Preparations before Operation
Materials Needed
When using a moxa stick, choose a pure moxa stick or medicated moxa stick based on the state of disease and make sure that the package is intact without any mold or moisture.
When using a moxa cone, choose pure moxa floss without any mold and moisture.
When using indirect moxibustion, prepare selected materials to place between the moxa cones and the skin. Check that these materials are not moldy or moisture. Make these materials into flat surfaces/pieces with air holes of appropriate size.
When using a moxibustion burner, choose a suitable one for the area for moxibustion, such as a moxibustion stand, moxibustion barrel, and moxibustion box.
Get the ignition tools ready, such as matches, lighters, incense threads and paper strings, etc, as well as the treatment disks, bending plates, forceps and fire extinguishing tube before starting the treatment.
Point Selection and Location
The selection of acupoints is based on the diagnosis and treatment plan. Select and locate the acupoints according to the disease.
The location of the acupoints should be consistent with the standard location published in the WHO Standard Acupuncture Point Locations in the Western Pacific Region.
The posture of the Body
Choose a suitable body posture that facilitates the manipulation and is also comfortable and safe for the patient during the treatment.
Environmental Setting Required
Be aware of environmental hygiene and avoid pollution. In order to maintain good ventilation, install ventilation facilities or air purifiers if possible.
Disinfection
All the disinfections mentioned above should follow the instruction on sterilization mentioned in the Guidelines on Basic Training and Safety in Acupuncture published in 1999 by WHO.
1. Needle Disinfection
When treating with warm needling moxibustion, disposable needles should be used. If the needles are used repeatedly, they should be sterilized strictly with an autoclave or other appropriate methods such as ethylene oxide gas.
2. Skin Disinfection
When treating with warm needling moxibustion, clean the treatment area of the skin from the center to the peripheral parts using cotton balls with medical alcohol or 0.5% ～ 1% iodophor. The area to be strongly stimulated should be sterilized by using cotton balls with 0.5% ～ 1% iodophor.
3. Practitioner’s Disinfection
Before treating the patient with warm needling moxibustion, the acupuncturists can use soapy water to wash the hands and then clean them again using cotton balls with medical alcohol or any other sterilizer.
Operating Method
Moxa Stick Moxibustion
1. Suspended Moxibustion
The acupuncturist applies a burning moxa stick vertically above a selected point/area without touching the skin so that moderate heat can be felt on the area. The suspended heating modes of moxibustion can be gentle moxibustion, circling moxibustion and pecking sparrow moxibustion.
2. Gentle moxibustion
Ignite a moxa stick at one end and suspend it 2 ～ 3cm above the treatment area of the skin to transmit a mild warmth sensation to the area until the skin becomes slightly red without burning sensation.
3. Circling moxibustion
For Circling moxibustion, Ignite a moxa stick at one end and suspend it 2 ～ 3cm above the treatment area and move it in a circular motion parallel to the skin to bring mild warmth sensation to the area without burning the skin.
4. Pecking sparrow moxibustion
Ignite a moxa stick at one end and suspend it 2 ～ 3cm above the treatment area and move the stick up and down over the acupoint without touching the skin like a bird pecking a tree.
5. Pressing Moxibustion
Put 6 ～ 8 layers of tissue paper, gauze or cotton cloth, etc. on the treatment area and press the area using a burning moxa stick by keeping it for 1 ～ 2 seconds to bring the heat to the skin. Once the patient feels partial burning and pain, the moxa stick should be removed. Press 3 ～ 7 times at each acupoint. When the skin becomes slightly red, the moxa stick and the paper or cloth can be removed.
Pressing moxibustion usually uses medicated moxa stick. Choose the different moxa sticks according to the pathology of a disease.
Warm Needling Moxibustion
Needle the selected acupoint as usual. After the arrival of qi and the suitable manipulations of reinforcing or reducing, directly place a small section of the moxa stick (about 1 ～ 3cm long) on the needle handle and ignite it. Or wrap a 2 ～ 3g ball-shaped moxa floss on the needle handle and ignite it. When it burns out, remove the ashes and then the needles. A piece of cardboard would be placed on the skin around the needle to catch the ashes as they fall to avoid burning the skin.
Moxa Cone Moxibustion
1. Direct Moxibustion
Start by making an appropriate size of moxa cone with moxa of high quality to suit the patient’s condition. Then place the moxa cone directly on the selected point and ignite its top. In order to fix the moxa cone on the skin, apply some adhesive or stimulus such as garlic juice, vaseline, glycerine, water, or medical alcohol before placing the moxa cone.
When 50% ～ 80% of the moxa cone has burned and the skin appears flush and a burning sensation is felt, remove the moxa cone and replace it with another one. Repeat the procedure until the required amount of cones is completed. This method involves light stimuli without scar and purulence. Hence, it is called nonscarring moxibustion, or heat sensation moxibustion.
