A Study on the Enhancement of the Therapeutic Effect of Moxibustion

GAO Xi-yan Henan College of Traditional Chinese Medicine,Henan 450003, China Moxibustion is a method for treatment of diseases and preservation of health by means of burning moxa wool or other moxa preparations at points on body surface to warm channels, disperse cold, boost qi flow, promote blood circulation, strengthen body resistance and eliminate pathogenic factors. A medical book by Bian Que records: In terms of saving life, moxibustion can be chosen first, pills second, Fu Zi Radix Aconite Praeparata third. Yi Xue Ru Men ( Elementary Medicine)says: Moxibustion performed once every season of a year can consolidate primary qi to fend off diseases and It is imperative to practise moxibustion on patients who have no response to medication or acupuncture. These ancient medical books stress the important role played by moxibustion in medical treatment and health care. Modern experimental researches have proved that moxibustion can regulate the functions of the internal organs and enhance immunity of the body. How to enhance the therapeutic effect of moxibustion is studied as follows. 1 Proper selection of points The therapeutic effect of moxibustion is closely related to selection of points. Many

practitioners believe that in clinical practice of moxibustion, fewer but better points should be selected at the exact locations.. (1) Fewer points selected The arrival of qi in moxibustion is slower than that in acupuncture. That is to say, it takes some time, generally more than 10 minutes, to produce warm and comfortable sensation at the site where moxibustion is performed. Therefore, it is necessary to select few points for the purpose of concentrating heat and guaranteeing enough time to make moxibustion reach adequate dosage. It is described in Zhen Jiu Da Cheng ( Great Compendium of Acupuncture and Moxibustion ) that in moxibustion, it is necessary not only to select few points but better ones where many channels converge, and Only those practitioners who are good at moxibustion know that if the main points are missed, moxibustion at as many as other points will fail to cure patients; only by grasping main points, can therapeutic effect be successfully achieved. These statements indicate that the

therapeutic effect of moxibustion lies not in selecting as many as points but in selecting the main points precisely [1]. This viewpoint still has instructive significance in modern clinical practice. Precisely selecting points is conducive to manipulation and communication with the patient particularly in object-separated moxibustion on the back of a patient. When 1-3 moxa cones are burnt, the patient can accurately describe the warm sensation produced by each moxa cone, and the practitioner can adjust the site of moxa cones and the duration of moxibustion treatment flexibly so as to control the dosage of moxibustion in order to avoid burning the skin. Moxibustion points should be rationally selected based on TCM theory, under the guidance of the principle of treating diseases according to syndrome differentiation and in the light of the focus of disease and in combination with the functions of points. For example, moxibustion should be performed at Qihai (CV 6) for qi deficiency, at Shenque (CV 8) and Zusanli (ST 36) for health preservation, at Yinbai (SP 1) for uterine bleeding, at Zhiyin (BL 67) for abnormal position of a fetus, and at Baihui (GV 20) for sinking of qi in meddle jiao, prolapse of the rectum or prolapse of the uterus. Zhen Jiu Da Cheng ( Great Compendium of Acupuncture and Moxibustion ) summarizes the experience as: Moxibustion should be performed at Fengchi (GB 20) and Baihui (GV 20) for dispelling wind, at Gaohuang (BL 43) and Bailao for fatigue, at Qihai (CV 6) for qi, at Shuifen (CV 9) for water, at Zusanli (ST 36) for abdominal disease, at Hegu (LI 4) for the disease in the head and eyes, at Huantiao (GB 30) and Fengshi (GB 31) for the waist and legs, at Jianyu (LI 15) and Quchi (LI 11) for arms. According to traditional theory, accumulated experience and personal understanding, precise selection of points is an important link for enhancing the therapeutic effect of moxibustion. (2) Accuracy in selection of points Points are specific sites for qi and blood in internal organs, channels and collaterals to flow to the body surface. Affected by different pathogenic factors, patients with different constitutions react to moxibustion at different sites on body surface. The point of reaction to many diseases will take place at corresponding sites. However, the reaction point is not fixed but altered with the change in illness condition. Sometimes, the point of reaction to a disease will differ in different patients. Therefore, the practitioner should carefully look for the reaction point on body surface during

moxibustion because accurately judging the point of reaction to a disease is a key to enhancing therapeutic effect. For example, when moxibustion with moxa stick is performed at Baihui (GV 20) and Sishencong (EX-HN1) to treat insomnia, the reactions at 5 sites of the points are not completely the same, and warm and comfortable sensation may be felt at one of these points, which is so-called reaction point. This method can be used to accurately determine the point. Zhen Jiu Da Cheng ( Great Compendium of Acupuncture and Moxibustion) by Yang Jizhou states: Accurately selecting points lies not in miraculous method but in carefulness. Case 1: Mr. He, 46, a cadre, suffered from insomnia from December 2006 due to work stress. It was difficult for him to fall asleep, easy to wake after falling asleep and uneasy to fall asleep again after wakening. He slept for only 3-4 hours every day with lassitude and reduced memory. Moxibustion with moxa cigar suspended was performed on him at Baihui (GV 20) and Sishencong (EX-HN1) 50 minutes once daily. In the first 3 treatments, the patient had burning sensation at each point in less than 5 minutes of moxibustion. After moxibustion, he felt pain in scalp with heat lasting a short time and his symptoms relieved unnoticeably. During the fourth treatment of moxibustion at Baihui (GV 20), the patient felt warm and comfortable sensation penetrating from the scalp to the inside. Moxibustion performed at the point for 20 minutes made him feel burning heat, and then moxibustion was performed at other points. After moxibustion, he felt hot sensation lasting a long time in the whole vertex (The site is the reaction point). From then on, He had the above-mentioned sensation during treament at the point everyday. Starting from the sixth

