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​(This page reports the results of the impromptu 2021-2 moxa/Long COVID study that investigated whether moxa might help COVID longhaulers recover from Long COVID. If you are currently struggling to recover from PASC yourself and are interested in moxa as a means to help recovery, please do read on, but please also got to www.100daymoxachallenge.com to find out exactly how you might use moxa to help you recover)

 

The original rationale for moxa being used to support recovery from Long COVID

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 We’ve been involved in three clinical trials for moxa and TB which together has convinced us that this simple cheap therapy can both improve and hasten recovery rates from this chronic lethal infection, probably by a cumulative strengthening of host immune response.

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We recognised that the SARS-CoV-2 coronavirus is a very different pathogen to the tuberculosis mycobacterium, and both COVID-19 and Long COVID are also very different diseases to TB. The initial coronavirus infection, for instance, develops far too quickly for moxa to have any effect in its acute phase. The effects of its afterburn, though, still drew our moxa-focused attention -  (like TB) Long COVID is a slow-burning intransigent condition that appears to have complex inter-relationship with the state of the host immune system. Also, just like with TB, some parts of the immune system appear to get hijacked in the process.

 

So in 2021 our original question was: Could moxa help COVID long-haulers in a similar way to how it appears to help TB cases? And if so, how best might it be used?

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The 100 Day Moxa Challenge

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Enrolment for the original Challenge is now closed (with the results detailed below), but we are developing this project further by administering a rolling remote moxa programme which we are now making available for free to long-haulers anywhere (as long as you have a functional postal service and an internet connection). What follows below specifically discusses the results of our 100 Day Moxa Challenge for Long COVID.

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Before doing so, however, we want to thank most profusely every single challenger, most particularly those who managed to complete their 100 Days, and wish all of them well with their continuing recoveries.

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Moxafrica’s 100 Day Challenge for Long COVID's results

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We stopped recruiting on 10th September 2022, and wound the Challenge down to its final conclusion over the following 100 days. We can, therefore, now disclose the specific details of the four protocols we originally designed and also share some of the results. We particularly hope that these will be of some interest to acumoxa practitioners anywhere, and particularly be of potential help to their patients. We also want to provisionally discuss the clinical implications of the 'data-so-far' and, as importantly, their limitations.

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The Challenge's design

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Our original goal was to enrol 200 long-haulers, split them into four groups (each specific to one of four protocols) and then see how each one fared using questionnaires to develop quantitative comparative data. Each protocol was carefully designed to have similar dosages in respect of number of moxa ‘cones’ prescribed, and each one was comprised of different treatment points (apart from including bilateral St36 which was common to all protocols).

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A brief breakdown of the Challenge

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Recruitment unfortunately turned out to be something of a challenge. While we did manage to receive more than 200 applications, not all of them were eligible to enrol, fewer still actually ended up committing to starting the Challenge at the end of their enrolment process, and even fewer completed their Challenge as we’d hoped.

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What follows describes the general enrolment process that we used which consisted of five discrete stages (each of which accounted for significant drop-outs):

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1. Initial application by the potential Challenger prompting an:-

2. Invitation to submit a preliminary questionnaire (from which we could assess inclusion or exclusion)

3. Subject to (2), an invitation to submit a twenty-question baseline questionnaire followed (allowing us to develop a starting health score for each individual).

4. On receipt of each completed baseline questionnaire moxa was sent out along with detailed instructions also asking them to confirm to us the day they started their Challenge.

5. At the end of each challenger’s 100 days, we invited each finisher to complete a ‘final’ questionnaire which comprised the original questions (from which we could develop final comparative individual scores) along with a few others intended to give us a better picture of how they experienced the 100 days of moxa.

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With these two key scores at start and finish we have calculated individual improvement indices from which to develop average improvement indices for each protocol. In the course of the Challenge we also developed a ‘control group’ (comprising those who told us that moxa ‘wasn’t for them’ after we had sent them their moxa, but who were nevertheless willing to answer the same final questionnaires around 100 days after we originally sent them their moxa). We thus ended up with 5 groups – four of which reflected the four protocols, and one of which could be defined as reflecting ‘no moxa’ at all.

