In Australia due to the lack of experience of patients with acupuncture it is quite rare to receive or observe direct moxa treatments. Even in school most teachers when teaching the theoretical foundation of moxibustion will briefly mention about direct moxa but then most of the time say that most Australian people won't let you scar them so don't bother with it. But I have observed it to be a very powerful treatment technique.
While organizing my PhD at Liaoning University of TCM in Shenyang China I was fortunate to meet with Dr. Jin in one of the associate hospitals. Dr. Jin's standard points and direct moxa protocol is as follows. He burns 5 moxa cones per point. The cones are made of high quality bright yellow moxa punk, which is rolled between the fingers to the size of a rice grain. Dr. Jin starts with the patient in a seated position and burns 5 consecutive moxa cones on BaiHui Du20. The cones are not extinguish but are left to burn themselves out. Reverse sided sticky tape is then used to clean the ash from the scalp. The patient then lies face down on a massage table placing their closed fists above their heads while resting their elbows on the edge of the table. The points QuChi LI11, FeiShu UB13 and GaoHuangShu UB43 are used. When points are close together a calligraphy brush is used to sweep the ash into a pile between the points and then the reverse sticky tape is used to remove the pile of ash. The patient then turns over onto their back and the points ZhongWan Ren12, QiHai ren6, QiGu Ren2 and ZuSanLi St36 are used. It is to be noted that the 1st time a patient is given direct moxa a lot of time and care is spent finding and marking with ink the acupuncture points as accurately as possible. Obviously for consecutive treatments the moxa cone is placed over the previous scar. Other point alternatives particularly for female patients include SanYinJiao sp6 and ZiGong (extra point).
I noticed that in extremely severe cases of stroke and paralysis, particularly with wheel chair bound patients points such as PiShu UB20, Weishu UB21, Sanjiaoshu UB22 and Shenshu UB23 were added to the above point prescription. Based upon classical literature it states it is better to start with the points of the upper body and then finish with the points of the lower body so the heat and Yang Qi generated by the direct moxa can be directed down to the Xia Dan Tien (lower elixir field). " The Illustrated Classic of Acupuncture Points on the Bronze Man recommends the application of a hundred or even as many as three hundred moxa cones to Gaohuangshu BL-43. Early texts, however, stress that after moxibustion at Gaohuangshu BL-43, moxibustion should also be applied to points below the umbilicus, e.g. Qihai REN-6 and Guanyuan REN-4, in order to conduct downwards the heat thus generated." (Peter Deadman)
Dr. Jin stated that he found direct moxa to be far stronger and faster acting than herbal medicine and the reason he uses such a powerful technique is he needs to be able to tonify the patient quickly and as strongly as possible to get them walking again soon before muscle atrophy and structural deformities set in.
The treatment seems to be extremely effective. I witnesses many wheelchair bound patients being able to stand and walk unassisted within 2-3 weeks of daily direct moxa treatment. He does acupuncture and TuiNa skeletal structure manipulation (chiropractic) in conjunction or as an alternative to the direct moxa treatment. If patients suffer from internal cold diseases he uses a heat lamp on their lower abdomen or lower back instead of the direct moxa. When asked why not use indirect moxa he said it was not very effective, was slower and time consuming. He also stated that if you are using indirect moxa just for its warming function, a heat lamp was easier and more hygienic.
The quality of the moxa must be very high for direct moxa. High quality moxa only burns at 60°C creating a mild burn which is easy to look after and in most cases the scar can heal completely, while lower quality moxa can burn up to 100°C creating deeper, larger and permanent scars. If the person has certain underlying constitutions or patterns this will also affect the healing process and the chances of having a permanent scar increases the sicker and weaker the patient is. The purpose of direct moxa is not to make a huge painful infected scar. It is to create a mild, small, controlled burn that brings the bodies’ awareness, Qi and immune system to an acupuncture point. The sensation that is caused at the exact moment of the burn is considered a very strong De Qi sensation and has a profound Yang Qi tonifying effect on the selected acupuncture point. As the body heals the burn, the constant attention keeps the point stimulated in a way that no other treatment technique can.
It is important to be aware of wind when using direct moxa. Make sure there is no wind blowing on the patient at all. This includes your breath, the air current created by brushing off the ash, a draft from an open window, air conditioning and even the breeze creating from someone moving or walking past quickly. This is a very important point. Once the treatment is finished allow the patient to dress and cover themselves up. The theory is that since you have caused a burn you have opened the acupuncture point up to the external environment. Also the sensation caused by direct moxa can give you a hot flush sensation over your body or others describe it as an adrenalin hit, or as energy or electricity rushing quickly around your body. This causes your pores, channels and points to open, another reason to protect the patient from wind until they have a chance to dress and let the pores close up again after 5mins.
