What, Why, and How it Works – The Way of the Great Physician (2024)

What is Moxibustion?

Moxibustion, or Moxa, refers both to an herb and a technique. The herb most commonly used in moxibustion is Artemisia argyi, Ai Ye (艾叶), or Chinese mugwort. The best mugwort is found in the Qizhou province of China as it has the most natural oils. It is harvested a few days before the summer solstice, as it is the time of year with the most yang energy, and that yang energy is harvested and used medicinally. Mugwort is processed through drying and tossing until it contains more or less twigs and it becomes fluffy moxa wool. The moxa wool is then gently burned on or near the skin on the acupuncture points and has many therapeutic benefits.

Moxibustion can also refer to the therapy of using heat from various sources, directed at specific points or areas of the body with the intention of helping the body heal.

The HuangDi NeiJing SuWen, the Yellow Emperor’s Inner Canon Simple Questions, chapter 12 shares how different Chinese medical modalities were developed in different regions of China and why. Guasha (stone therapy) came from the east, herbal medicine from the west, acupuncture from the south, and massage from the center region of China. About the north, it says,

“In the northern district of mostly highlands, where the weather is cold, shutting and hiding like winter, the people there live in the mountains and hills, and the cold wind often sweeps the frozen land. The local people like to stay in the wilderness to drink the milk of cows and sheep. In this case, their bowels can easily contract cold and cause abdominal distention. In treating the disease, moxibustion therapy should be used, thus the moxibustion therapy is transmitted from the north.”

Moxa is excellent at helping with abdominal complaints, though is currently used for many different conditions.

How Does Moxibustion Work?

Two of the ways moxibustion heat therapy works is as follows.

Firstly, the heat causes vasoconstriction and vasodilation at the acupuncture point, thus increasing and improving peripheral blood flow (1). Blood flow in the body, especially in the limbs is important in nourishing and maintaining the tissues of the body, such as the skin, joints, and muscles. Problems in circulation can lead to a never ending list of medical problems, including clotting, breaking down muscle, wound healing, etc. (2). Moxa’s ability to increase and improve blood flow in the body is hugely important in maintaining a healthy functioning body.

How Can Moxa Help Me?

It is stated by ancient doctors that “When a disease fails to respond to medication and acupuncture, moxibustion is suggested” (5). Moxibustion:

Warms the meridians and expelling cold. In the northern hemisphere, this is a cold time of year where it is easier for cold to enter the body and cause problems. When someone spends a lot of unprotected time in a cold or windy environment, the cold can cause a condition called a “Wind-Cold Invasion”, accompanied by congestion, chills, sneezing, headache, and stiffness, particularly in the back of the neck. Cold can also enter and stagnate qi, blood, and fluids in the body. Sharp pain is often perceived as the result of stagnation in the body. Moxa warms the body and allows free flow to occur and aiding in driving out the wind-cold.
Induces smooth flow of qi and blood. Blood flows in specific directions in the body – leaving the heart, going to the limbs and organs, coming back to the heart, reoxygenating in the lungs, coming back to the heart, and repeating the cycle. Just as blood flows in a specific way, qi also flows in specific ways. Qi flows along meridians. Qi also flows in different directions around and from organs. For example, the Stomach sends qi downward. When the Stomach is weak or struggling to send qi downward, it can bubble up and cause conditions like heart burn or headaches. Moxa helps blood and qi to flow in healthy and appropriate directions in the body.
Strengthens yang against collapse. The principles of yin and yang are key to life and death. Yang is light, life, spirit, heat, and wakefulness, while yin is darkness, death, physicality, cold, and sleeping. Yang is not good and yin bad, but it is all more nuanced. Both are necessary for life but living things have slightly more yang than yin, more heat than cold. Moxa, as heat, produces and reinforces the yang qi in the body. The HuangDi NeiJing LingShu, chapter 73 elaborates, states, “Deficiency of both yin and yang should be treated by moxibustion.”
Prevents disease and keeps healthy. As stated previously about the immune boosting effects of moxibustion, the JingGui YaoLue, Essential Prescriptions from the Golden Cabinet concurs, stating “Anyone who travels in the southwest part of China, such as Yunnan and Sichuan provinces, should have moxibustion at two or three points to prevent sores or boils and to avoid pernicious malaria, epidemic diseases and pestilence.”
Warms the uterus and regulates menstruation. Menstrual cramping is often due to blood stagnation, particularly if there are visible clots. While cramping, the uterus is working harder to get the clotting endometrium out. Moxa on the lower abdomen warms up the area, dissipating clotting, and relieving cramping. On another note, moxa has been shown to support the fetus during pregnancy. One randomized controlled study found that moxa on the smallest toe, the acupuncture point Bladder 67, significantly increased fetal movement and turned breeched babies (6).

