What is Oriental Medicine?
Oriental Medicine, or Traditional Chinese Medicne (TCM), is as diverse in its practice as western medicine. It is employed in both acute and chronic illnesses, and it includes internal and external pharmacological therapy. Chinese herbal medicine includes the use of plant, animal and mineral substances. Preparations are administered, similar to western medicine, via a number of routes:
- oral consumption (such as pills, teas and powders)
- nasogastric administration
- topical applications
- intravenous, intramuscular, subcutaneous injections
- vaginal and rectal preparations
- ear and eye preparations;
- acupuncture, including traditional manual needle stimulation
- modern usage of laser and electrical stimulation
- embedding needles
- Chinese massage
- dietary and lifestyle advice
- specific techniques including moxibustion, cupping, scraping, point injection therapy, breathing, movement and meditation
TCM is based on an understanding of health and illness which differs substantially from that in western medicine. Clinical phenomena are interpreted by reference to theories of bodily operation which are alien to the western-trained scientific eye. A brief overview of the key differences between Oriental and western medicine is provided.
The Mechanism of Moxibustion: Ancient Theory and Modern Research
The moxibustion has a dual effect of tonification and purgation in TCM theories, which are based on two aspects: the actions of the meridian system and the roles of moxa and fire. Modern research works of the moxibustion mechanism mainly relate to the thermal effects, radiation effects, and pharmacological actions of moxa and its combustion products. Experimental results showed that moxibustion thermal stimulation affects both shallow and deep tissues of the skin, and the warm-heat effects of moxibustion have a close relation to the warm receptors or/and the polymodal receptor. The burning moxa radiation spectrum ranges from 0.8 to 5.6 μm; peak is nearby 1.5 μm, lying within the near infrared portion. There is an amazing consistency in the infrared spectrums of three types of indirect moxibustion and the unified spectrum of acupoints; all have their peaks of radiation near 10 μm. Lots of ingredients had been identified from mugwort leaves and moxa smoke, which have a variety of biological activities; they were considered to participate in the comprehensive effects of moxibustion. Although lots of research works have been carried out and made some progress, there is still a great distance from fully understanding the mechanism of moxibustion.
Moxibustion is a kind of external treatment; it is based on the theory of traditional Chinese medicine (TCM), and it usually bakes acupoints with burning moxa wool. Moxibustion can dredge meridians and regulate qi-blood and has been used to prevent and cure diseases for more than 2500 years. Zuo zhuan of the pre-Qin dynasty in China, which recorded a disease discussion occurred in 581 B.C., is considered to be the earliest literature of moxibustion. The silk books discovered in Mawangdui tomb of the Han dynasty (about 168 B.C.), Moxibustion Classic of Eleven Foot-hand Meridians and Prescriptions for Fifty-two Diseases, had documented the use of moxibustion to treat complex diseases. There are a lot of moxibustion contents in Inner Canon of Huangdi; it inferred that the origin of moxibustion is related to the living habits and disease characteristics of northern Alpine nation in the part of Su wen, Yi fa fang yi lun. Later doctors after Han dynasty had made considerable progress in theory and practice on moxibustion and promoted moxibustion to be a mature and widely used therapy.
Moxibustion has been applied in treating a great range of diseases. A bibliometric analysis on the papers published from 1954 to 2007 in China showed that up to 364 kinds of diseases can be treated with moxibustion. The most proper indications of moxibustion therapy are malposition, diarrhea, and colitis; the common proper indications are urinary incontinence and dysmenorrhea; the next common proper indications are knee osteoarthritis, temporomandibular joint disturbance syndrome, soft tissue injury, heel pain, asthma, urinary retention, and herpes zoster . Moxibustion can also be used to treat weakness, fatigue, and aging related problems. Moxibustion can be classified as traditional moxibustion, drug moxibustion, and modern moxibustion. Traditional moxibustion therapy is the most commonly used in the ancient and contemporary moxibustion clinics; it is characterized by the use of moxa as burning material and can be divided into direct moxibustion and indirect moxibustion depending on whether moxa is directly in contact with the skin while operating. A moxa cone placed directly on the skin and ignited is called direct moxibustion, while the moxa kept at certain distance from the skin is called indirect moxibustion. The insulating materials of indirect moxibustion can be air, garlic, ginger, aconite, salt, and so forth. Drug moxibustion, also named nature moxibustion, uses irritant drugs (such as cantharis, garlic, and semen sinapis) to coat the surface of acupoints and make local skin flushed and blistered to cure diseases. Modern moxibustions, such as microwave moxibustion, laser moxibustion, and electrothermal moxibustion, are used to simulate traditional moxibustion stimulation factors by physical or chemical methods to achieve therapeutic effects of moxibustion. Usually, narrow sense of moxibustion refers to the traditional moxibustion with moxa. This review will concentrate on the ancient theory and modern mechanism research of traditional moxibustion.
