作者：世界针灸学会联合会
出版社：中国中医药出版社
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艾灸操作规范试读：
Preface
The standardized manipulation of moxibustion was drawn up by the World Federation of Acupuncture-Moxibustion Societies. In addition to the main body, there are three referential annexes, namely A, B and C; and two normative annexes, namely D and E.
Supporting institutions: Institute of Acupuncture and Moxibustion of China Academy of Chinese Medical Sciences, Anhui University of Traditional Chinese Medicine.
Main authors: Liu Weihong, Yang Jun.
Assistant authors: Han Yanjing, Wang Xiaohong, Yang Yuyang, Ma Lanping, Tan Yuansheng, Zhang Qingping, Yang Lili, Liu Wanning, Qi Shulan.
International members of the working group: Judy James (Australia), Bin Jiangwu (Canada), Liu Weihong (China), Yang Jun (China), Hsu Shengfeng (Taiwan, China), Rinaldo Rinaldi (Italia), Koo Ja Own (Korea), Arna Kausland (Norway), Lau KahYong(Singapore), Kuo Tung Ho(Singapore).
International observers: Wakayama Ikuro (Japan), Katai Shuichi (Japan).
Introduction
“Acupuncture” and “Moxibustion” are two main therapies in acupuncture and moxibustion medicine. The scientific researches have concluded that moxibustion therapy offers unique advantages over certain diseases, especially in enhancing the function of the immune system. In view of the rapid expansion of the use of acupuncture and moxibustion worldwide, setting up the standard of the manipulation for moxibustion therapy is extremely important in order to clarify its proper application, enhance its effectiveness, and reduce or avoid its side effects.1 Scope
This standard defines terms of the common moxibustion, specifies its procedures and requirements, operational methods, and gives precautions and contraindications of moxibustion.
This standard is applicable to the common manipulation of moxibustion.2 Quotation Norms
The following referenced documents are indispensable for the application of this document. For dated references, only the edition cited applies. For undated references, the latest edition of the referenced document (including any amendments) applies.
Guidelines on Basic Training and Safety in Acupuncture World Health Organization (1999)
WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region World Health Organization(2007)
WHO Standard Acupuncture Point Locations in the Western Pacific Region World Health Organization(2008)3 Terms and Definitions
The following terms and definitions are applicable to this standard.3.1 Moxibustion
Moxibustion is a therapy which treats and prevents diseases by mainly using moxa floss. The combustion of the moxa floss permits transmission of heat to the acupoints or other parts of the body that have various pathological change. It is an external therapy to treat and/or prevent diseases and promote health of the body.3.2 Moxa Floss
Mugwort leaves are processed to create a soft flavescent cashmere-like substance. It is rated into various grades according to its fineness. Moxa floss of high quality is usually used for direct moxibustion.3.3 Moxa Stick
A long cigar-shaped stick is made by rolling or compressing moxa floss. These moxa sticks are sorted into two categories: pure moxa stick (no substances added) or medicated moxa stick if they contain other herbal ingredients. Smokeless moxa sticks are made with a special process to avoid producing excessive smoke while they are burning.3.4 Moxa Cone
Moxa cone can be made by compressing, rolling or shaping the moxa floss. The machine-made ones can be cone-shaped or column-shaped. Their sizes vary from the wheat-grain size to the soybean and the jujube-stone sizes. According to the sizes they are called small cones, medium cones, and large cones, respectively.3.5 Warm Needling Moxibustion
This technique combines acupuncture needling and moxibustion by fixing moxa floss (one section of moxa stick or a ball of moxa floss) on the top of needle handle during the retention of needles of the acupuncture treatment.3.6 Direct Moxibustion
Direct moxibustion is the method of burning moxa cones directly on the skin. Depending on the degree of the heat stimulation to skin, it can be classified into scarring moxibustion and non-scarring moxibustion.3.7 Indirect Moxibustion
Indirect moxibustion is performed by placing a material between the moxa cone and the skin. According to the different materials used, it can be classified as moxibustion on ginger, moxibustion on salt,moxibustion on garlic and so on.3.8 Moxa Burner
A moxa burner is a tool specially designed for moxibustion therapy. Presently, they are commonly called moxibustion stand, moxibustion barrel, moxibustion box, moxibustion cylinder and moxibustion bowl or plate.3.9 Fainting due to Moxibustion
Fainting due to moxibustion refers to the extreme response symptoms such as sudden dizziness, pale complexion, vertigo, nausea, sweating, palpitation, cold extremities, and a drop in the blood pressure during the moxibustion. In severe cases, there might be loss of consciousness, with stumbling, purple lips and nails, incontinence of urine and stool, profuse sweating and a weak pulse.4 Procedures and Requirements4.1 Preparations before Operation4.1.1 Materials Needed
When using a moxa stick, choose a pure moxa stick or medicated moxa stick based on the state of disease and make sure that the package is intact without any mold or moisture.
