion,G referring to use of acupuncture and possibleinclusion of moxibustion in at least some of the treatments (with no mention of specific moxibustion techniques). % rare example of a report in which non1scarring moxibustion was used as a primary therapy for a chronic disease was

published in ' . $t involved ' / patients with coronary heart disease. 7ere isthe description of the technique, using moxa rolls4

The acupoints selected included neiguan (PC1 , bilaterally), shenzhong (CI1';), and xinshu (E@1'9 bilaterally). >uring treatment, the patient was in a lying position with full exposure of the acupoints. The ignited end


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of the moxa roll pointed directed toward neiguan (one side),with the burning end .91'. cun away from the s!in, for 9minutes until the patient had a warm but not burning feelingand the s!in color turned slightly red. Then, the same methodwas applied to neiguan of the other hand, shanzhong ,and xinshu (both sides), each for 9 minutes. The treatmentwas given once a day, times constituting one treatmentcourse. There was one day of a rest before the second courseof treatment started. The acupoints used for the control groupwere the same as for the moxibustion group, onlyacupuncture was used instead of moxibustionF.3sually, the

patients in both the moxibustion and control groups weregiven 91' courses of treatment, covering a period of '1months.

$n their summary, the authors, echoing the comment that moxibustion doesnot receive much attention, noted that4 G$n recent years most clinical andexperimental studies have proved that acupuncture with neiguan as the main

point has good therapeutic effect in the treatment of coronary heart disease#however, few reports on moxibustion in the treatment of this disease have beenseen.G They also noted that4 GThere is no significant difference between themoxibustion and acupuncture groups in their effects.G 3nfortunately, in theabsence of a placebo control, it is difficult to !now how much of the effectswere due to stimulation of the points and how much were due to other factorsnot specifically related to the treatment (such as responses usually attributed toGplacebo effectsG). The claimed benefits included relief of symptoms,improvement of -CJ, and lowering of blood pressure and blood lipids. $n thiscase, the authors suggested that the indirect moxibustion was preferred by

patients over acupuncture because of lac! of pain and discomfort (needling inChinese clinics is far more vigorous than in 5estern clinics). This is in contrastto the situation with direct moxibustion, which can be more painful thanacupuncture# the painful nature of the usual direct moxibustion beingmentioned in several texts.

The intensive moxibustion described in this clinical report where moxarolls were used contrasts with common practice in 5estern clinics.+oxibustion was given for 9 minutes at each point, with five points treated, for a total of 9 minutes of moxibustion and the treatment was given daily for / 1

days consecutively. 7eating was done until there was an obvious reddeningof the s!in. $n Acupuncture% A Co#prehensi&e Text ( ;), the importance of adequate heating is mentioned4 G% text of the King >ynasty, The 'olden


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Mirror of Medicine , explains4 85hen treating diseases with moxibustion, for there to be any effect, the heat must be sufficient to obtain the Ki.8G

$n another case of treating a chronic disease, herb1interposed moxibustionwas administered in the treatment of 7ashimoto8s thyroiditis ( ). Two groupsof points were selected for treatment on alternate days4 dazhui (JI1'?), shenshu (E@1 /), and mingmen (JI1?) made up one set# shanzhong (CI1';), zhongwan (CI1' ), and guanyuan (CI1?) were in the second set. -achtime, five cones of moxa, grams each, were burned continuously on each

point of the set. $n patients were treated daily, out patients were treated everyother day, with a total of 9 treatments for a course of therapy. +any of the

patients were said to have benefited in terms of symptoms and findings in blood tests with regard to thyroid hormones and antithyroid antibodies.

&eferences to the use of moxibustion have declined in recent issues of the

*ournal. Two very brief articles in recent issues described use of moxibustion, both by the herb interposed method, one with ginger, the other with garlic4

Jastroptosis (;)4 6irst, moxa was applied on a fresh ginger sliceon baihui (JI1 ) while the patient is sitting still and relaxing.5hen that part of the treatment is concluded, the patient liesdown, and moxa is applied to zhongwan (CI1' )and qihai (CI1 ). Treatment time was 0ust '9 minutes (9minutes per point), and the treatment was given once or twice aday. The patients were also given exercises to do daily toimprove strength of the abdominal muscles. %fter a '91daycourse of treatment, it was said that / of 9 cases were curedand that all other cases showed some degree of improvement.The authors stated that4 G baihui is a point of the governingchannel, which dominates yang of the whole body. +oxibustionon it can tonify qi and promote qi ascending in themiddle jiao . zhongwan and qihai of the conception vessel areselected as the essential local points. +oxibustion on these two

points may warm up the middle1 jiao , replenish qi, promoteascending of yang qi, so as to relieve the prolapse.G

%cute lymphagnitis (also called Gred1thread furuncle#G )4 %three1edge needle is used to let out blood at both ends of thefuruncle. Thin slices of garlic are placed on these two bloodletting points, and then moxa is applied. The therapy involved 'to / treatments, with claim of cure in all cases, most of themrequiring treatments.


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The second report involves moxibustion at a s!in lesion. This methodappears common in the practice of treating s!in disorders, as relayed in the

boo! Treat#ent of "xternal (iseases !ith Acupuncture andMoxibustion ('9), where this is the primary role of the moxibustioncomponent presented by the authors.

IS THE MOXA-WOOL IMPORTANT?5hile it is evident from most presentations on moxibustion therapy that theheat administered during the treatment is a !ey element in dealing with coldand stagnation, the question arises as to what must be used to produce the heat.%n explanation for use of moxa wool (shredded artemisia) is that it growseverywhere, so is cheap and easy to get, it readily holds its shape in cones, andits burning characteristics are ideal4 it burns slowly, stays lit, produces an evenheating, and has a pleasant fragrance ( ;). Eut entrance of moxa ingredientsinto the body doesn8t seem to be essential. $n Tibet, moxibustion was appliedwith a hot rod rather than burning moxa, and in China it is not uncommon to

put something between the moxa and the s!in (as in the cases above, withginger or garlic) so that any elements of the moxa smo!e are unli!ely to getinto the s!in. $n almost all 5estern practices and several of the modern Chinese

practices, the elements of the burning moxa mainly go into the air, very littlegets to the s!in. Thus, one would expect that heat is the aspect of moxa beingrelied upon.

