A history of preventive moxibustion.

Abstract

Preventive moxibustion has a long history and deep roots in Chinese medicine. This essay describes the history of preventive moxibustion from the Neijing through the Ming dynasty.

Keywords: moxibustion, prevention, preventive moxibustion, nourishing life.

Introduction

Preventive moxibustion is part of the Chinese tradition of nourishing life. It refers to the application of moxibustion with the goal of guarding against disease, strengthening the body and decelerating the ageing process.

The use of moxibustion to prevent disease has a long history. Although the Huangdi Neijing (Yellow Emperor's Inner Canon) did not explicitly record instructions for preventive moxibustion, it laid the groundwork for it from two perspectives:

1. It emphasised preventive treatment, for example the Suwen (Elementary Questions), Chapter 2 says, "The sages did not treat what was already ill. They treated what was not yet ill."

2. It included in its description of the effects of moxibustion the ability not only to warm but to supplement vacuity. The Lingshu (Magic Pivot), Chapter 73 states, "When yin and yang are both vacuous, fire is naturally appropriate for this [condition]." Chapter 51 describes the technique for using moxibustion to supplement.

Based on this foundation, later generations of doctors established the theory and developed the practice of preventive moxibustion.

Jin dynasty 

The earliest recorded use of moxibustion to guard against disease progression was from the Jin dynasty (265-419) writings of Fan Wang,1 who said, "Generally, one should use moxibustion on someone with sudden turmoil (cholera). Although occasionally they do not recover, they will ultimately be without the worry of death." He called this type of treatment "counter-moxibustion."

Sui dynasty 

During the Sui dynasty, Chao Yuanfang expressed his disapproval of a popular custom in certain areas of China: using moxibustion to guard against paediatric fright wind (acute or chronic childhood convulsions). Chao wrote, "In healthy newborns, be careful not to use counter-acupuncture and moxibustion. When counter-acupuncture and moxibustion are applied, the infants endure pain and it stirs up the five pulses, causing susceptibility to epilepsy ... It is very cold in the region between the Yellow River and the Luo River. Children are susceptible to tetany. Their custom is to use counter-moxibustion on three day old infants to guard against tetany". Chao opposed this type practice because it meant blindly following a rule that does not differentiate between cold and heat. He favoured discrimination in the use of moxibustion and also valued pattern identification when applying it.

Tang dynasty 

At the beginning of the Tang dynasty, the concepts of preventing disease and nourishing life were prevalent and the clinical use of moxibustion was widespread. Because of this, preventive moxibustion was valued.

Sun Simiao was a vigorous advocate of preventive medicine. He warned, "Do not take health as a constant. One must constantly secure it and must not forget danger. One must guard against all disease." (3) Sun advanced the idea that healthy people should regularly apply moxibustion to prevent illness. He explained, "Generally when entering the lands of Wu and Shu, travelling officials must constantly apply moxibustion to two or three sites on their body. If the moxa sores are not allowed to heal even for a short while, miasmic pestilence, warm malaria and toxin qi are unable to touch the person. That is why people traveling to Wu and Shu frequently apply moxibustion." (4) This is the origin of the practice of making long-term moxa sores to prevent disease.

Sun was also was the first to discuss Gaohuangshu BL-43 moxibustion in detail. He stated, "There is nothing Gaohuangshu BL-43 does not treat ... When this moxibustion is completed, it makes a person's yang qi healthy and prosperous." (5) Moxibustion on Gaohuangshu BL-43 has been used for centuries to treat vacuity taxation and emaciation.

Sun Simiao also wrote, "Generally, leg qi initially begins with leg weakness. Quickly apply moxibustion to it." (6) He then suggested applying moxibustion to various points on the legs. In this case, Sun advocated treating a mild condition to prevent it from worsening.

Later in the Tang dynasty, Wang Tao proposed that constant application of moxibustion on Zusanli [ST-36] had the anti-ageing effect of downbearing counterflow and brightening the eyes. He said, "Generally, if people over thirty years of age do not apply moxibustion to Zusanli [ST-36], it lets qi ascend to dim their eyes. Sanli [ST-36] is used to descend qi." (7) Wang was actually quoting from Volume 28 of Sun Simiao's Qianjin Yifang (Supplement to Prescriptions Worth a Thousand Pieces of Gold), but left out a phrase. Sun said the problem of excessive ascent of qi to the eyes occurs when moxibustion is applied to the head without also applying it to Zusanli [ST-36]. He considered this a side effect of improper use of moxibustion. Wang Tao, whether by misquoting or by rephrasing Sun's statement, gave impetus to the idea that frequent moxibustion on Zusanli [ST-36] could prevent some of the effects of ageing.

