Chinese Medicine, 2011, 2, 53-57
doi:10.4236/cm.2011.22010 Published Online June 2011 (htt p://www.SciRP.org/journa l/cm)
Effects of Moxa (Artemisia vulgaris) Smoke Inhalati on
on Heart Rate and Its Variability
Baixiao Zhao1, Gerhard Litsch er2, Jun Li1, Lu Wang2, Yingxue Cui1, Chaxi Huang1, Ping Liu1
1School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
2TCM Research Center Graz and Research Unit of Biomedical Engineering in Anesthesia
and Intensive Care Medicine, Medical University of Gra z, Graz, Austria
Received March 24, 2011; revised April 1, 2011; accepted April 6, 2011
Abstract
Objective: To evaluate the changes of human heart rate (HR) and heart rate variability (HRV) during and
after moxa smoke inhalation and to investigate the effects of moxa smoke on human autonomic nervous sys-
tem. Methods: 24 healthy volunteers were exposed to moxa smoke with their HRV parameters measured
before, during and after the moxa smoke inhalation. Results: The healthy volunteers exposed to moxa smoke
had significant reductions in HR and also significant changes in HRV parameters. Conclusio ns: Moxa
smoke can improve the autonomic nervous system activity. The inhalation of moxa smoke will induce a de-
pressant effect on human body.
Keywords: Moxibustion, Moxa Smoke, Artemisia Vulgaris, Heart Rate (HR), Heart Rate Variability (HRV),
Traditional Chinese Medicine
1. Introduction
Moxibustion, accompanied with herbal medicine and
acupuncture, is one of the mainstream medical thera-
pies in Traditional Chinese Medicine (TCM) with a
history of more than 3000 years. Comparing with acu-
puncture, most of the common applications of moxibus-
tion are non-invasive, thus it can be accepted by people
more easily. As one of the major therapies in TCM,
there exist a large amount of literature in the history of
moxibustion which showed that moxibustion is appli-
cable to many diseases, especially for chronic condi-
tions, deficient pattern of a disease, prevention of dis-
ease, and health preservation. Modern researches have
proven that moxibustion can improve the immune
function of the body [1].
Since many people are exposed to moxa smoke during
acupuncture-moxibustion treatment, some studies have
been done recently to investigate if burning moxa in
TCM constitutes a health hazard recently. There are no
immediate concerns found arising from the continued use
of moxa as therapeutic modality in TCM [2] However, to
our knowledge the influence of moxa smoke on biologi-
cal signals has not been investigated sufficiently in Asia
and also in Europe [3,4].
Heart Rate Variability (HRV) refers to the time variation
coefficient between successive heart beating cycles. It is
a sensitive indicator of the autonomic nervous system
and can reflect the activities of the sympathetic and
parasympathetic nerves, the balance quality and the car-
diovascular function. The objective of this study was to
evaluate the changes of human heart rate (HR) and heart
rate variability (HRV) after moxa smoke inhalation and
to investigate the effects of moxa smoke on human
autonomic nervous system .
2. Materials and Methods
2.1. Healthy Volunteers
The investigations were performed on 24 healthy volun-
teers (11 female, 13 male; aged 22 - 28 years old) from
the Beijing University of Chinese Medicine. Th e subjects
had no history of chronic diseases (such as hypertension,
coronary heart disease or cerebrovascular disease), res-
piratory or neurological problems. On the day before the
trial, the subjects were ins tructed to refrain from tobacco,
alcohol, tea and coffee and to avoid strenuous exercise.
They were fully informed about the nature of the inves-
tigation and all were given written informed consent. The

B. X. ZHAO ET AL.
54
methodological procedure and the registration of the
non-invasive parameters were in accordance with the
Helsinki Declaration of the World Medical Association.
