Moxibustion

NB: In acumoxatherapy treatments provided in this database, ^mx denotes that moxibustion may be applied to the acupoint mentioned.

Moxibustion (艾灸 ài jiǔ, 灸 jiǔ) is the most common method of thermal stimulation of acupuncture points. Dried and sifted leaf particles from the widely found herb Artemisia argyi, commonly known as mugwort in English, are burned on or above the skin, with the aim of freeing qì and blood, coursing qì, dispersing cold, eliminating damp and warming yáng. Moxibustion is also valued for its ability to ward off disease.

Mugwort (艾叶 ài yè) is chosen as the substance to be burnt because of its yáng qualities and its use in medicinal therapy for the treatment of cold and dampness conditions. In addition, it is of good consistency for forming into cones and burns well. The English term moxa derives from the Japanese name for this plant, mugusa.

Mugwort is harvested in early summer, after the leaves have developed their characteristic woolly underside. Leaves are dried and aged, and then crushed and sifted to separate the wool from the unwanted leaf and stem material. The amount of sifting and cleaning used in its manufacture (and, to a lesser extent, its age) determines the grade of the moxa.

• High-grade moxa is ivory to white in color and is composed nearly entirely of leaf wool. Since it produces a gentler cauterization (searing) effect and less smoke and odor when burned, it is the preferred moxa for application directly to the skin. High-grade moxa is also more easily shaped and permits formation of the small lumps the size of sesame seeds. Moxa that has been cleansed less rigorously, and thus contains higher concentrations of leaf particles, is considered lower grade.
• Low-grade(crude) moxa is gray or grayish green in color. This is preferred for indirect moxibustion, a process whereby burning moxa is used to heat, rather than cauterize, the skin. Such applications often require large quantities of moxa wool, while not necessitating the special advantages of the higher-grade product.

Moxibustion is divided into two distinct methods: indirect moxibustion and direct moxibustion.

Direct Moxibustion (直接灸 zhí jiē jiǔ)

Direct moxibustion involves the burning of hand-rolled moxa cones directly on the skin at selected points. This method is again divided into two subcategories: scarring and non-scarring.

Scarring moxibustion (瘢痕灸 bān hén jiǔ): Scarring moxibustion employs a small cone of moxa wool (some less than 1 cm in diameter) that is placed directly on the skin and completely burned. The area is then wiped clean with a damp cloth and the process is repeated until the prescribed number of cones have been burnt. When this has been done the area should be conscientiously cleaned and dressed.

After one to three days the patient will develop a blister that will eventually leave a small scar. The blister generally takes about a month to heal. During this time, the patient must keep the area clean and frequently change the dressing to prevent infection.

The scarring method is the most potent form of moxibustion. The ancients considered the formation of a blister important in the healing process and thus it is said, if moxibustion does not form a blister, the disease will not be cured. This method is currently used in China to treat serious vacuity cold or cold-damp diseases.

When performing scarring moxibustion, note the following:

• The procedure must be explained to the patient, with a forewarning about the formation of a scar.
• The number of recommended cones should be adjusted to the patient’s condition. Young and strong patients can withstand more burnings and larger cones than old and weak patients.
• The pre-burning of a cone or two not quite down to the skin is a gradual way to accustom the patient to the burning pain. These pre-burnt cones, however, should not be counted toward the prescribed number.
• When the moxa is burning, the practitioner can scratch or tap the area around the point to reduce the burning pain.
• Garlic juice or some other liquid is usually placed on the point being treated in order to secure the moxa cone.

Moxa cones are usually described as large, medium, or small. Large cones are about the size of a broad bean (and are used only in indirect moxibustion); medium cones are the size of a soybean; and small cones are the size of a wheat grain.

Non-scarring moxibustion (无瘢痕灸 wū bān hén jiǔ): Non-scarring moxibustion is the same as the above except that the moxa cone is removed with tweezers when the patient feels pain. Cones are burned until the skin at the point turns red. Care must be taken to avoid accidental scarring when using this technique. This method is less potent than scarring moxibustion and therefore is used for milder vacuity cold patterns. Some sources state that extinguishing the cone by pressing it to the skin provides a supplementing stimulus and that removing it with tweezers before extinguishing it is draining in nature.

Indirect Moxibustion (间接灸 jiān jiē jiǔ)

Indirect moxibustion is done by placing a medium between the moxa cone and the skin. This method causes little pain (and in fact can be quite pleasant) and is less problematic than direct moxibustion.

There are several types of indirect moxibustion. The following are the most commonly used.

Moxibustion on an insulating medium: Salt, garlic, ginger and aconite (fù zǐ) slices are often used as an insulating medium.