2. Traditional Moxibustion Theory
Ling Shu, Guan Neng says that where needle does not work, moxibustion does. TCM theory holds that moxibustion has a dual effect of tonification and purgation. Different from needles and drugs, characteristics of moxibustion in materials and using fire determine that its efficacy is inclined to warming and nourishing. So, moxibustion is often applied in deficiency-cold syndrome, though some excess-heat syndrome can also use it. The roles of moxibustion can be broadly grouped into warm nourishing, warm dredging, and warm melting. Warm nourishing refers to the benefits of warming Yang, tonifying qi, nurturing blood, and relieving depletion; warm dredging refers to the functions of activating blood, dissolving stasis, promoting qi, dredging channels, and relieving pain; warm melting refers to the roles of reducing phlegm, eliminating stagnation, removing wind, dispelling dampness, drawing out poison, and purging heat. Some people believe that warm dredging is the nature of moxibustion and is the key role of moxibustion effects. The functions of moxibustion, expelling cold, promoting the circulation in meridians and collaterals, clearing away heat, detoxification, and so forth, are dependant on the efficacy of moxibustion for circulating qi and blood flow .
In TCM basic theory, moxibustion effects are based on two aspects: the action of the meridian system and the role of moxa and fire.
2.1. Meridian System
TCM usually takes “needling” and “moxibustion” collectively, for both of them are similar therapeutics based on the same theory of meridian and acupoint. In other words, the moxibustion therapeutic effect is partly dependant on the body’s nonspecific system of meridians.
Moxibustion is closely related to meridians, cutaneous regions, and acupoints. Meridian system consists of channels and collaterals; they are pathways of communicating internal and external, contacting organs, running qi-blood, and regulating the whole body. Ling Shu, Hai Lun says that there are twelve regular channels, the inner ones belong to viscera and the outer ones connect with limbs. TCM believes that a person is as a whole. The organs and limbs communicate and interact through the meridian system, which plays a very important role in physiological functions and pathological processes. The cutaneous regions are the surface part of the twelve regular channels, which are nourished by channel-qi. The cutaneous regions can show the status of qi-blood from meridians and organs, also it can receive treatment stimulation and then make effects. Acupoints are the sites on the body surface, in which the qi of organs and meridians assembled, that act as target points and response points of treatment.
In the moxibustion treatment process, the cutaneous regions and acupoints are the terminals of the meridian system, as the receivers, by which moxibustion stimulations can be transmitted into the body. Through the meridian system, moxibustion can reinforce insufficiency and reduce excessiveness and directly correct the disease state of the human body or activate the meridian system self-healing function and play a therapeutic role. For example, the different acupoints can cure different diseases in moxibustion, and the same acupoints can get similar results regardless of acupuncture or moxibustion; all of these proved that the body meridian and acupoint system play an important role in the treatment of moxibustion.
2.2. Moxa and Fire
Elementary Medicine believes that the diseases that cannot be cured by drugs and acupuncture should be treated with moxibustion. The unique therapeutic effects of moxibustion are closely related to the specificity of moxa and fire.
On moxibustion fire in TCM, there is a discussion in Shen jiu jing lun stating that moxibustion using fire, for being hot and rapid, with soft body can bear with that to eliminate the shadow; it can move instead of stay and always go into organs. Fire is hot, so it can warm back the Yang and eliminate cold of the Yin, even it can melt the poisoning things caused by damp, wind, phlegm, and so on; fire is speedy, so it can dredge the channels, remove the pain or numbness, and active blood and qi. So, the feature of moxa fire shows the main role of moxibustion.
Materials are very important to moxibustion. The choosing of materials of moxibustion in TCM is really harsh. Pu ji fang, Acupuncture cited the Xiao pin fang on eight kinds of fire: moxibustion with pine wood fire, hard to cure; cedar wood fire, ulcer and pus; orange wood fire, skin hurt; mulberry wood, muscle withered; jujube wood fire, body emaciated; bamboo fire, tendons injured, excessive lead tendons flabby; trifoliate orange wood fire, veins “collapse”; elm wood fire, bone hurt, excessive lead bone withered; none of them can be used. But moxa fire is warm without dry, and it can ascend and descend with strong penetration ability into the viscera. Compendium of Materia Medica had said that moxa leaf are slightly bitter and over-spicy when raw, and slightly spicy and over-bitter when processed. Moxa with the nature of pure Yang, raw moxa is warm and become hot after processing. It can take the Tai-Yang fire and get back dying Yang. It can go through three Yin, get rid of all the cold and dampness, and turn the cold into warm after taking orally. Moxibustion with moxa leaf can get into the channels and cure hundreds of diseases. Its function is great. The drug properties of moxa leaves (raw) are that they turn warmer after being processed, become moxa wool (processed), which are suitable for moxibustion, and the older the better. The ancients chose moxa as moxibustion material for it is easy to collect and more for its drug properties, and long-term clinical practices have proved that.
3. Mechanism Research of Moxibustion
Modern research of moxibustion started in the earlies of last century, Japanese scholars began to observe physical characteristics of moxibustion materials and the effects of moxibustion on blood pressure and intestinal peristalsis in 1912 [3, 4]. Up to this day, there have been more and more studies of effects of moxibustion on the human body or experimental animals, almost involving all major physiological systems, especially in the fields of analgesic, enhancing immunity and antiaging. At the same time, researching works on the mechanism of moxibustion also gradually developed, mainly related to the thermal effects, radiation effects, and pharmacological actions of moxa and its combustion products.
