March 22, 2017



Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • Acupuncture, baguanfa (Chinese: suction cup therapy), blood letting, chinetsukyu (Japanese: direct cone moxibustion), classical acupuncture, five element acupuncture, Korean belly bowls, kyukaku (Japanese: cupping), kyutoshin (Japanese: moxa on the head of the acupuncture needle), okyu (Japanese: rice-sized direct moxa), traditional Chinese medicine (TCM), zhenjiu (Chinese: acupuncture combined with moxibustion).

  • Not included in this review: Acupuncture, acupressure, classical acupuncture, five-element acupuncture, TCM.


  • Cupping and moxibustion are healing techniques employed across the diverse traditions of acupuncture and oriental medicine for over 2,000 years.

  • In modern times, both methods are usually used to complement acupuncture with needles but they may be used independently.

  • Cupping and moxibustion share the principle of using heat to stimulate circulation and break up congestion or stagnation of blood and chi.

  • Cupping has some relation to the massage technique tuina, which uses rapid skin pinching at points on the back to break up congestion and stimulate circulation.

  • Moxibustion is more closely related to acupuncture as it is applied to specific acupuncture points, while cupping may be used over acupuncture points or elsewhere.

  • The literature on these techniques consists predominantly of opinion based on clinical experience, case reports, and a few case series reports in which the methods of observation and analysis are not clear or consistent. This does not mean the techniques do not work, but little of what has been reported can be evaluated as scientific evidence.


  • The actions of cupping and moxibustion are explained by theory from acupuncture and Chinese medicine. Specifically, health and illness are manifestations of the circulation of chi (vital energy or life energy) through the person. These techniques are used to influence the circulation of chi, or to alter its subtle qualities, in order to relieve symptoms in the body.

  • Heat is believed to be a potent force for influencing the flow or qualities of chi through the body.

  • Historically, one theory of action of moxibustion is that the local tissue damage (extended cellular damage by the intense heat of moxibustion) initiates a non-specific healing reaction that can have effects throughout the body, stimulated by production of immunological mediators and neurotransmitters.

  • It has been proposed that moxibustion elevates immune responses and stimulates the circulation of white blood cells in the body.

  • Moxa may have antiseptic (antibacterial) and analgesic (pain-relieving) effects, by virtue of one of its components, borneol, which is commonly applied to the skin.

  • Moxibustion may improve circulation and enhance localized drug uptake in areas of the body being targeted by therapeutic drugs.

Scientific Evidence


These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.


Bell's palsy

One study suggests acupuncture plus moxibustion, with or without conventional treatments for Bell's palsy, may have benefit. However, more studies are needed to verify this finding.



Preliminary evidence from one study of patients with nasopharyngeal cancer suggests that moxibustion (without needles) may reduce side effects of chemotherapy or radiation therapy. More studies are needed before concrete recommendations can be made.


Cervical spondylosis

There is some evidence from two studies of groups of patients with cervical spondylopathy indicating that moxibustion combined with acupuncture may contribute to reduced symptoms. However, no controlled studies have been conducted. There is insufficient evidence on which to base concrete recommendations at this time.



Evidence from several small studies suggests moxibustion with acupuncture may have potential in treatment of colitis. However, there is insufficient evidence on which to base concrete recommendations at this time.


Crohn's disease

One study suggests acupuncture combined with moxibustion may benefit symptoms in Crohn's disease. More and better-designed studies are needed to verify this finding before concrete recommendations can be made.



Preliminary evidence from one small study suggests moxibustion and acupuncture may reduce symptoms of lymphedema caused by intrapelvic lymph node dissection in gynecological cancer. However, evidence is insufficient for making concrete recommendations at this time.


Peripheral facial paralysis

Preliminary evidence suggests an integrated protocol of herbs, acupuncture, moxibustion and Western medicine may benefit peripheral facial paralysis. However, there is insufficient evidence on which to base concrete recommendations at this time.


