Fire vs. Fire
Research on Moxibustion for Heat Diseases
As I mentioned a couple of posts back, I have been accumulating Chinese research on moxibustion for a year or so. There are a lot of interesting papers out there, and I decided to highlight a study which uses moxibustion as both experimental and control method. The somewhat unusual aspect to the study is that it uses moxibustion in a situation for which many of us were taught that moxibustion is at best poorly suited and at worst potentially dangerous.
The study
Jiao et al. (2024) detail an outpatient study on treating diminished ovarian reserve (DOR), done at the gynecology department of Huáiběi Hospital of Traditional Chinese Medicine from January 2022 to December 2022. The subjects were 60 patients who met the diagnostic criteria for kidney yīn vacuity type ovarian dysfunction. Patients were between 20-40 years old, had not received hormone therapy for at least 3 months, and had no other cause of infertility.
The control group used moxibustion at CV8 Shénquē, CV4 Guānyuán, UB23 Shènshù, SP6 Sānyīnjiāo and CV12 Zhōngwǎn.
Additional points based on the symptoms:
for anxiety and depression, add LV3 Tàichōng and GB34 Yánglíngquán ;
for tidal fever and night sweats, add KD1 Yǒngquán;
for insomnia and profuse dreaming, add HT7 Shénmén and KD3 Tàixī.
Moxibustion method: Warm mild moxibustion method [温和灸方法], using a lit moxa stick aimed at the acupoint, with a radius of 3 cm from its center, 3–5 cm from the skin, so that it feels warm but not burning. Each point is heated for 15 minutes, until the skin is rosy and moist. Moxibustion treatment starts on the 10th day after the end of the menstrual cycle, once every other day; one menstrual cycle is one treatment course, and the treatment is continued for three cycles.
The treatment group was given the same moxibustion protocol as the control group but also took Zuǒguī Wán [Left-Restoring Pill]:
熟地黄24g、山药12g、山茱萸12g、牛膝12g、菟丝子13g、鬼板胶12g、鹿角胶22g
加减：失眠者多梦加酸枣仁、夜交藤等；腰膝酸软者加补骨脂、杜仲等；焦虑抑郁者加郁金、香附、合欢皮等；潮热盗汗者加知母、地骨皮等；神疲乏力者加党参、黄芪等。
Shúdìhuáng [Rx Rehmanniae praeparatae] 24g, shānyào [[Rz Dioscoreae] 12g, shānzhūyú [Fr Corni] 12g, niúxī [Rx Achyranthis Bidentatae] 12g, tùsīzǐ [Sm Cuscutae] 13g, guǐbǎn jiāo [Gelatinum Plastri Testudinis] 12g, lùjiǎo jiāo [Gelatinum Cornu Cervi] 22g
Additions and subtractions:
For insomnia and frequent dreams, add suānzǎo rén [Semen Ziziphi Spinosae], yèjiāo téng [Caulis Polygoni multiflori], etc.
for limp aching low back and knees, add bǔgǔzhī [Fr Psoraleae], dùzhòng [Eucommia ulmoides], etc.
for anxiety and depression, add yùjīn [Rx Curcumae], xiāngfù [Rz Cyperi], héhuān pí [ Cx Albizziae], etc.
for tidal fever and night sweats, add zhīmǔ [Rz Anemarrhenae], dìgǔpí [Cx Lycii], etc.
for fatigued spirit and lack of strength, add dǎngshēn [Rx Codonopsis], huángqí [Rx Astragali], etc.
1 hour before meals, brew in warm water, take orally. Divide dose into two halves and take one half in the morning and again in the evening. Treat for a total of three menstrual cycles. Start taking the medicine on the fifth day of the menstrual cycle and stop taking it during menstruation.
