By Amy Mager, MS, LAc, FABORM, and Christine Cronin, DAOM, LAc
Heat therapy is an integral treatment of Chinese medicine. Although we concur with our colleagues that moxa is our best choice for heat therapy, barriers may exist that could prevent a patient from using moxa or being able to use it often enough to have a therapeutic effect, yet in many instances, heat therapy is a necessary component of a patient’s treatment plan. In this article, we discuss historical references to the use and importance of moxa, alternatives to moxa using other forms of heat therapy, and practical applications of heat therapy that patients can apply using common household items.
Historical references to the use and the importance of moxa
Our classic texts discuss the need for moxa when appropriate, but also the dose or frequency in which it is most effective. From The Golden Mirror of Medicine, we learn the importance of heat dosage: “When treating diseases with moxibustion, for there to be any effect, the heat must be sufficient to obtain the Qi” (O’Conner & Bensky, 1981; Wiseman & Mitchell, 1999). This means that it is not enough to wave the moxa stick above the point, but that the patient must experience the sensation of the heat coming to the point. I was taught by Raven Lang to teach the patient to say “hot” when it is too warm for them and to immediately press the heat into the skin if using a moxa stick, or to remove the ibuki or direct moxa if one is using that, to ensure that the experience of the heat coming to the point three times is achieved.
Dharmananda (2004) discusses chapter 73 of the Lingshu, which states, “A disease that may not be treated [is not successfully treated] by acupuncture may be treated by moxibustion”. We see this situation with a variety of patients. One example is with patients who have compromised or weak wei qi and get sick easily or frequently. Another instance is with patients in cold climates (including the elderly) who have trouble staying warm, who are prone to cold conditions and often deplete their yang and jing. In addition, heat therapy may be added to treat women with weak spleen qi who, for example, may have hemorrhoids, or are working to get and stay pregnant. Furthermore, heat therapy is used with people who have either weak central qi, weak spleen qi, or both, accompanied by digestive issues. Heat therapy is also indicated for anyone with weak kidney qi or kidney yang. In short, moxa can be used in any instance where there is damage from cold and part of the treatment goal is to warm, nurture, and nourish qi and yang.
Moxa is always our first choice for heat therapy. Other options are a moxa pot, a favorite used by Miriam Lee, who had them made in China to her specifications, or a moxa box, which may be made of brass or wood. If possible, if your patient has a family member or caregiver whom you trust to use a moxa stick, moxa pot, or moxa box on your patient without causing harm, moxa is the first choice.
However, while moxa is an incredible therapy, the most adverse event is burns. Between 2005-2014, 4% of the claims that involved civil litigation or investigations by the acupuncture board and were paid by MIEC were the result of moxa burns (Medical Insurance Exchange of California, 2015). Please make sure you have an ashtray or small vessel with water to extinguish moxa balls for needle moxa, a scoop to remove needle moxa, and a place to extinguish ibuki moxa on hand before you begin applying heat therapy with moxa. Also, ensure your patients and caregivers understand the possibility of burns.
In addition to burns, moxa is sometimes a poor fit for our patients or our colleagues. Due to the spaces where we practice, co-workers who do not like or cannot tolerate the smell and smoke, or the perceptions of others, alternatives to moxa are necessary. All of these situations and many others bring us to possible alternatives to moxa.
Alternatives to moxa for heat therapy
As we said in the beginning, moxa is always our first choice. For example, moxa is used in postpartum care (Mager, 2018) to warm, nourish, and help the birth parent heal. Unfortunately, moxa doesn’t work well for every family for a variety of reasons. When barriers to receiving moxa exist or the appropriate amount of moxa to access de qi is an issue, and heat therapy is in the best interest of our patient, then we need to think outside the box and consider what else could be effective. What can a patient use instead of moxa for heat therapy?
