Moxibustion for knee osteoarthritis: what the research says
A sourced summary of systematic reviews and trials on moxibustion for knee osteoarthritis: reported effects on pain and function, the methods studied (warm needle, electric, light vs heat), safety findings and why the evidence is rated low quality. No treatment claims.
Short answer: knee osteoarthritis (KOA) is one of the most studied uses of moxibustion. Several systematic reviews report better pain and function scores with moxibustion than with comparison treatments [1][2][3]. However, an independent overview found that every one of ten systematic reviews was of critically low methodological quality, and the original trials were at high risk of bias. Researchers say the findings are promising but not reliable [4][5].
Evidence summary only. Moxa Sourcing does not recommend moxibustion for knee osteoarthritis or any condition. Knee pain should be assessed by a doctor or physiotherapist.
Why knee osteoarthritis is studied so often
Knee osteoarthritis causes chronic pain and stiffness, and moxibustion is traditionally used for what practitioners describe as cold, stagnation-type joint pain [6][7]. One review of moxibustion’s adverse events also lists knee osteoarthritis among its common indications in Chinese practice [8]. As a result there are dozens of trials and at least ten systematic reviews [5].
What the systematic reviews report
| Review | What it included | Reported finding | Authors’ caveat |
|---|---|---|---|
| Overview of systematic reviews, 2022 [4] | 10 reviews, 57 trials, 5,149 participants | Moxibustion “seems” effective on a pooled response rate; no serious adverse events reported | All reviews rated critically low (AMSTAR-2); high risk of bias in original trials |
| Meta-analysis, 2025 [1] | Randomized trials of moxibustion for KOA | More pain relief than other treatments and fewer adverse events | “Further high-level evidence is warranted” |
| PRISMA meta-analysis, 2019 [2] | Trials vs drugs and vs sham, no treatment or usual care | Better than both positive and negative controls, with fewer adverse reactions | Trials were of “universally low quality” |
| Meta-analysis, 2016 [3] | Trials vs drugs, injections and sham | Similar to oral drugs and injections; better than sham on WOMAC score | Called moxibustion a possible alternative, pending better trials |
| Meta-analysis, 2016 [9] | Moxibustion vs controls | “To some extent” alleviates symptoms; some outcomes showed no significant difference with very high heterogeneity | More rigorous trials needed |
How to read this table. The reviews point in the same direction, but most draw on overlapping, small, mostly Chinese trials that often lacked blinding or a credible sham. The overview authors note that this lowers the reliability of all the conclusions [4]. A broader overview of traditional Chinese medicine for KOA reached a similar verdict: treatments “generally appear” effective, but methodological flaws mean conclusions should be treated with caution [10].
Which kinds of moxibustion were tested?
KOA trials use many different methods, which makes the results hard to compare:
- Warm-needle moxibustion, where a moxa ball burns on an acupuncture needle. One meta-analysis compared it with oral drugs and reported better function and pain scores [11]. See Warm-needle moxibustion.
- Acupuncture combined with moxibustion. A 2025 meta-analysis reported benefits especially at mid- and long-term follow-up [12].
- “Light” versus “heat” components. A multi-centre trial tried to separate the effects of moxa’s light and heat, and reported a stronger effect from the heat component [13].
- Electrical moxibustion devices. An assessor-blinded multi-centre trial reported improved pain and function [14]. These devices do not burn moxa; see Electric moxibustion devices.
- Alternative materials. One trial reported “jade moxibustion” to be comparable with traditional moxa [15].
Smokeless moxa. The trial abstracts we reviewed rarely say whether the moxa was smokeless. Because smokeless sticks differ in heat and infrared output [16], results from traditional moxa may not transfer to them.
What about safety?
Across knee osteoarthritis reviews, reported adverse events were generally mild: the overview counted ten common discomfort symptoms that subsided on their own, and no serious events [4]; another review notes most adverse events healed without medical care [3]. Moxibustion in general still carries a real risk of burns, especially with direct moxibustion or in people with reduced sensation [8]. See Risks and side effects.
Why the evidence is rated low
These issues are common to most moxibustion research [17][18]:
- Blinding is hard. Patients can feel and smell moxa, so a convincing sham is difficult.
- Small trials, often from a single centre.
- Comparators vary (drugs, injections, sham, usual care), so pooling them is problematic.
- Outcome measures such as an overall “effective rate” are less rigorous than validated pain scales.
- Possible publication bias, because positive trials are more likely to be published.
What people ask
- “Moxa stick for knee pain: does it work?” Search data show strong interest in moxa for joint and back pain [19]. The honest summary is “possibly, on low-quality evidence”.
- “Can I do it at home?” Most trials were done in clinics with set points and doses. See Moxibustion at home and talk to a qualified practitioner.