2onetheless, some authors describe the value of moxa in relation to itsherbal nature. 7ere is what the authors of Chinese Acupuncture andMoxibustion ( ) have to say4

Artemisia vulgaris produced in Ki hou is !nown as the best!ind for moxa, as the climate and soil is good for its growth.The leaves of Ki hou Artemisia are thic! with much morewool


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meridians eliminating hundreds of diseases.8 Aang can beactivated by the %rtemisia leaf by virtue of its warm nature.The acrid odor


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circulation by entering the meridians. "imilarly, if one uses an interposingsubstance, the moxa ingredients are not going to penetrate the s!in (though avery tiny amount of the substance from the interposing material might). +ostmodern clinics are designed to vent the moxa smo!e or utili e air purifiers toeliminate as much of it as possible# this approach thus removes a large part of the inhaled smo!e with moxa ingredients that might serve a therapeuticfunction. 6urther, herbal moxibustion is sometimes substituted by heat lamps or other techniques that eliminate the artemisia altogether# a lotion of herb extracts(that may or may not include artemisia) can be applied to the s!in with heatdelivered through such lamps in an effort to provide both warmth and somelocal penetration of herb constituents.

$n China, an additional impact of moxibustion was to help sterili e theatmosphere of the rooms in which it was being used# until recently, Chinesehospitals were not clean, and it was easy for patients to pass on infections.Iisitors to China noted that acupuncture needles were not sterili ed, but merelydipped in an alcohol solution, and the lac! of hygienic rigor extended to other aspects of the hospitals. This role of moxa became recogni ed and somehospitals decided to use the approach routinely, even in rooms where moxatreatment wasn8t being given. 7ence, an incense made of artemisia andatractylodes (cang hu) would be used to reduce the bacterial count in the air# italso apparently inhibited viruses ('/). %ccording to Chinese evaluations, itcould be used in !indergartens and nurseries to reduce the transmission of diseases, including chic!en pox, mumps, scarlet fever, common cold, and

bronchitis. Thus, when used in an acupuncture clinic, the smo!e frommoxibustion might help to prevent transmission of disease from one patient toanother, which is especially important when dealing with immune1compromised patients. 7owever, with modern 5estern clinics, the rooms tendto be clean and the smo!e of moxa or incense in any large quantity goesunappreciated.

INDICATIONS AND APPLICATIONS FOR MOXIBUSTION>etailing the functions of moxibustion, the authors of Chinese Acupunctureand Moxibustion ( ) say that it is used for the following purposes4

'. To !ar# #eridians and expel cold+ %bnormal flow of qi and blood usually results from cold and heat. Cold causesobstructed flow or even stagnation of qi, and heat results inrapid flow of qi. 2ormal heat activates blood circulation andcold impedes its smooth flow. "ince stagnation of qi and bloodis often relieved by warming up the qi, moxibustion is the rightway to generate the smooth flow of qi with the help of the


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ignited moxa wool. $n Chapter ;9 of the Lingshu it says4 8$fstagnation of blood in the vessels cannot be treated by warmingup with moxibustion, it cannot be treated by acupuncture.8 $nChapter ? of the Lingshu it states, 8>epressed symptomsshould be treated by moxibustion alone, because depression isdue to blood stagnation caused by cold, which should bedispersed by moxibustion.8

. To induce the s#ooth flo! of qi and blood+ %nother functionof moxibustion is to induce qi and blood to flow upward ordownward. 6or example, moxibustion is givento yongquan (H$1') to treat the disorders caused by excess inthe upper part and deficiency in the lower part of the body andliver yang symptoms due to upward flowing yang qi so as tolead the qi and blood to go downward....$f the disorder is due to

deficiency in the upper portion and excess in the lower portionof the body and due to sin!ing of qi caused by deficiency, suchas prolapse of the anus, prolapse of the uterus, prolongeddiarrhea, etc., moxibustion to baihui (JI1 ) may lead yang qito flow upward.

/. To stren)then *an) fro# collapse+ Aang qi is the foundationof the human body. $f it is in a sufficient condition, a man livesa long life# if it is lost, death occurs. Aang disorder is due toexcess of yin, leading to cold, deficiency, and exhaustion of the

primary qi, characteri ed by a fatal pulse. %t this moment,

moxibustion applied can reinforce yang qi and prevent collapse.$n Chapter ;/ of the Lingshu it says, 8>eficiency of both yinand yang should be treated by moxibustion.8

?. To pre&ent diseases and #aintain health+ $n ThousandPieces of 'old it states4 G%nyone who travels in the southwest

part of China, such as Aunnan and "ichuan Provinces, shouldhave moxibustion at two or three points to prevent sores or

boils and to avoid pernicious malaria, epidemic diseases, and pestilence.G $t is often said, G$f one wants to be healthy, youshould often have moxibustion over the point zusanli ("T1/ ).G$n Notes on Bian ,ue$s Moxibustion , it says, G5hen a healthyman often has moxibustion to the points guanyuan (CI1?), qihai (CI1 ), mingmen (JI1?), and zhongwan (CI1' ), hewould live a very long life, at least one hundred years.G

These treatments might include scarring moxibustion depending on the particular case. The different styles of moxa application and the method of


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!eeping1fit moxibustion (the fourth application listed above) were elaborated by Auan @iren and @iu Liaoming (''), though with reliance on different points,namely shenque (CI1 ), zhongwan (CI1' ), yongquan (H$1'), and zusanli ("T1/ ), the latter point was mentioned above and is a standard for manyacupuncture and moxibustion treatments. %ccording to the authors, these pointsare selected and treated as follows4

zusanli -ST./01% 6requent moxibustion on zusanli caninvigorate the spleen and stomach, assist in digestion, hence,strengthening the body and slowing down the process of aging. "ome ancient experts advocated the use of scarringmoxibustion, placing moxa wool directly on the s!in over the point so that a scar is formed after the local s!in hasdeveloped a boil with pus. Constant application of scarringmoxibustion will maintain the moxibustion boil, and this will

help to strengthen the body and prolong life. %nother similar method, !nown as hanging moxibustion, is composed of hanging an ignited moxa stic! /1; centimeters over the pointwithout touching the s!in for 91' minutes.

