The Primary Moxibustion Points

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The Main Points Moxibustion
There are some points made repeatedly in the literature on moxibustion, the experience accumulated with the help of these points suggests that they may be particularly effective. Outside zusanli (ST-36), which is also the most frequently mentioned of all points for needling, moxibustion points are located on the governance and design of 

Expelling wind, clearing heat and disperse the lung to relieve the outside (for acute febrile diseases);

ships. On ship design, points 4, 6, 8, 12 and 17 are mainly used. On the boat which, in paragraphs 4, 14 and 20 are mainly used. A major moxa is dazhui (GV-14), which is the meeting point of the vessel with the six yang channels of the hand and foot. An article examining the many uses of moxibustion at this point (31) the following examples of applications of moxa on this point:
Disperse the lungs, which eliminates the cold, and activating yang to relieve asthma;
Restore consciousness, calming the mind and calming internal wind to relieve epilepsy;
Remove the obstruction in the channel to relieve the spasms and dispersion yang to eliminate pathogenic factors (for spondylopathy cervical and other disorders of the spine);
Warming chains, catering yang, qi and consolidate the renewal of the resistance (protection against recurring colds and influenza).
Dazhui has also been described as the acupoints separately to treat herpes zoster by moxibustion (23). Given the use of points, students leting Wang noted that the items he used for moxibustion are relatively few. Ship design, in particular paragraphs 4, 6, 8 and 12, and the ship GV-4 and 20 (he also used the back shu points fenshu, BL-13, and shenshu, BL-23). Harmonization of treatment for the yin and yang is the Guanyuan moxibustion (CV-4) and dazhui (GV-14). Robert Johns, in his book The Art of Acupuncture Techniques (32) mentions that the old formula is well suited to help cancer patients recover from the adverse effects of modern cancer therapies. Moxibustion therapies to help patients with leukopenia noted in the Chinese dazhui with zusanli, usually with one or two other points. Another point often raised is Yongquan (KI-1), a point raised for the treatment of collapse of yang, the moxibustion which seems appropriate. It could also be used, the slow heating to help tonify yin.

Possible mechanisms of action of Moxibustion
A theory of the effects of acupuncture and moxibustion is that tissue damage (torsion fiber tissue at the stimulation of acupuncture needles, extended cellular damage by the intense heat of moxibustion) is launching a non-specific reaction healing that can affect the whole body. This healing response is stimulated by production of immunological mediators and neurotransmitters. Modern techniques of acupuncture and moxibustion therapy used in the West are in May, instead, at least one stimulation which does not produce significant tissue damage (eg, using fine needles manipulated the least possible, using moxa gently warm the skin). However, we must also recognize that some modern May do little more than cause relaxation, but some of the effects that other Chinese doctors have long depended on.

The impact of the local heat stimulation has been studied in the laboratory to follow up the suggestion that the production of inflammation mediators, primarily histamine, instead of burning the skin has been important to the impact of moxibustion therapy (24). After burning a moxa cone, the authors found that:

The maximum temperature of the place was treated at 130 to the skin, and about 56 within the skin. Therefore, moxibustion are naturally regarded as treatment of heat stimulation with the inflammatory response. In general, the inflammatory response induced vascular changes. Our results moxibustion as vasoconstriction induced by heat stimulation on the website under the moxibustion around the vasodilation and moxibustion place. The cause of cutaneous vasodilation and a histamine substance. Our results indicate that moxibustion induced increased capillary permeability mediated by histamine, in addition, the improvement of permeability can be correlated with the degree of degranulation of mast cells [release of mediators of inflammation by the cells] , on the weight of moxa cone used.

The authors concluded from this study and others (25) a mechanism capable of moxa was the strengthening of the mechanism of host defense in response to local inflammation. They described the response to the localized heat cone moxibustion as significantly different from that of a widespread burning, which may impair immunity. Other researchers have also indicated that moxibustion carefully controlled in the laboratory, produced immunological responses, including increased numbers of lymphocytes, and could help restore immune functions affected by radiation (26). Moxibustion has been suggested that the potential use in the treatment of cancer because of improved immune activity mediated by red blood cells (30). In a study of laboratory animals moxibustion at point equivalent to dazhui (GV-14) in mice, it was argued that the growth of established tumors can be inhibited by enhancing cellular immune functions, probably by improvement of production of cytokines favorable (eg, IL -2) and the resulting increased activity of natural killer cells (42). While moxa therapy seems to enhance immune responsiveness, it is not necessarily exacerbate autoimmunity. For example, moxa treatment reduces delayed-type hypersensitivity reaction in mice; May perform this action by enhancing the function of suppressor T cells (37).

