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Moxibustion, to correct a breech presentation of the fetus
Moxibustion in practice

Moxibustion is a therapy based on the heat stimulation of acupuncture points. In traditional Chinese medicine, moxibustion is used on patients suffering from lack of energy, stagnation or cold. It is thought that moxa favours better circulation of the blood and vital energy thus fighting the causes of the illness.

Heat is generated by burning a herb, artemisia vulgaris, whose Japanese name, moxa, is the source of the term in use. Artemisia is first pressed, dried and then rolled in mulberry paper which smoulders once lit.

Artemisia belongs to the family of composite tubuliflores. It grows spontaneously in most of the northern hemisphere and there are about 200 species. Artemisia vulgaris is found in Europe. For example, in Italy there are about 20 species of artemisia. It grows on uncultivated land and on road verges. The artemisia sticks used for moxibustion can be imported from China, but if necessary any other kind of heat can be used. Data from the literature confirm that moxibustion using artemisia produces the same effect as heating the points by laser and that, in clinical practice, use is sometimes, made of lighter, a candle, a cigarette, a cigar and so on.




HOW TO USE MOXA

With a match or a lighter, you light one end of the stick and blow on it so that the whole section is incandescent and smoulders uniformly. With caution, the incandescent tip of the stick is brought close to the carefully localised point to be treated, ensuring that you hold the stick in a perpendicular position and at a distance of about 3-5 centimetres from the skin. The distance depends on how much heat you want to transmit and the energetic constitution of the patient. In the case of a breech presentation, the points to be heated are located beside the outer corner of the fifth toenail, bilaterally.

In this way, the patient will feel the heat penetrate gradually causing a pleasant sensation that will intensify until it becomes unpleasant. The stick is then withdrawn for a brief pause and then the operation is repeated. The procedure must be repeated several times until the point of application becomes warm or hot and begins to turn red. This can take from a few minutes to a few hours when a patient’s lack of energy is particularly serious. In the case of malposition of the fetus, this heat treatment lasts twenty minutes (with some differences according to author).

Once the application has finished, the artemisia stick must be extinguished (never in water because traditionally artemisia used to be dried for seven years) by suffocating the heat source, for example by placing it in a small bottle only slightly bigger than the stick, or else by cutting off the lit part (it continues to burn in sand). Whatever method is chosen, it is important to check that the artemisia stick is not still smouldering before putting it away. It is advisable to air the room before and after the treatment.

In the case of a breech presentation, it is thought that moxibustion works as a result of a documented increase in fetal activity.

Various authors agree that the number of previous births and the stage of pregnancy are important factors in the success of this method. The treatment is more effective in women expecting their first child and when it is performed early on, preferably between the 32nd and 34th week.

The technique described can be performed on women who do not present any contraindications and who have accepted to undergo this treatment, signing the relevant informed-consent form.

Moxibustion treatment, as offered by the health services in Tuscany, is given over a maximum of six sessions, all done in the same way, and can be carried out by specially trained medical or paramedical staff.




The procedure is carried out as follows
•With the woman lying down on the bed on one side (according to preference) and with her hips slightly forward, supported with the aid of a pillow if necessary, two operatives apply heat bilaterally to acupoint BL67 situated on the little toe. The smouldering stick must be held for 20 minutes as near as possible to the skin, without causing a blister, but producing redness. The ambient temperature should be 22°C.
•The treatment is repeated six times over a maximum of nine days, not at set times.
•Before each treatment, the heartbeat must be monitored (position and rate) and where possible an ultrasound scan should be done to determine the position of the fetus. This allows an assessment of when the fetus turns in relation to the number of treatment sessions. The data are recorded on the patient’s medical record.

The treatment must be interrupted in the following circumstances:
•if the ultrasound scan shows that the fetus has turned;
•if painful abdominal contractions begin during or after the session;
•if the woman becomes pale or there her blood pressure falls - in this case, besides interrupting the treatment, the room should be aired, the patient’s feet raised above the level of her head, and her pulse rate and blood pressure should be monitored;
•the appearance of obstetrical changes which make it advisable to interrupt the treatment.