1 © Chinese Medicine Times - Volume 3 Issue 3 - Late Summer 2008
The Forgotten Art of Moxa
Needling
by Lorraine Wilcox
Introduction
T he first description of the moxa roll was written
near the beginning of the Ming dynasty (late
fourteenth or early fifteenth century). A moxa
stick is made by packing mugwort floss and rolling it
up in paper to make a stick that resembles a cigar or a
large cigarette.
The original manipulation prescribed for use with it, is
different than what we usually practice today. After the
stick is lit, most modern practitioners hold it over the
skin, whereas ancient doctors pressed it into the skin,
which was isolated by cloth or paper. This technique is
called pressing moxibustion or moxa needling (not to
be confused with warm needle technique). This method
is still described today in most Chinese books on
moxibustion and some doctors in China and Japan
continue to use it. It is little known outside of Asia, but
practitioners may find it useful in their clinic.
In the Chinese language, the use of a moxa stick is
sometimes called hand-held moxibustion, because the
stick is often grasped in the doctor’s hand. This is
unlike direct or indirect moxibustion where cones are
placed on the patient’s body. Hand-held moxibustion
has two subcategories, see table 1. Suspended
moxibustion means holding the moxa roll over a point
and is more commonly used today. Moxa needling or
pressing moxibustion is the other subcategory and is
the subject of this article.
Hand-held moxibustion (Moxa stick)
Gentle technique
Circling technique
Suspended
Sparrow–pecking
moxibustion
technique
Wandering technique
Using cloth or paper on
the site
Moxa needling or Using a medicated pad
pressing moxibustion on the site
Wrapping the stick in
cloth
Table 1. The different categories of hand-held
moxibustion.
Background and History
Moxa rolls were originally designed to be pressed into
the point or affected site. A doctor named Zhu Quan
(dates unknown, early Ming) left the earliest record of
the moxa roll. He wrote, “Roll up mugwort in paper.
Pack it firmly. Use paper to isolate the point. Press the
roll firmly into the isolating paper. Wait for the
abdomen to feel hot. When the patient sweats, he will
promptly recover.”
This earliest roll was made of pure mugwort floss.
Rolls made of mugwort mixed with powdered
medicinals appeared later in the Ming dynasty. These
were first described in the Great Pharmacopoeia by Li
Shizhen (1596) and five years later in the Great
Compendium of Acupuncture and Moxibustion by
Yang Jizhou (1601). Medicinals were added to enhance
the mugwort floss effects, for example Chuan Shan Jia
(Squama Manitis), Ru Xiang (Gummi Olibanum), Gui
Zhi (Ramulus Cinnamomi), and Bai Zhi (Radix
Angelicae dahuricae). Other medicinals were included
to help the mugwort qi penetrate deeply such as She
Xiang (Secretio Moschus).
These moxa rolls were not only used by practitioners
of acupuncture-moxibustion, but also by many well-
known herbalists, who used moxa sticks containing
medicinals, even if they rarely used acupuncture. They
could easily devise a formula for a specific patient or
condition and make up the sticks in their own
pharmacy. Herbalists such as Ye Tianshi and Zhang
Jiebin recorded a number of prescriptions.
Moxa sticks were called “needles” because of the long
thin shape, and because it was felt that their qi could
penetrate deeply, like a needle. In addition, the early
method of application, pressing the burning roll into
the site, resembles the insertion of an acupuncture
needle. This technique will be described below.
After the first recipes for moxa sticks were published,
they quickly became popular. Before that time, direct
moxibustion was the most common method but
burning cones on an isolating substance, such as ginger,
garlic, or Fu Zi (Radix Aconiti) was also relatively
popular. Today, moxa sticks are commercially
manufactured and are used by many practitioners as the
default technique instead of direct moxibustion.
2 © Chinese Medicine Times - Volume 3 Issue 3 - Late Summer 2008
During the Ming and Qing dynasties, the instructions
for use were to press the moxa stick into layers of cloth
or paper. The stick was often used on the painful or
affected site, although it could also be applied to
acumoxa points. It was felt that the qi of the moxa
needle could extend and penetrate deep into the body
and that yin conditions could be counteracted with the
needle’s yang qi. The most common indications for
treatment were pain due to wind, cold, or damp; pain in
the sinews or bones; pain from trauma; stagnation or
stasis in the channels and network vessels; any cold or
damp disease; or yin abscesses and swellings. Doctors
also suggested that moxa needling could be used when
the patient was afraid of acupuncture.
Li Shizhen described the method for his thunder-fire
miraculous needle, “At the time of use, light it with a
lamp and blow it out. Place ten layers of isolating
paper on the affected site and apply the hot ‘needle.’
The hot qi will directly enter into the diseased site so
the effect is quick.”
Yang Jizhou also recommended pressing the burning
roll “for a good while” into layers of paper on top of
the site. Then the ashy end was cut off. The stick was
lit again and applied for a total of nine times. Nine is a
yang number, so it would help fortify the yang qi of the
thunder-fire needle. Yang included a Daoist incantation
that was to be chanted each time the needle was
applied.
Moxa Rolls, Toxicity, and Moxa Needling
Moxa needling has come to be associated with certain
formulas, such as the thunder-fire (lei huo) needle or
great unity (tai yi) needle. This is because these
formulas help the mugwort qi penetrate more deeply,
so they don’t just warm the surface. However, in recent
times, doctors have devised ways to treat the isolating
cloth with medicinals, in which case a pure mugwort
roll can be used for moxa needling. A few recipes for
this are given below.
Traditionally, Xiong Huang (Realgar) was used in
