Moxibustion

1
Tibetan Medicine Moxibustion for Pain
Management Azad Hirpara Office of
Global Health, Rutgers - Robert Wood Johnson
Medical School, Piscataway, NJ 08854

• Tibetan Medicine Background
• Ancient medical system with origins in the
  7th-12th century AD
• Principal text is the Four Tantras (Gyud-shi)
  which incorporates Buddhist philosophy along with
  Indian, Chinese, Greco-Arab medical systems
• Health depends on harmony between three bodily
  humors (Bile, Phlegm, and Wind)
• Treatments include diet and behavior
  modifications, herbal remedies, and external
  therapies (ex. moxibustion)

• Himalayan Health Exchange Program
• The Chang Thang Plateau expedition was a 19-day
  medical excursion to various sites in the
  northern state of Jammu and Kashmir in India. The
  expedition was designed to Tibetan settlers in
  Ladakh, and various Tibetan tribes living in the
  Chang Thang Plateau, in the Western-Trans
  Himalayan region along the Indo-Tibetan
  borderlands. With 30 medical students, 5
  attending physicians, and several other members
  of the HHE staff, we traveled to 4 clinic sites
  in Leh, Ladakh and 5 more clinic sites in various
  villages in the Chang Thang Plateau.
• During patient encounters, we discovered that
  many patients were utilizing alternative
  medicine, specifically ancient Tibetan medicine.
  One of the most common treatment modalities was
  moxibustion, which consists of applying burning
  moxa made from dried mugwort (Artemisia argyi)
  onto the patients skin at various acupuncture
  points for treatment of numerous medical
  conditions, including pain.

• Results and Discussion
• Many clinic patients reported some relief of pain
  following moxibustion treatment by local Tibetan
  healers
• Several clinical trials report that moxibustion
  may be effective in treating pain, as well as
  other medical conditions
• However, systematic reviews (3) reveal that only
  a few RCTs have been conducted and the majority
  of trials have a high risk of bias due to poor
  study design
• Research on moxibustion for pain management
  provides insufficient evidence and therapeutic
  value of moxibustion for pain is uncertain

• Moxibustion
• Burning moxa (dried mugwort) is applied to the
  patients skin at acupuncture points to stimulate
  the flow of blood and energy (qi) to promote
  healing
• Direct and indirect methods
• Common uses include treatment of GI complaints,
  osteoarthritis, gynecological problems, soft
  tissue injury, herpes zoster, and more

• Conclusions
• Despite several reports of significant pain
  reduction from moxibustion, the relatively small
  number of RCTs and high risk of bias in current
  research prevents acceptance of moxibustion as an
  effective treatment for pain.
• Patients belief in pain reduction following
  moxibustion may be due to placebo effect
• More rigorous RCTs with better study design and
  larger sample size are required for better
  evaluation of moxibustion for treatment of pain
  and other medical conditions.

References Arya, Pasang Y. "Tibetan
Medicine." Tibetan Medicine. Tibetan Medicine
Education Center, Mar. 2012. Web. 31 Oct.
2014. Choi, Tae-young, Jiae Choi, Kun Hyung Kim,
and Myeong Soo Lee. "Moxibustion for Treating
Osteoarthritis A Systematic Review and
Meta-analysis." Rheumatology International 32.10
(2012) 2969-978.  Lee MS, Choi TY, Kang JW, Lee
BJ, Ernst E. Moxibustion for treating pain a
systematic review. American Journal of Chinese
Medicine 2010 38(5) 829-838 Xu, J, HY Deng,
and XY Shen. "Safety Of Moxibustion A Systematic
Review Of Case Reports." Evidence-Based
Complementary And Alternative Medicine (2014) Sci
ence Citation Index. 31 Oct. 2014.

• Methods
• We encountered patients from a wide range of
  ages, presenting with many diverse conditions.
  After examination and assessment, we were able to
  provide medication, eyewear, and other items to
  nearly 1000 patients over the span of 9 clinic
  days in July 2014.
• Some common diagnoses included gastroesophageal
  reflux disease, gastritis, osteoarthritis, low
  back pain, and vision problems.
• It was observed that a large number of the
  patient population had used moxibustion as
  treatment for various medical conditions,
  commonly for the management of pain.
• A literature review was performed to evaluate
  moxibustion and assess its efficacy in the
  treatment of pain.

• Purpose
• What is moxibustion?
• Is moxibustion an effective technique to treat
  pain?