Moxibustion Acupuncture for Chronic Neck Pain

moxibustion acupuncture for chronic neck painAcupuncture has long been a popular alternative therapy for neck pain relief but moxibustion acupuncture may be novel, and a tad scary, for even aficionados of acupuncture. The idea of setting fire to a substance (moxa) at the end of an acupuncture needle may strike some as a step too far, so why is this centuries’ old practice continued, and could moxibustion acupuncture help your neck pain?

Moxibustion is a technique of traditional Chinese medicine (TCM) that typically involves the use of mugwort, a herb revered for its healing properties. In fact, the Chinese character for acupuncture actually translates to acupuncture-moxibustion, as this practice was used to strengthen the blood, stimulate qi, and support overall health and well-being.

Moxibustion acupuncture is frequently used to help stimulate the uterus, with benefits for breech births, menstrual cramps and other problems of the female reproductive system. It has also been studied in recent years to determine the possible benefits (and risks) for conditions such as neck pain.

Indirect and Direct Moxibustion Acupuncture

Direct moxibustion is less common in Western practice as there is a risk of blisters and scarring. This practice involves a small amount of moxa (the mugwort) being placed on top of an acupuncture point, ignited, and left to burn out. Direct moxibustion practitioners may also remove the moxa before it burns out completely, thereby minimising any burning of the skin. Pain, blistering and scarring should not occur if the moxa is removed at the appropriate time. Instead, a pleasant sensation of heat should penetrate the skin and help release pain and tension.

Indirect moxibustion is more commonly used in Western acupuncture practices. This involves applying the moxa to the end of a retained acupuncture needle and setting it alight so that the needle warms. The moxa is extinguished and the needle removed after the treatment is complete. Another form of indirect moxibustion is where a moxa stick is lit and held close to the acupuncture treatment point for a few minutes until the skin heats and turns red. Both of these forms of moxibustion acupuncture pose a much lower risk of pain or burning than direct moxibustion.

When to Use Moxibustion

According to the principles of TCM, moxibustion acupuncture is only appropriate for those with cold or stagnant conditions, not for those who have too much heat. In the case of neck pain this may translate to it being useful for those whose pain is deemed associated with poor circulation, tension, trapped energy (or qi), rather than inflammatory conditions.

As always, anyone applying an alternative treatment such as moxibustion acupuncture for neck pain should have undergone appropriate training. In this case that will usually mean that the practitioner is a qualified acupuncture or holds a traditional Chinese medicine degree. To practice moxibustion in the US, a practitioner must have an acupuncture license. The use of smokeless moxa sticks has become standard practice for treating anyone with a respiratory condition as the smoke and odour of burning moxa can be overpowering.

Can Moxibustion Acupuncture Help Neck Pain?

A study published earlier this year looked specifically at the use of moxibustion acupuncture to treat neck pain caused by cervical spondylosis (arthritis in the neck). The randomized trial divided 145 patients with neck pain into three groups:

  • An acupuncture-moxibustion group (49 patients)
  • An acupuncture group (48 cases)
  • A moxibustion group (48 cases)

All three groups were treated using the Acupoints of Bailao (Extra), Dazhui (GV 14), Jianzhongshu (SI15) and Zhongzhu (TE 3). For the acupuncture group, 20 minute needling retentino was applied at all of these acupoints. For the moxibustion group, seed-size moxa was applied using three cones at each point. For the combination group, both of these protocols were used.

All patients underwent this treatment once every three days, with 10 treatments to be completed within a four week period and a follow-up period of 3 months. Assessments were made using the Northwick Park Pain Questionnaire (NPQ) and McGill Pain Questionnaire (MPQ).

The results showed that, compared to baseline, all three groups had decreased scores on the NPQ and MPQ after three months, but that the acupuncture-moxibustion group had lower scores compared to the groups receiving either acupuncture or moxibustion alone. The difference in treatment effect was significant, but all three groups had effective pain relief from cervical spondylisis.

Direct Moxibustion for Neck Pain

Another study published this year looked at the effects of moxibustion on cervical spondylosis of the vertebral artery. In this trial, 60 patients were randomly assigned to a group receiving a saturated moxa dosage or a regular moxa dosage. Moxibustion was applied at two acupoints where themosensitisation was deemed to be strongest. Moxibustion time in the saturated treatment group was determined by the loss of thermosensitisation, while a standard 15 minute treatment was applied to each acupoint in the regular dose group. Two treatments were given each day for the first four days, then once a day for the following ten days.

Patients were assessed before and after treatment, and at a 6-month follow-up to record symptoms, function, and clinical efficacy of treatment. For those receiving saturated moxa treatment the rate of efficacy was deemed to be 56.7% after treatment and 60% at 6 months. The regular moxa dosage resulted in relief from symptoms in 26.7% and 30% of patients after treatment and at 6 months, respectively. Both groups had improvements on clinical symptoms and function after treatment and at follow-up, with the saturated moxa group having the greater improvement.

Limitations of Current Research

These studies demonstrate the potential benefits of moxibustion acupuncture for neck pain relief from arthritis, but caution is warranted as the studies are isolated and not placebo-controlled (which could be done using needling or moxibustion at non-acupoints). More research is needed to determine if the benefits of moxibustion acupuncture extend to other conditions that can cause neck pain, and whether there is a placebo effect occurring here. Direct moxibustion acupuncture for neck pain can cause lasting skin damage and other complications and should only be done by an experienced practitioner.


Di Z, Jiang S, Lin XM, Fu WB. The short-term and long-term effects on neck pain caused by cervical spondylosis treated with combination of acupuncture and moxibustion with seed-sized moxa cone. Zhongguo Zhen Jiu. 2014 Apr;34(4):325-8.

Zhou XP, Lin H, Fu Y, Wan XY, Fang P, Jie JY, Qiu CL, Wu HP, Zhou JJ. Cervical spondylosis of vertebral artery treated with thermosensitive moxibustion with different dosages: a randomized controlled trial. Zhongguo Zhen Jiu. 2014 May;34(5):461-4.

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