Can moxa help protect us from COVID-19?

SARS Cov-2 ... COVID-19 ... nCoV19… whatever it’s called, can we help protect ourselves from it with moxa?

- How dangerous is it, for instance?

- Can we reduce the risks of infection?

- Can we strengthen our immune systems?

- Might moxa help do this?

- For instance, might moxa reduce the risk of getting a primary infection?

- Might it help reduce the risk of a more dangerous disease progression?

- Or might moxa help if quarantined?

It’s not even clear yet what name we’re going to remember this new disease by.[i] And unfortunately, it’s still even less clear exactly how dangerous it is. But it does look like we're all now at some risk of being infected by it.

We’re determined not add to any alarm about so much uncertainty in this blog, but equally we feel we can contribute to the developing discussion. We also recognise that it’s important to be realistic: it is quite possible that this is a highly infectious pathogen that’s going to infect a lot of people, and also that it may be around for a long time to come. We certainly don't think that it’s wise, meanwhile, to put much trust in mainstream media reports about it given that creating fear sells newspapers, but nevertheless some of the public health reports both inside and outside China do suggest that this may turn out to be a very serious pandemic indeed.

So is it alarmist to publicly discuss what that might mean in terms of one’s individual risk and whether we can reduce this? Well we’ve thought about this very carefully and concluded that it isn’t, and this blog is the result of these considerations.

How dangerous is it?

We can be in no doubt that this novel pathogen is infectious, though there are varying versions of just how infectious it might be. It’s also potentially lethal, but again there are variable versions of this being reported, even in august medical journals. There’s no point us repeating any of them here because in the end all of them will probably turn out to be wrong anyway.

What’s certain is that the virus is spreading despite a lot of effort to contain it, and this means that all of us face the strong possibility that sooner or later we will end up being at some degree of risk of being infected by it.

Dr Li Wenliang

(who originally exposed the virus and died from it on Feb 6th)

So how can we reduce this risk?

We can certainly expect to be bombarded with suggestions about this in the coming weeks (because doing so also sells newspapers), and some of these suggestions will relate to ways of fortifying our immune systems. Many of them, incidentally, will also probably be suspect or even downright specious. A lot will also come with offers of existing products which will be priced significantly higher than they were a few weeks ago (such is the nature of supply and demand). And all will come with no evidence at all of being able to provide any specific protection from a pathogen that until a couple of months ago was totally unknown, and so is both unfamiliar and only partially understood by infectious disease experts.

Well here comes one of these very suggestions (so feel free to put your sceptic’s cap on from the outset!).

What we can at least say is that what follows comes with no accompanying profit motive. In fact, it’s offered cautiously but in good faith by a charity that’s already deeply committed to helping fight infectious disease. Nevertheless it's unavoidably offered without the benefit of any sort of full picture, but is corroborated by some hard-won background data from our research into another lethal infectious disease (with some simple down-home logic added for good measure).

Moxa

We’re simply suggesting using daily self-applied moxa to a point on the leg (on an acupoint known in WHO terminology as Stomach 36 [St36], and in Chinese as zu san li, or ‘leg three miles’). Doing moxa at this point appears to strengthen the host immune system (although we currently don’t know exactly how it does this). It’s a point on the body that has a centuries’ old tradition in East Asia of promoting resistance to infections and prolonging life when moxa is regularly applied to it, but to add to this Moxafrica also now has accumulating robust modern scientific data which supports this tradition.

Strengthening the host immune system

It’s not in any way controversial to suggest that a stronger immune system might be a good thing to have when there’s an infectious disease around (but we’ll discuss this more later because, like most things, it may not be quite that simple). If we generally accept this principle, though, then what evidence is there for us to suggest that moxa might especially strengthen such ‘host’ immunity?

Actually, we’ve found a fair amount out there, though for many reasons we’ve found it difficult to make coherent sense of it all. We’ve spent years now attempting to do this and have written on it elsewhere. But more importantly we’ve also been actively involved in primary research looking at how moxa may be able to protect people against infection with another infectious pathogen (drug-resistant tuberculosis) and we’ve amassed a set of evidence that it does exactly that, both preventing TB infections and also helping recoveries from MDR-TB after infection (click on this link for more info). What’s more we’re as certain as we can be that it does this by provoking a broad and low-level strengthening of the host immune system.

