The Chinese word for acupuncture is zhenjiu. Zhen means needle, and jiu means moxibustion, the warming of points with burning herbs. When acupuncture travelled to the West, the needle half of the word came with it and the moxa half largely stayed behind. That is a pity, because moxa may well be the older of the two.
The earliest known texts on the channels of the body come from a tomb at Mawangdui, in Hunan province, sealed in 168 BCE. Two silk manuscripts from the tomb describe eleven channels, an early version of the twelve that acupuncturists work with today, and for most of the problems they list, the treatment they give is moxibustion. Needling takes a bigger role in later texts. A 2017 review of these excavated texts, in Evidence-Based Complementary and Alternative Medicine, argues that moxibustion developed before acupuncture and may even have led to the discovery of the channels themselves.
What moxa is
Moxa comes from mugwort, a common plant in the Artemisia family. Producers dry the leaves, often age them, and grind them until the fibres separate into a soft, golden wool. Practitioners roll that wool into small cones, pack it into sticks the size of a large cigar, or press it onto the handle of a needle. Once lit, it smoulders slowly instead of flaring, and it gives off a steady, penetrating heat and a distinctive herbal smell. Smokeless moxa sticks, made from carbonised mugwort, give a similar heat with far less smoke.
How practitioners use it
There are several ways to apply moxa:
- holding a lit moxa stick a little above a point until the skin feels pleasantly warm
- placing a small cone on the skin and lifting it off as soon as the heat builds
- burning moxa on a thin slice of ginger, or on the handle of an inserted needle so the warmth travels down it
- warming a larger area with a moxa box that rests on the abdomen or back
Some traditions in Asia used direct moxa that deliberately left a small blister or scar. The methods I use keep the heat comfortable and stop well before the skin could burn.
In Chinese medicine, moxa warms and strengthens. Practitioners turn to it when the picture involves cold or depletion: tiredness with cold hands and feet, period pain that eases with a hot water bottle, joints that ache more in cold, damp weather, or digestion that feels slow and cold. In Five-Element acupuncture, small cones of moxa often warm a point before the needle goes in.
What it feels like
The warmth builds gradually. On a point, it can feel like a small spot of sunshine; with a moxa box, more like a warm hand resting on the body. Many people find it deeply relaxing, and for anyone nervous of needles, a treatment that relies mostly on warmth can be a gentle place to start. The smell is earthy and slightly sweet, a little like sage, and it tends to linger in clothes and hair.
What the research shows
The best evidence for moxibustion concerns babies in the breech position late in pregnancy. The traditional treatment warms a point beside the nail of the little toe, known as Bladder 67.
In a trial published in JAMA in 1998, researchers in Jiangxi province, China, randomly assigned 260 women expecting their first baby, all with a breech baby at 33 weeks, to moxibustion at this point or to routine care. At birth, 75.4% of the babies in the moxibustion group were head down, compared with 62.3% in the routine care group.
A Cochrane review, updated in 2023, brought together the trials on this question. It concluded, with moderate-certainty evidence, that moxibustion added to usual care probably reduces the chance of a baby being in a non-head-down position at birth. It found that moxibustion probably makes little or no difference to the caesarean section rate, and that its effect on the need for external cephalic version (turning the baby by hand) is very uncertain. The reviewers also noted that most trials reported side effects poorly.
For other conditions, the evidence is weaker. A 2010 overview in BMC Research Notes looked at ten systematic reviews of moxibustion, covering cancer care, ulcerative colitis, stroke rehabilitation, constipation, high blood pressure, pain and breech presentation. Breech was the only area with relatively clear evidence. Elsewhere, the poor quality of the original studies left considerable uncertainty.
If your baby is breech, talk to your midwife or obstetrician before trying moxibustion, so they can confirm the position and check it suits you. Moxibustion can sit alongside your antenatal care, and never replaces it.
Why moxa deserves more attention, and when to take care
Moxa is harder to fit into a modern treatment room than needles. It smokes, it smells, and it needs constant attention while it burns. Research has also concentrated on needling. Those are practical reasons for its low profile in the West, and none of them says much about its worth. In the classical system, moxa covers ground that needles alone do not, adding warmth where a person is cold and depleted. Leaving it out means working with half the toolkit.
Like any treatment that uses heat, moxa needs care:
- Burns are the main risk, so speak up as soon as the heat feels more than pleasantly warm.
- If you have reduced feeling in your skin, for example from diabetes, you may not notice heat building, so tell your practitioner beforehand.
- Smoke can irritate asthma and other breathing problems; smokeless moxa is often a better choice.
- During pregnancy, use moxa only with your midwife's knowledge.
Chinese medicine has used moxa for more than two thousand years, and it still earns its place in the clinic. If you have had acupuncture before and never come across it, it is worth asking about.