The Zhang Zhongjing tradition warns against moxibustion in heat patterns, and the warning is repeated in later literature. Yet other texts describe moxibustion for febrile disease, for abscesses and for heat in the upper body, and the technique of drawing heat outward with moxa is old.
The disagreement is resolved by distinguishing kinds of heat. Moxibustion is avoided in excess heat with high fever and in yin deficiency with dryness. It is used where heat is localised, where it is due to stagnation, or where the purpose is to draw heat downward and outward, as at KI1 for hypertension. The deciding question is not whether there is heat but whether there is anything for the moxa to move.