Another interesting observation was the actual scarring process itself. I noticed many people had different skin reactions to the direct moxa and the scars ranged from small and neat to large purple welts. I did some research and then asked Dr. Jin's opinion. He stated that since he had not been practicing direct moxa for many years he was still studying it himself. "I didn’t like moxa in the beginning. I try not to give pain in treatment procedure. In my opinion, acupuncture is more like sedation rather than tonification. I have chosen the moxa treatment as a tonification method instead of herbal prescription. The reaction of direct moxa treatment may indicate what the patients have wrong in their diet and lifestyle as well as their underlying constitution or TCM pattern." (Jin Sep,2013)
In other words the skins reaction to the direct moxa can also be used as a diagnostic method. Examples are if the patient is healthy with no major unbalances then the direct moxa will not produce a blister, it will scab very quickly and the scar will remain very small and blend in with the skin very well. If the patient suffers from dampness or phlegm then it will blister in relation to how severe the dampness is, either large, medium or small blisters. If there are heat signs mixed with damp and/or phlegm then there will be turbid yellow-orange fluid inside the blister and the darker the colour the stronger the internal heat. If the patient has internal heat then the skin will become red and hive like around the scar sight with a radius ranging from 0.5 - 3cm, again larger red rings denotes more severe heat. If the patient suffers from Zheng Qi deficency then it is very easy for the scar to become infected and for the scar to produce a lot of pus. If the patient suffers from Zhong Qi deficiency then the scars will take more than 3 weeks to heal as healthy patient's scars are usually healed in under 3 weeks. If there is Zhong Qi and spleen Qi deficiency then it is easy for the scar to weep some blood and not scab properly. If there is blood stasis then the scars will turn dark purple and can grow in size. If there is external wind then the scars will become very itchy and the patient will want to pick the scabs off. If the patient suffers from Yang deficiency or internal cold they will not complain about the moxa sensation at all and will probably comment that it feels really good. For Qi stagnation the sensation will be stronger and the scar will have redness and lingering soreness. This is not a complete list of reactions but should give the reader a basis and idea of how other scars and patterns will manifest. To help heal the burn quickly it is recommended to apply 100% pure lavender essential oil directly on the burn. Australian 100% Paw Paw ointment is also wonderful for scar and burn healing.
Below I will only list the results of 2 patients that I saw and include my own experience of Dr. Jin's direct moxa treatment. During the 3 weeks I witnessed Dr. Jin treat hundreds of patients but these 2 stood out to me.
Patient1: Was a young man aged 28. He was a tall solid build. Bright eyes, shiny black hair with no grey. Skin complexion was clear. Tongue was slightly red tipped with a thin white coating at the root of the tongue. Pulse was a little slippery and deep on the right side earth position and wiry on the left side wood position. He had a busy and stressful job working for an international accounting firm and complained of tiredness and lacked sexual endurance. He also suffered from poor digestion which was made worse by cold and raw food. While I was observing Dr. Jin I met with this young man twice. He said he has had 5 treatments of direct moxa, approximately1- 2 treatments per week, or when is work schedule allows him to visit the hospital. He was very happy with the results so far. While we were applying the moxa to him I asked him how he felt, he replied "wonderful" while pulling a pained expression, he was being sarcastic about the sensation of course but then he became serious and said he honestly felt increased energy for between 3-4 days after treatment. His digestion has improved but he still has to avoid raw and cold food or it worsens again. Because he is young and doesn't really suffer from any severe chronic illness, so he is using the direct moxa as health maintenance. At one point he hesitated for a second then smiled and stated "being with a girl is really good now"!
Patient2: Was a gentleman aged 60. He had suffered a stroke from a blood clot bursting in his head. He had had surgery 3 weeks ago and had been cleared to leave the intensive care unit. He had a surgical scar on his throat because the surgeons had had to perform a traciotomy to allow him to breath and eat while he was in intensive care. When we saw him the scar had healed, he could swallow normally. He was wheel chair bound and had no strength or movement in the right hand side of his body. He could not even turn his head. He could not speak and even his eyes had trouble focusing and concentrating on your face. He seemed easily confused and it was hard to tell if he could comprehend anything that was being said to him. He also had a bright red rash around the T zone of his face. He suffered from high blood pressure. We were told by his family that on the day of the stroke he had become extremely angry during a business meeting. We couldn't check his tongue as he couldn't open his mouth but his pulse was strong and forceful on the 1st position and got deeper and weaker on the 2nd and 3rd positions like it was descending a steep slope.