2.2. Physiological Measurements and Procedure
The trial was carried out in two adjacent rooms equipped
with massage beds at the Beijing University of Chinese
Medicine. The environment around both rooms was quiet,
and electrocardiographic parameters were registered in
the subjects in a reclined position. The environmental
conditions were kept constant (room temperature 20˚C,
humidity 40%) in both rooms. In addition, in room 2,
moxa floss (Artemisia vulgaris) was burnt producing
moxa smoke. The concentration of the smoke was kept at
a level comparable to that in acupuncture clinics (around
5 mg/m3) using a digital dusty indicator ( Beijing BINTA
Green. Technology co. Ltd, Beijing, China). The meas-
urement procedure and the respective per iods of rest and
smoke inhalation can be seen in Figure 1.
An HRV medilog® AR12 (Huntleigh Healthcare, Car-
diff, UK, and Leupamed GmbH, Graz, Austria) system
was used for cardiac monitoring. The system is designed
for long-term monitoring. The sampling rate of the new
recorder is 4096 samples per second. Therefore RR-in-
tervals can be detected extremely accurately. All raw
data, stored digitally on special memory cards, were
transferred via internet to the TCM Research Center
Graz in Austria where the data analysis and the statistical
analysis were performed.
HRV is measured as the percentage change in sequen-
tial chamber complexes, so-called RR-intervals, in the
electrocardiogram (ECG). The registration of HRV is
performed using three electrodes on the chest. Parame-
ters used are those recommended by the Task Force of
the European Society of Cardiology and the North
American Society of Pacing and Electrophysiology [5].
Calculation of ECG power spectra is thought to provide
an understanding of the effects of sympathetic and para-
sympathetic systems on HRV. Two main spectral com-
ponents are distinguished in a spectrum calculated from
short-term recordings of 5 minutes: low frequency (LF;
0.04 - 0.15 Hz) and high frequency (HF; 0.15 - 0.4 Hz)
components. The LF/HF ratio has been accepted as an
index of sympathovagal modulation of the sinoatrial
node by the Task Force mentioned above [5]. In this pilot
study, the evaluation parameters were: heart rate, total
heart rate variability and the LF/HF ratio.
2.3. Statistical Analysis
The HR and HRV data were tested with one way re-
peated measures ANOVA. As post-hoc analysis, Tukey
test was used (SigmaPlot 11.0, Systat Software Inc.,
Chicago, USA). The results were graphically presented
as box plots. Changes were considered significant at a p-
value < 0.05.
3. Results
All subjects completed the study. The electrocardio-
graphic data of 24 subjects were transferred without any
problems via internet over a distance of 7,650 km.
Figure 2 summarizes the moxa smoke induced
changes of HR in all 24 volunteers. The results showed
that significan t (p < 0.001) decreases in HR occur during
moxa smoke inhalation. These effects remain present and
intensified (p ≤ 0.039) even ten minutes after completing
the stimulation with moxa smoke.
The results of the total HRV of the volunteers (n = 24)
are shown in Figure 3. A significant increase (p ≤ 0.037)
of H RVtotal after moxa smoke inhalation was observed as
outstanding result of the beat-to-beat variability.
In addition to the global assessment of HRV, a separa-
tion into a LF and a HF-band was performed, and the
LF/HF ratio was calculated. Figure 4 shows the results
of this parameter. Insignificant changes were found from
this analysis.
4. Discussion
The western understanding of “acupuncture” actually re-
fers to the Chinese characters “Zhen Jiu”, which literally
means acupuncture-moxibustion. This shows the enorm-
ous importance that moxibustion has in Chinese medicine
since thousands of years. Moxibustion is composed
Figure 1. Measurement profile and measurement time periods (a – h; 5 minutes each).

B. X. ZHAO ET AL.
55
Figure 2. Box plot illustration of changes of heart rate (HR) in beats per minute in 24 healthy volunteers before (a,b), during
(c-f) and after (g,h) moxa smoke inhalation. The horizontal line in the box gives the position of the median. The ends of the
boxes define the 25th and 75th percentile; the error bars mark the 10th and 90th percentile.
Figure 3. Changes of total heart rate variability (HRVtotal) before, during and after moxa smoke inhalation. Note the signifi-
cant increase in HRVtotal after inhalation. Further explanations see Figure 2.
of the words mogusa (burning herb, mugwort is most
commonly used) and “comb us tion” (burning). Mugwort
is regarded as the best moxibustion material, established
after thousands of years of practice. Comparing with the
other materials for combustion, mugwort is inflammable
and fragrant. The fire generated is moderate and gentle
and suitable for treatment. When burning the mugwort,
the heat given off can penetrate deeply into the muscles
and bring about a comfortable feeling. There are also
many other advantages of using mugwort such as exten-
sive sources, simple mode of operation and safety.