Pregnancy - breech presentation

Moxibustion is a long-used traditional remedy in China for cephalic version (a way to try to turn a baby from breech position to head-down position while it's still in the mother's uterus), including as a self-administered technique at home by mothers. The available evidence confirming its efficacy, while showing some promise, is mixed. More studies are needed to verify whether there are predictable benefits in moxibustion for cephalic version.


Rheumatoid arthritis

There is preliminary evidence suggesting that patients suffering from rheumatoid arthritis, an auto-immune disorder, may experience improved immune function as a result of acupuncture and moxibustion. However, evidence is insufficient at this time for making concrete recommendations.



A report of a series of cases observed at a hospital in Mongolia suggests that schizophrenia may respond to a treatment regime including acupuncture and moxibustion. However, there is no systematic evidence available on which to base any recommendations for or against such treatment in schizophrenia.



One study suggests electro-acupuncture may reduce spasticity in patients who have experienced stroke, but there was no evidence that moxibustion offered any additive benefit. More studies are needed to determine whether or not moxibustion may contribute to recovery from stroke.



There is evidence from one small study suggesting that moxibustion may help accelerate the return to normal gastric functioning after anesthesia and surgery. However, there is insufficient evidence for making concrete recommendations for or against moxibustion in recovery from surgery.


Treatment of upper respiratory tract infections (children)

Moxibustion is widely used in China for respiratory tract infections in children. However, at this time evidence is insufficient for making concrete recommendations.


Trigeminal neuralgia

One small study reported treatment of trigeminal neuralgia (sharp shooting pain found in the forehead, face, or jaw region) with cupping to have a significant therapeutic effect. However, there is insufficient available evidence on which to base recommendations for or against cupping in trigeminal neuralgia.



There is preliminary evidence from one study suggesting that moxibustion combined with acupuncture may help reduce urological symptoms in women with urethral syndrome (inflammation of the urethra resulting in painful urination). However, more studies are needed before definitive recommendations for or against this approach can be made.


Weight loss

Evidence does not support use of moxibustion to aid in weight loss at this time, although it may contribute to increased psychological well-being and improved eating attitudes in obese patients. More studies are needed to determine whether or not moxibustion may play a role in weight loss.


*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).


The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • Acne, acute lymphangitis, arthralgia (joint pain), asthma, bronchitis, chronic pain syndromes, common cold, diarrhea, dysmenorrhea (painful menstruation), dysentery (severe diarrhea), epilepsy, facial paralysis, frozen shoulder, gastritis, gastroptosis, infertility, insomnia, leukorrhea (vaginal discharge), lung diseases, osteoarthritis of the knee, parietal and occipital headaches; soft-tissue injury (adjacent to), toothache, trigeminal neuralgia (nerve pain), urticaria (hives), uterine cramps.


Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

  • Frequency of adverse events in acupuncture practice is rare (see Natural Standard monograph on Acupuncture), and even more rare in its adjunctive techniques of cupping and moxibustion.

  • Cupping commonly leaves a temporary bruising of the skin that disappears on its own.

  • It has been suggested that serious cases of adverse events caused by moxibustion are actually cases of negligence; e.g., not removing the moxa from the skin at the appropriate time, or accidentally dropping ash from the burning moxa cigar onto the skin.

  • For both cupping and moxibustion, precautions and contraindications are offered based on tradition, clinical experience and theory rather than controlled research, as follows:

  • Cupping:

  • Avoid the abdomen/sacral area during pregnancy.

  • Avoid contraindicated acupuncture points.

  • Avoid during high fever, convulsions or cramps, or over allergic skin conditions or ulcerated sores.

  • Avoid areas with an inflamed organ, inflamed areas in general (can cup distally and/or around it).

  • Avoid in patients with cardiac disease and/or aneurysms.

  • Avoid in patients with extreme fatigue and/or anemia.

  • Avoid in patients who have just finished exercising or taking a hot bath or shower.

  • Avoid sliding cups over the spine, moles or other skin abnormalities.

  • Moxibustion:

  • Caution with patients with neuropathy.

  • Avoid face, head, nipples and genitals.

  • Avoid with skin adhesions in the area.