3.1. Thermal Effects
Burning moxa without flame can produce high temperature of about 548–890°C [5, 6]; it will give a warm feeling when it isclose to the body, so some people think that this treatment is essentially a thermal physical effect . Experiment confirmed that single Zhuang (a dose unit of moxibustion) of moxa cone (2 mg) moxibustion on mice abdomen can raise the temperature to 130°C outside the skin of the point and 56°C inside the skin; the same changes of temperature were not observed in the forelimb far away from the stimulation site . By using 50 mg moxa cone direct moxibustion on the skin of mice with thermocouple implanted, the temperatures of epidermal, subcutaneous, and basal layers were different; the results suggested that moxibustion thermal stimulation affects both shallow and deep tissues of the skin . The maximum temperature change by indirect moxibustion was about 65°C on the skin and 45°C in the subcutaneous layer . The temperature-time curve of moxa cone can be characterized by slow rising, rapid rising, rapid decline, and slow decline phases, and ginger-separated moxibustion can “buffer” the temperature changes . The actual temperature of indirect moxibustion is greatly affected by the texture, size, and the moisture content of the insulating material .
The thermal effects of different moxibustions are not the same. Some people used thermal resistor thermometer and computer online real-time processing to measure the skin temperature at the acupoints of different moxibustions: direct moxibustion, ginger-separated moxibustion, suspension moxibustion, light moxibustion, and He-Ne laser moxibustion. All of them except He-Ne laser moxibustion had significantly changed the temperature of the acupoints through the skin to the muscularis, and each had their own rules and characteristics. The results suggested that the effects on acupoint and even the efficacy of moxibustion depend on the temperature changing of acupoint caused by moxibustion . Others observed the relationship between the moxibustion effect and the intensity of thermal stimulation through the change of pain threshold. In the 40~60 minutes of moxibustion, the pain threshold rose with the operative time and increasing the burning moxa amount per unit time can significantly improve the immediate analgesic effect and lingering effects . Experiment of activation of subnucleus reticularis dorsalis (SRD) neuron by variety intensities of moxibustion thermal stimulation shown that noxious thermal (44–52°C) stimulation can activate SRD neurons, which reaches a plateau when the stimulated area is increased to a certain range .
The warm-heat effect of moxibustion has a close relation to the warm receptors (WRs) or/and the polymodal receptor (PRs). The antipyretic and thermolytic effects of moxibustion are achieved by stimulating polymodal receptors of acupoints [16–18]. Effects of moxibustion on the skin can appear as hottness, flushing, pain, blisters, and other skin irritations and burns phenomena. Moxibustion can lead to vasoconstriction at the burning point while vasodilatation around the point and increase peripheral arterial blood flow and microvascular permeability [8, 19]. Another thermal effect of moxibustion is to induce heat shock proteins (HSPs) in local tissues. HSPs are a class of functionally related proteins involved in the folding and unfolding of other proteins. As an endogenous protective mechanism, HSPs can be synthesized in cells in response to hyperthermia and other environmental stresses. The HSPs induced by moxibustion may be an important factor of its mechanism of action .
3.2. Radiation Effects
By irradiating acupoints of pain model rats with radiogenic heat of 40–43°C, there are no significant changes in the tail-flick latency or vocalization threshold, suggesting that not any thermal stimulation can achieve moxibustion efficacy . The burning moxa emits visible light and infrared (IR) radiation; therefore, besides the heat effects, nonthermal radiation effect may be an important role in the efficacy of moxibustion. Physics tells us that the radiation is a process of energy outward diffusion in the form of electromagnetic waves or particles; any object above absolute zero in temperature emits electromagnetic radiation. At present, the common view is that the ignited moxa radiation spectrum ranges from 0.8 to 5.6 μm; peak is nearby 1.5 μm, lying within the near infrared (NIR) portion . But results are reported differently due to the measurement methods and the experimental conditions. Thermal radiation of burning moxa stick measured by indirect methods is mainly far infrared (FIR) near NIR, with spectrum peak at 2.8 μm . Measured with visible-infrared monochromator, radiation spectrum of drug moxa sticks is distributed from red light through NIR to middle infrared (MIR), in which multipeaks especially at 2.4 μm are detected and without the parts of wavelength shorter than 0.6 μm .
By analyzing and comparing the infrared radiation spectrums of the moxibustion, the substitute moxibustion, and acupoints of human body, it was found that there was a surprising consistency in the spectrums of three types of indirect moxibustion, namely, separated with prepared monkshood, ginger, and garlic, and the unified spectrum of acupoints. Both had their peaks of radiation near 7.5 μm (after modification, this wavelength should be around 10 μm). However, the spectrum of the substitute moxibustion (separated with cucumber and carrot) was completely different from them. Its warming function was far less than the traditional moxibustion, and there was also a big difference between the infrared radiation spectrums of the moxa-stick (with a peak at 3.5 μm) and acupoints (see also Figure 1and Table 1). The results indicated that, in the therapeutic effect of traditional indirect moxibustion, the resonance vibrations of infrared radiation of indirect moxibustion and acupoints play an important role and the substitute moxibustion could not replace the traditional moxibustion in terms of the infrared characteristics of moxibustion [25–29].
