The 100 Days Moxa Challenge for Long COVID
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The original rationale for moxa being used to support recovery from Long COVID
Since 2008 the Moxafrica charity has been systematically investigating whether small cone moxa can help recoveries from multi-drug-resistant TB. We knew that it was successfully used in 1930s in Japan to treat TB before antibiotics were available, but today, even with all the might of modern medicine, the treatment of MDR-TB has a terrible success rate.
We’ve been involved in three clinical trials which together convinced us that this simple cheap therapy can both improve and hasten recovery rates from TB, probably by a cumulative strengthening of host immune response.
The SARS-CoV-2 coronavirus is a very different pathogen to the tuberculosis mycobacterium, and both COVID-19 and Long COVID are also very different diseases to TB. The initial coronavirus infection, for instance, develops far too quickly for moxa to have any effect in its acute phase. The effects of its afterburn, though, still drew our moxa-focused attention - (like TB) Long COVID is a slow-burning intransigent condition that appears to have complex inter-relationship with the state of the host immune system. Also, just like with TB, some parts of the immune system appear to get hijacked in the process.
So in 2021our question was: Could moxa help long-haulers in a similar way to how it appears to help TB cases? And if so, how best might it be used?
The 100 Day Moxa Challenge ( firstname.lastname@example.org )
Enrolment for the Challenge is now closed, but we are continuing by administering a rolling remote moxa programme which we are making available for free to any long-haulers anywhere (as long as you have a functional postal service and an internet connection). What follows explains why we have introduced this ambitious programme (which we will continue until our resources run out), and also disclose and discuss the results of our 100 Day Moxa Challenge for Long COVID.
We should first of all, however, thank most profusely every single challenger, most particularly those who managed to complete their 100 Days, and we wish them well with their continuing recoveries.
Moxafrica’s 100 Day Challenge for Long COVID has now closed and we have some preliminary results
We stopped recruiting on 10th September 2022, and are now winding the Challenge down to its final conclusion over the following 100 days (which should happen some time around Christmas). At that point we should have final data but in the meantime we can share more on what we now know.
We can also disclose the specific details of the four protocols we originally designed and also share some of the current preliminary results trusting that these will be of some interest to acumoxa practitioners and potential help to their patients. We can also provisionally discuss the clinical implications of the data-so-far and, as importantly, their limitations.
The Challenge's design
Our original goal was to enroll 200 long-haulers, split them into four groups (each specific to one of the four protocols) and then see how they fared using questionnaires so as to develop quantitative comparative data. Each protocol was carefully designed to have similar dosages in respect of number of moxa ‘cones’ prescribed, with each comprised of different treatment points (apart from including bilateral St36 which was common to all protocols).
A brief breakdown of the Challenge
Recruitment unfortunately turned out to be something of a challenge. While we did manage to receive more than 200 applications, not all of them were eligible to enroll, fewer still actually ended up committing to starting the Challenge at the end of their enrolment process, and even fewer completed their Challenge as we’d hoped.
What follows is the general enrolment process that we used which consisted of discrete stages (each of which accounted for significant drop-outs):
Initial application by the potential Challenger prompting an:-
Invitation to submit a preliminary questionnaire (from which we could assess inclusion or exclusion)
Subject to (2), an invitation to submit a twenty-question baseline questionnaire followed (allowing us to develop a starting health score for each individual).
On receipt of each completed baseline questionnaire moxa was sent out along with detailed instructions also asking them to confirm to us the day they started their Challenge.
At the end of each challenger’s 100 days, we invited each finisher to complete a ‘final’ questionnaire which comprised the original questions (from which we could develop final comparative individual scores) along with a few others intended to give us a better picture of how they experienced the 100 days of moxa.
With these two key scores we have calculated individual improvement indices from which to develop average improvement indices for each protocol. In the course of the Challenge we also developed a ‘control group’ (comprising those who told us that moxa ‘wasn’t for them’ after we had sent them their moxa, but who were nevertheless willing to answer the same final questionnaires around 100 days after we originally sent them their moxa). We thus ended up with 5 groups – four of which reflected the four protocols, and one of which could be defined as reflecting ‘no moxa’ at all.
Here are the details of each protocol. In all cases the moxa was intended to be done on a daily basis over a period of 100 days. It is worth noting that, apart from the theoretical reasons for selecting these points, we also found them to be commonly palpatory reactive in our preliminary palpatory assessments of our own first clinical long-hauler patients.
Protocol #1 (which we called the ‘Sawada protocol’ because we loosely based it on points which we know 20th century Japanese moxa master Sawada Ken sensei used as part of his Taikokyu protocol):-
Bilateral (Sawada) Ki6
3 cones/point = 21 cones per day
Protocol #2 (which we called the Extra Vessel protocol):-
Right Pc6 18 cones per day
Protocol #3 (which we called the ‘Detox protocol’):-
Bilateral Ki9 18 cones per day
Protocol #4 (which we called the ‘vagus protocol’ – the only one which required a helper, and therefore the most problematic in respect of completions):-
GV12 21 cones per day
Adherences to the study design
We report the current outcome data below, but stress that they are not final because we still have a number of ongoing uncompleted Challengers somewhere between start and finish. We must also stress that they should only be considered in the light of many limitations, some of which we identify below.