It took 3 family members to get him from the wheelchair onto the massage table. Dr. Jin then applied his standard point combination. The patient obviously found the moxa incredibly painful because he was squirming on the table but considering he was paralyzed that was a really good sign. Also when his ZuSanLi was moxa'd his affected right leg jumped and twitched by itself. We took his pulse and were surprised to feel the 1st position was much more mild and the other positions had come up so that the pulse was all at the same middle level. The most profound change was noticeable when he sat up. Straight away he looked us all in the eye and gave a small smile and grunted a noise, we didn't know if he was communicating gratitude or a curse but we were all impressed with the sudden improvement, even Dr. Jin commented he didn't expect such a result so suddenly. We told the patient he had to come in for the same treatment everyday, at first you could see a look of dread on his face, but then he realized how much cognitive function he had received and so tried to nod an affirmative. The next day the patient came in we were shocked, he was helped out of the wheel chair by just 1 family member. We gave him the same points plus Pi, Wei, San Jiao and ShenShu points. At the end he gave us a small wave good bye with his good left hand.
The 3rd day the patient was helped out of the wheel chair and with the assistance of just his son and was half dragged and half shuffled into the treatment room and to the massage table. They had made a kind of sling for his right foot and he would step with his left and then his wife would use the sling to pull his right foot forward for him while his son supported his weight. The results gave me goose bumps. This time when the treatment was done his wife asked him to thank us and he gave us all a smile and nodded his head. If given yes or no questions he would nod or shake his head and attempted to speak but it just came out as grunts.
The 4th treatment I was really touched. He was moaning most of the time during the treatment and the body twitches were even bigger than other times. After the treatment he sat up and had tears running down his face. I grabbed a tissue and wiped them for him. I gave him a comforting pat on the back and he turned his head, looked up at me smiled and patted me back. His wife stated that he was trying to feed himself today and I had firsthand experience that he was definitely getting his gross motor skills back. He slid off the table with less assistance from his son and with his foot sling made his way out of the office to his wheel chair. Unfortunately that was the last time I got to see him as the national holiday started in china and I returned to Australia but needless to say I was deeply moved by this patient. I want to mention that this patient only received direct moxa treatment and nothing else.
After seeing all these successes I was curious to direct moxa myself. I already had scars on my ZuSanLi from direct moxa but I honestly had a bit of trepidation about getting other points scarred. I thought about it for a few days then finally decided to try it. Dr.Jin started with my BaiHui and during the 5 cones I felt a kind of hot flush sensation rising up through my body. The moxa itself didn't hurt much. Then we did QuChi, Feishu and Gaohuangshu, these ones definitely stung more. Next Zhongwan, QiHai, QiGu and ZuSanLi were selected. I have to say the RenMai points were pretty sensitive and I had to do some deep breathing while they were being applied, they gave me a bit of an adrenalin rush with tingling around my whole body. ZuSanLi was easy to deal with by itself but while it was burning with Zhongwan and QiHai the sensation of all the points was intensified. Afterwards I had a quick look at the marks and got dressed. They were all just dark brown dots that looked like a mole. I stood still for a few minutes afterwards waiting to feel a rush of Qi. Nothing profound happened. I finished off my day in the hospital in the usual fashion, had dinner and went back to my dormitory.
At about 7:30pm I heard some other students working out in the gym. I paused for a second and noticed I felt quite energized. I joined them weight lifting for about 2 hours. Most of the time I only lift weights for about 30mins. I was surprised that I could train with them for 2 hours. I felt really strong and very vital. I thought "hey this direct moxa works well”. The next day I checked the time and I had woken up about 2hrs earlier than usual, I noticed the usual stiffness after a big workout but I still had more vitality than I did the previous day. On the 3rd day the extra energy seemed to have been burned out, but I have to admit I did push myself while I had that extra energy to see what I could do with it. I didn't feel that I had cut into my own energy I just felt I had used up the extra boost the moxa had given me.
I hope this story has at least opened your mind to the possibility of learning more or experiencing/experimenting with direct moxa. Regardless of social trends it is important that ancient knowledge is understood, practiced and not allowed to disappear. The ancient TCM sages taught what they did for a very good reason, it is our responsibility to keep the flame of their knowledge and wisdom burning and not chop and change it to suit the vanity or convenience of our modern society.