Substance P is a neurotransmitter, one of many believed to be induced by acupuncture and moxibustion stimulation, for example, is another neurotransmitter GALANIN observed to be synthesized in response to moxibustion (38). These neurotransmitters are considered important in the regulation of pain, spasms and neurological disorders such as depression and anxiety, but they are also invoked in response to exercise in May and be part of the explanation of benefits for health due to higher levels of physical activity (40).

In a laboratory study on rabbits, the equivalent to zusanli (ST-36) was treated with moxibustion, and it was shown that smooth muscle spontaneous bowel movements decreased (39), suggesting a role of neurotransmitters. The antispasmodic effect is consistent with what is seen during the clinical treatment of stomach and intestinal spasms with relief of diarrhea. Neurotransmitters evoked by acupuncture (especially electro-acupuncture) and moxibustion in May in conjunction with the modulation of immune responses and contribute to a broad systemic change.

Moxibustion and the immune system of humans according to the clinical
One of the most frequently mentioned survey moxibustion in modern Chinese literature clinic is stimulating the immune system. It is not known yet whether moxibustion is different in its effects of acupuncture in this field. In the elderly, both warm and acupuncture needle acupuncture (with needles for moxa applied for 20 minutes, using daily treatment for 10 days) applied to zusanli (ST-36) improve the production IL-2 (45). In an article summarizing the research to examine the immunological effects of acupuncture and moxibustion (18), no distinction is made in respect of both techniques, only the points and the results have been noted for each method interchangeably.

The author of the review paper concluded that the effect of technology on the immune system could be a secondary consequence of their effects on the entire body, rather than a specific action. This interpretation is not necessarily inconsistent with the results of animal studies on the mechanism of moxibustion: the technique could have an initial effect on the immune system that produces, via the action of various mediators, a systemic effect that goes beyond the initial immune response, possibly resulting in greater immunological improvement. In the report on moxibustion treatment of coronary artery disease, some immune parameters of patients were measured (including the conversion rates of the lymphocytes and the levels of immunoglobulins), showing a better immunological response. The authors concluded that moxibustion treat coronary heart disease through the regulation of the internal environment of the organization and strengthen its capacity to fight against the disease. This interpretation of results is consistent with the idea that the production techniques nonspecific improvement of the whole body that manifests itself in a better immune function and improved functions of all internal organs.

In the system of traditional Chinese medicine, spleen deficiency (a subcategory of qi deficiency) syndrome is often associated with weakened immune functions. Assessment of immunological effects of moxibustion in the failure rate of patients was conducted (19, 20) with the advantages claimed in immune function tests that accompany the alleviation of symptoms. A clinical report on the treatment of chronic diarrhea associated with ulcerative colitis and chronic colitis with simple moxibustion on immunological mechanisms (29). Herb-moxibustion interposed was used with two sets of alternating points every day: zhongwan (CV-12), qihai (CV-6), and zusanli (ST-36) represent a whole; dachangshu (BL-25), tianshu (ST -25), and shangjuxu (ST-37) made the second set. The number of moxa cones used varies according to site and syndrome, but ranged from 2 to 7 cones. Daily treatment was for 12 days, followed by an interval of 3 days, then another 12-day training for a total of 60 treatments. It was alleged that with the resolution of the diarrhea, it has been a reduction in excess of IgM and complement were present at the start of treatment for people suffering from ulcerative colitis and an improvement in the subgroup of T cell suppressor cells that inhibit the reactions self -.

An improvement in an auto-immune disorder based has also been noted for Hoshimoto of thyroditis (28). Immune parameters were normal at baseline has not changed. In a summary of laboratory studies and clinical effects of immunological moxibustion, it was reported that moxibustion can reduce the level of rheumatoid factor (considered as a measure of self aspect of the disease) in rheumatoid arthritis and improve the symptoms of allergic rhinitis (41).

These results suggest that the immune system and organs and changes in May to help strengthen each other, and that the immune functions are regulated by strengthening the weak part of the immune system rather than simply stimulate the immune system in general.