treatment, the patient slept for more and more time at night. After 10 times of moxibustion, he fell asleep more easily than before, could fall asleep again after wakening, had sound sleep for longer time and slept for as long as 6 hours at night. After 15 times of moxibustion , his sleep retuned to normal with no relapse found in a follow-up visit one month later. In the first 3 times of moxibustion, because the reaction point had not been found, the patient had burning sensation in less than 5 minutes of moxibustion at each point, and after moxibustion, he felt pain in his scalp and warm sensation lasting a short time without obvious therapeutic effect. However, starting from the fourth time, during moxibustion at Baihui (GV 20), the patient felt warm and comfortable sensation penetrating to the inside, indicating that the reaction point had been found. From then on, good therapeutic effect was achieved in moxibustion at that point everyday.

Adequate dosage of moxibustion Adequate dosage of moxibustion is the prerequisite for achieving the therapeutic effect.

Having sensation is the reaction of the patient to moxibustion. Therefore, in order to enhance the therapeutic effect of moxibustion, it is necessary, first of all, to make the patient feel moxibustion sensation. Different patients have varied sensations to moxibustion, such as warm and comfortable sensation, wind-blowing sensation, formication sensation and skin reaction as patch. The severity and nature of a disease as well as the dosage of moxibustion can be judged from different sensations of patients. For example, moxibustion dosage should be increased for patients with lingering windcold syndrome who have no strong moxibustion sensation or for whom it is difficult to have moxibustion sensation. On the contrary, moxibustion dosage should be decreased for patients with short illness course for whom it is easy to have moxibustion sensation or who have strong moxibustion sensation. Burning and painful sensation felt by patients in moxibustion shows that no more moxibustion should be performed at that point and another point should be selected. (1) Experience of ancient practitioners in performing moxibustion Ancient practitioners attached great importance to grasping adequate moxibustion dosage. A medical book by Bian Que reads: Moxibustion with 30-50 moxa cones can do nothing but curing mild diseases. He used as many as 300-500 moxa cones. For example, For stroke-caused hemiplegia, moxibustion is performed at Guanyuan (CV 4) with 500 moxa cones. For diabetes, moxibustion is performed at Guanyuan (CV 4) with 500 moxa cones. For numbness in loin and feet, moxibustion is performed at Guanyuan (CV 4) with 500 moxa cones. Chen Yanzhi in Jin-Sui Dynasty believed that Huangdis statement of moxibustion being vainly performed on an area with its diameter less than 0.3 cun should be adopted because only by using a moxa cone with the diameter of its base at 0.3 cun, can a point be completely covered, and moxibustion take effect through the point and channel after the moxa cone is ignited. Yi Zong Jin Jie ( The Golden Mirror of Medicine) reads: Only by using adequate dosage, can moxibustion cure diseases. The practitioner should determine the moxibustion dosage to cure a disease according to focus, illness condition, cold, heat, deficiency, excess syndromes and the patients tolerance. Ancient practitioners attached great importance to the appearance of moxibustion-caused sore

and regarded it as a main index for judging moxibustion dosage and therapeutic effect. It is said in Zhen Jiu Zi Sheng Jing Experience on Acupuncture and Moxibustion Therapy : Only by producing moxibustion-caused sore, can good therapeutic effect be achieved; without moxibustion-caused sore, the disease can not be cured. For patients with no moxibustion-caused sore, using larger dosage, increased number of moxa cones, local hot compress and taking pungent food can make it easier for the sore to appear. (2) Controlling dosage of moxibustion Through clinical observation, we have discovered that during moxibustion, patients feel warm and comfortable sensation penetrating to deep sites or transmitting to far ends, and that after moxibustion, even flush and perspiration can be seen on the skin, indicating that adequate moxibustion dosage has been achieved for a treatment. It generally takes more than 50 minutes for moxibustion to take effect without sore. It is easy for patients to accept such moxibustion. After moxibustion, if uneven flush appears on the skin and whitish spots varied in size spread in flush with sometimes the white even more than the red, which is attributed to restricted flow of qi and blood due to obstruction of local channel, moxibustion should be continued until patients feel stronger warm sensation, the white spots vanish and even flush and perspiration appear, indicating that the dosage is adequate for a course of treatment. A great deal of clinical practices has proved that moxibustion with several to scores of moxa cones at a point for 10 minutes to 1 hour takes different effect [2]. Therefore, in clinical application, the effect of moxibustion hinges on adequate dosage and even heat [3]. Case 2: Miss Liu, a 21 year-old student, felt aching pain, heaviness and restricted movement of the knees caused by cold, aggravated in cold condition and worse in right knee from October 2006. She was diagnosed as suffering from arthralgia syndrome of wind-cold type and treated mainly with the principle of warming channels, dispersing cold, clearing collaterals and relieving numbness. On the first day of treatment, six sections of a moxa roll with both ends of each section ignited were put in a box, which was placed on her right knee and taken away after the moxa roll was burnt up, when the skin of affected site was found in more white than red, indicating that the channels and collaterals were blocked, moxibustion dosage should be increased. On the second day when the same method was used on her right knee with 3 moxa rolls burnt up in a row, she felt

