Moxibustion - Case Studies
Pushing the Envelope of Moxibustion abstracted & translated by
Honora Lee Wolfe, Dipl. Ac., Lic. Ac., FNAAOM
For a number of years now I have been saying that the modern Chinese teachings
on moxibustion emanating from the People’s Republic of China have been overly
narrow and doctrinaire. Having studied moxibustion with pre-Liberation Chinese,
Chinese from Hong Kong and Singapore, and both Japanese and Korean
practitioners, it is my experience that moxibustion can be used to treat many
more conditions than many contemporary Chinese acupuncture and moxibustion
textbooks suggest.
As part of my drive to broaden the Western understanding and scope of
moxibustion, I am always on the look-out for Chinese articles which substantiate
this point of view.
In issue #11, 2002 of the Shang Hai Zhong Yi Yao Za Zhi
(Shanghai Journal of Chinese Medicine & Medicinals), Xu Jie, of the Acupuncture
& Moxibustion Orthopedic & Tramatology Department of the Jiangxi College of
Chinese Medicine, published an article titled, “Lifting the Borders of the
Artemisia Moxibustion Method of Treatment,” on pages 28-29 of that journal.
A precis of that article is given below. Hopefully it will help broaden Western
practitioners’ use of this extremely important and effective treatment modality.
Dr. Xu begins his article by quoting Zhang Zhong-jing who said, “For yang
conditions, use needles; for yin conditions, use moxibustion.” Based on this
saying, some Chinese doctors believe that moxibustion is prohibited in heat
patterns. For instance, the authors of Zhen Jiu Xue (A Study of Acupuncture &
Moxibustion), a commonly used contemporary Chinese textbook, state that
moxibustion is prohibited (or contraindicated) in the treatment of replete heat
and yin vacuity emission of heat patterns. However, as Dr. Xu points out, no
small number of Chinese medical practitioners have said that one can use
moxibustion in the treatment of heat patterns. To substantiate this point of
view, Dr. Xu presents four instances based on his own clinical experience where
moxibustion can be used in the treatment of heat patterns.
1. Guiding heat to exit outwards
In the Yuan dynasty, Zhu Dan-xi said that, “In various heat [patterns],
moxibustion [can] guide the qi of depressive heat to be effused outward.” In
later dynasties, numerous other Chinese medical practitioners echoed these
sentiments. For instance, the author of the Yi Xue Gang Mu (Detailed Outline of
the Study of Medicine) said:
[In] heat patterns, one can use moxibustion. One can obtain heat to move it. One
can use heat to move heat and thus promote the exiting of heat outward.
In the Ming dynasty, Gong Ding-xian said that Artemisia moxibustion can promote
“toxins to follow fire and scatter [due] to fire’s liking to spread and
out-thrust.” Dr. Xu has used Artemisia moxibustion on numerous occasions in
clinic to lead heat evils to exit outward in the case of sores, swellings, and
toxins during their initial stage. In this case, moxibustion is used in order
that heat may promote pustulation which can then shorten the course of disease.
This is just the same as what the famous Ming dynasty doctor Wang Ji-ti said,
“During the initial outbreak of welling and flat abscesses, one must first
moxibustion in order to open their door.”
Case history #1:
The patient was a 26 year-old female. Eight days after
delivery, her right breast became red, swollen, hot, and painful. This had gone
on for three days. Accompanying symptoms included aversion to cold, emission of
heat, a body temperature of 38 degrees Centigrade, and a swollen, hard lump in
the right breast which was 3cm x 3 cm large. The flow of milk from that breast
was also not smoothly and easily flowing. Based on these signs and symptoms, Dr. Xu’s diagnosis was breast welling abscess or mastitis. To treat this, he burned
one cone of moxa on an a shi point directly over the lump and at Ru Gen (St 18)
on the same side and bilaterally on He Gu (LI 4), Qu Chi (LI 11), and Nei Ting
(St 44). After 10 minutes, the patient’s breast milk on the affected side began
to spontaneously flow and the swelling and pain markedly decreased. The next
day, Dr. Xu repeated the moxibustion one time and the patient was cured.
According to Dr. Xu, the disease causes and mechanisms of mastitis are stomach
heat congestion and stagnation, liver qi depression and binding, blood heat
internally amassing, or recurrent contraction of external evils and heat toxins.
