Thinking Outside the Moxa Box

In this article, I wish to discuss the topic of direct moxibustion. Unless you work in a smoke-free environment, whether or not you use direct moxibustion to treat your patients has, until now, been a matter of choice. In the near future, however, this choice may no longer be yours to make. Recently, I received an application for "Acupuncturist Professional Liability Insurance" from the Healthcare Providers Service Organization and saw direct moxibustion listed as an exclusion to coverage. I suspect other insurance companies may soon follow suit. When you combine this new development with the multitude of reasons practitioners already have for not using direct moxibustion, this practice would seem to have a dim future at best.

How important is it that acupuncturists be able to practice point warming? I think it is extremely important, and apparently so did the Chinese when they created the character that we translate in English as acupuncture. Our word for acupuncture is missing half of the content of the Chinese character. In English, acupuncture is a combination of the Latin word acus, which means needle, with the word puncture. The Chinese character is a composite of two older characters. The top half depicts a metal needle, and the bottom half describes the application of heat or burning directly to the skin. Historically, Chinese characters evolve and change over time, so the fact that these two methods remained inseparably joined for thousands of years demonstrates their combined importance.

The practice of direct moxibustion has not been well-received by the West. There are several possible reasons for this. One is the difficulty in developing the skill required to safely and effectively burn moxa directly on a patient's skin. Then there is the problem of gaining the patient's trust for such a foreign practice. Furthermore, the great Japanese moxibustion masters Fukaya and Sawada found that the best results were achieved when the patient or their family continued the moxa treatments on a daily basis at home. This brings up the issue of compliance, which, given the problematic nature of this practice, is very difficult to expect from many patients. Last, but not least, is the issue of liability. Whether to use direct moxibustion may come down to just one question: Do its potential benefits outweigh its risks and their potential legal ramifications?

It is time we explore innovative new alternatives so we can avoid throwing out the baby with the bathwater. New ways can be found to achieve the thermal benefits of direct moxibustion while at the same time eliminating the risk of burns. Furthermore, it is time we teach our patients the healing power of direct point warming, and give them the means by which they can safely continue treatment at home. We may soon have little choice but to think outside of the box, and we will find that modern technology offers the best solution to what is unfortunately a problem that cannot be solved using traditional methods.

My personal experience with direct moxibustion comes from nearly 12 years of working as a moxa assistant at Kiiko Matsumoto's busy office, as well as from my own private practice. I have developed immense respect for the power of direct moxibustion, both when used in conjunction with needling and as a stand-alone treatment method. Nevertheless, direct moxibustion has its limitations, a subject on which I have spoken in great length in prior articles in this publication.

We may be surprised to see that something positive can come out of this current situation in which the insurance companies are forcing our hand and requiring us to bring the practice of point warming to new standards of safety and excellence. Through the development of new methods and with creative new ways of thinking, we may be able to bring point warming back to its rightful place of prominence in acupuncture. We can do this by reaching out to new populations, such as young children, that could greatly benefit from gentle, daily home treatments. We can also find new ways to use the subtle yet profound effect of thermal therapy to help restore balance to the dysregulated autonomic nervous systems of trauma survivors. A safer, easy-to-use method of point warming will enhance the effects of auricular, scalp, hand, and many other microsystems in acupuncture, as well as potentiate the effects of essential oils. Once we break the bonds of old ways of thinking, fresh new ideas can freely be investigated.

I would like to leave the reader with a quote by Yoshio Manaka from Chasing the Dragon's Tail, which I believe describes the spirit we will need to cultivate in order to adapt to the challenge that we face. In this passage, Dr. Manaka explains the Japanese term shu ha ri (pronounced shou-po-li in Chinese):

"Simply put, this means that what we absorb and obey, we must eventually break away from (so as to begin our own new tradition). To merely follow our teacher's tradition is not sufficient, but it is a necessary starting point. If we take the wisdom of shu ha ri, we can develop a suitably flexible mind and approach, and begin to make real progress."