Name: Warm Moxibustion and Scraping as a Traditional Chinese Medicine Therapy for Cervical Spondylosis Treatment (Video) | JoVE Journal
Uploaded: 2025-06-27T13:10:00.000+00:00
Duration: 4 min 28 s
Description: Learn warm moxibustion and scraping therapy for cervical spondylosis treatment using heat and mechanical stimulation. This protocol demonstrates good efficacy, safety, and high patient acceptance.

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This study was supported by the Fifth Batch of the National Traditional Chinese Medicine Excellent Clinical Talents Training Project. (Announcement from the Personnel and Education Department of the National Administration of Traditional Chinese Medicine. No. 2022-1).

All participants were recruited from the Preventive Treatment Center, Liaoning University of Traditional Chinese Medicine Second Affiliated Hospital. The protocol was approved by the Ethics Committee of Liaoning University of Traditional Chinese Medicine Second Affiliated Hospital (NO. 2023(XS)-013-01(CS)). Patients were required to provide informed consent before participating in this clinical trial. All operators were required to be qualified and professionally trained TCM practitioners, and no operator was changed during the trial unless necessary. The details of the reagents and equipment used in this study are listed in the Table of Materials.
1. Pre-treatment evaluation
<ol>
	<li>Set the following inclusion criteria: (1) Patients aged between 18-60 years (both ends included); (2) pain or stiffness in the neck and shoulder muscles with corresponding pressure points, and clinical examination showing limitation of cervical spine movement; (3) radiographic examination showing normal findings or only physiological curvature changes, mild intervertebral space narrowing, or rare osteophyte formation.</li>
	<li>Set the following exclusion criteria: (1) severe dermatosis or broken skin in the treatment area; (2) previous history of neck trauma, neck fracture, or surgery; (3) pregnancy or lactation period; (4) serious physical or mental illnesses; (5) receipt of other treatment within the past 3 months; (6) hypersensitivity to aspirin or flurbiprofen; (7) presence of other diseases such as vertebral artery stenosis, benign paroxysmal positional vertigo, or diseases with a tendency to bleed.</li>
	<li>Set the following dropout criteria: (1) allergic reactions or other complications occurring during the study; (2) voluntary withdrawal by the patient; (3) poor compliance or the initiation of other treatments during the study period (e.g., self-massage, physical therapy).</li>
</ol>
2. Grouping
<ol>
	<li>Divide the recruited patients into the treatment group and the control group using the random number table method18,19.</li>
	<li>Administer WMAS therapy to the patients in the treatment group four times, 20 min each time, once every 4 days (Figure 1).</li>
	<li>Administer flurbiprofen cataplasms (40 mg per patch) to the patients in the control group for 13 days, with one patch applied twice daily20,21.</li>
</ol>
3. WMAS procedure
<ol>
	<li>Pre-operation preparation
	<ol>
		<li>During treatment, maintain an appropriate indoor temperature to protect the scraping area from wind and cold, and avoid having fans or air conditioning blow directly in the summer.</li>
		<li>Introduce the treatment method and related notes to the patients to ease their tension.</li>
		<li>Check medical devices: WMAS cup, thunder-fire moxa stick, scissors, scraping oil, lighter, tweezers, gauze, and disposable medical gloves. 
		NOTE: Check whether the WMAS cup and its fireproof net are intact or have cracks, and check whether the thunder-fire moxa stick is damp.</li>
		<li>Ask the patient to sit and fully expose the neck, shoulders, and both hands22,23.</li>
	</ol>
	</li>
	<li>Select the acupoints: (1) Governor Vessel: Fengfu (GV16), Shenzhu (GV12); (2) Bladder Meridian of Foot-Taiyang: Tianzhu (BL10), Feishu (BL13); Gallbladder Meridian of Foot-Shaoyang: Fengchi (GB20), Jianjing (GB21); Triple Energizer Meridian of Hand-Shaoyang: Zhongzhu (TE3), Yangchi (TE4); Small Intestine Meridian of Hand-Taiyang: Houxi (SI3), Wangu (SI4). 
	NOTE: For the locations of the acupuncture points, refer to the Nomenclature and Location of Meridian Points published in 2021 (GB/T12346-2021)24. The detailed positions of the acupuncture points can be found in Table 1.</li>
	<li>Operation procedure
	<ol>
		<li>Cut the thunder-fire moxa stick with scissors into four equal parts, approximately 2.5 cm each. Insert one part into the screw in the WMAS cup. Ignite the bottom surface of the moxa stick evenly, cover it with a fireproof net, and place it in the treatment tray for spare use. 
		NOTE: Insert the moxa stick into the screw in the WMAS cup until it can no longer go further. Ensure the fireproof net is tightly covered (Figure 1).</li>
		<li>Clean hands with the seven-step hand-washing method and wear disposable medical gloves.</li>
		<li>Use tweezers to pick up gauze and clean the treatment area, then apply scraping oil. 
		NOTE: Before applying the scraping oil, ask if the patient is allergic to it and needs to switch to a different scraping oil. For safe operation, add a protective cover to the outside of the WMAS cup.</li>
		<li>Place the rim of the WMAS cup close to the skin. After testing the temperature by hand, tilt the edge until the angle between the mouth of the cup and the skin is about 10&#176;-15&#176;. The cup mouth should face the direction of movement (Figure 2).&#160;
		<ol>
