'Terry Oleson1996, 1998'2003, Elsevier Limited. All rights reserved No part of this publication may be reproduced, stored In a retrieval system, or transmitted in any form or by any means,electronic, mechanical, photocopying, recording or otherwise, without either the prior permissionof the publishersor a licencepermitting restricted copyrnqIn the United Kingdom issuedby the Copyright licensing Agency, 90 Tottenham Court Road, London WtT 4LP.Permlsslons may be sought directly from Elsevier's Health SCiences RightsDepartment In Philadelphia, USA phone: (+1) 215 239 3804, fax: (+1) 215 239 3805, e-mail
[email protected]. You may alsocomplete your request on-line via the Elsevier homepage(http://wvvvv.elsevier.com).by selecting 'Support and contact' and then 'Copyright and Permission' First edition 1996 Secondedition 1998 Third edition 2003 Reprrnted 2004, 200S, 2006, 2007 (twice), 2008 ISBN. 978044307162 1 Brrtish library Cataloguing in Publication Data A catalogue record for this book IS availablefrom the British Library Library of Congress Cataloguing in Publication Data A catalogue record for this book is availablefrom the libraryof Congress Note Medical knowledge is constantly changing. As new information becomesavailable, changesin treatment, procedures, equipment and the useof drugs become necessary. Theauthor and publishershave,asfar asit is possible, taken careto ensure that the information given in thistext is accurate and up to date. However, readers are strongly advised to confirm that the Information, especially with regard to drug usage, compiles with the latest legislation and standards of practice _ your source for books, journalsund multimedia inthehealthsciences www.elsevierhealth.com Working together to grow librariesindeveloping countries www.elsevier.corn I www.bookaid.org I www.sabre.org Printed in China The publisher's policy istouse paper manufactured fromsustainable forests I Foreword I haveknown Dr TerryOleson for anumber of years andI amverypleased tohave been asked towritesome lines of introduction for thethirdedition of the Auriculotherapy Manual: Chinese and Western Systems ofEar Acupuncture. I havevery high regardfor theadvanced level of information contained inthisbook. Dr Oleson statesextremely well that therearetwoverydifferent approaches tounderstandabout auriculotherapy. Oneapproach isOriental, theother one isOccidental. TheOriental approach calls upon thebasic concepts of classical acupuncture. Most prominent are theconcepts of yinandyang. InthisEasternapproach towardsauriculotherapy, the notion of ’energy’ isomnipresent. Themetaphysical viewof theworld andof man isthe primaryfocus, even moreprominent thanthedoctrines of physiology andanatomy. TheWestern approach towardsauriculotherapy, thatwhich Paul Nogier first proposed, rests upon thescientific method of observations, andtherepetition of such observations. It isalso grounded upon thebasic foundations of anatomyand physiology. IntheWestern approach, thereisnonotion of energy andnometaphysical philosophy thatunderlies thistechnique. Infact, without going intodetails, the external ear hasparticular diagnostic andtreatment properties because of its innervationandbecause of thepresence of neuro-vascular complexes. These complexes aresmall, actual entitiesconsisting of micro-hormones dispersed under the skin of theexternal ear. Thereareactually twojuxtaposed somatotopic systems which explain auriculotherapy asit ispracticed today inEurope. Thefirst system isbased on nervous fibers distributed throughout theauricleandispurely areflex. It iswiththissystem thatone uses auriculotherapy toalleviatepain. Thesecond system rests upon theexistence of the neuro-vascular complexes discovered bytheteamof Pr Senelar: OdileAuziech, ClaudieTerral. On theexternal ear, thereexist cutaneous pointsof reduced electrical resistance thatcorrespond tohistological microformations made upof anerve, a lymphatic vessel, asmall artery, andaveinule. It isthese microformations that are called neuro-vascular-complexes. Stimulationof these complexes by infrared light modifies thetemperatureandthethermal regulation of internal body organs, thus modifying their function. Schematically, theexternal ear islikeacomputer keyboard which acts on thewhole organismthrough theintermediaryof thecentral nervous system andtheauricular micro-hormonal system. Thisauricular system hastwotypes of computer keys, one set connected tothespinothalamic system that modulates painperception andanother set which initiatestherelease of activehormonal substances which modify specific internal organs. When looking at theear, one will obtainadifferent effect if aneedle isused, or alaser light, or amagnetic field. As witheverythinginmedicine, great skill isrequired tomaster thistechnique. Thecomputer keyboard on theear allowsclinicians to effectively treatpain, functional disorders, addictive problems, andminor psychiatric disorders. It iswell known that Paul Nogier, myfather, discovered thesomatotopic properties of theexternal ear. Therearejust afewfortunatepeople whonot only dream, but whoare able tocarry out their dreams andbringthemintoreality. Paul Nogier wasat thesame timeamanof innovativethoughts andaman of productive action. Hewasagifted clinician of exceptional abilities whoattentivelylistened tohispatients, respected what they had tosay, andthoroughly investigated their maladies. Tirelessly, heexamined patientsfrom MondaymorningtoSaturdayevening, tryingtounderstandandtocure their illnesses. Onecannot understandthework of Paul Nogier without knowinghis character. Hewasamanwhospent much of histimeproposing sometimes contradictory newideas, themajorityof which fell bythewayside. Nevertheless, his most original ideas remain: thesomatotopic representations on theear, thevascular autonomic signal, andthetreatment effect of specific frequencies. It isfor these discoveries that many students followed himso devotedly. At thesame time, confronted withso much apparent inconstancy, much of theteachingbythisgreat master wasnot understood or fell out of favor. Foreword ix Thisthirdedition of theAuriculotherapy Manual strives tobringcloser together Western neurophysiological concepts andOriental energetic concepts asthey relateto auriculotherapy. Dr Oleson livesinastateinthe USA which also assimilates Western and Easterncultures. Perhapsonly inCaliforniacould onebeable todo thework that hehas done. Inthethirdedition of thisbook, theorigins of auriculotherapy aretraced tohistorical sources inthe West aswell asChina. The use of acupuncture pointson the external ear hashadalong traditioninOriental medicine, which expanded ina different direction withtheintroduction of thesomatotopic ear chartsdeveloped by Paul Nogier. At thesame time, interest inauricular medicine brought greater attention tothepractice of classical acupuncture inEurope. Thisbook explores abroad rangeof theoretical perspectives that havebeen developed tounderstandtheunderlyingbases of auriculotherapy. Thesomatotopic features of multiplemicro-acupuncture systems, the relationship of ear acupuncture toother concepts inOriental medicine, andholographic models areall described ina comprehensive manner. Neurophysiological investigations of auricular acupuncture, andtherole of hormonal substances such asendorphins, aresubstantiatedwith numerous scientific studies. Artisticillustrationsrevealingtheanatomical regions of theexternal ear facilitategreater comprehension of the correspondences between the ear andthebody. Theauricular zone system developed by Dr Oleson provides clinically useful reference guidelines for conducting auricular diagnosis and auriculotherapy treatments. The predominant portion of thisbook presents several hundredear acupuncture points organizedbymajor anatomical systems. Auricular representation of themusculoskeletal system, visceral organs, endocrine glands, and thenervous system aredifferentiated by their anatomical location andclinical function. Thetreatment plans presented at theendof thisbook integrateear acupuncture points discovered intheWest aswell asinChina. InEuropean applications of auricular medicine, greater emphasis isplaced upon palpationof thevascular autonomic signal todetermine thereactivity of anear point anditsappropriateness for treatment. This book isaveryimportant contribution tothefield of health care intheWest andthe East. DrOleson’s work issignificant. Evenif I ardentlydefend theWestern conceptualizations of auricular acupuncture based upon theear’s uniquephysiology, I wishthat hishook meets thesuccess which itwell deserves, x Lyon, July 2003 Foreword Raphael Nogicr MD Preface When one hasbeen on ajourney for almost threedecades, itisnot uncommon to wonder howthejourney first began. For me, theexploration of thefascinating field of aurieulotherapy startedwithanafternoon lecture I heardwhilecompleting my graduatestudies at theUniversity of Californiaat Irvine(UCI ). Thepresentation