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The Moon over Matsushima

The Moon over Matsushima

The Moon Over Matsushima sets out on a journey of exploration, one with unexpected twists and turns. It adds up to much more than a standard or run-of-the-mill acumoxa text, its unusual approach subtly stitching together motifs which take it outside the conventions of most books in the genre.

Two themes resonate throughout the text: the idea that moxibustion was and still is under-estimated as a treatment modality - since the first true formalized developments of Chinese medicine in the Han Dynasty but especially so today; and the second is that it was and may still be an effective therapy for the common man.

One theme is the Moxafrica Project (the astonishing investigation of moxa's possible role in the battle to contain drug-resistant TB in Africa) and the other is the compelling travelogue and seventeen-syllable haikus of Japan's master poet, Matsuo Basho. They make for an unlikely but enlightening polyphonic combination - and an unexpectedly enjoyable and informative read.

The book itself shifts systematically through five parts, the title of each reflecting parts of the mugwort plant itself. "The Roots" speculatively deliberates on the history of the treatment, at times a little playfully, but always with respect. "The Stalk" explores the nature and biochemistry of mugwort. "The Branch" reviews various traditional approaches as well as offering some slightly novel takes on them. "The Stem" takes an often hard-nosed analytical look at the therapy’s possible mechanisms particularly in the light on its well-accepted effect on immune response. "The Leaves" completes the main text by reviewing the therapy in the light of how it might be adapted for best use today.

An invaluable appendix contains over thirty pages of clinical treatments.

The work particularly focuses on Japanese moxibustion techniques and approaches. This focus is validated by the fact that, despite moxibustion having been taken to unique levels in Japan, these approaches have previously been largely ignored in the literature on the subject in the English-speaking world.

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JCM Review

The Moon Over Matsushima does for moxibustion what Understanding Acupuncture by Birch and Felt did for acupuncture. It is an important book that brings moxibustion out from the shadow of acupuncture and shines a rational light on its origins, mechanisms and uses. Named after a line from the travelogue of a classical Japanese poet that refers to moxibustion, the book is reverentially structured into chapters named after parts of the mugwort plant: 'The Root', 'The Stalk', 'The Branches', 'The Stems' and 'The Leaves'. Respectively, these chapters explore the history of moxibustion, its nature, methodology, science and finally research. It is a poetic way of sectionalising what proves to be a very scientific and rational book, although it is clear that Young sees much poetry and romance in mugwort and its associated therapy. With a hats-off to Understanding Acupuncture in the first few pages, Young engages us on an extraordinary quest back through time to the possible origins of moxibustion, examining the uses of mugwort throughout the world and the historical, linguistic and archaeological record, not just for techniques but also for the words and characters used worldwide to describe it. Immediately enthralling, this quest through history and language becomes a detective story with mysteries to solve and a cast of at-times roguish characters. Throughout, Young keeps the story human and accessible. For instance, he asks how it was that the good doctor Busschof - credited with bringing moxibustion to Europe - came to describe it as a Japanese herb, even though it was introduced to him in Jakarta (Indonesia) by a female Vietnamese 'doctress'? This is a puzzle for which Young offers several possible solutions - perhaps it was through Bushchoff's contact with Japanese mercenaries who were stationed in Jakarta, or perhaps through contact with the Vietnamese port of Hoi An, which was a dynamic hub for Japanese-bound trade at the time. As the story unfolds we gather that the hard-drinking Busschof's interest in moxibustion as a cure for gout was not motivated solely by his love of humanity, but also by the potential benefits to his purse; Young's frequent references to Busschof as 'the good doctor' become fondly.

Chapter 2, 'The Stalk', deals with the nature of mugwort, noting that it has been used in many similar ways across different parts of the world, for example to ward off evil spirits. Young conjectures that its qualities as an insect repellent when hung from the threshold of a home may have led to this association, as the link between mosquitoes and disease was not made until much later. This chapter also starts to address the fascinating question of the chemistry of the herb, which changes as moxa is refined and as it ages. This is relevant to the practice of direct moxibustion, and later in the text we learn of research to support the idea that chemicals from moxa are absorbed through the skin at the treatment point, adding a second layer of still poorly understood therapeutic effects - other than heat and infrared.

Chapter 3, 'The Branches', deals with the methodology and application of moxibustion, and here we learn that different methods have very different effects on the body. Direct and indirect moxibustion are not the same. This is a very important observation: The internet is full of references to the effect of moxibustion on white blood cells and immunity, but this research refers specifically to small-cone direct moxibustion. Sparrow-pecking with a moxa stick and needle-moxa have very different and as-yet-unresearched effects on blood chemistry. It is simply not right to generalise about the benefits to 'immunity' from all moxibustion techniques. There is a huge amount we still do not know about what these different techniques achieve. This chapter also discusses in detail the most commonly used clinical moxibustion methods and the rich tradition of using moxibustion for longevity.

Young also introduces a group of points that appear again and again in the literature as key points for moxibustion. One of these, as you would expect, is Zusanli ST-36, and this point is discussed in great detail. The remaining points on the list, Gaohuangshu BL-43, Shenque REN-8, Si Hua (the Four Flowers – Geshu BL-17 and Danshu BL-19, M-BW-6 Huanmen, Shidou SP-17 and Guanyuan REN-4 are each discussed individually. Methods for treating the sinew channels, the extraordinary vessels and even Young's own pragmatic and thoughtful perspective for treating the divergent channels are presented in a clear, well-referenced way. This is a very rich section and also includes a guide to applying Korean Hand Therapy (KHT) with dai kyu (stick-on moxa cones with a platform base), which seems like it could be a very useful home moxa technique to teach to patients.