Infrared acting on the body will produce thermal and nonthermal effects. Thermal effects are produced under the action of electromagnetic waves; the human body molecules absorb energy from IR and convert it into heat and therefore promote blood circulation and improve the cell and enzyme activities. The nonthermal effect is related to the interaction of electromagnetic waves and organism; it is more complex and with nonlinear characteristics. The actions of NIR and FIR on organism are different. NIR is generally believed to play a major role in the biological radiation effect of moxibustion. When NIR irradiates body, the light reflected by the skin is relatively low, the energy can be transmitted about 10 mm deep into the skin, reach the tissues, and be absorbed by them . The NIR can induce some active substances produced within the tissues, after being absorbed by connective tissue, blood vessels, lymphatic vessels, and nerves under the irradiated skin, distribute to other parts of the body with the blood circulation, and enhance the metabolism and thermogenesis of organs they reached. NIR can also energize the metabolism of cells. The energy generated by the photoelectric effect and photochemical process and passed through the nerve-humoral system can provide the activation for the pathological cells lacking energy and then further adjust the body’s immune and neurological functions [31, 32].
3.3. Pharmacological Actions
Moxa, Artemisia argyi Levl.et Vant., also known as mugwort, is a Compositae Artemisia perennial herb. Mugwort leaf can produce moxa wool after drying and grinding, which is a common moxibustion material. The ingredients of moxa are complicated; more than 60 kinds of components had been identified . The volatile oils of moxa include 1,8-Cineole, alkenes (alpha-thujene, pinene, sabinene, etc.), camphor, borneol, and little aldehydes, ketones, phenols, alkanes, and benzene series compounds. Heptatriacontane (C37H76) plays an important role in combustion . The moxa also has tannins, flavonoids, sterols, polysaccharides, trace elements, and other ingredients.
The ingredients of moxa always change according to the place and season of production. The oil rate of QiAi in Hubei is obviously higher than in Hebei, Shangdong, and other places. Some people had measured the heat of combustion from different kinds of moxa: QiAi (from Hubei) was 18139 J/g, BeiAi was 17463.4 J/g, QiAi (from Hebei) was 17419.3 J/g, and ChuanAi was 16136.4 J/g . The combustion heat of QiAi (from Hubei) was the biggest, and it has been considered to be the best moxibustion material since ancient times.
The volatile oil rate of moxa is 0.45%–1.00%. It has a variety of biological activities such as the expansion of airway smooth muscle, relieving cough, expectorant effect, and a strong antioxidant activity [36–38]. The moxa is rich in flavonoids and polysaccharides, which have strong antioxidant activity too [39, 40].
The moxa combustion test showed that the relative equilibrium moisture content of moxa was 13.51%, the relative ash content was 11.77%, and the relative smoke production rate was 126.42% . Parts of the moxa combustion products are brown tar-like substances; they play a role by penetrating into the human body through the skin damaged by the burning. The moxa and the combustion products of moxa having been extracted with methanol, both extracts showed the actions of clearing the free radicals and lipid peroxidation, and the latter was stronger. The result indicated that the active ingredients of moxa were increased rather than being destroyed after burning. The methanol extracts of moxa combustion products, tars, can be divided with silica gel column chromatography, and the antioxdant components were found in band IV. Further divided by thin-layer chromatography, the antioxidant effect in band Rf 0.14 is better than the synthetic antioxidant BHT. Ginger and garlic, the important auxiliary materials for moxibustion, are commonly used in indirect moxibustion. The ginger and garlic had been put on the evaporating dish for experiment and had confirmed that gingerol and allicin, the active ingredients of them, could act on the body by heat to give the therapeutic effects [42–44]. The extracts of moxa combustion ashes also have the strong ability of antifree radical .
Another combustion product of moxa is smoke. The smoke of moxa contains a variety of complex components, and its volatile ingredients are ammonia, alcohols (ethylene glycol, pentyl butanol), aliphatic hydrocarbons, aromatic hydrocarbons, terpene compounds and their oxides, and so forth. They may come from the incomplete combustion products of moxa volatile oil of moxa and its oxidation products. Qualitative analysis of the smoke of burning moxa by solid phase microextraction-gas chromatography-mass spectrometry (SPME-GC-MS) had isolated 61 peaks and identified 26 ingredients. The founded substances can be divided into 3 parts by time: the furan structure substances in 0–10 min, mainly aromatic compound in 10–40 min, and esters, alkanes, or hydroxyl-containing compounds in 40–70 min . The smoke of moxa can be used in air disinfection and as antiviral and antifungal. It was also reported that it has applications in wound infections, vaginal itching, uterine prolapse, anal fistula, common warts, and so forth , and some studies showed that the smoke of moxa would make effects on the body through breathing .
There is still a debate on the safety of moxa smoke. Some reports showed that moxa smoke may be harmful to the human body, such as causing allergic reactions [49, 50]. The mugwort leaf contains terpenes; it may produce polycyclic aromatic carcinogens in the process of combustion, and during moxibustion, the concentration of air pollutants, such as nitrogen oxides, carbon monoxide, and particulates, is tenfold higher than the level of standard class II which was issued in the State Environmental Protection Act. They would do damage to the patients and staffs . But a research giving consideration to short-term and long-term exposure showed that the volatile matter and carbon monoxide generated by the smoke of moxa under normal operating conditions did not exceed the safety level .
On the mechanism of moxibustion effects, there have been many viewpoints, such as thermal stimulation effect, non-specific autologous protein therapeutics, non-specific stress responses, and aromatherapy. The generally accepted view is that the meridian system combines with moxibustion physical and chemical effects to produce comprehensive effects. When physical and chemical factors act on the acupoint receptors, the signal enters the central nervous system through the peripheral pathways and outgos after being integrated, adjusting the nerve-endocrine-immune network and circulatory system, so as to regulate the internal environment of the body, in order to achieve the effects of preventing and curing diseases . Although lots of research works have been carried out and made some progress, there is still a great distance from fully understanding the mechanism of moxibustion. Therefore, we will propose the following views on the study of mechanism of moxibustion in the future.
