Chinese medicine (CM) offers a variety of intriguing modalities to aid healing. Have you ever wondered why your practitioner uses smouldering sticks or moxibustion, sometimes with ginger, or salt? This ancient practice has piqued the interest of many of my clients, so I thought it would be a good to shine some light on this ancient practice, and the modern scientific backing.
What is Moxibustion?
Moxibustion is an external treatment rooted in traditional Chinese medicine (CM), characterised as a form of heat therapy. In this practice, moxa, derived from dried Mugwort (Artemisia vulgaris), is burned near or directly on the skin. The moxa can be processed into wool, sticks, or even smokeless forms by infusing it with carbon.
Moxibustion has been utilised for over 2,500 years to prevent and treat diseases. The earliest documentation of moxibustion dates back to 581 B.C. in the Zuo Zhuan of the pre-Qin dynasty. Further references were found in the silk books from the Mawangdui tomb of the Han dynasty (168 B.C.), detailing its application in treating complex diseases.
The Purpose of Moxibustion
Primarily a heat therapy, moxibustion is used to warm the body, aligning with the holistic principles of CM. It aims to restore balance and move energy blockages within the body. Moxibustion is known for its dual effects of tonification and purgation, warming and nourishing the body.
The roles of moxibustion are broadly categorised into:
Warm Nourishing: This involves warming the Yang (the body's warming fire), tonifying Qi, nurturing Blood, and relieving depletion. It's used to enhance digestion, build blood, and improve energy efficiency.
Warm Dredging: This function includes activating blood circulation, dissolving stasis, promoting Qi movement, and relieving pain, thus reducing bruising and swelling.
Warm Melting: This targets the reduction of dampness, resolving phlegm, moving stagnation, eliminating wind, drawing out poison, and purging heat, which translates to reducing solid nodules, calming tremors, and treating inflammation.
How Does Moxibustion Work?
In CM theory, moxibustion's effects are based on the meridian system and the properties of moxa and fire heat.
The Meridians: Both needling and moxibustion use acupoints and meridians to influence the body's internal and external functions. During moxibustion, cutaneous regions and acupoints serve as terminals for the meridian system, transmitting stimulation into the body and regulating the whole system.
Moxa and Fire: An ancient belief holds that diseases unresponsive to drugs and acupuncture may be treated with moxibustion. The Shen Jiu Jing Lun states that moxa fire can warm the Yang, eliminate cold, and address damp, wind, and phlegm. Moxa fire is unique for being warm without dryness, with strong penetrating abilities to the internal organs.
What are the components of Moxibustion to aid healing?
The history of moxibustion research started in the early last century in Japan, a country whose style of acupuncture uses a lot of moxibustion. They started observing the effects of moxibustion on things such as blood pressure and intestinal peristalsis.1,2 These days there is much research on this topic, involving all major physiological systems, especially analgesic, enhancing immunity and anti-aging. They have also researched how it works with the thermal effect, radiation, and pharmacological actions of moxa.
Thermal Effects: Burning moxa can produce high temperatures (548-890°C), it warms the skin so people think this is the thermal effect but it is actually deeply penetrating to the skin. Studies showed that using a 50mg moxa cone direct on the skin of mice with thermocouple implanted, the temperatures of the epidermal, subcutaneous and basal layers were different. This suggesting that moxibustion thermal stimulation affects both shallow and deep tissues of the skin. It also affected the area moxa was performed on and didn't affect the temperature on the distal limbs. (3,4)
Other people have done studies using thermal resistor thermometer and computer online real-time processing to measure the skin temp at acupoints using differing types of moxibustion and differing suspension examples. They compared direct moxa, ginger-separated moxa, suspension moxa, light moxa and He-Ne laser moxibustion. All except the He-Ne moxibustion significantly changed the temperature of the acupoints through the skin and muscles and all had their own attributes.5 Also the time duration of burning moxa can significantly improve the immediate analgesic effect and lingering effects.6
Where the effects of moxibustion on the skin can appear as hotness, flushing, pain, blisters and other skin irritations and burn phenomena. Moxibustion can lead to vasoconstriction at the burning point while vasodilation around the point and increasing peripheral arterial blood flow and microvascular permeability (4,7)
Radiation effects – A study was performed on irradiating acupoints for pain model rats with radiogenic heat of 40-43 °C, and there were no significant changes to the tail flick latency or vocalisation, which suggested that not any thermal stimulation can achieve moxibustion efficacy.8 The burning moxa emits visible light and infrared (IR) radiation, so non-thermal radiation could be an important role of the efficacy of moxibustion.
