TCM Book Club Issue 1972
Daily updates to accompany the growth of TCM practitioners
IIntroduction: Moxibustion is widely known for tonifying Yang deficiency, but is it limited to this function? Can it be used for excess heat conditions? How should it be applied? How can we avoid harming Yin? Furthermore, how should we define the indications and contraindications of a therapy? Have we narrowed the indications in modern clinical practice? This article will detail the effects of moxibustion, which are not solely for tonifying Yang but also encompass other benefits. (Editor/Qing Li)
Moxibustion: Nourishing and Draining
Author/Shi Guangyu
The “Suwen: Discussion on Different Methods and Formulas” states: “The north is the region where heaven and earth are closed and hidden, with high and cold terrain, where wind and cold are severe… Cold in the organs leads to fullness and disease, which should be treated with moxibustion.” The “Suwen: Discussion on Regulating Menstruation” states: “Blood and Qi prefer warmth and dislike cold; when cold is present, it cannot flow, but when warm, it dissipates and leaves.” The “Lingshu: Channels Chapter” states: “If it sinks down, moxibustion should be applied.” Moxibustion is commonly used to treat conditions caused by cold evil, Yang deficiency, and sinking Qi, achieving effective results. This has led some to believe that moxibustion only tonifies and does not drain, or that it is only suitable for deficiency and cold conditions, not for excess and heat conditions. Therefore, it is necessary to clarify the relationship between nourishing and draining in moxibustion.
Both Cold and Heat, Deficiency and Excess Can Be Treated with Moxibustion
In the Ming Dynasty, Li Ting stated in “Introduction to Medicine”: “For deficiency, moxibustion should be applied to assist the original Yang; for excess, moxibustion should be applied to disperse the evil with the fire Qi; for cold, moxibustion should be applied to warm the Qi; for heat, moxibustion should be applied to release the stagnant heat, which is the principle of dryness.” This indicates that the application of moxibustion is broad.
Moxibustion has the effects of tonifying the middle and benefiting Qi, reviving the pulse and rescuing from collapse, returning Yang and securing the escape, nourishing the source and benefiting essence, tonifying the spleen and stomach, and reinforcing the kidneys. For example, in patients with weak Yang deficiency and impotence due to kidney essence deficiency, direct moxibustion on the Shenshu (Kidney Shu) and Guanyuan (Gate of Origin) points can gradually restore function. Moxibustion on the Yinbai (Hidden White) point can stop deficiency-type uterine bleeding, moxibustion on the Baihui (Hundred Meetings) point can treat prolapse of the rectum and uterus, and moxibustion on the Zusanli (Leg Three Miles) point can treat deficiency-type stomach pain, all achieving good results.
Moxibustion also has the effects of warming the middle and dispersing cold, warming and unblocking the meridians, and dispelling wind and alleviating pain. Its clinical application is particularly common. Moxibustion on the Zusanli and Quchi (Pool at the Bend) points can treat cold bi syndrome, moxibustion on the Shenshu and Zusanli points can treat cold pain in the lower back and knees, and moxibustion on the Zhongwan (Middle Stomach) and Zusanli points can treat stomach cold pain. In the Qing Dynasty, Wu Yiding’s “Classic of Moxibustion” states that for cold collapse, moxibustion is appropriate, stating: “If the face is pale, abdominal pain, vomiting, diarrhea, tongue is curled and contracted, fingers and lips are blue, heart area is hard and distended, cold sweat does not stop, and the body feels like ice, with faint pulse, moxibustion on the Qihai (Sea of Qi), Dantian (Elixir Field), and Guanyuan points with large moxa sticks can lead to recovery.” This is actually a development of moxibustion for the cold conditions described in the “Shanghan Lun” (Treatise on Cold Damage).
Moxibustion has the effects of regulating the middle jiao, moving Qi and blood, clearing stasis and dispersing masses, and cleansing the intestines. The “Qianjin Fang: Volume Fifteen” mentions using moxibustion to treat heat dysentery: “For dysentery with pus and blood, and severe lower abdominal pain, moxibustion on the Xiaochangshu (Small Intestine Shu) point with a hundred moxa sticks.” For cholera, which is caused by chaotic Qi in the intestines and stomach, moxibustion is used to regulate the rising and falling of Qi to treat chaotic Qi. The “Classic of Moxibustion” states: “For those on the verge of death from cholera, fill the navel with salt and moxibustion with seven sticks will lead to immediate recovery.” The “Qianjin Yaofang: Volume Twenty” states: “For painful urination due to damp heat, moxibustion on the Taichong (Great Surge) point with fifty sticks.” Moxibustion is also a method to promote Qi and invigorate blood, allowing the meridians to be unblocked, Qi and blood to flow smoothly, and stagnation to be resolved. The “Jingyue Quanshu” states: “For severe stasis and blockage, it is most difficult to disperse; it must rely on the power of fire to disperse quickly.”