Dr. CS Cheung, MD (China), LAc (CA), an administrator and professor at the American College of Traditional Chinese Medicine (ACTCM) taught us at ACTCM to use our diagnosis grid and treatment grid and look for what functioned within our treatment grid (CS Cheung, personal communication,1986). For those of us who are not familiar with the term “treatment grid”, a treatment grid is when we look at the combination of the generating and controlling cycles, the organs, senses, color, taste, human sound, and emotions associated with the 5 elements/phases, the 4 pillars of examination, 8 principles, and the modalities that make up Chinese medicine to determine what treatment(s) would be best for the patient. In conclusion, once we make a diagnosis, what treatment principles would effectively treat the pattern we are seeing that would help bring the patient back into the sheng or generating cycle?
If we decide that our treatment principle includes the application heat to help bring the patient back into the sheng or generating cycle (e.g., warming and nourishing, warming and tonifying, or warming and lifting) then we need to decide how best to accomplish that treatment goal.
Alternative heat sources to moxa include but are not limited to: hot water bottles, hot packs, hydrocolator packs, heating pads, rice or sand bags, and the multipurpose hair dryer.
I think about this daily when I work with patients who need heat therapy. I ask them if they own a hair dryer—even if they don’t use it to dry their own hair. I discovered that a hair dryer is an alternative to moxa when I was postpartum with my second child. I was nursing two children, working part time, and wondered how I could make all of this happen and remain healthy. Using my hair dryer as a moxa stick proved key to my success at making the flow work between my household, practice, and continued healing, and it protected my personal ming men, life gate fire. Working on this article, I thought about it again as I found myself using my hair dryer as a moxa stick because it’s part of my yang sheng practice. Since then, I have had patients use not only a hair dryer but a variety of the alternatives listed above to add to their treatment and, in some cases, incorporate them into their own yang sheng practice. Below are examples of how heat therapy can be done with a hair dryer or any of the other alternatives we listed above.
Practical applications of heat therapy
A variety of different heat sources work when moxa is too smelly, too smoky, or too inconvenient to use. When we are stronger and busier, it can be a challenge to find the time. Please use your personal experience to determine which of the above works best for the patient in front of you and for the points you are choosing. The examples below are only a small selection of instances where these applications can be effectively applied.
- The top of the head, Bai Hui, Du 20, for hemorrhoids and recovery from birth as well as to lift the pelvic floor. Apply heat to this point for a few minutes, then check to see if that area is still cooler or if it is retaining heat. Only go to the next point when the previous point/area feels hot or sufficiently warm without the heat source nearby.
- The top third of the bottom of the foot when you pull your toes back. There is a hollow there. This is the acupuncture point Yong Quan, Gushing Spring Ki 1—what roots us to the earth. All organ systems borrow from the kidneys. Being rooted and warm helps our bodies stay in the dynamic balance that generates life. Heat this point for a few minutes, then check the area to see if it is retaining heat. Go to the next point only when Ki 1 feels hot or sufficiently warm.
- Your lower back—directly opposite your belly button and on your sacrum. We seek to warm the Ming Men, Life Gate Fire, which helps consolidate the muscles of the lower back, nourishes our energetic kidneys, and supports recovery from birth as part of Mother Roasting. Mother Roasting is part of the Zuo Yue Zi tradition of “sitting a month” or lying-in. In China, Thailand, and the Philippines, it is a tradition that helps clear the lochia and supports the cervix to close down, so cold cannot enter and disrupt the uterus, and supports the postpartum mother in recovery (R Lang OMD, LAc, personal communication, 1988; personal communication, 1989). A booklet that discusses Mother Roasting in more detail is available at http://ravenlang.com/products/.
- ST 36: Zu San Li, Leg Three Miles. Dr. CS Cheung taught at ACTCM that this point could be interpreted two ways: it makes one so strong that one can walk three miles and it chases disease three miles away (CS Cheung, personal communication, 1986). Dr. Miriam Lee, who studied in a moxa hospital in China and with whom Dr. Mager spent a year learning outside of graduate school, taught that using moxa on ST 36 only supports the true qi/life force and that the heat supports digestion, spreading the qi throughout the body: the acupuncture equivalent of the herb Huang Qi (Dr. M Lee, class,1988).