hotter in moxibustion area with white spots and perspiration. After 5 treatments, the patient felt hotter than before (The same dosage of moxa rolls was used) and relaxed in the knee joint with the area of white spots shrunk gradually. After 8 treatments, even flush and slight perspiration appeared on the skin of her right knee. Then moxibustion with one moxa roll was performed twice to consolidate the therapeutic effect. 8 treatments with the same method cured her left knee. 3 Selecting different types of moxibustion according to diseases Those often used are moxibustion cones (direct moxibustion and indirect moxibustion), moxibustion with moxa roll (warm moxibustion, sparrow-pecking moxibustion, revolving moxibustion and Taiyi miraculous needle), needle-warming moxibustion and moxibustion with mild moxibustioner. Various kinds of moxibustion have different characteristics. In clinical practice, proper methods of moxibustion should be selected according to illness condition and moxibustion site to enhance the therapeutic effect. For example, when facial paralysis is treated, in view of small moxibustion area, shallow and thin muscle, tender skin, and sites where moxibustion is prohibited (such as points in eye area) in the face, it is appropriate to use moxibustion with moxa roll suspended. The practitioner can adjust moxibustion sites, duration and distance according to the extent to which the patient is locally heated. Direct moxibustion producing strong heat with the effect of relieving pain and making the patient regain consciousness can be used to rescue patients with severe diseases who have no response to medication or acupuncture. Sheng Shengkuan has used the method to treat blood-loss shock, spontaneous angina pectoris and other severe cases with very good effect
[4]

. The method is rarely used in clinical practice at present because it produces

sharp pain, moxibustion sore and scar, making most patients unwilling to accept the method. Indirect moxibustion with moxa cone, a kind of moxibustion with ginger, garlic, salt or other objects put under the moxa cone, has the duel effect of moxibustion and medication, hence having very good effect on abdominal pain, vomiting and sore. It is widely used in clinical practice and can be used as a method for preserving health and preventing diseases in the family. Needlewarming moxibustion, a method combining acupuncture with moxibustion, can conduct the heat produced by moxa wool into the body through the needle to play the duel role of acupuncture and moxibustion. The method is often used to treat diarrhea, abdominal pain and other diseases of deficiency and cold.

It is particularly noted that moxibustion box, one of the mild moxibustioners, is increasingly used in clinical practice. Because of its large area, concentrated heat and obvious effect,

moxibustion box can be used to treat diseases with large area of pathological change in the waist, back, abdomen, elbows and knees. The method is applied with much less manpower, simpler manipulation; easier control on temperature and higher safety than other kinds of moxibustion, hence an ideal therapy of moxibustion. Case 3: Ms. Zhu, 52, a teacher, suffered from pain, swelling and deformation in her right knee joint with more hydrarthrosis and positive floating patella test for more than 3 years. She had no response to Chinese and Western medication, and applying plaster had little effect on her. After 5 days of treatment with moxibustion box, once a day, the pain was alleviated but the joint swelling remained obvious. In order to strengthen the effect of moxibustion to remove dampness, eliminate swelling and stop pain, as from the 6 th day, smashed fresh ginger was evenly applied on her knee joint and then moxibustion box was put on it. After 3 treatments, her swelling was alleviated. After 10 treatments, the swelling and pain in her knee joint disappeared. Moxibustion has obvious therapeutic effect on many refractory diseases. The enhancement of the effect depends on selecting proper manipulation, accurately determining moxibustion sites (or points) and controlling adequate dosage References [1] Gao Xiyan, On Contribution Made by Yang Jizhou to Moxibustion, Chinese Acupuncture and Moxibustion, 2006, (6) [2] Dong Hongying, On Factors Influencing Therapeutic Effect of Moxibustion, Jiangsu Traditional Chinese Medicine, 2003, 24 (8): 40 [3] Gao Xiyan, Clinical Application of Penetrating Moxibustion, Henan Traditional Chinese Medicine, 2007, (11) [4] Sheng Shengkuan, Application of Foaming Moxibustion to Severe Cases, Chinese Acupuncture and Moxibustion, 2000, 20 (9): 538

Translated by Duan Shumin