What’s more this research has taken place specifically where resources are poor (i.e. where it’s difficult to diagnose or treat MDR-TB) – which, it must be said, is likely to be the case in much of the world with COVID-19 if it spreads at scale in the short-to-medium term.

So how might moxa help?

We’re still cautious about casually invoking similarities between host immune responses that are specific to TB and to COVID-19. Tuberculosis after all, is a mycobacterium, while COVID-19 is a virus (and the immune system responds to each of these in different ways). TB, furthermore, has been haunting humanity since prehistory so the human immune system has long been familiarised to it (as much as it may still struggle with it); COVID-19 meanwhile is an entirely new pathogen for the human immune system to recognise and respond to.

What’s more, TB infects and develops very slowly (in years), whilst COVID-19 seems to do this very quickly (in days and weeks).

These are significant differences, so how sure can we be that moxa might help protect us if the disease spreads in the way many now fear that it will?

Well the truth is that we can’t be sure, but we’re also certain that it won’t harm as long as some simple rules are adhered to. We say this because (and we want to stress this) we’re confident that moxa has a broad-spectrum low-level cumulative strengthening effect on the host immune system so won’t throw things wildly out of balance whilst working. We are now convinced that this effect works rather well with a slow-burning disease like TB after an initial infection, although we recognise that we can’t be so confident about how much it might help after a much faster-moving infection with COVID-19 (especially once the infection has developed into something acute, and dangerously symptomatic).

So might it help reduce the risk of initial infection? Or indeed (if this has failed, and infection does occur) might it be the case that the addition of moxa might help prevent the disease from progressing into a much more dangerous and life-threatening state?

Let’s take a look at both of these questions in turn.

Firstly the risk from primary infection.

The truth is that no-one yet seems to have a clear picture of how transmission of this new disease occurs, whether it’s mainly through inhalation, whether through digestion, whether through membranes like the eyes - or any combination of these. Nor is there yet a clear picture about how exposed you need to be to the virus for an infection to take root, in other words exactly how infectious it may be. (All routes for transmission are probably highly susceptible to environmental factors anyway, and there are existing highly variable reports of the virus’s infectious potential).

But what is already evident is that, thankfully, not everyone who is exposed to the virus ends up with active symptomatic disease. And given that this is a novel virus, this can’t be because some of us harbour existing sensitised immune cells that might instantly trigger against it and so protect us from an infection developing. It must more probably be because of a less specific immune response.

So is it reasonable to assume that those who’ve not developed the disease after exposure have done so because their existing immune system is strong and broad enough to provide sufficient protection against a novel virus to prevent it replicating or creating havoc? It certainly seems possible. (And this is hardly a crazy idea – otherwise humanity would have died out a long time ago from the sorts of novel plagues that have intermittently occurred in previous centuries). In other words, if moxa can fortify a host immune response, then maybe it could help.

The second question: might moxa help prevent the disease from progressing into a more dangerous life-threatening state?

Similarly, is it also reasonable to suggest that those who do contract the disease but only develop a milder form of it do so because their existing immune systems are relatively stronger than those whose infection develops seriously? Again, we’d suggest that this is probably true, not least because existing reports about those who most often succumb to the disease appear to have existing lower immunity (i.e. the elderly and diabetics, etc.).

We should add here that a review of the first 42,000 cases in Wuhan has suggested that 81% of these cases only developed a mild illness. This is certainly reassuring for those who consider themselves to probably be on the healthier side of this percentage threshold, but if there’s widespread infection it also tells us that there are still a lot of us at risk from this virus.

So similarly to answering the first question, it seems reasonable to suggest that if moxa can fortify the immune system then it might help these more vulnerable cases.

And there's also a third question: it's been reported that this disease has re-emerged in at least one case who had already recovered from a first infection (not unlike a cold sore virus does in other words); so might moxa help prevent the disease from re-emerging if this phenomenon is found to be common?

It's certainly a reasonable question to consider - but for now we know far too little to say more on this.

