A  Study of the Efficacy of Adjunctive Moxibustion in the Treatment of Tuberculosis

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, affecting primarily the lungs, but other organs include lymph nodes, bones, brain and skin. A large percentage of Uganda’s population (more than 90%) have a positive skin test for TB, indicating either presence of  latent infection or past immunization with the BCG vaccine. The advent of HIV/AIDS has however, led to significant increase in the incidence of TB, with estimates of it rising five-fold across the African continent in the last fifteen years.

Multidrug resistant TB (MDR-TB) is the TB infection which is resistant to two or more of the first line drugs (Ethambutol, Isoniazide, Pyrazinamide, and Rifampicin). Worldwide at least 3.1% of new cases of TB and 19% of the retreatment cases are MDR-TB. East Europe takes 47% of the world burden of MDR-TB (WHO 2010), but given the limitations in diagnostic capacity follow up, and drug supply chains, sub-Saharan Africa is likely to have a  bigger MDR-TB burden than estimated.

In Uganda, approximately 500 new cases of MDR-TB are diagnosed each year and 50% of these are co-infected with HIV. The WHO targets elimination of TB (<1/10⁶ population) by 2050. This requires new approaches to TB control, particularly in Africa, and these could include new drugs, and vaccines, better prevention methods and alternative or innovative approaches.

 The treatment of MDR-TB is prohibitively expensive for the already strained health system in Uganda and acrosssub-Saharan Africa due to the cost of the initial diagnoses, the second-line drugs and follow-up investigation of contacts. Because of the risks of drug resistance in relapsed cases, it is imperative that measures intended to lower/eliminate MDR-TB should, if at all possible, target an increase in the cure rates among both new infections and retreatment cases. Such measures would include those that either increase the efficacy of the drugs used or improve the host immunity to fight off the disease (given a far higher prevalence/incidence of the disease among immune suppressed individuals).

One method that could have impact on host immunity is moxibustion, a therapy which involves the use of moxa (a product of dried mugwort weed) to treat diseases. Moxibustion has been developed over many centuries as part of East Asian medicine and is often used alongside acupuncture. It involves the burning of moxa at particular points on the patients’ bodies, often the same points as used in acupuncture. In “direct” moxibustion the pieces of moxa (known as cones) are placed directly on the skin, and burnt. It is this burning of the skin that is said to improve the immunity of the patient.

Moxibustion has been used by generations of East Asian medical practitioners to treat very severe conditions,  including infections, hernia, severe gastrointestinal illnesses and tuberculosis. However, none of the historical reports provides clear and measurable ways to assess patient response or the effectiveness of the treatment.

Various studies have investigated how moxibustion might bring about relief/healing/cure in such a wide array of illnesses. In 1929, Dr Shimetaro Hara published a study in which he claimed to have noted an increase in the white blood cells in rats subjected to moxibustion. Fifty years later the same Dr Hara participated in a study which suggested that, when tiny grain-sized cones of moxa were burnt on treatment points it was largely the cells of the adaptive immune system that increased in response to moxibustion. A more recent study, however, found that it was the innate immunity that was activated when larger dosages of moxa (and hence higher temperatures) were applied (Choi et al. 2004). It is likely that the effect of moxibustion immune response is determined by many variables, among which could be dosage (cone size), frequency and duration of treatment, and location of application (see reviews in Appendix1).

One explanation for the different immune responses which apparently relateto moxa dosage is provided by the work of immunologist Toru Abo (2007) who carried out detailed studies of the relationship between the nervous system and the different parts of the immune system. According to his observations, stimulation of the sympathetic nervous system leads to activation of innate immune responses, whereas stimulation of the parasympathetic nervous systemactivates the adaptive immune system. Applying this idea to moxa dosage, larger cones of moxa generating higher temperatures and leading to more palpable burnsmight result in stimulation of the sympathetic nervous system. This would mainly activate innate immunity and increase the granulocyte to lymphocyte ratio. On the other hand prolonged smaller doses of moxa, providing more gentle heat and a relaxing effect of temperature, would stimulate the parasympathetic nervous system. This in turn would activate the adaptive immunity - important in fighting some chronic illnesses including tuberculosis.

The mechanisms of moxibustion’s actions on the body require further clarification:  in addition to dosage, the effects of variables such as type of moxa, degree of processing, active chemical constituents, techniques and location of application all need to be investigated. The only facts that can be stated with some certainty are that moxibustion has immune stimulatory effects and that it has variously been recorded as having been used to effectively treat TB.