Integrating Moxibustion and Auricular Therapy into Harm Reduction Work in Durban, South Africa: Focus on the 2025–2026 Phase

 

Dr. Yuki‑S. Itaya, DAOM
Moxafrica Trustee / Okyu‑do Founder / Mukaino Method Global Senior Instructor

 

Brief Background

Durban has a large street‑living population (estimated around 16,000), many with heroin dependence and a high burden of HIV and tuberculosis (TB). The Bellhaven Harm Reduction Centre (BHRC) provides:

• Daily methadone and other medications to individuals 

• Basic medical care and wound care

• Psychosocial support

• A daily meal

• X-ray machine to check TB

• Shower

• Homeopathy 

• Moxibustion and ear seeds treatment 

Almost all BHRC clients are homeless or staying in shelters. Heroin addiction and failed job‑seeking are typical reasons they end up on the street.

Through Moxafrica, we introduced direct moxibustion and a five‑point auricular protocol at BHRC in 2022, with a follow‑up visit in 2023. Those first two visits were mainly about:

• Demonstrating that moxa and ear protocols could be used safely in this setting

• Training staff and a few “moxa captains” chosen from among the clients

• Checking acceptability and basic feasibility

By the end of 2023, it was clear that people valued moxa particularly for stress, sleep, and pain, and that some clients were able to learn and pass on the skills.

The rest of this report focuses on the third visit (October–November 2025) and the new TB/lung‑focused collaboration in 2026.

 

Third Visit (24 October – 4 November 2025): Main Focus and Team

Team

For the third visit, from 24 October to 4 November 2025, the team was:

• Myself, Dr. Yuki‑S. Itaya, DAOM – main project leader

• Ms. Minako Higa – Japan team captain, third Durban visit

• Ms. Lisa Kayanoma – volunteer practitioner, first visit

• Mr. Yuta Ishijima – volunteer practitioner, first visit

All Japanese practitioners are Moxafrica Japan team members. 

Situation on arrival

When we arrived in 2025:

• The original first captains we trained in 2023 had left (for reasons linked to the harsh realities of street life), but we still have a good personal relationship with them; they even came to visit us at the Centre in November 2025.

• A third captain who had held the programme together for a time had also left BHRC in March 2025 after a disciplinary dismissal.

• Two newer captains, whom I will call “Biggie” and “Q”, had taken over the work. They had been trained informally by the third captain and were now running the moxa activities without any direct training from us or the Japan team.

• Around them, an informal “moxa club” of about 12 regular clients had formed. These were all street‑living or shelter‑living individuals who attended BHRC almost every day, did self‑moxa, and helped when sessions were busy.

In other words, by late 2025 the programme was functioning in a peer‑led way, and our role was to consolidate, refine, and expand it, rather than to start from scratch.

Objectives of the third visit

The 2025 visit had three main aims:

1. Upgrade and standardise the skills of the existing captains (Biggie and Q) and core moxa club members.

2. Strengthen female leadership by recruiting and training female captains.

3. Review and strengthen data collection, since BHRC had already accumulated a large number of treatment records.

 

Training and Practice in 2025

Technical training for captains and club members

During the 1-week visit, we ran intensive, hands‑on training with:

• The two active captains, Biggie and Q

• Selected members of the moxa club, as “back‑up” captains

We focused on:

• Moxibustion skills and safety:

  • Size and shape of the cones

  • Correct locations on the body

  • Recognising the right level of heat (comfortable but effective)

• Protocol consistency:

  • Applying the Moxafrica protocol correctly, and using it in a practical way 

• Clinical priorities:

  • Listening to the main complaint (usually stress, insomnia, pain, fatigue)

  • Adjusting the number of points and amount of moxa to match the client’s condition 

• Hygiene and communication:

  • Basic cleanliness

  • Explaining the procedure clearly and checking the client’s response

Because we expected ongoing turnover (people moving, getting jobs, disappearing from the street), we deliberately raised the skill level of more than just two captains. All of the moxa club members were brought to a level where they could take over if a captain leaves, which has already happened several times in the programme’s history.

Female captains

Bringing women into visible leadership roles was an important target in 2025.

• We successfully trained one female captain, here referred to as “Sne”. She learned quickly, showed good clinical sense, and was capable of running sessions.

• Shortly after training, within 2 months, she left BHRC for a better job opportunity. I fully understand this choice; given the economic conditions, we must support people when they find more stable work.

• To maintain female leadership, we promoted another woman from the moxa club into a captain role and she has started working with Biggie and Q as of Jan 2026

By the end of the visit, BHRC had:

• Two established male captains (Biggie and Q)

• At least one active female captain in training

• Several moxa club members with intermediate skills who can step in as needed

 

Treatment Model in 2025

Moxibustion (main treatment)

By 2025, moxa had become the core intervention as well as a Homeopathy clinic run by local University Homeopathy department 

Key features:

• We use the Moxafrica protocol, adapted to the BHRC setting.

