Complementary Medicine Practical 2

MOXIBUSTION
& CUPPING Compiled by Dr Darren Carpenter
University of Johannesburg

THERAPIES
 CONTENT
1. Moxibustion
I. Introduction
II. Types of moxibustion
III. Application of moxa
IV. Contra-indications
2. Cupping
I. Introduction
II. Indications
III. Manipulations
IV. Precautions

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 Moxibustion
I. Introduction
II. Types of moxibustion
III. Application of moxa
IV. Contra-indications

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I. INTRODUCTION
• Application of heat to specific points
on the body to treat and prevent
disease
• Normally moxa cones consist of the
leaf of the herb Artemisia Vulgaris
• Its properties are bitter, acrid and
warming
Functions
1. To warm the meridians and expel
cold
2. To promote the smooth flow of qi
3. To strengthen yang for collapse
4. To prevent disease and keep healthy

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1. WARM MERIDIANS AND EXPEL COLD
• Due to the warming function of
the herb (Artemisia Vulgaris)
combined with the heat
generated from burning it
• It can be used for all diseases
involving cold-dampness and
chronic conditions of
pathogenic cold
• Such as; cold-damp bi-
arthralgia, dysmenorrhoea,
amenorrhea, stomach-ache, etc.

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2. TO PROMOTE THE SMOOTH FLOW
OF QI
• Cold causes the slow flow or
stagnation of qi
• Heat increases the flow of qi
• “Qi is the commander of blood,
and blood is the mother of qi”
• Used to treat disorders related
to qi and blood stagnation
• Acute mastitis, scrofula etc.

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3. TO STRENGTHEN YANG FROM
COLLAPSE
• When yang is low there will be
excess yin leading to cold and
deficiency of qi
• The warming function of the
moxa helps to reinforce the
yang qi and reduce the cold in
the body
• Yang deficiency conditions

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4. TO PREVENT DISEASES AND KEEP
HEALTHY
• In traditional texts
moxibustion can regularly be
applied to certain points to
invigorate healthy qi and
strengthen the immunity
• Points such as
• ST36 (Zusanli)
• Ren4 (Guanyuan) and Ren6
(Qihai)

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II. TYPES OF MOXIBUSTION
Scarring
moxibustion
Direct
moxibustion
Nonscarring
Moxa Cones
cones moxibustion
Moxa

Ginger insulation
Indirect
moxibustion
Moxibustion Moxa Sticks Garlic insulation

Salt insulation

Warming
Needle Monkshood cake 9
insulation
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MOXIBUSTION WITH MOXA CONES
The herb Artemisia Vulgaris is shaped into a cone

A. Direct moxibustion
Moxa is placed directly on skin
a) Scarring moxibustion
b) Non-scarring moxibustion

B. Indirect moxibustion
Moxa is placed on a material
a) Moxibustion with ginger
b) Moxibustion with garlic
c) Moxibustion with salt
d) Moxibustion with monkshood cake

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A. DIRECT MOXIBUSTION
a) Scarring moxibustion
Technique
1. Shape moxa into a cone (the size of a grain of
rice) and apply ginger/ garlic liquid on area
2. Place the cone on the skin of the chosen points
3. Ignite the cone and leave until it completely
burns out
4. Repeat procedure as required
5. There may be local burns and blisters
1. With possible scarring after it has healed

Indications
• Used for chronic conditions such as asthma
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A. DIRECT MOXIBUSTION
b) Non-scarring moxibustion
Technique
1. Shape moxa into a cone (the size of a grain of
rice) and apply ginger/ garlic liquid on area
2. Place the cone on the skin of the chosen points
3. Ignite the cone and leave it until patient feels
burning sensations or halfway/ two thirds
burnt then remove
4. Repeat procedure as required
5. There should be no local burns, blisters and scar
formation
Indications
• Used for chronic, deficient and cold nature
conditions such as asthma, chronic diarrhoea,
indigestion 12