itself had nothingtodo either withacupuncture or theexternal ear, but itstimulated my mind tobedrawntoapath that continues toexcite mestill. The UCI Departmentof Psychobiology sponsored aweekly guest lecturer series that brought invisitingfaculty fromall over theUnitedStates, but thatday’s presenter wasfromour neighboring Californiacampus at UCLA. Dr J ohn Liebeskind mesmerized mewithhispioneering research on aconcept that, in1972,wascompletely newtothefield of neuroscience. Hislaboratory haddemonstrated thatelectrical stimulation of theperiaqueductal gray of thebrainstemcould inhibit behavioral reflexes topainful stimuli. While thesensory pathways that carry pain messages tothebrainhadbeen thoroughly investigated, the laboratory of Dr Liebeskind provided thefirst scientific indication thatthebrain has thecapability toturnoff pain aswell asrespond topain. It wasseveral years later that subsequent studies would discover endorphins, themorphine-like substances that serve asthebody’s naturallyoccurring analgesic. What had made theLiebeskind research so impressive wasthattheanalgesia produced byelectrical stimulationcould beblocked bythechemical antagonist tomorphineknown asnaloxone. I wrote to Dr Liebeskind after thelecture, met withhimat UCLA, andsoon submitted an application for afederally funded postdoctoral scholarship workinginhislaboratory. As mydoctoral dissertation examined thefiringpatternsof neurons inthesomatosensory andauditorypathways duringPavlovianconditioning, mypostdoctoral grantsought to examine neural firingpatternsinthebrainpathways related totheinhibitionof pain sensations. InJ ungianpsychology thereistheconcept of synchronicity, ameaningful coincidence of separateevents thatdo not seem causally connected (J ung1964). J unghimself noted that theclassical Chinese texts didnot ask, What causes anevent?, but instead, What likes tooccur withwhat?Toooften, individualsfail tonotice such synchronistic events, dismissing themasrandomcoincidences. I can often observe such events only inretrospect. I began mywork inDr Liebeskind’s labafter receiving myPhD in Psychobiology in1973.It so happened thattheneuroscience laboratories at theUCLA Departmentof Psychology wereinthebasement of an l l-storybuilding. After awalk down along underground hallwayonearrivedat theUCLA Acupuncture Research Clinic. What first drew metothatendof thebuildingwasastrangesmell which seemed likemarijuana,but infact wastheChinese herb moxa. While I conducted animal research experiments duringtheday, I began spending more of myfree timehours interactingwiththedoctors investigatingtheeffects of acupuncture. In1974,UCLA wasone of only afew, major US universitiestoexplore themultipledimensions of alternativemedicine. TheUCLA painclinic successfully treatedhundreds of chronic pain patientswithacupuncture, biofeedback, hypnosis, guided imagery andnutritional counseling. Thedirectors of theclinic, Dr DavidBresler andDr RichardKroening, invitedmetotheir offices one afternoon andasked metobe their research director. It waslikeaninvisibleforce pushed mefrombehind asI leaped at theopportunity. I did not haveanyacupuncture skills, but asapsychologist I hadextensive trainingin conducting research. And thusbegan theamazingjourney. Thefirst research project thatweundertook wastoexamineauricular diagnosis, rather thanconduct aclinical outcome study. At that time, themedical profession devalued acupuncture assimply aplacebo, but adiagnostic study could not becontaminated bya patient’sdesire toplease their practitioner. It took several years todesign theresearch andcollect thedata, but therewasanenergizingatmosphere affecting everyone participatingintheclinic that made itagreat pleasure towork there. I wassurprised myself when theresults werefinallyanalyzed andtherewassuch astrongstatistical finding. Byjust examiningtheexternal ear, andblind toapatient’sdiagnosis, a physician could identify thepartsof thebody whereapatient hadreported musculoskeletal pain. While I wasinitiallyonly ascientific observer of such Preface xi phenomena, I subsequently took numerous classes andseminars inauriculotherapy andbody acupuncture. Therewerenot many US acupuncture schools at thattime, but therewere plenty of teachers. While mostly unknowninthewhite, black andHispanic partsof Los Angeles, therewere alargenumber of practitioners of Oriental medicine intheAsian districts. Theywereverywillingtosharetheir knowledge of their ancient andalmost mystical arts. Itwasonly after I presented theresults of theauricular diagnosis research tothe I nternational Society for theStudy of Painthat I learned of thewhole field of auricular medicine thatispracticed inEurope. American doctors prefer theelectrical detection andtreatment of acupuncture pointsmore thanAsian doctors, andseveral electronic equipment manufacturers sponsored seminars that incorporated thework of European aswell asChinese acupuncturists. I had readabout thepioneering auriculotherapy work of DrPaul Nogier, but I began studyingwith physicians whohadactually studiedwithhiminFrance. Dr Tsun-NinLee sponsored a presentation byNogier inSanFrancisco, anditwasthen thatI first had theopportunity tomeet thisgreat man. Dr Nogier only spoke inFrench, so DrJ oseph Helms had to translatethematerial intoEnglish. It isnot alwayseasy tolisten tolectures asthey are translated, but DrNogier held theaudience enthralled. Hehad readof myresearch on auricular diagnosis and made aspecial invitationtomeet withme, which I wasvery glad toaccept. I had threemore opportunities tomeet withhimpersonally at international congresses inEurope, andit alwaysseemed likeanhonor. I always wished that I hadmore timetoupgrademyhigh school French so that I could converse withhimmore fluently, but it isveryintriguingthat ameetingof minds can occur beyond one’s linguistic abilities. I feel veryfortunatetohavereceived individual guidance on understandingtheunderlying mechanisms thatcan account for the impressive benefits of auriculotherapy. Dr RichardKroeninghad once told me that inmedical school, when learninganew medical procedure, themotto issee one, do one, teach one. While not progressing quitethatfast, I havenowhad theoccasion toteach courses inauriculotherapy at colleges anduniversitiesacross theUnitedStates. Theadagethat one learnsfrom one’s students continues toapply even after 20years of teaching. Studentscome tome andinformmeof patientsthey havetreatedwithauriculotherapy for unusual conditions that I haveonly studied inbooks. While they tell methat they learned how todo such treatmentsfrom earlier editions of myAuriculotherapy Manual, theclinical contents of thismanual did not begin withme. Theworks of many acupuncture masters inAsia, Europe, andAmerica inspired metocompile their teachings inameaningful way. I also had thegood fortunetoconnect withDrJimShores whoco-sponsored the I nternational Consensus Conference on Acupuncture, Auriculotherapy, andAuricular Medicine in1999.It wasmycontinued efforts tounderstandthisunusual clinical procedure thathas led tothismost recent edition. Thatstimulationof the external ear can affect conditions inother partsof thebody does not seem intuitivelyobvious. Even after treatinghundreds of patientswiththisapproach, it continues toamazemethat it can work. Thepurpose of thisbook istoexplain both the theoretical basis andthe clinical practice of auriculotherapy so thatothers mayknow of itsvalue. I would liketoacknowledge TimMcCracken, JanJ ames, andSinuheAlberto Avalos for their invaluableassistance inproducing thisbook. I wanttoalso thankDannyWatts for hiswillingness toserve asthemodel for thehumanfigures used inthisbook. xii Los Angeles 2003 Preface TerryOleson Auricular microsystem points Master points and landmarks Musculoskeletal points Ankle.C Toes.C Chest Arm Elbow Abdomen SkinDisorder.E SkinDisorder.C ...---Hand __’ Wrist Shoulder Neck Master Shoulder Occiput TM] Hip.C Knee.C Face Eye CS;l.. Depthview ~ Auricular somatotopic map on posterior of ear Dental Analgesia Forehead Hip.E Heel.E Heel.C Toes.E Ankle.E Knee.E Inner Nose.C Inner Ear.E Cervical Spine.-"." Temples EyeDisorder 1 EyeDisorder 2 Sacral Spine l.umbar Spine Thoracic Spine External Ear.C--+--...