Smoking out those qi blockages with moxibustion

When the moxa cone is burnt while attached to an acupuncture needle, the redistribution of qi is faster. — Photos: LOW BOON TAT/The Star

For centuries, heat therapy has been extensively used to treat various diseases in traditional medicine systems.

Whether the heat is derived from a hot drink, hot bath, hot pack, fire, or simply rubbing the palms together and placing them on a “cold” body part, the intention is to warm the body.

In traditional Chinese medicine (TCM), practitioners employ a method called moxibustion – a type of external heat therapy using mugwort (Artemisia vulgaris L.) leaves – to facilitate healing.

The plant has been used in Asia for thousands of years due to its medicinal properties, with its use spreading not just across China, but also to Japan, Vietnam, Korea and Mongolia.

Mugwort leaves are dried, ground, and rolled or shaped into small sticks or cones called moxa (similar to incense), and put on or over specific points on the body.

IMU University senior lecturer and clinician in charge of Chinese medicine Dr Ong Siew Siew says: “Mugwort is a herb that can be consumed in its raw form or used as an ingredient in daily recipes, such as mixing it in to fry an egg.

“More often, these herbs are used in herbal formulas and prescribed for women in confinement and people with gastrointestinal issues.

“You might also see them being sold as an essential oil or plaster; the effect is the same – it warms the body.”

Qi block

TCM works on the premise that a vital force of life, called qi, surges through the body – any imbalance in qi can cause disease and illness.

Seen here are a variety of moxa sticks and cones, along with gadgets to hold them.

Moxibustion is closely related to 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 cells, tissues and organs in the body.

Dr Ong explains: “When the qi does not flow well, it may lead to congestion in certain parts of the body.

“When you apply moxibustion on the acupoints, the smoke and heat are absorbed into the skin, and help redistribute and regulate this qi.

“When the blockages are released, the qi can then flow smoothly again.”

For example, your hands and feet may be cold, but other parts of your body may be warm, so there is some imbalance in the body.

“A lot of patients who walk into my clinic are averse to cold, and energy cannot flow into their fingers as it is stuck somewhere along the ‘highway’.

“When I place the moxa cone or stick on certain acupoints, the first thing they notice is that their fingers are no longer cold.

“Ideally, the treatment should be combined with acupuncture so that the effect can be amplified,” she says.

According to TCM textbooks, moxibustion is contraindicated for people with “warm” constitutions.

But Dr Ong personally believes that we are not bound by a single constitution.

“Most of us have a mixed constitution like in the example above,” she says.

Direct and indirect

Moxibustion can be applied directly or indirectly.

Many of Dr Ong's patients have an aversion to cold and waving the moxa stick over certain points of their feet causes them to warm up, and often, fall asleep immediately.

In the direct method, a small moxa cone is applied directly on the skin and burnt.

Practitioners might place the moxa on a piece of gauze, ginger, garlic or salt to protect the skin.

Dr Ong says: “Just before the burning moxa comes to an end, the practitioner will remove it so that it doesn’t burn the skin.

“This is known as non-scarring moxibustion.

“The heat provides a warming sensation deep within the skin, but does not produce any burn or scarring.”

Conversely, during scarring moxibustion, practitioners 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.

“Traditionally, the Chinese believed in this technique as they think the heat will be trapped once the scar forms, so the effect is better.

“But I’ve hardly come across anyone doing it here, only in China,” she adds.

With the indirect method, as its name implies, the moxa stick does not touch the skin, but is waved at a distance of roughly two inches (5.08 centimetres) away from the acupoint.

Or at a TCM clinic, the practitioner might light the moxa cone at the exposed tip of an acupuncture needle already inserted into the patient for faster results.

“The heat penetrates faster, like the bullet train that bypasses traffic,” Dr Ong jokes.

Many studies show that moxibustion can aid with menstrual cramps, muscle tension and arthritis pain.

Also proven to be beneficial for middle-aged and elderly people, it is especially helpful in maintaining the health of the spleen, stomach and kidneys.

In a 2023 article published in the journal Supportive Care in Cancer, researchers reviewed literature from randomised controlled trials and found that moxibustion may have a therapeutic effect on cancer-related fatigue.

For maintenance, Dr Ong teaches her patients to do indirect moxibustion at home, without the needles.

“It may reduce pain and inflammation.

“Some TCM proponents believe this therapy strengthens the immune system as it balances the energy in the body so that the body becomes more resilient.

“Depending on what the problem is, I advise patients to do five minutes on each acupoint.

“But in my clinic where they are under supervision, I do it for a longer time,” she explains.

Need for monitoring

However, moxibustion cannot simply be used on any part of the body.

Dr Ong guides a patient on how to use the moxa stick, via the indirect method, at the clinic, so that she can safely do it herself at home.

Dr Ong points out: “When we diagnose a patient from the TCM perspective, we look at their tongue, skin, hair, pain, face colour, etc.

“We look at the exterior and interior, and usually, the disease moves from the exterior to the interior, so we need to expel these diseases before they go in.

“Take abdominal pain for instance.

“It can be due to irritable bowel syndrome, gallstones, etc, but in TCM, we use syndrome differentiation based on the eight principles of qi.

“So the pain could come from excess or weak qi, cold or dampness, or stasis in the stomach.

“Therefore, moxibustion is not suitable for all abdominal pain, and sometimes, acupuncture needles alone are enough to alleviate the problem.”

Abdominal pain aside, the navel is an important point in moxibustion as it is the place of growth and where life forms.

“This is the starting point of the internal qi, and it must always be warm as it is the centre burner of the body.

“But we hardly do any heating therapy on the navel.

“In China, I’ve seen practitioners take the temperature at the umbilicus area and tell patients that the body temperature and umbilicus temperature are not identical.

“They will then do moxibustion on the umbilicus until the temperatures are the same,” she shares.

Just like exercising and dieting, consistency is key in achieving results, so patients must be diligent in doing moxibustion daily.

Dr Ong cautions: “My only worry is that patients sometimes get carried away, and instead of staying within the safety range, they will do 30 minutes to an hour because it’s so soothing.

“We don’t want to overdo and send the wrong signal to the body.

“If the body gets too heaty, it will kickstart another mechanism and you’ll start getting a sore throat.

“That’s the reason why we ask patients to return to the clinic to assess how they’re doing and if they need to taper off the moxa.”

Since there are a lot of fake moxas in the market, Dr Ong suggests patients purchase them from reputable TCM clinics instead of online.

And of course, only after they get evaluated by a TCM practitioner to gauge if moxibustion is suitable for them.

Be warned that the moxa smoke can be overwhelming as it has a pungent odour.

So if the smoke is bothersome, try doing your therapy outdoors.