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Neuroregulatory mechanism of heat-sensitive moxibustion on the Dubi acupoint (ST 35) in patients with knee osteoarthritis: a resting-state functional magnetic resonance imaging study.

Frontiers in neurology·February 2026·Lu Tian, Tiansheng Lian, Hongwu Xie et al.
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Key Finding

Heat-sensitive moxibustion produced superior pain relief through coordinated bidirectional brain modulation—increased temporal lobe and decreased occipital lobe activity—with changes directly correlating to pain reduction (r=0.764, p<0.01), unlike the generalized suppression seen in non-heat-sensitive treatment.

What This Means For You

Researchers in China used brain imaging to understand why some people with knee osteoarthritis get better pain relief from moxibustion than others. They studied 60 patients total, dividing them into two groups: those who felt a special "heat-sensitive" sensation during moxibustion treatment and those who didn't. Both groups received 10 daily moxibustion sessions at the Dubi acupoint (ST35) near the knee. The study used functional MRI brain scans before and after treatment to see what was happening in patients' brains. The results showed that patients who experienced the heat-sensitive sensation had much better pain relief, and their brain scans revealed why. In these patients, activity increased in the temporal lobe (involved in processing sensory information) and decreased in the occipital lobe (involved in visual processing). These specific brain changes were directly linked to how much their pain improved—the bigger the brain changes, the greater the pain reduction. Patients who didn't feel the heat-sensitive sensation showed only generalized decreases in brain activity without the coordinated pattern. This research provides scientific evidence that the traditional concept of "heat-sensitivity" in moxibustion isn't just subjective—it reflects a real difference in how the brain processes pain relief. For patients considering moxibustion for knee arthritis, this suggests that finding the right sensitive points may be important for getting the best results. If you're interested in moxibustion treatment, seek a qualified and licensed acupuncturist trained in traditional techniques.

Clinical Notes for Practitioners

This rs-fMRI study (n=60) investigated brain functional changes following heat-sensitive moxibustion at ST35 in knee osteoarthritis patients using fractional amplitude of low-frequency fluctuation (fALFF) analysis. Patients were divided into heat-sensitive moxibustion (HSM, n=30) and non-heat-sensitive moxibustion (NHSM, n=30) groups, receiving 10 daily treatments. Post-treatment fMRI revealed the HSM group demonstrated bidirectional modulation: increased fALFF in left temporal lobe and white matter, decreased activity in occipital lobe and right hemisphere. The NHSM group showed only generalized suppression across multiple regions. Critically, HSM group temporal lobe fALFF changes positively correlated with VAS score reduction (r=0.764, p<0.01), while occipital changes showed negative correlation (r=-0.595, p<0.01). Clinical implications: Heat-sensitive sensation appears to reflect neurophysiologically distinct pain processing, with coordinated activation-deactivation patterns predicting superior analgesic outcomes. This supports traditional heat-sensitivity identification as clinically meaningful rather than merely subjective, warranting careful point sensitivity assessment during moxibustion treatment selection.

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