The Tang dynasty treatise Huangdi Mingtang Jiujing (Yellow Emperor's Moxibustion Classic of the Bright Hall) (8) expanded the scope of preventive moxibustion on Zusanli [ST-36] by prescribing it to guard against the occurrence of windstroke. This book detailed the application method: "Generally two months before, maybe three or five months before someone has windstroke, not at any particular time, they will suddenly develop aching, heavy, insensitive impediment (bi) on their shins ... This is a symptom of windstroke. One must quickly apply moxibustion to Sanli [ST-36] and Juegu [GB-39]: three cones to each of these four places. Afterwards, decoct the four flavors of scallion, peppermint, peach leaves and willow leaves. Wash the moxa sores with the decoction. This treatment expels wind qi through the opening of the moxa sores and moves it out." (9)

Volume 165 of the Jiu Tang Shu (Old Tang History Book) recorded a case of moxibustion used for longevity and health: Liu Gongquan (10) was over 80 years old, and still walked lightly. Someone asked him his technique for nourishing life. He said, "I have not used original qi up with joy and anger and I constantly warm Qihai REN-6. That's all."

During the Tang dynasty, moxibustion was not only used to guard against the occurrence of certain diseases, but more significantly it had begun to be used to enhance the constitution, delay ageing and lengthen life. At this point, moxibustion had fully become a method to guard against disease and nourish life.

Song dynasty 

In the Song dynasty, medical doctors and specialists in nourishing life gave even more attention to preventive moxibustion. Its usage for this purpose increased and theories explaining its effects were developed. Dou Cai wrote extensively about the importance of moxibustion in the Bianque Xinshu (Book of Bian Que's Heart). He said, "In the method of preserving life, burning artemisia is first, elixir medicinals are second, and Fu Zi (Radix Aconiti) is third."

Dou elaborated on the theory and principles of preventive moxibustion. He strongly believed that yang was the key to life: "If yang essence is vigorous, one will have a lifespan of a thousand years. If yin qi is strong, it will bring death and damage. It is also said, if yin qi is never dispersed, the end is death. If yang essence exists, it will bring long life." Dou also said, "When yang qi has not expired, life is firm and fast." Therefore, he felt that treatment to conserve life and guard against illness must focus on "preserving and supporting yang qi as the root." Moxibustion was the ideal means for achieving this goal.

Dou described his protocol for preserving life: "When people reach their later years, yang qi is debilitated. Thus, their hands and feet are not warm, the lower origin is vacuous and worn out, and movement is difficult. Now, as long as people have qi remaining, they do not die. Qi is yang, which is life. Thus, when yang qi is exhausted, one must die. When a person is without disease, they should often moxa Guanyuan REN-4, Qihai REN-6, Mingguan SP-17 and Zhongwan REN-12 ... Although one may not obtain [an extremely] long life, one can still maintain a lifespan of a hundred years."

Dou theorised that a person who was old and feeble gradually exhausted their original yang. Frequent moxibustion on points like Guanyuan REN-4 could strengthen original yang, delay decline and ageing and lengthen the lifespan. Application of moxibustion to Guanyuan REN-4 in healthy people could strengthen and fortify their body, while in those who are already ill, applying moxibustion could also prevent disease progression. Based on this, Dou also recommended that preventive moxibustion of Guanyuan REN-4 should keep pace with a person's age and they should increase the number of cones as the years went by, in order to delay ageing and decline.

Dou described his personal experience with preventive moxibustion, "At the time I was fifty, I frequently applied 500 cones of moxibustion to Guanyuan REN-4 ... I gradually achieved a light and fortified body, and desired food and drink. When I was 63, because of anxiety and anger, I suddenly found a death pulse in my left cun position: nineteen beats and one rest. I then applied 500 cones of moxibustion each to Guanyuan REN-4 and Mingmen DU-4. Fifty days later the death pulse had not returned. Each year I constantly add to this moxibustion, pursuing and obtaining health in my old age."

Dou Cai expanded the point selection for nourishing life moxibustion, and recognised that healthy people who often used moxibustion on these points were more likely to resist disease and live longer.

