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Moxibustion in Dermatology

Ümit Türsen and Begüm Ünlü

Department of Dermatology, Mersin University, Mersin, Turkey

Introduction

Moxibustion is a form of Traditional Chinese Medicine (TCM) that has been used to treat a variety of medical conditions for more than 2500 years. It is a non‐needle acupuncture method. Since the 1970s, there has been a growing tendency to use acupuncture as an important component of integrative medicine worldwide. For patients to receive the full benefit of acupuncture, it is important to ensure that it is practiced safely. Acupuncture is described as a family of procedures involving stimulation of skin by different techniques [1]. Originally it meant to puncture specific anatomic locations of the body by needle. Today the term acupuncture is used to describe a wide spectrum of interventions such as moxibustion, cupping, acupressure, etc. [2]. Moxibustion is a technique that applies heat to acupuncture points by burning a compressed, powdered, combustible substance at or near the points to be stimulated [2]. It involves the use of burning moxa (dried leaves of an Asian species of Artemisia vulgaris, mugwort) to generate heat and stimulate acupoints [3]. Acupoints are selected by palpation after confirming a skin or muscle condition [4]. According to a study conducted by Yamashita et al., the total number of needle insertions per patient on average was 21 [5]. The acupuncturists used needles with diameters ranging from 0.14 to 0.3 mm with guide tubes; most of them had diameters <0.2 mm [5].

Types of Treatment

There are several types of moxibustion treatment: traditional moxibustion, drug moxibustion, and modern moxibustion [6]. Traditional moxibustion is characterized by the use of moxa as a burning material and can be divided into direct moxibustion and indirect moxibustion [6]. A moxa cone is placed directly on the skin and ignited ın direct moxibustion [6]. In indirect moxibustion, the moxa cone or stick is kept at a distance from the skin and ignited [6]. The insulating materials used in indirect moxibustion can include air, garlic, ginger, aconite, and salt [6]. In the drug moxibustion (natural moxibustion) method, irritant drugs, such as cantharis, garlic, or semen sinapis (mustard seed), are applied topically on acupoints [6]. These irritant agents cause erythema and blistering on skin [6]. Modern moxibustion consists of microwave moxibustion, laser moxibustion, and electrothermal moxibustion.

Moxibustion has been used to treat variety of diseases for many years [7]. According to Chinese medical records, 364 kinds of diseases can be treated with moxibustion [7]. The indications of moxibustion therapy include malposition, diarrhea, colitis, urinary incontinence, dysmenorrhea, temporomandibular joint disturbance syndrome, soft tissue injury, heel pain, asthma, urinary retention, herpes zoster, weakness, fatigue, and problems related to aging [7, 8].

Mechanism of Action

According to information in the literature, the mechanism of moxibustion is related to the thermal effects, radiation effects, and pharmacological actions of moxa and its combustion products [7]. Burning moxa can produce temperatures of 548–890 °C [7]. The maximum temperature change through indirect moxibustion was about 65 °C on the skin and 45 °C in the subcutaneous tissue [9]. The texture, size, and moisture content of the insulating material may affect the temperature of indirect moxibustion [10]. The efficacy of the moxibustion treatment depends on the temperature change of the acupoint [7]. The pain threshold increases after the alteration of the temperature [7]. Authors suggest that this increment relieves pain [7]. Moxibustion leads to vasoconstriction at the acupoint, as well as vasodilatation around the point and an increase in peripheral arterial blood flow and microvascular permeability [11, 12]. It has also antipyretic and thermolytic effects stimulated by receptors on acupoints [13, 14]. Heat shock proteins induced by moxibustion may be an important factor of its mechanism of action [15].

The burning moxa emits visible light and infrared radiation; this process may play an important role in the efficacy of moxibustion [7]. The energy absorbed from infrared radiation promotes blood circulation and improves the cell and enzyme activities [7].

Moxa is produced by drying and grinding mugwort [7]. Mugwort is a perennial herb [7]. The ingredients of moxa are complicated; more than 60 kinds of components have been identified. These ingredients change according to the place and season of production. The evaporating oils of moxa induce a dilatation of airways and relieving cough, an expectorant effect, and a strong antioxidant activity [7]. The smoke of moxa contains a variety of complex components, and its volatile ingredients are ammonia, alcohols, aliphatic hydrocarbons, aromatic hydrocarbons, terpene compounds, and their oxides [7]. The methanol extracts, flavonoids, and polysaccharides of moxa combustion products have strong antioxidant activity [7]. The smoke also has antifungal and antibacterial activity [7].

Yun et al. presented to report the efficacy of direct moxibustion on cutaneous warts. Three patients with chronic cutaneous warts received direct moxibustion made of Artemisia argyi (Dongbang Inc., Chungnam, Korea). Moxa burning was performed using moxa cones. Approximately 80% of a cone was burned, until patients reported feeling a burning sensation, at which time the cone was removed and another one burned. As part of this approach, patients underwent 5–19 moxibustion procedures during and after wart removal. After warts were completely eliminated, moxa burning was performed on each patient until approximately 60% of a cone was burned or the patient felt heat sensitization but no pain. In these patients, moxibustion seemed to have an effect on cutaneous viral warts. A possible mechanism is that direct moxibustion likely induces tissue damage from burning and, subsequently, a wound healing effect at a different temperature level. They suggested that it could be worthwhile to conduct further studies on the safety and efficacy of moxibustion on warts or to develop a medical device that uses modified moxibustion [16].

Modern medicine presumes that the heat of moxibustion can open the follicular orifice, relax the epidermis, and improve local microcirculation, which can elevate surface immunity. Han et al. indicated that combining moxibustion with narrow‐spectrum ultraviolet B (UVB) ray irradiation in treating psoriasis vulgaris can relieve psoriasis skin damage and improve quality of life (QoL

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