In a meta-analysis on scientific papers published from 1954-2007 in China analyzing the effects of moxa, it was noted by the scientific community that moxa can most greatly benefit the following conditions (7):

Diarrhea,
Colitis,
Urinary incontinence,
Dysmenorrhea,
Knee osteoarthritis,
Temporomandibular joint disturbance syndrome,
Soft tissue injury,
Heel pain,
Asthma,
Urinary retention,
Herpes zoster,
Weakness and fatigue, and
Aging related problems.

Moxa can help with more conditions than just this, but this is a great place to start.

What are the Different Kinds of Moxa and How are they Used?

Traditionally, moxa is used directly and indirectly on acu-points. The goal is to increase warmth and remove or put out the moxa before it becomes hot.

Direct forms of moxa include:

Rice Grain Moxa – As a Japanese way of using moxa, moxa wool is rolled between two flat pieces of wood until it forms a long string of moxa, as thin as a grain of rice. Burn cream is applied to the point and rice-sized pieces of moxa are placed on the point so they are standing up. They are lit on the top by an incense stick and pinched out before the lit portion reaches the skin. Usually, multiple small rice grain moxa cones are used on each point.

Cone – Processed moxa wool is formed into a cone shape, placed on the body, lit using an incense stick. The fire slowly burns the moxa, radiating heat, and is quickly removed before the bottom of the cone touching the skin burns

What, Why, and How it Works – The Way of the Great Physician (1)

What, Why, and How it Works – The Way of the Great Physician (2)

Ibuki Moxa – Also a Japanese form of moxa, ibuki comes as small moxa sticks with stickers at the bottom that can be applied to the skin. They are designed to have a space between the bottom of the moxa stick and the skin. The top of the stick is lit and the moxa slowly burns, eventually burning out and not touching the skin.

Scarring Moxa – This is a favorite of ancient doctors but is rarely used in the modern day, especially in the West. Auricular acupuncture, in fact, was developed by French physician Dr. Paul Nogier in 1966 after he had several patients come to him with a scar on a certain part of their ear. When he inquired into it, he discovered they all had experienced sciatica which went away when a therapist burned a specific spot on the ear. Dr. Nogier looked more into this and developed the auricular acupuncture map. Scarring can be very helpful but is not done in the US or Canada because practitioners are afraid of being sued for burning their patients.

Indirect forms of moxa involve separating the moxa from the skin through different mediums. Some of those include:

Air – One of the easiest and easily accessible ways for the average person to use moxa is with a moxa stick. Moxa sticks come in two varieties: moxa wool tightly packed into a paper tube, known as smoky moxa, or a charcoaled moxa stick, known as smokeless moxa. These sticks are lit so they smolder on one end and then held over different acupuncture points or areas of the body. Occasionally ash that builds up on the stick is tapped off. This is a great method for covering larger areas of the body or doing treatments to turn a breeched baby. Air and distance is the barrier between the smoldering moxa stick and the body.

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What, Why, and How it Works – The Way of the Great Physician (5)

Acupuncture Needles – A practice discussed in ancient medical texts is to place a tight ball of moxa or a cut section of a moxa stick (lovingly called a “kabob” in my school clinic). These forms of moxa are placed on the end of the inserted acupuncture needle and lit. The acupuncturist is very attentive and cautious while it burns, ready to catch it if anything unexpected happens. The heat from the moxa travels down the needle and is directed into that point.
Salt – When there is cold in the abdomen, it can be appropriate to use moxa over the belly button. While a moxa stick can be used in this scenario, the more direct way is by pouring some salt into the umbilical indentation and placing a moxa cone on top of the salt. The salt serves as insulation to protect the skin from the moxa cone, spreading out the warmth. The salt is removed after the treatment.
Box – Moxa boxes are usually designed with wood and a wire mesh placed horizontally midway inside so there is a great distance between the mesh and skin when the box is placed on the back or abdomen. Moxa wool is placed on the mesh and lit. A lid is placed on the box to concentrate the heat and direct it downward. The box creates space that separates the moxa from the skin.