First, value the importance of whole, moxibustion cannot be separated from the theory of TCM. More than a simple stimulus, meridian and acupoint system of the human body is the key of efficacy of moxibustion. The studying of mechanism of moxibustion from the overall level, based on the further understanding of the meridian system or even of the TCM system, is indeed very difficult. But on the other hand, maybe the studies of moxibustion should be helpful to the understanding of acupoint, meridian, and TCM. For example, some people had reported the phenomenon of “heat-sensitive points” ; it is a useful exploration of extending the study perspective from the part to the whole with moxibustion as the breakthrough point.
Second, pay more attention to scarring moxibustion (suppurative moxibustion). Scarring moxibustion had been the favorite to ancient doctors, “where there is moxibustion sore, there is cure.” Modern clinical practice has also shown that scarring moxibustion, compared with other moxibustions, has advantage of curative effect in the treatment of some chronic refractory diseases.
Third, it is necessary to introduce more new technologies and disciplines into the mechanism research of moxibustion effect, such as bioheat transfer theory, the interdiscipline focus heat transfer phenomena in living organisms; its purpose is to reveal the rules of energy transport in the organisms by introducing the basic theory and research methods of the heat transfer into the field of biology and medicine. The application of the interdisciplinary approach will undoubtedly promote the research of moxibustion .
Fourth, study on the mechanism of moxibustion should be oriented to promote its clinical application. Many research achievements have already been applied in clinic, such as the applications of 650 nm–10.6 μm combined laser moxibustion on knee osteoarthritis and bradycardia [56, 57] and the multifunctional moxibustion instrument which simulate the traditional moxibustion by heating artificial moxa (contains effective components of moxa) with electromagnetic-heating device . There are enough reasons to believe that, with the progress of mechanism research, the new achievements will surely provide a larger space to improve the patient experience and the curative effect of moxibustion.
The authors are grateful to Ms. Ji Xu for her help in translating the paper. This review paper partly supported by Ancient Books of TCM Protection and Utilization, Capacity building, Project of SATCM of China (P20941); Project of SATCM of China (ZYSNXD-CC-ZDXK-07); NSFC (81320108028); and the 973 Program of China (2009CB522901).
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon
Cupping refers to an ancient Chinese practice in which a cup is applied to the skin and the pressure in the cup is reduced (by using change in heat or by suctioning out air), so that the skin and superficial muscle layer is drawn into and held in the cup. In some cases, the cup may be moved while the suction of skin is active, causing a regional pulling of the skin and muscle (the technique is called gliding cupping).
This treatment has some relation to certain massage techniques, such as the rapid skin pinching along the back that is an important aspect of tuina (12). In that practice, the skin is pinched, sometimes at specific points (e.g., bladder meridian points), until a redness is generated. Cupping is applied by acupuncturists to certain acupuncture points, as well as to regions of the body that are affected by pain (where the pain is deeper than the tissues to be pulled). When the cups are moved along the surface of the skin, the treatment is somewhat like guasha (literally, sand scraping), a folk remedy of southeast Asia which is often carried out by scraping the skin with a coin or other object with the intention of breaking up stagnation. Movement of the cups is a gentler technique than guasha, as a lubricant allows the cup to slide without causing as much of the subcutaneous bruising that is an objective of guasha. Still, a certain amount of bruising is expected both from fixed position cupping (especially at the site of the cup rim) and with movement of the cups.
Traditional cupping, with use of heated cups, also has some similarity to moxibustion therapy. Heating of the cups was the method used to obtain suction: the hot air in the cups has a low density and, as the cups cool with the opening sealed by the skin, the pressure within the cups declines, sucking the skin into it. In this case, the cups are hot and have a stimulating effect something like that of burning moxa wool.
In some cases, a small amount of blood letting (luoci; vein pricking) is done first, using a pricking needle, and then the cup is applied over the site. The pricking is usually done with a three-edged needle, applied to a vein, and it typically draws 3â€“4 drops of blood (sometimes the skin on either side is squeezed to aid release of blood). A standard thick-gauge acupuncture needle or plum blossom needle may be used instead. This technique is said to promote blood circulation, remove stasis, and alleviate swelling and pain. It is employed especially when there is a toxic heat syndrome and for a variety of acute ailments.
The following report is derived mainly from a survey of reported cupping techniques published in 1989 (1), supplemented by information from acupuncture text books (5â€“9).
The earliest use of cupping that is recorded is from the famous Taoist alchemist and herbalist, Ge Hong (281â€“341 A.D.). The method was described in his book A Handbook of Prescriptions for Emergencies, in which the cups were actually animal horns, used for draining pustules. As a result of using horns, cupping has been known as jiaofa, or the horn technique. In a Tang Dynasty book, Necessities of a Frontier Official, cupping was prescribed for the treatment of pulmonary tuberculosis (or a similar disorder). More recently, Zhao Xuemin, during the Qing Dynasty, wrote Supplement to Outline of Materia Medica, including an entire chapter on â€śfire jar qiâ€ť (huoquan qi). In it, he emphasized the value of this treatment, using cups made of bamboo or pottery, in alleviating headache of wind-cold type, bi syndrome of wind origin, dizziness, and abdominal pain. The cups could be placed over acupuncture needles for these treatments. One of the traditional indications for cupping is dispelling cold in the channels. This indication is partly the result of applying hot cups. For example, bamboo cups would be boiled in an herbal decoction just prior to applying to the skin (this is one type of shuiguanfa, or liquid cupping, so-called because a liquid is incorporated into the treatment). Both liquid cupping and cupping over an acupuncture needle are favored for treatment of arthralgia. Cupping also is thought to dispel cold by virtue of its ability to release external pathogenic factors, including invasion of wind, damp, and cold.