When using moxa cone, choose pure moxa floss without any mold and moisture.
When using indirect moxibustion, prepare selected materials to place between the moxa cones and the skin. Check that these materials are not moldy or moisture. Make these materials into flat surface/piece with air holes of appropriate size.
When using a moxibustion burner, choose suitable one for the area for moxibustion, such as moxibustion stand, moxibustion barrel and moxibustion box.
Get the ignition tools ready, such as matches, lighters, incense threads and paper strings, etc, as well as the treatment disks, bending plates, forceps and fire extinguishing tube before starting the treatment.4.1.2 Point Selection and Location
The selection of acupoints is based on the diagnosis and treatment plan. Select and locate the acupoints according to the disease.
The location of the acupoints should be consistent with the standard location published in the WHO Standard Acupuncture Point Locations in the Western Pacific Region.4.1.3 Posture of the Body
Choose a suitable body posture which facilitates the manipulation and is also comfortable and safe for the patient during the treatment.4.1.4 Environmental Setting Required
Be aware of environmental hygiene and avoid pollution. In order to maintain good ventilation, install ventilation facilities or air purifiers if possible.4.1.5 Disinfection
All the disinfections mentioned above should follow the instruction on the sterilization mentioned in the Guidelines on Basic Training and Safety in Acupuncture published in 1999 by WHO.4.1.5.1 Needle Disinfection
When treating with warm needling moxibustion, disposable needles should be used. If the needles are used repeatedly, they should be sterilized strictly with autoclave or other appropriate methods such as ethylene oxide gas.4.1.5.2 Skin Disinfection
When treating with warm needling moxibustion, clean the treatment area of the skin from the center to the peripheral parts using cotton balls with medical alcohol or 0.5% ～ 1% iodophor. The area to be strongly stimulated should be sterilized by using cotton balls with 0.5% ～ 1% iodophor.4.1.5.3 Practitioner’s Disinfection
Before treating patient with warm needling moxibustion, the acupuncturists can use soapy water to wash the hands, and then clean them again using cotton balls with medical alcohol or any another sterilizer.4.2 Operating Method4.2.1 Moxa Stick Moxibustion4.2.1.1 Suspended Moxibustion
The acupuncturist applies a burning moxa stick vertically above a selected point/area without touching the skin so that moderate heat can be felt on the area. The suspended heating modes of moxibustion can be gentle moxibustion, circling moxibustion and pecking sparrow moxibustion.4.2.1.1.1 Gentle moxibustion
Ignite a moxa stick at one end and suspend it 2 ～ 3cm above the treatment area of the skin to transmit a mild warmth sensation to the area until the skin becomes slightly red without burning sensation.4.2.1.1.2 Circling moxibustion
Ignite a moxa stick at one end and suspend it 2 ～ 3cm above the treatment area and move it in a circular motion parallel to the skin to bring mild warmth sensation to the area without burning the skin.4.2.1.1.3 Pecking sparrow moxibustion
Ignite a moxa stick at one end and suspend it 2 ～ 3cm above the treatment area and move the stick up and down over the acupoint without touching the skin like a bird pecking a tree.4.2.1.2 Pressing Moxibustion
Put 6 ～ 8 layers of tissue-paper, gauze or cotton cloth etc. on the treatment area and press the area using a burning moxa stick by keeping it for 1 ～ 2 seconds to bring the heat to the skin. Once the patient feels partial burning and pain, the moxa stick should be removed. Press 3 ～ 7 times at each acupoint. When the skin becomes slightly red, the moxa stick and the paper or cloth can be removed.