Our bottom line is this, though: if we’re right in claiming that daily moxa can strengthen the immune system, then it certainly seems likely (without any existing evidence to the contrary) that moxa might help.

But, of course, we should at least provide some evidence to back up this claim. So here’s what we have to say on this aspect.

First our careful caveats

1. We’re specifically talking here about small cone direct moxa, because that’s what we have evidence for. This is the smouldering of tiny 1mg cones of refined moxa on specific acupoints (in this instance St36 on the leg). We say this for the simple reason that it’s the method which we have best evidence for. (There are a lot of different methods of using moxa, and the fact is that we simply don’t have enough evidence for the other methods to make any claims about them – and, as importantly, we also know that this method is safe, quick to complete and effective.)

2. We also think that this simple therapy is best done on a daily basis, ideally before any risk of infection is reported in a local community (in other words so that the slow low-level cumulative effect of the moxa can have the best chance of taking effect) but otherwise as soon as possible.

3. There are few contraindications for moxa therapy when small cones are used, but common sense should nevertheless be applied, particularly if other health conditions already exist (so-called ‘co-morbidities’). Unfortunately, such co-morbidities are being reported to add to the risk of serious acute disease needing hospitalisation, so (like everything) careful weighing of risk may be important. We suggest that common sense answers this quandry: we know that moxa when properly applied induces only a low-level response that accumulates over days and weeks, so a simple principle should prevail: if there are signs that any other condition that already exists might be getting worse, then stop the moxa and review. Otherwise, proceed and let the effect develop.

We should specifically add here, however, that if your immune system is severely compromised (by diabetes, for instance, or by HIV/AIDS) that moxa should be begun very carefully.

4. Furthermore we do NOT recommend using moxa at all if there are any signs of a fever. In other words, if there are any signs that COVID-19 disease is active, then moxa should only be attempted by a trained acupuncturist.

5. We also fully recognise that there are many other ways to help protect ourselves from this infectious pathogen, and recommend paying careful attention to any suggestions emanating from either global authorities or other more local health providers. (We will certainly be doing this ourselves as well!)[ii]

Moxa when quarantining?

Whether self-imposed or imposed by national authorities, quarantining is a logical and effective way of reducing risks of both being infected and infecting others. Quarantines, or lock-downs, are put in place because there’s already a known infectious pathogen stalking the neighbourhood (as in the Wuhan lock-down) or because there’s a risk that you may already be infected and you mustn’t pass it on to anyone else (as in the Diamond Princess cruise ship in Yokohama, although it may have been counter-effective in this case).

Being quarantined, whether as a community or individually, is a pretty scary situation to find yourself in. Currently the recommendation is that you should hole up for at least two weeks and wait it out.

In such scenarios, whether holed up or locked down, doing anything that might potentially fortify your immune system would seem to be a rather good idea. Think about it: in the first instance it makes sense to protect yourself as best you can against a dangerous infection that you are being told is out there in your neighbourhood (and you’ll be back out there again soon yourself); in the second you would want to do all you can to minimise the risk that, if you’re already infected and you do develop the symptoms, they might turn out to be as mild as possible.

What can you do in such a situation?

Our suggestion is very simple – to apply moxa at St36 on each leg. Maximum 7 cones each day.

What grounds do we have for suggesting all of this?

We can firstly invoke some of the research we helped develop with the North Korean Public Health Department which looked to see whether moxa might help prevent TB from developing in close contacts of infectious cases who were known to be at specific risk.

The North Koreans compared daily moxa against daily drug therapy with isoniazid (which is the most widely used drug that’s approved for preventing TB in such cases), and daily moxa compared well against the drug. (This was an important finding since, if the strain of infection is drug-resistant, then isoniazid is practically useless so moxa could do its job). But the key finding in respect of moxa for preventing COVID-19 was that they reported a ‘positive trend’ of increased lymphocytes in the patients who used moxa.

This report doesn’t just suggest that the effect was simply because of a generalised immune response in other words – it suggests that the immune response includes a proportional increase in a component of white blood cells which are specifically useful for defending the body against viruses (including unfamiliar ones). This is one of the things that lymphocytes are known to do. So while TB may be a bacteria and COVID-19 is a virus, there’s still suggestive evidence here that daily moxa might potentially defend us against this new pathogen.