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What, Why, and How it Works – The Way of the Great Physician (7)

Metal Case – Tiger warmers are metal cases the size and approximate shape of a pen. Thin moxa sticks are inserted and lit, allowing the user to directly control airflow to the smoldering moxa and place the moxa in places that are not safe using the other forms, such as on the head or near the face.
Garlic & Ginger – Dragon fire moxa involves using grated ginger and garlic as insulation from the smoldering moxa. When using this style of moxa, the patient lies down face first on the massage table and gauze is laid down along their spine. Grated ginger is piled along on top of the gauze with grated garlic placed on top and moxa wool on the very top. The moxa is lit and because of the insulation, only general warmth is felt. And having personally received this twice, I declare that it feels amazing!

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What, Why, and How it Works – The Way of the Great Physician (10)

Other forms of moxa therapy are drug moxibustion, using the moxa oil or irritant drugs to coat an acupoint, or modern moxibustion practices, such as laser acupuncture. Laser acupuncture is especially good for little children and uses red or blue lasers to activate an acupuncture point.

What is it Like to Receive Moxibustion?

Moxibustion is regularly used as part of an acupuncture treatment.

Preparation: If there is a lot of body hair where an acupuncturist wishes to place direct moxa, they may shave the area or just use a form of indirect moxa. You can ask to your acupuncturist about what their plans are and what method you prefer. They are there to support you and should be open to your preferences.

Communicate: If you receive acupuncture, openly communicate with your acupuncturist on if the location becomes too hot and they will support you by removing or backing off the moxa treatment. As acupuncturists in training, we are taught to not do moxa on those who are not of clear consciousness, with poor blood circulation or dull nervous sensation. It is important that those experiencing acupuncture are able to communicate if it becomes too hot.

Smoke: Moxa often creates smoke and has a distinctive smell which often sticks to clothes. I once opened an acupuncture book from my school library, and it clearly smelled of moxa. The smell can be too much for some people, but usually doesn’t negatively affect the majority of people. If you are sensitive to smells, let your acupuncturist know so they can support you.

Precautions: The acupuncturist may use burn cream to protect the skin or one of the indirect forms of moxa. They closely monitor the area where the moxa is placed, removing it if the area becomes too hot or the skin turns red.

If you have any experiences with moxibustion or have any other questions, let me know here.

Sources:

Deng H, Shen X. The mechanism of moxibustion: ancient theory and modern research. Evid Based Complement Alternat Med. 2013;2013:379291. doi:10.1155/2013/379291
P. Christian Schulze, Michael J. Toth. Alterations in Skeletal Muscle in Heart Failure. Editor(s): G. Michael Felker, Douglas L. Mann. In Companion to Braunwald’s Heart Disease. Heart Failure: a Companion to Braunwald’s Heart Disease (Fourth Edition). Elsevier: 2020. Pages 222-232.e3. ISBN 9780323609876. https://doi.org/10.1016/B978-0-323-60987-6.00016-8.
Park CJ, Seo YS. Heat Shock Proteins: A Review of the Molecular Chaperones for Plant Immunity. Plant Pathol J. 2015;31(4):323-333. doi:10.5423/PPJ.RW.08.2015.0150
Peng L, Liu M, Chang X, et al. Effects of pre-moxibustion at Zusanli (ST36) on heat shock protein 70 expression in rats with gastric mucosal lesions after neurotomy. Neural Regen Res. 2012;7(30):2370-2376. doi:10.3969/j.issn.1673-5374.2012.30.007
Cheng XN. Chinese Acupuncture and Moxibusstion (4^th Edition). Foreign Language Press. 1999.
Cardini F, Weixin H. Moxibustion for correction of breech presentation: a randomized controlled trial. JAMA. 1998;280(18):1580-1584. doi:10.1001/jama.280.18.1580
Qinfeng H, Huangan W, Jie L, et al. Bibliometric analysis of diseases spectrum of moxibustion therapy. Journal of Acupuncture and Tuina Science. 2012; 10(6):342-334.

Images Sources:

Rice Grain Moxa: https://www.facebook.com/775282732662299/posts/check-out-the-perfect-rice-grain-moxa-cone-right-here-bloody-marvellous-isnt-it/1059682197555683/
Moxa Cones: https://www.britannica.com/science/moxa-treatment
Ibuki Moxa: https://opis-supplies.ca/chosei-kyu-facial-moxa/
Salt & Moxa: https://www.acupaintherapy.com/moxibustion_treatment.php
Tiger Warmer: https://www.acuneeds.com/rolling-tiger-warmer-large-moac0021