Moxibustion also has the functions of clearing heat and detoxifying, drawing fire to transform Qi, moving from deep to shallow, and expelling evils outward. In the Ming Dynasty, Gong Juzhong’s “Red Stove Pointing Snow” states: “For heat diseases, the resolution comes from fire, just as extreme heat turns to coolness, which is the principle of stagnant fire being released.” Ming Dynasty’s Chen Shigong’s “Orthodox of Surgery” also states: “Moxa fire draws out stagnant toxins, opening the sores and allowing internal toxins to be expelled, which is indeed the first method for treating sores.” In the “Classic of Moxibustion”, over fifty types of heat diseases are treated with moxibustion, providing strong factual evidence for the application of moxibustion in heat diseases such as febrile diseases, dry throat, dry mouth, women’s heat entering the blood chamber, heat cough, and lung abscess.
The Tang and Song Dynasties were the peak periods for the development of moxibustion in China. In the “Qianjin Yaofang” alone, there are over forty types of heat diseases treated with moxibustion, with more than 180 entries. These include heat conditions in the five organs such as wind-heat throat obstruction, red and swollen eyes; heat caused by the viscera leading to cough and constipation, irritability, heat dysuria, intestinal abscess, damp-heat diarrhea, and thirst in internal medicine; and heat causing blood movement leading to blood in stool, blood in urine, as well as heat toxins leading to sores, carbuncles, and abscesses in surgery. The book states: “When abdominal heat is closed, urination and defecation are difficult… moxibustion on the fontanel with a hundred sticks,” and “For heat diseases in the stomach, moxibustion on the Zusanli with thirty sticks.”
Moxibustion is not only used for treating excess heat conditions but also has good effects on some Yin deficiency heat conditions. Cui Zhitai’s “Moxibustion for Bone Steaming Disease” specifically introduces moxibustion methods for treating bone steaming and labor heat. Building on previous experiences, moxibustion has also been applied to various acute heat diseases. For example, Song Dynasty’s Wenren Qinian’s “Emergency Moxibustion Methods” proposed effective treatment measures for acute throat obstruction, cholera, and other critical conditions.
Moxibustion Can Both Nourish and Drain
Since Han Dynasty’s Zhang Zhongjing in the “Shanghan Lun” considered moxibustion as an “attack” method, many have regarded moxibustion as a purely nourishing method, believing that there is no draining method in moxibustion. However, long-term clinical practice has proven that moxibustion can both nourish and drain, and there is a wealth of experience accumulated in both methods.
As early as in the “Lingshu: Back Points”, it was pointed out: “For nourishing with fire, do not blow the fire; it must extinguish itself; for draining with fire, blow the fire quickly, passing the moxa, and the fire must extinguish.” This clearly indicates that when performing nourishing methods, the moxa should burn slowly, with gentle and lasting heat; when performing draining methods, the practitioner should blow the moxa to make the fire vigorous, allowing it to penetrate the disease area. It can be seen that the amount of stimulation in moxibustion is closely related to nourishing and draining. It emphasizes that the most suitable amount of stimulation must be selected during moxibustion to achieve the best results. Subsequent clinical practice has also proven that the size of the moxa stick, the number of moxibustion applications, and the intensity and speed of the fire are closely related to the methods of nourishing and draining.
Ming Dynasty’s Yang Jizhou further developed and supplemented the aforementioned nourishing and draining methods. In his “Great Compendium of Acupuncture and Moxibustion: Volume Nine: Moxibustion Nourishing and Draining”, he pointed out: “For nourishing with fire, do not blow the fire; it must extinguish itself, and press on the point; for draining with fire, blow the fire quickly, and open the point.” Allowing the ignited moxa to extinguish slowly while pressing on the point gathers the true Qi and prevents it from dispersing, which is nourishing; blowing the fire quickly after ignition without pressing on the point opens the point, allowing evil Qi to disperse, which is draining. The “Lingshu: Channels Chapter” states: “For heat, act quickly; for cold, linger.”
