Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Basic Research into Japanese Moxibustion– Introduction –Shigekatsu Aizawa
Department of Basic Medical Research
Tokyo Eisei Gakuen College
Introduction
Therapy forms using heat stimulation of the skinare considered to have developed independently innumerous locations all over the world. Up to thepresent day a treatment modality closely resembling
its original form is still used clinically in Japan and
China. In particular, in Japan subtle changes havebeen made to adjust it to the characteristics of thepeople, numerous different forms of moxibustion havebeen contrived and are currently in use. Particularly
noteworthy is form of moxibustion used currently inJapan. It is considered to have originated in Japan. It
is seldom used in China, where the moxa is burned
directly on the skin: direct moxibustion. This form ofmoxibustion differs from indirect moxibustion, wherean attenuated heat stimulus is used like in stickmoxibustion as a representative form of this treatment
modality. It is considered not only to apply local
warming, but rather also exerting considerable effects
on distant sites like acupuncture. Yet, directmoxibustion causes, even if only temporarily,
moxibustion marks. The heat stimulus when compared
to indirect moxibustion is fairly strong and the
preparation of the small moxa cones requires someskill so that recently its use has declined. It has not yet
been properly investigated from the standpoint of
which of these forms is the more effective one andwhether there are possible differences in indications.
Here I would like to present a brief summary of theresearch into moxibustion as it is performed in Japan,
crude materials, the manufacturing process and theinfluence moxibustion has on the body.
Moxa raw material, manufacture, quality
The region of Ibukiyama has been famous as a
growing district for moxa, but Oda conducted adetailed investigation of the subject and reported thefollowing.1) There are two sites called Ibukiyama: one
in Shiga prefecture and another in Tochigi prefecture,both of which are famous production sites of moxa. The

noted production site called Ibukiyama, that has been
famous since the Heian period, is located in Tochigi
prefecture, whereas Shiga emerged as a growing
region following the Azuchi-Momoyama period. The
Ibuki moxa varieties of both Tochigi and Shiga havetheir respective characteristics not found in the otherlocation. Both Ibukiyama regions have a place called'Shimeji ga Hara' and both regions have similar
Buddhistic legends. By the Edo period, the Shiga
region flourished, while the Tochigi region declined.
Again, regarding the raw mugwort (yomogi) material
botanical investigations were performed showing thatmost of the yomogi material from the Niigata, Toyama
and Ishikawa prefectures was Artemisia princes Pamp,
while some of it was oo-yomogi (yama yomogi =Artemisia Montana Pamp., whereas all the materials
from Shiga prefecture was reportedly of the yomogi
variety.2) Regarding the growing conditions for yomogi,
Aizawa et al. compared yomogi grown in sunlight andin shade and reported that the yomogi grown insunlight is the better suited variety.3) Regarding the
manufacturing equipment Oda has conducted adetailed investigation. The investigation included suchaspects as structure, size, power and scale ofmanufacture for the various types of machinery usedduring the yomogi manufacture. In particular, therough stones for stone mortars are obtained fromquarries from the upstream region of Itoigawa city in
Niigata prefecture of which hornblende andesite or
enstatite hornblende andesite materials are reportedly
the main products. Reportedly each manufactory uses
these stones in particular forms.4)
Classified by their use, there are about 10 different
product types. The moxa used for indirect moxibustionor needle warming moxibustion contains besides theprincipal component of the T-shaped cilia a fairamount of fragments of leaves or stalks, while superior
quality products for direct moxibustion does notcontain any impurities. Aizawa used electron
microscopy for his related examinations and publisheda detailed report. This showed that the previously
known T-shaped cilia themselves also show differencesamong high and low grade products and are related to
the feel of the material when forming the little moxa
cones.5) Moreover, according to previous hypotheses,

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

29

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

the temperature characteristics and fragrance of highgrade moxa was considered due to the fat and oilcontent in the cilia, but the above mentioned report by
Aizawa and the below described report by Shimomura
showed6), that is a mistake in that high grade moxa
almost does not contain any oils or fats. It seems
highly likely, that the fragrance of the moxa is due tothe essential oils contained in the stalk cells of the
T-shaped trichome.