( MuscleRelaxation LM7 .Apex of Ear / Hepatitis.C I __ t : ~ __ / Prostate.C "Sciatic Nerve Bladder Kidney.C / Lesser Occipital Nerve (WindStream.C) Adrenal Gland.E Small Intestines /Spinal Cord Heart.E Pancreas Spleen.E Stomach -Liver ThyroidGland.E Spleen.C Lung1 ------ThyroidGland.C Heart.C Brainstem.C Antidepressant point " "Brain.C ’Asthma ".. -, Hippocampus (memory) Gonadotropins (FSH, Ovaries.C) Amygdala (aggressiveness) Antihistamine Internal organ and neuroendocrine points Autonomic point Omega 2 Hypertension ’-. \ Uterus.C Kidney.E Constipation Psychosomatic Reactions ExternalGenitals.C Uterus.E _____ Largeintestines Diaphragm.C Ovaries/Testes.E ~ __ ExternalGenitals.E Mouth Vitality point --- › Throat.C Throat.E Appetite Control› Adrenal Gland.C ~ Lung2 San[iao >:", ACTH/ / Pineal Gland/ PituitaryGlancY TSH/ / Frontal Cortex’/ LimbicSystem/ (Prostaglandin) .C- Chinese ear reflex point "E- European ear reflex point e2003Elsevier Science Limited Anatomical zones of the ear Inverted fetusmap AZ Auricular anatomy HX Helix AH Antihelix LO Lobe TG Tragus AT Antitragus IT Intertragic Notch SF Scaphoid Fossa TF Triangular Fossa SC Superior Concha IC Inferior Concha CR Concha Ridge CW Concha Wall ST Subtragus IH Internal Helix PL Posterior Lobe PG Posterior Groove PT Posterior Triangle PC Posterior Concha PP Posterior Periphery Depth view Antihelix TF 3 inferior :;':'"'---.lL- crus Antihelix body AMAH10 --I:r C ~ AH 8 Antihelix tail o SF 1 ~ J f ~ IC8. C':JI "e Frequency zones Posterior viewof auricular zones if) 2003 Elsevier Science Limited Surface viewof auricular zones Hidden viewof auricular zones II Overview and history of auriculotherapy 1.1 Introductiontoauriculotherapy 1.2 Health care practitioners using auriculotherapy 1.3 Historical overview of auriculotherapy 1.4 Earacupuncture developments inChina 1.5 Auriculotherapy and auricular medicine intheWest 1.6 Comparison of ear acupuncture to body acupuncture 1.1 Introduction to auriculotherapy Auriculotherapyisahealthcaremodalityinwhichtheexternal surfaceof theear, orauricle, is stimulatedtoalleviatepathologicalconditionsinotherpartsof thebody.Whileoriginallybased upontheancientChinesepracticeofacupuncture,thesomatotopiccorrespondenceofspecific partsof thebodytospecificpartsoftheear wasfirstdevelopedinmodernFrance.Itisthis integratedsystemofChineseandWesternpracticesof auriculotherapythatisdescribedinthis text. 1.2 Healthcare practitioners using auriculotherapy Acupuncturists: Thepracticeofclassical acupunctureandTraditionalChineseMedicine(TCM) includestheinsertionof needlesintoearacupointsaswell asbodyacupuncturepoints.Thesetwo approachesofstimulatingacupuncturepointsonthebodyortheearcanbeusedinthesame treatmentsessionorindifferentsessions. Someacupuncturistsstimulateearreflexpointsasthe solemethodof theiracupuncturepractice,oftenfindingthatitismorerapidinrelievingpainand moreeffectiveintreatingsubstanceabusethanbodyacupuncture. Biofeedback therapists: Whereasbiofeedbackisveryuseful inteachingpatients self-control techniquestoachievegeneral relaxationandstressmanagement,auriculotherapy augmentsbiofeedbackproceduresbyproducingmoredirectandimmediatereliefof myofascial painandvisceral discomfort. Chiropractic doctors: Auriculotherapyhasbeenusedtofacilitatespinal manipulations,deep tissuework, andmotorpointmassage. Stimulationof auricularpointsreducesresistancetothe releaseof musclespasmsandthecorrectionofposturalpositionsbychiropracticadjustments. Whenauriculotherapyisappliedafteramanipulativetreatment,ittendstostabilizepostural realignmentsachievedbyachiropracticprocedure. Dentists: Auriculotherapyhasbeenusedtoachievedentalanalgesiafor thereliefof acutepain fromeitherdental drillingorteethcleaningprocedures.Forchronicproblems,suchasheadaches and temporomandibularjoint(TMJ)dysfunction,auriculotherapycanbecombinedwithtrigger pointinjections,dentalsplints, andocclusal work, thusfacilitatingmoresuccessful alleviationof chronicheadandneckpain. Medical doctors: Physiciansspecializinginanesthesiology, surgery, internalmedicine,andfamily practicehaveemployedauriculotherapyfor themanagementofchronicpain, thetreatmentof acutemusclesprains, andthereductionofunwantedsideeffects fromnarcoticmedications. Whetherpracticedbythemselves, orbymedical assistantsworkingunderthem, auriculotherapy hasbeenusedtoalleviateavarietyofsomaticcomplaintsseen instandardmedical practice. Naturopathic doctors: Naturopathicpractitionersoftenincludeauriculotherapyalongwith homeopathic,nutritionalandpreventivemodalities.Auriculardiagnosishasbeenusedto Overviewandhistory 1 2 determinespecificallergiesandappropriateherbal recommendations.Auricularstimulationcan relievedistressoriginatingfromdysfunctionalinternalorgans. Nurses: Thestandardmedical careprovidedbynursescanbegreatlyassistedbytheapplication of auriculotherapyforthesystematicreliefof painandpathologythatisnotadequatelyalleviated byconventionalmedicationsorprocedures. Osteopathicdoctors: Auriculotherapyhasbeenusedtofacilitatethecorrectionof misaligned vertebrae,toreduceseveremusclespasms, andtoaugmentpainmanagementprocedures. Physical therapists: Auriculotherapyisapowerful adjuncttotranscutaneouselectrical nerve stimulation(TENS), traction,ultrasound,andtherapeuticexercisesfor thetreatmentof acute whiplashinjuries,severe musclespasms, orchronicbackpain. Psychotherapists: Psychiatristsandpsychologistshaveemployedauriculotherapyfor the reductionof anxiety, depression,insomnia,alcoholism,andsubstanceabuse. Reflexologists: Tactilemanipulationof reflexpointsontheearcanbecombinedwithpressure appliedtotenderregionsof thefeet andhandsinordertorelievespecificbodyachesandinternal organdisorders. 1.3 Historical overview of auriculotherapy Ancient China: All recordedsystemsofclassical acupunctureareattributedtotheChinese medical text, theYellowEmperor’sclassic ofinternalmedicine(Veith 1972),compiledbetween206 BCE and220CEoInthistext, all sixyangmeridiansweresaidtobedirectlyconnectedtothe auricle. Onlytheyangmeridianchannelstravel toorfromthehead,whereasthesixyinmeridians weresaidtoconnecttotheearindirectlythroughtheircorrespondingyangmeridians.These ancientChineseearacupuncturepoints,however, werenotarrangedinananatomicallyorganized pattern.Theyweredepictedontheearasascatteredarrayof non-meridianpoints,withno apparentlogical order.Reactiveearacupointsthatweretendertopalpationwerereferredtoas yangalarmpoints. Ancient Egypt,GreeceandRome: TheEgyptologistAlexandreVarillehasdocumentedthat womeninancientEgyptwhodidnotwant anymorechildrensometimeshadtheirexternal ear prickedwithaneedleorcauterizedwithheat. GoldearringswornbyMediterraneansailorswere notjustusedasdecorations,butweresaidtoimprovevision. Hippocrates,the’father’of Greek medicine, reportedthatdoctorsmadesmall openingsintheveinsbehindtheeartofacilitate ejaculationandreduceimpotencyproblems.Cuttingof theveinssituatedbehindtheearwasalso usedtotreatsciaticpains. TheGreekphysicianGalenintroducedHippocraticmedicinetothe RomanempireinthesecondcenturyCE, andcommentedonthehealingvalueofbloodlettingat theouterear. Ancient Persia: After thefall of Rome, themedical recordsofEgyptian,Greek, andRoman medicinewerebestpreservedinancientPersia. IncludedinthesePersianrecordswerespecific referencestomedical treatmentsforsciaticpainproducedbycauterizationoftheexternal ear. EuropeanMiddleAges: TheDutchEastIndiaCompanyactivelyengagedintradewithChina fromthe1600sto1800s.Aswell assilk,porcelain,tea, andspices, Dutchmerchantsbrought ChineseacupuncturepracticesbacktoEurope.Doctorsworkingwiththecompanyhadbecome impressedbytheeffectivenessofneedlesandmoxafor relievingconditionssuchassciaticpainand arthritisof thehip.Thispainreliefcouldbeobtainedbyneedlesinsertedintobodyacupoints,by thecauterizationoftheexternal ear, orbycuttingtheveinsbehindtheears. ModernEurope: In1957,DrPaul Nogier,aphysicianresidinginLyons, France,firstpresentedhis observationsof thesomatotopiccorrespondencesoftheauricle. Consideredthe’Fatherof Auriculotherapy’,DrNogieroriginatedtheconceptof aninvertedfetusmapontheexternal ear. Hedevelopedthepropositionafternoticingscarsontheearsof patientswhohadbeensuccessfully treatedfor sciaticpainbyalayhealer. Nogier’sresearchwasfirstpublishedbyaGerman acupuncturesociety, wasthencirculatedtoacupuncturistsinJapan,andwasultimatelytranslated intoChinese,for distributiontoacupuncturiststhroughoutChina.TheMedical StudiesGroupof Lyons(GLEM)wascreatedtofurtherexploretheclinical benefitsof auricularmedicine. AuriculotherapyManual ModernChina: After learningabouttheNogierearchartsin1958,amassivestudywasinitiated bytheNanjingArmy EarAcupunctureResearchTeam.ThisChinesemedical groupverifiedthe clinical effectivenessof theNogierapproachtoauricularacupuncture.Theyassessed the conditionsofover 2000clinical patients,recordingwhichearpointscorrespondedtospecific diseases. Aspartof MaoTseTung’seffortstode-WesternizeChinesemedicine,’barefootdoctors’ weretaughttheeasilylearnedtechniquesofear acupuncturetobringhealthcaretotheChinese masses. Inthe1970s,theHongKongphysicianHLWenconductedthefirstclinical studiesonthe useofear acupunctureforopiatedetoxification(Wen&Cheung1973;Wen1977;Wenetal. 1978, 1979). ModernUnitedStates: Beginningin1973,clinical workbyDrMichael SmithatLincolnHospital inNewYorkledtotheapplicationofauricularacupunctureforwithdrawingaddictsfromopiate drugs, crackcocaine, alcohol, andnicotine(Patterson1974;Sacks1975;Smith1979).Thefirst doubleblindevaluationof auriculardiagnosiswasconductedin1980,attheUniversityof CaliforniaatLosAngeles (Olesonetal. 