Moxibustion, also known as moxibustion therapy or moxa therapy, involves the use of moxa sticks or cones made from mugwort leaves to produce heat that stimulates acupuncture points or specific areas of the body. This method aims to activate the flow of qi (vital energy) and adjust the disordered physiological and biochemical functions of the body, thereby achieving the goals of disease prevention and treatment. The mechanism of action of moxibustion is similar to that of acupuncture and complements it in therapeutic effects. It has many advantages, including simplicity of operation, low cost, and significant effectiveness.
Indications for Moxibustion
The indications for moxibustion are as extensive as those for acupuncture and medication, applicable to both acute and chronic diseases across various medical specialties, including internal medicine, surgery, gynecology, and pediatrics. Regardless of whether the condition is cold or heat, deficiency or excess, superficial or deep, there are indications for moxibustion therapy. The general principle is to apply moxibustion more for conditions of deficiency, internal cold, and excess heat, while using it less for conditions of excess heat and acute diseases such as carbuncles, toxic sores, collapse, and counterflow. For chronic diseases, weakened yang qi, wind-cold-damp obstruction, numbness, and non-healing sores, moxibustion is often essential. Moxibustion can also be used for resuscitation and stabilization in cases of diarrhea, faint pulse, cold fingers, syncope, and shock to warm the pulse. In summary, the functions and indications of moxibustion include the following aspects:
1. Treatment of various conditions caused by cold stagnation and blood stasis, such as wind-cold-damp obstruction, dysmenorrhea, amenorrhea, and abdominal pain due to cold hernia.
2. Treatment of exterior wind-cold conditions and middle-jiao deficiency-cold symptoms like vomiting, abdominal pain, and diarrhea.
3. Treatment of spleen and kidney yang deficiency, and conditions of sudden loss of vital energy, such as chronic diarrhea, dysentery, enuresis, nocturnal emissions, impotence, premature ejaculation, collapse, and shock.
4. Treatment of qi deficiency and organ prolapse conditions, such as gastric prolapse, kidney prolapse, uterine prolapse, and rectal prolapse.
5. Treatment of initial stages of surgical sores and lymphatic conditions. Moxibustion can promote healing and tissue regeneration in chronic non-healing sores.
6. Treatment of conditions related to qi counterflow, such as heart qi counterflow, which can be treated with moxibustion at the Yongquan (Kidney 1) point.
7. Disease prevention and health maintenance. Moxibustion can prevent diseases and promote longevity; self-administered moxibustion can enhance disease resistance, invigorate energy, and contribute to longevity. Modern clinical findings suggest that regular moxibustion at points like Zusanli (Stomach 36) and Dazhui (Governing Vessel 14) can stimulate the body’s vital energy and enhance disease resistance, serving a preventive health function.
Types of Moxibustion
1. Direct Moxibustion
In ancient times, the moxa cone method was primarily direct moxibustion, also known as skin moxibustion or bright moxibustion, where moxa cones are placed directly on the skin at acupuncture points. Direct moxibustion can be categorized into three types based on the purpose and degree of skin stimulation: non-scar moxibustion, blistering moxibustion, and scar moxibustion.
(1) Non-scar moxibustion: This method applies heat gently to avoid blistering and scarring. It often uses small moxa cones and is clinically suitable for mild cases of deficiency-cold diseases. (Caution is advised for patients with fainting, children, and those with sensory impairments to prevent blistering or burns.)
(2) Blistering moxibustion: This method typically uses small moxa cones and applies mild heat to the skin. When the patient feels warmth, moxibustion continues for an additional 3-5 seconds, leading to yellow spots on the skin and sweating, with blisters appearing 1-2 hours later. This method is suitable for general chronic deficiency-cold diseases such as asthma, dizziness, chronic diarrhea, and skin warts. (The practitioner must control the duration of moxibustion.)