Photo: Comparison of T-shaped cilia of high and low
grade products (1: low 2: medium 3: superior)catechols. Comparing the ratios by weight of theheptatriacontene and tannins among the various moxa
varieties for a given moxa weight showed that the ratio
by weight for heptatriacontene is approximately thesame in all moxa varieties. However, the tannin
content varies with the product quality, being low inthe highest grade moxa and increased with increasingcoarseness of the moxa. The combustion temperature –time curve for moxa treated to extract the lipophiliccomponents und untreated moxa showed, that there
were no differences in peak temperature, but for moxa
from which the lipophilic components were extracted,
the time required after ignition of the moxa to reachthe peak temperature from 25°C increased andremoving the heptatriacontene tended to makecombustion more difficult. These workers thus
reported that heptatriacontene affects the time for therise in temperature in the combustion temperature –time curve.10)
Temperature
treatment
Reports

characteristics
pertaining

duringmoxibustion

thetemperaturetocharacteristics observed during direct moxibustion
Essential oil components of moxa
Nakao et a. reported that the moxa leaves containapproximately 0.02% essential oils of which the main
component, comprising 50%, is cineol, followed by
thujone, sesquiterpene alcohol and similar compounds,
where the fragrance of moxa is most likely due to thesecomponents.7) Yet, these reports deal mainly with themoxa leaves and are not the results of an analysis
performed using therapeutic moxa material. Generally,moxa is said to contain tricosanol, hentricontane,arachinacohol, thujone and similar substances. In
recent years, Toda et al. have identified n-non-acosane
andn-hentriacontaneusingliquidgas
chromatography8) and the results of their essential oil
component analysis of commercially available moxa
(highest, high, normal grade) showed that the highest
grade product contains lower saturated aliphatichydrocarbons, but in high and normal grade products
reportedly higher levels of saturated aliphatichydrocarbons are present.9)
Kobayashi et al. isolated from moxa a new tannin
composed of the lipophilic heptatriacontene and30

have been published for a long time11), but few papers
dealt with the amount of heat generated by the moxa
and the large size of the temperature measurement
probe did not allow exact measurements. Aizawa etal.12) and Sugeta et al.13) reported on their use of
microscopic

thermocouples

tomeasurethetemperature characteristics on and below the skin ofmice. They reported that in contrast to what was
believed

in

the

past,

skin

temperaturewassignificantly higher than 60℃, while the subcutaneoustemperature was lower than the temperature on theskin and even continuous performance of moxibustion
did

not

produceanincreaseintemperature

proportional to the number of moxa cones burned.
Commonly the fact that moxibustion treatment using
low grade moxa felt hot was ascribed to a large amountof heat generated. Yet, quite recently, Aizawa's
research showed that the difference in the amount ofheat generated by different qualities of moxa is
minimal and the effect is more likely due to differencesin heat sensation and the burning technique.14)

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Figures: Moxibustion temperature curve

The left graph is for warming moxibustion

temperature characteristics of moxibustion using amoxa tube or moxibustion on pedestals of intervening
materials and reported considerable differences
depending on products used regarding thetemperature and its sustenance. Onishi reported thatwith indirect moxibustion, also used as frequently as
warming moxibustion, it is not only the warming effect,
but the components of the material used as pedestal
may possibly also exert some effect.17)

The right graph is for needle warming moxibustion(vertical axis indicates Temperature (°C), and horizontal
axis indicates Time (s).)

The upper left is Ogonzan; the upper right is Kamaya; thelower left is Ibuki; and the lower right is Miyabi.
(vertical axis indicates Temperature (°C), and horizontal
axis indicates Time (s).)

The upper left is Burdock root; the right is Bulrush; andthe lower left is Absorbent cotton.
(vertical axis indicates Temperature (°C), and horizontal
axis indicates Time (s).)