Against Moxibustion
The main indication against-moxibustion has always been the presence of a heat syndrome. This is consistent with the idea that the moxa heat introduced into the system and effectively, and thus the method of treatment does not meet the criteria of balance with a hot cooling therapy. Theoretically, it can cause the disease to worsen increasingly by the imbalance. There are some who have argued against this, as noted above. In the same way, there are cases where herbalists have argued against the idea that, in febrile diseases should always avoid heat herbs and rely only on cooling herbs. However, against this indication-moxibustion is still listed in all the standard texts. In particular, moxa is considered quite inappropriate for a syndrome of deficiency heat (one based on the yin deficiency), and must be used with caution in cases where it is dry. In a report on the indications of acupuncture and moxibustion (43), the authors noted that we have seen in our practice that most patients with herpes zoster responded to the Round needling and moxibustion卆ien ago were some obvious cases due to local drought, where the skin wounds of patients have increased more than the pain of moxibustion was applied. They suggested that since the area is a syndrome of heat that has responded well to treatment in most cases, do not automatically reduce the use of moxibustion heat syndromes, especially those with localized heat, as is the case with an outbreak of shingles.

Other contraindications against moxibustion involve sensitive areas of the body, such as the face (especially when we avoid the scars of therapy, but also avoids directly get smoke in your eyes or nose), nipples and genitals. Ancient texts to clarify certain points on the head as against-moxibustion (27), such as shangxing (GV-23), Chengqi (ST-1), Sibai (ST-2), touwei (ST-8), jingming ( BL -1), zanshu (BL-2), sizhukong (TB-23), heliao (LI-19), and yingxiang (LI-20). Concerns are raised about the use of moxa during pregnancy for the region of the abdomen and lower back (14, 27).

Techniques Moxibustion
As reported in the Journal of Traditional Medicine review article on acupuncture and moxibustion in China (4), there are about 50 techniques that were developed. Many of these changes are minor: the various substances used in interposed moxibustion (mainly slice fresh ginger, garlic slice, aconite cake, salt), the various methods for applying heat to a wide area (moxa rolls, the containers with large quantities of moxa), different sizes of cones, the application of moxa to the end of an acupuncture needle, and using materials other than burning artemisia (as reeds) or cause blistering hot and feeling without using the fire (for example, mustard seeds or mylabris an insect irritant properties). For purposes of this article, the techniques most likely to be used in the modern clinic, will be described, taken mainly by the recent collection of acupuncture and moxibustion (14), prepared by the Beijing University of Traditional Chinese Medicine .

1. No Scar Moxibustion with Moxa Cones
A cone of moxa is placed on a point and ignited. When about 2 / 3 of it is burned or the patient feels a burning discomfort, remove the cone and place in another. Three to seventeen cones are regularly burned in flush because the local site, but no plaque must be formed. This method is widely used, often cold and insufficient disorders such as asthma, chronic diarrhea, and indigestion.

2. Indirect moxibustion (Moxibustion interposed)
The ignited moxa cone does not touch the skin directly, but is isolated from the skin by a layer of ginseng, salt, garlic, or aconite cake. Depending on the technique used, such moxa May cause blisters, but it is often used for non-scarring moxibustion.

Ginger: Cut a slice of ginger about 2-3 cm wide and 0.2-0.3 cm thick, many holes in the punch and place it on the selected point. In addition, a cone of moxa is placed and ignited. When the patient feels burning, remove and trigger another. Repeat this until all the cones and burn the skin becomes red. This method has the effect of warming the spleen and stomach and dispersion of the cold. It is indicated for symptoms caused by weakness and cold of the spleen and stomach, such as abdominal pain, diarrhea, joint pain and other symptoms due to yang deficiency.

Garlic: Cut a slice of garlic 0.2-0.3 cm thick (one clove of garlic is recommended), drill holes in it, put it on the point with the ignited moxa cone on the top . Renewing the cone when the patient feels burning. This method has the effect of swelling and relieve pain, and is often used for the early stage of the ulcer of the skin with boils or scrofula.

Salt: This method is generally applied to the navel. Fill in the umbilicus with salt on the skin, a moxa cone on the top of the salt and then ignites it. When it burns, renew another until all the cones were burnt. Since this method has the action of the restoration of the collapse of yang and warming the spleen and stomach, it is effective for symptoms of sweating, cold limbs, and undetectable pulse resulting from vomiting and diarrhea acute flaccid or type of wind-and post-partum stroke fainting.

