The Evidence Base

contents including:

- the Chinese connections

- TB treatment in Japan in the 1930’s and 40’s

- the wider research on immune response from moxibustion

- conclusions

- a selective list of research papers

The Chinese Connections

The first traces of a trail appeared to us tentatively in a text over fourteen hundred years old entitled “the Moxibustion Method for Consumptive Disease”. It was written by a Tang dynasty physician called Cui Zhidi but was subsequently lost from posterity. While it was still extant, however, other authors referred to it repeatedly through several centuries.

In the early literature consumptive disease was referred to in descriptive ways in Chinese medicine. The names tell their own stories - “Passing from Door to Door Disaease”, “Cadaverous Infixation”, “Steaming Bone Disease”, or simply “Lung Taxation”.

In the twelfth century the Gao Huang Shu Xue Jiu Fa, a famous historical medical text, particularly focused on the treatment of tuberculosis using moxa using one pair of specific treatment points on the back. Later in the Ming dynasty, a golden period for China in many fields including medicine, several famous texts including  “the Great Compendium of Acupuncture and Moxibustion” repeatedly recommend moxa for the treatment of TB, promising reliable results if applied correctly.

We have noted, however, that in all cases that we’ve uncovered from the historical literature,  moxa was applied in a far more aggressive fashion than anything we might conceivably use in any Moxafrica protocol. So whilst there is clear evidence of moxibustion's use to treat TB (and other intransigent disease) for centuries in East Asia, it is not necessarily so relavant for today. It is in Japan, however, in the decades just prior to the advent of antibiotics that the trail becomes significantly fresher clearer and more relevant.

TB treatment in Japan in the 1930’s and 40’s

Japan in the 1930’s was a very different country to the one which we know today. The vast majority of the population was poor and lived on the land. TB was a common disease which particularly decimated this strata of society with much in common with Africa now – low incomes, low levels of literacy, poor living conditions, little access to affordable or effective health care, poor diet and constitutionally weakened immune systems. There are well-known reports of moxibustion specialists treating TB effectively with moxa from this time. Two names are particularly well known: Sawada Ken, and Hara Shimetaro. Hara’s treatments have interested us most for several reasons. Firstly he was a medical doctor and his approach was therefore largely scientific. Secondly his protocols were designed to be extremely simple and were intended to be done at home by patients and their relatives with point location easily mastered with little in the way of instruction. Thirdly, they were extremely light in terms of dosage, in terms of both size  and numbers of cones, and therefore represent the most appropriate approach. Fourthly, his reports come with some interesting scientific research, despite the fact that his explanations of the mechanisms of response may be outdated.

Intrigued by the responses he was finding in his patients (and he explicitly claimed that his treatment was curing TB if done over a long term) Hara conducted his own research into its effects of moxa on guinea pigs which had been infected with TB. Using comparative groups of animals both with and without moxa treatment and using some with deliberately delayed onsets of treatment, he built up a picture of both mortality rates and recovery tendencies in his subject animals. This depended upon how the treatment was or wasn't administered. Although his research was clearly only on animal subjects, his results remain persuasive – dependant upon dosage the moxa treatment clearly aided recovery from TB.  We recognise, of course, that his claims may be overstated and also that his research was only on animals, But his accounts of his human patients' responses provided us with incentive enough to look further into the Japanese literature. 

We found no more recent repetition of his experiments. Since the advent of TB drugs, there has been no apparent interest in Japan in investigating moxa’s effects on tuberculosis. The disease is being quite adequately controlled by drugs so no incentive exists. Doctor Hara, however, and others who were his contemporaries, also investigated the wider effects of moxa on the immune system, particularly monitoring White Blood Cell counts, and there is plenty of more recent information on this subject which casts better light for us today.

The wider research on immune response from moxibustion

In fact there exists a record of Japanese research into the immunological and serological effects of moxibustion which spans over eighty years. More recently its focus has been on its effects on tumour growth, however. Also, of course, since the advent of AIDS a far deeper appreciation of the complexities of the immune system has developed than that which was understood by Doctor Hara in the 1930’s.

We amassed as much of this data as we could to try and make sense of it, all the time examining it through the lens of Doctor Hara’s research.The story is not conclusive, although it remains persuasive enough to be encouraging. Problems arise particularly from the fact that the published research uses widely varying approaches, especially in terms of cone sizes, cone numbers and points used. It also more often than not employs small mammals for subjects, with different papers also asking differing questions from similar but different treatment approaches.  

Perhaps not unexpectedly, quite widespread variations in immune response are reported. What is of primary importance, however, is that immune responses are indeed most definitely confirmed. In this regard these papers endorse what is also reported by every experienced moxibustion practitioner we have encountered or contacted based on their clinical experience: moxa strengthens the body's immune system.

We have prepared a two part paper from our research on this subject which is due for publication this year in the European Journal of Oriental Medicine. Because most of the Japanese research on this subject is not currently available in English, the wider acumoxa community remains relatively unaware of much of this data so we beileve our paper will prove informative to many. In brief, our analysis also leads us to believe that moxa response is both point and dosage specific, and may be predictably discrete to specific components of the immune system dependant upon how it is applied.