During the 20th century, new glass cups were developed (see Figure 1). Common drinking glasses have been used for this purpose, but thick glass cupping devices have also been produced and are preferred. The introduction of glass cups helped greatly, since the pottery cups broke very easily and the bamboo cups would deteriorate with repeated heating. Glass cups were easier to make than the brass or iron cups that were sometimes used as sturdy substitutes for the others; further, one could see the skin within the cup and evaluate the degree of response.
The glass cups are depressurized by providing some fire in the cup to heat up the air within just prior to placement. For example, hold a cotton ball dipped in alcohol with a pincer, ignite it, hold it in the cup, then rapidly apply to the skin; this is called shanhuofa (flash-fire cupping; see Figure 2). Sometimes, a small amount alcohol is put in the cup and lit; this method is called dijiufa (alcohol-fire cupping).
At the end of the 20th century, another method of suction was developed in which a valve was constructed at the top of the jar and a small hand-operated pump is attached so that the practitioner could suction out air without relying on fire (thus avoiding some hazards and having greater control over the amount of suction). Both glass and plastic cups were developed, though the plastic ones are not very well suited to moving along the skin once in place, as the edges are not entirely smooth and the strength of the cups is limited. The modern name for cupping is baguanfa(suction cup therapy).
In order to allow easy movement of the glass cups along the skin, some oil is applied. Medicated massage oils (with extracts of herbs) are particularly useful for this purpose. Since the cups are applied at room temperature, the indication of removing cold from the channels is no longer as applicable, at least to stationary cups. There is some friction generated with moving cups, so that there is a small but significant amount of heat applied by that method, especially if a warming oil is used as lubricant.
Generally, the cup is left in place for about 10 minutes (typical range is 5â€“15 minutes). The skin becomes reddened due to the congestion of blood flow. The cup is removed by pressing the skin along side it to allow some outside air to leak into it, thus equalizing the pressure and releasing it. Some bruising along the site of the rim of the cup is expected.
Today, cupping is mainly recommended for the treatment of pain, gastro-intestinal disorders, lung diseases (especially chronic cough and asthma), and paralysis, though it can be used for other disorders as well. The areas of the body that are fleshy are preferred sites for cupping. Contraindications for cupping include: areas of skin that are inflamed; cases of high fever, convulsions or cramping, or easy bleeding (i.e., pathological level of low platelets); or the abdominal area or lower back during pregnancy. Movement of the cups is limited to fleshy areas: the movement should not cross bony ridges, such as the spine.
Following are some of the recommended treatment sites for various disorders.
- For chronic bronchitis and asthma, one can apply cupping at the following points: dingchuan, dazhui (GV-14), shenzhu (GV-12), geshu (BL-17), xinshu (BL-15), jueyinshu (BL-14), feishu (BL-13), fengmen (BL-12), dashu(BL-11), tiantu (CV-22), shanzhong (CV-17), huagai (CV-20), and zhongfu (LU-1). [see: Acupuncture treatment of asthma for more information about several of these treatment sites].
- For pediatric bronchitis: blood letting followed by cupping at dazhui (GV-14).
- For pediatric acute bronchitis: feishu (BL-13), shenchang (KI-25), lingxu (KI-24).
- For dysentery, early morning diarrhea, and acute and chronic gastritis, perform cupping in the following areas: around the navel; at the bladder meridian shu points; or these stomach meridian points: burong (ST-19), guanmen (ST-22), huaroumen (ST-24), tianshu (ST-25).
- Pediatric indigestion: dachangshu (BL-25).
- Shoulder blade: jianwaishu (SI-14) and tianzhong (SI-11).
- Loins: shenshu (BL-23), qihaishu (BL-24), guanyuanshu (BL-26).
- Head: taiyang and yintang for refractory headaches and migraines; dazhui (GV-14) and baihui (GV-20) for parietal and occipital headaches; for trigeminal neuralgia: qihu (ST-13), fengchi (GB-20), sizhukong (TB-23), jiache (ST-6); for toothache: dashu (BL-11), with acupuncture, massage, and cupping at yifeng (TB-17), jiache(ST-6), xiaguan (ST-7), and hegu (LI-4).
- Soft tissue injury: treat local pressure pain points and area of swelling; use plum blossom needling followed by cupping; additionally or alternatively use points above or below the site of injury along the channels that pass through the injury.
- Infertility and irregular menstruation: shenshu (BL-23) with movement of cup downward (treat with acupuncture first, then do cupping).
- Leukorrhea: yaoyan (extra point under the 3rd lumbar vertebra) and around baliao (BL-31 through BL-34).
- Uterine cramps: needle zusanli (ST-36) and guanyuan (CV-4) and do cupping at guanyuan (CV-4).