			<li>Scrape evenly 20 times with light force. Then, scrape 20 times with gradually increasing strength until the patient can tolerate it. Finally, scrape 20 times with gradually reducing strength. Scrape with even force each time, at a rate of 30 times/min. Local flushing or eruption may appear on the skin25,26. 
			NOTE: Localized flushing or eruption of the skin may occur after the operation. Eruption refers to skin changes, such as purplish-red color or the appearance of corn grains, pimple-like spots, flaky, striated plaques, and other morphological changes accompanied by a local heat sensation or slight pain. Some patients who do not easily produce eruptions should not be forced to. Adjust the operation intensity as needed, and monitor the patient&#39;s condition. Ask the patient if they can tolerate the strength.</li>
		</ol>
		</li>
		<li>Ensure that the treatment includes a total of 5 meridians and 9 treatment lines (Figure 3). 
		NOTE: A treatment line refers to the line between two acupoints of the same meridian, which is the area through which the WMAS cup needs to pass.
		<ol>
			<li>Governor Vessel: Bend the patient&#39;s head slightly forward to fully expose the back of the neck. Support the patient&#39;s forehead with one hand to keep it stable, and hold the WMAS cup with the other hand. Scrape along the treatment line from GV16 to GV12.</li>
			<li>Bladder Meridian of Foot-Taiyang: Two treatment lines, one on each side. The posture is the same as that of the Governor Vessel. Scrape along the treatment line from BL10 to BL13 on the same side.</li>
			<li>Gallbladder Meridian of Foot-Shaoyang: Two treatment lines, one on each side. Turn the patient&#39;s head slightly to expose the treatment area. Support the patient&#39;s head on the same side to keep it stable. Scrape along the treatment line from GB20 to GB21 on the same side.</li>
			<li>Triple Energizer Meridian of Hand-Shaoyang: Two treatment lines, one on each hand. Scrape along the treatment line from TE3 to TE4 while asking the patient to perform neck rotation and lateral flexion.
			<ol>
				<li>Ask the patient to turn the head to the left slowly until the maximum angle, then hold for 5 s. Repeat the process, turning to the right. Perform five repetitions.</li>
				<li>Slowly bend the neck to the left side to the maximum angle and hold for 5 s. Then, bend to the right side as above. Repeat five times.</li>
			</ol>
			</li>
			<li>Small Intestine Meridian of Hand-Taiyang: Two treatment lines, one on each hand. Scrape along the treatment line from SI3 to SI4 while asking the patient to perform forward flexion and backward extension of the neck. Slowly bend the neck forward to the maximum angle and hold for 5 s. Then, bend backward as above. Repeat five times on each side.</li>
		</ol>
		</li>
		<li>Wipe the excess scraping oil with gauze and ask the patient to rest for 10 min to avoid adverse reactions.</li>
	</ol>
	</li>
	<li>Post-treatment care
	<ol>
		<li>Ask the patient to drink a cup of warm water after the treatment and keep warm.</li>
		<li>Advise the patient not to take a bath within 30 min after treatment.</li>
	</ol>
	</li>
</ol>
4. Treatment of adverse events
<ol>
	<li>Scraping syncope: Stop the treatment, assist the patient in lying down with the head lower than the feet, and elevate the feet. Ask the patient to rest quietly and closely monitor vital signs. Administer first aid measures immediately if the situation is serious.</li>
	<li>Skin injury: Stop the treatment and avoid getting water on the skin lesion. Disinfect and dress the local skin using aseptic techniques to prevent infection.</li>
	<li>Allergy: Immediately wipe off the scraping oil, clean the skin with warm water, and closely observe the patient&#39;s vital signs. Apply calamine lotion for external treatment. If the situation is severe, transfer the patient to the dermatology department for further treatment.</li>
</ol>
5. Efficacy evaluation
<ol>
	<li>Neck disability index (NDI): Evaluate the impact of cervical spine (CS) dysfunction on daily life. This includes 10 questions on pain level, self-care, lifting, reading, headache, work, concentration, driving, recreation, and sleep. Each item is scored on a scale from 0 to 5 points, for a total of 50 points, with a higher score indicating poorer cervical spine function27.</li>
	<li>Visual analog scale (VAS): Evaluate the level of neck pain. The score ranges from 0 to 10 points, with a higher score indicating a greater level of pain28,29.</li>
	<li>Neck pain questionnaire (NPQ): Evaluate the degree to which neck pain affects daily life. This includes 9 questions on the severity of neck pain, sleep quality, presence of pins and needles or numbness in the arm at night, symptom duration, lifting objects, reading and watching TV, working and doing household chores, social activities, and driving. Each item is scored from 0 to 4 points, for a total of 36 points, with a higher score indicating a greater impact on daily life30.</li>
</ol>
6. Data collection and analysis
<ol>
	<li>Measure the patient&#39;s observational indicators before treatment on day 1, after treatment on days 5, 9, and 13, and during a follow-up 4 weeks after the final treatment (Figure 4). 
	NOTE: Implement blinding for statistical analysts.</li>
	<li>Use statistical software for data management and statistical analysis. Perform the chi-square test for count data. Conduct the normality test for measurement data. If the data follow a normal distribution and have homogeneous variance, perform a paired samples t-test for intra-group comparisons and an independent samples t-test for inter-group comparisons.</li>
	<li>Express results as mean &#177; standard deviation (SD). Differences are considered statistically significant at P &#60; 0.05.</li>
</ol>

