Types of Moxibustion: Direct, Indirect, Moxa Boxes and Sticks

Why the methods matter

"Moxibustion" covers several ways of using burning mugwort (moxa). Methods differ in how close the burning herb is to the skin, how much smoke they make and how likely they are to burn. This page describes them in general terms only. It gives no instructions, because home use risks burns, and it is not a substitute for a trained practitioner. For the overview see Moxibustion.

Direct moxibustion

In the classical method the moxa is made into a cone and applied to the skin at points identical to those used for acupuncture. [1] One overview notes it could be used as a counter-irritant by blistering and scarring the skin. [1] Scarring methods are a deliberate skin injury, which is a reason to ask exactly what a practitioner plans before agreeing. We did not find a source we could read that describes non-scarring direct methods, so we do not describe them.

Indirect moxibustion

In indirect methods the burning moxa does not rest on bare skin. The overview describes a milder form of heat treatment in which a layer of vegetable material or salt is placed between the skin and the cone. [1] Another form uses moxa held above the skin. A UK hospital breech-clinic page, for example, describes holding moxa sticks, or burning moxa cones, on or over the Bladder 67 point on the toes. [2] Commercial "indirect" moxa products also exist and have been tested for the gases they release. [3]

Moxa on a needle (warming needle)

A third method combines moxibustion with acupuncture. A piece of moxa is placed on top of an inserted needle and ignited, so that heat travels down the needle to nearby tissue. [1] This is only done by trained practitioners, and needle safety is covered under Acupuncture Side Effects and Precautions.

Moxa boxes and other devices

Practitioners may also use containers or holders for moxa. Proper evidence not found: we did not find a source we could read that describes box-type devices or compares them with other methods, so this page makes no claim about them, either for safety or for effect.

Smoky and smokeless moxa

Some moxa products are made to produce less smoke. A laboratory study of three types found that "smoky" and "mild" moxa had emission patterns close to tobacco, while smoke-free moxa differed, and that all three had higher emission intensities than other typical indoor sources it compared. [4] A separate pilot trial in Japan compared smoke and smokeless moxibustion for breech presentation with a control group. It was small and not randomized, so it cannot show which is better. [5] If smoke bothers you, ask how the room is ventilated.

What research says about comparing methods

We did not find a trial that compares direct and indirect moxibustion head to head for a health outcome. Proper evidence not found. Results for any one condition, such as breech presentation, cannot be assumed to apply to another method.

Choosing a practitioner

Ask which method will be used, whether it can leave a mark or scar, how skin is protected and how the room is ventilated. See How to Choose a TCM Practitioner.