The Forgotten Art of Moxa Needling
The first description of the moxa roll was written near the beginning of the Ming dynasty (late fourteenth or early fifteenth century). A moxa stick is made by packing mugwort floss and rolling it up in paper to make a stick that resembles a cigar or a large cigarette.
The original manipulation prescribed for use with it, is different than what we usually practice today. After the stick is lit, most modern practitioners hold it over the skin, whereas ancient doctors pressed it into the skin, which was isolated by cloth or paper. This technique is called pressing moxibustion or moxa needling (not to be confused with warm needle technique). This method is still described today in most Chinese books on moxibustion and some doctors in China and Japan continue to use it. It is little known outside of Asia, but practitioners may find it useful in their clinic.
In the Chinese language, the use of a moxa stick is sometimes called hand-held moxibustion, because the stick is often grasped in the doctor’s hand. This is unlike direct or indirect moxibustion where cones are placed on the patient’s body. Hand-held moxibustion has two subcategories, see table 1. Suspended moxibustion means holding the moxa roll over a point and is more commonly used today. Moxa needling or pressing moxibustion is the other subcategory and is the subject of this article.
Hand-held moxibustion (Moxa stick)
Moxa needling or pressing moxibustion
Using cloth or paper on the site
Using a medicated pad on the site
Wrapping the stick in cloth
Table 1. The different categories of hand-held moxibustion.
Background and History
Moxa rolls were originally designed to be pressed into the point or affected site. A doctor named Zhu Quan (dates unknown, early Ming) left the earliest record of the moxa roll. He wrote, “Roll up mugwort in paper. Pack it firmly. Use paper to isolate the point. Press the roll firmly into the isolating paper. Wait for the abdomen to feel hot. When the patient sweats, he will promptly recover.”
This earliest roll was made of pure mugwort floss. Rolls made of mugwort mixed with powdered medicinals appeared later in the Ming dynasty. These were first described in the Great Pharmacopoeia by Li Shizhen (1596) and five years later in the Great Compendium of Acupuncture and Moxibustion by Yang Jizhou (1601). Medicinals were added to enhance the mugwort floss effects, for example Chuan Shan Jia (Squama Manitis), Ru Xiang (Gummi Olibanum), Gui Zhi (Ramulus Cinnamomi), and Bai Zhi (Radix Angelicae dahuricae). Other medicinals were included to help the mugwort qi penetrate deeply such as She Xiang (Secretio Moschus).
These moxa rolls were not only used by practitioners of acupuncture-moxibustion, but also by many well-known herbalists, who used moxa sticks containing medicinals, even if they rarely used acupuncture. They could easily devise a formula for a specific patient or condition and make up the sticks in their own pharmacy. Herbalists such as Ye Tianshi and Zhang Jiebin recorded a number of prescriptions.
Moxa sticks were called “needles” because of the long thin shape, and because it was felt that their qi could penetrate deeply, like a needle. In addition, the early method of application, pressing the burning roll into the site, resembles the insertion of an acupuncture needle. This technique will be described below.
After the first recipes for moxa sticks were published, they quickly became popular. Before that time, direct moxibustion was the most common method but burning cones on an isolating substance, such as ginger, garlic, or Fu Zi (Radix Aconiti) was also relatively popular. Today, moxa sticks are commercially manufactured and are used by many practitioners as the default technique instead of direct moxibustion.
During the Ming and Qing dynasties, the instructions for use were to press the moxa stick into layers of cloth or paper. The stick was often used on the painful or affected site, although it could also be applied to acumoxa points. It was felt that the qi of the moxa needle could extend and penetrate deep into the body and that yin conditions could be counteracted with the needle’s yang qi. The most common indications for treatment were pain due to wind, cold, or damp; pain in the sinews or bones; pain from trauma; stagnation or stasis in the channels and network vessels; any cold or damp disease; or yin abscesses and swellings. Doctors also suggested that moxa needling could be used when the patient was afraid of acupuncture.
Li Shizhen described the method for his thunder-fire miraculous needle, “At the time of use, light it with a lamp and blow it out. Place ten layers of isolating paper on the affected site and apply the hot ‘needle.’ The hot qi will directly enter into the diseased site so the effect is quick.”