Considerable research has been conducted into
warming moxibustion or indirect moxibustion. Ozaki15)
and Ueda16) performed a detailed examination of the

Tissue changes at the site of moxibustion treatment
Aizawa et al. observed the effects of directmoxibustion on mouse skin over a period of 14 days
following treatment and found that after application of
three moxa cones the skin had recovered almost to its
normal state after 14 days, without moxa scar. In thecase of treatment using 20 cones there was some
hypertrophy of the epidermis after 14 days, but after
about 20 days the skin was considered to haverecovered almost to its normal state.18) Menjo et al.
electron microscopically observed morphologicalchanges in cutaneous collagen microfibrils using bothelectron and light microscopy. He found that the local
alterations were the most marked, where the greater
the amount of moxa was and these effects did notdisappear even after 24 hours. This is a highlyinteresting fact when considering the influence of thetemperature reached during moxibustion treatment on
the body. Moreover, the heat stimulus provided bymoxa treatment on the one hand and burns on theother hand may be considered to differ in the degree of
their invasiveness for the body and will need further
study in the future. The effects of moxa treatment areconsidered to be mediated via local inflammatory
reactions, but it should be taken into account that theterm inflammation could imply that the effects of
inexplicable heat stimulation may also be considered
as being included in the moxibustion effects.19) In thisrespect, this report was very interesting. In otherwords, burns in general and burns caused by
moxibustion are completely different regarding thedegree of invasiveness and size. Accordingly, theinflammatory reaction alone caused by a simple burn
cannot conceivably be considered to have the effects
moxibustion does. Rather, the heat stimulus applied

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

31

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

during the moxibustion is considered to be important.
Influence of moxibustion on blood circulation
There are also many reports dealing with local anddistant changes in blood flow. Takeda et al. haveinvestigated the changes in local and distantcutaneous blood flow depending on the number ofapplied moxa cones and found that the application of asingle moxa cone may produce locally a maximal
increase of 580%, while application of 10 cones
resulted in an increase of 720%. The stimulus intensity
dependent increase in blood flow and sequentialchanges subsequently gradually decreased andreturned reportedly after about 30 minutes to thecontrol value set for the experimental time.
Almost no changes are observed in the peripheral
blood flow after application of 1 cone, but moxibustion
using 3 to 10 cones produced a transient reduction inblood flow that subsequently returned close to thecontrol value, after which a tendency towards a slightincrease was reportedly observed.20) Ueda et al.
applied various types of warming moxibustion to theforearm to examine the temperature characteristics
and then used the laser Doppler method and athermocouple thermometer to observe the changes indermal blood flow both locally and on the dorsum of
the hand as a distant reference site. In case ofmoxibustion on pedestals, the duration of the hightemperature phase was short and the temperature
curve cone-shaped, where the peak temperature variedwith product type. For moxibustion using moxa tubes,
the duration temperature was long and wasmaintained near the peak temperature with thetemperature curve trapezoidal. Locally at the site ofmoxibustion an increase in blood flow was observedwith all forms warming moxibustion, but the rate ofincrease depended on the peak temperature andquantity of the stimulus. Moreover, it was reported,that no obvious changes were observed in the
periphery both in dermal blood flow and temperature.
Yet, the rate of increase in blood flow increased with
the quantity of the stimulus, but very strong warming
moxibustion sometimes caused burns. There aremarked individual differences in the rate of increase inblood flow and intensity of thermal pain sensation.

