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JOURNAL OF CHINESE MEDICINE • NUMBER 76 • OCTOBER 2004

A Survey and Analysis of Zhu


Danxi’s Use of Acupuncture
and Moxibustion
by Lorraine Wilcox

It is a common myth that in ancient times doctors practised that almost without exception, Zhu used moxibustion as
internal medicine using either medicinals or acupuncture an adjunct to herbal treatment.
and moxibustion, but not both types of modalities. This Zhu rarely discussed moxibustion from a purely
has never been true. The Inner Canon, while focused on theoretical point of view, and for the most part one needs
acupuncture and moxibustion, contained thirteen herbal to understand his treatment principles from analysis of his
formulas and much discussion on the theories of herbal treatment recommendations or case studies. However in one
usage. Zhang Zhongjing concentrated on herbal formulas, passage in his book Danxi’s Heart Methods (Danxi Xinfa), he
but recommended acupuncture or moxibustion a number comments on a section of Magic Pivot, Chapter 51, saying,
of times. Ge Hong used all these treatment methods. Sun “Moxibustion has methods to supplement and to drain. To
Simiao said, “When medicinal decoctions attack the interior use fire to supplement, burn the artemisia down to the flesh.
and acupuncture and moxibustion attack the exterior, the To use fire to drain, do not let the fire reach the flesh. It is
disease has no place to escape.” All four great masters of appropriate to clear the cone away. Blowing wind on the
the Jin-Yuan period (Liu Wansu, Zhang Zihe, Li Dongyuan burning cone governs dissipating.” Since Zhu supported
and Zhu Danxi), while famous for their use of medicinals, the viewpoint that there are moxibustion techniques for
also applied acupuncture and/or moxibustion. Zhu Danxi both supplementing and draining, he felt moxibustion
(1281-1358, Yuan dynasty), the last of these four masters, could be used in all patterns, whether vacuity or repletion,
was no exception. In fact, he had his own unique theories hot or cold.
about how and why acupuncture and moxibustion should It is ironic that Zhu also quotes from Zhang Zhongjing’s
be used. These theories will be examined below.The earlier Treatise on Cold Damage regarding the conditions in which
three masters of the Jin-Yuan period exerted a great influence moxa can or cannot be used. Zhang’s theory regarding
over Zhu’s thinking, but he went on to develop their moxibustion can be summarised as ‘Acupuncture is
theories in new directions. Zhu focused on damp-heat as appropriate for yang patterns, while moxibustion is
an important aetiological factor; he developed the theory of appropriate for yin patterns,’ and ‘In yang exuberance
the six depressions; he took Li Dongyuan’s understanding and yin vacuity, avoid using moxibustion.’ Yet in some
of minister fire and his concept of yin fire, and advanced circumstances, Zhu used moxibustion for repletion fire
them to a higher degree. The most famous statement of Zhu and for yin vacuity.
Danxi is that “yang often has surplus, while yin is often There are two schools of thought regarding the use of
insufficient.” Because of this, the school of thought that he moxibustion in heat conditions. The predominant one says
founded is called the school of enriching yin. that moxibustion is contraindicated in heat patterns. Doctors
Zhu is primarily known as a theoretician and herbalist. from Zhang Zhongjing (Han dynasty) to Zhang Jiebin
However, his works frequently include recommendations (Ming dynasty) followed this idea. For example, Zhang
or case studies using moxibustion or acupuncture. Zhu’s Jiebin wrote, “Using the method of fire is only appropriate
use of these modalities is infrequently discussed, yet it is for yang vacuity, lots of cold or congealed and stagnant
fascinating and also serves to illustrate the application of channels and vessels. If there are symptoms of exuberant
his theories. fire, debilitated metal, depleted water, lots of dryness, rapid
pulse, fever, dry throat, red face, thirst, hot defecation or
Zhu on moxibustion urination and so on, one cannot rashly add artemisia fire.
Zhu Danxi’s application of moxibustion has two major areas If one mistakenly uses it, the result will be that the blood
of interest. Firstly, in a number of cases he recommended becomes dryer and the heat becomes more severe. This, on
moxibustion for conditions that were due to yin vacuity or the contrary, quickens the peril.” It seems surprising that
repletion heat, and secondly his use of isolating substances Zhang Jiebin, a proponent of the school of supplementing
for moxibustion was rich and varied. It should be noted yang, was cautious in his use of moxibustion, while Zhu