Yang Jizhou also recommended pressing the burning roll “for a good while” into layers of paper on top of the site. Then the ashy end was cut off. The stick was lit again and applied for a total of nine times. Nine is a yang number, so it would help fortify the yang qi of the thunder-fire needle. Yang included a Daoist incantation that was to be chanted each time the needle was applied.
Moxa Rolls, Toxicity, and Moxa Needling
Moxa needling has come to be associated with certain formulas, such as the thunder-fire (lei huo) needle or great unity (tai yi) needle. This is because these formulas help the mugwort qi penetrate more deeply, so they don’t just warm the surface. However, in recent times, doctors have devised ways to treat the isolating cloth with medicinals, in which case a pure mugwort roll can be used for moxa needling. A few recipes for this are given below.
Traditionally, Xiong Huang (Realgar) was used in many recipes for moxa rolls, including the thunder-fire and great unity needles. However, questions have been raised about the safety of Xiong Huang when burned as it contains arsenic sulphide. Because of this, it is likely that toxic compounds are in the smoke. Other medicinals, especially minerals, may also be unsafe for burning. Therefore, unless the ingredients are known, it is probably best to avoid commercially available moxa rolls. If you are going to use them anyway, make sure the ventilation in the room is excellent.
A few types of herbal moxa rolls are available commercially. The manufacturer of two common products from China (Hua Tuo Brand) lists the following ingredients, none of which are considered especially toxic and can be considered suitable for moxa needling.
Tai-I Moxa Roll
Qiang Huo (Rhizoma et Radix Notopterygii)
Mu Xiang (Radix Aucklandiae)
Bai Zhi (Radix Angelicae dahuricae)
Dan Shen (Radix Salviae miltiorrhizae)
Nien Ying Moxa Roll
Gao Liang Jiang (Rhizoma Alpineiae officinarum)
Gui Zhi (Ramulus Cinnamomi)
Du Huo (Radix Angelicae pubescentis)
Bai Zhi (Radix Angelicae dahuricae)
Functions and Usage
The functions of moxa needling are to treat vacuity, coldness, and pain. It treats bi patterns, sciatica, incontinence, impotence, menstrual disorders, cough, wheezing, common cold, and chronic stomach or intestinal diseases. It can also be used on patients who are not suitable for acupuncture and on regions that are difficult or painful to needle, such as fingers, toes, bony protuberances, the palms, soles, or heels.
Do not use pressing moxibustion on pregnant women and hypertensive patients, or on the head (except Bai Hui, Du 20 when indicated), face, or genitals. Be cautious on the upper body as heat rises.
Moxa needling is a strong treatment and the heat penetrates very quickly. One benefit of this is that less smoke is emitted than with suspended moxibustion. This is because with moxa needling, you only need press the point a few times, so a strong treatment takes less than a minute per point. With suspended moxibustion, you often need ten or more minutes of treatment per point, so much more smoke is emitted.
Directions for Moxa Needling
In moxa needling, the site or point is isolated with five to ten layers of paper or cloth. You can also press the moxa roll into another substance, such as ginger. Whatever you decide to use, it is better to experiment on yourself first before trying it on patients. You should experience this treatment in order to have confidence in it and a proper sense of timing. At first, I was afraid the cloth would catch fire and I would be burned, but this proved not to be the case at all, see figure 1. However, the heat is strong, so the practitioner should have experience in managing it.
Figure 1.Moxa needling using layers of white cotton. You can see it leaves some ash, but does not burn the cloth.
Traditionally, the layers were folded from one piece of cloth, not cut out of many pieces. The exact number of layers depends on the thickness of the paper or cloth. If the patient feels the treatment is too hot, you can always add additional layers. Ye Tianshi (Qing) recommended using red cloth, probably to increase yang and add to the fire qi, see figure 2. Below are a few examples of recipes for treating the cloth with medicinals.
Figure 2.Moxa needling using red cloth, as recommended by Ye Tianshi.
If you use paper, experiment with different types to make sure it does not easily ignite. Cloth seems less prone to catch on fire, but avoid cloth made of synthetic materials. Natural cotton is always best.
Junji Mizutani, a Japanese doctor who lives in Canada, recommends one or two layers of cloth, then two layers of newspaper on top. He says you can use a fresh loquat leaf – Pi Pa Ye (Folium Eriobotryae) – over the cloth instead of paper.