- Common cold: dazhui (GV-14).
- Insomnia: xinshu (BL-15), geshu (BL-17), shenshu (BL-23).
- Facial paralysis: needling and cupping dazhui (GV-14), along with needling local facial points.
The following protocols were reported to provide good results in individual clinical research reports:
- Head pain (2): headache, toothache, sore throat, redness and soreness of the eyes, treated with blood letting followed by cupping. Treatment is applied to dazhui (GV-14) and dingchuan.
- Frozen shoulder (3): after acupuncture at jianyu (LI-15) and jianliao (TB-14) to get propagated qi reaction, use pricking of ashi points followed by cupping over the bleeding area for 10â€“15 minutes. Ten treatments is a course of therapy.
- Acute trigeminal neuralgia treating with blood letting followed by cupping (4): treatment is applied to dazhui(GV-14) and feishu (BL-13).
- Acne (10): treatment is to use bloodletting followed by cupping at feishu (BL-13) and geshu (BL-17) on one day, then xinshu (BL-15) and ganshu (BL-18) the next day, alternating treatments for a total of eight days.
- Urticaria (11): perform cupping at shenque (CV-8) three times consecutively for ten minutes each time. This is done for three days, followed by one day rest, and another three days as needed.
- Acute diseases (13): fever and headache due to infection, acute conjunctivitis, lumbar sprain; perform blood letting at dazhui (GV-14), and then cupping (which promotes further bleeding).
Cupping therapies often follow the point selection pattern that is used for standard acupuncture therapy, with somewhat greater emphasis on the use of back points (due to the ease of performing this technique there). In particular, most practitioners rely on using back shu points (bladder meridian) and dazhui (GV-14). Cupping is frequently applied after treatment by acupuncture, blood letting, or plum blossom treatment.
- Cui Jin and Zhang Guangqi, A survey of thirty yearsâ€™ clinical application of cupping, Journal of Traditional Chinese Medicine 1989; 9(3): 151â€“154.
- Wu Jiashu, Observation of analgesic effect of acupuncturing dazhui point, Journal of Traditional Chinese Medicine 1989; 9(4): 240â€“242.
- Ju Huadong, 30 cases of frozen shoulder treated by needling and cupping, International Journal of Clinical Acupuncture 1998; 9(3): 327â€“328.
- Zhang Zhilong, Observation on therapeutic effects of blood-letting puncture with cupping in acute trigeminal neuralgia, Journal of Traditional Chinese Medicine 1997; 17(4): 272â€“274.
- Cheng Xinnong, Chinese Acupuncture and Moxibustion, 1987 Foreign Languages Press, Beijing.
- State Administration of Traditional Chinese Medicine and Pharmacy, Advanced Textbook on Traditional Chinese Medicine and Pharmacology, volume IV, 1997 New World Press, Beijing.
- Oâ€™Conner J and Bensky D (translators), Acupuncture: A Comprehensive Text, 1981 Eastland Press, Seattle, WA.
- Chang Ruifu, Wu Xiufen, and Nissi Wang (compilers), Illustrated Dictionary of Chinese Acupuncture, 1986, Sheepâ€™s Publications, Hong Kong.
- Academy of Traditional Chinese Medicine, An Outline of Chinese Acupuncture, 1975 Foreign Languages Press, Beijing.
- Chen Decheng, Jiang Nawei, and Cong Xin, 47 cases of acne treated by prick-bloodletting plus cupping, Journal of Traditional Chinese Medicine 1993; 13(3): 185â€“186.
- Wang Huaiping, Treatment of urticaria with cupping, Journal of Traditional Chinese Medicine 1993; 13(2): 105.
- Li Jiang, A miraculous spinal pinching therapy, Journal of Traditional Chinese Medicine 1996; 16(3): 228â€“229.
- Yin Ying, Blood-letting at a single point for treatment of acute diseases, Journal of Traditional Chinese Medicine 1997; 17(3): 214â€“216.
Tuina (pronounced “twee nah”) is a form of Oriental bodywork that has been used in China for centuries. A combination of massage, acupressure and other forms of body manipulation, tuina works by applying pressure to acupoints, meridians and groups of muscles or nerves to remove blockages that prevent the free flow of qi. Removing these blockages restores the balance of qi in the body, leading to improved health and vitality.
The details of tuina‘s techniques and uses were originally documented in The Yellow Emperor’s Classics of Internal Medicine, which was written about 2,500 years ago. Its popularity and recognition grew steadily to the point that by the sixth century, many traditional Chinese medical schools had incorporated tuina into their programs as a separate department. In China, tuina is currently taught as a separate but equal field of study, with practitioners receiving the same level of training (and enjoying the same professional respect) as acupuncturists and herbalists. It is also taught as part of the curriculum at every ACAOM-accredited school in the United States.
What to Expect on Your First Visit
In a typical tuina session, the client remains clothed but wears loose clothing, and sits on a chair or couch. The practitioner will ask the patient a series of questions, then begin treatment based on the answers to those questions.
Tuina practitioners may employ a variety of methods to achieve their goal. Commonly used techniques include soft tissue massage; acupressure and manipulation. Practitioners may sometimes use herbal compresses, liniments, ointments and heat to enhance these techniques.
