performs moxa on the lower body and then on the head, the patient may experience baking heat in their head and face as well as dry mouth and throat.
Of course, when performing moxibustion, one ought to be flexible in customizing the treatment for different patients and conditions. For example, when treating anal prolapse, one may first moxa Chang Qiang (DU-1) in order to cause the intestine to retreat, then moxa Bai Hui (DU-20) to encourage upward movement.
Figure 1.7.1. Posture Diagram
8. Managing Moxa Sores and Post-Moxa Care
8.1 MANAGING MOXA SORES
Ancient practitioners believed that using scarring moxa and creating moxa sores was a necessity; treatment efficacy would only be achieved if the moxa cone directly contacted the skin and created a sore. However, it is currently considered not necessary to create moxa sores in order to achieve the goal of treatment; non-scarring moxa, indirect moxa methods and gentle pole moxa, for example, also achieve excellent results.
Causative Factors for Moxa Sores
Moxa-sores are caused by blisters that form after moxibustion. This may occur in the following circumstances: when the moxa cone is not compacted tightly enough, causing a loose portion of burning cone to fall onto the skin; when the cones are too large and too many are used; and when blisters are punctured and become infected. However, a moxa sore will present only if puss forms in the blisters, whereby the formation of pus is due to breaking or infection of the blister.
Prevention and Treatment of Moxa Sores
The first requirement is that moxa cones are tightly compacted to prevent large burning moxa cones from directly contacting the skin. Secondly, control the size and number of moxa cones to prevent burning and blistering and, finally, after blisters are caused, keep the area clean. Small blisters can heal naturally, but they must not be scratched even if they are itchy. If the blisters are large, a sterilized needle can be used to drain the liquid, then the blister can be covered with a cloth bandage or mild medicated plaster. If the blister is accidentally broken it should be sterilized then tightly wrapped; this will prevent suppuration and festering. If the heat of the moxa is too intense and moxa sores are created, the following treatment should be performed:
1.Protect the Sore: Besides draining liquid as described above, the moxa sore must also be protected to prevent infection. An appropriate amount of red-skinned scallion and mint can be decocted and used to wash the area around the sore. Yu Hong Gao (Jade and Red Paste) can be used to encourage scab formation, allowing it to heal naturally.
2.Resist Infection: If the moxa sore becomes infected and suppurative, herbs with antibacterial properties should be used. If after the sore heals the skin is still dark and does not improve, the tender skin of Tao Zhi (peach twigs; Persicae Fructus) can be decocted and used while warm to wash the area. If the moxa sore is unbearably painful, then appropriate amounts of Tao Zhi (Persicae Fructus), Liu Zhi (Salicis Ramulus), Yan Sui (Coriandri Herba cum Radice) and Huang Lian (Coptidis Rhizoma) can be decocted and used to wash the area, immediately stopping the pain. If the moxa sore fails to close, it is usually because of qi vacuity, in which case Nei Tuo Huang Lian Wan (Internal Drawing Coptic Balls) should be taken: 48g of Huang Qi (Astragali Radix), 12g of Dang Gui (Angelicae Sinensis Radix), and 6g each of Rou Gui (Cinnamomi Cortex), Mu Xiang (Aucklandiae Radix), Ru Xiang (Olibanum) and Chen Xiang (Aquilariae Lignum Resinatum). During hot weather, if there is excessive secretion of liquids, a paper towel or cloth bandage may be used to dry them; do not wash with cold water. During cold weather it is difficult for granulation to occur, scallion decoction can be used to clean the area around the sore to assist the action of medicinal paste. When the scab detaches from the moxa sore, besides using decoctions of peach twigs and willow twig to wash the area, it ought also to be protected from exposure to wind and cold.
8.2 POST-MOXA CARE
Scarring cone moxa has an effect on essence, blood and fluids, so it is important to emphasize post-moxibustion care. Certain individuals with weak constitutions may experience mild heat-effusion, a dry mouth, fatigue and other discomforts. It is not necessary to cease moxatherapy, as these will disappear with continued treatment. If this discomfort becomes more pronounced, and symptoms such as dry mouth, dark yellow urine, and constipation occur, it is a sign that the moxa has caused injury to the body’s yin. To eliminate these symptoms the patient can be prescribed Jia Wei Zeng Ye Tang (Supplemented Humor-increasing Decoction): 15g each of Shen Di Huang (Rehmanniae Radix Exsiccata seu Recens), Mai Dong (Ophiopogonis Radix), Xuan Shen (Scrophulariae Radix), and Rou Cong Rong (Cistanches Herba) (decoct and take once per day). Other methods of moxibustion rarely result in such discomfort, and therefore do not require any special post-treatment care.
9. Moxibustion Sensation and Moxibustion Quantification
9.1 MOXIBUSTION SENSATION
Moxibustion sensation refers to the subjective sensations experienced by the patient during moxibustion. Moxibustion achieves its curative and preventative effects through directly or indirectly providing an appropriate level of heat stimulation to the surface of the body. For this reason, with the exception of scarring moxibustion, the primary subjective sensation experienced during moxibustion is a feeling of warmth or burning on the surface of and below the skin. In addition, the sensation of heat may be experienced at a deep level, remain for a long time or travel along channel pathways.
9.2 MOXIBUSTION QUANTIFICATION
In ancient times, the quantification aspect of moxibustion therapy was considered to be very important. In Qian Jin Fang it is recorded: ‘On the limbs, moxibustion should be light and not carried out for too long. On the chest, back and abdomen, moxibustion should be stronger, but on the lower back and spine moxa should be applied less.’ Wai Tai Mi Yao asserts that: ‘The elderly and infirm should receive less moxatherapy, and those with strong constitutions should receive more moxatherapy.’ Bian Que Xin Shu states that ‘Severe diseases receive 100 cones […] and for minor disease less than 3, 5, or 7 cones.’ From these examples it can be seen that determining the amount of moxibustion performed depends on, for example, the patient’s constitution, age, area receiving treatment and disease condition. Clinically, the unit by which moxibustion is quantified is the size and amount of moxa cones. The length of the course of moxibustion treatment is another important aspect: a course of treatment in the case of acute disease is shorter (sometimes only 1–2 treatments), while chronic conditions require a longer treatment course (from several months to more than one year). Generally speaking, at the beginning of a course of treatment, moxibustion is performed once every day; after 3 treatments, the frequency is adjusted to once every 2–3 days. In acute cases 2–3 treatment sessions can be performed per day, while in chronic cases requiring long-term treatment, one treatment can be performed every 2–3 days.
10. Moxibustion Treatment Principles
10.1 ROOT AND BRANCH, MODERATE AND ACUTE
The concepts of root and branch, moderate and acute, are relative, not absolute. In the occurrence and development of disease, root, branch, moderate and acute are complex and changeable. According to the principle of ‘striving for the root in the treatment of disease’ found in Huang Di Nei Jing, combined with the summarization of clinical practice and experience, the following four points regarding the usage of root, branch, moderate and acute can be made:
1.Treat the Root: Treatment of disease should be directed at the root of the disease. Clinical signs and symptoms are only the external phenomena reflecting the disease, and through identification of patterns, starting with analysis of the exterior and then the interior, from phenomena to basic nature, the cause, location and mechanism of the disease can be identified and concluded as a certain pattern type. This pattern type substantially summarizes the basic nature of the disease. The next step is to determine a treatment for this specific pattern type to achieve the goal of treating the root.
2.In