After the site is covered with the cloth or paper, press the stick into it for one or two seconds. Press until the patient feels the heat strongly, then lift it. Wait a few seconds until the wave of heat sensation begins to decrease, and then press again. You can alternate between two points to give each point a little time to cool off.
Pressing each time is referred to as “one cone.” Remember that the word for “cone” in Chinese (壯 zhuang) does not imply shape and literally means “an invigoration” or “a fortification.” Press the “needle” three, five, seven, or nine times (odd numbers are yang). Reposition or replace the isolating paper or cloth if it begins to char.
Some books say that when the area feels hot and the patient sweats, the treatment is completed. Others say the session is complete when the skin at the site develops a red halo. While the skin should turn red, it should not be burned.
Instead of laying the cloth or paper on the site, some doctors put layers of cloth around the end of the moxa stick, see figure 3. The cloth must be held with the proper tension. If it is too loose, the cloth will burn more easily. If it is too tight, it will extinguish the stick. By holding the cloth on the stick, you can more clearly see the point location and can conveniently move from point to point. However, be careful: If the cloth begins to burn through, it is less visible to the doctor.
Figure 3.Wrapping the stick with cloth.
Treating the Cloth
Instead of using plain cloth or paper to isolate the moxa stick, you can use cloth that has been treated. Here are a couple of recipes for preparing the cloth to enhance the therapeutic effects. If you use a treated cloth, a pure mugwort roll may be used.
Medicinal padding for moxa needling
Advance preparation: If you are using a new cloth, it is probably best to wash it first as new cloths are often treated and may not be very absorbent.
Boil 15 grams of Gan Jiang (dry Rhizoma Zingiberis) in 300 millilitres of water see figure 4. You can add other warming medicinals that move qi-blood or have a penetrating nature, if desired. Strain the liquid and mix it with flour to make a paste, see figure 5.
Figure 4.Making a cloth pad with ginger. Simmer the ginger.
Figure 5.Mix with flour to make a paste.
Apply the starch to a strip of cotton ten centimetres wide. Place another strip of cotton on top and cover it with the starch. Continue until you have five or six layers of cloth. Make sure they stick together and are smooth and flat, see figures 6 and 7.
Figure 6.Spread it on the strips of cloth.
Figure 7.Add more layers.
Let it dry, preferably in the sun, to stiffen the cloth, see figure 8. Then cut the cloth into ten centimetre squares. I have found that if the squares are kept dry, they are good for an indefinite period of time and do not become mouldy.
Figure 8.It is hanging to dry next to some mugwort.
At the time of moxibustion: Place a square of treated cloth on the site and perform the moxa needling. You can press on the cloth for one to five seconds, until the site feels burning heat. Lift the stick, pause, and press again. Press five or seven times, see figures 9 and 10.
Figure 9.The pad is stiff, but the ginger helps the hot qi penetrate.
Figure 10.The redness in the region anterior to the lateral malleolus is from the moxa needling. The puffiness is from an old injury.
Medicated cloth for moxa needling
Below are two different recipes. Use whichever one you prefer. You could also write your own based on the condition to be treated.
1. Powder together nine grams each of:
Hong Hua (Flos Carthami)
Jiang Huang (Rhizoma Curcumae)
Si Gua Luo (Fasciculus Vascularis luffae)
Ge Gen (Radix Puerariae)
2. Powder together twelve grams each of:
Hong Hua (Flos Carthami)
Jiang Huang (Rhizoma Curcumae)
Dan Shen (Radix Salviae)
Wei Ling Xian (Radix Clematidis)
For either formula, put the powder in 250 grams of rice vinegar and steep it for 30 minutes to two hours. Filter the vinegar to remove the dregs. The result is called Hong Hua Liquid (Hong Hua Ye).
Depending on the size of the area to be treated, cut a piece of cotton 30 to 70 centimetres long by five to ten centimetres wide. Immerse the cloth in the Hong Hua Liquid. Squeeze it out and let it dry in the sun. Fold the cloth into six layers. You are now ready to treat the patient.
At the time of moxibustion: Light the moxa stick. When it is burning well, wrap the burning end tightly in the six layers of the cloth. Press the moxa needle into the affected region with a twisting motion. Hold the roll and cloth tightly and turn it 360º as you press it. The patient should feel warm heat and distension.