  • Avoid points where needling is contraindicated for the individual patient.

  • Caution with direct moxa over large blood vessels or on elderly people with large vessels.

  • Avoid on patients with any kind of "heat syndrome" according to acupuncture theory

  • Avoid in patients with strong heat signs - high fever, etc.

  • Avoid on or near inflamed and/or red areas of the body.

  • Avoid in patients with diabetic neuropathy or in any situation where the patient may not respond to the sensations of heat.

  • Advise patient not to bathe or shower for up to 24 hours after a moxibustion treatment.

  • Pregnancy & Lactation: The abdominal area and the lower back during pregnancy are traditionally avoided in both cupping and moxibustion practice out of concern for adversely impacting the uterus or fetus, although there are no published reports of related adverse effects. Moxibustion is not recommended in pregnant or breastfeeding women.

Author Information

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).


Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Li Y, Liang FR, Yu SG, et al. Efficacy of acupuncture and moxibustion in treating Bell's palsy: a multicenter randomized controlled trial in China. Chin Med J (Engl ) 2004;117(10):1502-1506. View Abstract

  2. Chen K, Jiang Y, Wen H. [Clinical study on treatment of nasopharyngeal carcinoma by radio- and chemotherapy with supplementary moxibustion on Shenque point]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2000;20(10):733-735. View Abstract

  3. Wang G, Qu F. Treatment of 482 cases of cervical spondylopathy by combining point-injection and needle-warming via moxibustion. J Tradit Chin Med 2001;21(1):31-33. View Abstract

  4. Yang C, Yan H. Observation of the efficacy of acupuncture and moxibustion in 62 cases of chronic colitis. J Tradit Chin Med 1999;19(2):111-114. View Abstract

  5. Joos S, Brinkhaus B, Maluche C, et al. Acupuncture and moxibustion in the treatment of active Crohn's disease: a randomized controlled study. Digestion 2004;69(3):131-139. View Abstract

  6. Kanakura Y, Niwa K, Kometani K, et al. Effectiveness of acupuncture and moxibustion treatment for lymphedema following intrapelvic lymph node dissection: a preliminary report. Am J Chin Med 2002;30(1):37-43. View Abstract

  7. Wang GM. [Treatment for 87 cases of peripheral facial paralysis with the integration of TCM and Western medicine and the use of herbs and acupuncture & moxibustion]. Shanghai Kou Qiang Yi Xue 2003;12(4):304-306. View Abstract

  8. Cardini F, Lombardo P, Regalia AL, et al. A randomised controlled trial of moxibustion for breech presentation. BJOG 2005;112(6):743-747. View Abstract

  9. Neri I, Airola G, Contu G, et al. Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study. J Matern Fetal Neonatal Med 2004;15(4):247-252. View Abstract

  10. Moon SK, Whang YK, Park SU, et al. Antispastic effect of electroacupuncture and moxibustion in stroke patients. Am J Chin Med 2003;31(3):467-474. View Abstract

  11. Lin X, Wu J, Du J. [Study on effect of spine surgery on gastric function and its efficacy of relevant treatments]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2000;20(11):834-836. View Abstract

  12. Long X, Chang Q, Shou Q. Clinical observation on 46 cases of infantile repeated respiratory tract infection treated by mild-moxibustion over acupoints on back. J Tradit Chin Med 2001;21(1):23-26. View Abstract

  13. Zhou W. Acute lymphangitis treated by moxibustion with garlic in 118 cases. J Tradit Chin Med 2003;23(3):198. View Abstract

  14. Wu C, Wang Z, Ye X, et al. Fifty cases of gastroptosis treated by moxibustion therapy. J Tradit Chin Med 2000;20(1):42-43. View Abstract

  15. Vas J, Perea-Milla E, Mendez C. Acupuncture and moxibustion as an adjunctive treatment for osteoarthritis of the knee--a large case series. Acupunct Med 2004;22(1):23-28. View Abstract

Copyright © 2013 Natural Standard (www.naturalstandard.com)

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.


March 22, 2017