The Power of Fire

by Honora Lee Wolfe, DiplAc, FNAAOM

At West China Medical University in Sichuan in 1998, there was an acupuncture professor who was over 90 years of age and still in practice. He had never had any serious disease in his life, his hearing and vision were still acute, his steps were still nimble, and his viscera and bowels still functioned regularly. This professor ascribed his good health and long life to moxaing Zu San Li (St 36) incessantly for many years. In an article written by his son it was said that he had been moxaing this point with wheat grain-sized cones from the first to the eighth day every month for over 60 years.(1)

This story is not unusual in the annals of Chinese medicine (Taoist masters have suggested this treatment for many centuries). However, in the United States, moxibustion remains an under-used and under-appreciated therapy in the world of Asian medicine. Moxibustion encompasses several therapies, but it mainly pertains to the burning of the moxa plant, Artemisiae Argyii, on, over, under, or near specific acupoints or areas of the body. More generically, moxibustion can be described as using any type of heat therapy to warm the channels and scatter cold, open the channels and stop pain, clear heat and disinhibit dampness, boost the qi and supplement the blood, and open the channels and free the flow of the network vessels.

This broad range of application gives moxibustion many uses and can improve the effectiveness of fine-needle acupuncture, channel pricking therapy, or Oriental bodywork. In his writings, Wang Le-ting, one of the most famous of all acupuncturists in China during the middle of the 20th century, stated that when fine needle therapy did not work and herbal medicine was ineffective, moxibustion was stronger and should be used.(2) In the Yi Xue Ru Men (Entering the Gate of the Study of Medicine) Li Chan stated that “if medicinals do not reach [the condition] and needling does not result [in a cure], you must use moxibustion.” These statements suggest that moxibustion is one of the most powerful tools we have at our disposal to help our patients return to health and balance.

Moxibustion in the Modern Clinic

There are, of course, considerations concerning the use of moxa in the modern Western clinical setting that did not and do not exist in traditional Chinese clinics today or in the past. The smell of moxa is the first issue and is a real problem for many clinicians in the U.S. Also, some patients (and some practitioners) are very sensitive to smoke from any source. There are at least three possible solutions to this problem if we can expand our definition of moxa to include other types of heat therapy.

There are smokeless moxa in both pole, needle-top, and stick-on forms that can be used. These do have the drawback of being more difficult to light than regular forms of moxa, and they are also hotter than other forms of moxa. However, smokeless needle-top moxa “caps” have the advantage of really heating up a needle and facilitating a great deal of heat to enter a point.
Thread or smaller-than-rice-grain-sized moxa can be done without creating any more smoke than the incense that is used to light it. While this technique requires practice, non-sweaty hands, and probably at least one good class in its uses, it is clinically effective for a wide variety of ailments, including conditions due to yin deficiency heat.
Electric “moxa” such as TDP, infrared, and other heat lamps used with a variety of warming and moving liniments is very well accepted by patients who, after having had this therapy once, will often ask for it again and again!
There are now various types of moxa heat packs and hydroculators that can be used in the clinic or as patient “homework,” which is a very effective tool for extending therapy beyond the limitations of treatment in your clinic if appropriate. These can also be “home” made using several different herbs (fennel, cinnamon, artemesia, aconite, etc.), covered with soft cloth, and warmed in a microwave.

I encourage all practitioners to learn to use these alternatives if they, their patients, or their building-mates are sensitive to smoke or the smell is inappropriate in their particular clinic setting.

The second problem with moxa is that there is always a possibility of burning your patients, and moxa burns are one of the most common causes of lawsuits in our industry. To avoid such a suit, I suggest two things.

First, it is important to explain what you are going to do and why with each patient that you treat. If you truly believe that this is the treatment that is most likely to help a patient get well and that, while there is a small possibility of a burn, that it will not be a problem, will not be disfiguring, and will not be more than the mildest discomfort, my experience is that most patients are very happy to receive moxa. In my experience, this is very similar to many practitioners’ belief that “my patients will not drink decoctions.” If we truly believe that a decoction (or moxibustion) is the best choice for this patient at this time, neither our voice or our body language betrays any squeamishness or doubt, and we are willing to use decoctions (or moxibustion) when appropriate for our own personal therapy, then our patients are less likely to balk at the idea.
Second, your malpractice insurance policy may require that you use a moxa release form, commonly used in most acupuncture college clinics. This needs to be handled with skill and confidence and may not be the first thing we give to patients on their first visit! Again, the clarity and conviction we bring to our explanation of this is very important. We must believe that moxa is what is truly indicated for this patient if we wish them to agree to its use.

Moxibustion for Longevity

Even without choosing points based on pattern discrimination, it is possible to use moxa for longevity purposes alone, as described in the example above. This type of treatment is appropriate for inclusion when treating anyone over 40, and especially over 50, years old. There are several points from which one might choose, depending upon what is most convenient during your treatment.

Guan Yuan (CV 4) is one of the most common points used for “longevity therapy.” Moxa 3-11 ½ rice grain or sesame seed sized cones/threads once per day.

Shi Dou (Sp 17) is for any and all symptoms due to spleen vacuity including fatigue, digestive complaints, or blood vacuity symptoms. Use only the tiniest thread moxa on this point and 3-5 threads per day. If appropriate for use, this point will be tender to light pressure.

Zu San Li (St 36) for everyone over 40 even if healthy or in patients with poor resistance who often catch colds or flu, moxa 3-7 ½ rice grain sized or sesame seed sized threads each day for the first week of every month or every day for a month at each equinox.

Qi Hai (CV 6) As the sea of the original qi, this acupoint connects with the five viscera, providing them with supplies of qi. Therefore, moxa on Qi Hai nourishes life and promotes health. Moxa the same as Guan Yuan, listed above.

Moxa is such an important tool that we have for helping our patients to increased health and longevity, I strongly encourage all of us to study and perfect some form of its use and to take classes in moxa when we see them offered for CEUs. With care and practice we can use the power of this wonderful therapy successfully and without fear.

(1) Liu Zheng-cai. (1999). A Study of Daoist Acupuncture & Moxibustion, Blue Poppy Press, p. 165

(2) Wang Le-ting. (1997). Golden Needle Wang Le-Ting. Blue Poppy Press

Honora Lee Wolfe has been involved in professional health care education since 1976. Director at the Boulder School of Massage Therapy for five years between 1976-1981, Ms. Wolfe went on to study tuina massage at the Shanghai College of TCM and completed her acupuncture training in 1988. She teaches at acupuncture colleges and conferences throughout North America and Europe and is the author or co-author of several books, including Points for Profit: The Essential Guide to Business Success for Acupuncturists, The Successful Chinese Herbalist, Prince Wen Hui’s Cook: Chinese Dietary Therapy, How to Have a Healthy Pregnancy Healthy Birth with Chinese Medicine, Managing Menopause Naturally with Chinese Medicine, Better Breast Health Naturally with Chinese Medicine. She will be teaching a moxibustion CEU course at the Southwest Symposium in Austin, TX, in March of 2008.