many recipes for moxa rolls, including the thunder-fire
and great unity needles. However, questions have been
raised about the safety of Xiong Huang when burned as
it contains arsenic sulphide. Because of this, it is likely
that toxic compounds are in the smoke. Other
medicinals, especially minerals, may also be unsafe for
burning. Therefore, unless the ingredients are known, it
is probably best to avoid commercially available moxa
rolls. If you are going to use them anyway, make sure
the ventilation in the room is excellent.
A few types of herbal moxa rolls are available
commercially. The manufacturer of two common
products from China (Hua Tuo Brand) lists the
following ingredients, none of which are considered
especially toxic and can be considered suitable for
moxa needling.
Tai-I Moxa Roll
Qiang Huo (Rhizoma et Radix Notopterygii)
Mu Xiang (Radix Aucklandiae)
Bai Zhi (Radix Angelicae dahuricae)
Dan Shen (Radix Salviae miltiorrhizae)
Nien Ying Moxa Roll
Gao Liang Jiang (Rhizoma Alpineiae officinarum)
Gui Zhi (Ramulus Cinnamomi)
Du Huo (Radix Angelicae pubescentis)
Bai Zhi (Radix Angelicae dahuricae)
Functions and Usage
The functions of moxa needling are to treat vacuity,
coldness, and pain. It treats bi patterns, sciatica,
incontinence, impotence, menstrual disorders, cough,
wheezing, common cold, and chronic stomach or
intestinal diseases. It can also be used on patients who
are not suitable for acupuncture and on regions that are
difficult or painful to needle, such as fingers, toes,
bony protuberances, the palms, soles, or heels.
Do not use pressing moxibustion on pregnant women
and hypertensive patients, or on the head (except Bai
Hui, Du 20 when indicated), face, or genitals. Be
cautious on the upper body as heat rises.
Moxa needling is a strong treatment and the heat
penetrates very quickly. One benefit of this is that less
smoke is emitted than with suspended moxibustion.
This is because with moxa needling, you only need
press the point a few times, so a strong treatment takes
less than a minute per point. With suspended
moxibustion, you often need ten or more minutes of
treatment per point, so much more smoke is emitted.
Directions for Moxa Needling
In moxa needling, the site or point is isolated with five
to ten layers of paper or cloth. You can also press the
moxa roll into another substance, such as ginger.
Whatever you decide to use, it is better to experiment
on yourself first before trying it on patients. You
should experience this treatment in order to have
confidence in it and a proper sense of timing. At first, I
was afraid the cloth would catch fire and I would be
burned, but this proved not to be the case at all, see
figure 1. However, the heat is strong, so the
practitioner should have experience in managing it.
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Figure 1. Moxa needling using layers of white cotton.
You can see it leaves some ash, but does not burn the
cloth.
Traditionally, the layers were folded from one piece of
cloth, not cut out of many pieces. The exact number of
layers depends on the thickness of the paper or cloth. If
the patient feels the treatment is too hot, you can
always add additional layers. Ye Tianshi (Qing)
recommended using red cloth, probably to increase
yang and add to the fire qi, see figure 2. Below are a
few examples of recipes for treating the cloth with
medicinals.
Figure 2. Moxa needling using red cloth, as
recommended by Ye Tianshi.
If you use paper, experiment with different types to
make sure it does not easily ignite. Cloth seems less
prone to catch on fire, but avoid cloth made of
synthetic materials. Natural cotton is always best.
Junji Mizutani, a Japanese doctor who lives in Canada,
recommends one or two layers of cloth, then two layers
of newspaper on top. He says you can use a fresh
loquat leaf – Pi Pa Ye (Folium Eriobotryae) – over the
cloth instead of paper.
After the site is covered with the cloth or paper, press
the stick into it for one or two seconds. Press until the
patient feels the heat strongly, then lift it. Wait a few
seconds until the wave of heat sensation begins to
decrease, and then press again. You can alternate
between two points to give each point a little time to
cool off.
Pressing each time is referred to as “one cone.”
Remember that the word for “cone” in Chinese (壯
zhuang) does not imply shape and literally means “an
invigoration” or “a fortification.” Press the “needle”
three, five, seven, or nine times (odd numbers are
yang). Reposition or replace the isolating paper or
cloth if it begins to char.
Some books say that when the area feels hot and the
patient sweats, the treatment is completed. Others say
the session is complete when the skin at the site
develops a red halo. While the skin should turn red, it
should not be burned.
Instead of laying the cloth or paper on the site, some
doctors put layers of cloth around the end of the moxa
stick, see figure 3. The cloth must be held with the
proper tension. If it is too loose, the cloth will burn
more easily. If it is too tight, it will extinguish the stick.
By holding the cloth on the stick, you can more clearly
see the point location and can conveniently move from
point to point. However, be careful: If the cloth begins
to burn through, it is less visible to the doctor.
Figure 3. Wrapping the stick with cloth.
Treating the Cloth
Instead of using plain cloth or paper to isolate the moxa
stick, you can use cloth that has been treated. Here are
a couple of recipes for preparing the cloth to enhance
the therapeutic effects. If you use a treated cloth, a pure
mugwort roll may be used.
Medicinal padding for moxa needling
Advance preparation: If you are using a new cloth, it is
probably best to wash it first as new cloths are often
treated and may not be very absorbent.
Boil 15 grams of Gan Jiang (dry Rhizoma Zingiberis)
in 300 millilitres of water see figure 4. You can add
other warming medicinals that move qi-blood or have a
4 © Chinese Medicine Times - Volume 3 Issue 3 - Late Summer 2008

