Fundamentals of Acupuncture and Moxibustion-- Moxibustion

　　
Moxibustion is a therapeutic method to prevent and treat diseases, which is achieved by warm stimulation of the ignited moxa stick closed to or moxa cone placed on the body surface. It is an important part of the science of acupuncture and moxibustion.

I Material and Preparation of Moxibustion
1. Materials for Moxibustion
The main material of moxibustion is moxa wool made of moxa leaves. Moxa wool means the soft fibers achieved by pounding the dry moxa leaves without impurity. Moxa wool has fragrance smell and is easy to be ignited. As an main material of moxibustion, it has the functions of warming the meridians and collaterals, promoting qi and blood, dispelling cold and dampness, releasing swelling and masses and restoring bang and stopping collapse, also be used to prevent diseases. Generally speaking, the older the moxa leaves for preparing moxa wool, the more effective. So there is a way of saying, "treating the diseases suffering for 7 years, moxa leaves for preparing wool should be 3 years old after plucking".

2. Classification of moxibustion
Commonly used moxibustion methods include moxibustion with moxa cone, moxibustion with moxa stick, warming needle moxibustion and moxibustion of mild moxibustion device. For the first two methods, moxa cone and moxa stick should be prepared before treatment.

Moxa cone: Place a small amount of moxa wool on a board, knead and shape it into a cone with fingers. The smallest is as big as a grain of wheat; the medium size is about half a date stone; and the largest one is the same as half an olive. The smaller ones are used for direct moxibustion, while the largest one for indirect moxibustion. One unit is named one zhuang, the volume and size of moxibustion should be decided according to the condition of the patient, course of disease, nature of disease, location of the disease, selected points, reinforcing or reducing methods, etc.

Moxa stick: Spread 24 g of moxa wool on a piece of paper made of mulberry bark sized 26 x 20 cm², roll it tightly into a cylinder in diameter of 1. 5 cm, then seal it up with glue. Sometimes herbal powder can be mixed within moxa wool; the stick is called the herbal stick. During the treatment, practitioner holds the stick and aims the ignited end of the stick to the treated area or selected point to do moxibustion.

II Commonly-used Moxibustion Methods
1. Moxibustion with Moxa Cone
This method can be divided into direct moxibustion and indirect moxibustion. Direct moxibustion refers to that place moxa cone on the skin directly to do moxibustion; indirect moxibustion refers to that separate moxa cone and skin with some herbal substance, this method can be named according to the separator, such as ginger moxibustion, salt moxibustion.

1) direct moxibustion
Direct moxibustion can be subdivided into scar-producing moxibustion and non-scar-producing moxibustion.
(1) Non-scar producing moxibustion
Apply a small amount of Vaseline to the treated area to increase the adhesion, then put a suitable-sized moxa cone on the point and ignited it. When the moxa cone burns out into half or the patient fells a little burning pain, replace the moxa cone by a new one. Generally apply 3-5 zhuang (a moxa cone is called one zhuang) for one treatment until the local skin becomes reddish. This method will not injure the skin or produce scar, is easy to be accepted by patients. It is applicable to the deficient-cold type diseases.

(2) Scar-producing moxibustion
It is also termed festering moxibustion. Apply a little garlic juice to the treated area to increase the adhesion and stimulating function, then apply moxibustion with suitable size of moxa cone. Each cone should be burnt up completely, then clear ash and repeat the operation. 5  10 zhuang may be applied for each treatment. Because this method can induce severe pain during treatment and leave scar after treatment, getting agreement and corporation of the patient is necessary. During the treatment, practitioner may tap the skin around the treatment area gently with hand to release the pain. Normally, the local fester or post-moxibustion sore will appear in a week after the moxibustion, and will be healed by itself in about 5 -- 6 weeks, leaving scar on the skin after scab falls off. Clinically, this kind of moxibustion is suitable to the patient suffering from asthma, chronic bronchitis, chronic gastrointestinal diseases, fatigue and hypoplasia, etc..

