This chapter is based on 《Ling Shu》Chapter 10, 48, and 51.

5-1: The Principle behind Moxibustion

《靈樞經脈第十》

陷下則灸之。

《Ling Shu Chapter 10》

         Apply moxibustion if the location of the acupoint shows signs of sinking.

《靈樞禁服第四十八》

陷下則徒灸之﹐陷下者﹐脈血結于中﹐中有著血﹐血寒﹐故宜灸之。

《Ling Shu Chapter 48》

The sinking of a Meridian means there is blood stagnation due to cold; thus moxibustion is needed.

5-2: The Reinforcing and Reducing Method for Moxibustion

《靈樞背輸第五十一》

黃帝問于歧伯曰﹕願聞五藏之輸﹐出于背者。歧伯曰﹕胸中大輸在杼骨之端﹐肺輸在三椎之傍心輸在五椎之傍﹐膈輸在七椎之傍﹐肝輸在九椎之傍﹐脾輸在十一椎之傍﹐腎輸在十四椎之傍﹐皆挾脊相去三寸所﹐則欲得而驗之﹐按其處﹐應在中而痛解﹐乃其輸也。

灸之則可﹐刺之則不可。氣盛則瀉之﹐虛則補之。以火補者﹐勿吹其火﹐須自滅也。以火瀉者﹐疾吹其火﹐傳其艾﹐須其火滅也。

《Ling Shu Chapter 51》

         Huangdi states: I want to know the Back-Shu Points of the Five Zang organs.

          Qibo answered: The biggest point [(UB 11) because it is located above all the Back-Shu Points] is located 1.5 cun lateral to the spine, at the lower border of the spinous process of the first thoracic vertebra.

         The Back-Shu point of the Lung (UB13) is located 1.5 cun lateral to the spine, at the lower border of the spinous process of the third thoracic vertebra.

         The Back-Shu point of the Heart (UB 15) is located 1.5 cun lateral to the spine, at the lower border of the spinous process of the fifth thoracic vertebra.

         The Geshu (UB 17) is located 1.5 cun lateral to the spine, at the lower border of the spinous process of the seventh thoracic vertebra.

         The Back-Shu point of the Liver (UB 18) is located 1.5 cun lateral to the spine, at the lower border of the spinous process of the ninth thoracic vertebra.

         The Back-Shu point of the Spleen (UB 20) is located 1.5 cun lateral to the spine, at the lower border of the spinous process of the eleventh thoracic vertebra.

         The Back-Shu point of the Kidney (UB 23) is located 1.5 cun lateral to the spine, at the lower border of the spinous process of the second lumbar vertebra.

         The pain will be relieved right away by pressing the right location of the point, this is the method to check if one has found the right location of these points or not.

         One can apply moxibustion at those points but not needling. The principle of the treatment is to reduce if there is a Qi-excess condition, and reinforce if there is a Qi-deficient condition.

         The method of reinforcement by Moxibustion is to light it, and let it burn out by itself. The method of reduction by Moxibustion is to light it, and then keep blowing on it until it burns out.

【Comment】

         Moxibustion is a part of acupuncture technique, instead of using needles; it uses moxibustion on the acupoint to treat certain diseases. Discussions regarding the indication and technique of reinforcement and sedation of moxibustion are as follows.

         (1)  For the indication of moxibustion, 《Ling Shu Chapter 10》states, “apply moxibustion if the location of the acupoint shows signs of sinking.” And in the 《Ling Shu Chapter 48》, it further points out that “the sinking of a meridian is due to cold in the blood, which causes blood stagnation.”  《Ling Shu Chapter 73》has a similar statement. (《靈樞官能第七十三》:經陷下者﹐火則當之。結絡堅緊﹐火之所治。)

         Therefore, the indication of moxibustion is to treat blood-cold syndrome. It complies with the treatment principle stated in《Huangdi Neijing》, which is “apply heat for a cold syndrome.” In the past century, some acupuncturists claim that moxibustion can be used for heat syndromes too, but this does not comply with the theory in Ling Shu.

         (2) The location for moxibustion according to the relationship between a meridian and acupoint is only on an acupoint of a meridian affected by cold in the blood. The statements in 《Ling Shu Chapter 51》coincide with the principle of applying moxa.