Shenque -C2.31% 6requent moxibustion on this point canreplenish qi and strengthen the body# it is especially suitablefor the middle1aged and elderly. The particular procedure of this !ind of moxibustion is as follows4 put some salt on thenavel, !nead some moxa wool into the shape of a cone to beignited and placed on the salt for moxibustion. The si e of the moxa cone should vary with the individual conditions.6or people of strong constitution, use big cones in the si e of a broad bean and for those of wea! constitution, use themiddle1si ed cones as big as a soybean or use small cones inthe si e of a wheat grain. The burning up of one moxa coneis referred to as one huang. +oxibustion on shenque pointrequires ;1'9 zhuang .

zhongwan -C2.451% This point is an important point for reinforcement, capable of strengthening the spleen and

stomach. Eoth moxa stic! and moxa cone are advisable for moxibustion on this point, the duration of which may last 91' minutes.

yongquan -6I.41% 6requent moxibustion at this point canstrengthen the body and contribute to longevity, for itreplenishes the !idney and invigorates yang. 5hen usingmoxa stic!s for moxibustion, it should last /19 minutes, and


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in the case of using moxa cones, /1; cones are usuallyneeded each time.

The authors state that the duration of moxibustion should be at least /19minutes, but not more than ' 1'9 minutes. % relatively longer duration of treatment is indicated for recovery from a serious disease or in0ury to recapturegood health, in autumn and winter, on points of the abdomen (i.e., CI1 andCI1' ), and when treating young and middle1aged adults. &elatively shorter duration of treatment is indicated for simple health maintenance and longevity

promotion, for spring and summer treatments, when applying moxibustion tothe limbs (i.e., H$1' and "T1/ ), for the aged and for children. They cautionthat4

The aim of strengthening the body and achieving longevitycannot be attained by 0ust applying moxibustion once or

twice, it requires persistence for a long time. This does notmean that one should receive moxibustion every day. 6or the purpose of convalescence for the wea! and sic!, themoxibustion may be applied once every 1/ days in the earlystage# yet for reinforcement of the body or longevity, itshould be once a wee! in the early stage. %nd when it hasshown some effect, the frequency can be reduced to once amonth, and later, once or twice every three months, or evenonce or twice a year. "o long as the practice is persisted in,good effect is sure to ensue.

%nother description of life1prolonging moxibustion was offered by @iuMhengcai (';), with primary focus on zusanli ("T1/ ), qihai (CI1

), guanyuan (CI1?), and zhongwan (CI1' ). The technique was intensivemoxibustion. 6or example, the experience of 5ang Chao is mentioned4 he saidthat he never failed to burn ', cones of moxa at guanyuan between summer and fall# or the experience of @iu *iesheng, who used moxa once a day for fivedays at beginning of "pring and again at the beginning of %utumn, using largecones on sliced ginger, a total of / cones each day of treatment.

5ang @eting, a famous physician in Eei0ing who practiced from ' 1' ; , also commented on using moxa for prolonging life, as described by >r.5ang8s students ( )4

The Bian Que Xin Shu (Bian ,ue$s Boo7 of 8eartTeachin)s ) says4 8% person without disease should moxahimself for a long time


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span=, one can achieve longevity of more than ' years.8Eecause moxibustion has a warming action and it supportsyang, it can be used to course and free the flow of thechannels and networ! vessels, move the qi and quic!en the

blood, dispel dampness and cold, disperse swelling, andscatter nodulation, secure yang and stem counterflow. 6or instance, constantly moxaing zusanli ("T1/ ) is able toregulate and rectify the spleen and stomach function,increase and strengthen the bodily constitution. Constantlymoxaing feishu (E@1'/), it is not easy to catch an externalaffliction. >r. 5ang @eting was years old, with theexception of being a little bit hard of hearing, he was stillvery healthy, his thin!ing was very !een, and he was stillreading and writing boo!s. 7is secret was mainly doingmoxibustion on himself among other methods of protectinghis health. 7e held that after age ? , one8s !idney qi declinesday by day. 7ence, between "ummer and 6all every year,when yang qi declines day by day, he began to domoxibustion at qihai (CI1 ) and guanyuan (CI1?) with moxacones. %t first, he used ; moxa cones per day. Then, hegradually used ' per day and up to a total of 9 for theseason. This method greatly strengthened his bodilyconstitution. 7e persisted in doing moxibustion for decadesand obtained great benefit from it.

The basis for using moxa in the late summer and early fall can beunderstood by comments in the classics, including the teaching of @i >ongyuanin his i !ei Lun (Treatise on Sto#ach and Spleen ). %lthough @i was anherb specialist and didn8t describe use of moxa in this text, he noted that it wastraditionally said that diseases of the spleen would heal in the %utumn and thatGElood must be nurtured by all means and the defensive must be warmed by allmeans. 5ith blood warm and the defensive in harmony, one will live out one8sheaven1decreed life span (/ ).G +oxa provides a warming therapy at this timeof year to invigorate the circulation and activity of defensive qi (weiqi) and

protect the spleen from the declining yang qi that is occurring as part of theannual cycle, and the blood can be nourished by eating healthy foods, whichare digested, and the resulting essence is transported, by the strong spleenfunction. 6ailure to ta!e care of this would lead to repeated illness during thecold months, and overall wea!ening of the body. The important role of thestomach and spleen in generating ying and wei qi helps explain the emphasison moxibustion at "T1/ .


