HEAVENLY MOXIBUSTION AND SAN FU  DOG DAYS OF SUMMER

Mugwort is not the only type of "moxibustion" used; there has been a resurgence of Heavenly Moxibustion in recent years - a practice dating back to the Qing Dynasty that has become the subject of a number of clinical trials.

Instead of mugwort, the treatment uses herbs ground into a powder, mixed with fresh ginger juice into a paste, and taped to points to treat asthma, lung disorders, and allergies which affect the upper respiratory system.

The treatment is traditionally done on specific days in summer according to the Chinese calendar and Daoist cosmology - hence the name "heavenly" since it is in part based on where we are in the heavens at that time of year.

San Fu is sometimes translated as the "three hidings" since it references three 10-day periods that are predicted to be the hottest days of the year - or what we sometimes call in English "the dog days of summer". The treatment is given on the first day of each Fu period; so the patient comes in once every 10 days to have the paste taped to points mostly located either on their back or lower legs. Traditional Chinese hospitals are known to have lines out the doors on the Fu days with patients waiting for hours to have their points taped.

Not only does our geographic location affect our health (there's a reason people move to Arizona), but so does our tenure on any given point on the calendar. 

What's interesting to note in clinical studies is that they tested the effectiveness of the treatment regimen on the San Fu days against regular days in the calendar. The treatment was more effective on the noted dates in the calendar!  The recommendation that came out of the studies suggested that if the strict regime was too difficult, to stick as close to the dates as possible and at a minimum try to ensure the treatment was done in summer.  

San Fu dates for 2024:
July 15th, July 25th, August 4th, and August 14th

How to Calculate San Fu Dates

San Fu dates are calculated using the Earthly Branches and Heavenly Stems system in the Daoist Calendar. You’re going to need a Chinese almanac, a list of the 24 solar terms for the year, and a western calendar to calculate the conversion.

San Fu dates are the yang metal days (庚 geng) that occur after the summer solstice and are 10 days apart.

• Start by finding the date for the summer solstice (2023 = June 21st).

• The initial fu begins on the third 庚 geng day after the summer solstice (2024 = (1) June 25, (2) July 5th, (3) July 15th)

• The middle fu begins ten days later on the fourth 庚 geng day after the summer solstice (2024 = July 25th).

• Look up the solar date for “Lì Qiū / 立秋 / Autumn Begins” (2024 = August 8th).

• The final fu is the first 庚 geng day after “Lì Qiū / 立秋 / Autumn Begins” (2023 = August 14th)

Every year is a little different, but there is often an extra 庚 geng day between the middle and last fu days that you’ll need to keep an eye out for. Some years we’ll get three San Fu days, and some years we’ll get four. In 2024, there is an extra 庚 geng day on August 4th. If we’re lucky enough to get that extra day, the timing between all 4 dates is 10 days apart. But if we land on a year where that extra 庚 geng day doesn’t make a cameo in the calendar, the timing between the middle and last San Fu day can be up to 20 days long rather than ten.

The Allergic Asthma formula is best used for presentations where there is an over production of cold, damp, and phlegm that’s congesting the Lungs. Meaning it’s best used in cases where phlegm damp is PRIMARY. Gan Sui is an herb we rarely use because it’s so strong; however, when used topically, it purges phlegm damp and forces it out of the tissues. Yan Hu Suo invigorates the Qi within the blood while Xi Xin helps to warm the Lungs. The addition of Ma Huang helps get the Lung Qi moving downwards and, because of its relationship to the Urinary Bladder, gets the fluids moving out of the body rather accumulating and backlogging as damp.

The Lung and Kidney Deficiency formula consist mostly of herbs that either tonify Qi or tonify Yang. The only herb in the formula that really addresses phlegm damp is Ban Xia. This formula is best used where phlegm damp is SECONDARY and the root cause is coming from a Wei Qi deficiency. A lot of the herb target the Tai Yin pair of the Spleen and Lung Qi while adding some juice to the Kidney Yang. It even goes so far as to act as a Jing astringent - so this is for true deficiency cases.

What San Fu points should I use?

Good question. A recent study was conducted in 2015 where the scientists tracked patients over a 3 year period; however, the final paper has yet to be published. The points that I have employed clinically since 2009 are based on Lorraine Wilcox’s seminal article; however, as a clinician you will need to chose what’s right for your patients. The points for each of the days are listed below, but consider the additions of Tian Tu (REN22), Dan Zhong (REN17), Zhong Fu (LU1), and Zu San Li (ST36).

San Fu Scarring and Blisters

Everyone reacts differently to the San Fu application and it can be hard to gauge exactly what your body will do until you try it. Everything from melanin level, to genetics, to age, to sex, to medications, to current health status, to comorbidities will impact whether or not you will scar and what that scar will look like. Common reactions include: 

• Blisters; some people will have blisters that can take up to 72 hours to appear

• Red dots that are about the same color as a sun burn when they first remove the applications

The color, size, appearance, and location of the blisters will vary. Sometimes only a few of the points will blister, while other points that were applied at the same time will appear seemingly unaffected. The skin may also start to darken and create a thin scab like covering which will eventually fall off to expose healed pink "baby" skin underneath.

Remove the San Fu applications after 6 hours or if they start to become overly hot and itchy - whichever comes first.

• Wash the skin with with soap and water followed by gently patting the skin dry with a clean cloth or towel.

• If blisters appear, treat them as you would with any normal blister.

  • Keep the area clean and once the fluid comes out, do not remove the top layer of skin.

  • Keep the wound clean at all times and cover with a band aid during the day to keep it protected.

  • Feel free to use Neosporin or a topical cream that works well for you. Do not use medicinals known for taking the heat out of a burn because you want to be sure to preserve the Yang herbal remedies that were delivered through the dermis into the muscle layer. However, you do want to insure that the blister does not become infected as it heals.

• As with all wounds, depending on your skin you may scar. Wheat germ oil, tamanu oil, or Mederma scar gel all work wonders do lighten the color of scars.

Want to know how to roll and apply San Fu?
Please check out our tutorials to get started.

It was an article in The Journal of Chinese Medicine written by Dr. Lorraine Wilcox that led to my obsession with San Fu Moxibustion. Her book, Moxibustion: A Clinical Handbook, is the singularly best book on moxibustion written in English to date. Dr. Wilcox includes an entire section on San Fu that deep dives into studies, different herbal San Fu formulas, point protocols, future San Fu dates, and overall theory. Both the article and her book are written for practitioners and students of Chinese Medicine; I encourage anyone interested in offering this to patients in their own private practice to procure both the original article and her book. 

Once you get the hang of it, San Fu is surprisingly easy

For my colleagues who are visual learners, here are a few videos to get you started or act as a reminder if it’s been a while. We’ve included a 15 minute primer, a quick 2 minute video on how to roll San Fu, and a 3 minute video on how to apply San Fu. Hopefully this will answer most of your questions!