Firstly, though, here are some important enrolment anomalies reflecting adherences and completions (as of 10th September):
207 ‘preliminary’ questionnaires were completed (this number now will not change).
Of these,137 ‘baseline’ scoreable questionnaires were submitted (i.e. 70 fell at the first hurdle!)
As a result, we sent out 137 sets of moxa.
48 of these 136 have now completed their Challenges (this number should increase because18 are currently ongoing)
Of these 48, only 36 have so far completed and returned their final questionnaires (along with an additional 5 ‘controls’ who dropped out but agreed to complete the final questionnaire).
Of those 137 to whom we sent moxa but who aren’t part of the final data, 45 never confirmed that they started, 20 more of these subsequently confirmed they were dropping out, and a further number stopped replying to our emails in response to asking for updates.
Of those who have so far finished and completed their questionnaires, the numbers using each protocol (P) were:
P 1 : 9
P 2 : 8
P 3 : 9
P 4 : 10.
In respect of those to whom we sent moxa kits but who never confirmed starting, 6 were on P1, 4 were on P2, 2 were on P3 and only 2 were on P4. This does not give a comprehensive comparative picture of adherence rates, however. To offer a much better picture of how hard P4 turned out to be, almost half of those who were initially allocated to this protocol confirmed that they had started with a helper but subsequently asked to switch to another protocol because it was too tricky for their helper to perform.
Table 1 shows that whilst the average % scores for each protocol were not vastly different, the range of individual scores was very wide.
We found there to be a negative correlation between starting score (with higher scores amounting to a more severe initial condition) and percentage improvement. This was most clear with Protocol 1, but was not really seen with Protocol 4, suggesting that, if a helper is available, this may overall be the most generally appropriate protocol to use independent of severity of Long COVID.
Fig 1. individual protocol correlations between improvement and original score
Superficially, we can state that, on average, all the moxa protocols outperformed no-moxa (i.e. we can suggest that moxa generally may well be helpful in supporting recovery from Long COVID). Furthermore, we can add that the best performing protocol was P4, followed by P3. In other words, were we to home in on two protocols at this point of time (one of which would need a helper and the other not) these two could currently be the protocols we would choose (although it is actually difficult to differentiate between P1, P2, and P3).
However, we can equally caution that the numbers completing each of the protocols were far too small for us to be at all confident of this summary (completions currently totalling around a fifth of what we originally had planned to be the case). This significant limitation is compounded further by the fact that the ranges of improvements individually recorded within each group were enormous in their scope, meaning that some responses were inexplicably erratic.
We can also, however, state with some confidence that moxa very clearly is not for everyone. Only a quarter of those to whom we sent moxa have so far reported completing their Challenge. Of course, we anticipated this would be a problem given that moxa is not just strange but also can be fiddly but (given the effort made to provide instructions and support) this conclusion nevertheless was a disappointment in respect of its scale. Given that a key symptom described by those responding to the first questionnaire was ‘brain fog’ perhaps it should have been better expected, however.
In respect of all the protocols, and also in respect the ‘controls’, we furthermore cannot be confident of any the following, all of which may have been subject to high degrees of variability and account for some of the erratic scores:
Whether challengers adhered to the requisite protocols as regularly as requested
Whether they located the points accurately
Whether they applied the moxa as technically consistently as instructed
Whether they were using other therapies at the same time, For ethical reasons we specifically never insisted on such a proscription, beyond being clear that they should not have any other moxa therapy in their 100 days; in other words we can suggest that many may have had adjunctive acupuncture, homoeopathy, nutritional therapy etc., while many may not have had any other therapy at all. To illustrate this issue, one of the highest ‘control’ scores (that helped lift this group’s average above what would otherwise have been below 20%) has attributed her significant recovery to personalised homoeopathy that started during her 100 days.
We also, of course, do not know whether our protocols were originally sub-optimally selected – there may well be better protocols out there that we failed to consider.
Furthermore, we know from the feedback we have received that many Challengers found their daily moxa to be too much of a chore or something they basically got no enjoyment or meaningful results from. Some also plainly found the experience a little frightening. At the same time, however, we also had reports that some found it enjoyable, profoundly relaxing and also empowering in that it gave them much needed positive control over their condition (which both they and we consider to be extremely important).
This project was designed primarily to reveal if one or more moxa protocols might be helpful in aiding and accelerating recoveries from Long COVID. Our current conclusion is that, while two protocols have currently emerged, they have not done so to a degree that we can be confident in respect of their efficacies. Nevertheless, there seems a strong likelihood that P4, despite being the most challenging to adhere to, is the most effective.