1980a).Thelocalizationof musculoskeletal painwas establishedbyoneinvestigator,thenaseconddoctorexaminedtheauricleforspecificareasof heightenedtendernessandincreasedelectrical conductance.Earpointsidentifiedasreactivewere significantlycorrelatedwithspecificareasofthebodywheresomepainordysfunctionhadbeen diagnosed.Trainingprogramsontheprotocolof usingfiveear acupuncturepointsforsubstance abusetreatmentledtotheformationoftheNationalAcupunctureDetoxificationAssociation (NADA) (Smith1990).Anotherorganization,theAmericanCollegeofAddictionologyand CompulsiveDisorders(ACACD), hastrainedchiropracticandmedical doctorsinthetreatmentof addictionwithauricularstimulation(Holderetal.2001).In1999,theInternationalConsensus ConferenceonAcupuncture,Auriculotherapy,andAuricularMedicine(ICCAAAM) brought togetherauricularmedicinepractitionersfromAsia, Europe,andAmericatoestablisha consensusonthecurrentunderstandingofauricularacupunctureasitispracticedthroughoutthe world.TheAuriculotherapyCertificationInstitute(ACI)wasestablishedin1999tocertify practitionerswhohaveachievedahighlevel of masteryinthisfield. Figure 1.1 AncientChinesechartsindicatinglocationofacupuncturemeridianchannelsinthreedifferentpresentations. Overviewandhistory 3 4 World Health Organization (WHO): Internationalmeetingsof theWHOsoughttostandardize theterminologyusedforauricularacupuncturenomenclature.Consensusconferenceswereheld inChina,Korea, andthePhilippines,from1985to1989.At the1990WHOmeetinginLyons, France, doctorsfromAsia, Europe,andAmericaagreedtofinalizethestandardizationof names forauricularanatomy(Akerele1991;WHO1990a).Aconsensuswasarrivedatfor the identificationofear pointsaccordingtoChineseandEuropeanearacupuncturecharts. 1.4 Ear acupuncture developments inChina Classical acupuncturewasfirstdevelopedinChinaover 2000yearsago. Itshistorical rootshave beenintriguinglydocumentedinUnschuld’sMedicineinChina(1943),Chen’shistoryofChinese medicalscience (Hsu&Peacher 1977),Eckman’sInthefootstepsoftheYellowEmperor(1996),and Huan&Rose’sWhocanridethedragon? (1999).Aswithprimitivemedical practiceinotherparts oftheworld, Chineseshamanssoughttowardoffevil demonsthattheyperceivedasthesourceof diseases; theyenlistedancestral spiritsfor assistanceinhealing.ThephilosophiesofTaoism (Oaoism),Confucianism,andBuddhismeachinfluencedsubsequentmedical developmentsin China.Mystical spiritualbeliefswerecombinedwithphysical observationsofclinicallyeffective treatments.Metaphoricalreferencestolightanddark,sunandmoon,fireandearth,metal and wood, all contributedtotheChineseunderstandingofdisease. Themicrocosmof mankindwas relatedtothemacrocosmof theuniverse, withsystematiccorrespondencesbetweenthevisibleand theinvisibleworlds. Humanpainandpathologywereattributedtodisturbancesintheflowofqi (pronouncedchee) alongdistinctenergychannelscalledmeridians.Thecirculationofthisvapor-like,invisibleenergy through’holes’intheskinwassaidtobefacilitatedbytheinsertionof needlesintospecific acupuncturepoints.TheHuang-di-nei-jingtextattributedtotheYellowEmperorhadreferredto 360suchholesassuitablefor needling(Veith1972).TheemperorHuangDi purportedlycameto power in2698BCE, andtheNei lingwaspresentedasadialoguebetweentheemperorandhis healthminister.However, currentscholarssuggest thattheNei lingwasactuallywrittenmuch later, inthesecondcenturyBCE. Thefirstrecordingof medical informationbycarvingsonflat stones, turtleshells, andbambooslipsdidnotoccur until 400BCE, andpaperwasnotinventedin Chinauntil 150CEoAcupunctureneedleswerefirstmadefrombonesandstones, andlaterfrom bronzemetal. In1027CE, afull-sizedfigureofamanwascast inbronzetoguidemedical practitioners.Over thesurfaceof thisbronzestatuewaslocatedaseriesof holesthatcorresponded tothelocationsofacupuncturepoints.Orientalmedicinewasacompletetreatmentsystembased upontheempirical findingsthatexaminedtheclinical efficacyof needlingacupuncturepoints. OrGongSunChenoftheNanjingMedical University, hasreportedthattheNei lingincluded numerousreferencestothetheoriesandexperiencesof usingauniqueear channel (Chen&Lu 1999).Theearwasnotconsideredanisolatedorgan,butwasintimatelyconnectedwithall organs of thebody,thefiveviscera(liver, heart,spleen, lungs,kidneys), andthesixbowels(stomach,small intestine,largeintestine,gall bladder,bladder,andsanjiaoor triplewarmer).Examinationsof the earwereusedasameansfor predictingtheonsetofailmentsandtherecoveryfromdisease. Ear acupuncturecouldtreatavarietyofdiseases, suchasheadaches, eyedisease, asthma,facial nerve paralysis, andstomachaches. AccordingtoHuang(1974),theNei lingfurtherstatedthat’bloodandair(subsequentlytranslated asbloodandqi)circulatethrough12meridiansandtheir365accessory pointstoinfiltratethefive senseorgans, sevenorifices, andbrainmarrow.’Huangfurthernotedthat’themeridianof the lesser yangof thehandweresaidtoextendupwardstowardthebackof theear. Themeridianof thegreatyangof thefootextendedtotheuppercornerof theear. Thecirculationof thesixyang meridianspasseddirectlythroughtheear,whilethesixyinmeridiansjoinedwiththeir correspondingyangmeridians.’InspectionofancientandmodernChineseacupuncturecharts demonstratesthatonlytheStomach,Small Intestines,Bladder,Gall BladderandSanJiao meridianchannelscirculateinfrontofor aroundtheexternal ear, withtheLargeIntestines channel runningnearby. Thephrase’meridianchannel’isactuallyredundant,butbothwordswill sometimesbeusedinthe presenttexttohighlighttheOrientalmedicineapplicationof theseterms. Somemeridiansare referredtoasfuchannelsthatcarryyangenergytostrengthentheprotectionof thebodyfrom AuticulotherepyManual external pathogenicfactorsandfromstress. Thezangmeridianchannels,whichcarryyinenergy, originateorterminateintheinternalorgansof thechestandabdomen,buttheydonotprojectto theheador ear. Byconnectingtotheircorrespondingfumeridianwhentheycametogetheratthe handorfoot, thezangchannelswereabletointeractwithacupuncturepointsontheear. The microcosmoftheearwassaidtohaveenergeticcorrespondencewiththemacrocosmof thewhole body,andthemicrocosmofthewholebodywassaidtohavecosmiccorrespondencewiththe macrocosmoftheuniverse. TheChineseperceivedhealthdisordersasafunctionofthe relationshipsof theseenergeticsystems, ratherthanacausal effect ofspecificgermsproducing specificdiseases. VariouseartreatmentsforcuringdiseasesweretracedbyHuang(1974)tothe281CEChinesetext, Prescriptionsforemergencies. Anotherancienttext,Thousandgoldremedieswrittenin581CE, stated thatjaundiceandavarietyofepidemicswerereportedlycuredbyapplyingacupunctureand moxibustiontotheupperridgeinthecenteroftheear. Thestudyofeightspecialmeridians,published in1572,containedreportsthatanetworkconnectingall theyangmeridiansalsopassedthroughthe headtoreachtheear. Theearwasthussaidtobetheconvergingplaceofthemainmeridians.Itwas recordedinMysticalgate: pulsemeasurementthatair(qi)fromthekidneyisconnectedwiththeear. In 1602,Criteriaindiagnosisandtreatmentsuggestedthatwhenairinthelungsisinsufficient,theear turnsdeaf. Thisworkstatedthat: Lungcontrolsair(qi), whichspreadsall overthebodytoconvergeintheear. Theearisconnectedto everypartofthebodybecauseoftheceaseless circulationofair(qi)andbloodthroughthese meridiansandvessels. Theouterandinnerbranchvesselsservethefunctionofconnectingwiththe outerlimbstoformtheharmoniousrelationshipbetweentheear, thefourlimbs,andahundred bones.Theearjoinswiththebodytoformtheunified,inseparablewhole,atheorywhichformsthe basisfordiagnosisandtreatment. Also printedin1602,Thecompendiumofacupunctureandmoxibustionrecordedthatcataracts couldbecuredbyapplyingmoxibustiontotheearapexpoint.Thisbookalsodescribedusingone’s twohandstopull downtheearlobestocureheadaches.As lateas1888,duringtheQingdynasty, thephysicianZhangZhendescribedinLi ZhenAnmoYaoShuhowtheposteriorauriclecouldbe dividedintofiveregions, eachregionrelatedtooneofthefivezangorgans.Thecentral posterior auriclewassaidtocorrespondtothelung, thelateral areatotheliver, themiddleareatothe spleen,theupperareatotheheart,andthelower areatothekidney. Massagingtheearlobewas usedtotreatthecommoncold, needlingthehelixcouldexpel windandrelievebackaches,while stimulationoftheantihelixandantitraguswasusedtotreatheadachesduetowind-heatand pathogenicfire. Duringthemedieval periodinEurope,Westernphysicianscutopenmajorveinsonseriouslysick patientsinordertorelease’evil spirits’thatweresaidtocausedisease. Chinesedoctorsconducted amuchlessbrutalformof bloodlettingbyprickingtheskinatacupointstoreleasejustafew dropletsof blood. Oneof theprimaryloci usedforbloodlettingwastoprickthetopof theexternal ear. Throughouttheirmedicine,Chinesedoctorssoughttobalancetheflowof qi andblood. By drainingsurplusesof spirit, orbysupplementingdepletionsof subtleenergies, Orientalmedicine providedhealthcaretotheChinesemasses throughouttheseveral thousandyearsoftheHan,Sui, Tang,Song, Mongol,Ming,andManchudynasties. However,widespreaduseof acupuncturein Chinadiminishedinthe1800s,whenChinabecamedominatedbyimperialistpowersfrom Europe.In1822,theministerofhealthfor theChineseEmperorcommandedall hospitalstostop practicingacupuncture,butitsusenonethelesscontinued.Whiletheapplicationof Western medical proceduresbecameincreasinglyprominentinthelargecitiesof China,healthcare