(3) Scar moxibustion: Also known as suppurative moxibustion, this method uses moxa cones the size of soybeans or jujube pits placed directly on acupuncture points. The local tissue is burned, leading to suppuration and scabbing, leaving permanent scars. This method is suitable for asthma, pulmonary tuberculosis, epilepsy, ulcerative diseases, chronic gastrointestinal diseases, lymphatic conditions, and developmental disorders. For patients with hypertension, it can help prevent strokes. For healthy individuals, this method can improve constitution and enhance resistance to diseases. (Consent from the patient is required.)
2. Indirect Moxibustion
Indirect moxibustion, also known as distance moxibustion, involves using other materials to separate the moxa cone from the skin. This method avoids skin burns and provides milder heat, making it more acceptable to patients. Indirect moxibustion is widely used in various medical specialties, including internal medicine, surgery, gynecology, pediatrics, and otorhinolaryngology. Types of indirect moxibustion include ginger moxibustion, garlic moxibustion, salt moxibustion, and aconite moxibustion.
(1) Ginger moxibustion: This method uses slices of ginger as a barrier for moxibustion. Fresh ginger is pungent, warm, and non-toxic, promoting circulation and dispelling cold, harmonizing the defensive and nutritive qi, and is effective for all deficiency-cold diseases, especially for vomiting, abdominal pain, and wind-cold-damp obstruction. (The practitioner should frequently lift the ginger slice to check for blistering due to the patient’s insensitivity.)
(2) Garlic moxibustion: This method uses garlic as a barrier for moxibustion. Garlic is pungent, warm, and disperses, with the ability to reduce swelling, dissolve lumps, and relieve pain. Clinically, it is suitable for treating boils, abscesses, unripe sores, unknown swellings, pulmonary tuberculosis, abdominal masses, and injuries from venomous creatures.
(3) Salt moxibustion: This method uses salt as a barrier for moxibustion, specifically at the navel, also known as Shenque moxibustion. Salt is salty and cold, entering the stomach, kidney, and large and small intestine meridians, with functions of inducing vomiting, clearing heat, cooling blood, and detoxifying. This method is used for resuscitation, stabilization, and is suitable for acute abdominal pain, vomiting, dysentery, cold limbs, gonorrhea, and collapse.
(4) Aconite moxibustion: This method uses aconite as a barrier for moxibustion. Aconite is pungent, hot, and toxic, capable of reviving yang, rescuing from counterflow, supplementing fire, and relieving pain. Aconite combined with moxa fire is suitable for treating various yang deficiency diseases.
3. Moxa Stick Moxibustion
Moxa stick moxibustion, also known as moxa roll moxibustion, involves igniting a moxa stick and applying it to the treatment area (acupuncture point). Moxa stick moxibustion can be performed by hand or with a moxibustion device. Hand-held moxibustion can be further divided into gentle moxibustion, rotary moxibustion, and sparrow pecking moxibustion.
(1) Gentle moxibustion: The practitioner places their middle and index fingers on either side of the acupuncture point to gauge the patient’s skin temperature. This method warms the meridians, dispels cold, and is commonly used for chronic diseases, being the most widely applied in clinical practice.
(2) Rotary moxibustion: The ignited moxa stick is rotated above the treatment area, about 3 cm from the skin, moving back and forth or in circles, providing warmth without burning. Generally, this can be done for 20-30 minutes and is suitable for rheumatic conditions, neurological paralysis, and widespread skin diseases.
(3) Sparrow pecking moxibustion: The ignited end of the moxa stick is directed at the acupuncture point, moving up and down like a sparrow pecking rice, typically for about 5 minutes. This method is often used for acute diseases, emergency fainting, and pediatric conditions; caution is needed to avoid burns.
4. Use of Moxibustion Box: During moxibustion, place the moxibustion box on a flat area of the treatment site, position the ignited moxa roll on the iron mesh above the acupuncture point, and cover it with the box lid. The size of the opening can be adjusted based on temperature. Each moxibustion session lasts 15-30 minutes. Multiple acupuncture points can be treated in one session, and moxibustion can be repeated after acupuncture. This method is suitable for common conditions such as dysmenorrhea, low back pain, and diarrhea.