Pressing moxibustion usually uses medicated moxa stick. Choose the different moxa stick according to the pathology of a disease. See the Annex A.4.2.2 Warm Needling Moxibustion
Needle the selected acupoint as usual. After the arrival of qi and the suitable manipulations of reinforcing or reducing, directly place a small section of the moxa stick (about 1 ～ 3cm long) on the needle handle and ignite it. Or wrap a 2 ～ 3g ball-shaped moxa floss on the needle handle and ignite it. When it burns out, remove the ashes and then the needles. A piece of cardboard would be placed on the skin around the needle to catch the ashes as they fall to avoid burning the skin.4.2.3 Moxa Cone Moxibustion4.2.3.1 Direct Moxibustion
Start by making an appropriate size of moxa cone with moxa of high quality to suit the patient’s condition. Then place the moxa cone directly on the selected point and ignite its top. In order to fix the moxa cone on the skin, apply some adhesive or stimulus such as garlic juice, vaseline, glycerine, water, or medical alcohol before placing the moxa cone.
When 50% ～ 80% of the moxa cone has burned and the skin appears flush and burning sensation is felt,removes the moxa cone and replaces it with another one. Repeat the procedure until the required amount of cones is completed. This method involves light stimuli without scar and purulence. Hence, it is called nonscarring moxibustion, or heat sensation moxibustion.
When more than half of the moxa cone is burned and the skin flushes and burning sensation is felt, the acupuncturist can press, tap gently or scratch the skin around the buring moxa to reduce the pain sensation and distract the patient’s attention. When the moxa cone is burned out, put another one until the required amount of cones is completed. This strong stimulation may lead to aseptic suppuration with scars. This method is called scarring moxibustion, diathermic moxibustion, and suppurative moxibustion. Various sizes of moxa cone for direct moxibustion are shown in the Annex D.4.2.3.2 Indirect Moxibustion
Place a selected material on the treatment area and place a moxa cone on the material then ignite the moxa cone from its top. When the skin reddens or the heating pain is felt, lift the material with moxa cone away from the skin for a moment and replace at once. Keep doing so until the end of the treatment. For patients who need light stimuli, when 2/3 of the moxa cone has burned, remove the moxa cone or replace it with a new one until the required amount of cones is complete. For patients who need strong stimuli, when 2/3 of the moxa cone has burned, the acupuncturist can gently tap or scratch the surrounding area to distract the patient’s attention and relieve the pain. When the moxa cone is burnt out, put another one until the required amount of cones is complete.
Refer to Annex B for the method of common indirect moxibustion and its preparation.4.2.4 Moxa Burner Moxibustion
The moxa burner is used by putting moxa sticks or moxa floss into the moxa burner to start the treatment. Its advantages are convenient, safe, and comfortable.
Refer to Annex C for the common moxa burners and their usage.4.2.4.1 Moxibustion with Moxa Stand
Insert the burning moxa stick in the moxa stand from the top and fix the stand directing on the acupoint. Acupuncturist or patient can adjust the position of moxa stick in order to regulate the temperature suitable to the patient’s tolerance. After the treatment, remove the moxa stand and take out the moxa stick. Then put out the fire and clean up the ashes.4.2.4.2 Moxibustion with Moxa Barrel
Firstly take out the inner barrel to put the moxa floss into it and replace the inner barrel. Then ignite the moxa floss and place the moxibustion barrel outdoor. Wait until the smoke becomes less and the exterior surface of outer barrel becomes hot. Bring it back indoor and put a lid on it. Arrange the patient in an appropriate posture and place the moxa barrel on the appropriate chosen area over 8 ～ 10 layers of cotton cloth and gauze. Have the patient feel a comfortable level of heat without burning the skin. After the treatment, remove the moxa barrel and put out the fire and clean up the ashes.4.2.4.3 Moxibustion with Moxa Box
Place the moxa box on the moxibustion area of the body. Prepare suitable moxa floss or moxa stick according to the required treatment
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