penetrating nature, if desired. Strain the liquid and mix

it with flour to make a paste, see figure 5.

Figure 7. Add more layers.

Let it dry, preferably in the sun, to stiffen the cloth, see

Figure 4. Making a cloth pad with ginger. Simmer the figure 8. Then cut the cloth into ten centimetre squares.
ginger. I have found that if the squares are kept dry, they are
good for an indefinite period of time and do not
become mouldy.

Figure 5. Mix with flour to make a paste.

Apply the starch to a strip of cotton ten centimetres

wide. Place another strip of cotton on top and cover it
with the starch. Continue until you have five or six
layers of cloth. Make sure they stick together and are
smooth and flat, see figures 6 and 7.

Figure 8. It is hanging to dry next to some mugwort.

At the time of moxibustion: Place a square of treated

cloth on the site and perform the moxa needling. You
can press on the cloth for one to five seconds, until the
site feels burning heat. Lift the stick, pause, and press
again. Press five or seven times, see figures 9 and 10.

Figure 6. Spread it on the strips of cloth.

5 © Chinese Medicine Times - Volume 3 Issue 3 - Late Summer 2008
Figure 9. The pad is stiff, but the ginger helps the hot
qi penetrate.
Figure 10. The redness in the region anterior to the
lateral malleolus is from the moxa needling. The
puffiness is from an old injury.
Medicated cloth for moxa needling
Below are two different recipes. Use whichever one
you prefer. You could also write your own based on
the condition to be treated.
Advance preparation:
1. Powder together nine grams each of:
Hong Hua (Flos Carthami)
Jiang Huang (Rhizoma Curcumae)
Si Gua Luo (Fasciculus Vascularis luffae)
Ge Gen (Radix Puerariae)
or
2. Powder together twelve grams each of:
Hong Hua (Flos Carthami)
Jiang Huang (Rhizoma Curcumae)
Dan Shen (Radix Salviae)
Wei Ling Xian (Radix Clematidis)
For either formula, put the powder in 250 grams of rice
vinegar and steep it for 30 minutes to two hours. Filter
the vinegar to remove the dregs. The result is called
Hong Hua Liquid (Hong Hua Ye).
Depending on the size of the area to be treated, cut a
piece of cotton 30 to 70 centimetres long by five to ten
centimetres wide. Immerse the cloth in the Hong Hua
Liquid. Squeeze it out and let it dry in the sun. Fold the
cloth into six layers. You are now ready to treat the
patient.
At the time of moxibustion: Light the moxa stick. When
it is burning well, wrap the burning end tightly in the
six layers of the cloth. Press the moxa needle into the
affected region with a twisting motion. Hold the roll
and cloth tightly and turn it 360º as you press it. The
patient should feel warm heat and distension.
To drain, twist the stick counter-clockwise and apply it
three or five times per point. To supplement, turn it
clockwise and apply it four or six times on each point.
Treat daily or on alternating days.
Example Treatments
Prolapse of the uterus or rectum: Moxa needle Bai Hui
(Du 20). Press three or five times. Treat once a day.
Impotence due to binding depression of liver qi: Select
two to four of the following points: Gan Shu (UB 18),
Shen Shu (UB 23), Nei Guan (PC 6), Qi Men (LV 14),
Zu San Li (ST 36), San Yin Jiao (SP 6), Tai Chong