The author believes that this method is not only applicable to acupuncture but is also a major principle in moxibustion therapy, serving as a guideline. For example, in patients with weak Yang deficiency and impotence due to kidney essence deficiency, direct moxibustion on the Shenshu and Guanyuan points, allowing the moxa to extinguish slowly, followed by pressing the moxibustion area, and after the warmth dissipates, moxibustion the second time, using moxa the size of a grain of rice for 5-10 applications achieves good results, which is “nourishing when deficient”.
Similarly, using navel moxibustion to treat labor injuries, blood loss, and prolonged diarrhea; moxibustion on the Zusanli point to treat deficiency cold stomach pain; moxibustion on the Guanyuan point to treat cold collapse, deep cold, and weak Yang; moxibustion on the Zusanli and Quchi points to treat cold bi syndrome; moxibustion on the Shenshu and Zusanli points to treat cold pain in the lower back and knees can all use this nourishing method, achieving the goal of warming and unblocking the meridians and benefiting the righteous Qi through gentle warmth.
For example, moxibustion on the Yinbai point to treat deficiency-type uterine bleeding involves igniting a moxa stick and placing it about 10 cm above the Yinbai point, moxibustion for 10-20 minutes until the surrounding skin becomes warm and red, performed 3-5 times a day, achieving excellent results.
Conversely, for acute mumps with local redness, swelling, heat, and pain, and fever, using the fire of the lamp wick dipped in sesame oil, blowing the fire quickly to make it vigorous, and moxibustion on the Jiao Sun point until the fire extinguishes can quickly reduce heat and swelling.
Additionally, for sore throat and toothache due to deficiency heat, moxibustion on the Quchi and Hegu (Union Valley) points can also use large moxa sticks ignited and applying the “blow the fire quickly” method, without pressing on the points, to achieve dispersal and transformation of heat. For heat in the stomach, moxibustion on the Zusanli point can also adopt the aforementioned method to disperse stomach heat.
From the above examples, we can conclude that: Moxibustion for nourishing involves allowing the fire to extinguish itself, with many applications over a long time, and gentle heat. Moxibustion for draining involves blowing the fire quickly or applying moxibustion for only 1-2 applications, or applying moxibustion for a brief moment with high heat. Regarding the methods of opening and closing points, we can only observe their significance and efficacy through repeated verification in clinical practice.
Furthermore, the author believes that moxibustion is not merely a form of thermal stimulation; the pharmacological effects of the moxibustion materials should not be overlooked. For instance, in the “Great Compendium of Acupuncture and Moxibustion: Volume Seven”, moxibustion on the Juquan point for cough states: “For heat cough, use a small amount of realgar powder mixed with the moxa; for cold cough, use a small amount of winter jasmine flower powder mixed with the moxa; after moxibustion, chew and swallow with ginger tea.” Ming Dynasty’s Zhu Quan’s “Shouyu Shendao: Volume Three” states: “For dog bites, use cooked moxa, finely chopped pangolin, and yellow earth fried, regardless of the amount, mix with cooked moxa, and apply to each bite site, moxibustion for fourteen applications.” These all indicate that the pharmacological effects of moxibustion materials influence the nourishing and draining effects.
In summary, the notion that “there is no draining method in moxibustion” or “moxibustion only nourishes” is difficult to establish. The scholars of traditional acupuncture have explored and discussed for thousands of years, and their contributions cannot be overlooked. Practice has proven that the fundamental principle of TCM is to regulate Yin and Yang to achieve balance; nourishing and draining are relative concepts. If there is no draining method, how can the nourishing method exist independently?
In recent years, there has been a tendency to emphasize acupuncture over moxibustion. The author believes that acupuncture and moxibustion are closely linked and inseparable. The issue of nourishing and draining in moxibustion should receive our attention, and regarding the application of moxibustion for “excess and heat conditions”, we should repeatedly practice and verify from a dialectical materialist perspective, re-evaluate, and gain true insights, which will benefit the development of acupuncture in our country. Of course, the operational techniques of moxibustion should also be continuously improved and updated, allowing this ancient yet innovative traditional medicine to shine even brighter.