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JOURNAL OF CHINESE MEDICINE • NUMBER 76 • OCTOBER 2004

Danxi, the founder of the school of nourishing yin, would vacuity heat. A theory behind the use of moxibustion for
aggressively use moxibustion even in heat conditions. nourishing yin is explained in another passage, “The use
Perhaps in some sense, there is balance in this. of artemisia moxibustion on the cinnabar field [dantian] is
Historically, however, there were a number of doctors to supplement yang, because when yang is generated, yin
who held the view that moxibustion could be used in heat is also generated1.” This is a reasonable explanation for the
patterns. Sun Simiao (Tang dynasty) said, “When the small use of moxibustion in vacuity heat conditions, firmly based
intestine is hot and full, apply moxa to Yindu [KID-19].” Liu in yin-yang theory.
Wansu and Li Dongyuan (both Jin dynasty), two of Zhu’s The use of moxibustion in heat conditions sounds counter-
near predecessors, held the view that moxibustion could intuitive to many. However, we do not recommend taking
be used for repletion and heat patterns. For example, Liu, a herbal decoction cold when treating patients with heat
who began the school of cold and cooling treatment, used conditions. Decoctions are usually taken lukewarm at the
moxa for sores caused by heat to “discharge the evil qi”. very least. Perhaps the use of heat in moxibustion is similar
He also used moxibustion to “lead heat to move downward” to the use of fire in cooking the herbs. And, even though
when the body is hot but the feet are cold. Liu also wrote, “A artemisia is classified as warm-natured, we are not using
person with thirst that leads them to drink has heat above the it internally. Its effects when burned externally are not the
diaphragm ... In this pattern, one should apply 3-5 moxa cones same as its effects when used in decoction.
on Dazhui [DU-14]. The patient will immediately recover. This Zhu Danxi applied moxibustion in an extensive range of
treatment drains the governing vessel.”It is said, however, that applications. Throughout his writings, he describes using
it was Zhu Danxi who perfected the theory that moxibustion it to drain and lead heat down, supplement fire, drain or
can be used in heat patterns. Zhu’s writings clearly show that scatter fire evils, dispel phlegm, disperse swelling, lead fire
he used moxibustion to drain fire as well as to supplement toxins out, open the orifices, course wind, dispel wind, drain
yin vacuity. His views about the use of moxibustion in heat lung qi, upbear and raise central qi, descend counterflow,
conditions can be summarised as follows: supplement the Kidneys, unblock the network vessels,
Moxibustion drains and leads heat of the upper burner resolve toxins, stop pain, regulate the Liver, stop bleeding,
downwards. Zhu wrote, “Sometimes leg qi surges into the quicken blood stasis, return yang, stem desertion, warm
Heart. This is blood vacuity with ascending fire qi … Use coldness, clear heat, nourish yin, unblock urination and so
aconite [Fu Zi] powder mixed with spittle to make a cake on. He used moxibustion for acute or chronic conditions, for
the size of a small coin. Apply it to Yongquan [KID-1]. vacuity or repletion, for heat or cold, to raise qi or to drain
Use artemisia fire to moxa it. This will drain and lead the fire. It is apparent that Zhu felt the use of moxibustion was
heat down.” flexible and valuable.
Zhu also said, “Great heat of the two hands is bone A number of later doctors followed Zhu’s lead in using
reversal [jue]. It feels as if the hands were placed in fire. moxibustion for heat conditions. During the Ming dynasty
Apply five moxa cones to Yongquan [KID-1]. There will Gong Juzhong indicated that moxibustion can be used in
be immediate recovery.”Moxibustion scatters fire, dispels all patterns: cold and heat, vacuity and repletion. He said
phlegm and clears the lungs. It is recorded that Zhu treated that moxibustion is suitable in every case.
a runny nose with malodorous snivel. This was “a pattern Wang Ji (Ming dynasty) explained this theory, “Apply
of phlegm, depressed fire and heat.” He applied moxa to moxa in vacuity conditions to make fire qi reinforce
points such as Shangxing DU-23, Zusanli ST-36 and Hegu original qi. Apply moxa in repletion conditions to make the
L.I.-4, and added a herbal formula to clear heat and dispel repletion evil follow the fire qi and scatter. Apply moxa in
phlegm. The patient recovered. cold conditions to make qi return and warm the patient.
In another case, the patient had a runny nose with yellow Apply moxa in heat conditions to lead depressed hot qi to
snivel and ‘brain pain.’ Zhu applied seven moxa cones discharge outward.”
each on Xinhui GB-22 and Tongtian BL-7. The patient then Li Xuechuan (Qing dynasty), the author of Meeting the
eliminated a lump of ‘malodorous flesh’ and recovered. Source of Acupuncture and Moxibustion, wrote, “Generally
Elsewhere Zhu said that to treat cough with phlegm, apply abscesses and malign sores are all due to toxins of lingering
moxa to both Tiantu REN-22 and Feishu BL-13. He said this Heart fire. When treated by moxa, the Heart fire circulates
“can discharge fire and heat, and greatly drain qi.” and the toxins spontaneously scatter.”
Zhu rationalised the use of moxibustion in repletion Zhu Danxi used many different moxibustion techniques,
heat patterns as: “Fire using its characteristic of both direct and indirect. He applied the moxibustion to local
uninhibited radiation to transfer and lead fire toxins out.” and distal points for various problems and also directly to
This principle was used for hot skin conditions such as the affected area, even if not an acupuncture point.
abscesses or sores. Zhu seems to favour certain classes of points or areas of
Moxibustion can even nourish yin and clear heat. There the body for moxibustion. He used the navel or the region
is a record of a patient with fever who was coughing up below it for windstroke, diarrhoea, disturbance of urination,
blood. Zhu used 5 cones of moxa on Feishu BL-13, and yin reversal (jue) and leg qi. Most of these treatments were
the patient recovered. This case was attributed to yin for severe vacuity, often vacuity of yin.

