A small, cone-shaped amount of moxa is placed on top of an acupuncture point and burned on the skin. Direct moxibustion is a traditional technique considered to be very therapeutic. Much of the scientific study has been done on scarring direct moxibustion. The effectiveness of direct moxibustion particularly on immune function has been reported as early as 1927 by Dr. Shimetaro Hara, at the Kyushu University in Japan. Presently however, direct moxibustion is not performed routinely outside of Japan, as it may have some undesirable effects such as blistering, burn marks, and even scarring at the moxibustion site.

In an attempt to prevent skin damage, some acupuncturists place a medium (slice of ginger, topical paste, etc.) between the skin and the burning moxa or extinguish the burning moxa just before it reaches the skin. The possible effect derived from this type of moxibustion (sometimes referred to as non-scarring direct moxibustion or categorized as indirect moxibustion) should not be considered the same as the scarring direct moxibustion since the main effect of direct moxibustion is considered to result from actual damage to the skin (thus stimulating the release of immunological mediators resulting in a healing reaction).