Effectiveness criteria:
(1) Cure: The patient's menstrual cycle and menstrual volume return to normal, symptoms completely disappear, the number of sinus follicles is normal, and the TCM symptom score decreases by ≥95%;
(2) Marked efficacy: menstruation returns, the cycle shortens, the menstrual flow increases, and the symptoms are relieved to some extent, the number of sinus follicles is close to normal, and the TCM symptom score decreases by 70-95%;
(3) Effective: menstruation returns occasionally, the menstrual flow increases slightly, the number of sinus follicles increases but remains within the normal range, and the TCM symptom score decreases by 30-70%;
(4) Ineffective: No menstruation, TCM symptom score decreased <30%.
Total effective rate = (cured + markedly effective + effective)/n×100.00%;
Results
The study compared moxibustion alone [control] with moxibustion combined with Zuǒguī Wán [treatment].
The total effective rate of the treatment group was 93.33% and of the control group was 73.33% (P<0.05).
After treatment, the endometrial thickness and follicle count of the two groups were higher than before treatment, and the treatment group was significantly higher than the control group (P<0.05).
After treatment, the scores of menstrual dysmenorrhea, delayed menstruation and dark or purplish menstruation of the two groups were significantly lower than before treatment, and the treatment group was significantly lower than the control group (P<0.05).
A summary of the discussion section:
According to Jiao et al. (2024), modern western medicine believes that the onset of DOR is usually due to a decline in the ovaries' ability to synthesize sex hormones, which in turn leads to a decline in the negative feedback mechanism of the hypothalamic-pituitary axis and a decrease in estrogen levels. Traditional Chinese medical literature does not mention ovarian reserve function, but in terms of clinical manifestations, DOR can be classified as “amenorrhea” in traditional Chinese medicine. TCM closely relates this disease to the kidneys. Studies cited by the paper have found that most women with DOR are diagnosed with kidney vacuity. Female reproductive function is dependent on the essence and blood; the kidneys store essence, and essence and blood are mutually generated. Thus a core pathogenesis of declining ovarian function is kidney essence vacuity.
Moxibustion can significantly improve local circulation and has the effect of warming and freeing the channels. Modern medical research on moxibustion has shown that it can regulate the patient's hormone levels and achieve the effect of improving ovarian function.
Commentary on the study
This study was interesting in a couple of ways. One is that it examined moxibustion as a stand-alone treatment against moxibustion plus herbal medicine. Another is that it used moxibustion as an element of both treatment and control groups for a pattern of yīn vacuity, which a lot of us learned in school was an automatic contraindication.
The study article mentioned diagnostic criteria for yīn vacuity type ovarian reserve decline, and the corresponding symptoms as reduced by at least 30% in almost three-quarters of the moxibustion-only group. The diagnostic criteria in the published PRC industry standard 中医病证诊断疗效标准 [Zhōngyī bìng zhèng zhěnduàn liáoxiào biāozhǔn / Chinese medicine disease pattern diagnosis and treatment efficacy standards] that appears to be the source cited in the article’s footnotes did not mention DOR specifically. The study paper did mention that DOR may be classified as amenorrhea [闭经] and the criterion for yīn vacuity type amenorrhea is listed as follows:
9.2.4 阴虚内热：月经先多后少，渐致闭经。五心烦热，颧红升火，潮热盗汗，口干舌燥。舌质红或有裂纹，脉细数。
Yīn vacuity with internal heat: Menses profuse at first then scanty, gradually leading to amenorrhea. Vexing heat in the five hearts, red cheeks from upbearing fire, tidal fever and night sweats, dry mouth and tongue, tongue red or with fissures, fine rapid pulse.
There is also a criterion listed in the industry standard for kidney yīn vacuity type infertility:
34.2.2 肾阴亏虚：婚后不孕，经行先期，量少色红，五心烦热，咽干口渴，头晕心悸，腰酸腿软。舌红少苔，脉细数。经少腹疼痛。苔薄黄，脉弦。
Kidney yīn depletion: infertility after marriage, advanced menstruation, scanty red-colored menstruation, vexing heat of the five hearts, dry throat and thirst, dizzy head and palpitations, aching lumbus and limp legs, red tongue with scanty fur, fine rapid pulse, lower abdominal pain during menses, thin yellow tongue fur, stringlike [wiry] pulse.
