Moxibustion

Moxibustion is a therapeutic technique that entails burning a bundle of dried mugwort. The dried mugwort is chosen for its gentle burn rate, pleasant and soothing aroma, and pliable loose fibrous texture that makes it easy to pack them into a desired shape. We may supplement acupuncture treatments with moxibustion on the needle to further enhance the blood circulation and relax the deep muscles, which is not achievable by more common techniques such as a heat lamp.

This is tribal.  But good tribal.

Moxibustion, as a process, simply involves setting some Chinese mugwort on fire and then then direct the warmth generated by that combustion toward specified points on the body to effect therapeutic betterment. 

Why Chinese Mugwort?

Because it’s the tradition!  

Seriously though, there are a few reasons why this plant was chosen for this duty:

  1. the plant can be processed into a fine fluffy form that can be easily packed by hand
  2. the fluffiness of the ball makes it relatively easy to burn
  3. right burn rate, it does not burn too fast or too slow. 
  4. very pleasant and soothing aroma, which is an important factor.  

Variations of Moxibustion

There are many variations of the moxibustion, in terms of how the burning mugwort is applied to the body.  A practitioner who is more closely associated with the practice of  Traditional Chinese Medicine (TCM) is more likely to hold a burning moxa stick directly over the skin of an acupuncture point.  Which in my opinion is downright idiotic.

Direct Moxa

direct moxa2As the name implied, in direct moxa, the burning element is placed directly on the body.  For example, the practitioner may place the mugwort ball or moxa directly over the skin and then light it on fire (usually with an incense).  The patient will need to monitor the temperature sensation and inform the practitioner in a timely matter to remove the moxa before getting burned.  

This is a less common moxa style in modern days for obvious reasons. However, you can still see direct moxa being practiced by fervent advocate of Japanese style acupuncture.  However, they use minute amount of moxa, usually in the size of a grain of rice, so the moxa provide sufficient stimulation but with much lower risk of a serious burn to the patient. 

Indirect

Moxa Stick

direct moxaYou probably find more pictures of moxa sticks than any other form of moxibustion, because that is what is taught in TCM schools.  With the moxa stick, the practitioner hold the burning tip near the patient's and move it around either at his/her own discretion or upon the patient's request.  

This approach has a few obvious drawbacks.  First the practitioner has only two hands and that means only two spots can be heated at any given time.  And the practitioner must be fully involved 100% of the time, holding a stick, as opposed to doing higher value work.  Not at all a scalable practice.  Also, commercial moxa sticks are almost always made with low grade mugworts so they smell like cheap cigarette.  So if you happen to work with a practitioner who performs moxibustion by holding a stick, you have to wonder why he/she chooses to forego several other obviously superior approaches.   

Moxa box

Moxibustion Box double HoleThis entails placing the burning moxa in a specially designed container, which can be placed direct on the body of the patient.  There is certain level of clearance between the burning moxa and the box so that creates certain level of protection for the patient.  The box also creates an enclosed environment for the moxibustion so the heat can be retained over the target area.  

The traditional box is usually rather bulky and thus it requires certain amount of space.  So, it is only suited for relatively flat surface, like the abdomen or the back.  The modern version, especially the ones that burn the smokeless charcoal, is roughly palm-size so it's much smaller.  So multiple containers can be used.  However, the nature of the design still limits its use on flat areas like the abdomen or the back.  However, since these are the two most commonly moxa'ed areas, that is not a total loss.

The effectiveness of a moxa box depends on its design and the amount of moxa burning in it.  And the practitioner needs to choose between placing a needle or the moxa box over the target area since doing both at the same location is award and impractical at best.  The weight and bulk of the box can also be uncomfortable to the patient after a while.

Warm Needle

This method requires packing the moxa onto a specially designed metal cap, which will then be inserted on top of the handle of the needle.  Of course, this insertion process is done only after the needle has been inserted into the patient.  Because of the extra weight of the cap plus the moxa, the inserted needles usually will not be able to stay upright by itself, thus additional reinforcement, such as a clothes or a clamp is required to secure the needle to ensure it stay upright throughout the process.

The warm needle is arguably the best approach, for the following reasons:

  1. it allows the practitioner to erect moxa at multiple locations and burn them at one time, thus increase the efficiency and efficacy.
  2. there is sufficient air space between the burning moxa and the skin to prevent any burn, but close enough to warm the exterior topically. 
  3. the heat generated by the burning moxa can travel past the skin to the tip of the needle through conduction to reach the target muscle that needs the heat and increased blood circulation the most
  4. because the warm needle technique does not present a burn threat like direct moxa, the patient does not need to worry about getting burned, it is thus a much more passive participation and that allows the patient to take the guard off and relax as they are supposed to

Most Commonly Targeted Area

One of the best places for moxibustion is the abdomen.  Many patients carry their stress in their abdominal area and that manifests as tension and pressure pain upon palpation.  Distal needling definitely helps reduce the tension and pain, but there is something really comforting and soothing about having warm needles on the Ren-12 and or Ren-10 and Ren-6 areas.  Again the warm needle helps direct the heat beyond the skin and into the muscle, it works better than any other form of moxibustion.

I have also applied moxibustion to ST-36 (tibialis anterior along the outer border of the shin) and the back.  

Caution

Because moxibustion involves actual flames and combustion.  Care must be exercised at all time.  The practitioner must be near by and keep a kin eye on the burning moxa and make quick adjustment whenever it’s needed.

The moxibustion should not be applied to areas that show signs of active inflammation.

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