These result in disharmony of the constructive and defensive and obstruction and
stagnation of the channels and network vessels. Therefore, there is nodulation
and swelling which produce a welling abscess. This condition is categorized as a
heat pattern and as a repletion pattern.
Nevertheless, two moxibustion
treatments cured the above patient. This is because Artemisia moxibustion has
the effect of leading heat and exiting it outward. Once evil heat has been
discharged externally, channel and network vessels depression and stagnation
obtain elimination and swelling and pain are automatically dispersed.
2. Leading heat to move downward
Not only can Artemisia moxibustion lead heat to exit outward, it can also lead
heat to move downward. In the Dan Xi Xin Fa (Dan-xi’s Heart Methods), it says:
If foot qi penetrates the heart, one should [use] Si Wu Tang (Four Materials
Decoction) plus stir-fried Cortex Phellodendri (Huang Bai). In addition, one
should use moxibustion on top of Aconite cakes at Yong Quan (Ki 1) to discharge
and lead heat downward.
Similarly, Zhu Dan-xi, in his Mai Yin Zheng Zhi (Pulses, Causes, Patterns &
Treatments) said, “[If] both hands [have] great heat causing bone reversal,
there is fire within, and one can moxibustion Yong Quan (Ki 1) five cones to
cure this.” It has also been said in terms of the situation of heat above and
cold below:
[In] heat reversal heart pain [where] the body is hot [but] the feet are cold
and pain is severe, leading to vexation and agitation, vomiting, and spontaneous
perspiration, know this is due to heat and the pulse is surging and large. [In
this case,] one should moxibustion Tai Xi (Ki 3) and Kun Lun (Bl 60)... to lead
heat to move downward.
Based on these sayings, one can use moxibustion on points on the lower
extremities and feet in order to lead yang heat to move downward so as to
disperse yin cold and thus promote the interaction and communication of yin and
yang.
Case history #2: The patient was a 46 year-old male who was initially
examined by Dr. Xu in August 1994. Due to excessively great sorrow over a family
affair, this man’s emotions had been depressed for many days. This had resulted
in insomnia, profuse dreams, vexation and agitation, easy anger, lassitude of
the spirit, fatigue, chest oppression, torpid intake, low back and knee soreness
and limpness, a red tongue tip and edges, and a fine, rapid pulse. Dr. Xu
diagnosed this man as suffering from insomnia and needled Shen Men (Ht 7), Yin
Tang (M-HN-3), Tai Chong (Liv 3), Lao Gong (Per 8), and San Yin Jiao (Sp 6) for
one week without result. Then Dr. Xu re-analyzed the case’s disease causes and
mechanisms. Excessive sorrow had resulted in liver qi depression and binding and
the patient’s qi mechanism was not smoothly and easily flowing. Depression had
engendered fire and kidney water was not longer interacting with the heart.
Instead, fire was internally harassing the heart spirit. Therefore, Dr. Xu
thought that treatment should lead heat to move downward in order to reconnect
the heart and kidneys. Thus water and fire can then mutually support each other.
In order to accomplish just this, Dr. Xu moxaed Yong Quan (Ki 1) and Zhao Hai (Ki
6) and immediately there was a marked therapeutic effect. Dr. Xu then moxaed
these points several more days in order to secure these therapeutic effects and
the man was cured.
According to Dr. Xu, moxibustion can be used like this to treat a number of
conditions, such as headache and the sequelae to cerebral stroke. In this case,
it is not necessarily that “fire strengthens yang evils.”
3. Dispelling phlegm & scattering fire
In terms of dispelling phlegm and scattering fire, Zhu Dan-xi used this
technique to treat runny nose with foul-smelling snivel when the pulse is
bowstring and small (i.e., fine), the right inch is slippery and the left inch
is choppy. This indicates a condition of “phlegm depression fire and heat.” In
this case, Zhu Dan-xi said to moxibustion Shang Xing (GV 23), San Li (St 36),
and He Gu (LI 4) to cure this and he gave a case history of how he used
moxibustion to dispel phlegm and scatter fire. In the Ming dynasty, Gong
Ju-zhong said, “[When] phlegm diseases obtain fire, they can be resolved because
heat causes the qi to move and thus the fluids and humors course and flow
freely.” Likewise, Dr. Xu has used moxibstion in his own clinical practice in
order to dispel phlegm and scatter fire.
Case history #3: The patient was a 10 year-old boy who had a swollen, painful
gland under his right ear. The affected area was red, swollen, and burning hot,
and his temperature was 38.3 degrees Centigrade. Accompanying signs and symptoms
included oral thirst, a red tongue with yellow fur, and a floating, rapid pulse.