Southern Song author and doctor Wang Zhizhong wrote the Zhenjiu Zisheng Jing (Classic of Nourishing Life with Acupuncture and Moxibustion). He stated, "Qihai REN-6 is the sea of original qi. Man uses original qi as his root. If original qi is not damaged, disease will not harm him. Once original qi is damaged, one dies even without disease. It is appropriate to frequently apply moxibustion to this point in order to invigorate original yang. If one must wait for disease before applying moxibustion, I am afraid the opportunity will be lost until it is too late."

Southern Song medical doctor Zhang Gao carried on the practice of using suppurating moxibustion on Zusanli ST-36 to guard against windstroke. He wrote in Yi Shuo (Medical Explanations), published in 1224, the often quoted statement that "If one desires to be secure, Sanli [ST-36] must not be dry." Zhang felt that the principle behind making moxa sores to guard against windstroke was because "Sanli [ST-36] is the irrigation canal of the five viscera and six bowels. One needs to constantly circulate and unblock it so that there is no wind disease."

The above illustrates that the knowledge and use of preventive moxibustion was abundant during the Song dynasty, and its theoretical development progressed during this time.

Ming and Qing dynasties

During the Ming and Qing period, preventive moxibustion built on the foundation of earlier experience and continued to advance in its development.

Zhu Quan prescribed moxibustion on Baihui DU-20, Dazhui DU-14, Fengchi GB-20, Jianjing GB-21, Quchi L.I.-11, Zusanli ST-36 and Jianshi P-5 for the initial signs of windstroke with symptoms of wind evils entering the viscera. He also stated, "If one has a wind condition in general, constantly apply moxibustion to these seven points every spring and autumn in order to discharge wind qi. Especially watch out for people who have had long-term wind conditions." (11)

Li Yan recorded an interesting type of preventive moxibustion in Yixue Rumen (Entering the Gate of Medicine). "Smelting the umbilicus method" is suitable for curing disease in people with vacuity taxation and for prevention. He indicated that when this technique is used "once in each of the year's four seasons, original qi is firm and secure, and the hundred diseases are not engendered." Yang Jizhou recorded his "method of steaming the umbilicus to treat disease" in Volume 9 of the Zhenjiu Dacheng (Great Compendium of Acupuncture and Moxibustion). This uses roughly the same procedure as Li Yan's "smelting the umbilicus method" but the medicinals in the prescription are not the same. Both take powdered medicinals, and mix them with a liquid and .our to make a ball which is placed inside the umbilicus. Moxa cones are then burned on top.

Master Yang advocated applying this type of moxibustion at special times (see Figure 1 above).

Yang said that using this timing "unites with the right qi of the four seasons, and completes the creation and transformation of heaven and earth. Moxibustion is never ineffective." Yang also indicated that this method's effect is in "taking the right qi of heaven and earth, yin and yang, to enter into the five viscera. The various evils cannot invade and the hundred diseases cannot enter. Long life withstands ageing and the Spleen and Stomach are robust."

Famous author and doctor Zhang Jiebin discussed the application of preventive moxibustion on various points in the Leijing Tuyi (Diagram Wings of the Categorised Classic). He recommended Fengmen BL-12 to guard against certain skin ailments: "This point is able to drain hot qi from the whole body. One who constantly applies moxibustion to it will never suffer abscesses, sores and scabs." He also discussed salt moxibustion on Shenque REN-8: "A lot of moxibustion is good. If three or five hundred cones of moxibustion are applied to it, not only will illness be cured, but it will also prolong life." Zhang also said "Avoid applying moxibustion on Sanli [ST-36] in children. Those beyond 30 years can apply moxibustion to this point. Otherwise, it will generally produce illness."

Conclusion

In summary, preventive moxibustion arose during the Jin dynasty (265-419) and developed over the next 1,500 years, each period contributing to its development. Its history followed the establishment of preventive medical thought and the concept of nourishing life. It also developed through clinical observation of the effects of moxibustion in long term treatment and the understanding of point functions continuously deepened. Moxibustion gradually developed from solely being used to treat disease to becoming a method of prevention and nourishing life, used to resist the body's decline and ageing.

Notes

(1) Fan Wang was the author of Fan Dongyang Za Yaofang (Fan Dongyang's Assorted Herbal Formulas). This book has been lost (Li, 1995). However, the quotation was cited in Yi Xin Fang (Medical Heart Formulas), Volume 11.