32

Thus, these authors stated that it is important during
clinical application of warming moxibustion to choosea type of warming moxa which provides a suitable
quantity of stimulus within a scope not causingburns.16)
Regarding indirect moxibustion, Matsuhata et al.
performed "ginger moxibustion" on Ashi no sanri(zusanli, ST36) and observed the effects on the bloodflow through the lower extremity and deep plantar
tissue temperature. Local blood flow through the lower
extremity increased over a period of 2 to 4 minutes
following the stimulation, but no changes wereobserved on the contralateral side.21) They also
reported to have observed no changes in deep tissue
temperature at the site of measurement. Recently,
warming moxibustion providing a mild heat sensation
tends to be favored, but there are certain differences
pertaining to the changes caused in blood flow bydirect and indirect moxibustion. Regarding the otheractions, similar differences may well be expected. The
lighthearted concept of moxibustion being the use ofmoxa, or else whatever is warm may also be called
moxibustion needs to be revised. It seems necessary toinvestigate the different actions of direct, warming andindirect moxibustion.
Immune system, blood etc.
Furuya et al. performed moxibustion on mice toobserve changes in phagocytosis using the carbon
clearance method and reported an increase.22) Effects
on blood coagulation capacity have been reported by
Sakamoto et al., observing a slight increase in liverfunction and obvious effects on the clotting system.23)
Okazaki et al. examined the influence on blood clotting
capacity and observed a tendency toward activation of
the coagulation induced by burning a single cone ofmoxa, but intermittent continuous moxibustion
apparently did not maintain this increase. Moreover,platelet aggregation tended to be inhibited over a
period of 1.5 hours after application of 5 mg of moxa,
while after application of 15 mg of moxa a tendency
towards ATP release over a period of 1 hour, as well asa tendency towards shortening of the lag time by 1 to 5
hours was observed. ADP induced platelet aggregation
after application of 15 mg of moxa showed a tendency

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

towards continued elevation over a period of 24 hours,
while the moxa application produced in both the 5 and
15 mg treatment groups an apparent increase in ATP
after 1 and 3 hours respectively. The above results
showed that a single application of moxa produced
responses in the platelet system of mice that were notobserved after intermittent continuous moxibustion
stimulation, so that in case of a repeated moxa
stimulation the effects may be considered todisappear.24)
Matsukuma et al. applied an amount of moxa usedduring daily clinical practice in humans (0.3 mg ofmoxa, 5 cones) for the treatment of adjuvant arthritis
in rats on a point corresponding to Ashi no sanri(zusanlin, ST36) in humans and reportedly observed
an anti-inflammatory effect.25)
While the amount of moxa usually used in clinicalpractice on humans when applied during researchusing normal animals is relatively greater, no obvious
changes were obtained. In contrast, in research using
animal disease models the amount of moxa usuallyused during daily clinical practice in humans produced
observable effects. Thus, since the stimuli ofacupuncture and moxibustion are very subtle, it may
conceivably be difficult to demonstrate their effects
during experiments using normal animals.
hsp
After maintaining the subcutaneous temperaturefor 15 minutes at 45℃ and within the muscle layer at
39-40℃ following the application of moxibustion,
extraction of proteins from the gluteal regional muscle
samples obtained after 3 and 24 hours showed that 3
hours after the performance of moxibustion on rats
hsp70 and hsp71 were detected. Immediately after themoxibustion and 24 hours after it hsp71 was detectedin the rats, hsp70 was not observed. Hsp71 wasobserved, however, in the control rats. Heat shockproteins (hsp) are synthesized as one form ofphysiological stress proteins. This suggests that the
local application of heat in the form of moxa
stimulation leads to the synthesis of hsp and thus
exerts a physiological effect.26) 27)
These reports indicate that hsp are involved in themodes of action of moxibustion so that warming

moxibustion provides a method of increasing hsp. Yet,
while methods to increase hsp concentration generally
require a certain degree of equipment and time,
moxibustion can be considered to be a very simple
method to achieve an increase in hsp concentration.
Anti-ageing
Sakamoto et al. investigated the effects ofmoxibustion treatment on age induced locomotor
ataxia using Marshall's method applied to 4- and9-month old Wistar female rats, treating the animals
continuously at a rate of once per week with a total
amount of moxa of 15 mg/body on points corresponding
to Hyakue (Baihui, GV20) and Keimon (Jingmen,
GB25). Regarding the vigor, no significant
improvements in the locomotor ataxia were observed,
the moxa treatment caused some improvements inlocomotor ataxia regarding success.28) 29) 30) 31)
Since anti-ageing has recently become a common
topic, this report suggests that moxibustion treatment
may be expected to have some anti-ageing effects.
Antioxidation
For a methanol extract of moxa and the combustion
products of moxa, radical, eliminating effects havebeen observed.32)
Activity differs depending on the type of moxa,
where the radical eliminating activity of warming
moxa was weak, but that of moxa for directmoxibustion strong. Based on these results, it wasconsidered that the inhibiting activity of moxa for
direct moxibustion of lipoperoxidation is stronger thanthat of warming moxa.33)
The above described results show that there aredifferences between direct moxibustion and warming
moxibustion. As described above, the differences in theeffects of direct, warming and indirect moxibustion are
considered to require further thorough investigation.
Closing remarks
It is not easy to introduce all the researchpertaining to the entire scope of moxibustion induced
actions. Research into the both ancient and modern
treatment modality of moxibustion is progressing withresults used in treatment form for people of the world.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

