Moxibustion Therapy for Circulatory and Cold-Related Musculoskeletal Pain in Aging Adults

As the global population ages, chronic musculoskeletal pain has emerged as one of the most pervasive and disabling conditions in elderly individuals. Beyond joint degeneration, a significant portion of this discomfort stems from poor microcirculation, tissue hypometabolism, and cold-sensitive neuromuscular responses—especially in ligaments, tendons, and deep fascial planes. Traditional Eastern medicine has long utilized moxibustion, a heat-based therapy involving the burning of dried mugwort (Artemisia vulgaris), to counteract these pathological states. But modern biomedical science is now offering deeper insight into why this seemingly ancient intervention holds such relevance in today’s clinical practice.

The Pathophysiological Roots: Aging, Cold Sensitivity, and Circulatory Decline

In elderly patients, structural and functional deterioration of connective tissue is common. Ligaments and tendons, being poorly vascularized, suffer the most from age-related reductions in blood flow. This decline leads to:

• Delayed collagen remodeling and repair,

• Accumulation of inflammatory cytokines and metabolites,

• Peripheral sensitization of nociceptors, particularly in cold weather,

• And eventual development of fibrosis or enthesopathy.

Cold exposure compounds these effects through vasoconstriction, further reducing perfusion, amplifying ischemic pain, and slowing tissue recovery. In this context, cold weather or air-conditioned environments can act as pain triggers, especially in patients with prior degeneration or injury.

Moxibustion as Targeted Thermotherapy: Mechanisms of Action

Unlike superficial heat packs, moxibustion delivers penetrative and sustained thermal stimulation to specific acupoints or myofascial regions. This generates both local and systemic effects via the following mechanisms:

• Vasodilation and improved capillary perfusion
  → Enhanced oxygen and nutrient delivery to ischemic tissue.

• Accelerated clearance of metabolic waste and pro-inflammatory agents
  → Reduced cytokine concentration, improved interstitial fluid turnover.

• Activation of TRPV1 channels (heat-sensitive nociceptors)
  → Neuromodulation and analgesia through spinal gating and desensitization pathways.

• Mitochondrial activation and ATP synthesis
  → Restoration of cellular energy metabolism in hypoxic tissue, contributing to repair.

Moreover, moxibustion appears to stimulate cutaneous-visceral reflexes, where local skin stimulation may lead to systemic autonomic regulation, particularly in the sympathetic tone related to vascular control.

Why Moxibustion Works Best in Geriatric Pain Syndromes

Older adults frequently present with what traditional medicine describes as "cold-dominant" pain—a state where symptoms are worse in cold temperatures and improve with warmth. This pattern is closely mirrored in modern understandings of cold-induced vasospasm and thermoregulatory dysfunction in aging tissue.

Moxibustion offers more than symptomatic warmth—it promotes neurovascular remodeling, supports endothelial function, and enhances fascial glide in fibrotic tissue planes, thus helping restore both mobility and comfort. Its thermal gradient affects not only surface skin but also deeper muscle and tendon tissue, where degenerative pain often originates.

Clinical Applications and Observed Benefits

Numerous studies and clinical reports have documented moxibustion’s effectiveness in managing cold-aggravated musculoskeletal disorders such as:

• Knee osteoarthritis

• Chronic low back pain

• Rotator cuff tendinopathy

• Sacroiliac joint instability

• Post-menopausal myofascial stiffness

In a 2021 randomized controlled trial, elderly patients with cold-sensitive knee osteoarthritis showed greater pain reduction and joint function improvement in the moxibustion group compared to those receiving conventional physical therapy alone.

Conclusion: Integrative, Physiologically Sound, and Especially Valuable in the Elderly

Moxibustion is far from an archaic folk practice—it represents a biologically active intervention that integrates thermal physiology, connective tissue science, and neurovascular modulation. It is particularly effective for cold-induced, circulation-deficient musculoskeletal pain, and should be considered a frontline adjunctive therapy in geriatric integrative pain management.

References

1. Park JE, Lee SS, Lee MS, et al. (2014). “Moxibustion for treating knee osteoarthritis: A systematic review and meta-analysis.” BMC Complementary and Alternative Medicine, 14, 112. https://doi.org/10.1186/1472-6882-14-112

2. Shin JY, Ha IH, Lee JH, et al. (2021). “Efficacy and safety of moxibustion in patients with cold hypersensitivity in the hands and feet: A randomized controlled trial.” Trials, 22(1), 156. https://doi.org/10.1186/s13063-021-05066-5

3. Liao Y, Zhang C, Liu H, et al. (2019). “Moxibustion treatment for chronic low back pain: A systematic review and meta-analysis of randomized controlled trials.” Journal of Pain Research, 12, 433–443. https://doi.org/10.2147/JPR.S189424

4. Li X, Wang Y, Xu Q. (2015). “Mechanisms of moxibustion: Ancient theory and modern research.” Frontiers of Medicine, 9(1), 103–109. https://doi.org/10.1007/s11684-015-0370-6

5. Lim S. (2010). “WHO Standard Acupuncture Point Locations.” Evidence-Based Complementary and Alternative Medicine, 7(1), 91–95. https://doi.org/10.1093/ecam/nen058