(2) Volume 45 of Zhubing Yuanhou Lun (Discussion on the Origins of Symptoms in Illness).

(3) Volume 27 of Qianjin Yaofang (Essential Prescriptions Worth a Thousand Pieces of Gold).

(4) Essential Prescriptions, Volume 39.

(5) Essential Prescriptions, Volume 40.

(6) Essential Prescriptions, Volume 7.

(7) Waitai Miyao (Secret Necessities of a Frontier Official), Volume 39.

(8) The Yellow Emperor's Moxibustion Classic of the Bright Hall was written at the end of Northern Song. The name of its author is lost. During the Yuan dynasty it was made part of the Four Books of Acupuncture and Moxibustion. (Li, 1995).

(9) I was unable to find the original source for this quotation and this is my translation of the quotation in Chinese as it appeared in

Gu & Zhao, 1994.

(10) Liu Gongquan (778-865) was a statesman and calligrapher (Liu, 1999).

(11) Zhu Quan's book, Qiankun Shengyi (Vitality of Qian and Kun), has been lost. This passage is recorded in the Zhenjiu Dacheng (Great Compendium of Acupuncture and Moxibustion).

References

Chao, Y.F., (1992). Proofread and Annotated Discussion on the Origins of Symptoms in Illness. Beijing: People's Health Publishing House.

Dou, C., (1991). Book of Bian Que's Heart. Seoul: All China Publishers.

Gu, C.S. & Zhao, J.X., (1994). Essentials of Special Types of Clinical Moxibustion: A Brief History of Preventive Moxibustion. Beijing: Chinese Medicine Herbal Science and Technology Publishing House.

Huang, L.X., (2000). Grand Compendium of Each Book on Acupuncture and Moxibustion. Beijing: Cathay Publishing House.

Li, J. W. (1995). Chinese Medicine Great Dictionary. Beijing: People's Health Publishing House.

Li Y., (1999). Entering the Gate of Medicine. Tianjin: Tianjin Science and Technology Publishing House.

Liu, Z.C., (1999). A Study of Daoist Acupuncture. Boulder, CO: Blue Poppy Press.

Sun, S.M., (1997). Essential Prescriptions for Emergencies [Worth] a Thousand [Pieces of] Gold, Corrected and Explained. Beijing: People's Health Publishing House.

Tamba, Y., (1993). Medical Heart Formulas. Beijing: People's Health Publishing House.

Wang, T., (1979). Secret Necessities of a Frontier Official. Taibei: Wenguang Books Limited Company Publishers.

Wu, L.S., and Wu, A.Q., (1997). Yellow Emperor's Canon Internal Medicine. Beijing: China Science and Technology Press.

Yang, J.Z., (1998). Great Compendium of Acupuncture and Moxibustion. Beijing: Chinese Medicine Ancient Book Publishing House.

Zhang, J.Y., annotated by Wang, Y.S. et.al. (1966). Categorized Classic Diagram Wings and Categorized Classic Attached Wings with Annotations. Xian: Shanxi Science and Technology Publishing House.

Author's note

The basic outline of this essay came from: Gu, C.S. & Zhao, J.X., (1994). Essentials of Special Types of Clinical Moxibustion: A Brief History of Preventive Moxibustion. Beijing: Chinese Medicine Herbal Science and Technology Publishing House. Gu Chunsheng and Zhao Jingxin are the full names of the authors. They are from Hebei Chinese Medical University, Acupuncture and Moxibustion department. However, it is not a direct translation and was expanded and developed by me.

Lorraine Wilcox has been a licensed acupuncturist in California since 1989. She is currently a student at the American University of Complementary Medicine in Los Angeles and is writing her Ph.D. dissertation on the state of moxibustion during the Ming Dynasty.

Figure 1: Master Yang's moxibustion time chart

Date                                   Time

Seasonal Marker        Approx. Date    Branch   Double Hour

Spring establishment   February 4th    si       9-11am
Spring equinox         March 21st      wei      1-3pm
Summer establishment   May 5th         chen     7-9am
Summer solstice        June 22nd       you      5-7pm
Autumn establishment   August 8th      xu       7-9pm
Autumnal equinox       September 22nd  wu       11am-1pm
Winter establishment   November 7th    hai      9-11pm
Winter solstice        December 22nd   yin      3-5am