33

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

It is my goal to finish my research results in the hopethat this treatment form may be helpful for promoting
health.
References
1) Ryuzo Oda: Studies of Moxa (II) - About Mt. Ibuki-, Journal of the Japan Society of Acupunctureand Moxibustion 35(1): 66-72, 1985
2) Ryuzo Oda: Studies of Moxa. (I) The Latest Processof Manufacture in Moxa and Its Raw Material,
Journal of the Japan Society of Acupuncture andMoxibustion 33(3): 427-430, 1984
3) Shibekatsu A. et al.: Fundamental Study of Moxa
(Report I) Comparison with Altemisia vulgaris
grown in the sunlight and in the shade, Journal of
the Japan Society of Acupuncture andMoxibustion 31(1): 27-33, 1982
4) Ryuzo Oda: Studies of Moxa (part 3) a study ofmillstones used in producing moxa, Journal of theJapan Society of Acupuncture and Moxibustion
43(2): 135-141, 1993
5) Shibekatsu A. et al.: Fundamental Study of Moxa
(Report II) - Morphological Changes in the
Producing Stage of Moxa / Morphological
Differences in the Quality of Moxa -, Journal of
the Japan Society of Acupuncture andMoxibustion 32(3): 242-249, 1983
6) Tsutomu S. et al.: Pharmacognostical Studies on
the Artemisiae Folium., Journal of Natural
Medicines 20(2): 84-91, 1966
7) Manzo Nakao, Chuzo Shibue: Regarding thecomponents of mugwort leaves, Journal of
Pharmacology 44: 636-643, 1924
8) Shizuo T. et al.: Research on Essential Oil of Moxa
(No. 1), Journal of the Japan Society of
Acupuncture and Moxibustion 38(3): 330-333, 1988
9) Shizuo T. et al.: Research on Essential Oil of Moxa
(No. 2), Journal of the Japan Society of
Acupuncture and Moxibustion 40(4): 380-382, 1990
10) Kazuko Kobayashi: Organic Components of Moxa
Analyzed by NMR Spectroscopy, The Bulletin of
Meiji University of Oriental Medicine 3: 45-51, 1987
11) Katsusuke Serizawa: The Science of Acupunctureand Moxibustion, Theory, 2nd Edition, Ishiyaku
Shuppan: 17-28, 1964

34

12) Shigekatsu A. et al.: Effect of moxibustion on skintissue - Changes of skin temperature duringmoxibustion - Journal of the Japan Society of
Acupuncture and Moxibustion 35(2): 105-110, 1985
13) Ryoujin S. et al.: A Study on TemperatureChanges in vivo with Moxibustions, Journal of
the Japan Society of Acupuncture andMoxibustion 38(3): 326-329, 1988
14) Shigekatsu Aizawa: Characteristics of moxa andresearch into its use for thermal stimulation,
Journal of the Japan Society of Acupuncture andMoxibustion 57 (3): 290, 2007
15) Akihiro Ozaki: A Special Quality of Themal
Stimulus on the Indirect Moxibustion, The
Bulletin of Meiji University of Oriental Medicine
3: 85-99, 198716) Tomofumi Ueda, Yoshiko
Egawa,
Takao
Kawahara, Shunji Koike, Masame Sakamoto:Temperature
characteristics
ofwarming
moxibustion and comparison of hemodynamics –local and peripheral changes depending on
different varieties, Tokyo Eisei Gakuen College,
Department of Oriental Medicine, collection of
graduation theses 10: 89-100, 200217) Motoyo O. et al.: Research on indirect moxibustion,
Journal of the Japan Society of Acupuncture andMoxibustion 38（4）: 420-422, 1988
18) Shigekatsu Aizawa: Temperature in the epidermis
and dermis as well as the thereby induced tissuechanges at sites treated by moxibustion in mice,
Educational promotion group of Vocational school,
Research Bulletin: 207-218, 1983
19) Yuki Menjo et al.: Ultrastructural Changes ofCollagen Fibrils in Mouse Dermal Connective
Tissue after Moxibustion Treatment, Acta
Anatomica Nipponica 77: 7-15, 200220) Shinichi Takeda, Miki Menuma, Kenji Hasegawa,
Takahiro
Katsumata,Shigekatsu
Aizawa:Investigation pertaining to methods of skintemperature measurement at combustion sites,
Journal of the Japan Society of Acupuncture andMoxibustion 51(3): 418, 200121) Izuru Matsuhata, Koji Hisashita: Regarding theinfluence of ginger moxibustion on lower
extremity blood flow and the deep tissue
temperature in the sole of the foot, Journal of the

