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The higher it is, the more damage you give and take, and more xp you get
Casting spells, the item you're talking about (moonlight vial), and the irl moon phase
casting spells will likely be the thing that raises the most, but the moonlight vial is a big % boost if you have them
If its something you want higher though, blood spells dont cost mana, and you can just spam them most of the time to raise it
full moon gives most lunacy new moon gives no lunacy, so depending on when you play the game Lunacy can build up really fast, or you'll literally never see it at all (or more likely somewhere in the middle)