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%side from these uses of moxa for preventive health care, moxa is oftenapplied for alleviating acute symptoms. $n an attempt to relieve herpes oster outbrea!s, moxibustion was applied to dazhui (JI1'?). %ccording to the reportof this application ( /), the technique to be used would depend on the patient4for the elderly and wea!, warming moxibustion (using a moxa roll) wasadministered, but for the strong and robust, direct moxa ( cones, but non1

blistering) was done. Treatment was given once per day, with pain alleviationand change of the oster lesions to scabs occurring in /1; days of treatment. %report on moxibustion for gastric spasm by "ong and Mhu (' ) in the *ournal of Traditional Chinese +edicine involved ; patients with either gastric spasms or intestinal spasms who were treated primarily on the abdomen points CI1(along with "T1/; for intestinal spasm) and CI1' (along with "T1/? for gastric spasm). The authors report that nearly all the patients had their abdominal pain alleviated with one moxa treatment. The technique used was4

The moxa roll was ignited and placed over the selected points to produce a comfortable warm feeling. 5hen the heat became excessive, the moxa roll was moved around the points or a little higher to avoid burns. % piece of gau ecould be laid over the point to protect the s!in fromaccidental in0ury. / minutes constituted one session of treatment.

3nli!e the concern expressed here to !eep the patient comfortable andunin0ured, many traditional moxa specialists (such as 5ang Henliang, quoted

previously) believed that blistering of the s!in was essential to the success of moxibustion when treating serious ailments, much the way that getting the qireaction and propagated sensation in response to needling was deemed essentialto successful acupuncture therapy. This blistering and scarring method is evenmentioned in relation to Heeping1fit +oxibustion, which is for preventivehealth care. "uch intensive moxibustion is avoided in the 5estern practice,which follows more closely the method used for the gastric and intestinalspasm treatments.

THE PRIMARY MOXIBUSTION POINTS

There are certain points mentioned repeatedly in the literature on moxibustion#the accumulated experience with using these points suggests that they might beuniquely effective. %side from zusanli ("T1/ ), which is also the mostfrequently mentioned of all the points used for needling, the primarymoxibustion points are located on the governing and conception vessels. :n theconception vessel, points ?, , , ' , and '; are mainly utili ed. :n thegoverning vessel, points ?, '?, and are mainly used. :ne of the important


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moxa points is dazhui (JI1'?), which is the meeting point of the governingvessel with the six yang channels of the hand and foot. %n article reviewing themany uses of moxibustion at this point (/') listed the following examples of applications for moxa at this point4

-xpelling wind, clearing heat, and dispersing the lung to relievethe exterior (for acute feverish diseases)#

>ispersing the lung, eliminating cold, and activating yang torelieve asthma#

&estoring consciousness, tranquili ing the mind, and calminginternal wind to relieve epilepsy#

&emoving obstruction in the governing channel to relievespasm and dispersing yang to eliminate pathogenic factors (forcervical spondylopathy and other disorders of the spinal

column)# 5arming the channels, restoring yang, and replenishing qi to

consolidate resistance (protecting from recurrent common coldand influen a).

Dazhui was also described separately as the acupoint suitable for treatingherpes oster by moxibustion ( /). &eflecting the common usage of the points,the students of 5ang @eting noted that the points he used for moxibustion wererelatively few. They included conception vessel points ?, , , and ' , andgoverning vessel points JI1? and (he also used the bac! shu points fenshu ,

E@1'/, and shenshu , E@1 /). % harmoni ing treatment for the yin and yang ismoxibustion at guanyuan (CI1?) and dazhui (JI1'?). &obert *ohns, in his boo! The Art of Acupuncture Techniques (/ ), mentions that this ancientformula is well suited to helping cancer patients recover from the adverseeffects of modern cancer therapies. :ther moxibustion therapies for helping

patients with leucopenia mentioned in Chinese textsinclude dazhui with zusanli , usually along with one or two other points. :neother point frequently mentioned is yongquan (H$1'), a point relied upon for treatment of collapse of yang, for which moxibustion seems appropriate. $tmight also be used, with slow heating, to help tonify yin.

POSSIBLE MECHANISMS OF ACTION OF MOXIBUSTION:ne theory of the effects of both moxibustion and acupuncture is that the localtissue damage (twisting of tissue fibers when stimulating acupuncture needles,extended cellular damage by the intense heat of moxibustion) initiates a non1specific healing reaction that can have effects throughout the body. This healingreaction is stimulated by production of immunological mediators and


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neurotransmitters. +odern techniques of acupuncture and moxibustion therapyused in the 5est may rely, instead, on lesser stimulation that does not producesignificant tissue damage (e.g., using thin needles minimally manipulated,using moxa to gently warm the s!in). 7owever, it must also be recogni ed thatsome modern techniques may do little more than induce general relaxation,without some of the other effects that Chinese physicians have long dependedon.

The impact of the local heat stimulus was studied in the laboratory tofollow1up on the suggestion that the production of inflammation mediators,mainly histamine, at the site of burning s!in were important to the impact of moxibustion therapy ( ?). %fter burning a single cone of moxa, the authorsfound that4

The maximum temperature of the treated spot was about

'/ N C at the outer s!in, and about 9 N C at the inner s!in.Therefore, moxibustion treatments are naturally consideredheat stimulation with inflammatory response. $n general,inflammatory response induces vascular changes. :ur resultsof moxibustion as a heat stimulation inducedvasoconstriction at the site under the moxibustion spot andvasodilation around the moxibustion spot. The cause of cutaneous vasodilation was histamine and substance PF.:ur results indicate that moxibustion induces an increase incapillary permeability mediated by histamine# additionally,

this enhancement of permeability can be correlated with thedegree of mast cell degranulation


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by enhanced cellular immune functions, probably mediated by enhanced production of favorable cyto!ines (e.g., $@1 ) and resulting increased natural!iller cell activity (? ). 5hile moxa therapy appears to bolster immuneresponsiveness, it does not necessarily exacerbate autoimmunity. 6or example,moxa treatment was shown to reduce delayed type hypersensivity reaction inmice# this action may be accomplished by enhancing the function of suppressor T1cells (/;).

"ubstance P is a neurotransmitter, and one of several that are thought to beinduced by acupuncture and moxibustion stimulation# for example, galanin isanother neurotransmitter observed to be synthesi ed in response to moxibustion(/ ). These neurotransmitters are thought to be important in the regulation of

pain, spasm, and neurological disorders, such as depression and anxiety# theyare also invo!ed in response to exercise, and may be part of the explanation for several of the health benefits attributed to higher levels of physical activity(? ).