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Special Edition | Current Japanese Acupuncture and Moxibustion 2010

Japan Society of Acupuncture and Moxibustion
54: 402, 2004
22) Eiji F. et al.: Effects of Moxibustion on the
Phagocytic Activity in Mice (report I) TIMECOURSE FOR CHAGE IN PHAGOCYTIC
ACTIVITY AFTER SINGLE MOXIBUSTION,
Journal of the Japan Society of Acupuncture andMoxibustion 31(1): 34-41, 1982
23) Hideharu Sakamoto, Masako O. et al.: Effect ofMultiple Moxibustion on Blood Coagulation inMice, Journal of the Japan Society of Acupunctureand Moxibustion 36(3): 152-157, 198624) Masako Okazaki, Mayumi Y. et al.: Effect of Single
Moxibustion on Platelet Aggregation andATP-release in Mice, Journal of the Japan Society of
Acupuncture and Moxibustion 38(2): 188-194, 198725) Hideaki M. et al.: Anti-inflammatory Effect ofMoxibustion on Adjuvant-Induced Arthritis,
Journal of Japanese Association of Physical
Medicine Balneology and Climatology 68(3):181-188, 2005
26) Kobayashi K. et al.: The Appearance ofHeat-Shock Proteins (hsp) by Moxibustion, The
Bulletin of Meiji University of Oriental Medicine
4: 67-71, 1988
27) Kazuko K. et al.: Relationship between
Acupuncture and Stress Proteins, Journal of theJapan Society of Acupuncture and Moxibustion
39(3): 338-341, 1989

28) Hideharu Sakamoto: Effects of moxibustion
stimulation on ageing phenomena (second report)– Effects relating to recovery from locomotor
ataxia (1), Journal of the Japan Society of
Acupuncture and Moxibustion, 37(3): 153-158,
198729) Hideharu S. et al.: Effect of Moxibustion on Aged
Rats (Report 3) Reversal from Movement
Disorders of Aged Animals (2), Journal of theJapan Society of Acupuncture and Moxibustion
37(3): 159-163, 198730) Hideharu Sakamoto: Effect of Moxibustion on
Aged Rats (Report IV): Reversal from Movement
Disorders and Recovering the Regular Cyclicity,
Journal of the Japan Society of Acupuncture andMoxibustion 38(2): 195-201, 198831) Hideharu Sakamoto: Effect of Moxibustion on
Aged Rats (Report V) Reversal from Movement
Disorders of Aged Animals (3), Journal of theJapan Society of Acupuncture and Moxibustion
38(3): 314-319, 198832) Motoyo O. et al.: Effects of Moxa andMoxibustion-products on superoxide, Journal of
the Japan Society of Acupuncture andMoxibustion 40(2): 228-231, 1990
33) Motoyo O. et al.: A Study on Radical Scavenging
Effects of Moxa, Journal of the Japan Society of
Acupuncture and Moxibustion 40(4): 377-379,
1990

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

35