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B. INDIRECT MOXIBUSTION
a) Moxibustion with ginger
Technique
1. Cut a slice of ginger 0,2 – 0,3 cm thick and
punch small holes in it
2. Place the ginger on the skin of the specific points
3. Shape moxa into a large cone and place on top of
the ginger
4. Ignite the cone and leave it until patient feels
burning sensations then remove
5. Repeat procedure as required
6. There should be no local burns, blisters and scar
formation
Indications
• Used for conditions involving weakness of the spleen
and stomach such as diarrhoea, abdominal pain,
painful joints and symptoms of yang deficiency
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B. INDIRECT MOXIBUSTION
b) Moxibustion with garlic
Technique
1. Cut a slice of garlic 0,5 cms thick and punch
small holes in it
2. Place the garlic on the skin of the specific points
3. Shape moxa into a large cone and place on top of
the ginger
4. Ignite the cone and leave it until patient feels
burning sensations then remove
5. Repeat procedure as required
6. There should be no local burns, blisters and scar
formation
Indications
• Indicated for conditions such as scrofula,
tuberculosis, insect bites and early stage of skin
ulcers
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B. INDIRECT MOXIBUSTION
c) Moxibustion with salt
Technique
1. Usually applied at the umbilicus
2. Fill the umbilicus with salt (to the level of the
skin)
3. Shape moxa into a large cone and place on top of
the salt
4. Ignite the cone and leave it until patient feels
burning sensations then remove
5. Repeat procedure as required
6. There should be no local burns, blisters and scar
formation
Indications
• Indicated for conditions such as abdominal pain,
vomiting and diarrhoea, pain around the umbilicus,
pain cause be a hernia, prolonged dysentery, etc.
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B. INDIRECT MOXIBUSTION
d) Moxibustion with monkshood
Technique
1. A coin-sized cake of monkshood powder mixed
with alcohol is punctured with numerous holes
2. Place onto the selected points
3. Shape moxa into a large cone and place on top of
the monkshood
4. Ignite the cone and leave it until patient feels
burning sensations then remove
5. Repeat procedure as required
6. There should be no local burns, blisters and scar
formation
Indications
• Indicated for deficient and persistent yin-cold
syndromes such as impotence and premature
ejaculation
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II. TYPES OF MOXIBUSTION
Scarring
moxibustion
Direct
moxibustion
Nonscarring
Moxa cones moxibustion

Ginger insulation
Indirect
moxibustion
Moxibustion Moxa Sticks Garlic insulation

Salt insulation

Warming
Needle Monkshood cake 17
insulation
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MOXIBUSTION WITH MOXA STICKS
A preformed and packaged cylinder (Stick) of Artemisia Vulgaris
1. Easier to control heat and time
2. Smoke and smokeless
Two techniques
a) Mild-warm moxibustion
b) “Sparrow-pecking” moxibustion

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MOXIBUSTION WITH MOXA STICKS
a) Mild-warming moxibustion
Technique
1. Ignite moxa stick
2. Grasp in the needling hand
3. Hold over the point for five to ten minutes
4. Should be around 2-3 cm away
5. Patient should feel the area getting warm but not
any burning sensations
6. Use either your little and ring fingers or the other
hand to judge the intensity of the heat
7. Regularly remove ash to prevent it falling on the
patient
8. Area should be slightly red after treatment
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MOXIBUSTION WITH MOXA STICKS
b) “Sparrow-pecking” moxibustion
Technique
1. Ignite moxa stick
2. Grasp in the needling hand
3. Bring the stick close to and then away from the
point
1. Movement can also be left and right or circular
4. Area should be a deep red colour after the
treatment

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II. TYPES OF MOXIBUSTION
Scarring
moxibustion
Direct
moxibustion
Nonscarring
Moxa cones moxibustion

Ginger insulation
Indirect
moxibustion
Moxibustion Moxa Sticks Garlic insulation

Salt insulation

Warming
Needle Monkshood cake 21
insulation
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WARMING NEEDLE MOXIBUSTION
Combines acupuncture and moxibustion
Technique
1. Needle the point as usual and obtain qi sensation
2. Wrap the needle handle with moxa wool or use pre-
packed moxa
3. Ignite the moxa
1. The patient should feel a mild heating sensation
4. Repeat as desired
5. The area should become red but should not burn
6. Place tray beneath the moxa in case ash falls off
Indications
• Painful joints due to cold and damp, numbness with
cold sensation and paralysis

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III. APPLICATION OF
MOXIBUSTION
1. Order of moxibustion
According to ‘The Precious Prescriptions’
a) Apply to yang portion then yin portion of the body
b) Upper part of the body and then the lower
c) Treat the back first and then the abdominal region
d) Treat the head and body first and the limbs
2. Reinforcing and reducing with Moxibustion
1. Leave moxa to burn naturally for reinforcement
2. Blow moxibustion from time to time to cause the moxa to
burn more intensely for reduction
3. Volume
1. 3-7 moxa cones per point
2. 10 – 15 minutes for the moxa stick
4. Influencing factors
1. Pathological condition, age, constitution and
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23 moxibustion sites
IV. CONTRA-INDICATIONS
1. Excess syndromes and heat syndromes
1. Including heat due to yin deficiency
2. Scarring moxibustion on the head, face and areas near
large blood vessels
3. Specific points
1. BL1 (Jingming)
2. ST9 (Renying)
4. Abdominal region and lumbosacral region during
pregnancy
5. Finally make sure you take the appropriate precautions to
prevent fire from the moxa falling on to the clothes or skin
(use a tray below the moxa)

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Cupping Therapy
1. Introduction
2. Indications
3. Manipulations
4. Precautions

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 1. INTRODUCTION
A therapy in which a cup is attached to the skin with suction to cause local stimulation for
disease treatment and prevention

• There are a variety of jars

• Bamboo jar
• Glass cup
• Suction cups (plastic)
• Various sizes
• Chosen based on location
and size of the patient
• Clinically it is often used with
other therapies