Aconitum cake: drilling holes in a cake aconite powder mixed with alcohol, 3 cm in diameter and about 0.3 cm thick. Place on the site of moxibustion with moxa cone, which is ignited and burned over it. This method is effective for heating and strengthening kidney yang and, therefore, is adopted to treat impotence, infertility, and resistant to rupture of an abscess healing.

3. Moxibustion with Moxa Stick
Light-hot moxa: Ignite moxa stick and place it off 2-3 cm above the site to make a slight warmth to the place, but does not burn, for about 15 minutes until skin is slightly red. It is suitable for all syndromes indicated for moxibustion.

Sparrow pecking moxibustion: In this method, the ignited moxa stick is moved up and down about to peck like a bird, or move left and right, or circular. It is indicated for numbness and pain in the limbs.

4. Warming Needle Moxibustion
Moxibustion with warming needle is an integration of acupuncture and moxibustion, and is used for conditions in which the maintenance of the needle and moxibustion are needed. It is applied as follows: after the arrival of qi and kept the needle in the point, have a small section of a moxa stick (about 2 cm long) and put on the handle of the needle; ignite the moxa stick his bottom and let burn. This method is designed to warm the meridians and promote the circulation of qi and blood to deal with bi-syndrome caused by cold, damp and paralysis. Applying cold wet syndrome has been a clinical evaluation of patients with rheumatoid arthritis (46). Acupuncture was carried out by the deep needling shu (stream) points, and was applied to moxa needles of 30 minutes, performed every day (with short breaks) for two-month course of therapy. The first technique described in the classics is different and has been called the fire needle. He is holding the needle in a very hot fire until the flame, and then inserted at the appropriate depth in the body quickly and remove it (34). Warming needle, as now used, allows more storage and heating gently.

Tonification and drainage strategies
Just as there are techniques associated with needling tonification (reinforcement) and drainage (reduction), moxibustion can be applied to these two different approaches. The basis for the different methods is the intensity and duration of heating during the moxa treatment. The distinction was described by the followers of Wang leting and relayed here with slight editing:

On the question of supplementation and drainage moxibustion, they are generally administered in the clinic based on the theory of Lingshu chapter on transport back points: "To be completed by a fire, do not blow on the fire, but let burn. To drain by fire, quickly jump onto the fire and let burn spontaneously. "The first method is to leave a cone of slow-burning, burning in itself: although the heat is low, it is persistent and important. This is accelerated by blowing on it. Although the thermal energy is violent, it is temporary and short. If the technical supplement is intended to be used, do not jump on the cone of moxa after operation there. It is sufficient to allow it to burn out and burn himself. Then, press as to concentrate the qi and warming persistent. If drainage technique should be used to blow on the substance moxa to increase its burn speed, then let it burn or remove it at too hot, do not insist on this point, but I pathogenic qi scattered outside.

When using moxa rolls or other techniques, the basic approach toning or drainage may still be applied. Tonification uses regular and prolonged heating, while the drainage to a more rapid and more intense but shorter heating point (birds pecking moxa is often used, with the end of the moxa roll fairly close to the skin with repeated lines for more intense heating of the skin).

A description of the reduction techniques to strengthen and moxibustion has been included in a broader report on these techniques needling (35). Commentators have noted:

In ancient times, and the strengthening of reduction techniques have been attributed to moxibustion, while in modern textbooks, they are rarely mentioned. We treated a patient suffering from impotence due to kidney insufficiency with the help of moxibustion enhance handling, the patient was cured after 5 treatment sessions. In herpes zoster, moxa cones were ignited and the fire blown to raise the temperature and thus produce a multiplier effect. We have treated dozens of patients in this way with an attenuation of 95% immediately after the first session. All patients were cured after 2 to 3 sessions of treatment. In a case of cold syndrome of chronic insufficiency type, mild moxibustion (moxa roll is a place about 3.5 cm above the skin to produce a sensation of heat until the skin is a little flushed) and renewable moxibustion (circles lit the end of a moxa roll around the acupuncture point until the skin is flushed) are most often used. In case of serious problems of excess heat type, direct moxibustion and birds pecking moxibustion are most often used? When mild moxibustion is applied to stimulate Baihua (GV-20), life-giving action of prostration and stopping the yang is produced, to heal the organ prolapse. When the garlic paste or birds pecking moxibustion moxibustion is applied to stimulate Yongquan (KI-1), an obvious effect of feeding yin pathogenic fire to purge results, providing a treatment for hemoptysis and epistaxis (ie say, bleeding due to heat).