practicesinruralChinachangedmuchmoreslowly. TherewasasubsequenterosionoffaithintraditionalOrientalmedicinefollowingthedefeatof ChinesemilitaryintheOpiumWarsofthe1840s.BritishmerchantswantedtopurchaseChinese teaandsilk,buttheywereconcernedaboutthehugetradeimbalancecreatedwhentheChinese didnotwant tobuyEuropeanproductsinreturn.Theirsolutionwasopium.Althoughtheemperor forbadeitsimportation,smugglerswerehiredtosneakopiumintoChina.WhenChineseofficials burnedawarehouseoftheBritishEastIndiaCompanystockedwithsmuggledopium,theBritish parliamentclaimedan’attackonBritishterritory’asjustificationfor thedeclarationofwar. The ChineseshouldprobablyhaveimportedEuropeanweapons, for theyweresoundlydefeatedinthe Overviewandhistory 5 6 opiumwarswithGreatBritain.Theywereforced topaysubstantialsumsofcurrencyforthelost Britishopiumandtosurrendertheterritoryof HongKong. Opiumhousesthenproliferatedand theChineselostasenseofconfidenceinuniquelyOrientalmedical discoveries. Becausethe Occidentaltradershadmorepowerful weaponsthantheChinese,itcametobebelievedthat Westerndoctorshadmorepowerful medicine.TheChinesewereimpressedbyWesternscience andbyEuropeanbiological discoveries. Antisepticpracticesthathadbeenintroducedfrom Europegreatlyreducedpost-surgical infections.ThegermtheoryofWesternmedicinecameto havegreaterrelevancefor healththantheenergetictheoryofqi.JesuitmissionariesinChina utilizedthedisseminationofWesternmedicationsasamanifestationof thesuperiorityof their Christianfaith. TheChinesegovernmentattemptedtosuppresstheteachingof Orientalmedicinc asunscientific, issuingprohibitoryedictsin1914andagainin1929,yet thepracticeofacupuncture continued. Bythe1940s,however, EuropebecameembroiledinWorldWarII,andMarxismbecameamore influentialWesternimporttoChinathanChristianity.After theCommunistrevolutionin1949, MaoTseTungcalledfor arevitalizationof ancientChinesemethodsfor healthandhealing. Acupuncturehaddeclinedinthelargecitiesof China,andthemainhospitalswereprimarilybased onconventionalWesternmedicine.However, doctorsintheruralcountrysidesof Chinahad maintainedtheancientwaysof healing. ItwasfromtheseruralroutesthatMaoderivedhis militarypower, anditultimatelyledtoarenewedinterestinclassical Orientalpracticesof acupuncture,moxibustion,andherbs. However, inadditiontoitscondemnationof bourgeois Westernmedicine,Communistatheistsalsorejectedthemetaphysical,energeticprinciples ofacupuncture.MaoistdogmaencouragedthedevelopmentofthemorescientificDialecticof NatureandwhatisnowknownasTraditionalChineseMedicine(TCM).Nonetheless, theactual practiceof acupuncturestill usedtheenergeticconceptsofyinandyang, thefiveelementsof fire, earth,wood, water, andmetal, andtheeightprinciplesfor differentiatingmedical syndromes. Itwasfortuitousthatthediscoveriesof theearreflexchartsbyPaul NogierarrivedinChinain 1958,atthistimeof renewedinterestinclassical acupuncturetechniques.Theso-calledbarefoot doctors,highschool graduatesgiven6monthsofmedical training,werealsotaughtthetechniques of earacupuncture,andwereabletobringhealthcaretothelargepopulationsinurbanandrural China. Withlittleplasticmodelsoftheinvertedfetusmappedontotheear, itwaseasy tolearnto needlejust thepartof theearthatcorrespondtowherethepatientreportedpain.Althoughear acupuncturewasusedacrossChinapriortolearningofNogier’streatiseonthesubject, itwasnot practicedinthesamemanner.In1956,for example, hospitalsinShandongProvincereportedthat theyhadtreatedacutetonsillitisbystimulatingthreepointsontheearhelixchosenaccordingto folkexperience. GongSunChen(1995)hasconfirmedthatitwasonlyaftertheChineselearnedof Nogier’sinvertedfetuspictureof auricularpointsthatgreatchangesinthepracticeof ear acupunctureoccurred.TheNanjingdivisionof themedical unitof Chinesemilitaryenlisted acupuncturistsfromall over thecountrytoexamineandtotreatthousandsof patientswiththis somatotopicauricularacupunctureprotocol.Theirreportonthesuccess of earacupuncturefor several thousanddifferenttypesof patientsprovidedscientificreplicationof Nogier’sworkandled tobroadinclusionofthisapproachintraditionalChinesemedicine. Anotherhistorianof Chinesemedicine, Huang(1974),alsostatedthat1958saw’amassive movementtostudyandapplyearacupunctureacrossthenation.Asaresult,general conclusions weredrawnfromseveral hundredclinical cases, andthescopeof earacupuncturewasgreatly enlarged.’Shecontinues:’however,certainindividualsbegantopromotetherevisionistlinein medicineandhealth.Theyspreaderroneousideas, suchasChinesemedicineisunscientificand insertionof theneedlecanonlykill painbutnotcuredisease. SincetheCulturalRevolution dispelledtheseerroneousideas, earacupuncturehasbeenagainbroadlyappliedall over the country.’Huangobservedthat: Themethodofear acupunctureisbasedonthefundamentalprincipleoftheunityofopposites. The humanbeingisregardedasaunified, continuallymovingentity.Diseaseistheresultofstruggle betweencontradictions.ByapplyingChairmanMao’sbrilliantphilosophicalideas. wecan combine therevolutionaryspiritofdaringtothinkanddaringtodowiththescientificmethodof’ experimentationintheexplorationandapplicationofear acupuncture. AuriculotherapyManual Tomodernreaders,itmightseemunusualthatCommunistpolitical rhetoricisintegratedwithina medical text, butitmustberememberedthattheColdWar inthe1970sgreatlyisolatedChina fromWesterninfluences. Huangalso includedmoremetaphysical influencesinChinesethought, citingthetextMysticalgate: treatiseonmeridiansandvessels: ’theearisconnectedtoeverypartof thebodybecauseof theceaseless circulationofenergyandbloodthroughthesemeridiansand vessels. Theearjoinswiththebodytoformtheunified,inseparablewhole.’ Medical researchinChinaintheyearssincetheintroductionof Nogier’ssomatotopic auriculotherapydiscoverieshasfocusedontherelationshipofearacupuncturetoclassical meridianchannels,theuseofearseedsaswell asneedlesfor thetreatmentofdifferentdiseases, andtheuseof auriculardiagnosisasaguidefor recommendingChineseherbal remedies. Medical conditionsweregroupedintothreecategories: 1. thosewhichcanbecuredbyauricularacupuncturealone 2. thosewhosesymptomscanbeatleast partiallyalleviatedbyauriculotherapy 3. thosewhereimprovementisseenonlyinindividualcases. AuricularpointsinChinaareselectedaccordingtoseveral factors: thecorrespondingbodyregions wherethereispainor pathology;theidentificationofpathologicallyreactiveearpointstenderto touch;thebasicprinciplesof traditionalChinesemedicine;physiological understandingderived frommodernWesternmedicine;andtheresultsofexperimentsandclinical observations. Havingusedearacupuncturefor postoperativesymptoms,Wen&Cheung(1973)observedthat opiateaddictedpatientsnolongerfelt acravingfor theirpreviouslypreferreddrug.TheShenMen andLungearpointsusedfor acupunctureanalgesiaalsoaffecteddrugdetoxification.Wen subsequentlystudiedalargersampleof opiumandheroinaddictswhoweregiven auricular electroacupuncture.Bilateral,electrical stimulationbetweentheLungpointsintheconchaledto completecessationof drugusein39of 40addicts. GiventhatitwasWesternmerchantswho supportedwidespreadopiumabuseinChina,itisintriguingthataChineseauriculotherapy treatmentfor drugaddictionisnowoneof themostwidelydisseminatedapplicationsof acupunctureintheWest. TherearedistinctdiscrepanciesbetweenOrientalandWesternearcharts.Distortionsmayhave appearedinthetransmissionof earmapsfromFrancetoGermanytoJapantoChina.Inaccuracies couldhavebeenduetomistranslationbetweenEuropeanandAsianlanguages. Moreover, drawingsoftheconvolutedstructureof theauriclehavebeenthesourceofmanydiscrepancies regardingtheanatomicalareasof theearbeingdescribed. TheChinese,however, maintainthat theearacupuncturepointsusedintheirtreatmentplanshavebeenverifiedacrossthousandsof patients.Chineseconferencescompletelydevotedtoresearchinvestigationsof earacupuncture wereheldin1992,1995and1998,andtheChinesegovernmentauthorizedacommitteeto standardizethenameandlocationof auricularpoints.Thiscommitteedesignatedthelocalization of 91auricularpoints,standardizedalongguidelinesestablishedbytheWorldHealth Organizationin1990(Zhou1995,1999). 