Beginning when I was an acupuncture student eight years ago and continuing into the present, I have worked as a "moxa assistant" at Kiiko Matsumoto's busy office in Newton, Massachusetts.

Working alongside a dynamic teacher like Kiiko has been an inspiration and an invaluable learning experience. My primary function throughout my assistantship has been heating acupuncture points. Needless to say, a great deal has been learned about the value of this practice. Kiiko offers some form of point warming to every patient she treats, and I believe this step to be integral to the remarkable results she achieves. However, I have been troubled by the limitations and inherent dangers associated with point warming using a burning substance. This article hopes to address these problems and offer a new solution.

Since the FDA has only approved acupuncture needles as class II medical devices, all other acupuncture devices still fall under the "investigational" classification. Therefore, the scope of this article will be limited to addressing only the problems associated with using "fire-based" warming methods. No statements will be made that could be considered medical claims about the therapeutic effectiveness of acupuncture point warming methods and devices. Each practitioner should rely on his or her own experience of how and when to use these methods appropriately.

The major problems faced when using fire-based warming techniques such as direct or indirect moxa, a moxa pole, or a tiger warmer (thermie) are as follows:

1. All of these methods create smoke and odor. This prohibits their use:
   • in most professional and hospital settings;
   • for patients and practitioners who are sensitive or allergic to the smoke and odor.
2. There is always the potential for an accidental burn to the patient. Furthermore, this is likely to be a growing concern for insurance companies that provide malpractice insurance.
3. We are losing a valuable opportunity to empower our patients to participate more in home self-care due to the fear and inconvenience of using a burning substance to warm treatment points.
4. There has been no point-warming method for patients who are fearful of having a burning substance placed on or near their body.

Given the problems listed above, as acupuncture gains greater acceptance in more mainstream medical settings, there are sure to be many occasions where traditional fire-based point-warming methods will not be an option. Point warming is far too important a practice to be abandoned in these situations.

Because of the concerns listed above, and motivated by the chronic cough/asthma I have developed from years of smoke inhalation, I became interested in finding a safe, smokeless alternative for warming acupuncture points. Such a device has finally reached the market, providing a controlled source of heat without the smoke, odor and risk associated with traditional burning methods. It comes in several models that offer versatility to meet different practice requirements, and can be used in combination with essential oils and moxa extracts. The usefulness of this product was proven when I recently participated in a study at one of Boston's leading hospitals. We were able to warm acupuncture points on patients using this new method in a setting where no fire-based point warmer would ever have been permitted.

I can already hear the rumblings of practitioners who believe in the sanctity of more traditional methods. Keep in mind that this is not an all-or-nothing scenario. We should choose the warming method that is most appropriate to the individual patient and to the treatment setting in which we practice. The Chinese system of medicine has always been inclusive.

The scenario we are facing with the practice of point warming is similar to that which was met by practitioners of Chinese herbal medicine. To accommodate the needs of a Western patient population, new methods had to be adopted to make the traditional raw herbal formulas into more convenient and palatable forms. Through this compromise, herbal practitioners increased their range of effectiveness by gaining increased compliance. In the end, everyone came out a winner.

Clearly, the more options we have at our disposal, the more likely we are to find one that will work well in most cases. As a profession entering an age of broader acceptance, it is imperative that we find ways to adapt our techniques to fit this new environment. We should carefully preserve what is essential in the methods we employ while continuing to explore new ways to bring the gifts of Chinese medicine to a rapidly changing world.

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Matthew J. Robinson is in private practice in Waltham, Mass. He can be contacted at www.safetywarmer.com.

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