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The four protocols

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Here are the details of each protocol. In all cases the moxa was intended to be done on a daily basis over a period of 100 days. It is worth noting that, apart from the theoretical reasons for selecting these points, we also found them to be commonly palpatory reactive in our preliminary palpatory assessments of our own first clinical long-hauler patients.

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Protocol #1 (which we called the ‘Sawada protocol’ because we loosely based it on points which we know 20th century Japanese moxa master Sawada Ken sensei used as part of his Taikokyu protocol):-

             Bilateral St36

             Bilateral LI11

             Bilateral (Sawada) Ki6

             Left TB4          

                                               3 cones/point = 21 cones per day

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Protocol #2 (which we called the Extra Vessel protocol):-

            Bilateral St36

            Left Lu7

            Right Ki6

            Left Sp4

            Right Pc6                                 18 cones per day

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Protocol #3 (which we called the ‘Detox protocol’):-

            Bilateral St36

            Bilateral LI4

            Bilateral Ki9                              18 cones per day

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Protocol #4 (which we called the ‘vagus protocol’ – the only one which required a helper):-

            Bilateral St36

            Bilateral Bl20

            Bilateral Bl23

            GV12                                        21 cones per day

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Adherences

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We report the current outcome data below. We must also stress that they should only be considered in the light of many limitations, some of which we identify below.

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Firstly, though, here are some important enrolment anomalies reflecting adherences and completions (these data have not been updated since 10th September 2022):

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207 ‘preliminary’ questionnaires were completed (this number now will not change).

Of these,137 ‘baseline’ scoreable questionnaires were submitted (i.e. 70 fell at the first hurdle!)

As a result, we sent out 137 sets of moxa.

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48 of these 136 completed their Challenges.

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Of those 137 to whom we sent moxa but who aren’t part of the final data, 45 never confirmed that they started, 20 more of these subsequently confirmed they were dropping out, and a further number stopped replying to our emails in response to asking for updates.

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Of those who have so far finished and completed their questionnaires, the numbers using each protocol (P) were:

    P 1 : 11

    P 2 : 8

    P 3 : 10

    P 4 : 19

    Control : 7 

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In respect of those to whom we sent moxa kits but who never confirmed starting, 6 were on P1, 4 were on P2, 2 were on P3 and only 2 were on P4. This does not give a comprehensive comparative picture of adherence rates, however. To offer a much better picture of how hard P4 turned out to be, almost half of those who were initially allocated to this protocol confirmed that they had started with a helper but subsequently asked to switch to another protocol because it was too tricky for their helper to perform.

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The results 

 

These are measured in respect of the averaged percentage improvements of each protocol cohort in respect of their final health scores compared to their original scores:

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#1             40%  (41%)

#2            44%  (43%)

#3            50%  (53%)

#4            44%  (45%)

Control    24%  (22%)

 

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Discussions

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Superficially, we can state that, on average, all the moxa protocols outperformed no-moxa (i.e. we can suggest that moxa may well be generally helpful in supporting recovery from Long COVID). Furthermore, we can add that the best performing protocol was Protocol #3. In other words, were we to home in on one protocol based on these data, this would be the protocol to choose.

 

However, we must equally caution that the numbers completing each of the protocols were far too small for us to be confident of this summary (completions totalling around a quarter of what we originally had planned to be the case). This significant limitation is compounded further by the fact that the ranges of improvements individually recorded within each group were significant in their scope, meaning that some responses were inexplicably erratic compared with others, quite probably because of factors which were entirely out of our control.

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We can also, however, state with some confidence that moxa is not for everyone because less than half of those to whom we sent moxa reported completing their Challenge. Of course, we had anticipated this would be a problem given that moxa is not just strange but also can be fiddly but (given the effort made to provide instructions and support) this was nevertheless a disappointment in respect of its scale. Bearing in mind, howwever, that a key symptom described by those responding to the first questionnaire was ‘brain fog’ perhaps it should have been better expected.