$n a laboratory study on rabbits, the point equivalent to zusanli ("T1/ ) wastreated by moxibustion and it was shown that intestinal smooth musclespontaneous movements declined (/ ), suggesting a role of theneurotransmitters. This antispasmodic effect is consistent with what is seenduring clinical treatment of gastric and intestinal spasms with alleviation of diarrhea. The neurotransmitters evo!ed by acupuncture (especially electro1acupuncture) and moxibustion may act in parallel with the modulation of immune responses and contribute to a broad systemic change.

MOXIBUSTION AND IMMUNE SYSTEM FUNCTION IN HUMANCLINICAL WORK

:ne of the frequently investigated functions of moxibustion mentioned inmodern Chinese clinical literature is boosting the immune system. $t remainsunclear whether moxibustion differs in its effects from acupuncture in thisregard. $n elderly patients, both acupuncture and warm needle acupuncture(with moxa applied to the needles for minutes, using daily treatment for 'days) applied to zusanli ("T1/ ) enhanced production of $@1 (?9). $n a reviewarticle on research examining immunological effects of acupuncture and

moxibustion (' ), no distinction was made regarding the two techniques, onlythe points treated and the outcomes were noted for each methodinterchangeably.

The author of the review article concluded that the effect of the techniqueson the immune system might be a secondary result of their effects on the whole

body, rather than a specific action. This interpretation does not necessarily


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contradict the results of animal studies on mechanism of moxibustion4 thetechnique might have an initial effect on the immune system that then produces,via the action of various mediators, a systemic effect that goes beyond theinitial immune response, eventually causing a greater immunologicalimprovement. $n the report on moxibustion treatment of coronary heart disease,some immune parameters of the patients were measured (including lymphocyteconversion rates and levels of immunoglobulins), showing an enhancedimmunological response. The authors had concluded that Gmoxibustion treatscoronary heart disease through regulating the internal environment of theorganism and reinforcing its ability to fight disease.G This interpretation of results is consistent with the idea that the techniques produce non1specificimprovements in the entire body that manifest in better immune function aswell as better function of all the internal organs.

$n the TC+ system, spleen deficiency (a subcategory of qi deficiency)syndrome is often associated with wea! immune functions. -valuation of immunological effects of moxibustion in spleen deficiency patients has beenconducted (' , ) with claimed benefits in immune function tests thataccompany alleviation of symptoms. % clinical report on treatment of chronicdiarrhea associated with ulcerative colitis or simple chronic colitis withmoxibustion focused on immunologic mechanisms ( ). 7erb1interposedmoxibustion was used with two sets of points alternated daily4 zhongwan (CI1' ), qihai (CI1 ), and zusanli ("T1/ ) made up one set# dachangshu (E@1

9), tianshu ("T1 9), and shangjuxu ("T1/;) made up the second set. Thenumber of moxa cones used would vary by site and syndrome, but ranged from

to ; cones. >aily treatment was provided for ' days, followed by an intervalof / days, and then another course of ' days, for a total of treatments. $twas claimed that along with resolution of the diarrhea there was a reduction inthe excess $g+ and complement that were present at the beginning of treatmentfor those with ulcerative colitis, and an improvement in the T1lymphocytesubgroup of suppressor cells that inhibit autoimmune reactions.

%n improvement in an autoimmune based disorder was also noted for 7oshimoto8s thyroditis ( ). $mmune parameters that were normal at the

beginning of the studies did not change. $n an outline summary of laboratoryand clinical studies of the immunological effects of moxibustion, it wasreported that moxibustion could reduce the level of rheumatoid factor (considered a measure of the autoimmune aspect of the disease) in rheumatoidarthritis and improve symptoms of allergic rhinitis (?').

"uch findings suggest that the immunological and organ system changesmay reinforce and contribute to one another, and that the immune functions are


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regulari ed by reinforcing the wea! portion of the immune system rather thansimply stimulating the immune system generally.

CONTRAINDICATIONS FOR MOXIBUSTIONThe primary contraindication for moxibustion has historically been the

presence of a heat syndrome. This goes along with the idea that moxaintroduces heat to the system and does so effectively, and thus the treatmentmethod fails to meet the criteria of balancing a hot condition with a coolingtherapy. Theoretically, it could cause the disease to worsen by increasing theimbalance. There are some who have argued against this, as noted above. $nsimilar manner, there are cases where herbalists have argued against the viewthat in febrile diseases one must always avoid heating herbs and rely only oncooling herbs. 7owever, this contraindication for moxibustion still remainslisted in all standard texts. $n particular, moxa is considered entirelyinappropriate for a deficiency heat syndrome (one based on yin deficiency) andit must be used cautiously in cases where there is local dryness. $n a reportreviewing indications for acupuncture and moxibustion (?/), the authors notedthat G5e found in our practice that most of the herpes oster patients respondedto moxibustion and round needlingFalthough there were some cases withobvious local dryness due to s!in in0ury where the patients experiencedincreased pain the more that moxibustion was applied.G They suggested thatsince herpes oster is a heat syndrome that responded well to the treatment inmost of the cases, one should not automatically discount use of moxibustion for heat syndromes, especially those with locali ed heat as occurs with a oster outbrea!.

:ther contraindications for moxibustion involve the sensitive areas of the body, such as the face (where one especially avoids the scarring therapy, butalso avoids getting smo!e directly into the eyes or nose), the nipples, and thegenitals. %ncient texts specify certain points on the head as beingcontraindicated for moxibustion ( ;), such as shangxing (JI1 /), chengqi ("T1'), sibai ("T1 ), touwei ("T1 ), jingming (E@1'), zanshu (E@1 ), sizhu ong (TE1

/), heliao (@$1' ), and yingxiang (@$1 ). Concerns are raised about usingmoxa during pregnancy for the region of the abdomen and lower bac! ('?, ;).