• Treatment is open to anyone who requests it; we do not restrict by diagnosis.

• Almost 100% of clients are homeless or living in shelters.

Most common complaints:

• Severe stress and anxiety

• Insomnia and difficulty sleeping (often worsened by heroin and methadone)

• Pain from sleeping in rough conditions (back, neck, legs, joints)

• Fatigue and feelings of being cold or run‑down

TB/HIV status:

• Is not consistently available and often not recorded

• Many clients do not wish to disclose this; we respect that and do not push

• Our focus is on the symptoms clients choose to share

Five‑point ear seeds (no needles)

The original five‑point ear protocol (introduced in 2022) 

• We use a five‑point ear protocol, but delivered only with ear seeds (small pellets on tape).

• At BHRC, we refer to it simply as the “five points” or “five‑point ear treatment.”

• There is no needling at all.

Ear seeds are especially used for:

• Stress and agitation

• Sleep disturbance

• Emotional tension and cravings

Clients are encouraged to press the seeds themselves when they feel anxiety, craving, or difficulty relaxing. This:

• Avoids the regulatory and infection‑control issues 

• Allows trained captains and club members to apply the seeds

• Involves clients actively in their own symptom management between visits

Many clients come back specifically saying they slept well after moxa and ear seeds. They often return asking for “the five points” or “that same treatment that helped me sleep.”

 

Data Collected by 2025

Captains have kept a paper‑based log of treatments from the start.

• In 2024, 758 people left documented records of receiving moxa and/or ear seed treatment. (More were likely treated, but not all completed forms.)

• In 2025, up to the time of our visit, 221 clients had documented treatments. We were missing several months of records after the third captain left 

• Altogether, there were roughly 3,000 pages of treatment logs, consent forms, and related notes.

• We introduced a new intake form (please read in moxafrica.org, all the data sheets are available to see)

Each treatment record usually contains:

• Name 

• Age and sex

• Main complaints (stress, insomnia, pain, etc.)

• Which modality was used (moxa, ear seeds, or both)

• Moxa points used 

TB/HIV status is rarely recorded, mainly to protect confidentiality and because these diagnoses are not always known at the time of treatment.

Despite these limits, the data clearly show:

• Stress and sleep problems are the most common reasons for seeking treatment.

• Many clients report coming back after a good night’s sleep, saying that is the main reason they return.

• The gentle, respectful style of the captains (particularly Biggie and Q) seems to play a big role in making the space welcoming and approachable.

 

2026: New Collaboration on Lung Health and TB

In 2026, a new and very important collaboration developed with one of BHRC’s nurses, whom I will call “Clovis”.

His roles include:

• Overseeing daily dispensing of TB drugs and other medication.

• Treating minor injuries and wounds

• Operating the chest X‑ray unit in the Bellhaven courtyard

Clovis sees X‑rays of clients with TB and other lung issues every day. Over time, he noticed that clients who were receiving moxa often looked better and reported:

• Improved sleep

• Reduced stress

• A general feeling of increased wellbeing

After meeting and talking in detail with me he recognised that:

• TB/lung disease and moxa might work well together as complementary approaches—medical treatment plus self‑care.

• He also recognized our research done in Uganda in 2012

• The Japanese TV program NHK made an excellent documentary about how traditional medicine works which helped him to understand the benefits. 

Planned lung‑focused self‑care moxa programme

Together, we are now developing a structured programme for clients with lung problems, including TB:

• Identification:  Clovis will identify clients with lung issues (from X‑ray findings or chronic symptoms) and introduce them to moxa as a self‑care option.

• Education:  Clients will receive simple written and verbal information explaining what moxa is, how it may support lung health and energy, and how to use it safely.

• Training in self‑moxa:  interested clients will be trained in a moxa protocol adapted to lung issues, with a strong self‑care focus.

• Home/shelter moxa kits:
  Each participant will receive a moxa kit to take away, so that continuing treatment does not depend on always coming to BHRC.

These kits are prepared by volunteer students in a Japanese acupuncture school every year.

• Follow‑up (3–6 months):
  Clovis and I will follow up clients for 3–6 months, monitoring:

• How regularly they use self‑moxa

• Any self‑reported changes in cough, breathlessness, fatigue, and general lung comfort

• Changes in sleep, stress, and overall wellbeing

This collaboration links the moxa work more directly with TB and lung health, using:

• X‑ray and standard medical care, together with

• A low‑cost, body‑based self‑care method (moxa)

 

Aim and Call for Collaboration

My personal aim now is to make this programe:

• Accessible,

• Easy to learn, and

• Replicable in other settings.

I would like to develop:

• A book or manual

• Video materials

based on our experience at BHRC, so that more satellite clinics or community groups can use the same model for homeless populations, people who use drugs, and those living with TB.

If you are genuinely interested in this work, or if you are eager to help create similar program please feel free to contact us.

​

We welcome collaboration with practitioners, educators, students, researchers, and organisations who share an interest in practical, low‑cost approaches within harm reduction and TB care.