Moxibustion and Cancer
What Is Moxibustion?
Moxibustion is an ancient Chinese practice often used along with acupuncture. It is the medical application of burning mugwort floss (as cones or sticks) on or over an acupuncture-moxa point or an affected site. Mugwort is the common name for Folium Artemisiae Argyi, a plant whose leaves are dried, aged, ground and then sifted to make a fine powder.
In Traditional Chinese Medicine, human bodily functions are controlled by the meridian, qi and blood systems. There are 365 designated points located along 14 meridians which can be used to stimulate, balance and harmonise the yin and yang by relieving blockages in the flow of Qi.
Benefit of Moxibustion in Cancer
Ancient experience as well as more recent modern clinical trials have shown it to treat many benign diseases. In the cancer arena, the moxa and the moxa smoke itself are theoretically thought to have anti-cancer properties and to contain active chemicals that preferentially kill human cancer cells.
Modern studies have shown it to be useful in treating the side effects and symptoms of cancer and cancer treatment such as pain, vomiting, diarrhoea, neuropathy, cough, headache, dizziness and insomnia. It can also raise low white blood cell counts that have occurred due to chemotherapy.
An overview of systematic reviews conducted by Wu et al published in 2015 concludes that acupuncture and related therapies are effective for cancer-related fatigue, chemotherapy-induced nausea and vomiting and leucopoenia (low white cell count from cancer or its treatments). There was conflicting evidence for cancer-related pain, hot flushes, hiccups and improving quality of life and insufficient evidence to support effectiveness in xerostomia (dry mouth from cancer or its treatment), dyspnoea (shortness of breath), lymphoedema (limb swelling due to blocked lymph from cancer or from removed lymph nodes due to cancer) and psychological well-being.
Breast Cancer Related Lymphoedema
According to the theory of TCM, upper limb lymphoedema is closely related to san-yang meridian and san-yin meridian. Stimulating the meridian system of patients makes the blocked lymphatics flow, helps the striated muscles contract and promotes the backflow of lymph to relieve the pain of lymphoedema.
A systematic review and met-analysis conducted by Jin et al in 2020 included 12 randomised controlled trials. The results showed that, compared with western medicine, physiotherapy or functional training, acupuncture moxibustion therapy was better at treating breast-cancer related lymphoedema in particular in reducing symptoms and improving quality of life.
Cancer Related Fatigue
He et al conducted a systematic review and meta-analysis published in 2013 assessing the use of acupuncture and moxibustion for cancer-related fatigue. When moxibustion plus routine care was compared with routine care alone, the meta-analyses demonstrated the combination had a relatively significant benefit in improving severe fatigue (OR 0.16 95%CI 0.07 – 0.37, P<0.0001). The results also showed that compared with routine care alone, moxibustion plus routine care could improve emotional function, global health status and fatigue.
Treatment-Related Side Effects
A Cochrane Review conducted by Zhang et al and published in 2018 included 29 randomised controlled trials involving 2569 patients. 5 compared moxibustion with none, 15 compared moxibustion + conventional therapy versus conventional therapy alone, and others compared moxibustion with sham or conventional therapy alone. The results showed beneficial effects on immunological function by improving the white cell count and haemoglobin levels, reduced gastrointestinal symptoms (nausea and vomiting) from chemotherapy and radiotherapy and improvements in quality of life.
This built on a systematic review and meta-analysis conducted by Lee et al that was published in 2010 that showed similar statistically significant benefits for reducing the side effects of chemotherapy, namely nausea and vomiting.
Enhancing Effect of Chemotherapy
Xue et al (2020) conducted a trial on a breast cancer mouse model using moxibustion and paclitaxel. They found that there was reduced weight loss, improved survival and an increased white cell count. Immune function was enhanced (by upregulating INF-γ and IL-2 and reducing IL-10). As well as that, angiogenesis was inhibited (by reducing HIF-1a and VEGFA) and the immunosuppressive microenvironment was overcome by inhibiting the PD-1/PDL1 signal pathway.
Toxicity and Side Effects
Moxibustion is relatively harmless although the application of heat in situations of peripheral neuropathy (reduced nerve function and sensation either due to cancer or chemotherapy-related) needs to be considered. However, it can also be used to restore nerve function in traumatic or diabetic nerve damage and trials are underway for its effectiveness in chemotherapy-related peripheral neuropathy.
Conclusions
Moxibustion appears to be a safe and effective treatment whether alone or as an adjunct to conventional care for the treatment of cancer-related symptoms such as fatigue and for the improvement in side effects related to cancer treatment such as nausea, vomiting and lymphoedema. It can be considered for improving immune system function in situations of depletion due to chemotherapy and can overall enhance quality of life compared with other treatments alone. It is simple to administer with little to no toxicity and if chosen, should be carried out by a trained and experienced professional in Traditional Chinese Medicine.
References
Moxibustion: A Modern Clinical Handbook by Lorraine Wilcox Blu Poppy Press 4th ed 2012
Wu X, Chung VC, Hui EP, Ziea ET, Ng BF, Ho RS, Tsoi KK, Wong SY, Wu JC. Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews. Sci Rep. 2015 Nov 26;5:16776. doi: 10.1038/srep16776. PMID: 26608664; PMCID: PMC4660374.
Jin H, Xiang Y, Feng Y, Zhang Y, Liu S, Ruan S, Zhou H. Effectiveness and Safety of Acupuncture Moxibustion Therapy Used in Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2020 May 11;2020:3237451. doi: 10.1155/2020/3237451. PMID: 32454855; PMCID: PMC7240793.
He XR, Wang Q, Li PP. Acupuncture and moxibustion for cancer-related fatigue: a systematic review and meta-analysis. Asian Pac J Cancer Prev. 2013;14(5):3067-74. doi: 10.7314/apjcp.2013.14.5.3067. PMID: 23803081.
Zhang HW, Lin ZX, Cheung F, Cho WC, Tang JL. Moxibustion for alleviating side effects of chemotherapy or radiotherapy in people with cancer. Cochrane Database Syst Rev. 2018 Nov 13;11(11):CD010559. doi: 10.1002/14651858.CD010559.pub2. PMID: 30480754; PMCID: PMC6517257.
Lee MS, Choi TY, Park JE, Lee SS, Ernst E. Moxibustion for cancer care: a systematic review and meta-analysis. BMC Cancer. 2010 Apr 7;10:130. doi: 10.1186/1471-2407-10-130. PMID: 20374659; PMCID: PMC2873382.
Xue N, Fu X, Zhu Y, Da N, Zhang J. Moxibustion Enhances Chemotherapy of Breast Cancer by Affecting Tumor Microenvironment. Cancer Manag Res. 2020 Sep 4;12:8015-8022. doi: 10.2147/CMAR.S249797. PMID: 32943934; PMCID: PMC7481310.