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In respect of all the protocols, and also in respect the ‘controls’ of course, we furthermore cannot be confident of any the following, all of which may have been subject to high degrees of variability and account for some of the erratic scores:

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1. Whether challengers adhered to the requisite protocols as regularly as requested

2. Whether they located the points accurately

3. Whether they applied the moxa as technically consistently as instructed

4. Whether they were using other therapies at the same time. (For ethical reasons we specifically never insisted on such a proscription, beyond being clear that they should not have any other moxa therapy in their 100 days). In other words we can suggest that many may have had adjunctive acupuncture, homoeopathy, nutritional therapy etc., while many may not have had any other therapy at all. To illustrate this issue, one of the highest ‘control’ scores (that helped lift this group’s average above what would otherwise actually have been below 20%) has attributed her significant recovery to personalised homoeopathy that started during her 100 days.

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We also, of course, do not know whether our protocols were originally sub-optimally selected – there may well be better protocols out there that we failed to consider.

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Furthermore, we know from the feedback we have received that many Challengers found their daily moxa to be too much of a chore (or something they basically got no enjoyment or meaningful results from). Some also plainly found the experience a little frightening. At the same time, however, we also had reports that some found it enjoyable, profoundly relaxing and also empowering in that it gave them much needed positive control over their condition (which both they and we consider to be extremely important).

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Summary

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This project was designed primarily to reveal if one or more moxa protocols might be helpful in aiding and accelerating recoveries from Long COVID. Our current conclusion is that one protocol has emerged and this is #3 which is not only the simplest protocol but also can be self-administered - something which we believe to be very important since it can give the long-hauler more empowerment over her/his recovery.

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What happens next

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Second to establishing whether a clear ‘best protocol’ might emerge, we wanted to provide information to the acumoxa profession globally in hope that some of the many long-haulers who are currently out there and struggling to recover their health might thus benefit. To the best of our knowledge, no other similar evidence-based information has yet been available, so we hope that the Challenge will have thus proved itself to be of some practical use. We are furthermore inviting any acumoxa practitioners with other positive experiences to  share what they themselves have been finding in the spirit of the ‘open source’ style of collaborative investigation which the Moxafrica charity cherishes.

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We were also, however, attempting to establish whether it is either reasonable or safe for Moxafrica to propose implementing a programme of remote moxibustion for long-haulers anywhere, but most particularly in countries where health infrastructures mean that any sort of ongoing recovery support might be essentially absent and where acumoxa practitioners are few or far between.

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Our answer to this second question is especially informed by both what we know and what we don’t know about the current prevalence of Long COVID in the so-called ‘Majority World’ where rates of primary infections have so far been reported to be significantly lower than in richer countries. Furthermore, we note that currently there is not just a massive knowledge gap about prevalence of Long COVID even in richer countries, but also relative ignorance as to whether its incidence rate (as defined by the rate of incident Long COVID cases per symptomatic COVID 19 cases) is either increasing or reducing as the emerging variants are weakening in their immediate virulence. In our opinion, closing down this knowledge gap should be a high priority for health authorities everywhere since this knowledge gap may be hiding a significant amount of human suffering.

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Without question we have revealed that managing a remote moxa programme of moxa therapy is very challenging. With regards to safety, however, we can report that we have had no serious adverse reactions reported to us (despite proactively inviting reports of any problems from the moment of sending out the moxa), but we should also stress that we did everything we reasonably could do to provide the clearest of instructions including video clips and ongoing check-in support, and we would not recommend anyone attempting any similar project without similar accompanying efforts. In other words, we recognise that self-moxa by the uninitiated is accompanied by risk, specifically of blistering and therefore scarring if the material is misapplied or carelessly administered, and so appropriate steps need to be taken to reduce this risk as much as is possible, with any remaining risk carefully balanced against the potential for benefit. All medical interventions, of course, are accompanied by some risks and the key to their successful beneficial implementation is not just reducing the risk, but also carefully weighing it against the consequences of no intervention at all.

