From traditional warming and tonifying to psychoneuroimmunology: theoretical reconstruction and clinical application of moxibustion for cancer-related fatigue.

Cancer-related fatigue (CRF) is a multidimensional and highly prevalent symptom that severely impairs the quality of life in patients with cancer. Due to its complex etiology and the limited effectiveness of current therapeutic options, CRF remains a major clinical challenge. Moxibustion, a traditional thermal stimulation therapy characterized by its "warming and tonifying" effects in East Asian medicine, has shown potential in alleviating CRF, however, its underlying biological mechanisms remain insufficiently defined. This review aims to reconstruct the mechanistic basis of moxibustion in the management of CRF from an integrated psychoneuroimmunology (PNI) perspective and to reposition moxibustion as a systemic modulator of the PNI network capable of restoring neuro-endocrine-immune homeostasis rather than a unidimensional warming therapy. Current evidence indicates that moxibustion may exert coordinated regulatory effects on CRF across psychological-emotional, neuroendocrine, and immune-inflammatory dimensions. By reinterpreting the traditional concept of "warming and tonifying" within a modern PNI framework, this review proposes a novel integrative paradigm for moxibustion-based interventions in CRF. This framework supports a transition from symptom-oriented management toward network-level modulation, providing a theoretical foundation for non-pharmacological precision strategies in CRF.