What are the risks and side effects of moxibustion?
Reported side effects of moxibustion from a systematic review of case reports: burns, allergy, infection, coughing, nausea and more. Who is most at risk, fire safety, and how smokeless moxa changes the picture.
Short answer: moxibustion is generally described as low-risk when done carefully, but it does cause harm. A systematic review of published case reports lists burns (the most common), allergic reactions, infection, coughing, nausea and vomiting, fetal distress and premature birth, basal cell carcinoma, ectropion, skin darkening and even death [1]. Smokeless moxa lowers smoke exposure but not the burn and fire risks.
Information compiled from published reviews and manufacturer safety guides. It does not replace advice from a qualified practitioner.
What side effects have been reported?
The review gathered 64 cases from 24 articles in six countries (China, USA, South Korea, Spain, Japan and Israel) [1]:
| Type | What was reported |
|---|---|
| Burns | 43 of the 64 cases. Pain, blisters, ulcers and secondary infection; severe burns led to permanent scarring, mostly with direct moxibustion [1] |
| Allergy | Skin reactions that resolved after stopping and recurred if moxa was used again [1] |
| Infection | Secondary infections after burns, including serious systemic infection in newborns treated with a folk “spark” technique [1] |
| Respiratory | Coughing and smoke-related reactions [1][2] |
| Nausea and vomiting | Reported [1] |
| Pregnancy-related | Fetal distress and premature birth reported in case reports [1]; see pregnancy page |
| Other | Basal cell carcinoma at an old burn site, ectropion (eyelid turning out), hyperpigmentation, and rare deaths [1] |
Case reports show that harm can happen; they do not show how often it happens. The review lists the factors linked to these events: the body position, how long moxa is applied, the distance from the skin, the practitioner’s skill, the patient’s condition, the presence of smoke and the treatment environment [1].
Who is most at risk of burns?
In the reported cases, most burns occurred in newborns, children and people with reduced sensation, because they cannot feel or report heat in time [1]. For the same reason, clinic handouts tell home users not to apply moxa to areas they cannot feel properly, and not to use it over open wounds or red, inflamed skin [3].
Other groups that sources single out:
- Pregnant women. A US moxa-box maker advises people who are not licensed providers never to use moxa during pregnancy or on pregnant women [4]. Cochrane reports side effects such as uterine contractions in breech studies [5].
- People with asthma or smoke sensitivity, because of smoke exposure [2][6].
- People with “heat” conditions. Traditional practitioners advise against moxa for infections and other conditions they classify as heat [3].
Fire safety
Moxa is a slow-burning ember, and charcoal moxa in particular smoulders for a long time and does not go out easily [7]. Manufacturer safety guides and clinic handouts agree on these points [8][4][3]:
- Never leave burning moxa unattended, and never set a lit stick down unless it is secured in a holder or extinguisher.
- Keep bedding, clothing and hair away from moxa boxes and holders.
- Put moxa out by cutting off the oxygen, using an extinguisher, sealed jar or sand, and check that it is fully out. Do not use water [9].
- Keep moxa away from children. Manufacturers stress that moxa products are not toys [8].
- Sticks that spark are a hazard. A retailer warns that poor-quality “smokeless” moxa adulterated with wood charcoal can spark and burn the skin [7].
Is smokeless moxa safer?
It changes which risks dominate:
- Lower: visible smoke, smoke density and smell. Smokeless samples measured 3.4–5.5 Ds against 172.1–291.4 Ds for regular moxa in one test [10].
- Not lower: burns and fire. Smokeless moxa still burns hot and needs the same care [6].
- Still present: carbon monoxide and nitrogen oxides were measured from smokeless samples too [10]. See Moxa smoke, smell and indoor air.
What about “forbidden” acupuncture points?
People searching about moxa sticks also ask about “forbidden” points [11]. Point selection is a clinical judgment outside the scope of this page. Ask a licensed acupuncturist.
Related pages
- Moxa smoke, smell and indoor air
- How to use smokeless moxa
- Moxibustion in pregnancy and for breech babies
FAQ: related questions
What are the risks of moxibustion?
A systematic review of 64 published case reports found burns, allergic reactions, infection, coughing, nausea and vomiting, fetal distress and premature birth, skin cancer at a burn site, eyelid problems, skin darkening and, rarely, death. Burns were the most frequently reported.
Who is most at risk of moxa burns?
In published case reports most burns occurred in newborns, children and people with reduced skin sensation, who cannot feel or report heat in time. Direct moxibustion on the skin was linked to the more severe burns and scarring.
Is smokeless moxa safer?
Smokeless moxa reduces smoke-related problems but not burn and fire risks. It burns hot, smoulders for a long time and is hard to put out, so it needs the same care as any moxa.
What are the five forbidden acupuncture points?
This page does not cover acupuncture point contraindications. Ask a licensed acupuncturist which points to avoid for you.
Sources for this page
- Safety of Moxibustion: A Systematic Review of Case Reports (PMC4058265). pmc.ncbi.nlm.nih.gov/articles/PMC4058265/
- Moxa Smoke and the Need for Ventilation or Filtration (CCAOM position paper). www.ccahm.org/images/ccaom/Documents/Position-Papers/Moxa-Be
- Smokeless Moxa home instructions (Olympic Acupuncture). olympicacupuncture.com/acu/wellness-tips/smokeless-moxa/
- Safety Guidelines & Traditional Use (Moxa Northwest). moxabox.com/safety-guidelines-traditional-use/
- Moxibustion for turning a baby in breech position (Cochrane CD003928; 2023 update). www.cochrane.org/evidence/CD003928_moxibustion-turning-baby-
- Smokeless Moxa vs Traditional Moxa (Acupuncture Colorado Springs). acupuncturecoloradosprings.net/smokeless-moxa-vs-traditional
- How To Pick High-Quality Smokeless Moxa (Lierre). www.lierre.ca/blogs/featured/how-to-pick-the-right-moxibusti
- KINITSUKYU Safety Guide (Art of Moxa). www.artofmoxa.com.au/kinitsukyu-safety-guide
- How to use moxa therapy at home (Nautilus Acupuncture). www.nautilusacupuncture.com.au/blog/moxa-at-home
- Study of the Density of Smoke and Harmful Gases of Adhesive Indirect Moxibustion (J Korean Med 2012). jkom.org/upload/33-1-4.pdf
- 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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