The second corroborative evidence is from way back in 1929 – from research that was conducted by a Japanese doctor at the height of the country’s tuberculosis epidemic before any TB drugs had been discovered. Dr Shimataro Hara, whose achievements readers of our blogs will already know remain a continuing inspiration for our own work, was looking at how his TB patients might be best protected against the ravages of tuberculosis by using moxa – and he demonstrated this (using the so-called ‘scientific method’ as is still usual in medical research) by infecting groups of small mammals and then administering different treatment regimens on each group to see how they each responded.

One group was given their moxa therapy a few weeks before infection and continued afterwards; another group had the same regimen started at the same time but this was halted once infection had occurred; another group received moxa therapy starting on the day of their infection; and another group had moxa therapy withheld till a few weeks after infection. In other words, varying combinations of moxa application were being compared. Sadly, all of the animals had to be ‘sacrificed’ to science at the end of the study so that their internal organs could be examined to see how their respective infections had progressed. As a result there were no outright survivors from this experiment, but the outcome was nevertheless very clear: the animals who had had the benefit of moxa both before infection and after it fared significantly better than any of the other groups, and so logically we wonder whether the same thing might apply to a COVID-19 infection.

Of course, we accept that these were small mammals (Japanese marmots in fact) while we are human beings, and we also fully accept that COVID-19 isn’t tuberculosis, but put these two sets of evidence together (the North Korean and Dr Hara’s) and we think that using moxa could well reduce the general chances of (a) getting infected or (b) developing more serious disease if it happens.

We also accept that there’s not a chance that we’ll have access to any better data on this to support this suggestion whilst this pandemic runs its course, and we also suggest (as is the norm) that, if you can, you should consult a fully qualified medical practitioner before embarking on this therapy (although most won't know anything about it at all).

But if you’re in quarantine, we seriously wonder whether you would have that opportunity anyway – and our own research has taken us to corners of our world where such access is a luxury anyway which was one of the things that drew us to researching moxa in the first place (because of its simpilicity).

The truth is that for half of humanity the idea that either the technical diagnostics for this disease or the appropriate intensive care for acute cases will be widely available is a fantasy, and so the potential for this virus to create real problems for these vulnerable people and for the virus to spread at scale in such communities is very frightening.

So finally...

We would be delighted to engage with anyone who finds any of the contents of this blog of interest or indeed feels minded to challenge any of it. Please email us at info@moxafrica.org and we’ll do our best to respond.

Meanwhile we include a link to a short video showing how moxa can be safely applied at St36 made by some friends of ours in Australia[iii], and will almost certainly publish more on this as the situation develops. (We will also probably update this blog if we think it’s needed because we very much respect that this is a developing disease).

Footnotes:

[i]There does appear to be some semantic logic to these names incidentally but they’re still hard to unpick. The infection itself is now technically called “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2). It is apparently the pneumonia that is induced by SARS-CoV-2 that is named coronavirus disease 2019 (COVID-19), although to us this seems to be the wrong way round. Either way, you’re unlucky enough to be confirmed as being infected with the virus you’ll have one of these, but if you’re more unlucky and develop the associated pneumonia you’ll have the other. nCoV19, meanwhile was the earlier acronym that appears now to be superseded by these other two.

[ii]Here, for instance, are a few simple foods that have research behind them for boosting immunity.. Garlic:People who take garlic supplements over a three-month period have fewer colds.

Alcohol (!)_:Research suggests that moderate drinking (usually defined as one drink a day for women) helps the immune system. But binge drinking is out because it has the opposite effect!.

Apples: The fruit is rich in soluble fibre, a substance that seems to improve immunity. Researchers found that mice given this type of fibre got half as sick as mice that weren't given any, and recovered 50 percent faster.

Chicken soup (if you’re not vegan or veggie, of course):Chicken soup contains carnosine, which is an amino acid compound that helps your body fight off flu in the early stages.

Vitamins A, C & D: in decent doses are known to support the immune system. [iii] https://www.youtube.com/watch?v=A8dsWLSdtNA