Related pages
- Does moxibustion really work? (overview)
- Moxibustion for back pain
- Mechanism research: heat, infrared and chemistry
FAQ: related questions
Does moxibustion help knee osteoarthritis?
Several systematic reviews report that moxibustion improved pain and function scores in knee osteoarthritis trials, often compared with drugs, sham or usual care. An overview of these reviews rated all of them critically low in methodological quality, so the findings are uncertain.
Is moxibustion safe for knee arthritis?
Reviews of knee osteoarthritis trials report mostly minor discomfort that resolved without treatment, and no serious adverse events. Burns remain the main risk of moxibustion in general.
Was smokeless moxa used in knee osteoarthritis trials?
Most trials describe traditional moxa sticks, moxa boxes, warm-needle moxibustion or electric devices; the abstracts reviewed rarely state whether smokeless moxa was used, so results may not apply directly.
Sources for this page
- Chen et al. Efficacy and safety of moxibustion for knee osteoarthritis: A systematic review and meta-analysis. Complement Ther Clin Pract 2025. pubmed.ncbi.nlm.nih.gov/40184698/
- Yuan et al. The Effectiveness and Safety of Moxibustion for Treating Knee Osteoarthritis: A PRISMA Compliant Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Res Manag 2019. pubmed.ncbi.nlm.nih.gov/31949547/
- Song et al. Moxibustion is an Alternative in Treating Knee Osteoarthritis: The Evidence From Systematic Review and Meta-Analysis. Medicine (Baltimore) 2016. pubmed.ncbi.nlm.nih.gov/26871839/
- Yin et al. An Overview of Systematic Reviews of Moxibustion for Knee Osteoarthritis. Front Physiol 2022. pubmed.ncbi.nlm.nih.gov/35185621/
- An Overview of Systematic Reviews of Moxibustion for Knee Osteoarthritis (Frontiers 2022). www.frontiersin.org/journals/physiology/articles/10.3389/fph
- Smokeless Moxa home instructions (Olympic Acupuncture). olympicacupuncture.com/acu/wellness-tips/smokeless-moxa/
- Smokeless Moxa vs Traditional Moxa (Acupuncture Colorado Springs). acupuncturecoloradosprings.net/smokeless-moxa-vs-traditional
- Safety of Moxibustion: A Systematic Review of Case Reports (PMC4058265). pmc.ncbi.nlm.nih.gov/articles/PMC4058265/
- Li et al. Moxibustion Treatment for Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2016. pubmed.ncbi.nlm.nih.gov/27057863/
- Yang et al. Traditional Chinese medicine for knee osteoarthritis: An overview of systematic review. PLoS One 2017. pubmed.ncbi.nlm.nih.gov/29267324/
- Li et al. Comparison of Warming Needle Moxibustion and Drug Therapy for Treating Knee Osteoarthritis: A Systematic Review and Meta-analysis. Comput Math Methods Med 2022. pubmed.ncbi.nlm.nih.gov/35936371/
- Zhu et al. Efficacy and safety of acupuncture with moxibustion for knee osteoarthritis: a meta-analysis of randomized controlled trials. Syst Rev 2025. pubmed.ncbi.nlm.nih.gov/39819364/
- Liao et al. [Light and heat of moxibustion for knee osteoarthritis：a multi-center randomized controlled trial]. Zhongguo Zhen Jiu 2020. pubmed.ncbi.nlm.nih.gov/32538014/
- Kang et al. Effectiveness and safety of electrical moxibustion for knee osteoarthritis: A multicenter, randomized, assessor-blinded, parallel-group clinical trial. Complement Ther Med 2020. pubmed.ncbi.nlm.nih.gov/33066857/
- Yin et al. A comparison of jade moxibustion and traditional moxibustion in the treatment of knee osteoarthritis: A randomized clinical trial. Medicine (Baltimore) 2023. pubmed.ncbi.nlm.nih.gov/37543785/
- Table 1 infrared intensities (PMC3789413). ncbi.nlm.nih.gov/pmc/articles/PMC3789413/table/tab1/
- Does moxibustion work? An overview of systematic reviews (Lee et al.; PMC2987875). pmc.ncbi.nlm.nih.gov/articles/PMC2987875/
- The Effectiveness of Moxibustion: An Overview During 10 Years (PMC3136359). pmc.ncbi.nlm.nih.gov/articles/PMC3136359/
- Moxa Sourcing analysis of public search data (Google 'People also ask', autocomplete, AI Overviews; US, UK, AU and Arabic markets) and marketplace listings, November 2026.
Last reviewed: . Editorial note: this guide re-edits published sources; it does not provide medical advice or new research.
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