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Small cone direct moxibustion for TB, TB/HIV, MDR-TB and XDR-TB


Small cone direct moxibustion (or ‘moxa’) has a long history as a traditional therapy in East Asia which includes documentary evidence of its use as a treatment for consumptive disease (TB) in China along with more recent documentary evidence of its use for treating TB in the pre-antibiotic era in Japan. The latter includes some limited scientific evidence of effect, and also more recent evidence of its probable immunomodulatory effects.

The current situation with global tuberculosis is precarious. As a pandemic it is entrenched in most of the world’s most populous countries and is endemic in most middle- and low-income countries. Whilst estimated death rates have fallen over the last twenty years (to 1.5 million deaths per year), it is still difficult to make a convincing case that the disease is in final retreat, particularly because there is a growing secondary pandemic of drug-resistant tuberculosis – in fact it is currently the only anti-microbial pathogen that is airborne so poses a unique public health threat. The current challenge is to improve outcomes and reduce costs and lengths of regimens for treating DR-TB wherever TB is already entrenched.

Moxa has specific potential advantages in this respect: it is extremely cheap, is low-tech and the techniques required for its administration have been demonstrated to be easily taught. Furthermore it carries no risks of blood-borne cross-infections and doesn’t stoke drug-resistance.

A 180 patient RCT has been recently completed in Kampala Uganda by Makerere University’s School of Health Sciences which has revealed a range of data much of which is still being analysed. Currently the key findings are these:

Moxa seems to accelerate bacteriological conversion in both TB and TB/HIV patients.

It also seems to hike CD4 count in both TB and TB’HIV patients, and seems to do the same with Haemoglobin levels.

This makes it potentially a very useful adjunctive tool for use with MDR- and XDR-TB patients since it may improve outcome and adherence when the regimens are much more toxic and lengthier (and far less successful in outcomes). Of significance to the African region (where all TB rates are highest because of its HIV syndemic and the paucity of health resources) is the revelation that this therapy appears to be not just HIV-patient-friendly (which any TB treatment needs to be in the region), but it also may actually improve the response to ARV drugs as well. This is a potentially huge finding. Two new TB drugs are approved globally for controlled use for MDR-TB but neither are yet tested with HIV co-infected TB patients (probably because it’s anticipated their result will be poor) - making the current prospect for Africa with respect to MDR-TB very depressing indeed.

So far the research has been limited to a minimal moxa dose on diagnosed drug-susceptible TB patients. The necessity now is to replicate similar controlled studies on diagnosed MDR- and XDR-TB patients (especially including ones co-infected with HIV/AIDS), and even to study responses on patients who are determined to be ‘therapeutically futile’ having failed all drug treatment available to them (i.e. to test it as a stand-alone therapy of last resort).


The Moxafrica charity which has sponsored the existing research fully recognises that these studies will be more challenging than what has already been completed. As such it envisages creative collaborative partnerships needing to be developed between academics and researchers in MDR-TB endemic countries and experts in infectious disease in institutions in high-income nations. It also envisages possible pilot studies being developed by key NGOs including MSF and PIH.

Every effort is currently being made to engender interest in the findings so far (which after final analysis will be submitted by Makarere University to a peer-reviewed journal). Further detail of the findings so far can be obtained from the Moxafrica charity:

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Website: www.moxafrica.org

 
 

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