Supplementing and Reducing Techniques in Moxibustion
The principles of supplementing and reducing in moxibustion are first recorded in the Neijing and Ling Shu, stating: “When qi is abundant, reduce it; when deficient, supplement it. For supplementation, do not blow out the fire; let it extinguish naturally. For reduction, blow out the fire quickly, ensuring the moxa burns out.” The principles of supplementation and reduction in moxibustion also need to follow the diagnostic treatment principles, using supplementation for deficiency and reduction for excess. For supplementation, moxibustion should be allowed to burn out naturally; for reduction, the moxa should be blown out quickly to allow the heat to penetrate deeply into the acupuncture point to dispel pathogenic qi.
Order of Moxibustion
Ancient texts provide clear guidelines on the order of moxibustion, such as in the Beiji Qianjin Yaofang, which states: “In moxibustion, treat yang first, then yin… treat upper parts before lower parts.” The Mingtang Jiu Jing also notes: “First treat the upper, then the lower; first treat the lesser, then the greater.” This means to first moxibustion the yang meridians, then the yin meridians; first the upper body, then the lower body; in terms of quantity, first treat the lesser and then the greater; in terms of size, first treat the smaller moxa cones and then the larger ones.
The above order of moxibustion is a general guideline and should not be rigidly adhered to. For example, in treating rectal prolapse, one should first moxibustion Changqiang (Governing Vessel 1) to lift the rectum, then moxibustion Baihui (Governing Vessel 20) to raise the prolapse, indicating that one should treat the lower part first and then the upper part. Additionally, moxibustion should be performed in a well-ventilated environment.
Post-Moxibustion Reactions
Due to individual differences, some patients feel very well after moxibustion with minimal reactions and side effects, while others may experience significant reactions. Common reactions include:
1. Blisters after moxibustion, 2. Worsening of diseases after moxibustion, 3. Insomnia after moxibustion, 4. Wandering symptoms, 5. Heat symptoms, 6. Allergic-like symptoms, 7. Psychological reactions, 8. Disease expulsion reactions:
(1) Reactions related to expelling wind-cold: These often manifest as sneezing, runny nose, muscle and joint pain, and chills, with normal body temperature.
(2) Reactions related to expelling stagnant qi: These are primarily emotional changes such as irritability, sadness, and easy crying, often accompanied by belching and flatulence.
(3) Reactions related to expelling phlegm-damp: These often manifest as coughing, vomiting phlegm, abdominal pain, diarrhea, viscous stools, edema, difficulty urinating, or frequent, turbid, and foul-smelling urine, with local or systemic cold sweats.
(4) Reactions related to expelling heat toxins: These often manifest as itching, swelling, fever, similar to eczema with intense itching, or burning sensations during urination.
(5) Reactions related to expelling blood stasis: Stasis on the surface meridians may present as purpura, while stasis in the gastrointestinal tract may lead to dark brown or black stools, and stasis in the heart and lungs may present as blood-streaked phlegm or clots, while stasis in the uterus may be expelled with menstrual blood, sometimes with tissue fragments or necrotic tissue.
(6) Fever reactions: Fever is one of the severe systemic reactions that may occur after the body’s recovery mechanisms are fully activated, indicating vigorous qi and blood, enhanced constitution, and marking a transition from quantitative to qualitative change. When expulsion reactions occur, mild cases may not require treatment and can self-resolve, while severe cases may need symptomatic treatment based on changes in the condition to prevent further complications.
