Tuesday, February 5, 2013

Cannnot Burn Moxa in Your Office??

Problems with burning moxibustion in modern Western practice
Zhen jiu is translated into English as acupuncture and moxibustion, which means that moxibustion is half of of our art. Unfortunately, many practitioners here is the West feel they cannot use burning Mugwort moxa in their practice. Either it is too smoky for clinics in modern, multi-tenant office buildings, or it is too time-consuming…or both! I've certainly worked in offices where I could not burn smoky moxa over the years of my practice. However, needles and moxa are not interchangeable. They do not do the same things, and sometimes moxibustion must be used to get the right response. For instance, the Nei Jing says that moxa is simply stronger than needles and should be used when needles are not strong enough to treat the disease (regardless of whether the condition is hot or cold). Because so many Western patients come with chronic, enduring "difficult to treat" conditions, moxibustion is not always merely optional.

More than one kind of "moxibustion"
Fortunately, translating the word jiu as moxibustion is not exactly correct (or at least not complete), and therein lies the solution to this problem. Moxibustion means the burning of mugusa, the Japanese word for Mugwort or Folium Artemisiae Arygii (Ai Ye). However, this is only one kind of jiu, specifically ai jiu. The word jiu is actually a much more generalized term meaning "heat therapy." Other types of jiu described in the Chinese medical literature include burning Medulla Junci Effusi (deng xin jiu), using hot wax, various types of electric heat (called dian jiu in Chinese), various types of herbal fumigation, and various types of chemical heat (called yao fu jiu or applied medicinal heat therapy). So when the Nei Jing says to use moxibustion for conditions acupuncture "needles don’t reach," it does not mean that you have to burn Mugwort in your office.

Applied medicinal moxibustion
For thousands of years, Chinese doctors have been applying various Chinese medicinals directly to the skin as a form of "moxibustion." This can be in the form of a powder, a paste, or a liquid. The medicinals used in applied medicinal moxibustion are typically acrid, warm or hot medicinals which warm the channels, move the qi, and quicken the blood. When applied to the skin, they cause local erythema through chemical irritation. Erythema indicates increased blood flow to the affected area and increased local temperature. If the chemical irritation is very strong, it could actually cause a second degree burn. This means that it can raise a blister similar to strong Mugwort moxa.

The benefits of applied medicinal moxibustion
There are a number of benefits to using "applied medicinal" moxibustion:

● It is not smoky and does not smell. Therefore, it can be used in modern office buildings with smoke detectors other tenants and landlords who know nothing about Chinese medicine.
● There is no danger of accidents to either your patients or your premises from burning moxa rolls, incense sticks, or matches.
● Either the applications can be left on for hours at a time or can be re-applied several times throughout the day, thus extending the duration of stimulation.
● Patients can treat themselves at home between regularly scheduled office visits.
● When applied along with a heat lamp, the warming effect to the patient can be quite comfortable and the treatment effect is strengthened.

Liquid "Moxa"
There are several companies that have created different versions of what is called liquid moxa. Each has different ingredients and practitioners should look at each one and decide which is most useful for the patient in front of them. I personally have three or four different types of liquid moxa in my treatment kit. Some are more like a general pain liniment, some are more warming than others, some quicken the blood and resolve stasis, and they vary in relative mildness or strength. All of them can be used wit a heat lamp. So experiment!

The Blue Poppy version of Liquid Moxa is excellent if you cannot or do not want to use burning mugwort moxa in your practice or with a particular patient. Based on ancient Chinese precedents, it is convenient and easy to use, does not smell up your clinic, and does not set off smoke detectors. It is made from an alcohol tincture of five Chinese herbs, all traditionally used in applied medicinal moxibustion. These are Folium Artemisiae Argyii (Ai Ye), Herba Asari Cum Radice (Xi Xin), Ramulus Cinnamomi Cassiae (Gui Zhi), Fructus Zanthoxyli Bungeani (Chuan Hua Jiao), and Fructus Capsici Frutescentis (La Jiao).

Ai Ye is bitter, warm, and acrid. It enters primarily the liver, spleen, and kidney channels when taken internally, but enters all the channels and vessels when used externally. It warms the channels and scatters cold, moves the qi, quickens the blood, and stops pain.

Xi Xin is acrid and warm. It enters the lungs, spleen, and kidneys when taken internally, but also warms the channels and scatters cold, frees the flow of the network vessels and stops pain when applied externally.

Gui Zhi is acrid, sweet, and warm. It enters the lungs, heart, and urinary bladder when taken internally, but warms all the channels and scatters cold, moves the qi and quickens the blood when applied externally.

Chuan Hua Jiao is also acrid and warm. Some sources says it is even "greatly hot." It enters the spleen, lungs, and kidneys when taken internally. However, when used externally, it strongly warms the channels and scatters cold, moves the qi, quickens the blood, and stops pain.

La Jiao is acrid and hot. When used externally, it treats wind damp pain, low back pain, and muscular pain. It is used in Chinese medicine as a counterirritant.

Functions: Moves the qi and quickens the blood, warms the channels and frees the flow of the network vessels, stops pain

Directions for use: Apply to the affected area or acupuncture points chosen for stimulation similar to regular moxibustion. For best results, use in conjunction with a TDP or heat lamp or hair dryer. Because people’s skin reacts differently, begin by applying to a small test area before applying to larger areas. Most patients will only experience mild heat locally. Some may also experience reddening of the skin. Only a very, very few may experience blisters.

Caution: For external use only. Do not take internally. Do not apply to eyes or genital region. Keep out of the reach of children. If application causes a blister, discontinue use. The therapeutic effect will already have been obtained. Care for the blister as you would normally. Liquid Moxa only causes blisters in a very small percentage of patients with extremely sensitive skin.

Be sure to wash your hands with soap after applying any type of liquid moxa. Keep away from children. Never use liquid moxa internally.

Te Zhong Jiu Fa Lin Chuang Jing Yao (The Clinical Essence of Special Moxa Methods), Chinese National Folk Chinese Medicine & Medicinals Research Association, Chinese National Medicine & Medicinals Press, Beijing, 1994

Ai Jiu Yang Sheng Qu Bing Fa (Mugwort Moxa Life-nourishing, Disease-dispelling Methods), Xi Huo et al., Beijing Physical Culture University Press, Beijing, 1995

Jia Yong Jiu Fa Zhi Bing Xiao Qiao Men (A Small Key to Home Use Moxa Methods for the Treatment of Disease), Liu Jing-yu, Chinese National Chinese Medicine & Medicinals Press, Beijing, 1993

Even if you don't like the sound of the Blue Poppy moxa tincture, I strongly suggest that if you like moxa treatment, it is wise to have some type(s) of liquid moxa in your clinical toolbox. I have founds that there are often patients who need warming therapy but who are sensitive to smoke. So give a couple types of liquid moxa a try in your practice, or make your own version if you like to experiment!

Thanks for reading.