It is reported in ancient books that the mugwort pro-
duced in Qizhou city, Hubei province is the best product.
For the use of moxibustion, the mugwort leaves need to be
harvested in a special sea son and pla ce d in the shade t o dry,
then crush the leaves are crushed into moxa floss by re-

B. X. ZHAO ET AL.
56
Figure 4. Ratio of the low (LF) and high (HF) frequency band of HRV in the 24 healthy volunteers before, during and after
moxa smoke inhalation. No significant alterations were found. Further explanations see Figure 2.
moving the impurities. Good quality of mugwort floss
should be soft and fine like cotton and can be stored for a
long time. The longer the storage tim e, t he bette r it i s.
Mugwort leaf is also used as an herb for medication.
Research showed that the main components of mugwort
naphtha are eudesmol, thujone, camphor, borneo cam-
phor, 4-terpene alcohol, caryophyllene, oleanolic acid,
juniper camphor etc. [6]. These components may exist in
the moxa smoke and have some treatment effects.
The RR-intervals in the ECG are controlled by the
blood pressure control system, influenced by the hypo-
thalamus and in particular controlled by the vagal car-
diovascular center in the lower brainstem. HRV can be
quantified over time using registration of percentage
changes in RR-intervals in the time domain as well as
the changes in the frequency range by analysis of elec-
trocardiographic power spectra [7]. Earlier work done
pointed out a few bands in the spectrum of HRV that
could be interpreted as markers of physiological rele-
vance. The total heart rate variability reflects the overall
situation of HRV and the total autonomic nervous sys-
tem activity .HF represents the parasympathetic nerve
activity; LF represents the combined action of the
parasympathetic nerve and the sympathetic nerve but
mainly of the sympathetic nerve. Associated mecha-
nisms are thermoregulation which can be found in the
very low frequency band, blood pressure and respira-
tory effects [5,7].
The present study revealed that the healthy volunteers
exposed to moxa smoke had significant reductions in HR
and also sign if ican t chang es in HRV par ame ters, accompa-
nied by a stress reduced tendency toward quiet behaviour.
This shows that moxa smoke can improve the autonomic
nervous system activity. The inhalation of moxa smoke
will induce a depressa nt effect on human body.
This is in accordance with a preliminary study (di-
ploma thesis) performed under supervision of the same
institutions (Beijing University of Chinese Medicine and
TCM Research Center Graz) [8]. In this research activ ity,
a significant decrease of mean HR during treatment was
observed in a total of 20 measurements using moxibus-
tion on acupoint RN 4 (guān yuán) in two different ses-
sions (needle-moxa and moxa-stick). The decreased HR
then converged to baseline level again.
The possible reasons to account for the insignificant
change in the LF/HF ratio in this study, which reflects
the degree of balance between the two nervous systems,
could be that the duration time of moxa smoke inhalation
was not long enough and that the volunteers were already
in a balanced health state. Further researches focused on
patients and have longer observation time are needed.
Beside these cardiovascular investigations, researches on
other body systems, s uch as the neurophysiologic effects
of moxa smoke inhalation, are absolutely necessary.
5. Acknowledgements
The authors thank Ms. Ingrid Gaischek, MSc, for her
valuable support in creating figures and preparing the
manuscript. The investigations were supported by the
Austrian Ministries of Health and of Science and Re-
search and the Eurasia-Pacific Uninet (project “Bioengi-

B. X. ZHAO ET AL.
57
neering and clinical assessment of high-tech acupuncture:
a Sino-Austrian pilot study”) and the Jubiläumsfonds of
the Oesterreichische Nationalbank (OeNB; project 134 63 ) .
The measurements and analysis were performed within
the areas “Sustainable Health Research” and “Neurosci-
ence” at the Medical University of Graz.
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