When more than half of the moxa cone is burned and the skin flushes and a burning sensation is felt, the acupuncturist can press, tap gently or scratch the skin around the burning moxa to reduce the pain sensation and distract the patient’s attention. When the moxa cone is burned out, put another one until the required amount of cones is completed. This strong stimulation may lead to aseptic suppuration with scars. This method is called scarring moxibustion, diathermic moxibustion, and suppurative moxibustion.
2. Indirect Moxibustion
Place a selected material on the treatment area and place a moxa cone on the material then ignite the moxa cone from its top. When the skin reddens or the heating pain is felt, lift the material with the moxa cone away from the skin for a moment and replace at once. Keep doing so until the end of the treatment. For patients who need light stimuli, when 2/3 of the moxa cone has burned, remove the moxa cone or replace it with a new one until the required amount of cones is complete. For patients who need strong stimuli, when 2/3 of the moxa cone has burned, the acupuncturist can gently tap or scratch the surrounding area to distract the patient’s attention and relieve the pain. When the moxa cone is burnt out, put another one until the required amount of cones is complete.
Moxa Burner Moxibustion
The moxa burner is used by putting moxa sticks or moxa floss into the moxa burner to start the treatment. Its advantages are convenient, safe, and comfortable.
1. Moxibustion with Moxa Stand
Insert the burning moxa stick in the moxa stand from the top and fix the stand directing on the acupoint. The acupuncturist or patient can adjust the position of the moxa stick in order to regulate the temperature suitable to the patient’s tolerance. After the treatment, remove the moxa stand and take out the moxa stick. Then put out the fire and clean up the ashes.
2. Moxibustion with Moxa Barrel
Firstly takes out the inner barrel to put the moxa floss into it and replace the inner barrel. Then ignite the moxa floss and place the moxibustion barrel outdoor. Wait until the smoke becomes less and the exterior surface of the outer barrel becomes hot. Bring it back indoors and put a lid on it. Arrange the patient in an appropriate posture and place the moxa barrel on the appropriate chosen area over 8 ～ 10 layers of cotton cloth and gauze. Have the patient feel a comfortable level of heat without burning the skin. After the treatment, remove the moxa barrel and put out the fire and clean up the ashes.
3. Moxibustion with Moxa Box
Place the moxa box on the moxibustion area of the body. Prepare suitable moxa floss or moxa stick according to the required treatment time. Ignite moxa floss or moxa stick on the iron gauze which is in the lower part of the box and place the lid on top. Have the patient feel comfortable warmth without a burning sensation. The skin flushes. If the patient has a burning sensation, open the lid or slightly lift up the moxa box away from the skin for a short while, and then place it down again. Keep doing so repeatedly until the required amount of cones is complete. After the treatment, remove the moxa box, put out the fire and clean up the ashes.
4. Moxibustion with Moxa Bowl or Plate
Ignite the moxa floss and put it into a ceramic bowl or plate. When the bottom of the bowl or plate is hot enough, place it over 8 ～ 10 pieces of gauze or cotton on the treatment area. The heat should be felt comfortable by the patient and never burn the skin. After the treatment, remove the instrument, put out the fire and clean up the ashes.
5. Moxibustion with Moxa Cylinder
Ignite the incense stick and put it into the moxa cylinder. When the head of the cylinder is heated, place it on the layers of gauze or cotton on the treatment area. The heat should be felt comfortable by the patient and make the skin become red without burning the skin. After the treatment, remove the incense stick, put out the fire and clean up the ashes.
Post-Moxibustion Disposition
After moxibustion, the skin will appear red and hot. No special care is needed since the redness will gradually disappear on its own.
If the skin is burned, edema or blistering will occur. Blisters of about 1cm in diameter can be gradually absorbed by the body without any treatment. Larger blisters can be removed by sterilized scissors or punctured by sterilized needles to remove the fluid. Then an anti-inflammatory ointment can be applied to it. There is no need to remove the pus since the scab will form soon. Blistered skin can scab within 5 ～ 8 days, and the scab will fall off without any scar left.
Scarring moxibustion will damage the basal layer of skin which will cause edema, ulceration, fluid exudation, and even form abscesses. Light damage only destroys the basal layer of skin. Damaged skin will scab within 7 ～ 20 days and the scab will fall off, leaving a permanent light scar. Heavy damages will destroy the dermis tissues. Damaged skin will scab with a thick crust and the scab will fall off within 20 ～ 50 days, leaving a permanent thick scar, which is called moxibustion sores. When the moxibustion sores are festering, the patient should not be engaged in heavy work and need to rest well to prevent infection. If infection, mild redness or swelling appears, disinfection and anti-inflammatory treatment around the moxibustion sores are needed. Generally, these symptoms will disappear in a short period of time. If swelling and burning pain are severe, the patient can take oral or external anti-inflammatory medication. If the suppurative parts are comparatively deep, a surgeon’s assistance is needed. The acupuncturist must abide by the law of his/her country when engaging in the scarring moxibustion procedure.