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JOURNAL OF CHINESE MEDICINE • NUMBER 76 • OCTOBER 2004

Zhu favoured Yongquan KID-1 when fire was flaring up, use artemisia to moxa it.” Li Shizhen says that dandruff is
such as in leg qi surging into the Heart, bone reversal and salty, bitter and warm and has toxicity. He says that it treats
mouth sores. In a similar way, he used Baihui DU-20 for various types of toxins. Today, one might wonder how one
enduring diarrhoea, to raise sinking qi. would acquire enough dandruff to make a cake, and how it
Zhu used moxibustion on the jing-well points for acute would stick together. It should be remembered that in the
internal wind where repletion is predominant. He also time of Zhu and Li, people did not bathe or wash their hair
used Dadun LIV-1 for shan disorder and Zhiyin BL-67 to as often as we do today and both men and women wore
induce labour. In other cases when wind was involved, Zhu long hair. The dandruff would be oily, not dry.
might use points on the head, such as Baihui DU-20 or Cakes made of aconite powder and spittle: Zhu used
Yintang (M-HN-3). aconite [Fu Zi] and spittle cakes to isolate the moxa cones on
In external problems, such as abscesses, sores, scrofula, Yongquan KID-1 for leg qi surging into the Heart, to drain
haemorrhoids and fistula, Zhu used moxa locally right and lead the heat down. He also used moxa on these cakes
on the site of the problem. Since many of these problems applied directly onto a fistula. In this case, Zhu said to “just
involve heat, fire and toxins, this is another example of allow the moxa to make mild heat; one cannot allow it to
Zhu using moxibustion in heat conditions. Zhu also used make pain. When the cake is dry, change it. Grind it again
a variety of other points on the limbs and the trunk for into a powder, make a cake, and moxa again. When the
moxibustion, such as Quchi L.I.-11, Jianyu L.I.-15, Tianshu patient becomes tired, stop. The next day, moxa again. Use
ST-25, Zusanli ST-36, Shenshu BL-23, Kunlun BL-60, Fengchi this treatment until effective, when the flesh becomes level.”
GB-20, Huantiao GB-30, Xuanzhong GB-39, Qimen LIV-14, Zhu said the same method could be used for abscesses, sores
Tiantu REN-22 and Dazhui DU-14. In cough with phlegm, and boils on the limbs that do not close for a long time.
Zhu Danxi even recommended moxibustion on a slice of The use of cakes made from aconite and spittle go back at
ginger which was placed on the tongue so that the patient least as far as Sun Simiao, who used them in the treatment
would inhale the smoke. This particular treatment had of abscesses. Zhang Jiebin said that moxibustion on cakes
other unusual aspects. Zhu recommended that some other made of aconite and spittle, “treats open sores when qi
medicinals be ground into a powder and mixed with the and blood are both vacuous and are unable to contract,
artemisia so that the smoke inhaled would have additional or when wind cold attacks resulting in inability of blood
benefits. In the Yuan dynasty it was relatively uncommon to and qi to circulate, therefore not allowing contraction.”
grind herbs and mix them with the artemisia. This technique This is exactly how Zhu used it. Today, aconite slices or
seems to have become popular later, as Zhu never discussed cakes are still used for indirect moxibustion. Aconite is acrid,
the use of moxa rolls and their first usage seems to have hot and toxic, and enters the Heart, Kidneys and Spleen.
been during the Ming dynasty. It restores yang, warms fire, disperses cold, warms the
The first record of applying moxibustion over isolating channels and alleviates pain. However, the use of human
substances was in Ge Hong’s (c. 283-243, Eastern Jin) spittle is not discussed in modern books. Li Shizhen says,
Emergency Prescriptions to Keep Up One’s Sleeves. He used “Under the human tongue, there are four orifices. Heart qi
many types of isolating substances for moxibustion, such passes through two orifices. Kidney humours pass through
as garlic, salt, Sichuan pepper etc. two orifices ... Spittle is a person’s essence qi that has been
From Ge Hong’s time until the present, the use of transformed.” He says spittle is sweet, salty, balanced and
moxibustion on isolating substances has been common. without toxicity.
Even the main modern acupuncture texts in English Gleditsia: Zhu used gleditsia thorn [Zao Jiao] to treat
describe the use of moxibustion onto ginger, garlic, salt and wasp stings. He wrote that a hole should be drilled through
aconite [Fu Zi]. However, historically, there were also many a gleditsia thorn and then it should be placed on the site
doctors who rarely or never discussed the use of isolating of the wasp sting. Use moxa cones over the hole. The
materials. Huangfu Mi, Chen Yanzhi, and Wang Weiyi are pain of the sting should promptly quiet down. Li Shizhen
in this category. describes the same moxibustion technique. He said that
Zhu Danxi used both direct and indirect moxibustion. gleditsia is acrid, salty and warm and has mild toxicity.
He gave many examples of moxibustion on isolating Among its many functions, it kills worms, eliminates
substances, for example garlic, salt, gleditsia [Zao Jiao], phlegm and opens the orifices. We should remember that the
ginger, cakes made of aconite [Fu Zi] powder mixed with Chinese word for moxibustion does not necessarily imply
spittle, and even dandruff. the use of artemisia. Bob Flaws wrote in Liquid Moxa as a
Since descriptions of the more common isolating materials Species of Applied Moxibustion, “Literally, the Chinese word
are found in modern texts, only a few of the more unusual jiu (moxibustion) only means to cause localized erythema
materials will be discussed below: or a burn by means of either an external source of heat or
Dandruff: Zhu wrote that to treat haemorrhoids, “Use one the application of a caustic substance … By itself, the word
slice of garlic [Da Suan], and dandruff [Tou Gou] pinched jiu does not imply the method by which such therapeutic
together to make a cake. First place the dandruff cake on erythema or burns are created.”
the haemorrhoid. Outside, place the slice of garlic and