I remember presenting Japanese moxibustion techniques for fertility, pregnancy and delivery at a conference years ago. The keynote presenter was a very well-known author and fertility specialist who was adamant that moxibustion was not suitable for treating infertility because of its reputed negative impacts on the body’s yīn; when asked to comment on this during my talk, I just sort of shrugged.
Moxa for heat patterns
Another example of moxibustion for yīn vacuity that I have found in the literature is its use in treating dispersion-thirst [xiāokě 消渴], which is typically characterized by symptoms of depleted lung, stomach or kidney yīn. Lin et al. (2024) provides a theoretical rationale for using moxibustion in these cases, one that is similar to what we’ve previously covered here: namely that “yáng rises and yīn grows” [陽生陰長], in other words, supplementing yáng to boost yīn. In terms of research observations, the article states that warm mild moxibustion can effectively intervene and regulate blood glucose in type 2 diabetes patients, promote insulin secretion, and can effectively slow down the progress of the disease. It also mentions that moxibustion can aid in regulating lipid metabolism and improving immune function, and has anti-infection, anti-tumor, and other effects.
Li & Fu (2023) discuss the work of Zhōu Méishēng [周楣声] (b. 1917), who has been a strong advocate of using moxibustion in heat patterns. Zhou writes that many of the earlier Chinese medicine texts, such as those of Gé Hóng [葛洪], Dòu Cái [窦材], and Wáng Tāo [王焘], and even passages from the Huángdì Nèijīng [Yellow Emperor’s Inner Classic] support the use of moxibustion for heat diseases. The prohibition of moxa for heat patterns, Zhōu felt, was due to a misunderstanding of some of the writings of Zhāng Zhòngjǐng [张仲景], which were later reinforced by the heat-clearing and yīn-supplementing doctrines of Liú Wánsù [刘完素] and Zhū Dānxī [朱丹溪] . In terms of biomedicine, moxibustion has anti-microbial, anti-inflammatory, and immune regulating effects. The article points out that Zhōu has used moxibustion in treating such acute febrile conditions as epidemic hemorrhagic fever and purulent cerebrospinal meningitis.
Conclusion
The research suggests that moxibustion is quite a bit more versatile than I had originally been taught. While I had learned techniques from Japanese teachers which were said to be heat-clearing, there remains a large dose of skepticism in the acupuncturist community, at least in the West. I can’t say I’m always completely comfortable with the idea of moxibustion on vacuity heat patients or yáng rising cases, but then again, as with needling, much of the issue in such cases is with judicious point selection [or lack thereof].
That’s all for now. Thanks for reading.
Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
中华人民共和国中医药行业标准. (1994). 中医病证诊断疗效标准[Chinese medicine disease pattern diagnosis and treatment efficacy standards]. Retrieved December 12, 2024 from https://www.scribd.com/document/630860308/%E4%B8%AD%E5%8C%BB%E7%97%85%E8%AF%81%E8%AF%8A%E6%96%AD%E7%96%97%E6%95%88%E6%A0%87%E5%87%86-pdf
Jiao, R., Bo, Y., Wang, X., & Zhang, Y. (2024). Study on Zuogui Wan combined with moxibustion in the treatment of renal yin deficiency type ovarian reserve function decline. Chinese Archives of Traditional Chinese Medicine.
Li, S., & Fu, Z. (2023). Discovering hidden information and hooking deeply into the future - Mr. Zhou Meisheng “Moxibustion is effective for heat syndrome”. Clinical Journal of Traditional Chinese Medicine, 35(7), 1286-1289. DOI：10.16448/j.cjtcm.2023.0709
Lin, L. , Guo, Z. , Fang, P. , & Chen, M. (2024). Exploration of moxibustion therapy for type 2 diabetes mellitus based on the theory of yin disease should be treated with moxibustion. China Journal of Traditional Chinese Medicine and Pharmacy, 39(11), 6199-6202.