How to Handle the Dry-Heat and Persistent High Fever Caused by Excessive Moxibustion in Cancer Patients
Each year I see roughly over a hundred cancer patients who have developed dry heat or persistent high fever from excessive moxibustion; they come to me seeking solutions to this side effect.
The first thing to understand is that cancer patients with heat patterns are contraindicated to moxibustion. No patient with a rolling, rapid, forceful pulse or a thin, rapid pulse should undergo moxibustion. Moxibustion in such patients not only causes the side effect of dry heat but also promotes tumor recurrence and growth.
Some promoters of moxibustion always emphasize that moxibustion has only benefits and no harms. This view is wrong.
Incidentally, even patients with cold patterns and a slow, moderate pulse face risks from long-term, unrestrained moxibustion, because a person's constitution changes during treatment. After a period of moxibustion, a constitutionally cold patient is no longer cold. Continuing vigorous moxibustion at that point produces the opposite effect—going too far.
Next, keep in mind that moxibustion sessions must not be too long, and moxa cones are not better the thicker they are. Some patients apply thick, long moxa cones to themselves for a long time every day without any protective measures, and easily suffer lasting harm from over-moxibustion.
The third point I want patients to remember is that during moxibustion, one should take protective measures. In the past, when performing purulent moxibustion, people generally used Lüdou Gancao Tang (Mung Bean and Licorice Decoction, also called Huguo Tang, Heart-Protecting Decoction) to protect the patient from moxa-fire injury.
Purulent moxibustion is a form of potent heat therapy. While it acts on the local lesion, it can damage other organs. In particular, in TCM zang-fu theory the "heart" belongs to fire, so moxibustion easily gives rise to upward blazing of heart fire.
Once heart fire blazes upward, the patient becomes hot and restless, and may thereafter develop persistent high fever, heat sensation in the five centers (soles, palms, and chest), steaming bone disorder, and wasting-thirst.
So heat-pattern patients should not lightly try moxibustion; cold-pattern patients, after moxibustion reaches a certain point, should stop or reduce the frequency and intensity, otherwise they will suffer irreparable losses from moxibustion.
The year before last I saw a teacher at a Guangzhou university. After developing leiomyosarcoma, she attended a moxibustion teacher's lecture, became devoted to his theories, and under his guidance did moxibustion for a year. Afterward her body temperature remained around 40°C long-term; repeated Chinese and Western treatments failed.
Her family were almost all doctors, both TCM and Western, and her father was a famous senior TCM physician locally, yet none could help. Later I treated her with Qingying Tang (Heat-Clearing Ying Level Decoction), a famous formula from the warm-disease school, and her temperature returned to normal. But as soon as Qingying Tang was stopped, the high fever returned.
Recently I saw another ovarian tumor patient who, after being advised by someone, long used moxibustion for health preservation and developed low fever and heat in the five centers. After consulting me, I had her take Lüdou Gancao Tang (mung bean 50–100g, licorice 6–10g, decocted and drunk as tea), which finally resolved the heat in the five centers.
Later, because her symptoms had eased, she came to see me. Based on pulse diagnosis, I prescribed Zhibai Dihuang Wan (Anemarrhena, Phellodendron, and Rehmannia Pills) and Qinghao Biejia Tang (Artemisia and Turtle Shell Decoction), with modifications.
A few days ago, another patient who had used purulent moxibustion on himself and developed persistent high fever consulted me. Without a face-to-face visit I dared not prescribe casually, so I only suggested the relatively safe Lüdou Gancao Tang, but the patient was skeptical and gave up.
The reason patients easily develop dry heat and even persistent high fever after over-moxibustion is mainly that vigorous moxibustion causes deficiency of the ying-blood, with exhaustion of fluids and exuberant fire-toxin—similar to heatstroke. So treatment should mainly clear heat and cool the blood.
For years I have treated this with several formulas from the warm-disease school for summerheat warmth, combined with herbs that nourish yin and blood.
The following are formulas commonly used to treat such conditions.
Qingying Tang (Clear the Ying Level Decoction)
Shuiniujiao (Buffalo Horn) 30g, Shengdihuang (raw Rehmannia) 15g, Xuanshen (Scrophularia) 9g, Zhuyexin (Lophatherum Heart) 3g, Maidong (Ophiopogon) 9g, Danshen (Salvia) 6g, Huanglian (Coptis) 5g, Jinyinhua (Lonicera) 9g, Lianqiao (Forsythia) 6g.
