Who Should Not Receive Moxibustion? How to Handle Excessive Moxibustion?

Moxibustion is an economical, easy-to-practice TCM therapy for health maintenance and treatment that can solve many problems. Especially for chronic disorders caused by deep cold, moxibustion may be one of the best treatments.

But not everyone is suited to it. For some patients, moxibustion not only fails to help but causes serious side effects. I have written on this before, but as I have met more and more patients with severe adverse effects from moxibustion, I feel another article is needed.

Any therapy has indications and contraindications; moxibustion is no exception. Physicians through the ages have described in detail the harm from erroneous or excessive moxibustion.

Zhang Zhongjing, honored as the Medical Sage of TCM, was the first to speak on this issue.

Zhang Zhongjing saw an enormous number of problems caused by mistreatment. He lived in an era of widespread plague, and fire therapy was one of the common treatments of the Han dynasty, so he witnessed the many problems fire therapy caused.

The two most common Han fire therapies were: first, fomentation—either wrapping heated tiles in cloth and ironing the patient's back, or placing the patient over a fire pit, both aimed at inducing sweating; second, moxibustion, of which many forms existed but moxa was the most common.

This heat, or fire, therapy was mainly for what TCM calls cold patterns. But doctors or patients often could not distinguish cold from heat and abused heat therapy, causing serious consequences. Such mishaps are recorded many times in the Shanghan Lun.

For example, at the very start of the Taiyang section, the text on "wind-warmth" reads: "If, after sweating, the body burns hot, it is called wind-warmth. In wind-warmth, both yin and yang pulses are floating, there is spontaneous sweating, heaviness of the body, much sleep, snoring nasal breathing, and difficulty speaking. If purged, urination becomes difficult, the eyes stare, and incontinence results. If treated with fire, the skin mildly yellows; in severe cases it resembles epilepsy, with intermittent convulsions. If smoked by fire, one reversal still allows the day to be drawn out; a second reversal hastens the end."

This "wind-warmth" disease absolutely must not be treated with moxibustion. Zhang Zhongjing specifically says at the end, "one reversal still draws out the days; a second reversal hastens the life-term," meaning that moxibustion in wind-warmth is life-threatening.

Judging by its symptoms, "wind-warmth" corresponds to severe pneumonia, encephalitis, and similar diseases. Such patients, given fire therapy, worsen rapidly and may die.

Later in the Shanghan Lun there are many more passages on the harm of fire therapy; I quote a few:

"On the second day of a Taiyang disease, the patient is agitated; if the back is ironed and heavy sweating results, great heat enters the stomach, the stomach fluids are exhausted, agitation and restlessness appear, and delirious speech will follow."

"Wind-stroke in a Taiyang disease: if fire is forced to induce sweating, the evil wind meets fire's heat, qi and blood flow wildly beyond their normal degree; the two yangs fumigate each other and the body yellows. Yang excess leads to nosebleed; yin deficiency makes urination difficult; when both yin and yang are exhausted, the body withers dry..."

"In cold damage with a floating pulse, if fire is used to force sweating, yang collapses and the patient will be frightened and manic, restless lying or sitting; Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuni Tang governs."

"The shape resembles cold damage, but the pulse is not wiry and tight but weak; the weak pulse means thirst. If treated with fire, delirious speech will result."

"In a Taiyang disease, if fire is used to smoke the patient and no sweating results, the person will be agitated; when the channel time passes without resolution, blood will be passed in the stool; this is called fire evil."

"The pulse is floating and heat is severe; if moxa is wrongly applied, this is an excess condition treated as deficiency. Moving with fire, the throat will dry and blood be spat."

"For a faint, rapid pulse, be cautious and do not moxa. When fire becomes the evil, it causes vexed rebellion, pursuing deficiency and chasing excess; blood scatters in the vessels. Though the fire qi is slight, its inward attack is forceful, scorching bone and sinew, and blood is hard to recover."

"A floating pulse should be resolved by sweating; if fire moxa is used, the evil has no exit and, growing stronger by fire, the body below the waist will be heavy and numb. This is called fire inverse."

These clauses alone repeatedly stress that moxibustion and fire therapy have contraindications: patients with floating, rapid, or faint pulses or internal heat must not be moxaed or fire-treated.

The consequences are severe. Zhang Zhongjing named the sequelae of erroneous fire or moxa treatment "fire inverse" (huoni). Fire-inverse patients often show bleeding, dry throat and mouth, difficult urination, incessant sweating, steaming bone fever, yellowing of the body, agitation, and delirious speech.

As an experienced physician with rich clinical observation, Zhang Zhongjing recorded in the Shanghan Lun many "bad diseases" caused by erroneous treatment. These records warn both patients and doctors: if the contraindications of various therapies are not respected, medical accidents easily occur.

Months ago, the owner of a moxibustion clinic somewhere moxaed a sarcoma patient. This owner was not well versed in TCM, having learned moxibustion only from popular books, videos, and articles. While moxaing, he also had the patient drink large amounts of ginger decoction, causing massive hemorrhage in this young patient, who finally dropped dead from the bleed.

Such is the consequence of improper moxibustion. I hope those who have learned only a little and go off to practice moxibustion will take this as a warning. The core of medicine is safety and efficacy; no one can bear responsibility for such an event.

I also hope that, when practicing moxibustion for health, everyone reads more—knowing both its indications and its contraindications. Do not, out of partiality for some theory, believe moxibustion cures all ills and blindly moxa yourself into serious harm. Moxibustion is best done under the guidance of a qualified TCM physician.

In the Shanghan Lun, Zhang Zhongjing actually describes moxibustion's contraindications in detail. In short: heat patterns contraindicate moxa. Those with floating, rapid, or faint pulses must be cautious.

So how is "fire inverse" caused by erroneous moxibustion or heat therapy treated? The Shanghan Lun gives the answer: Guizhi Gancao Longgu Muli Tang and Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang are the classic formulas Zhang Zhongjing recommends.

Guizhi Gancao Longgu Muli Tang treats "fire inverse followed by purgation, with restlessness from fire needle (today's fire needle)."

Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang treats "cold damage with floating pulse, where fire was forced to induce sweating, yang collapsed, and the patient becomes frightened, manic, and restless lying or sitting."

But a common situation today is that some enthusiasts practice moxibustion year-round rather than briefly. So what symptoms do they end up with? A typical one is persistent high fever, dry throat and mouth, and in some patients even elevated white blood cells.

These resemble the "heat entering the ying and blood" pattern later warm-disease physicians described. Once heat enters the ying and blood, the patient has oily sweating and steaming bone fever. Such patients do not respond to Guizhi Gancao Longgu Muli Tang or Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiuni Tang.

At this point it must be treated as a warm disease, following the principle "when heat reaches the qi level, clear it; when it enters the blood level, cool it."

The physician should choose the formula by the severity of the harm from moxibustion. Mild cases can be resolved with Sangju Yin (Mulberry Leaf and Chrysanthemum Drink) or Yinqiao San (Honeysuckle-Forsythia Powder); severe cases need Qingying Tang (Nutritive-Clearing Decoction), Xijiao Dihuang Tang (Rhinoceros-Horn and Rehmannia Decoction), or Qinggu San (Bone-Clearing Powder).