Chapter 4, 'The Stems' is an insightful analysis of the current science of moxibustion, that draws on a huge range of research published in Japan and the West. Young also contributes fascinating and ground-breaking original research on the burning temperatures of different kinds of moxa and different sizes of cone. Working with long-time collaborator Jenny Craig, he has conducted many different experiments on the burning speeds and peak temperatures of different kinds of moxa, including measuring the temperature changes on the skin. Before they could do this Craig had to grapple with the traditional and obsolete terminology of moxa cone size. It is not scientific enough to call a cone 'rice-grain' sized. Rice grains vary. A repeatable standard was needed and Craig and Young have chosen to define cone sizes by their weight in milligrams. If this book achieves nothing else, it will be a seminal text just for delivering the profession from the confusing and anachronistic lore of measuring cones according to the perceived size of beans and grains. There is even a helpful 'Rosetta Stone' photograph in the book of beans, grains and seeds sitting next to their equivalent moxa cones. May pulses stay on the wrist where they belong!

The book moves significantly away from traditional explanations of moxibustion to try to understand it from a scientific perspective. It is a measure of the quality of the writing that a pragmatic reader such as myself, still hoping patiently to learn a new moxa prescription for this morning's difficult patient, could be so enthralled by discussions of transient receptor potentials, infra-red emission profiles and an exposition of Japanese doctor Toru Abo's theory of the relationship between the autonomic nervous system and immunity. It is worth noting that no matter how complicated or unfamiliar the subject matter became, I never felt lost. This is the gift of a good writer. Young, like evolutionary biologist Richard Dawkins, writes effortless prose about hard science that makes you feel that you are engaged in a personal conversation. With the editing skills of his wife behind him, Young's writing is delightful: modest and understated in a terribly British way; full of wonder, sincerity and humility. Even when disagreeing with another commentator, he describes her as being 'a little unfair'; or when strongly criticising a research board, they 'strayed a little' from their principles. He offers many personal perspectives, techniques and theories with appropriate and genuine scientific caution.

It is only in the final chapter, 'The Leaves', that Young's mildness disappears. He investigates the problems with moxibustion and the paradigm of evidence-based medicine (EBM). He highlights very real risks to our profession if the continuing medical backlash - that has seen university courses on acupuncture in the UK closed down as 'unscientific' - were to focus on moxibustion as a therapy. To a campaigning Western 'quackbuster', small cone moxibustion is so culturally unfamiliar it might well appear to be akin to voodoo. The establishment in the UK has already refused to fund research into the use of moxibustion for correcting breech presentation, despite a stated need for 'well-designed randomised controlled trials', because there was 'no evidence' that it might work. Surely the point of research is to provide the very evidence - for or against - that is missing. Young angrily points out the Catch-22 at work in this example.

The book ends with several important appendices. The first, entitled 'The Seed', describes the inspiration for this book. It was reading about the use of small cone moxibustion to treat TB in pre-antibiotic era Japan that led Young and Craig to set up the charity Moxafrica to treat drug-resistant TB in Africa in the same way. This book is the result of all the research necessary to bring this wondrous and visionary project to fruition.

For the pragmatic acupuncturist looking for clinical gold nuggets, the remaining appendices are the final paydirt. With clear explanations of how to make small cones and apply them, prescriptions of points for constitutional treatments and diagrams of the locations of new points, Appendix 1 is a smoke-filled garden of delights. Even better is the collation of points and methods for specific symptoms, divided helpfully into comprehensive sections on the treatment of respiratory, cranial, cardiovascular, neurological, gastrointestinal, integumentary, musculoskeletal, reproductive, renal, psychological and paediatric diseases. The pragmatic acumoxa therapist will revel in the lists and locations of extra points for moxibustion, as well as the helpful guide to dai kyu stick-on moxa treatment. The more research-minded will happily pursue the lists of further reading on research in Appendix 2. Finally, the shopaholics will be thrilled by Appendix 3, which lists resources - including suppliers worldwide - for all an enthusiastic moxibustionist could want.

Visually, this book is well laid out. I particularly liked that the source materials are referenced as footnotes on the same page. This means that the reader can easily see the provenance of a statement without breaking the flow of the narrative by having to flip to the end of the chapter, or even worse, to the end of the book. Why all textbooks are not presented this way is a mystery, as it makes it so much easier to read.

I have some small criticisms of the book. Sadly, there were some production problems with this edition that allowed quite a few typos to creep in. Furthermore, much of the artwork did not come out well and had to be manually pasted postproduction. This gives some of the pages a scrapbook-like feel, which must be very disappointing to the author. Also, much as I appreciate the sentiment behind the chapter titles, I found them unhelpful. While it must be clear to the author what he means by, for example, 'The Branches', it was not clear to me and a sub-heading such as 'Methodology' would have made things clearer. On the same note, towards the end of the book I found some of the metaphors a little too laboured: for example, whilst talking of how EBM poses more of a threat to moxibustion than to acupuncture in the future, he writes 'the glint in the needle will continue to gleam, while the glow in the moxa cone may find itself snuffed out' – a little too purple for me! When there is a second edition of this book I am sure these small flaws will be ironed out. I say 'when' rather than 'if' because, if I haven't made it clear already, I would like to emphasise my conviction that this will be a classic and influential textbook that will shape our future teaching, learning, research and practice of moxibustion for many years to come. To put it quite simply, if you read this book, you are giving yourself a much more intimate and more profound understanding - in so many ways and on so many levels - of this remarkable herb and therapy.

Oran Kivity


AuthorMerlin Young
PublisherGodiva Books
Number Of Pages376
Book FormatPaperback

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