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Moxibustion

There are many forms of Traditional Chinese Medicine (TCM), and many have the same underlying theory: they stimulate non-existent acupuncture points to alter the flow of non-existent qi. For each form of TCM there are many variations on a theme. There are, for example, a half-dozen styles of acupuncture and multiple forms of cupping all trying to move the qi. That qi is an untameable beast, hard to corral into a proper gate even by the best acupoint wrangler.

There is, fortunately, yet another way, moxibustion, to alter that most intractable mysterious life energy.

Moxibustion is the burning of mugwort over acupoints.

What is mugwort? I resist the urge to make a Harry Potter pun about where Muggles go to school. No wait, I just did. Sorry. You know the old saying: yield to temptation, it may not pass you way again. Mugwort is a member of the daisy family, related to ragweed and, like ragweed, a common cause of hay fever. It is also used in food and was used in beer before hops was discovered.

Why mugwort for moxibustion? I can’t find a good reason beyond the argument from antiquity. That is what they have done for thousands of years, so it must be good.

How is moxibustion done? There are multiple styles. There is both direct and indirect moxibustion.

In direct moxibustion, a small, cone-shaped amount of mugwort is put on an acupuncture point and burned.

This direct moxibustion is further divided into scarring and non-scarring. With scarring moxibustion, the moxa is placed on an acupuncture point and burns until it causes blisters and scarring, what we in medicine would call a deep-partial-thickness second degree burn.

With non-scarring moxibustion, the burning moxa is removed before it burns the skin. How nice.

Indirect moxibustion is a more popular form of since there is a lower risk of pain or burning. There’s a surprise. People want to avoid second degree burns. With indirect moxibustion, a moxa cigar is held over the skin until the area turns red.

Yet another form of indirect moxibustion uses both acupuncture needles and moxa. A needle is inserted into an acupoint then the needle is wrapped in moxa and lit. The needle heats up and so does the skin.

So many ways to try and alter qi. How a second degree burn could be helpful for any process, much less mythical qi, mystifies me.

What is moxibustion used for? Anything and everything. Except, I suppose, as a burn therapy. That would be throwing gas on the fire as it were. Moxibustion is often used in conjunction with other qi-wrangling interventions such as cupping and acupuncture.

It has been used without success for hypertension, pain, tennis elbow, and irritable bowel syndrome, all diseases with a similar underlying cause. I suppose when all you have is a mugwort, everything is a moxibustion. No surprise the studies with positive results are poorly done, are prone to bias, and are often from Asia where no TCM study is ever negative. As one systematic review of moxibustion systematic reviews noted:

In conclusion, this overview of SRs suggests that moxibustion is effective for correcting breech presentation, whereas for other conditions, the evidence does not reach a firm conclusion because of several limitations. All SRs are, however, based on studies with a high risk of bias. Therefore, considerable uncertainty remains about the therapeutic value of moxibustion.

They all suggest that higher quality studies need to be done to determine if moxibustion is actually effective. I would tend to think not. Negative studies never, ever, dissuade proponents. Given the prior plausibility that burning mugwort on or near the skin would have any effect on any disease is somewhere on the order of naught, I would not waste the money. But that is a defining characteristic of SCAM, its proponents develop resistance to disconfirming facts faster than gonorrhea to antibiotics.

The big claim to fame of moxibustion is reversal of breech positioning in the JAMA article “Moxibustion for Correction of Breech Presentation”.

Since ancient times, traditional Chinese medicine has proposed moxibustion of acupoint BL 67 (Zhiyin) to promote version of fetuses in breech presentation. Moxibustion is a traditional Chinese method that uses the heat generated by burning herbal preparations containing Artemisia vulgaris (mugwort) (the Japanese name is moxa) to stimulate acupuncture points. Acupoint BL 67 is beside the outer corner of the fifth toenail.

They did a non-blinded, small, non-placebo trial in China and it appeared to be effective.

To me it would be nuts to think burning mugwort at the 5th toenail would do anything to cause a baby to shift position in the uterus and I would be inclined to think positive results would be likely to noise and not be reproducible. It wasn’t.

They repeated the study in Italy and, what a surprise, moxibustion did nothing to breech positioning.

A Cochrane Review concluded:

Moxibustion was not found to reduce the number of non-cephalic presentations at birth compared with no treatment (P = 0.45)

Does moxibustion have complications? Yes. Burns are the most frequently-reported complication. Given that some forms of the technique try to cause second-degree burns, I suppose that burns are not technically a bug but a feature. But there has been a review of the issue and they found:

The most common effects identified in this review were allergic reactions, burns, and infections such as cellulitis and hepatitis C. Allergic reactions were reported in six case reports (four case reports related to infections and two related to burns). The other articles were case reports of xerophthalmia, xeroderma, hyperpigmented macules, ptosis and eversion of the eyelids. In clinical trials, various adverse events such as rubefaction, blistering, itching sensations, discomfort due to smoke, general fatigue, stomach upsets, flare-ups, headaches, and burns were reported. Tenderness and pressure in the epigastric region or in one of the hypochondriac regions, unpleasant odor with or without nausea and throat problems, abdominal pain, premature birth, premature rupture of the membrane and bleeding due to excess pressure on the anterior placenta were reported in pregnant women.

Summary: Moxibustion is yet another TCM modality with no utility for the treatment of any illness and has known complications from its use. Given the ludicrousness of its underlying mechanism I can see no reason to waste money on further clinical trials.

Follow-up:

1) The results are in. I prefer the beer in Portland to the beer in the UK for a variety of reasons, but UK beers are a bit flat and creamy compared to Pacific NW beer. And they do not know their hops. I was warned that a beer was hoppy. After a sip I wanted to do my best Crocodile Dundee imitation. ‘That’s not a hoppy beer.’ Pull out an Arrogant Bastard. ‘That’s a hoppy beer.’

2) QED was a fantastic conference. Great people, great lectures, great location.

Posted in: Acupuncture, Traditional Chinese Medicine

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