ResearchBlogging.orgWhat’s Moxibustion, And why would you want to use it for constipation? The first I can answer, the second…not so much.

Moxibustion is the practice of burning ground up mugwort and applying the smouldering plant indirectly or directly to the skin to alleviate illness. In the indirect method acupuncture needles are inserted and the burning mugwort is used to heat either the skin or the needle. Direct methods are exactly what it sounds like, the mugwort is burned while sitting on the skin and your skin burns too. The amount of skin burning can vary – from minor to burns that will leave scars. On purpose.

Why would you want to subject yourself to this? Beats me.

But people do, and others study what it might be good for and publish papers about it. One of these turned up in my in-box this morning courtesy of BioMed Central Complementary and Alternative Medicine. With a title like “The effectiveness of moxibustion for the treatment of functional constipation: a randomized, sham-controlled, patient blinded, pilot clinical trial” how could I ignore it?

Reading the study I was transported to a place where the underlying physical process of disease matters not a whit and where the sweat, facial features, , body energy, duration of disease, and pulse type are methods of determining treatment. To be fair other measures were also used, including stomach pain, stuffiness and duration of disease.

No indication was given of how “body energy” was measured. Stuffiness was not defined – I’m sure these are standard things that every doctor knows about.

Frankly, if you are using a magical treatment to unblock your magical life energy then this is the type of thing you should expect to be important.

The study itself was quite small, as the title suggests, only 25 participants. 12 in the treatment arm and 13 in the sham moxibustion arm. Now, how do you do sham moxibustion? Apparently, as it is the heat from burning the mugwart that is important, you just introduce an insulator to stop that heat reaching the patient.

Luckily the procedure used was the indirect acupuncture type, so those in the sham group didn’t wonder why no third degree burns where in evidence.

This approach leaves all the burny, smokey goodness of the mugwort though. Given the negative outcome of the study I suspected this would come up in the discussion. I was not disappointed.

We’ll get to that in a bit. First I want to cover how the patients were divided into “deficiency syndromes” and “excess syndromes”. Constipation in traditional Chinese and Korean medicine is apparently due to either a deficiency or excess of qi (chi), you know, the life energy. This is where checking out people’s faces and sweating etc comes in.

I’ll quote directly from the paper at this point:

“A patient with a deficiency syndrome has sunken, weak pulse, whereas a patient with an excess syndrome has superficial and broad pulse. The patients having symptoms such as a pale face, heavy sweat, and depression were considered to have a deficiency syndrome; the patients having symptoms such as a swollen face, little sweat, and chest pressure were considered to have an excess syndrome. Syndrome pattern differentiation was conducted by an OMD before randomization.”

Further on:

“Five participants were diagnosed with an excess syndrome, and twenty-one participants were diagnosed with a deficiency syndrome. In this study, the most prevalent symptoms for an excess syndrome were a strong body energy and superficial pulse; for a deficiency syndrome the symptoms were a long duration of disease and weak body energy.”

Given that “body energy” plays such a part in dividing the patients I was hoping at this point it would be defined and a method to assess it given. Alas, I was out of luck. Obviously it’s too basic to explain here.

To the results!

I already gave the game away: moxibustion was no different than sham moxibustion when it comes to improving symptoms of constipation. To their credit the authors admitted this could be because moxibustion is, in fact, ineffective. But then, maybe they chose the wrong acupuncture points (never mind that large well designed studies show that where you stick the needles has no effect on outcomes). Or perhaps the sample size was too small – I’ll give them this one, though if there was a significant effect then even a small sample should have shown it.

Then the inevitable, perhaps the sham moxibustion was effective after all. Because, you know, the smoke and stuff. And, oh yeah, the patients actually had “excess-cold” syndromes when normally you’d expect excesses to be warm – so maybe that has something to do with it…

Can you say “rationalising”?

The authors also note that while a number of adverse events have been reported for moxibustion, the patients in this group only experienced redness. Another quote:

“Previously reported adverse events related to moxibustion treatment include burns [no kidding, I thought that was a feature – not a bug], an itching sensation, infection, allergy and xerophthalmia [dry eyeballs]”

Dry eyeballs…. hmmm, better than a punctured lung.

The paper concludes with the obligatory call for larger more rigorous studies, despite the fact that this is an implausible treatment based on magical thinking. Oh well, such is the way of things nowadays.
Park JE, Sul JU, Kang K, Shin BC, Hong KE, & Choi SM (2011). The effectiveness of moxibustion for the treatment of functional constipation: a randomized, sham-controlled, patient blinded, pilot clinical trial. BMC complementary and alternative medicine, 11 (1) PMID: 22132755