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Conclusions

There is longstanding circumstantial evidence that moxa has been used to treat TB in East Asia. There exists far more powerful evidence from the 1930’s when moxa was used successfully to treat TB in the modern era and these treatments were accompanied by published research. There is also convincing recent evidence that moxa treatment creates an immune response in both animals and humans. Seen as a whole, this provides an irresistable argument as to why this treatment should be carefully re-examined in the light of the disease’s current mutations in the developing world, to see particularly if it might improve tendencies in recovery, or reduce morbidity and mortality, to investigate whether it may be in any way effective in the treatment of drug-resistant strains, or might even help improve prognoses in cases of co-infection with HIV/AIDS.

A selective list of research papers

1.       Histological study of skin treated with moxa. Shimetaro Hara. Fukuoka University Medical Journal. 1929; 22:2. Old Japanese.                                                                  

2.       Recovery tendencies of tuberculous animals treated with moxa. Shimetaro Hara. Fukuoka University Medical Journal. 1929; 22: 5. Old Japanese.                                

3.       Tuberculosis and moxibustion. Shimetaro Hara. Jiechi Ika to Rinsho. 1929: 6: 9. Old Japanese.                                                                                                                 

4.       Effects of moxa on subcutaneous histocyte cells. (1 & 2) Shinji Ota 1930. Nihon Biseibu-tsugaku Zasshi; 24: 4. Old Japanese.                                                           

5.       Effects of moxibustion on splenic function of leucocytes and in gamma-irradiated mice under general and local anasthaesia.Chinese Publication of uncertain provenance – approx 1980.                                                                                 

6.       Effects of Electronic Moxibustion on Immune Response 1. Watanabe S, Hakata H, Matsuo K, Hara H, Hara Shimetaro. Journal of Japan Society of Acupuncture and Moxibustion 1981;31(1): 42-50. Japanese.  

7.       Accuvaccination. Singh, B.K. Paper delivered to World Acupuncture Conference, Colombo 1982.     http://www.bhupendratechniques.com/Research/Theories/Acuvaccination                                                                     

8.       Effects of Electronic Moxibustion on Immune Response 2. Watanabe S, Matsuo K, Hara H, Hirose K, Hara Shimetaro. Journal of Japan Society of Acupuncture and Moxibustion 1982;32(1): 20-26.  Japanese.                                                                                     

9.       Effect of moxibustion on the phagocytic activity in mice. Okozaki M, Furuya E, Kasahara T, Sakamoto K. . Journal of Japan Society of Acupuncture and Moxibustion 1982;32(2): 9-16.  Japanese.                                                                                                 

10.    Effect of moxibustion on the phagocytic activity in mice. Okozaki M, Furuya E, Kasahara T, Sakamoto K. American Journal of Chinese Medicine 1983. Vol XI; No. 1-4: 112-122.                                                                                                              

11.    Effect of moxibustion on the cellular immunocompetence of gamma-irradiated mice. Hau D M, Wu J C, Chang Y H, Hwang J T. American Journal of Chinese Medicine. 1988; 3: 157-163.                                                                                                

12.    An electron microscopic study of the acupuncture or moxibustion stimulated regional skin and lymph node in experimental animals. Kimura M, Mastrogiovanni F, Toda S, Kuroiwa K, Tohya K, Sugata R, Ohnishi M. American Journal of Chinese Medicine. 1988: 16(3-4): 159-167.                                                                                       

13.    Changes of content of blood serum through moxibustion on acupoint equivalents. Sakamoto K, Kasahara T, Sakurai Y.  Journal of Japanese Society of Acupuncture and Moxibustion. 1988; 38(3): 320-325. Japanese

14.    Suppression of the DTH reaction in mice by means of moxibustion at electro-permeable points. Tohya et al. American Journal of Chinese Medicine 1989; 17(3-4):139-144.                                                  

15.    A study on Radical Scavenging Effects of Moxa. Ohnishi M, Toda S, Sugata R, Tohya K, Kuroiwa K, Kimura M. Journal of Japanese Society of Acupuncture and Moxibustion. 1990; 40(4): 377-379. Japanese                                                           

16.    Protective effect of moxibustion for mounbtain sickness Homma Y, Murai M. Journal of Japanese Society of Acupuncture and Moxibustion.1991; 41(3): 346-352. 

17.    Effect of moxibustion on the growth of primary tumor, pulmonary metastases and immune responses in mice bearing Lewis lung carcinoma (LLC). Utsunomiya Y. Bulletin of  Meiji University Oriental Medicine. 1995; 16: 27-38. Japanese.

18.    The immune system and acupuncture moxibustion. Amagai T, Itoi M. J Japan Society of  Acupuncture and Moxibustion. 1996; 46(4): 315-25. Japanese.

19.    Studies on anti-inflammatory and immune effects of moxibustion. Tang Z, Song X, Li J, Hou Z, Xu S. Chen Tzu Yen Chiu 1996;21(2):67-70.  Chinese.

