The pain and limitations of arthritis, together with the risks of nonsteroidal anti-inflammatory drugs, send many arthritis sufferers in search of alternative treatments, such as traditional Chinese medicine. The "proof" of effectiveness of traditional remedies often is simply that they’ve been used, literally, for ages. If they did not provide a benefit, the thinking goes, they would’ve been dropped by the wayside a few hundred years ago. But in today’s world—in our Western world, at least—credibility demands cold, hard evidence.

The more East meets West, the more scientists are putting traditional Chinese medicine remedies to the test. And they just did that with a remedy that has been part of traditional Chinese medicine for at least 2,000 years and used for everything from turning breech babies to curing Constipation to—you guessed it—relieving arthritis pain. It’s not a form of acupuncture or an herbal extract. It’s something even more exotic—moxibustion.

UP IN SMOKE
Moxibustion is a cross between acupressure and old-fashioned herbalism—but with fire. It involves burning moxa (the herb Artemisia vulgaris, also known as mugwort) very close to the skin at acupoints—acupuncture meridian points. In one common moxibustion technique, the moxa is packed into a very small pillar that sits in a hollow cylindrical base that is placed on an acupoint. Tiny holes in the base allow smoke and heat from the burning moxa to escape and make contact with the acupoint.

To prove by Western standards that moxibustion is effective for pain relief of knee osteoarthritis, Rheumatic Arthritis, Chinese researchers recruited 110 people with painful knee osteoarthritis. Half of the participants received real moxibustion treatments, as I described above, and the other half received a sham procedure three times per week for six weeks. Moxa was burned in its cylinder in the sham procedure, but the holes at the base of the gadget were covered by a hidden, internal membrane that blocked the escape of smoke and heat. None of the participants knew whether they were getting real moxibustion or a sham treatment. The practitioners providing the treatments also were kept in the dark by the study researchers about whether they were providing a real or sham moxibustion so that they wouldn’t unconsciously or consciously perform treatment or record results in a biased way.

NOT JUST BLOWING SMOKE
Three weeks into the study, the moxibustion group reported a 25% reduction in pain, on average, whereas the sham treatment group reported a mere 3% reduction. By the end of treatment, reduction in pain more than doubled—to 53%—in the moxibustion group and improved to 24% in the sham group. These results held up for quite some time after treatment ended. At 24 weeks, patients in the moxibustion group reported 51% less pain than before the study, and patients in the sham group reported 20% less pain.

There was improvement in use of the knee, too. Function increased by 39% after six weeks of moxibustion treatment and by 51% after six more weeks went by. Meanwhile, function improved by only 13% after six weeks of sham treatment and did not improve anymore after that.

For anyone hoping to improve an arthritic knee, here’s an important time marker—the level of improvement in function began to slip after 18 weeks had gone by, suggesting that the healing effects of six weeks of moxibustion for knee osteoarthritis could last 4.5 months.

And the only complication of moxibustion was temporary redness at the acupoint site.

These are wonderful results, clearly. No one knows how moxibustion works, but one theory is that the heat generated by the burning moxa stimulates the skin at the acupoint, which, in turn, stimulates the nervous system to release feel-good hormones called endorphins, which block the sensation of pain. Another possibility is that the heat generated by the moxa, which is not quite strong enough to cause injury, is irritating enough to trigger the body to launch a healing response anyway. If you are asking why moxa is used instead of any number of herbs, the answer is tradition. In Chinese medicine, burning mugwort is thought to have a therapeutically warming effect on the body that promotes blood circulation and pain relief.