What happens next
Second to establishing whether a clear ‘best protocol’ might emerge, we also wanted to provide information to the acumoxa profession globally in the hope that some of the many long-haulers who are currently out there and struggling to recover their health might thus benefit. To the best of our knowledge, no other similar evidence-based information has yet been available to our profession, so we hope that the Challenge will have proved itself to be of some practical use.
We were also, however, attempting to establish whether it is either reasonable or safe for Moxafrica to propose implementing a programme of remote moxibustion for long-haulers anywhere, but most particularly in countries where health infrastructures mean that any sort of ongoing recovery support might be essentially absent and where acumoxa practitioners are few or far between.
Our answer to this second question is nuanced by what we know and what we don’t know about current prevalence of Long COVID in, for instance, the so-called ‘Majority World’.
Without question we have revealed that managing a remote moxa programme is very challenging. With regards to safety, we have had no serious adverse reactions reported to us (despite proactively inviting reports of any problems from the moment of sending out the moxa), but we should stress that we did everything to provide the clearest of instructions including video clips, and ongoing check-in support and we would not recommend anyone attempting any similar project without similar efforts. In other words we recognise that self-moxa by the uninitiated can be accompanied by risk, specifically of blistering and therefore scarring if the material is misapplied, and that appropriate steps need to be taken to reduce this risk. Of course, all medical interventions are accompanied by some risk, and the key to their successful beneficial implementation is not just reducing the risk, but also carefully weighing it against the consequences of no intervention at all.
What we have also come to recognise in the course of the Challenge is that Long COVID is not just more complex than we suspected but also that it is often extremely pernicious, far more so than ‘classic’ post-viral fatigue which (when we first conceived the Challenge) we believed it to be similar to.
Has this ruled out the idea of implementing a resultant ‘remote’ programme in which we can send out free moxa and instructions anywhere in the world, but particularly to resource-poor countries? At this point of time we would answer that it does not rule this out’, and we do so for three reasons.
One of these arises from our experiences investigating moxa for TB during which we came face to face with just how deficient medical support is for so many (Partners in Health, as an example, estimate that half of humankind has no access to essential medicines as defined by the WHO) while also realising that for several reasons this deficiency is also currently chronically increasing.
The second is that this post-COVID phenomenon is still so desperately poorly understood from a biomedical perspective, and furthermore that addressing this significant public health issue is still shamefully under-resourced and ill-addressed even in richer countries. In other words, there remains an immense gap between the need for a practical therapy for Long COVID and the provision of one.
The Global situation with Long COVID
The third reason we remain positive about introducing a remote global moxa programme is because of how little is known about the scale of Long COVID worldwide. In fact, we currently find ourselves summarising what we believe to be the global situation based on what we now have some knowledge of in one country (the UK) where Long COVID is a significant health problem but is one as yet not just of unknown official magnitude but also is of total unknown duration.
Based on a very recent population survey by the UK government’s Office of National Statistics it has been assessed that 2 million Britons (or 3.1% of the total UK population) are currently self-reporting having Long COVID. What’s worrying is that a staggering 45% of these long-haulers report their condition as being of at least one year’s duration, and a profoundly concerning 22% (or nearly half a million) report their condition as still being ongoing after 2 years[i] (proportions, incidentally, which are not dissimilar from our own data gleaned from our questionnaires). How poorly these folk really are is not known (the numbers being gleaned from survey), but it’s how long their suffering may continue that is the really worrying unknown.
The new programme begins
So we feel that it was entirely reasonable for us to originally wonder whether some of their recoveries can be hastened with moxa, because our data suggests that this could well be the case. What’s more, we consider that this possibility significantly outweighs the risk of harm from moxa (assuming that appropriate clear instructions are provided and an open invitation to communicate problems is maintained).
The uncomfortable questions behind these conclusions are these: if 3% of the population of lower-income countries are suffering in similar ways to what appears to be the case in the UK, many of these people and their families will literally be facing destitution as a result. Who knows how many may be facing such problems because no-one is caring to ask these questions yet, but the consequences of such elective ignorance could unquestionably be awful.
We conclude, therefore, that it is reasonable to assume that a global need is almost certainly immense. And we further believe that, even if moxa might only help a fifth of those long-haulers to whom it might be introduced, it could still represent a valid and valiant gesture towards promoting healing and reducing human suffering.
Finally, the results reported here reflect the combined effects of moxa on a wide range of physical and mental symptoms covered by the questionnaires. We have yet to analyse any comparative effects of these four protocols on specific groups of symptoms and other parameters for which we collected data. We will, however, provide more details, as well as more information on participants’ demographics, in the course of time at which point this webpage will be updated accordingly.
(This report was initially submitted to the North American Journal of Oriental Medicine and will be published, we believe, later this year in its next edition. NAJOM has been a consistent stalwart supporter of Moxafrica for which we are immensely grateful.)
[i] Office For National Statistics (ONS), released 1 September 2022, ONS website, statistical bulletin, Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK, 1 September 2022
If you're a long-hauler and are interested in trying moxa to help you recover, please email email@example.com to find out more.