2) Indirect moxibustion
Indirect moxibustion also termed substance-partition moxibustion, means that the moxibustion is done by separating moxa cone and skin with some herbal substance. This method will not injure the skin and the herbal substance can perform the treatment function with moxibustion together. The commonly used indirect moxibustion are as following:

(1) Ginger moxibustion
Cut the fresh ginger into the thin slice of thickness of 0.2--0.3 cm, punch several Holes in central part of it with needle, put it on the treatment area, place a moxa cone on the ginger slice and ignite the cone to do moxibustion. When patient feels burning pain, replace another cone to continue the treatment until the local skin becomes flush. Ginger is acrid and warm in nature, it has the functions of expelling wind and eliminating coldness, Promoting meridians and collaterals. Ginger moxibustion is suitable to the deficient-cold type cases, such as abdominal pain, diarrhea, vomiting, and emission due to kidney deficiency, wind-cold-dampness Bi syndrome, and flacidity of four extremities.

(2) Garlic moxibustion
Cut the large fresh garlic into the thin slice of thickness of 0.2--0.3 cm, punch several holes in central part of it with needle, put it on the treatment area, place a moxa cone on the ginger slice and ignite the cone to do moxibustion. Replace a new garlic slice after applying 4-5 zhuang moxibustion. 4 -- 10 zhuang may be applied at one point each time. Garlic, having acrid, warm and expelling natures, can perform the functions of releasing swelling, removing toxins and stopping pain. Clinically, garlic moxibustion is suitable to the cases of pulmonary tuberculosis, mass as well as sore at the early stage, etc..

(3 ) Salt moxibustion
It is commonly used at Shenque (CV 8) point. When using this method, fill the patient's navel with salt first, put moxa cone on salt and ignite it to do moxibustion till the symptoms being released. Explosion is easy caused when fire contact with salt and burn the skin, so put a slice of ginger between the moxa cones and salt sometimes clinically. Salt moxibustion is effective to the cases of acute abdominal pain, vomiting, dysentery, coldness of four extremities and collapse.

(4) Monkshood-cake moxibustion
Take monkshood-cake as the separator; put moxa cone on the cake to do moxibustion. Monkshood is acrid and warm in nature, has the function of warming the kidney and tonifying yang. It is applicable to the yang deficient syndromes.

2. Moxa stick moxibustion
Moxa stick moxibustion is subdivided into mild moxibustion and bird-pecking moxibustion.
1 ) Mild moxibustion
Ignite one end of a moxa stick and aim it at treated area with a distance of 0. 5 -- 1 cun away from the skin, which makes the patient fed warm and hot at the treated area but no pain. Generally, each Place should be treated for 3 -- 5 minutes until the local skin becomes reddish. For the cases of unconsciousness and children, practitioner should place the index and middle fingers on the both sides of the treated area to feel the temperature and adjust the distance between the moxa stick and skin, master the long of treatment time, avoid burning the local skin.

2) Bird-pecking moxibustion
When doing moxibustion, the distance between the moxa stick and treat area is not fixed. The practitioner should repeatedly move the burning moxa stick up and down, just like a bird pecking its food. Furthermore, the practitioner may also move the moxa stick right and left or circling evenly and repeatedly.

3. Warming Needle Moxibustion
Warming needle moxibustion is a method combining acupuncture with moxibustion. It is suitable to the cases which need both the needles retain and moxibustion. The operation method is as follows: Retain the inserted needle after the needling sensation appeared, wrap the rnoxa wool around the needle handle, or attach a 2 cm long of moxa stick to the needle handle, then ignite the moxa wool or the moxa stick to administer the moxibustion. The heat power can be transmitted into the body through the needle to treat diseases. Generally, warming needle moxibustion is used to treat cold-type diseases, for example, rheumatic diseases, ache and pain in the joints, numbness, soft stool and abdominal distension due to deficient coldness, and so on. This method is commonly used at regular points and extra points, especially at Hua Tuo Jia Ji Points and Back-shu Points.

4. Moxibustion of Mild Moxibustion Device
Mild-moxibustion device refers to a kind of special-made metal implement. There are different types of mild-moxibustion device. Generally, it includes a cylinder with many holes on the bottom, a smaller one inside this cylinder used for putting moxa wool and herbs, and a handle outside of the cylinder. The using method is as follows: Put some moxa wool and herbs into the smaller cylinder and ignite them, hold the handle and move it on the points of affected area to do moxibustion until the local skin becomes reddish. This method is easy to be accepted by patients, especially by female patients, children and persons who are nervous to moxibustion.