The patient was diagnosed with the initial stage of mumps. Pediatric mumps are
due to phlegm fire accumulation and stagnation with external contraction of
warm, seasonal toxins. These become depressed and stagnate in the shao yang, and
thus the channels and network vessels lose their coursing and discharging. Dr.
Xu used Juncus moxibustion on the affected area 2-3 times. This means dipping a
strip of Medulla Junci Effusi (Deng Xin Cao) in oil, lighting it, and then
touching the lit Juncus to the skin. The next day, Dr. Xu repeated this
treatment one time and the patient was cured.
4. Boosting the qi, nourishing yin & clearing heat Some of the ancients believed
that moxibustion can damage yin and consume the qi. For instance, Zhang
Zhong-jing, in his Shang Han Lun (Treatise on Damage [Due to] Cold) said:
[If] the pulse is faint and rapid, be careful not to use moxibustion... Fire qi,
although faint, [can] attack internally with force, scorching the bones,
damaging the sinews, and [making] it difficult for blood to recuperate.
However, not a few Chinese doctors have taught that one can use moxibustion
in the treatment of yin (and qi) vacuity emission of heat. For instance, Zhu
Dan-xi again said, “Moxibustion for vacuity causes the fire qi to strengthen the
original qi,” and recommended moxibustion for the treatment of cough, hacking
blood, emission of heat, and emaciation (i.e., pulmonary consumption). In this
case, there is yin vacuity with emission of heat with heat damaging the blood
network vessels. This means that moxibustion can clearly be used to nourish yin
and clear heat. Gong Ju-zhong also said:
[When] vacuity diseases obtain fire, they are invigorated. Fire forces water [to
move] and qi is upborne. This is what is meant by warm supplementation and hot
boosting.
In the case of qi vacuity emission of heat, one can use moxibustion to hotly
supplement the qi. This promotes spleen-stomach qi exuberance and normalizes
movement and transformation. Vacuity heat is automatically eliminated. This is
the method of boosting the qi and eliminating heat which is similar to the idea
of using sweat, warm medicinals to eliminate heat. Because moxibustion has the
effect of boosting the qi, nourishing yin, and clearing heat, Dr. Xu uses
indirect moxibustion on ginger at Fei Shu (Bl 13), Shan Zhong (CV 17), Gao Huang
Shu (Bl 43), and Zu San Li (St 36) to treat qi vacuity and qi and yin vacuity
asthma. He uses indirect moxibustion on garlic on the Hua Tuo Jia Ji, Gao Huang
Shu (Bl 43), and Zu San Li (St 36) to treat lung taxation in the latter stages
with yin and yin vacuity. And he uses moxibustion on Zu San Li (St 36), Pi Shu (Bl
20), and Zhong Wan (CV 12) to treat pediatric gan accumulation and afternoon
tidal fever.
Case history #4: The patient was a 38 year-old male. Due to long-term stress
and tension at work and extreme fatigue, the patient commonly experienced a
fever which was typically worse in the afternoon and accompanied by bilateral
malar flushing, tidal heat in the centers of the hands and feet, vexation and
agitation, lassitude of the spirit, fatigue, scanty appetite, disinclination to
speak and low, weak voice, spontaneous perspiration, and poor sleep. The man’s
tongue was tender and pale in color, and his pulse was soft and forceless. After
entering the hospital and having his whole body examined, it was determined that
there was no apparent organic disease. Analyzing the disease causes and
mechanisms, Dr. Xu decided that taxation fatigue had caused internal damage and
that the middle burner had suffered detriment. Thus the harmony of the qi and
constructive had been lost and the clear yang was no upborne. Thus internal
damage had resulted in the emission of heat or fever. Dr. Xu moxaed Guan Yuan
(CV 4), Zu San Li (St 36), and Bai Hui (GV 20) with five cones each time, once
per day. After a half month, the man was cured.
According to Dr. Xu, moxibustion at Guan Yuan (CV 4) warmly supplements the
original qi. Moxaing Zu San Li (St 36) boosts the origin of engenderment and
transformation, while moxaing Bai Hui upbears the clear and lifts yang. Hence
vacuity heat is automatically eliminated. This case shows how the use of
moxibustion can boost the qi, nourish yin, and clear heat in the treatment of
internal damage emission of heat.
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