Contraindications for Moxibustion
The contraindications for moxibustion at anatomical sites are inconsistently recorded in ancient literature. Many ancient texts list numerous contraindications for moxibustion, including time, food, climate, and situational factors. The Great Compendium of Acupuncture and Moxibustion lists 45 contraindicated points, the Medical Canon of the Golden Mirror lists 47, and the Collection of Acupuncture and Moxibustion lists 49. From a modern perspective, some contraindications are unnecessary, and moxibustion at previously contraindicated points can yield effective results, such as using Jiuwei (Governing Vessel 15) for epilepsy, Yinbai (Spleen 1) for uterine bleeding, Xinyu (Heart 7) for nocturnal emissions, Shaoshang (Lung 11) for epistaxis, and Dunbi (Stomach 34) for arthritis. However, some contraindications are reasonable, such as avoiding moxibustion at points like Yamen (Governing Vessel 15), Jingming (Bladder 1), Cuanzhu (Bladder 2), and Renying (Stomach 9).
1. Contraindicated Sites for Moxibustion: The facial area should not be treated with direct moxibustion to prevent scarring and aesthetic issues. Joints should not be treated with scar moxibustion to avoid suppuration and ulceration, which may hinder healing. Additionally, areas over major arteries, the heart, veins, tendons, the lower back and abdomen of pregnant women, as well as the nipples, genitalia, and testicles should not be treated with moxibustion. The above are just general examples; with flexible methods like moxa roll moxibustion or indirect moxibustion, some areas can be treated with mild moxibustion. In cases of acute or critical illness, flexibility is necessary, and treatment should be adjusted accordingly.
2. Contraindicated Conditions: Moxibustion primarily uses heat stimulation to treat diseases. Therefore, it is generally not suitable for exterior warm diseases, yin deficiency, internal heat, or excess heat conditions. Additionally, infectious diseases, high fever, coma, convulsions, extreme exhaustion, and those in a cachectic state with no self-regulatory ability should also avoid moxibustion.
3. Contraindicated Populations: Generally, individuals who are fasting, overworked, overly full, overly hungry, intoxicated, excessively thirsty, overly shocked, overly frightened, overly angry, extremely fatigued, or fearful of moxibustion should use caution. Moxibustion should not be performed during storms, extreme cold or heat, excessive sweating, or during menstruation (except in cases of severe bleeding).
Post-Moxibustion Care
1. Handling Blisters: After moxibustion, patients may develop blisters or water vapor, which are manifestations of the body expelling pathogens. There is no need for excessive concern; if the blisters are small, they can be left to heal naturally. If the blisters are large, they can be punctured with a needle and treated with antiseptic to prevent infection, but the blister skin should not be removed.
2. Handling Moxibustion Sores: If blisters develop and suppurate, they may form moxibustion sores. After the formation of moxibustion sores, care should be taken to avoid infection. Daily disinfection around the sore with 75% alcohol and gently absorbing surface pus with dry cotton balls is recommended. Do not clean the pus crust, as this may cause pain and hinder pus drainage. If the sore shows signs of expansion, with pus changing from light white to yellow-green and producing a foul odor, it can be rinsed with hydrogen peroxide and treated with anti-inflammatory ointment or skin regeneration ointment.
3. Prevention and Care for Fainting from Moxibustion: Fainting from moxibustion is a rare adverse reaction, usually mild but can be serious. For mild fainting, stop moxibustion immediately, move the patient to a well-ventilated area, elevate the legs, and lower the head (without a pillow), resting for a moment. If the patient still feels unwell, provide warm water or hot tea. For severe fainting, lie the patient flat after stopping moxibustion; if urgent, they may be placed directly on the floor, and artificial respiration and injections of cardiotonics or acupuncture at Shuigou (Governing Vessel 26) and Yongquan (Kidney 1) may be necessary.
4. Post-Moxibustion Care: Post-moxibustion care is crucial and determines the effectiveness of moxibustion therapy. Patients should focus on emotional regulation, sleep, diet, and exercise. Maintaining a positive mindset and emotions, ensuring adequate sleep, and avoiding all cold, greasy foods, alcohol, and focusing on a light diet are essential.