Smokeless Moxa
Although not widely used in China, an increasingly popular in the West is the use of smokeless moxa. The following is the description for use in the modern clinic.

Smokeless moxa is a rod of charcoal impregnated with moxa. It burns hot, but slowly, at an average rate of 2.7 cm per hour, the stems are about 4.5 cm long, so that the total burning time is approximately 90 minutes before the stem is too short to use. The moxa is not an easy read, it is common to use a flashlight rather than a lighter. Once lit, it burns forever.
? BR> The cluster smokeless moxa ash produced at the end of engraving that tends to stick to the rod. In trying to remove the ash content of smokeless moxa, the stick must not be used against something (eg against an ashtray). Tapping, apart from making unwanted noise, can break the charcoal, creating a risk for a piece of falling and burning the carpet, treatment table, or the patient. However, the end of the burning moxa stick should be slightly rubbed against the top edge and inside a fire extinguisher moxa, which will be a quiet operation that removes the ash and not break the moxa rod.

The moxa extinguisher can be carried in an ashtray, so that the ash is contained. At the end of the session moxa, moxa stick May be carefully preserved, while burning to use with another patient (if it is intended to be used in a few minutes) or off. It is important to check from time to time that all stems are moxa in their place so that none remains burning where they can cause damage.

Moxa can be performed using a single pole to provide heat to a specific point, or both poles held side by side to heat a larger area. Moxa May be applied to acupuncture needles, but be careful not to keep the bed near the end of plastic holders, which can cause melting or evaporation of the plastic (or rely on the handle metal needles). If a brief moxa treatment can be fun for patients, all Chinese texts refer to prolonged heating, usually by repeated application of heat to the same site over a period of several minutes. Be careful not to lose the most potential benefits through the application of moxa for a very short period, or by trying to implement moxa too many sites, so that each site is discussed briefly.

Moxa Pads, heat lamps
Contrary to the intensity of direct heating of points for the treatment of diseases, heat therapy May also be used to relax muscles and relieve pain in a slight sweetness and pain. Self-heating moxa pads for this purpose have been available from Korea for over 20 years. This technology is to have a bag of sagebrush and charcoal with an oxygen sensitive (iron, which reacts strongly with oxygen), so that when the sealed package containing the bag is opened and the bag material is shaken vigorously for a while, it heats up. Within five minutes, the pack is heated and it maintains a temperature of 60-75 (140-165) for hours. This is the same technology used for the new pharmacy popular products such as Thermacare, which are self-heating pads applied to the body (but without artemisia).

Typical applications of the buffer include moxa treatment of injuries, back pain, knee pain, and menstrual pain. In addition, these plates are used to the chills and discomfort as a result of excessive exposure to air conditioning, cold outside in winter, wet or windy. A belt to hold the pad on the abdomen is also available. Buffers can be used following treatment with acupuncture and moxibustion to prolong the effects of initial therapy or as an alternative to these treatments when professional help is not practical. Moxa buffer should not be applied to the skin is broken or areas of inflammation display red or develop a greater embarrassment to the application of heat.

Another method of applying heat is the infra-red heat lamp, a useful variation on this was developed in China, called the TDP-fire. Elle a été inventée en 1980 par un groupe de scientifiques et de médecins dirigée par le Dr Gou Wenbin à l'Institut de médecine chinoise de Chongqing. Contrairement aux dispositifs à infrarouge thérapeutique, l'appareil dispose d'un TDP plaque revêtue d'un minéral formation (une faible conductivité du métal avec divers composition). Lorsqu'elle est chauffée par un élément de chauffage électrique, la plaque émet des ondes de minéraux dans l'infrarouge. Il produit un chauffage uniforme qui le rend plus utile que le verre ordinaire ampoule feux. Pour augmenter le chauffage d'une région par la lampe, une huile médicamenteux peut être frotté sur la peau, l'huile permet de conserver la chaleur à base de plantes et de ses mandants mai contribuer à l'amélioration de la circulation sanguine locale. Bien que les fabricants de la lampe TDP faire des allégations sur la valeur particulière de la fréquence des émissions infrarouge, il n'ya aucune preuve qu'il exerce une fonction unique sur cette base.