20.    Immunohistochemical expressions of HSP and CGRP induced by moxibustion stimulation in the peripheral neurons of CH3/HENCrJ mice.  Nakanishi H.; Chiba A, Chichibu S. Neuoroscience Research. 1997; 21(1): 79-79.

21.    Influence of direct moxibustion with moxa cones the size of a grice grain on cell count and proportion of leucocytes in rabbit and human peripheral blood. Yamashita H, Tanno Y, Ichiman Y, Nishijo K, Takahashi M. Japanese Journal of Oriental Medicine. 1998; 48: 599-608. Japanese.

22.    Effects of Moxibustion on the Enhancement of Serum Antibody in Rabbit against Staphylococcus aureus  Yamashita H, Ichiman Y, Takahashi M, Nishijo K. American Jounral of Chinese Medicine 1998:26.1;29-37. (also Japanese Journal of Oriental Medicine. 1996; 47: 457-64. Japanese)                                                                

23.    Appearance of peculiar vessels with immunohistological features of high endothelial venules in the dermis of moxibustion-stimulated rat skin. Tohya K, Urabe S, Igarashi J, Tomura T, Take A, Kimura M. American Journal of Chinese Medicine 2000; 28: 425-33.                                                                                                           

24.    Changes in peripheral lymphocyte subpopulations after direct moxibustion. Yamashita H, Ichiman Y, Tanno Y. American Journal of Chinese Medicine. 2001; 29 (2): 611-621.                                                                                                                 

25.    Effects of moxa-cone moxibustion at Guanyuan on erythrocytic immunity and its regulative function in tumor-bearing mice. Wu P, Cao Y, Wu J. Journal of Traditional Chinese Medicine 2001 Mar; 21(1): 68-71. 

26.    Diverse biological activities of moxa extract and smoke. Hitosugi N, Ohno R, Hatsukari S et al. In Vivo. 2001 May-Jun; 15(3) 249-54. Japanese.                                                   

27.    Present Research on Moxibustion. Aizawa S, Menjo Y, Tohya K, Nakanishi H, Toda S. Journal of Japanese Society of Acupuncture and Moxibustion. 2003; 53(5): 601-613. Japanese.                                                                                                                           

28.    Effects of moxibustion at shenque (CV 8) on serum IL-12 level and NK cell activities in mice with transplanted tumor.Qiu X; Chen K; Tong L; Shu X; Lu X; Wen H; Deng C. Journal of Traditional Chinese Medicine. 2004 Mar; 24(1): 56-8.                                                                                                                   .

29.    Effects of moxibustion at Zusanli (St36) on alteration of Natural Killer Cell activity in rats. Choi G S, Han J B, Park J H, Oh S D, Lee G S, Bae H S, Jung S K, Cho Y W, Ahn H J, Min B I. American Journal of Chinese Medicine. 2004 Mar; 32(1): 303-312.                                                                                                                      

30.    The study of Standardisation Plan and Uselfulness of Moxa Combustion. Geon-mok L, Kil-soong L, Seung-hun L, Jong-duk C, Eun-mi S, Jung-sun C, Yang-jung K. Journal of Korean Acupuncture and Moxibustion Society 2003; 20(6):63-79. (reprinted in Journal of JSAM 2004; 54(4): 604-619.                                               

31.    Assesment of the Function of Peritoneal Macrophages in Rats treated with long term direct moxibustion. Matsuo t, Kasahar Y, Kuibayashi K Journal of the Society of Acupuncture and Moxibustion 2005;1:36-42.                                                             

32.    Effect of moxibustion on the hemodynamics of cutaneous and sub-cutaneous tissue.- comparison between five-cone and seven-cone moxibustion. Tawa M, Kitakoji H, Sakai T, Yano T.  Japan Journal of Acupuncture and Moxibustion 2005; 55 (4): 538-548. Japanese.                                                                                                                     

33.    Literature Documentation of Basic Research on Immunological Effect by Acupuncture and/or Moxibustion Treatment Immunological Research Committee for Acupuncture and Moxibustion. Tohya K, Fukazawa Y, Kasahara Y, Okuda M, Tahara S, Kuribayashi K. Japan Journal of Acupuncture and Moxibustion 2006; 56 (5): 767-778.   Japanese.                                                                                         

34.    Do Japanese Style Acupuncture and Moxibustion Reduce Symptoms of the Common Cold? Kawakita, Shichidou et al (EBM working group, Research Department,  the Japan Society of Acupuncture and Moxibustion (JSAM), 2007. http://ecam.oxfordjournals.org/cgi/content/full/nem055v1                                       

35.    Study on Moxibustion: Elucidation of Characteristics of Moxa. Ozaki A, Aizawa S, Toda S, Kumamoto K, Ebara S, Koike T. Journal of the Japan Society of Acupuncture and Moxibustion, 2008. 58 (1): 32-50. Japanese .

36.    Direct Moxa and Immune Response – a Review Study. Part 1 Young M, Craig J. The European Journal of Oriental Medicine, 2010.  In print. 

37.    Direct Moxa and Immune Response – a Review Study. Part 2 Young M, Craig J. The European Journal of Oriental Medicine, 2010.  In print.