THE TECHNIQUES OF MOXIBUSTION%s noted in the *ournal of Traditional +edicine review article on acupunctureand moxibustion in China (?), there are about 9 techniques that have beenelaborated. +any of these are minor variations4 different substances used ininterposed moxibustion (mainly fresh ginger slice, garlic slice, aconite ca!e,salt), different methods of applying heat to a broad area (moxa rolls, containerswith large amounts of moxa), different si e cones, applying moxa to the end of


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an acupuncture needle, and using materials other than artemisia to burn (suchas 0uncus) or to cause hot sensation and blistering without using fire (e.g., withmustard seed or mylabris, an insect with irritant properties). 6or purposes of this article, the techniques most li!ely to be used in the modern clinic will bedescribed, ta!en primarily from the recent compendium Acupuncture andMoxibustion ('?), prepared by the Eei0ing 3niversity of Traditional Chinese+edicine.

1. Non-S !""#n$ Mo%#&'()#on *#)+ Mo%! Con,(% moxa cone is placed on a point and ignited. 5hen about B/ of it is burnt or the patient feels a burning discomfort, remove the cone and place another one.Three to seventeen cones are continuously burnt to cause flush in the local site,

but no blister should be formed. This method is used widely, often for cold anddeficiency disorders such as asthma, chronic diarrhea, and indigestion.

. In #", ) Mo%#&'()#on /In),"0o(, Mo%#&'()#onThe ignited moxa cone does not contact the s!in directly, but is insulated fromthe s!in by a layer of ginseng, salt, garlic, or aconite ca!e. >epending on thetechnique used, this !ind of moxa may induce blistering, but it is often used for non1scarring moxibustion.

'in)er% cut a slice of ginger about 1/ cm wide and . 1 ./ cm thic!, punchnumerous holes in it and place it on the point selected. :n top of this, a moxacone is placed and ignited. 5hen the patient feels scorching, remove it andignite another. &epeat this until all the cones burn and the s!in becomesreddish. This method has the effects of warming the spleen and stomach anddispersing cold. $t is therefore indicated for symptoms caused by wea!ness andcold of the spleen and stomach, such as abdominal pain, diarrhea, painful

0oints, and other symptoms due to yang deficiency.

'arlic% cut a slice of garlic . 1 ./ cm thic! (a large single clove of garlic isdesirable), punch holes in it, put it on the point with the ignited moxa cone ontop. &enew the cone when the patient feels scorching. This method has theeffect of relieving swelling and pain, and is often used for the early stage of s!in ulcer with boils or scrofula.

Salt% this method is usually applied at the umbilicus. 6ill the umbilicus withsalt to the level of the s!in, place a moxa cone on the top of the salt and thenignite it. 5hen it burns out, renew another until all the cones have combusted.%s this method has the action of restoring yang from collapse and warming thespleen and stomach, it is effective for the symptoms of sweating, cold limbs,and undetectable pulse resulting from acute vomiting and diarrhea, or flaccid1type of wind stro!e and post1partum fainting.


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Aconite ca7e% punch holes in a ca!e made of aconite powder mixed withalcohol, / cm in diameter and about ./ cm in thic!ness. Place on the site for moxibustion with the moxa cone, which is ignited and burnt on top of it. Thismethod is good for warming and strengthening !idney yang, and thus, isadopted to treat impotence, infertility, and ruptured abscess resistant to healing.

2. Mo%#&'()#on *#)+ Mo%! S)# 3Mild.!ar# #oxa% $gnite a moxa stic! and place it 1/ centimeters away over the site to bring mild warmth to the local place, but not burning, for some '9minutes until the s!in becomes slightly red. $t is suitable for all the syndromesindicated for moxibustion.

Sparro!.pec7in) #oxibustion% $n this method, the ignited moxa stic! ismoved up and down over the point li!e a bird pec!ing, or moving left and right,or circularly. $t is indicated for numbness and pain in the limbs.

4. W!"5#n$ N,, 6, Mo%#&'()#on+oxibustion with warming needle is an integration of acupuncture andmoxibustion, and is used for conditions in which both retention of the needleand moxibustion are needed. $t is applied as follows4 after the arrival of qi andwith the needle retained in the point, get a small section of a moxa stic! (about

cm long) and put on the handle of the needle# ignite the moxa stic! from its bottom and let it burn out. This method has the function of warming themeridians and promoting the flow of qi and blood so as to treat bi1syndromecaused by cold1damp and paralysis. %pplication to cold1damp syndrome wasthe sub0ect of a clinical evaluation involving patients with rheumatoid arthritis(? ). %cupuncture was performed by deep needling of the shu (stream) points,and then moxa was applied to the needles for / minutes, performed daily (withshort brea!s) during a two month course of therapy. The original techniquedescribed in the classics is different and was called the fire needle. Thisinvolved holding the needle in a lamp flame until very hot, and then inserting tothe appropriate depth in the body quic!ly and removing it (/?). 5armingneedle, as now used, allows longer retention and gentler heating.

TONIFICATION AND DRAINING STRATEGIES*ust as there are needling techniques associated with tonification(reinforcement) and draining (reducing), moxibustion can be applied with thesetwo different approaches. The basis for the different methods is the intensityand duration of heating during the moxa treatment. The distinction has beendescribed by the followers of 5ang @eting and relayed here with slight editing4

%s for the problem of supplementation and drainage bymoxibustion, these are generally administered in the clinic


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based on the theory of the Lingshu chapter on bac! transporting points4 8To supplement by fire, do not blow onthe fire, but let it burn out. To drain by fire, quic!ly blow onthe fire and let it burn out spontaneously.8 The former methodinvolves letting a slow burning cone burn out by itself4although the heat power is wea!, it is persistent andsubstantial. The latter is quic!ened by blowing on it.%lthough the heat power is violent, it is temporary and short.$f the supplementing technique is to be used, do not blow onthe moxa cone after igniting it. *ust allow it to burn graduallyand burn itself out. Then, press the point with the hand toconcentrate the qi and ma!e the warming persistent. $f thedrainage technique is to be used, blow on the ignited moxa toincrease its speed of burning, then let it burn out or remove itwhen too hot# do not press the point, but let the pathogenic qi

be scattered externally.

5hen using moxa rolls or other techniques, the basic approach totonification or draining can still be applied. Tonification utili es a more steadyand prolonged heating, while drainage involves a more rapid and more intense

but shorter duration heating of the point (bird pec!ing moxa is often used, withthe end of the moxa roll being brought quite close to the s!in with repeatedthrusts to get more intense heating of the s!in).