Interprétation
Le rapport présenté ici mai le praticien offre un aperçu des aspects pratiques de moxa applications. Il existe un certain nombre de questions sans réponses à propos de moxa, et cette section contient certaines des conclusions de l'auteur découlant de cette revue de la littérature.

Une certaine partie de la théorie de l'application de la moxibustion est tout simplement basé sur la médecine chinoise traditionnelle du dogme et de mai de ne pas avoir d'importantes implications pour la pratique. Par exemple, le rôle de la laine de moxa semble être principalement à l'introduction de la chaleur plutôt que pour les effets pharmacologiques de la promotion de l'ambroisie circulation, le réchauffement des méridiens, et ainsi de suite. De même, les applications spéciales pour moxa dépeint avec interposition herbe matériaux (le gingembre, l'aconit, l'ail, des herbes ou des formulations complexes) semblent être basés sur les rôles traditionnels des plantes lors de la prise en interne, mais ces actions ne sont probablement pas conférés par cette méthode et serait certainement mieux en fournissant ces herbes oralement. L'interposition de substances servent essentiellement comme support approprié pour fournir commodément moxibustion, sans contact direct avec la peau. Salt moxa interposition fonctionne bien pour le traitement de l'ombilic en raison de sa forme; moxa directe ne serait pas approprié pour ce point sensible, en particulier chez les enfants qui sont susceptibles de recevoir ce traitement.

Il ya eu une forte dépendance à l'égard des cicatrices moxibustion dans la tradition chinoise. Cette méthode est indiqué en premier dans la plupart des textes modernes qui décrivent moxa, et figure en bonne place dans l'examen article sur moxa dans les applications cliniques. Il ya une théorie de l'acupuncture dans laquelle la principale fonction est d'induire des lésions tissulaires au acupoints. Le twirling, levage, et d'estoc est indiqué pour saisir les fibres et tirez dans le sous-niveau, ce qui oblige l'organisme à réagir. Un autre aspect est la stimulation des nerfs entraînant des effets dans le cerveau ainsi que les effets de la production locale de neurotransmetteurs tels stimulation est particulièrement relevé avec la deqi réaction, y compris le remorquage des tissus à l'aiguille et la sensation de distension, des engourdissements et des picotements rayonnant . Les cicatrices moxa aussi des dommages aux tissus et produit une forte stimulation du nerf. Ces graves mai traitement ne soit pas essentiel, mais des spécialistes chinois de souligner à maintes reprises les avantages d'une forte incitation à les points et les études en laboratoire suggèrent que la réponse inflammatoire à des dommages causés par la moxibustion est important. À tout le moins, la peau doit être suffisamment rougies qu'il ya une réponse à la guérison des dommages limités. Certains de la dépendance à l'égard des cicatrices moxibustion mai être basées dans l'archaïsme des idées qui ne seront plus largement acceptées. Dans le traitement des maladies externes de l'acupuncture et la moxibustion (15), il est souligné que, parfois, les lésions induites par moxa direct n'est pas autorisé à guérir:

Les mille pièces d'or a déclaré: «Les gens qui visite Wu Shu et devrait moxa certains points régulièrement et de laisser les plaies non cicatrisées pendant un certain temps. Cela empêchera les effets toxiques de qi miasme, la lèpre, le paludisme et chaleureux loin d'eux. " La Grande Compendium aussi dit: "Si on veut être sûr et sain, il ne faut pas zusanli (ST-36) humides» [qui est, de l'écoulement d'une plaie moxibustion]? L'ampoule et sa plaie est appelée fleur moxibustion . Dans l'ancien temps et encore par certains praticiens, la production d'un tel moxa fleur a été considéré comme crucial pour la réussite du traitement. Le Taiping Shenghui Fang (992 AD) a dit: «Supposons un nombre suffisant de cônes sont brûlés. Seulement quand un mal de développement et pleure mai pus être guéris de la maladie. Si pas mal de production ou de ne pus engendrée, la maladie ne sera pas relevé. " Dans les temps modernes, certains praticiens chinois continuera à cette pratique, et de leur expérience clinique confirme que les produits intentionnellement moxa plaies ont quelque chose à voir avec l'effet curatif. En dépit de l'efficacité, seul un petit nombre de patients sont assez inébranlable de recevoir ce traitement à cause de la douleur qu'elle inflige.