- Ren 4, Guan Yuan, Gate of Origin, and Ren 6, Qi Hai, the Sea of Qi. Ren 4 is located approximately a hand’s width under your belly button and Ren 6 is halfway between Ren 4 and your belly button. Warming this region with a hair dryer will feel warm and good. It will support your qi/life force, your muscles, and healing in your fascia.
Using a hair dryer, hot pack, hot water bottle, and so on on these places warms, nourishes, and heals. For men, it helps maintain homeostasis and protects kidney qi and yang. For women, when we menstruate and when we give birth, we lose jing essence/vital energy and heat. After giving birth, we want to bring heat to warm and nourish. Heat on the lower abdomen and back also supports our cervix to close well and will help lift the pelvic floor, similar to how abdominal work and core work support our lower back. Working the tiny muscles makes less work for the big ones. Warming the fascia and muscles with moxa, helps our pelvic floor heal (RLang, personal conversations during apprenticeship, 1988).
In conclusion, anywhere you would use moxa, you can also use these alternative heat sources to bring some true heat as a substitute. To ensure you receive appropriate amounts, we suggest adding these practices (if they apply to you) to your yang sheng practices in addition to offering them to your patients who cannot do moxa themselves at home. We find patients love having tools to support their healing process and they make a meaningful difference in their quality of life as well.
Amy E. Mager is a licensed acupuncturist and practitioner of Chinese herbal medicine who has been working with women, mothers, and families for over 27 years. She was a breastfeeding peer counselor for the Hampshire County WIC for eleven years, and through this program became a certified lactation counselor. She serves as secretary of the Acupuncture Society of Massachusetts and as vice chair of the American Society of Acupuncturists. Amy lives in the Pioneer Valley with her husband and main editor, Dan Garfield, DC, and their six children. You can also hear her on WHMP with Bob Flaherty on “Healing Outside the Box, Inside the Heart”.
Prior to attending Pacific College of Oriental Medicine – San Diego (PCOM-SD), Dr. Christine Cronin earned degrees in history, political science, and psychology, served in the Marine Corps, then discovered her passion for helping others by treating the whole person, which led to her decision to attend PCOM. Immediately after completing her MSTOM, she began her doctoral work, where she evaluated the ability of the NADA protocol to treat combat stress-induced insomnia. Dr. Cronin completed her DAOM in 2012 and her work was published in The Journal of Chinese Medicine in 2013. Dr. Cronin started the Veterans Clinic in September 2013, which has provided over 5000 treatments to date, and co-supervised the clinic with Hind Conner and her mentor Dr. Erin Raskin until January 2019. She currently teaches at PCOM and serves as Curriculum and Program Review chair. Dr. Cronin is also a board member of the American Society of Acupuncturists. Additionally, she served as lead faculty for the t-DACM program, chairperson for the Institutional Review Board at PCOM, and clinic supervisor for both the Family Recovery Center and Seniors Clinic.
- Dharmananda, S. (2004). Moxibustion: Practical Considerations for Modern Use of an Ancient Technique. Retrieved from http://www.itmonline.org/arts/moxibustion.htm
- Lim, R. (1992) After the Baby’s Birth…A Woman’s Way to Wellness: A Complete Guide for Postpartum Women. Emeryville, CA: Ten Speed Press.
- Mager, A. (2018). Postpartum Care: The bridge that sustains and supports us as our families grow.Retrieved from https://www.pacificcollege.edu/news/blog/2018/09/27/postpartum-care-bridge-sustains-and-supports-us-our-families-grow
- Mitchell, C., Ye, F., and Wiseman, N. (1999). Shang Han Lun: On Cold Damage, Translation and Commentaries. Boulder, CO: Paradigm Publications.
- O’Connor, J. and Bensky, D. (1981). Acupuncture: A Comprehensive Text. Seattle, WA: Eastland Press.
- Xu, J., Deng, H., and Shen, X. (2014). Safety of Moxibustion: A Systematic Review of Case Reports. Evidence-Based Complementary and Alternative Medicine, Article ID 783704, 10 pages. https://doi.org/10.1155/2014/783704.