% description of reinforcing and reducing techniques of moxibustion wasincluded in a broader report on these techniques for needling (/9). Thecommentators noted4

$n ancient times, reinforcement and reduction techniqueswere attributed to moxibustion, while in modern textboo!sthey are seldom mentioned. 5e treated a patient sufferingfrom impotence due to deficiency of the !idneys withmoxibustion using reinforcing manipulations# the patient wascured after 9 sessions of treatment. $n herpes oster, moxacones were ignited and the fire blown with mouth to increase

the temperature and thus produce a reducing effect. 5e havetreated do ens of patients in this way with an alleviation rateof 9D immediately after the first session. %ll the patientswere cured after to / sessions of treatment. $n a case of chronic cold syndrome of the insufficiency type, mildmoxibustion (a moxa roll is held approximately /.9 cmabove the s!in to produce a sensation of warmth until the


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s!in becomes slightly flushed) and revolving moxibustion(circling the lighted end of a moxa roll around theacupuncture point until the s!in becomes flushed) are mostoften used. $n case of acute heat of the excess type, directmoxibustion and bird1pec!ing moxibustion are most oftenusedF.5hen mild moxibustion is applied tostimulate baihu (JI1 ), an action of invigorating yang andarresting prostration is produced, curing organ prolapse.5hen garlic paste moxibustion or bird1pec!ing moxibustionis applied to stimulate yongquan (H$1'), an obvious effect of nourishing yin to purge pathogenic fire results, providing acure for hemoptysis and epistaxis (i.e., bleeding due to heat).

SMOKELESS MOXAThough not widely used in China, an increasingly popular method in the 5estis the use of smo!eless moxa. The following is the description for use in themodern clinic.

"mo!eless moxa is a rod of charcoalimpregnated with moxa. $t burns hot, but slowly,at an average rate of 0ust .; inches per hour# therods are about ?.9 inches long, so the total

burning time is about minutes before the rod becomes too short to use. The moxa is not easily

lit, so it is common to use a torch rather than asimple lighter. :nce lit, it burns consistently.

The smo!eless moxa pole produces ash at the burning endwhich tends to stic! to the rod. 5hen trying to safely remove theash from smo!eless moxa, the stic! should not be tapped againstsomething (e.g., against an ashtray). The tapping, aside fromma!ing undesired noise, can crac! the charcoal, generating a ris! for a piece to fall off and burn the carpet, treatment table, or

patient. $nstead, the burning end of the moxa stic! should begently rubbed against the top edge and inside of a moxaextinguisher, which will be a quiet operation that dislodges theash and does not crac! the moxa rod.

The moxa extinguisher can be carried in an ashtray, so that the ash iscontained. %t the end of the moxa session, the moxa stic! may be carefully


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retained while still burning for use with another patient (if it is to be usedwithin minutes) or put out. $t is important to chec! from time to time that allmoxa rods are in their proper place so that none are left burning where they cancause damage.

+oxa can be carried outusing a single

pole to provideintense heat toa specific

point, or withtwo poles heldside by side toheat a larger area. +oxamay be appliedto acupunctureneedles, butta!e care notto hold the litend near the

plastic holders,as this cancause meltingor evaporationof the plastic(or rely onmetal handleneedles).5hile a brief moxatreatment canfeel good tothe patients, allChinese textsrefer to

prolongedheating,usually byrepeated


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application of heat to thesame site over a period of severalminutes. Eecareful not tolose most of the potential

benefits byapplying moxafor a very brief

period or bytrying to applymoxa to toomany sites, sothat each siteis only brieflytreated.

MOXA PADS7 HEAT LAMPS$n contrast to the intensedirect heating of points for

treating diseases, heattherapy may also beemployed to relax tensemuscles and gently relieveaching and mild pain. "elf1heating moxa pads for these

purposes have been availablefrom Horea for more than years. This technologyinvolves having a bag of mugwort and charcoal withan oxygen1sensitive system(iron that reacts stronglywith oxygen), so that whenthe sealed pac!agecontaining the bag is openedand the bag of material is


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vigorously sha!en for amoment, it heats up. 5ithinfive minutes, the pac! isheated and it maintains atemperature of 1;9NC('? 1' 9N6) for hours. Thisis the same technology usedfor the popular newdrugstore products, such asThermaCare, which are self1heating pads applied to the

body (but without theartemisia).

Typical applications of the moxa pads include treatment of in0uries, bac! pain, !nee pain, and menstrual pain. $n addition, these pads are applied for chilliness and discomfort following exposure to excessive air conditioning,frigid outdoor winter conditions, or damp windy weather. % belt to hold the padover the abdomen is also available. The pads can be used following a treatmentwith acupuncture and moxibustion to extend the effects of the initial therapy, or as an alternative to those treatments when professional help is not convenient.+oxa pads should not be applied to s!in that is bro!en or to areas that displayred inflammation or that develop greater discomfort with application of heat.

%nother method of applying heat is the infra1red heatlamp# a useful variant of this was developed in China,called the GT>P1lamp.G $t was invented in ' by a groupof scientists and physicians headed by >r. Jou 5enbin atthe Chinese +edicine $nstitute in Chongqing. 3nli!econventional infrared therapeutic devices, the T>P devicefeatures a plate coated with a mineral formation (a lowconductance metal with diverse composition). 5henheated by an electric heating element, the mineral plate

emits waves in the infrared range. $t produces a uniformheating that ma!es it more useful than ordinary glass bulblamps. To increase the heating of a region by the lamp, amedicated oil can be rubbed on the s!in# the oil helpsretain the heat and its herbal constituents may contributeto the improvement of local blood circulation. %lthoughthe ma!ers of the T>P lamp ma!e claims about the special


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value of its frequency of infrared emissions, there is noevidence that it performs a unique function on this basis.

INTERPRETATIONThe report presented here may offer the practitioner some insights into practicalaspects of moxa applications. There are a number of unanswered questionsabout moxa, and this section contains some conclusions of the current author derived from this literature survey.