Clearly, the thinking about moxibustion by most modern clinicians is moving away from the concept that scarring (with or without maintaining the drainage) must be used. The claims for superior effectiveness of scarring moxibustion have to be questioned since there are no studies comparing scarring versus non-scarring moxibustion. These claims are only impressions of the practitioners who obviously believe enough in the therapy to put the patients through the ordeal. On the other hand, it might be reasonable to assume that intense heating of the skin by direct moxibustion is likely to produce more of a response than mild heating as sometimes administered with use of moxa rolls held at a distance from the skin.

When non-scarring moxibustion is used, the duration of treatment in reported clinical trials is usually long and probably much longer than administered by most Western practitioners. Numerous moxa cones and moxa sticks are applied typically for 15 minutes or more in total, with 5-15 minutes per point (longer for warm needle technique). Thus, the treatment is still strong in nature even if there is no blister formed.

Practitioners in the West might consider the following:

If one wishes to avoid the smoke of regular moxibustion, it seems acceptable to use other methods of heating, so long as they can provide similar levels of heat and as long as one can maintain adequate control over the heating (e.g., to prevent burning and also to prevent the heating from becoming too light). As such, smokeless moxa may be satisfactory. In fact, moxibustion may be replaced by acupuncture in most applications, providing that the acupuncture stimulus is sufficiently strong to generate an immunological and neurological response.
When using herb-slice or cake interposed moxibustion, do not forget to punch holes in the material; this allows the heat to penetrate. The thickness of the slice should be just 0.2-0.3 cm; thicker slices may prevent adequate heating. For practical purposes, ginger slices may be most convenient and it is not evident that one must choose the interposing substance based on its pharmacological properties in relation to the condition to be treated.
For moxibustion to be effective, it needs to cause significant local heating and inflammatory response and should be done for a prolonged period, not just a minute or two. Therefore, specific points for moxa heating should be chosen and treated effectively, rather than trying to warm numerous points with only a little stimulus. Warming a broader region is an acceptable treatment for relaxing tension and moderating pain at the site; this is a different application than trying to stimulate the immune system, alter internal organ functions, or otherwise rapidly heal a disease. For chronic ailments, Chinese physicians typically administer moxa daily for several treatments, up to 50-60 sessions. Moxa treatments might be alternated with acupuncture and patients may appreciate the variation in treatment methods.
The most frequently mentioned applications of moxa are gastro-intestinal disorders, asthma, organ prolapse, bi-syndromes, and herpes zoster. These are reasonable targets for modern clinicians to consider for this type of therapy, which may otherwise be too inconvenient as a method (at least, when done properly). In particular, herpes zoster is emphasized as a case where moxibustion is effective. For asthma, both acupuncture and cupping have also been claimed to be highly effective, and these might be more appropriate for those who are sensitive to inhaling smoke from moxibustion.
The risks of exposure to moxa smoke are probably similar to that for any other smoke, and total exposure time, particularly when it involves prolonged exposure, is the key concern. Occasional use of ordinary moxa would be associated with low risk, while routine exposure to moxa smoke during much of the day would be a moderate risk. Therefore, venting or filtering is an appropriate step when moxa is done regularly. There is no evidence that moxa smoke contains any unusually harmful substances. Standard commercial moxa materials do not contain realgar (an arsenic compound), though this substance has been rarely included in blends made by individual doctors in China for their own use.
There are certain points that are most frequently mentioned in the moxibustion literature which may be a good basis for consideration by modern practitioners. These points may be relatively convenient to treat from a physical perspective, may be well accepted by most patients, and may have a higher response rate than others. Most of the points are on the conception and governing vessels, plus zusanli and yongquan, and shu points on the back.
It is difficult to know, based on the literature review, whether moxibustion is more effective than acupuncture or other stimulus methods administered for the same condition. In the absence of more detailed studies, moxa is applied primarily on the basis of the Chinese traditional medical descriptions, such as treating syndromes associated with cold, retention of food, spasms, immune deficiency, and local stagnation of fluids with formation masses. Moxa may be utilized in some cases of heat syndromes.

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