Conditions and Contraindications
Tuina is best suited for rectifying chronic pain, musculoskeletal conditions and stress-related disorders that affect the digestive and/or respiratory systems. Among the ailments tuina treats best are neck pain, shoulder pain, back pain, sciatica and tennis elbow. However, because tuina is designed to improve and restore the flow of qi, treatment often ends up causing improvements to the whole body, not just a specific area. There is anecdotal evidence that headaches, constipation, premenstrual symptoms and some emotional problems may also be effectively treated through tuina.
Because it tends to be more specific and intense than other types of bodywork, tuina may not necessarily be used to sedate or relax a patient. The type of massage delivered by a tuina practitioner can be quite vigorous; in fact, some people may feel sore after their first session. Some patients may also experience feelings of sleepiness or euphoria.
Microcurrent Therapy uses extremely small amounts of electrical current (millionths of an amp) to help relieve pain and heal soft tissues of the body.
Injury to the body disrupts its normal electrical activity. Microcurrent Therapy produces electrical signals like those naturally occurring when the body is repairing damaged tissues. By applying similar electrical currents, the healing process is enhanced.
The electrical current used in Microcurrent Therapy is so small that it is rarely felt. However, the water-moistened electrodes or gel used to conduct the current may seem cool when first applied.
Microcurrent Therapy is often recommended in cases involving soft tissue inflammation or muscle spasm. Since Microcurrent Therapy mimics the body’s electrical fields it is helpful in relieving pain and stimulating the healing of soft tissues.
- Can help speed the healing process
- Reduces swelling and inflammation
- Masks acute and chronic pain
- Releases muscle trigger points
- Improves soft tissue regeneration
Microcurrent Therapy approximates the natural electrical currents of the body to enhance the healing process.
Clinicians are using laser therapy more often than ever before to help reduce pain and inflammation related to many common conditions.
Thousands of doctors and patients have experienced the power of laser therapy and are familiar with its therapeutic effects, but for those who aren’t, here are 5 things everyone should know about it:
1. It reduces pain and inflammation without side effects
Laser therapy uses a process called photobiomodulation. Photons enter the tissue and interact with the cytochrome c complex within mitochondria. This interaction triggers a biological cascade of events that leads to an increase in cellular metabolism and a decrease in both pain and inflammation. Unlike medications, laser therapy reduces pain without undesirable side effects.
It is also important to point out that patients report long-lasting pain relief. While the number of treatments required may vary depending on the acuity of the condition, many patients experience lasting relief after only a couple treatments.
2. Can be used for acute and chronic conditions
When treating acute conditions with laser therapy, it is particularly effective when it is administered as soon as possible following injury (assuming there is no active hemorrhaging). The faster the inflammation is reduced and the healing process can begin, the better. In the case of acute injury, laser therapy helps restore the body to normal function quicker.
With chronic conditions, laser therapy is used most often to help combat persistent pain and inflammation. The new LightForce EXP 25-watt laser is being used by clinicians to quickly reduce inflammation in patients suffering from chronic pain. This therapy laser is especially well-suited for treating chronic conditions because it enables clinicians to treat a wider area of interest while still delivering therapeutically relevant dosages.
3. Treatments can be customized for each situation
Lasers that have larger power ranges offer versatile treatment options. A laser that can be set to operate from 0.5 W all the way up to 25 W, allows the clinician flexibility to treat low and slow or at maximum output.
The availability of multiple treatment heads offers additional flexibility for the clinician. The LightForce Empower™ Delivery System, for example, features 5 different treatment heads, each designed to facilitate optimal delivery in different scenarios. It is important to have several delivery options to ensure the delivery method is appropriately matched to the situation. For instance, when treating over bony prominences, an off-contact treatment method is advisable. However, when treating deep-tissue structures, such as a hamstring, an on-contact massage ball attachment is best to reduce reflection and scattering, and also encourage deeper penetration by displacing excess fluids. Different sized treatment heads can also be advantageous for administering treatments that require varying levels of precision.
Advanced software is another tool that helps with treatment customization. Influence Technology™ allows clinicians to build custom treatments by selecting body region, condition, and specific patient characteristics. Touchscreens and intuitive selection processes make delivering the right dose easy. For even more customization, clinicians can also formulate their own protocols by entering a couple key components with LightForce’s newest software feature, Perfect Protocol™.
4. Treatments Feel Good
One common question related to laser therapy is, “What does it feel like?” Depending on the laser, it can create little to no sensation or it can create a gentle, soothing warmth. Many patients receiving LightForce Laser Therapy treatments report enjoying the experience, especially when a massage-ball treatment head is used to deliver what is often referred to as a “laser massage.”
Patients receiving treatments with higher-power lasers also frequently report a rapid decrease in pain. For someone suffering from chronic pain, this effect can be particularly pronounced.
5. Treatments Are Fast
With LightForce lasers, treatments are quick, usually 5-10 minutes depending on the size, depth, and acuteness of the condition being treated. High-power lasers are able to deliver a lot of energy in a small amount of time, so therapeutic dosages are achieved quickly. For people with packed schedules, patients and clinicians alike, fast and effective treatments are a must.
- Hamblin MR, Demidova TN. “Mechanisms of low level light therapy.” Proc. of SPIE Photonics. 2006;
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- Kingsley JD, Demchak T, Mathis R. “Low-level laser therapy as a treatment for chronic pain.” Frontiers
in Physiology. 2014; 5(306): 1-3. doi: 10.3389/fphys.2014.00306