(LV 3). Press five to ten times per point. Treat once a
day.
Seminal emission due to effulgence of fire: Select two
to four of the following points: Xin Shu (UB 15), Zhi
Shi (UB 52), Zhong Ji (Ren 3), Shen Men (HT 7), San
Yin Jiao (SP 6). Press five to ten times per point. Treat
once a day.
Bedwetting due to lung-spleen qi vacuity: Select two or
three of the following points: Lie Que (LU 7), Fei Shu
(UB 13), Pi Shu (UB 20), Qi Hai (Ren 6), Zu San Li
(ST 36). Press five times per point. Treat once a day.
Frozen shoulder due to loss of nourishment in the
channels and sinews: Alternate the following sets of
points, selecting three to six points each time:
1. Jian Yu (LI 15), Jian Liao (SJ 14), Bing
Feng (SI 12), Jian Zhen (SI 9), Jian Jing (GB
21), Da Zhu (UB 11), Bi Nao (LI 14), Qu Chi
(LI 11), Wai Guan (SJ 5).
2. Tian Zong (SI 11), Tai Jian (N-UE-11),
Yun Men (LU 2), Jian Nei Ling (M-UE-48),
Nao Shu (SI 10), Chi Ze (LU 5), Yang Lao
(SI 6), Hou Xi (SI 3), a shi points.
Press five or seven times per point. Treat once a day or
on alternating days.
6 © Chinese Medicine Times - Volume 3 Issue 3 - Late Summer 2008
Sciatica due to cold-damp: Select three to six of the
following points: Ming Men (Du 4), Yao Yang Guan
(Du 3), Jia Ji (M-BW-25) from L2 thru L5, Zhi Bian
(UB 54), Huan Tiao (GB 30), Yang Ling Quan (GB
34), Jue Gu (GB 39). Press five or seven times per
point. Treat once or twice a day.
Bi patterns with dual qi-blood vacuity: Alternate the
following sets of points, selecting two to six points
each time:
1. Ge Shu (UB 17), Gao Huang (UB 43), Shen
Shu (UB 23), Pi Shu (UB 20), Wei Shu (UB
21), Zhong Wan (Ren 12), Zhang Men (LV
13).
2. Qi Hai (Ren 6), Zu San Li (ST 36), San Yin
Jiao (SP 6), Qu Chi (LI 11), Yang Ling Quan
GB 34).
Also select local and distal points for the affected site.
Press five or seven times per point. Treat once or twice
a day.
Vessel bi due to cold-damp: Select two to six of the
following points:
Lower limbs: Zu San Li (ST 36), Yin Ling
Quan (SP 9), Jie Xi (ST 41), Xing Jian (LV 2).
Upper limbs: Qu Chi (LI 11), Wai Guan (SJ
5), Zhong Zhu (SJ 3), He Gu (LI 4).
Press five or seven times per point. Treat once or twice
a day. This is often used during early stage of the
disease.
Joint-running wind due to invasion of damp-heat:
Symptoms include redness and swelling of the joints,
acute pain, difficulty bending and stretching, etc. Select
three to six of the following points: Da Zhui (Du 14),
Shen Zhu (Du 12), Qu Chi (LI 11), He Gu (LI 4), Yin
Ling Quan (SP 9), San Yin Jiao (SP 6), Xing Jian (LV
2), a shi points. Press five or seven times per point.
Treat once a day.
Biography
Lorraine Wilcox Ph.D., L.Ac. has been a licensed
acupuncturist in California since 1989. She received
her Ph.D. in Classical Chinese Medicine from
American University of Complementary Medicine and
has taught herself to read Chinese. Wilcox is also an
assistant to Master Larry Sang of the American Feng
Shui Institute and teaches in selected acupuncture
schools in Los Angeles. Lorraine Wilcox is the author
of Moxibustion: the Power of Mugwort Fire, published
by Blue Poppy Press. She can be contacted at
zhenjiu@gmail.com.
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