Qingying Tang is a famous formula from Wenbing Tiaobian (Systematic Identification of Warm Diseases) for treating summerheat warmth and summerheat epilepsy; it originally treated heatstroke. The symptoms of over-moxibustion closely resemble those of heatstroke, so Qingying Tang is effective.
If the patient has persistent fever, restless sleep at night, vexing thirst and insomnia, a red tongue with yellow coating, dry mouth, agitation, and a rapid, forceful pulse, Qingying Tang may be considered. This formula treats heat entering the ying-blood level.
Of course, if the patient has not moxibusted long and only has mild dry mouth, dry cough, and low fever, Qingying Tang should not be used; in that case, consider Jiawei Sangju Yin (Modified Mulberry and Chrysanthemum Decoction).
Jiawei Sangju Yin (Modified Mulberry and Chrysanthemum Decoction)
Xingren (Apricot Kernel) 6g, Lianqiao (Forsythia) 5g, Bohe (Mentha) 2g, Sangye (Morus Leaf) 8g, Juhua (Chrysanthemum) 3g, Jiegeng (Platycodon) 6g, Sheng Gancao (raw Licorice) 2–3g, Lugen (Phragmites Root) 6–30g, Maogen (Imperata Root) 6–30g.
Sangju Yin is an acrid-cooling light formula, mainly treating Taiyuan wind-warmth; it is used when the patient has a dry cough without sputum and no fever or only low fever.
Long-term moxibustion excessively consumes fluids, injuring not only the Taiyin lung channel but also the Shaoyin kidney channel, leading to insufficient kidney water. The patient not only has persistent high fever but also incessant night sweats; this is a severe yin-injury pattern. On one side use Qinghao Biejia Tang to reduce fever, and on the other use Liuwei Dihuang Wan or Zhibai Dihuang Wan to nourish yin and down fire. Only in this way can the patient be relieved from the torment of raging fire.
Qinghao Biejia Tang (Artemisia and Turtle Shell Decoction)
Qinghao (Artemisia) 6g, added later, Zhibiejia (honey-fried Turtle Shell) 15g, Shengdi (raw Rehmannia) 12g, Zhimu (Anemarrhena) 6g, Mudanpi (Moutan Bark) 9g.
Liuwei Dihuang Wan and Zhibai Dihuang Wan are commonly used patent medicines available in ordinary pharmacies. Such OTC products are easy to buy online even if unavailable at offline pharmacies.
Some patients, after over-moxibustion, not only have dry heat but also constipation and dry stool; this is because over-moxibustion consumes body fluids, causing intestinal dryness and blood dryness, so treatment should mainly nourish blood and moisten the intestines. I commonly use Jiawei Zengye Tang (Modified Fluid-Increasing Decoction).
Jiawei Zengye Tang (Modified Fluid-Increasing Decoction)
Xuanshen (Scrophularia) 30g, Shengdi (raw Rehmannia) 24g, Maidong (Ophiopogon) 24g, Huomaren (Cannabis Seed) 10–30g, Yuliren (Biotite Seed) 10–30g.
These are of course only the main ones. Every person's constitution differs, and the side effects of over-moxibustion differ too; for example, some patients may also have tinnitus, a bitter taste, or persistent nosebleeds, which require an in-person consultation. Only after fully understanding the patient's overall condition can a doctor prescribe symptomatically; one must not apply formulas mechanically.
Finally, I emphasize again: moxibustion is a very good health-preserving method, but patients must consult their treating physician before deciding whether to use moxibustion to relieve their condition, and promptly discuss any side effects with their doctor. Do not follow the crowd and moxibustion casually, and never over-moxibustion.
Patients whose over-moxibustion can be reversed are the lucky ones; not every side effect of excessive moxibustion can be handled by a doctor.
Patients often ask me whether their condition is suitable for moxibustion. Actually, this question cannot be answered in the abstract. Only after an in-person visit, knowing the patient's pulse and constitution, can one know whether moxibustion is suitable, how to moxibustion, and for how long.
China currently sees around 100,000–200,000 deaths annually from improper medication or moxibustion—a truly frightening number. So patients, when moxibusting, must look up information, consult doctors, closely observe changes in their bodies, and seek medical attention promptly.