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Moxibustion is a traditional Chinese medicine (TCM) practice that has grown in popularity globally. It’s been said to have benefits for arthritis pain, digestive issues, and breech presentation in pregnancy. Still, many wonder, what is moxibustion, exactly?

In this article, we’ll cover the facts about moxibustion, including how it works, its uses, and its purported benefits.

What Is Moxibustion?

Moxibustion is a type of heat therapy. It involves the burning of mugwort (Artemisia argyi or Artemisia vulgaris) on or over specific points on the body. This is believed to stimulate the flow of qi (pronounced “chee”), the vital energy force that exists in every living thing, according to TCM theory.

TCM holds that many common ailments and diseases can be traced to imbalances or disruptions of qi flow. Adequate amounts and proper circulation of qi are thought to be required to maintain overall good health and well-being, or the harmony of yin and yang within the body.

Moxibustion is closely related to the TCM therapy acupuncture, which posits that the human body contains some 2,000 points that connect to an unseen network of pathways, or meridians. These meridians transport qi and blood to all of the cells, tissues, and organs in the body.

By applying heat to the acupoints, moxibustion aims to free any blocked qi along the meridians and restore flow. This in turn promotes healing.

How Does Moxibustion Work?

A TCM practitioner may apply moxibustion directly or indirectly.

Direct Moxibustion

Direct moxibustion involves placing dried mugwort leaves, ground and fashioned into a cone or stick called moxa, on the targeted area (often an acupuncture point). The practitioner then lights the moxa, allowing it to burn slowly until the skin reddens and heats up. The moxa is removed before it burns the patient’s skin.

This is known as non-scarring moxibustion. The heat provides a warming sensation deep within the skin, but does not produce any burns or scarring.

Conversely, during scarring moxibustion, therapists will leave the moxa to burn until it dies out. The skin may burn or blister as a result, potentially leaving a scar after it heals.

Indirect Moxibustion

Indirect moxibustion is the more common form in North America. It’s considered safer, as the risk for burns or blisters is substantially lower.

In this type, the burning moxa does not make contact with the skin. The practitioner instead holds it close to the skin, about one to two inches above a specific area. Once the treatment area turns red and warm, the practitioner removes the moxa.

Some practitioners will combine acupuncture and moxibustion therapy by lighting the moxa at the tip of an acupuncture needle. The heat passes through the needle to the point and the bordering area. Once the patient feels relief, the flame is extinguished and the needle removed.

From a Western medical and scientific perspective, the therapeutic qualities of moxibustion may result from its thermal effects, radiation effects, and the pharmacological activity of moxa smoke.

Moxibustion Uses

Moxibustion has been used in China to treat and prevent diseases for over 2,500 years. The earliest record of its medicinal use dates back to 581 BC in the Zuo Zhuan, a pre-Qin dynasty collection of narrative commentaries.

Its use in treating complex diseases is also documented in the Mawangdui Silk Texts, which were sealed in a Han dynasty tomb in 168 BC.

An analysis of scientific papers published between 1954 and 2007 in China suggests that moxibustion can be used to treat 364 kinds of diseases.

Some of these include:

• Breech presentation (in pregnancy)
• Diarrhea
• Colitis
• Urinary incontinence
• Severe menstrual cramps
• Knee osteoarthritis
• Temporomandibular joint (TMJ) syndrome
• Soft tissue injury
• Heel pain
• Asthma
• Urinary retention
• Herpes zoster

However, current research suggests its efficacy is limited to a fraction of these conditions.

Potential Moxibustion Benefits

Researchers have conducted a number of studies on moxibustion’s effectiveness in treating various conditions. Some findings have been favorable, while others have been inconclusive.

Based on preliminary research, the following conditions seem to respond well to the alternative therapy.

Arthritis

Moxibustion may benefit patients with knee osteoarthritis (OA). The degenerative joint disease is common in the elderly, and its resulting pain is known to reduce patients’ quality of life.

According to two recent systematic reviews and meta-analyses, moxibustion could help alleviate knee OA symptoms such as pain.

The 2017 review of studies concluded that moxibustion is effective for reducing pain and managing symptoms in knee OA patients when compared to sham moxibustion and oral drug therapy.

In the 2016 review, findings showed that moxibustion is “likely” to manage symptoms and improve quality of life in patients with knee OA.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a group of disorders characterized by inflammation of the digestive tract. Ulcerative colitis and Crohn’s disease are two common examples. Symptoms may include diarrhea, severe abdominal pain, and fever.

In a 2013 review of randomized controlled trials, researchers found that acupuncture and moxibustion therapy was superior to oral sulfasalazine, an ulcerative colitis drug, in treating IBD.

Older reviews have drawn similar conclusions, but due to the quality of the studies reviewed (small sample sizes, lack of blinding, etc.) scientists have determined the evidence inconclusive. Higher quality studies are needed to confirm moxibustion’s use for IBD.

Osteoporosis

The bone disease osteoporosis develops with the loss of bone mass and bone mineral density. These decreases can create a higher risk for fractures.

There is some evidence to suggest that a combination of moxibustion and acupuncture may improve bone mineral density and help manage the pain from acute fractures.

A 2020 review of the existing research found “high-quality evidence” for the increase in bone mineral density, while the evidence for pain reduction was considered to be of “low- and medium-quality.”

Breech Presentation

The most promising results have been seen in the area of breech presentation. This occurs when a baby’s feet or buttocks are positioned first in the mother’s uterus in late pregnancy. It can cause complications for the baby and mother during delivery.

Researchers in a 2009 review of studies comparing moxibustion for breech presentation correction with other methods stated that moxibustion at acupuncture point BL67, or urinary bladder 67, in particular has been shown to have positive effects for correcting the issue.

A 2010 assessment of systematic reviews of moxibustion for multiple conditions noted that “the sum of the best evidence to date seems to suggest that moxibustion is effective for breech presentation.”

However, a later study review, published in the Journal of Midwifery & Women’s Health in 2018, acknowledged the supporting evidence but emphasized the need for further investigation on this subject.

Moxibustion Risks and Precautions

Moxibustion is an ancient Chinese therapy that may be useful as part of a complementary and integrative approach to medical treatment. But there are risks involved as well as precautions to take to avoid injury.

Patients may suffer unintentional burns during moxibustion therapy. These can range from minor to severe, and are often the result of self-treatment. This is why it is important to seek treatment from a licensed acupuncturist or traditional Chinese medicine provider.

If performing moxibustion on yourself (under the guidance of your practitioner), indirect moxibustion is strongly recommended.

There have also been reports of uterine contractions, fetal distress, and premature labor in pregnant women.

As mugwort is a herb, there is the risk of an allergic reaction. Symptoms may include sneezing, runny nose, itchy throat and eyes, skin rashes, or asthma. Those who are allergic to ragweed or any other plants in the Asteraceae family are more likely to experience a reaction to mugwort.

The smoke produced from burning moxa can be also an irritant, causing a dry cough and/or sore throat. Additionally, its odor has been compared to marijuana smoke, which may be unpleasant to some.

Other reported side effects include nausea and vomiting, basal cell carcinoma, and hyperpigmentation (dark spots or patches of skin).