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 2. INDICATIONS
• Warms and promotes the free flow of qi and
blood in the meridians
• Dispels damp-cold
• Reduces swelling and pain
• Such as
• Bi syndrome (lower back, shoulder or leg
pain)
• Gastrointestinal disorders such as stomach
ache, vomiting and diarrhoea
• Lung disorders such as cough and asthma
• Soft tissue strains, headaches dysmenorrhoea

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 3. MANIPULATIONS
Application Methods Manipulations

I. Fire Cupping A. Cup-Retention Method

i. Fire twinkling method B. Moving Cupping
ii. Fire throwing method
C. Flash Cupping
II. Water suction method
D. Pricking Cupping
III. Suction Cup method
E. Needle Retention Cupping

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I. FIRE CUPPING
Creating negative pressure inside the cup by introducing a ignited material into the cup

i. Fire twinkling method

1. Prepare the cups which will be used (inspect
and disinfect)
2. Secure a cotton ball with forceps/
3. Soak the cotton ball in 95% alcohol
4. Ignite the cotton ball
5. Hold the forceps in one hand and the cup in
the other hand
6. Place the cotton ball inside cup
7. Quickly place cup on skin
8. Cup should create suction on the skin

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I. FIRE CUPPING
Creating negative pressure inside the cup by introducing a ignited material into the cup

ii. Fire-throwing method

1. Soak a small piece of paper in alcohol
2. Ignite the paper
3. Throw the paper into the cup
4. After a short time place the cup on the skin
5. Cup should create suction on the skin

Cautions
• This method is for the glass cups only
• Only done when the cup is in a lateral position
• As if paper falls on the skin it can burn the
patient

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II. WATER SUCTION METHOD
Creating negative pressure inside the cup by the heat from boiling water

1. Bring a pot of water to a boil

2. Place bamboo cups into the water for several
minutes
3. The cup is the grasped with a clamp, dried and
immediately placed on the skin
4. The cup should create suction on the skin

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III. SUCTION CUP METHOD
Creating negative pressure inside the cup by a mechanical suction

1. Place a plastic suction cup on the selected points

2. Connect cup to suction device
3. Pull the trigger to withdraw air to the desired suction force
4. To reduce suction force pull valve slightly
5. Leave for the desired time
6. To release pull the valve upwards

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 3. MANIPULATIONS
Application Methods Manipulations

I. Fire Cupping A. Cup-Retention Method

i. Fire twinkling method B. Moving Cupping
ii. Fire throwing method
C. Flash Cupping
II. Water suction method
D. Pricking Cupping
III. Suction Cup method
E. Needle Retention Cupping

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III. MANIPULATIONS
A. Cup Retention Method
1. Select the treatment areas/points
2. Use one of the application methods
mentioned previously
3. Then leave the cups on the selected areas for
10 – 15 minutes
4. Remove by placing a finger on the skin near
the cups and pressing the skin to release the
suction
5. This is the most commonly used method

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III. MANIPULATIONS
B. Moving Cupping
1. Apply lubricant to treatment area such as a
massage oil
2. Use one of the application methods to create
suction
3. The cup is then moved up and down the
treatment area until the area becomes red
4. Remove by placing a finger on the skin near
the cups and pressing the skin to release the
suction
5. This method is only suitable for large
muscular areas such as the back, and thighs

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III. MANIPULATIONS
C. Flash Cupping
1. This method is done by rapidly applying and
removing the cup repeatedly on the selected
area
2. It can be used for a variety of conditions and
in situations where cup retention is
inadvisable
1. Such as with children or on the cheeks

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III. MANIPULATIONS
D. Pricking Method
1. Put on gloves and disinfect the treatment
area
2. Puncture the treatment area with the three-
edge needle/plum-blossom needle
3. Then the cup is applied to this area to induce
more bleeding
4. Can be used on a variety of conditions and in
retained for 10 – 15 minutes or until
sufficient blood had been drawn
5. When removing cups carefully clean blood
with a cotton ball

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III. MANIPULATIONS
E. Needle-Retention Method
1. This method involves first needling a point
using any of the needling techniques covered
previously (including disinfection)
2. Then apply the cup over the centre of the
needle
3. The cup is removed when the area becomes
red, congested and blood stagnation appears
4. The needle is then removed in the same
method as the standard acupuncture
treatment

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 4. PRECAUTIONS
I. Cup sizes are selected according to cupping location
I. Larger cups on middle back, lumbar and thighs. Smaller cups on neck, shoulder and calves
II. After Cupping there will be local bruising which should heal after a few days and
occasionally small blisters can form
III. Care should be taken not to overheat the rim of the cup as this may burn then patient
IV. Avoid placing cups on hairy regions or over bone ridges
V. Avoid placing the flame over the patient during application of cups
VI. It is not advisable to apply cupping to areas with skin ulcers, oedema or near large
blood vessels
VII. Do not apply cupping to the abdominal or sacral regions in pregnant women
VIII.Avoid cupping in patients with spontaneous bleeding disorders or delayed
coagulation disorders
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 WOODGROVE
BANK

THANK YOU
Dr Darren Carpenter dr.dbcarpenter@gmail.com

Department of Complementary Medicine

Faculty of Health Sciences
University of Johannesburg