III The Functions of Moxibustion
Moxibustion is widely used clinically, especially suitable to the chronic and weakness diseases and disorders caused by wind, cold and dampness evils. The main functions is as follows:

1. To Warm Yang and Expel Cold
Moxibustion is a treatment method through warm or heat stimulation achieved by moxa wool or other materials. The main function is expelling pathogenic cold to treat various cold syndromes, including excessive cold syndromes caused by pathogenic cold and deficient cold syndromes caused by yang deficiency.

2. To Warm Meridians and Active Circulation of Blood to Treat Bi Syndromes
Moxibustion can warm meridians and promote circulation of qi and blood to treat the diseases due to stagnation of qi and blood stasis, or unsmoothing of meridians and collaterals due to invasion of expathogenic factors, such as wind, cold and dampness Bi syndrome.

3. To Restore Yang and Stop Collapse
Moxibustion has the function of warming yang. Strong and long time moxibustion can be used to treat collapse syndrome with the symptoms of over sweating, coldness of limbs and forceless pulse, as well as enuresis, prolapse of anus and uterus due to yang deficiency or failures of the middle qi.

4. To Remove Blood Stasis and Masses
Qi is the commander of blood, blood circulation is following qi movement. Warming stimulation can promote the movement of qi, so that moxibustion can performs the functions of promoting circulation of qi and blood, removing stasis and masses to treat mastatis in early stage, scrofula, cold type of sores without pus.

5. To Strengthen Body and Prevent Diseases
Moxibustion is a method for strengthening body and preventing diseases from ancient times. Applying moxibustion at some points, such as Dazhui (GV 14 ), Guanyuan (CV 4) and Zusanli (ST 36), can activate the healthy qi to prevent diseases. Among the people is a way of saying "applying moxibustion at Zusanli (ST 36) regularly can make the baby always be health".

IV Precautions of Moxibustion
1. Postures of Moxibustion
Just like acupuncture treatment, patient's posture should be selected strictly before applying moxibustion. Patient should be calm and comfort. For direct moxibustion, keep the location of points exactly before and during moxibustion.

2. Process Of Moxibustion
Generally, the order of moxibustion is: Apply moxibustion to the points belong to the yang meridians first and yin meridians second, in upper part of the body first and lower secondly, on back first and chest and abdomen secondly, on head and trunk first and limbs secondly. But in clinic, we should decide the process according to the patient's condition.

3. Volume of Moxibustion
The volume of moxa cone moxibustion refers the size and unit of moxa cone. Patient's condition and disease should be considered. Generally, apply more units of moxa cone to the points on back, waist and abdominal region, less to that on the chest and limbs especially on face and neck; more units and longer to the patients with strong constitution, less and short to elder and children. The volume of moxa stick moxibustion and moxibustion of mild moxibustion device is measured with time.

4. Management of Sore of Moxibustion
Direct moxibustion can cause blister, sore and ulcer. If ulcer area is not large, it can be healed by itself. For preventing of infection, cover sterilized gauze on local area. Applying some antiphlogistics in local area if infection happened. For redness and burning sensation of the local skin happened after moxibustion, it will disappear by itself, need not special management.

5. Contraindications of Moxibustion
(1 ) Moxibustion can strengthen yang also can injure yin, so it is not advisable to the cases of deficient and excessive heat type. For the patients suffering from hemoptysis, hematemesis, headache due to hyper activity of liver yang, tense syndrome of wind-stroke, disorders due to heat-toxins, moxibustion should be used carefully.

(2) Direct moxibustion is not advisable to face, private part and area in the vicinity of the large blood vessels. The abdominal region and lumbo-sacral region of the pregnant woman are not allowed to use moxibustion.

(3) In ancient acupuncture books, about 50 points are not allowed to use moxibustion. Clinically, it is not strict for them except Jingming (BL 1 ), Sizhukong (TE 23), Tongziliao (GB 1), Renying (ST 9), Jingqu (LU 8), Quze (PC 3), Weizhong (BL 40), and so on. In addition, avoid burning clothes and others even causing fire, and avoid injuring the patient with coma, numbness and dysesthesia

By Qi Baoyi, Hu Minghai