To drain, twist the stick counter-clockwise and apply it three or five times per point. To supplement, turn it clockwise and apply it four or six times on each point. Treat daily or on alternating days.
Prolapse of the uterus or rectum: Moxa needle Bai Hui (Du 20). Press three or five times. Treat once a day.
Impotence due to binding depression of liver qi: Select two to four of the following points: Gan Shu (UB 18), Shen Shu (UB 23), Nei Guan (PC 6), Qi Men (LV 14), Zu San Li (ST 36), San Yin Jiao (SP 6), Tai Chong (LV 3). Press five to ten times per point. Treat once a day.
Seminal emission due to effulgence of fire: Select two to four of the following points: Xin Shu (UB 15), Zhi Shi (UB 52), Zhong Ji (Ren 3), Shen Men (HT 7), San Yin Jiao (SP 6). Press five to ten times per point. Treat once a day.
Bedwetting due to lung-spleen qi vacuity: Select two or three of the following points: Lie Que (LU 7), Fei Shu (UB 13), Pi Shu (UB 20), Qi Hai (Ren 6), Zu San Li (ST 36). Press five times per point. Treat once a day.
Frozen shoulder due to loss of nourishment in the channels and sinews: Alternate the following sets of points, selecting three to six points each time:
1. Jian Yu (LI 15), Jian Liao (SJ 14), Bing Feng (SI 12), Jian Zhen (SI 9), Jian Jing (GB 21), Da Zhu (UB 11), Bi Nao (LI 14), Qu Chi (LI 11), Wai Guan (SJ 5).
2. Tian Zong (SI 11), Tai Jian (N-UE-11), Yun Men (LU 2), Jian Nei Ling (M-UE-48), Nao Shu (SI 10), Chi Ze (LU 5), Yang Lao (SI 6), Hou Xi (SI 3), a shi points.
Press five or seven times per point. Treat once a day or on alternating days.
Sciatica due to cold-damp: Select three to six of the following points: Ming Men (Du 4), Yao Yang Guan (Du 3), Jia Ji (M-BW-25) from L2 thru L5, Zhi Bian (UB 54), Huan Tiao (GB 30), Yang Ling Quan (GB 34), Jue Gu (GB 39). Press five or seven times per point. Treat once or twice a day.
Bi patterns with dual qi-blood vacuity: Alternate the following sets of points, selecting two to six points each time:
1. Ge Shu (UB 17), Gao Huang (UB 43), Shen Shu (UB 23), Pi Shu (UB 20), Wei Shu (UB 21), Zhong Wan (Ren 12), Zhang Men (LV 13).
2. Qi Hai (Ren 6), Zu San Li (ST 36), San Yin Jiao (SP 6), Qu Chi (LI 11), Yang Ling Quan GB 34).
Also select local and distal points for the affected site. Press five or seven times per point. Treat once or twice a day.
Vessel bi due to cold-damp: Select two to six of the following points:
Lower limbs: Zu San Li (ST 36), Yin Ling Quan (SP 9), Jie Xi (ST 41), Xing Jian (LV 2).
Upper limbs: Qu Chi (LI 11), Wai Guan (SJ 5), Zhong Zhu (SJ 3), He Gu (LI 4).
Press five or seven times per point. Treat once or twice a day. This is often used during early stage of the disease.
Joint-running wind due to invasion of damp-heat: Symptoms include redness and swelling of the joints, acute pain, difficulty bending and stretching, etc. Select three to six of the following points: Da Zhui (Du 14), Shen Zhu (Du 12), Qu Chi (LI 11), He Gu (LI 4), Yin Ling Quan (SP 9), San Yin Jiao (SP 6), Xing Jian (LV 2), a shi points. Press five or seven times per point. Treat once a day.
Lorraine Wilcox Ph.D., L.Ac. has been a licensed acupuncturist in California since 1989. She received her Ph.D. in Classical Chinese Medicine from American University of Complementary Medicine and has taught herself to read Chinese. Wilcox is also an assistant to Master Larry Sang of the American Feng Shui Institute and teaches in selected acupuncture schools in Los Angeles. Lorraine Wilcox is the author of Moxibustion: thePower of Mugwort Fire, published by Blue Poppy Press. She can be contacted at email@example.com.
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