On salt: Fill the umbilicus with table salt until the salt is level with the abdomen, and then burn a large cone of moxa on top of the salt. This method is effective for the treatment of cold damage yīn patterns, sudden turmoil (cholera) with vomiting and diarrhea, and wind-stroke desertion patterns. It can return yáng, stem counterflow, and secure against desertion.

On garlic: A slice of garlic about 0.2 inches (5mm) thick that has been perforated with several holes is placed on the site. Place moxa on the bed of garlic and ignite with a burning incense stick; replace with a new slice after four to five cones have been burnt. In general, five to seven burnings constitute one treatment. This method is used to treat vacuity taxation (tuberculosis), toxicity from sores, scrofulous swellings, and abdominal accumulation masses. The patient should be informed that this method sometimes causes blistering.

On ginger: A slice of ginger about 0.2 inches (5mm) thick (slightly thicker than a quarter dollar) is perforated with a sewing needle and placed on the point. Large cones of moxa are burnt on the slice (lifting it from the skin momentarily when the heat surpasses the patient’s tolerance) until the skin at the point is moist and red. This method is ideal for central burner vacuity, abdominal fullness, stomach pain, mounting pain (shàn tòng), diarrhea, vomiting, wind-cold impediment (fēng hán bì) pain, wind cold exterior patterns, and yáng vacuity diseases in general.

On aconite: Fù zǐ is ground into a powder and mixed with yellow wine (rice or millet wine) and formed into a dry, crustlike substance about 0.1 inches (2.5mm) thick. This crust is perforated and placed on the point and moxa is burnt on top of it. Because fù zǐ is pungent and hot, this method can treat yáng vacuity diseases. It is most commonly administered on enduring lesions (and boils) to stop pustulation and permit healing.

Moxa pole (艾条 ài tiáo): By far the most common form of moxibustion used in modern times is that employing a moxa pole. Moxa poles are made from coarsely sifted moxa leaves (other herbs are frequently added to the mixture) that are rolled into cylinders roughly 6 inches (15cm) in length and a half inch (1.3cm) in diameter. The roll is held about one cùn above the point that requires heating and is moved slowly in a circular motion to spread the heat over a small area. Alternately, the roll may be moved quickly up and down to increase thermal stimulation; this latter is called the pecking sparrow method because it resembles the feeding motion of these birds. Moxa pole therapy can be combined with acupuncture by warming the area around the needle.

Moxa pole is generally applied for 3 to 15 minutes or until the skin turns red. The proper distance must be maintained to avoid reddening the skin too quickly or burning the patient.

Moxa pole treatment is commonly employed to provide mild heat and move qì and blood in a local area and thus treats wind-damp impediment (fēng shī bì) pain and similar patterns.

A contemporary variation of the moxa pole is ibuki moxa,a Japanese product consisting of half-inch (1.3cm) long, small diameter cylinders of moxa attached to a cardboard base. The cardboard base contains an adhesive for application to the skin. Ibuki moxa provides a gentle, non-scarring alternative to direct moxibustion.

Warm needling (温针 wēn zhēn): This method is appropriate for vacuity cold diseases and wind-damp impediment (fēng shī bì) patterns. It is done by first inserting the needle and placing a small piece of paper or aluminum foil around the needle (punch a hole in the center of the piece of paper).

Moxa wool is then wrapped around the wire handle and lit. The paper will catch any ashes. The moxa is allowed to burn completely. When no more heat radiates from the handle, the paper and moxa can be removed, and the needle can be withdrawn. One common practice is to snip a small cylindrical piece of moxa pole and press a pointed object such as a pencil into the center of the cylinder to form a hole that allows the moxa to be placed on the handle of the needle. This latter method is safer and more convenient because the ash is firmer and less likely to fall from the handle.

Warming instruments: Moxa wool can be placed in metal (usually brass) containers and then lit. While the moxa burns, the warming instrument is moved slowly over the prescribed area until the skin turns red. Most practitioners place a piece of cotton cloth (red) between the instrument and the skin to prevent accidental burns. This method is particularly valuable for the treatment of women, children, infants, and patients with sensitive skin. Different areas of the body can be treated in this way using warming instruments available in flat and angular shapes.

Moxibustion Precautions and Contraindications

• Moxibustion should not be performed on persons who are hungry, have just overeaten, or are intoxicated.
• Most points that are forbidden to moxibustion are near large blood vessels, on the face, on prominent skin creases, or at or near mucus membranes or sensory organs. These sites are particularly forbidden to direct moxibustion.
• Pregnant women should not receive moxibustion on their abdomen or lower back.
• If small blisters form as a result of moxibustion, they should be protected and allowed to heal without treatment. Large blisters, however, should be punctured and drained, and if infection occurs, an appropriate dressing should be applied.