Physics tells us that the radiation is a process of energy outward diffusion in the form of electromagnetic waves or particles; any object above zero in temperature emits electromagnetic radiation. Presently it is viewed that the ignited moxa radiation spectrum ranges from 0.8 to 5.6 μm; peak is nearly 1.5 μm, lying with the near infrared (NIR) portion(9). But the results reported differently due to measurement methods and experimental conditions. Thermal radiation of burning a moxa stick measured by indirect methods is mainly far infrared (FIR) near infrared (NIR) with spectrum peak at 2.8μm (10). When the infrared radiation spectrums of moxibustion and substitute moxibustion on acupoints were analysed, they found a surprising consistency between indirect, and separated with monkshood, ginger and garlic. However if it was separated with cucumber and carrot (cooler vegetables), it was completely different. There was also a big difference between the IR spectrums of moxa stick and substitute moxa, indicating that the substitute could not replace the traditional moxa in terms of infrared characteristics.(11)
Infrared acts on the body producing thermal and non-thermal effects. The thermal effects are produced under the action of electromagnetic waves; our molecules absorb energy from IR and convert it into heat and therefore promote blood circulation and improve the cell and enzyme activities. The NIR irradiates the body, the light reflected by the skin is relatively low, the energy can be transmitted about 10mm deep into the skin, reach the tissues and be absorbed by them. It also induces active substances within tissues absorbed by connective tissue, blood vessels, lymphatic and nerves under the irradiated skin and distributed to other parts of the body through blood circulation and enhance the metabolism and thermogenesis of organs reached. NIR also energises the metabolism of the cells by increasing your mitochondria of your cell. This energy is passed through the nerve-humoral system by the photoelectric effect and photochemical process and provides activation for the pathological cells lacking energy and then further adjust the body's immune and neurological functions.(12)
Pharmacological aspects – Artemisia argyi Mugwort, is a perennial herb, which grows easily in Aotearoa. It can produce moxa wool after drying and grinding which is the common material to moxibustion. But the ingredients are more complicated; more than 60 kinds of components have been identified (13). The volatile oils of moxa include; Cineole, alkenes,(alpha-thujene, pinene, sabinene etc.) camphor, borneol and little aldehydes, ketones, phenols, alkanes and benzene series compounds. It also has tannins, flavonoids, sterols, polysaccharides, trace elements and other ingredients (14). The ingredients change according to the place it originated and the season of production and different areas are known for their differing heats.
The volatile oil rate of moxa is 0.45%-1.00%. It has a variety of biological activities such as the expansion of airway smooth muscle, relieving cough, expectorant effect and strong antioxidant (15,16). The combustion of the moxa products bring out a brown tar-like substance that plays a role of penetrating into the human body through the skin who’s pores are open due to the heat and increased vascularity. Also using ginger or garlic as auxillary materials to assist moxa when placed on the evaporating dish for experimentation confirmed that gingerol and allicin the active ingredients could be extracted and act on the body with heat. The active ingredients in the moxa are increased rather than destroyed after burning.
The smoke of moxa can be used for air disinfection and as antiviral and antifungal. It is reported that it has applications in wound infections, uterine prolapse and anal fistuala, and common worts (17). There is still debate on the safety of moxa smoke. Some reports show it may be harmful to the human body such as causing allergic reactions (18). The mugwort leaf contains terpenes possibly causing aromatic carcinogens in the process of combustion. And during the burning of moxibustion the concentration of air pollutants such as nitrogen oxides, carbon monoxide and particulates is tenfold higher than the level of standard class II, which is issued in the US State Environmental Protection Act. They would do damage to the patients and staff (19). But research giving consideration to short-term and long-term exposure showed that the volatile matter and carbon monoxide generated by the smoke of moxa under normal ventilated operating conditions did not exceed the safety level (20).
So the mechanism of moxibustion effects there are many viewpoints, such as thermal stimulation effect, non-specific autologous protein therapeutics, non-specific stress responses, and aromatherapy. Generally, it is accepted that the meridian system combines with moxibustion physical and chemical effects to produce comprehensive effects. When physical and chemical factors act on the acupoint receptors, the signal enters the central nervous system through the peripheral pathways and outgo's after being integrated, adjusting the nerve-endocrine-immune network and circulatory system, to regulate the internal environment of the body, in order to achieve the effects of preventing and curing diseases (21).
