yang hyperactivity or internal accumulation of pathogenic heat should not receive moxatherapy, according to the theory of traditional Chinese medicine. Examples include yin vacuity with internal heat, expectoration and ejection of blood, profuse dreaming and seminal emission, wind strike (stroke) block pattern, high fever with clouded spirit, etc. From the perspective of Western medicine, such as high fever, hypertensive crises, late stage tuberculosis, massive hemoptysis, vomiting, severe anaemia, acute infectious disease and skin boils with fever should not receive moxatherapy. In addition, moxatherapy should not be applied to the abdomen and lumbar region of pregnant women or in cases of organic heart disease with cardiac dysfunction and schizophrenia.
Inappropriate use of moxa for heat diseases can injure yin-blood. Contraindicated pulse and tongue signs are: surging, large, string-like, rapid and replete pulses, and bright crimson or rough yellow tongue and coating. These signs indicate patterns of yin fluid depletion and yang heat excess. Application of moxatherapy demands careful examination of the clinical signs and customization of the treatment according to the pattern.
Contraindicated Time Periods
Times when it is not appropriate to apply moxibustion include when the patient is quite hungry, full, tired, intoxicated, thirsty, in a state of shock, terror or rage, or sweating profusely. Patients in an agitated emotional state or women during menstruation should also not receive moxa, but this does not preclude curing heavy bleeding. In clinical practice, these temporary contraindicated conditions should receive special attention in order to avoid moxa-sickness and other accidental injury.
5.2 CAUTIONS
The practitioner or individual carrying out moxibustion should be focused and perform all procedures with care. The requirements of moxibustion should be explained to the patient so as to avoid unnecessary concern and to achieve their full cooperation. If it is necessary to use scarring moxa, the patient’s agreement must be obtained prior to treatment.
1.An appropriate posture is important during moxibustion treatment. The patient’s posture should be symmetrical and comfortable in order to facilitate the correct location of acupoints, the placement of moxa cones and the application of moxa.
2.The standards for quantification of the amount of moxa are the size and number of moxa cones. Generally speaking, early stages of disease and strong patients are treated with a higher number of larger cones; late stages of disease and weaker patients are given smaller and fewer cones. The number and size should also be adjusted according to the characteristics of the area of application: cones on the head, face and chest should not be too big nor too numerous; cones on the lumbar region and abdomen can be large and multitudinous; areas on the limbs where the skin is thin and where there is a high concentration of sinew and proximity to bone are not suitable for frequent or excessive moxatherapy. In the case of sunken and intractable cold and yang qi on the verge of desertion (at this stage the patient will be almost unconscious and their limbs will be ice cold), efficacy will only be achieved by using a multitude of large cones; in the case of externally contracted wind-cold or welling, flat abscesses and impediment pain, it is important to keep the amount appropriate to avoid causing internal depression of pathogenic heat, resulting in harm.
3.The indications for moxa treatment are very broad, but one should keep in mind that although it boosts yang, at the same time it can also injure yin. In the case of patterns that belong to yin vacuity and yang hyperactivity, pathogenic repletion internal block, and exuberant toxic heat, moxa should be used with caution.
4.When performing moxibustion, areas such as the face, five sensory organs and large blood vessels should not receive direct moxa, and the abdomen and lumbar region of pregnant women should be avoided.
5.When performing moxibustion or using the warm needle moxa method, care should be taken that a burning ember does not fall onto the skin or other surfaces. During moxibustion one should be aware of the patient’s response to the heat stimulation, and adjust the distance between the moxa and surface of the skin accordingly. One should develop a good understanding of the amount of moxa to use, in order to avoid over-moxibustion and burning. In the event that blistering occurs after moxibustion, as long as the blisters are not broken they can be left to recede naturally. If the blisters are too large, they can be drained by puncturing the lower side of the blister with a sterilized needle; followed by applying Long Dan Zi medicated water.
6.Moxibustion facilities should have good airflow of fresh air to avoid excessively thick smoke and poor air quality, which can harm the body.
6. Moxibustion Supplementing and Draining
6.1 MOXIBUSTION SUPPLEMENTING
After lighting the moxa, do not blow on the ember, but rather let it slowly heat up and wait for it to extinguish naturally. The strength of the heat is gentle and long lasting, and can be applied multiple times. After moxibustion use the hand to press on the area of application, causing the moxa-qi to concentrate and not be dispersed. If performing pole moxa, light pecking sparrow moxa may be used on each acupoint for 0.5–2 minutes for each point. Another option is gentle moxa on each acupoint for 3–5 minutes. These methods promote the body’s physiological functioning and eliminate excessive inhibition of the nervous system, bringing about a normal state of excitation.
6.2 MOXIBUSTION DRAINING
After igniting the moxa, blow the ember until it is burning vigorously. Ignite and extinguish quickly, and once the patient feels a sensation of burning, quickly replace the moxa cone and continue. The treatment is relatively short, and the number of cones used is relatively few. After moxibustion do not press the acupoint in order to allow the pathogenic qi at the acupoint to disperse. If using pole moxa, one could choose the gentle moxa or circling moxa, and stimulate each acupoint strongly for 10 minutes or more to achieve calming of the acupoints and promote normal inhibition.
7. Postures and Order of Execution for Moxatherapy
7.1 APPROPRIATE POSTURE FOR PERFORMING MOXIBUSTION
The physical posture of the patient should be carefully chosen in order to make the process of locating acupoints and carrying out moxibustion safe, convenient and accurate. The patient should feel comfortable and at ease, and should be able to maintain the position throughout the entire process, or, according to the needs of the treatment, make appropriate changes in posture. Commonly used postures include: supine (Figure 1.7.1 A), prone (Figure 1.7.1 B), lateral (Figure 1.7.1 C), supine supported sitting (Figure 1.7.1 D), prone supported sitting (Figure 1.7.1 E), supported cupped arms (Figure 1.7.1 F), supported prone arms (Figure 1.7.1 G), supported supine arms (Figure 1.7.1 H), prone sitting (Figure 1.7.1 I), standing (Figure 1.7.1 J), and sitting (Figure 1.7.1 K). The overall requirements allow for a natural posture, exposed acupoints, stability in placing moxa cones and convenient operations.
7.2 THE ORDER OF EXECUTION OF MOXIBUSTION
The usual order of performing moxibustion in the clinical setting is as follows: upper body → lower body → back → abdomen → head → limbs. First select yang channels, then select yin channels. The number of moxa cones used during course of treatments starts low and then increases, and the moxa cones start small and gradually increase in size. Carrying out the procedure in this order allows you to encourage yin from yang while not being damaged by an exuberance of yang. If one does not follow