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JOURNAL OF CHINESE MEDICINE • NUMBER 76 • OCTOBER 2004

The usage of medicinals to the skin to cause some amount For heat entering the blood chamber3, Zhu says, “There
of irritation without artemisia or fire is called ‘medicinal is fullness below the chest and rib-sides, like the chest is
application moxibustion’ or ‘heavenly moxibustion’. The bound up, and delirious speech. This is an evil that has not
medicinals may be applied to an acupuncture point or been eliminated and is retained in the chest and rib-sides.
locally to the affected site. One should prick Qimen LIV-14.”
Zhu recommended medicinal application moxibustion “In sudden manic raving with ghost talk, needle the big
for mouth sores. He suggested applying certain minerals toe below the nail [Yinbai SP-1 or Dadun LIV-1]. It will
topically in the mouth along with the application of arisaema promptly stop.”
[Nan Xing] powder mixed with vinegar to Yongquan KID-1. “When the lumbar is bent and unable to extend, needle
When applied externally, arisaema dissipates blood stasis, Renzhong DU-26.”
resolves toxins, disperses swelling and stops pain. Zhu also recorded acupuncture treatments for the five types
Zhu states the number of cones used in less than half of his of Heart pain, based on the Magic Pivot, Chapter 24. Zhu’s use
discussions of moxibustion. When the number of cones was of acupuncture to treat pain is further justified by his theory
mentioned, it was usually less than ten. Many other doctors, that, “Qi cannot be supplemented in any painful condition.”
such as Ge Hong, Sun Simiao and Zhang Jiebin, frequently Since Zhu felt that acupuncture cannot supplement, its use
suggest more: 50, 100 or even up to 500 cones. So even though is appropriate and safe for painful conditions.
Zhu used moxibustion in heat conditions, he never used a All the above treatments are for repletion conditions,
large amount. Zhu also rarely described the size of the cone, involving an evil, stagnation, stasis or some form of
but in some cases, he recommended them to be as small as a counterflow qi. All of them require draining technique. At
grain of wheat or as large as the little finger. the most, Zhu recommended three points in one treatment.
More often he recommended needling or bleeding only one
Zhu on acupuncture point. Zhu said, “The needle can always be inserted into the
The literature shows that Zhu Danxi used acupuncture affected site.” This suggests local needling of the affected
infrequently, probably because he felt its functions were area, whether an ahshi point or a channel point, to course
limited. He originated the theory that “Acupuncture is and free qi and blood and to stop pain. For example, to treat
entirely draining and does not have supplementation”, and a scrofular node that has not broken open, Zhu said, “Use
in cases that he attributed to vacuity, he did not apply the a fire needle to pierce it and promptly use an ointment to
needle. Zhu often used the three-edged needle to bleed his expel toxins.” The fire needle, also known as hot needle, is
patients, as did the other three great masters of the Jin-Yuan a needle that has been made red hot in a flame and is then
period. Bleeding is almost always considered draining, inserted into the patient. The goal of this treatment is to attack,
so this technique matches the function of acupuncture break, eliminate and move. Acupuncture: A Comprehensive
according to Zhu’s reasoning. Text4 says that hot needle acupuncture is, “currently used
Zhu bled Weizhong BL-40 to treat leprosy, lumbar pain in the treatment of abscesses and hardening of the lymph
due to blood stasis and even abdominal pain. He suggested glands.” This modern text reflects a similar usage to that