The authors have nothing to disclose.

WMAS is a traditional Chinese therapy that combines thunder-fire moxibustion, scraping, and neck movements. It simultaneously offers the pharmacological effects and heat of fire moxibustion and the mechanical stimulation effects of scraping and massage techniques31. According to the theory of Traditional Chinese Medicine (TCM), the pathogenesis of cervical spondylosis (CS) involves cold and dampness blocking the meridians32. WMAS therapy has curative effects on both dredgin...

Cervical spondylosis (CS) is a common degenerative disease characterized by neck pain and neck stiffness, which lead to functional limitations and even significant disability1. The incidence of CS is closely related to age, the use of electronic products, 
spinal trauma, and specific physical activities&#160;such as football and horse riding, which can&#160;accelerate early onset and disease&#160;progression1,2. The lifetime prevalence is 48.5% in the adult population and 85% in those over 60 years of age1,3. However, the incidence rate of CS is increasing annually, and patients tend to be younger4; the incidence of CS in Chinese adolescents is more than 10%2,5,6. CS not only affects quality of life but also places a heavy economic and psychological burden on individuals, families, and society.
CS treatment includes surgical and non-surgical options7, and the choice of treatment depends on the patient&#39;s symptoms and signs. Surgical intervention is indicated for patients with severe or progressive cervical myelopathy, as well as those with persistent cervical pain or cervical radiculopathy that does not respond to non-surgical treatments1. For these patients, neuroimaging studies must reveal pathological conditions that correspond to their clinical features. The choice of surgical approach is based on the characteristics of the clinical syndrome and the specific location of the pathology. Non-surgical treatments include cervical traction, pharmacotherapy, and physical therapy. For patients with CS whose main symptom is neck pain or stiffness without significant myelopathy, non-surgical treatment is the first choice and basic therapy. Cervical traction is suitable for patients with cervical spondylotic radiculopathy and can reduce compression caused by foraminal stenosis. Nonsteroidal anti-inflammatory drugs (NSAIDs), neurotrophic drugs, and skeletal muscle relaxants can be used to relieve pain but are not recommended as first-line or long-term treatments because of their potential adverse effects1. Recent studies have consistently shown that physical therapy is not only effective in preventing and treating cervical spondylosis but also in enhancing the overall quality of life of affected individuals8,9.
Warm moxibustion and scraping (WMAS) is a traditional Chinese medicine (TCM) therapy. This non-pharmacological alternative therapy skillfully combines moxibustion, scraping, and acupressure to stimulate acupoints and treat diseases through thermal stimulation, mechanical stimulation, and neck movements10. Research indicates that non-pharmacological TCM therapies offer greater effectiveness, sustained benefits, fewer risks, and greater safety than drug-based approaches such as NSAIDs11. The non-invasive and effective properties of this treatment are particularly suitable for individuals who are averse to acupuncture or are sensitive to the unique taste of TCM decoctions12. By applying direct physical stimulation to the superficial skin, scraping can effectively relax muscles and promote local microcirculation13. The blood flow volume in the scraping area was found to be twice as high as that in the non-scraping area, with surface microcirculation also demonstrating significant enhancement for up to 90 min14. The herbs used in thunder-fire moxibustion can increase the heat radiation of moxibustion, which in turn improves blood circulation and promotes deeper penetration of drugs into the surface of the human body15. Combining neck movements helps to regulate muscle tension balance, enhance core muscle group stability, and correct abnormal biomechanics8. WMAS not only demonstrates good clinical efficacy in alleviating symptoms of cervical spondylosis, such as pain and numbness, but also shows positive effects on shoulder pain, lower back pain, and other similar symptoms16,17. The effectiveness and reduced side effects of WMAS therapy make it a promising approach that deserves greater promotion and serves as a valuable reference for managing pain symptoms in patients with CS or similar conditions.
This article introduces the WMAS therapy protocol for the treatment of CS in detail, including the patient recruitment criteria, the medical devices used, the treatment area, the course of treatment, post-treatment care, and the management of adverse reactions.

