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Getting to the heat of the matter

  Saturday, 28 l 05 l 2011  Source: The Straits Times   
By: Andy Ho


NOTING that I had been laid low again by my recurring lumbago, my sister gave me some self-heating “moxa” pads which she had bought when she was last in Seoul. They were as good as real moxibustion, she said, referring to a form of therapy in traditional Chinese medicine (TCM) that uses heat generated by burning a herb to stimulate acupuncture points. The small, spongy herb used is called mugwort or Artemisia vulgaris. The therapy is called moxibustion, meaning combustion of moxa, a monicker derived from the Japanese mogusa (with the “u” very short, thus mogsa or moxa).

The Korean self-heating pads were bags of moxa, charcoal and an oxygen-sensitive system. When a bag is opened and the ingredients shaken, the system heats up. Within minutes, the bag is a comfortable 70 deg C or thereabouts and stays like that for hours. Applied to acupuncture points, it supposedly heals what ails one. Applied to sore muscles directly, it definitely affords some pain relief. In classical moxibustion, the idea is to use heat to warm certain acupuncture points to stimulate the circulation of the qi or life force, so it flows freely around in your body. In TCM, if qi flows freely, health obtains. If the flow is blocked, however, ill health results.

The aim in TCM is to get qi flowing smoothly again in a sick person and moxibustion is one mode of doing so. Sometimes a therapist puts a small cone of processed moxa on an acupuncture point and lights it up. But just before the moxa actually burns down to the skin, he deftly pinches it away. The heat thus generated penetrates into the acupuncture point to do its magic. A Seoul National University of Technology study published in the Journal of Mechanical Science and Technology last year reported that this heat penetrates 5mm into the skin. In past times, some therapists would actually allow the moxa to burn down to the skin, which would blister and heal with scarring.

An 18th century eyewitness account written by Engelbert Kaempfer called Moxa in China and Japan noted that moxa powder about as much as half a grain of rice was burned directly on the skin. (It was this treatise that gave the technique its present name in English.) Because moxibustion was easier to do than acupuncture, it became widely used as folk medicine so much so that Kaempfer said he met no Japanese who did not have some moxa scarring.

Another method currently used is to burn moxa fluff wrapped around the ends of acupuncture needles already inserted into the skin. These metallic needles conduct the heat down into the relevant acupuncture points. Otherwise, a (non-smokable) moxa cigar is lit and the smouldering stick held near to the appropriate acupuncture points or around acupuncture needles if already inserted. This is maintained for a few minutes until the skin turns red. But does it work?

There are to be found in the Western and East Asian medical literature many studies addressing this issue in a variety of conditions. There have also been several systematic reviews of such studies. In the last few years, researchers from the Korea Institute of Oriental Medicine have done several systematic reviews of these studies that looked at the effectiveness of moxibustion in stroke rehabilitation, hypertension, ulcerative colitis, rheumatoid arthritis, osteoarthritis, diabetes, asthma, cancer and constipation. The Korean reviews were published in various journals and all said that the quality of the primary studies was so bad, methodologically speaking, no firm conclusions could be drawn.

This unflattering conclusion is akin to that of a 2009 study published in Trials that looked at the methodological shortcomings of clinical trials published in Chinese journals. Scientists from Chengdu, Hong Kong and Ottawa working together located 1,685 studies of TCM therapies said to be randomised controlled trials. They interviewed the authors only to find under 7 per cent were truly randomised controlled trials. Most of these Chinese researchers did not know how to design a rigorous clinical trial, they said. The study concluded “that so many non-randomised controlled trials... published as randomized controlled trials reflected the fact that peer review needs to be improved” in Chinese research.

So the fairest thing that can be said about moxibustion at this juncture is that we have no proof yet that it works. This is sad since it has been used for at least well over a millennium. We know this because, a century ago, some Buddhist manuscripts discovered in a cave at Dunhuang along the Silk Road in north-western China were found to contain sketches of the human body. These turned out to be moxibustion charts dating from the Tang dynasty (AD618 to 907). The charts are now held in the British Museum. Hopefully, we will not have to wait another century for Chinese science to ascertain if moxibustion actually works.

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