pricking to bleed Qichong ST-30 in the treatment of enduring of Zhu Danxi, 700 years earlier.
vomiting of blood, and Shaoshang LU-11 to treat throat Zhu did not confine himself to two of the nine needles.
impediment [bi]. In Extra Treatises Based on Investigation and He said “For clove sores and leprosy use a needle or knife
Inquiry, Zhu records a case: “A neighbor named Bao Liu to pierce or break the head … One must not [try to] remove
was twenty-some years old … He suffered painful wind, the clove sore. It will spontaneously recover.” Zhu reminded
crying out so loudly as to shake up the neighbourhood. his readers to use caution. After discussing some formulas
I looked at him and said, ‘This is a pattern of malign blood for breast abscess, he recommended moxibustion. Then he
entering the channels and network vessels.’ … I gave him said, “Do not rashly use needles or knife to cause a clumsy
four agents decoction [Si Wu Tang] plus peach kernel [Tao provocation of the disease.”
Ren] and carthamus flower [Hong Hua] … I also pricked Finally, Zhu Danxi made sure his students were versed
Weizhong BL-40 to let out nearly three he2 of black blood in the system of the channels, network vessels and points.
and then the condition was secure.”Zhu also used bleeding In Danxi’s Hand Mirror, there is a chapter with diagrams
to eliminate toxins. For example, “To treat sores, scabs or tables of point location based on region of the body. In
and lichens which have a golden thread … If the thread another chapter he discusses the patterns and symptoms
moves above or below to reach the Heart, the patient will of the main channels one by one.
promptly die. One can bleed above the head of the sore to
intercept its pathway. Afterwards, chew duckweed root Conclusion
[Ping Cao Gen] and apply it. The patient will immediately Zhu Danxi is most famous for his application of medicinals
be secure.”Zhu also used the filiform needle and fire needle and for the theories he developed, especially in the realm of
on occasion. When he did, the treatment principle was still yin fire, minister fire, the six depressions and damp heat. He
based on attacking and draining. Below are some recorded is well-known for his use of medicinal formulas to enrich
instances of Zhu’s use of acupuncture: yin and downbear fire.

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JOURNAL OF CHINESE MEDICINE • NUMBER 76 • OCTOBER 2004

However, in acupuncture and moxibustion, Zhu also brought


Lorraine Wilcox has been a licensed acupuncturist in California since
forth new ideas. He developed the theory and application
1989. She is currently writing her Ph.D. dissertation on the state of
of the use of moxibustion in heat patterns. Although Zhu’s
moxibustion during the Ming dynasty. She would like to thank Jerome
emphasis on moxibustion was greater, he exerted influence Jiang for his help.
in the field of acupuncture as well. Zhu originated the idea
that acupuncture can only drain and cannot be used to
supplement. Zhu wrote about his theories and treatment
protocols, and used case studies to illustrate his ideas.
During the Ming dynasty, some important doctors of
acupuncture and moxibustion incorporated these ideas of
Master Zhu. Wang Ji, Xu Chunfu and Yang Jizhou all cited
Zhu’s writings. These theories of Zhu are still studied and
used today by some practitioners.

Notes
1 The idea that ‘when yang is generated, yin is [also] generated’
comes from Elementary Questions, Chapter 5.
2 A he is one tenth of a litre.
3 The blood chamber is the uterus, Liver or thoroughfare vessel
(Wiseman, 1995).
4 Eastland Press, 1981, page 431.

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