Where moxibustion is a vessel to add heat it cannot be separated from the theory of traditional Chinese medicine (CM). Rather than just the stimulus of heat, the meridian and acupoint system of the human body is key to the efficacy.
What can Moxibustion treat?
Moxibustion can address various health issues, such as:
Gastrointestinal problems (diarrhoea, colitis, IBS, constipation)
Menstrual cramps
Pain relief (arthritis, joint/muscle pain, chronic pain)
Cancer-related nausea
Urinary incontinence
Fertility issues
Asthma symptoms
Eczema
Fatigue
Cold and flu prevention
Breech presentation
Stroke rehabilitation
Frostbite
Though studies on CM often face challenges like small sample sizes and potential bias, there is evidence supporting moxibustion's effectiveness.
A study on the effectiveness of moxibustion in pain and symptom management in knee osteoarthritis compared moxibustion to drug therapies and sham treatment concluded moxibustion was effective.(22)
An additional study showed that combining moxibustion with acupuncture, there is an increase in bone density in patients with osteoporosis.(23)
Studies on turning breech babies have shown this to be a cheap and effective treatment to aid movement of the baby position.(24)
A Korean study on acupuncture, herbal medicine and direct moxibustion to prevent amputation in severe grade 3 frostbite and encourage tissue regeneration showed some amazing results with no adverse effects.(25)
Disclaimer pics are slightly gory.
How is it used?
There are many ways moxa can be used. Generally when I give people a stick to take home it is called indirect moxa it is waved lighted and gently circled just away from the skin over the intended area. I encourage people to hold two fingers on the skin around the area being treated so they can ascertain if it is getting too hot. If it gets hot move away for a bit and start again. The skin should get nice and pink from the vasodilation, which is the movement of Qi and Blood to the area which encourages healing. I use this often with pain such as osteoarthritis, or tendon issues such as tennis elbow.
In clinic we often use direct moxa, sometimes right on the skin, which we remove before it burns, or using a warming medium to aid the therapeutic effect, such as ginger, salt or garlic.
Often clinically I use a warming the abdomen approach for gynecological or digestive issues. We use this to pull cold out of the middle, and can be felt as cold emanating from under your skin, often people feel this as cold in abdomen with hot extremities from the cold pushing the heat outwards. The adverse effects of this, apart from the imbalance of hot and cold in the body, is pain. Cold is restricting and painful. In this instance I gently place a large cup over the umbilicus to pull out the cold, then I place pieces of moxa burning on ginger and sometimes salt straight onto the umbilicus to warm the abdomen after removing the cold. My patients claim the warmth feels like a spider web warming them through, I envision this in my mind to ice cracking.
Sometimes I warm needles to add extra energy to an acupoint. It is important to remember that the movement of Qi with acupuncture is reliant on the energy the body has. It is not like herbs where we are adding stimulation, we are using the bodies energy in the points to help it work more efficiently and bring it to balance. So moxa is often used to add energy to points aiding acupuncture to work more efficiently. The acupuncture point ST-36 Zusanli is translated as leg three mile. It is said the old sages didn’t walk 3 miles with someone who didn’t moxa this point daily. Also rumour has it that the old sages in the day could live over 100 if they performed moxa on ST-36 Zusanli and the lower REN channel points of your abdomen daily, adding energy to these very nourishing points. With people with reduced immunity and very weak Qi and Blood I will give them a prescription of moxa on this point to help them build more blood and increase their white blood cells (WBC).
Anxiety is another reason I use this moxibustion. If people are too in their heads, warming the bottom of their feet KID1 Yongquan is very calming. It will pull your energy downwards and ground you. This can also work with certain types of headaches.
Conclusion
Moxibustion remains a vital component of CM due to its extensive applications and proven benefits. If you're curious about how moxibustion can enhance your health, consider exploring this affordable and effective therapy.
Feel free to reach out for a chat to learn more about incorporating moxibustion into your wellness routine.
References
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Ha, Seojung et al. “Acupuncture and herbal medicine in preventing amputation and promoting tissue regeneration in severe frostbite: A case series.” Explore (New York, N.Y.) vol. 20,1 (2024): 143-147. doi:10.1016/j.explore.2023.07.006
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