         (3) In terms of reinforcement and reduction《Ling Shu Chapter 51》explains the method of reinforcement and reduction in great detail. It says, “The method of reinforcement by Moxibustion is to light it, and let it burn out by itself. The method of reduction by Moxibustion is to light it, and keep blowing on it until it burns out.” 《Su Wen Chapter 5》 states “One may tonify a patient’s Qi by applying mild fire; one may deplete a patient’s Qi by applying fierce fire.” (《素問陰陽應象大論篇第五》﹕“壯火之氣衰﹐少火之氣壯﹐壯火食氣﹐氣食少火﹐壯火散氣﹐少火生氣。”) From the aspect of reinforcement and sedation, one may conclude that mild fire is for reinforcement and fierce fire is for sedation.  It is important to note that a blood-cold syndrome can be derived from Yang-Qi deficiency or Yin-Qi excess; hence there is both a method of reinforcement and a method of sedation.

         《Ling Shu》 does not record the size of the moxa or how many moxas should be applied in each treatment. One acupuncture classic book states that the smallest moxa is a size of a grain of rice and the largest is a size of a thumb. And the smallest moxa is for reinforcement and the largest is for reduction.

         The number of moxa needed depends on the result of treatment; the result of treatment can be checked by the Renying/Cunkou pulses.  For ore information refer to chapter “Renying/Cunkou pulse diagnosis” in the book. These are some suggestions as to what size of moxa and the amount to be applied in the clinic.

         Today, most acupuncturists who practice moxibustion do not know the method of reinforcement and reduction by moxibustion.  They apply moxa on Ren 3, 6 and ST 36 with fierce fire, and think that this type of moxa will reinforce a deficiency condition, which in reality can cause further depletion of Qi.

         (4) The method of moxibustion should be direct moxibustion, which means that one should put the moxa directly on the acupoint.

         (5) 《Su Wen Chapter 73》 says to use “moxibustion for cases that cannot be treated by needling.”  (《靈樞官能篇第七十三》中﹕“針所不為﹐灸之所宜。”)

This statement should not be taken literally.  Misinterpretation comes from the lack of understanding of Ling Shu theory. 

         《Ling Shu Chapter 7》, one of the most important chapters regarding acupuncture technique has a detailed discussion on various techniques for different diseases, including dysfunction of Zang-Fu organs, meridians, muscles and skin.  And all these techniques apply to needling, not moxibustion. 《Ling Shu Chapter 7》 does not mention anything about moxibustion; because it is only another treatment option for cold in the meridian.  Moxibustion is one of many acupuncture techniques, and it is applied to treat dysfunction of the meridian due to cold in the blood so its application is limited.

         (6) Due to a superficial understanding of acupuncture technique, more recent acupuncturists have inappropriately taken moxibustion to a new level.  Because of  the difficultly in learning needling techniques and because “needling may cause death if it isn’t used properly” in 《Huangdi Neijing》, Dr. Wang Tao suggests using only moxibustion for treating diseases. (AD 690 唐代王燾《外臺秘要明堂序》“其針法古來以為深奧，今人卒不可解。經云﹕針能殺生人，不能起死人，若欲錄之，恐傷性命。今並不錄針經，唯取灸法”。) Consequently, many different methods of moxibustion have been created in clinical practice, such as moxa with ginger, with salt, with garlic, etc.  And moxibustion has been suggested for treating many different diseases.  The book of 《Canon of Divine Moxibustion》, written by Dr. Wu Yinong, introduced many various moxibustion prescriptions. (AD 1853 清代吳硯丞《神灸經綸》) Furthermore, classic acupuncture book 《Clinic Experience of Dr Bian Que》written by Dou, Wei AD 960, not only emphasizes the importance of moxibustion in clinical practice, but also claims that moxibustion can prevent disease and increase longevity.  It also says, “One can live up to one hundred years of age if moxibustion is applied on Ren 3, 6, and 12 regularly.” (宋代竇材《扁鵲心書》﹕“人于無病時﹐常灸關元﹐氣海﹐命門﹐中皖﹐雖未得長生﹐亦可保百餘年壽矣。”)  These kinds of thoughts and practices have deviated from the basic theory of 《Huangdi Neijing》.  The needle, moxibustion and herbs are utilized in order to treat diseases, not healthy people.

            Today, most textbooks have used the word “acupuncture and moxibustion” together as the title of an acupuncture book, and acupuncturists speak of acupuncture by combining of both words, “acupuncture” and “moxibustion” together without a second thought about its meaning.