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What we have also come to recognise in the course of the Challenge is that Long COVID is not just much more complex than we originally suspected but also that it is often extremely pernicious, far more so (we think) than ‘classic’ post-viral fatigue which (when we first conceived the Challenge) we believed it to be so similar to.

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Has this ruled out the idea of implementing a resultant ‘remote’ programme in which we can send out free moxa and instructions anywhere in the world, but particularly to resource-poor countries? Our answer to this is simple. Given the lack of knowledge about this problem and the lack of response, we would be wrong not to roll out a carefully designed programme behind this study, and we do this for three reasons.

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One of these arises from our earlier experiences investigating moxa for TB when we came face to face with just how deficient medical support is for so many (Partners in Health, as an example, estimate that currently half of humankind has no access to essential medicines as defined by the WHO) while also realising that for several unfortunate reasons this deficiency is also currently chronically increasing.

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The second is that this whole post-COVID phenomenon is still desperately poorly understood from a biomedical perspective, and at the same time that addressing this significant public health issue is shamefully under-resourced and ill-addressed even in richer countries. In other words, there remains an immense gap between the need for a practical therapy for Long COVID and any reasonable provision of one.

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​The third reason we remain positive about introducing a remote global moxa programme is because so little knowledge exists about the scale of Long COVID worldwide. We can, however, tentatively summarise what might be the global situation based on what we now have some knowledge of in one country (the UK). In the UK Long COVID is rtecognised as a significant health problem but is one as yet not just of unknown official magnitude but also is of total unknown duration.

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Based on a recent population survey by the UK government’s Office of National Statistics it has been assessed that 2 million Britons (or 3.1% of the total UK population) are currently struggling with Long COVID. What’s more worrying still is that a staggering 45% of these long-haulers report their condition as being of at least one year’s duration, and a profoundly concerning 22% of them (or nearly half a million) amounting to 0.6% of the UK population report their condition as still being ongoing after 2 years[i]. (These proportions, incidentally, are not dissimilar from our own data gleaned from our questionnaires). How poorly these folk really are is not known (the numbers being gleaned from survey only), but it’s how long their suffering may continue that is the really worrying unknown.

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If a similar 0.6% of the global population is struggling with PASC two years after being infected then a potential 400 million people may be out there struggling to get themselves back to full health. Whilst there are many reasons this number may be too high, even if it were wrong by a factor of ten, it is still an immense problem.

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The new programme begins

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So we feel that it is reasonable for us to wonder whether some of these folk’s recoveries might be hastened with moxa, because our data suggests that this could well be the case. What’s more, we consider that collectively  the potential  scale and the known nature of this problem significantly outweighs the risk of harm from moxa itself (assuming that appropriate clear instructions are provided and an open invitation to communicate problems is maintained).

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One of the uncomfortable questions that lie behind these conclusions is this: how many of these people and their families might literally be facing destitution? We don’t have a clue, of course, mainly because no-one is caring to ask these questions yet, but the consequences of such elective ignorance could be truly awful.

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But we further believe that, even if moxa might only help a fifth of these long-haulers to whom it might be introduced, it could still represent a valid and valiant gesture towards promoting healing and reducing human suffering.

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And so finally

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The results reported here reflect the combined aggregated effects of moxa on a wide range of physical and mental symptoms covered by the questionnaires. We have yet to analyse any comparative effects of these four protocols on specific groups of symptoms and on other parameters for which we collected data. We will, however, provide more details, as well as more information on participants’ demographics, in the course of time at which point this webpage will be updated accordingly.

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[i] Office For National Statistics (ONS), released 1 September 2022, ONS website, statistical bulletin, Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK, 1 September 2022

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If you're a long-hauler and are interested in trying moxa to help you recover, please email 100daymoxachallenge@gmail.com to find out more.