% certain part of the theory of applying moxibustion is simply based on thetraditional Chinese medicine dogma and may not have important implicationsfor practice. 6or example, the role of the moxa wool appears to be primarily for introducing heat rather than for pharmacological effects of artemisia promoting

circulation, warming the meridians, and so on. "imilarly, the specialapplications depicted for moxa with interposing herb materials (ginger, aconite,garlic, or complex herb formulations) appear to be based on the traditional rolesof the herbs when ta!en internally, but these actions are probably not conferred

by this method and would certainly be better accomplished by providing suchherbs orally. The interposing substances serve primarily as suitable media for conveniently providing moxibustion without direct contact to the s!in. "altinterposed moxa wor!s well for treating the umbilicus because of its form#direct moxa would be inappropriate for this sensitive spot, especially inchildren who are li!ely to receive this particular therapy.

There has been a heavy reliance on scarring moxibustion in the Chinesetradition. This method is listed first in most of the modern texts that describemoxa, and is featured prominently in the review article about moxa in clinicalapplications. There is a theory of acupuncture whereby the main function is toinduce tissue damage at the acupoints. The twirling, lifting, and thrusting isshown to grab and pull fibers in the subcutaneous level, forcing the body torespond. %nother aspect is stimulation of nerves leading to effects in the brainas well as effects of locally1produced neurotransmitters# such stimulation isespecially noted with the GdeqiG reaction, including tugging of the tissues at the

needle and sensations of distention, numbness, and radiating tingling. "carringmoxa also damages the tissues and produces a strong nerve stimulus. "uchsevere treatment may not be essential, but Chinese specialists repeatedlyemphasi e the benefits of strong stimulus to the points and laboratory studiessuggest that the inflammatory response to local damage by moxibustion isimportant. %t the least, the s!in must become sufficiently reddened that there isa healing response to limited damage. "ome of the reliance on scarring


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moxibustion may be based in archaic ideas that would no longer be widelyaccepted. $n Treat#ent of "xternal (iseases !ith Acupuncture andMoxibustion ('9), it is pointed out that sometimes the sores induced by directmoxa not be allowed to heal4

The Thousand Pieces of 'old says4 8People who tour 5uand "hu should moxa some points regularly and leave thesores unhealed for some time. This will !eep the toxic qi of miasma, leprosy, and warm malaria away from them.8The 'reat Co#pendiu# also says, 8$f one intends to be safeand sound, one should !eep zusanli ("T1/ ) wet8


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per point (longer for warm needle technique). Thus, the treatment is still strongin nature even if there is no blister formed.

Practitioners in the 5est might consider the following4

'. $f one wishes to avoid the smo!e of regular moxibustion, itseems acceptable to use other methods of heating, so long asthey can provide similar levels of heat and as long as one canmaintain adequate control over the heating (e.g., to prevent

burning and also to prevent the heating from becoming toolight). %s such, smo!eless moxa may be satisfactory. $n fact,moxibustion may be replaced by acupuncture in mostapplications, providing that the acupuncture stimulus issufficiently strong to generate an immunological andneurological response.

. 5hen using herb1slice or ca!e interposed moxibustion, do notforget to punch holes in the material# this allows the heat to

penetrate. The thic!ness of the slice should be 0ust . 1 ./ cm#thic!er slices may prevent adequate heating. 6or practical

purposes, ginger slices may be most convenient and it is notevident that one must choose the interposing substance based onits pharmacological properties in relation to the condition to betreated.

/. 6or moxibustion to be effective, it needs to cause significant

local heating and inflammatory response and should be done for a prolonged period, not 0ust a minute or two. Therefore, specific points for moxa heating should be chosen and treatedeffectively, rather than trying to warm numerous points withonly a little stimulus. 5arming a broader region is anacceptable treatment for relaxing tension and moderating painat the site# this is a different application than trying to stimulatethe immune system, alter internal organ functions, or otherwiserapidly heal a disease. 6or chronic ailments, Chinese physicianstypically administer moxa daily for several treatments, up to 9 1

sessions. +oxa treatments might be alternated withacupuncture and patients may appreciate the variation intreatment methods.

?. The most frequently mentioned applications of moxa are gastro1intestinal disorders, asthma, organ prolapse, bi1syndromes, andherpes oster. These are reasonable targets for modernclinicians to consider for this type of therapy, which may


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otherwise be too inconvenient as a method (at least, when done properly). $n particular, herpes oster is emphasi ed as a casewhere moxibustion is effective. 6or asthma, both acupunctureand cupping have also been claimed to be highly effective, andthese might be more appropriate for those who are sensitive toinhaling smo!e from moxibustion.

9. The ris!s of exposure to moxa smo!e are probably similar tothat for any other smo!e, and total exposure time, particularlywhen it involves prolonged exposure, is the !ey concern.:ccasional use of ordinary moxa would be associated with lowris!, while routine exposure to moxa smo!e during much of theday would be a moderate ris!. Therefore, venting or filtering isan appropriate step when moxa is done regularly. There is noevidence that moxa smo!e contains any unusually harmfulsubstances. "tandard commercial moxa materials do not containrealgar (an arsenic compound), though this substance has beenrarely included in blends made by individual doctors in Chinafor their own use.

. There are certain points that are most frequently mentioned inthe moxibustion literature which may be a good basis forconsideration by modern practitioners. These points may berelatively convenient to treat from a physical perspective, may

be well accepted by most patients, and may have a higherresponse rate than others. +ost of the points are on the

conception and governing vessels, plus zusanli and yongquan ,and shu points on the bac!.

$t is difficult to !now, based on the literature review, whether moxibustionis more effective than acupuncture or other stimulus methods administered for the same condition. $n the absence of more detailed studies, moxa is applied

primarily on the basis of the Chinese traditional medical descriptions, such astreating syndromes associated with cold, retention of food, spasms, immunedeficiency, and local stagnation of fluids with formation masses. +oxa may beutili ed in some cases of heat syndromes.

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. Cheng Linnong (chief editor), Chinese Acupuncture andMoxibustion , ' ; 6oreign @anguages Press, Eei0ing.

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#%' cases , *ournal of Traditional Chinese +edicine ' # '( )4 91 .

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fibrinolysis in mice , %merican *ournal of Chinese +edicine' # ' ('1 )4 ;;1 9.

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