<table><tbody><tr><td>Disposable medical gloves</td><td>Dalian Latex Co. LTD</td><td>230701MW2</td><td></td></tr><tr><td>Flurbiprofen cataplasms</td><td>Beijing Teide Pharmaceutical Co.</td><td>J20160090</td><td></td></tr><tr><td>Gauze</td><td>AuCom Medical Equipment Co.</td><td>A-1</td><td></td></tr><tr><td>Scissors</td><td>Deli Co.</td><td>TJ14</td><td></td></tr><tr><td>Scraping oil</td><td>Beijing National Medical Research Medical Equipment Co.</td><td>20200002</td><td></td></tr><tr><td>Thunder-fire moxa-stick</td><td>Tongren moxa company</td><td></td><td></td></tr><tr><td>Warm moxibustion and scraping cup</td><td>Zhuhaokang Co.</td><td>160934689562864</td><td></td></tr></tbody></table>

warm moxibustion and scraping as a traditional chinese medicine therapy for cervical spondylosis treatment

Warm Moxibustion and Scraping as a Traditional Chinese Medicine Therapy for Cervical Spondylosis Treatment

Cervical spondylosis (CS) is characterized by abnormal sensations such as pain in the occiput, neck, and shoulder, which may be accompanied by pressure pain. Traditional Chinese Medicine (TCM) offers unique therapeutic advantages in the management of CS. Warm moxibustion and scraping (WMAS), a TCM therapy, combines the thermal stimulation of moxibustion, the mechanical stimulation of scraping, and neck movement, utilizing specialized TCM instruments to alleviate the symptoms of cervical spondylosis. This study details the WMAS protocol, including: (1) pre-treatment evaluation using standardized diagnostic criteria, (2) application protocols employing specialized TCM instruments, (3) standardized therapeutic manipulation techniques, (4) post-interventional management strategies, and (5) contingency protocols for adverse event mitigation. Clinical evaluations using the Neck Disability Index (NDI), visual analog scale (VAS), and Northwick Park Neck Pain Questionnaire (NPQ) confirmed the therapeutic efficacy. These findings indicate that WMAS provides an effective, standardized intervention for CS with few adverse effects, meriting broader clinical application and mechanistic exploration in CS and other related diseases.

A total of 64 patients were recruited for this study: 32 in the treatment group (11 males and 21 females, mean age: 43.00 years ± 9.18 years, mean course of disease: 12.75 months ± 6.10 months), and 32 in the control group (2 dropped out due to voluntary withdrawal, 6 males and 24 females, mean age: 46.23 years ± 8.76 years, mean course of disease: 11.40 months ± 4.88 months). These data were not significantly different between the two groups and were comparable (P &gt; 0.05) (Table 2).
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This article describes the clinical protocol for warm moxibustion and scraping therapy.

Cervical spondylosis (CS) is characterized by abnormal sensations such as pain in the occiput, neck, and shoulder, which may be accompanied by pressure ...

warm-moxibustion-scraping-as-traditional-chinese-medicine-therapy-for

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Learn warm moxibustion and scraping therapy for cervical spondylosis treatment using heat and mechanical stimulation. This protocol demonstrates good efficacy, safety, and high patient acceptance.

Warm Moxibustion and Scraping as a Traditional Chinese Medicine Therapy for Cervical Spondylosis Treatment

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