1.5 Auriculotherapy and auricular medicine intheWest AlthoughacupuncturewasmostlyunknownintheUnitedStatesuntilPresidentNixonvisited Chinain1972,acupuncturehadbeenintroducedtoEuropeseveral hundredyearsearlier.A 16th› centuryphysicianworkingfor theDutchEastIndiaCompany,DrWillemTeRhyne,wasoneof the first Westernpractitionerstodescribetheimpressivecurativepowersofacupuncture.Medical interestinacupuncturewaxedandwanedinEuropeover thefollowingcenturies.Itwouldelicit greatexcitement,thenbedismissedandgiven upasunreliablefolk medicine,yet subsequentlybe rediscoveredasanewmethodof healing. Inthe19thcentury,theFrenchAcaderniedesSciences appointedacommissiontostudyacupuncture.GustafLandgarenofSwedenconducted acupunctureexperimentsonanimalsandonhumanvolunteersat theUniversityofUppsalain 1829.Sporadicreportsoftheuseof acupunctureneedleswereincludedinEuropeanmedical writingsfor thenext several centuries. Itwasintheearly1900sthatinterestinacupuncturewas onceagainrevivedinEurope.From1907 to1927,GeorgesSouliedeMorantservedastheFrenchconsul toChina.StationedinNanjingand Shanghai,hebecamevery impressedbytheeffectiveness ofacupunctureintreatingacholera Overviewandhistory 7 Figure 1.2 Participantsatthe1990WorldHealthOrganizationmeetingonauricularacupuncturenomenclature, Lyons, France (A). The enlargementbelow(8) showsDrPaul Nogieratthefar lejtofthefrontrow,hissonDrRaphael Nogiersecondfromtheright.DrFrank Bahratthefarrightojthesecondrow,andDrTerry Olesonfourth[romtheleftofthesecondrow. B 8 AuriculotherapyManual epidemicandmanyotherdiseases. SouliedeMoranttranslatedtheNeiJingintoFrenchand publishedL’Acupuncturechinoise.HetaughtChinesemedical procedurestophysicians throughoutFrance, Germany,andItalyandisconsideredthe’FatherofAcupunctureinEurope’. Ofintriguinghistorical note,theFrenchJournal desconnaissancesmedico-chirurgicalesreported back in18S0that13differentcases ofsciaticpainhadbeentreatedbycauterizationwithahotiron appliedtotheear. Onlyoneof thepatientsfailedtodramaticallyimprove.Itwasnotuntil a centurylater,however, thattheLyonsphysicianPaul Nogierrediscoveredthisremarkableear treatment. In19S0,Nogier(1972)was’intriguedbyastrangescarwhichcertainpatientshadintheexternal ear.’ Hefoundthatthescarwasduetoatreatmentfor sciaticainvolvingcauterizationofthe antihelixbyMmeBarrin,alaypractitionerlivinginMarseille, France. Thepatientswere unanimousinstatingthattheyhadbeensuccessfully relievedofsciaticpainwithinhours,even minutes,ofthisearcauterization.MmeBarrinhadlearnedof thisauricularprocedurefromher father,who hadlearneditfromaChinesemandarin.Nogierstated: ’I thenproceededtocarryout somecauterizationsmyself, whichprovedeffective, thentriedsomeother,lessbarbarous processes.’ A simpledryjabwithaneedle’alsoledtothereliefofsciaticaifgiventothesame antihelixarea, anareaof theearwhichwaspainfultopressure.’ Nogierwasexperiencedintheuse of acupunctureneedles, ashehadpreviouslystudiedtheworksof SouliedeMorant.Another mentorfor NogierwastheSwisshomeopathicphysician,PierreSchmidt,whogavemassages, spinal manipulations,andacupunctureaspartof hisnaturopathicpractice.Somecriticshave contendedthatNogierdevelopedhisearmapsbasedontranslationofChinesewritings,butas statedpreviously, theChinesethemselvesacknowledgethatitwasonlyaftertheylearnedof Nogier’sfindingsdidtheydeveloptheirownmodernearcharts. A quotationattributedtothephysiologistClaudeBernardfurtherinspiredNogier: Ithasoftenbeensaid,thatinordertodiscoverthings, onemustbeignorant. Itishettertoknow nothingthantohavecertainfixedideasinone’smind,whicharebasedontheorieswhichone constantlytriestoconfirm.Adiscoveryisusuallyanunexpectedconnection,whichisnotincludedin sometheory.Adiscoveryisrarelylogicalandoftengoesagainsttheconceptionstheninfashion. Nogierdiscussedhisantihelixcauterizationexperienceswithanotherphysician,ReneAmathieu, whotoldhim’theproblemofsciaticaisaproblemofthesacrolumbarhinge’.Nogierconjectured thattheupperantihelixareausedtotreatsciaticacouldcorrespondtothelumbosacraljoint,and A Lower limb B Upper limb Abdominal organs Neck Thoracic organs -+--\-"’c:->"’t1! Head areas ~ ~ Figure 1.3 Initialear chartsdevelopedbyNogiershowsomatotopiccorrespondencestoparticularauricular regions (A) andtheinvertedfetuspatternrelatedtotheexternal ear (B). (ReproducedfromNogier1972. with permission.) Overviewandhistory 9 Body Spinal cord Visceral organs Brain 10 Figure 1.4 Nogierdiagramofinvertedmusculoskeletalbody,internalorgansandthe nervoussystemrepresentedontheauricle. (ReproducedfromNogier1972, with permission.) thewholeantihelixcouldrepresenttheremainingspinalvertebrae, butupsidedown. Thehead wouldhaveitscorrespondencelower ontheauricle. Theearcouldthusroughlyresemblean upsidedownembryoinutero.Nogiersubsequentlyobtainedpainreliefforotherproblems.Using electrical microcurrentsimperceptibletothepatient,Nogierconcludedthatthepainreliefwasnot duetoanervousreactiontothepainfromneedleinsertion,butwasinfact causedbythe stimulationofthatareaof theear. ’Todiscover something,’Nogierobserved, ’istoaccomplishonestageof thejourney.Topushonto thebottomofthisdiscoveryistoaccomplishanother.’In1955,Nogiermentionedhisdiscoveries toDrJacquesNiboyet, theundisputedmasterof acupunctureinFrance. Niboyetwasstruckbythis novel earreflexzone, whichhadnotbeendescribedbytheChinese. NiboyetencouragedNogierto presenthisfindingstotheCongressoftheMediterraneanSocietyofAcupunctureinFebruary 1956.Oneof theattendeesof thismeeting,DrGerardBachmannof Munich,publishedNogier’s findingsinanacupuncturejournalin1957,whichhadworldwidecirculation,includingtheFar East. FromthesetranslationsintoGerman,Nogier’searreflexsystemwassoonknownby acupuncturistsinJapan,andwassubsequentlypublishedinChina,whereitbecameincorporated intotheirearacupuncturecharts. Nogieracknowledgedinhisownwritingsthattheoriginsof auriculotherapymighthavebeguninChinaorinPersia.Theprimarychangethathebroughtto auricularacupuncturein1957wasthattheseearacupointswerenotjustascatteredarrayof differentpointsfor differentconditions,butthattherewasasomatotopicinvertedfetuspatternof auricularpointsthatcorrespondedtothepatternof theactual physical body. Nogier (1972)limitedhisclassic Treatiseofauriculotherapytothespinal columnandthelimbs becausethemusculoskeletal bodyisprojectedontotheexternal earinaclearandsimplemanner. Thetherapeuticapplicationsarefreefromambiguityandoughttoallowthebeginnertoachieve convincingresults. Itispossibletopalpatefortenderareasoftheearandreadilynoticehowthey correspondtopainfulareasofthebody. Thefirststagesoflearningthemapoftheearconsistof gettingtoknowthemorphologyoftheexternalear, itsreflexcartography, andhowtotreatsimple painsoftraumaticorigin. Eachdoctorneedstobeconvincedoftheefficacyofthisearreflexmethod bypersonalresultsthatheorsheisright. Theyareindeedfortunatepeoplewhocanconvince themselvessimplybynotingtheimprovementofasymptomtheythemselveshaveexperienced. AuriculotherapyManual After hetracedtheimageof thespineandthelimbs, Nogierexaminedthoracicorgans, abdominal organs,andcentral nervoussystemprojectionsontotheear. Heneededafewyears, however, to understandthattheearhadatripleinnervation,andthateachinnervationsupportedtheimageof anembryological derivative: endoderm,mesoderm,andectoderm. Theseembryological correspondencestotheearweredescribedbyNogier(1968) inanothertext, Thehandbooktoauriculotherapy,withillustratedanatomicaldrawingsbyhisfriendandcolleague, Dr ReneBourdiol.By1975,Nogierhadcreatedateachingstructurefor traininginauricular medicine, establishingtheorganizationGroupLyonaiseEtudesMedicales(GLEM), translatedinto EnglishastheMedical StudiesGroupofLyons. ThejournalAuriculo-medicinewasalsolaunched in1975,providingaprofessional vehiclefor disseminatingclinical studiesonauricularmedicine. Thatsameycar, Nogier, BourdiolandtheGermanphysicianFrankBahrcombinedtheireffortsto publishaninformativewall chartonearlocalizations,Loci auriculo-medicinae.DrBahrwentonto organizetheGermanAcademyofAuricularMedicine(Bahr1977),whichhasattractedover 10000 Germanphysicianstothepracticeof auricularmedicine. In1981,however, Bourdioldisassociated himselffromNogier, partlybecausehewasnotcomfortablewithsomeof Nogier’smoreesoteric, energeticexplanationsof healing. Consequently,Bourdiol(1982)wrotehisownbook,Elementsof auriculotherapy. Thisworkremainsoneof themostanatomicallyprecisetextsof therelationshipof theauricletothenervoussystemandincludesdetailedpicturesof theexternal earandits representationof themusculoskeletal systemandvisceral organs.Theinnovativecollaborations betweenNogierandBourdiol hadlastedfrom1965until 1981,buttheircollegial association unfortunatelywasatanend. Nogierturnedhiseffortsinadifferentdirectionwiththe1981publicationof Del’auriculotherapieal’auricolomedecine,translatedintoEnglishasFromauriculotherapyto auriculomedicinein1983.Inthiswork, Nogierpresentedhistheoryof threesomatotopicphaseson theearandhediscussedhisconceptsofelectric, magnetic,andreticularenergies. Themost prominentfeatureof thisauriculomedicinetext, though,featuredexpandeddescriptionof Nogier’s1966discoveryofanewpulse, therefiexeauriculocardiaque(RAC). Thispulsereaction waslaterlabeledthevascular autonomicsignal (VAS), asitwasrelatedtoamoregeneral reactivity of thevascular system. Inhonorof itsdiscoverer, thispulsereactionhasalsobeencalledtherefiexe arteriel deNogierbyBourdiolandtheNogierreflexbyBahr. Forthepurposesof thistext, theNogier vascular autonomicsignal will beabbreviatedasN-VAS, soasnottoconfuseitwithawell known painassessment measure, thevisual analoguescaleor VAS. TheN-VASarterialwaveformchange becomesdistinctinthepulseafewbeatsafterstimulationof theskinovertheear. Similar autonomicreactionstotouchingsensitiveearpointshavealsobeenreportedfor changesinthe electrodermalgalvanicskinresponseandinpupillaryconstriction.MonitoringthisN-VASradial pulsereactionbecamethefundamentalbasisof auriculomedicine.Nogiersuggestedthateach peripheralstimulation’perceivedatthepulseisatfirstreceivedbythebrain,thentransmittedby thearterial tree.’ Itseemedthattheearproducedasympatheticnervoussystemreflex, initiatinga systoliccardiacwavethatreflectedoff thearterialwall, followedbyareturning,retrogradewave. Thisreflex establishedastationaryvascularwave, whichcouldbeperceivedattheradial artery. Palpationof theN-VASwasusedtodeterminechangesinpulseamplitudeor pulsewaveformthat werenotrelatedtofluctuationsinpulserate.TheN-VAShasbeenattributedtoageneral vascular-cutaneousreflex thatcanbeactivatedbytactile, electrical, or laserstimulationof many bodyareas. ConsiderableconfusionwasgeneratedwhensubsequentbooksontheNogierphasesonthecar seemedtocontradictearlierwritings.Pointsreflexesauriculaires(Nogieret al. 1987)mappedsome anatomicalstructuresontodifferentregionsof theexternal earthanthosedescribedinprevious publicationsbyNogier.Themost detailedpresentationof thethreephaseswasdescribedby Nogieret al. (1989) inComplementsdespointsreflexesauriculaires. Thistext continuedtoshowthat inthesecondphase, themusculoskeletal systemshiftedfromtheantihelixtothecentralconcha, whereasinthethirdphase, musculoskeletal pointswerelocatedonthetragus,antitragus,andear lobe. However, Nogierreversedsomeof thedescriptionfromhispreviouswritings. Incontrastto thepresentationof thephasesinthe1981bookDel’auriculotherapieal’auriculomedecine,in1989 heswitchedthelateral orientationof thesecondphasespineandthevertical orientationof the thirdphasespine. AlthoughNogierhaddevelopedthethree-phasemodel asameansof reconcilingthedifferencesbetweenhisfindingsandthatof theChinese,itwasadrasticdeparture Overviewandhistory 11 fromtheoriginal,invertedfetuspicturefor theear. Thesuggestionof differentsomatotopic patternsonthesameauricularregionsbotheredmanyof Nogier’sfollowers. WidespreaddissensionwithintheEuropeanauriculomedicinemovementoccurredbythe1990s (Nogier1999).First, thethreephasetheorywasnotwell acceptedbymanyauriculomedicine practitionersinFranceandGermany.Second, Nogierdiscussedtheimportanceof ’reticular energy,’ withoutspecificallydefiningwhat itwas. Heexploredthechakraenergycentersof ayurvedicmedicine,whichseemedtosometobeunscientific.TheenergetictheoryofPaul Nogier hadalsobeenadoptedbyanon-medical school thatusedNogier’snametodevelopmoreesoteric philosophiesof auricularreflexotherapy,consequentlythreateningtheprofessional credibilityof auricularmedicine. ManyacupuncturistsinEngland,Italy, andRussiafollowed theChinesecharts describingthelocalizationof earreflexpoints,ratherthantheearchartsdevelopedbyNogier. A verypersonal accountof thedevelopmentandprogressof auriculomedicineinEuropewas presentedinthebookThemanintheear, writtenbyPaul NogierwithhissonRaphael Nogier (1985).Also aphysician, Raphael NogierhasbecomeoneofEurope’smostprominentfiguresin thecontinuedtrainingof doctorsinthepracticeof auricularmedicine. PublicationsattheUCLAPainManagementCentersoughttointegratetheChineseearcharts withNogier’ssystemsformappingthesomatotopicimageontheear(Oleson&Kroening1983a, 1983b).TheWorldHealthOrganizationheldits1990meetingonauricularacupuncture nomenclatureinLyons, France, partlytohonorNogier’spioneeringdiscoveries. After several previousWHOsessionsthathadbeenheldinAsia, thisEuropeangatheringsoughttobring togetherdifferentfactionsoftheacupuncturecommunity.At a1994internationalcongresson auricularmedicineinLyons, Nogierwasdescribedasthe’FatherofAuriculotherapy.’Paul Nogier diedin1996,leavinganamazingscientificinheritance.Hehadcontributedtheuniquediscoveryof somatotopiccorrespondencestotheexternal ear, developedanewformof pulsediagnosis,and expandedmedical appreciationofthecomplex, subtleenergiesof thebody. 12 Figure 1.5 Author’sdepictionofalternativeperspectivesofinvertedfetusimage(A) and invertedsomatotopicpattern(B) ontheauricle. AurkulotherepyManual 1.6 Comparison of ear acupuncture tobody acupuncture Historicaldifferences: Bothearacupunctureandbodyacupuncturehadtheirhistorical originsin ancientChina.However, bodyacupuncturehasremainedessentiallyunchangedinitsperspective of specificmeridianchannels,whereasChineseearacupuncturewasgreatlymodifiedbythe invertedfetusdiscoveriesof Paul NogierinEurope.Furtherresearchhasyieldedeven newer developmentsinauricularmedicine. Acupuncturemeridians: Bodyacupunctureisbaseduponasystemof 12meridians,sixyangorfu meridiansandsixyinorzangmeridians,whichrunalongthesurfaceof thebodyaslinesof energy forces. Earacupunctureissaidtodirectlyconnecttotheyangmeridians,butitisnotdependent upontheseyangmeridianstofunction.Theearisaself-containedmicrosystemthatcanaffect the wholebody. IntraditionalChinesemedicine,theheadismoreassociatedwithyangenergythan arelower partsofthebody. TheLargeIntestines,Small Intestines,andSanJiaomeridiansrun fromthearmtothehead,andtheStomach,Bladder,andGall Bladdermeridiansrunfromthe headdownthebody.Yin meridians,however, donotconnectdirectlytothehead,thustheyhave nophysical meanstolinktotheear. Pathologicalcorrespondence: Themainprincipleinauriculotherapyisacorrespondence betweenthecartographyof theexternal earandpathologicalconditionsinhomologouspartsof thebody.Acupuncturepointsontheauricleonlyappearwhenthereissomephysical orfunctional disorderinthepartofthebodyrepresentedbythatregionoftheear.Thereisnoevidenceof an auricularpointifthecorrespondingpartofthebodyishealthy.Acupuncturepointsonthebody canalmostalwaysbedetected,whetherthereisanimbalanceintherelatedmeridianchannel or not.Whilebodyacupuncturecanbeveryeffective inrelievingavarietyofhealthproblems,the organnamesof differentmeridianchannelsmaynotbenecessarilyrelatedtoanyknownpathology inthatorgan. Somatotopicinversion: Inbodyacupuncture,themeridianchannelsrunthroughoutthebody, withnoapparentanatomical logicregardingtherelationshipof thatchannel tothebodyorgan representedbythatmeridian.AcupointsontheLargeIntestinesmeridiansandtheKidney meridiansoccurinlocationsfar removedfromthosespecificorgans. Inearacupuncture,however, thereisanorderly,anatomical arrangementof points,basedupontheinvertedfetusperspectiveof thebody.Theheadareasarerepresentedtowardthebottomoftheear, thefeet towardthetop, andthebodyinbetween. Aswiththesomatotopicmapinthebrain,theauricularhomunculus devotesaproportionallylargerareatotheheadandhandthantotheotherpartsof thebody.The sizeof asomatotopicareaisrelatedtoitsfunctional importance,ratherthanitsactual physical size. Distinctacupuncturepoints: Theacupuncturepointsareanatomicallydefinedareasontheskin. TheoriginalChinesepictographsforacupointsindicatedthattherewereholesintheskinthough whichqi energycouldflow.Theyareset atafixed, specific locusinbodyacupuncture,andcan almostalwaysbedetectedelectrically. Inearacupuncture,however, anacupuncturepointcanbe detectedonlywhenthereissomepathologyinthecorrespondingpartof thebody,whichthatear acupointrepresents.Adull, deep, achingfeelingcalled’deqi’ oftenaccompaniesthestimulation ofbodyacupuncturepoints,butthissensationisnotusuallyobservedbystimulatingear acupuncturepoints.Asharp,piercingfeelingmoreoftenaccompaniesauricularstimulation.The exact locationoftheearpointmayshiftfromdaytoday, asitreflectsdifferentstagesofthe progressionorhealingofadisorder.Aprominentdifferencebetweenthesystemsisthatbody acupuncturepointslieinthetendonandmuscularregiondeepbelowtheskinsurface, whereasear acupointsresideintheshallowdepthof theskinitself. Increasedtenderness: Paul Nogierobservedthattherearesomecases of patientswithan exceptional sensitivityinwhichmerepalpationofcertainpartsof theearprovokedapronounced painsensationinthecorrespondingbodyregion. Thisobservationcanberepeatedseveral times withoutthephenomenondiminishing,allowingthedistinctidentificationof theconnectionwhich existsbetweensuchearpointsandtheperiphery.Thetendernessatanearacupointincreasesas thedegreeofpathologyof thecorrespondingorganworsens, andthetendernessontheear decreasesasthehealthconditionimproves.Thereisnotalwaysasmall, distinctacupoint,but sometimesabroadareaof theearwherethereistenderness. Overviewandhistory 13 14 Decreased skinresistance: Inbothbodyandearacupuncture,theacupuncturepointsare localizedregionsofloweredskinresistance, small areasoftheskinwherethereisadecreasein oppositiontotheflowof electricity. Sometimeselectrodermalactivityisinverselystatedashigher skinconductance,indicatingthatthereiseasy passageof electriccurrent.Thetechnologyof recordingthiselectrical activityfromtheskinhasbeenusedinthefieldsof psychologyand biofeedback,andwasoriginallydescribedasthegalvanicskinresponse(GSR). Electrical resistanceandelectrical conductancemeasuretheexact sameelectrodermal phenomena,butthey showitasoppositechanges, oneincreasingfrombaselineactivitywhiletheotherdecreases. When pathologyof abodyorganisrepresentedatitscorrespondingauricularpoint,theelectrodermal conductivityof thatearpointriseseven higherthannormal.Theconductanceintheflowof electricityincreasesasthepathologyinthebodyincreases. Asthebodyorganbecomeshealthier, theelectrodermalconductanceof thatearpointreturnstonormal levels. Electrodermal point detectionisoneof themostreliablemethodsfor diagnosingthelocationof anauricularpoint. Ipsilateral representation: Inbothbodyandearacupuncture,unilateral,pathological areasof the bodyaremoregreatlyrepresentedbyacupuncturepointsonthesamesideof thebodyasthebody organthanbypointsontheoppositesideof thebody. Remote control sites: Earpointsarefoundataconsiderabledistancefromtheareaof thebody wherethesymptomislocated,suchaspainproblemsintheankles, thehands,or thelower back. Even thoughbodyacupuncturealsoincludesremotedistal acupoints,manybodyacupointsare stimulateddirectlyover thesamebodyareaaswherethesymptomislocated.Auriculotherapycan remotelystimulateapartof thebodythatistoopainful totreatdirectly. Whilethebodyacupoints occurdirectlywithinameridianchannel,auricularacupointsserve asremotecontrolcenters. The earpointscanremotelyaffect theflowofenergyinmeridianchannels.Inthisway, earpointscan becomparedtothewayanelectronicremotecontrol unitisusedtooperateagaragedooror to switchchannelsonatelevisionset. Althoughverysmall inphysical sizebecauseof theirmicrochip circuitry,remotecontroldevicescanproducepronouncedchangesinmuchlargersystems. While theauricleisalsoaphysicallysmall structure,itscontrolof thegrossanatomyof thebodycanbe quiteimpressive. Diagnostic efficacy: Earacupunctureprovidesamorescientificallyverifiedmeansof identifying areasof painorpathologyinthebodythandosuchtraditionalChinesemedicineapproachesas pulsediagnosisandtonguediagnosis. Inauriculardiagnosis, onecanidentifyspecificproblemsof thebodybydetectingareasof thecarthataredarker,discoloredor flaky. Pathologicalearpoints arenotablymoretenderor havehigherskinconductancethanotherareasof theauricle. The subtlechangesinauriculardiagnosismayidentifyconditionsofwhichthepatientisonlymarginally aware. Anewpractitioner’sconfidenceinauriculotherapyisstrengthenedbytherecognitionof reactiveearpointsfor healthconditionsthatwerenotpreviouslyreportedbyapatient. Therapeutic proof: Thesecondmostconvincingproceduretoverify theexistenceof the correspondencebetweenthelocationof auricularpointsandaparticularpartof thebodyiswhen specific regionsof painareimmediatelyrelievedbystimulationof theareaof theexternal ear designatedbyestablishedwall charts.Therearesomepatientswhopresentwithvery unusual disordersinaspecific regionof theiranatomy.Theseexceptional patientshavebeenfoundto demonstratereactivepointsatpreciselythepredictedareaontheauricle. Oncetreatmentis appliedtothatearpoint,thepatient’sconditionisimmediatelyalleviated. At thesametime, many patientshavediffusetypesof pathologythatdonotprovidesuchconvincingdemonstrationsof selectivereactivity. Thelatterpatientshavemanybodyregionsinpain,contributingtobroad regionsof theauriclewhicharesensitivetopressureor areelectricallyactive. Pulse diagnosis: BothtraditionalOrientalmedicineandauricularmedicineutilizeaformof diagnosisthatinvolvespalpationattheradial pulseonthewrist. Classical acupunctureprocedures for examiningthepulserequiretheplacementof threemiddlefingersoverthewrist, assessingfor subtlequalitiesinthedepth,fullness, andsubjectivequalitiesof thepulse.Thesetactilesensations helptodetermineconditionsof heat,deficiency, stagnationor disordersassociatedwithspecific zang-fuorgans.TheN-VASinvolvesplacementof onlythethumboverthewrist. Thepractitioner discriminateschangesinthereactionof thepulsetoastimulusplacedontheear,whereasOriental doctorsmonitortheongoing,steady-statequalitiesof therestingpulse. AuriculotherapyManual Types of procedures: Bodyacupunctureandearacupunctureareoftenusedwitheach otherin thesamesession, oreachprocedurecanbeeffectively appliedseparately. Bodyacupuncture pointsandearacupuncturepointscanbothbestimulatedwiththeuseof acupressuremassage, acupunctureneedlesandelectroacupuncture.Manypatientsareafraidof theinsertionof needles intotheirskin, thustheyhaveastrongaversiontoanyformof needleacupuncture.Asan alternative,earpointscanbeactivatedbytranscutaneouselectrical stimulation,laserstimulation, orsmall metal orseed pelletstapedontotheauricle. Itisrecommendedthatbecauseauricular acupuncturecanworkmorequicklythanbodyacupuncture,theearpointsshouldbetreatedfirst. Clinical efficacy: Stimulationof earreflex pointsandbodyacupointsseemtobeequallyeffective treatments.Each requiresonly20minutesof treatment,yet each canyieldclinical benefitswhich lastfor daysandweeks. Bothbodyandearacupunctureareutilizedfor treatingabroadvarietyof clinical disorders,includingheadaches, backpain, nausea, hypertension,asthmaanddental disorders.Auriculotherapytendstorelievepainmorerapidlythanbodyacupuncture.Ear acupunctureneedlingismoreoftenthetreatmentofchoicefor detoxificationfromsubstance abusethanisbodyacupuncture.Earacupuncturehasbeenfoundtoquicklyrelievepostoperative pain, inflammationfromjointsprains,painfrombonefracturesandthediscomfortfromgall stones. Itreadilycanreduceinflammations,nausea, itchingandfever. Application to many disorders: Sinceevery organof thebodyisrepresentedupontheexternal ear, auriculotherapyisconsideredapotentialsourcefor alleviatinganydisease. Earacupunctureis certainlynotlimitedtohearingdisordersoreven toproblemsaffectingthehead.At thesametime, itcanbeveryeffectivefor treatinginnereardizzinessandfor alleviatingheadaches. Conditions treatedbybothearandbodyacupunctureincludeappendicitis,tonsillitis,uterinebleeding, dermatitis,allergicrhinitis,gastriculcers, hepatitis,hypertension,impotency,hypothyroidism, sunburn,heatstroke,frozenshoulder,tenniselbow, torticollisandlowbackpain. Healing. not just painrelief: Bothbodyacupunctureandearacupuncturedomorethanjust reducetheexperienceof pain. Whilepainreliefisthemoreimmediateeffect, bothprocedures alsofacilitatetheinternal healingprocessesof thebody.Acupunctureandauriculotherapytreat thedeeper, underlyingcondition,notjustthesymptomaticrepresentationof theproblem.They affect deeperphysiological changesbyfacilitatingthenaturalself-regulatinghomeostatic mechanismsof thebody. Stimulatingagivenacupointcaneitherdiminishoveractivebodily functionsor activatephysiological processesthatweredeficient. Ease inmastery of skills: Becauseauricularreflexpointsareorganizedinthesamepatternasthe grossanatomyof thebody, itispossibletolearnthebasicsof earacupunctureinjustafewdays. In contrast,bodyacupuncturerequiresseveral yearsof intensivedidactictrainingandclinical practice.Thepointsontheeararelabeledwiththeorganor theconditionthattheyareusedto treat.Whilethereareover200earacupoints,thefewearpointsneededfor treatmentarereadily identifiedbytheprincipleof somatotopiccorrespondenceandbytheirselectivereactivity. Ease intreatment application: Earacupunctureisoftenmoreeconomical andconvenienttouse thanbodyacupuncture,sincenodisrobingisrequiredof apatient.Theeariseasily availablefor diagnosisandtreatmentwhilesomeoneissittinginachairor lyingdownintheirstreetclothes. Insertionof needlesintotheearismoresimpletoapplythanistheuseof needlesatbody acupoints.Theskinover theauricleisverysoft andthereislittledangerof damagingacritical bloodvessel whenpuncturingtheearskinwithaneedle, aproblemthathasoccurredwith insertionof needlesintobodyacupuncturepoints. Side effects: Theprimarysideeffect of auriculotherapyisthepiercingsensationthatoccursat thetimeneedlesareinsertedintotheearsurfaceorwhenintenseelectrical stimulationisapplied toanearacupoint.For sensitivepatients,theauricleshouldbetreatedmoregently, andearpellets orearseedsmaybeusedinsteadof needles. Ifthestimulationintensityisuncomfortable,itshould bereduced.Theearitselfcansometimesbecometenderandinflamedafterthetreatment.This post-treatmenttendernessusuallysubsideswithinashorttime. Aswithbodyacupuncture,some patientsbecomeverydrowsyafteranauricularacupuncturetreatment.Theyshouldbeofferedthe opportunitytorest for awhile. Thissedationeffect hasbeenattributedtothesystemicreleaseof endorphins. Overviewandhistory 15 16 Equipment required: Well-trainedacupuncturistscandetectbodyacupuncturepointsjustby theirpalpationof thesurfaceof thebodyor bytherotationofaninsertedneedle. Amusclespasm reflexoftenseemsto’grab’theacupunctureneedleandholditinplacewhenthetipof theneedle isontheappropriatepoint.Auriculardiagnosis, however, isbestachievedwithanelectrical point finder. Furthermore,atranscutaneouselectrical stimulationdeviceusingmicrocurrentintensities canoftenachieve profoundclinical effectswithouttheunwantedpainwhichaccompaniesneedle insertion.Sincebodyacupointstypicallylieinthemuscleregiondeepbelowtheskinsurface, electrical pointfindersareoftennotneededandarenotparticularlypractical for body acupuncture.Theauricularskinsurface, however, isonlyafewmillimetersdeep, andreadily availablefor detectionandtranscutaneoustreatment.Reactiveearreflex pointscanslightlyshift in locationfromonedaytothenext, thustheuseof anelectrical pointfinderisimperativefor precise determinationof pointlocalizationthatparticularday. Electrical stimulationofearacupoints, eitherbyelectroacupuncturethroughinsertedneedlesor bytranscutaneousmetal probes, producesmoreeffectivepainreliefthandoesneedlestimulationof theear. AuriculotherapyManual Theoretical perspectives of auriculotherapy 2.1 Micro-acupuncture systems 2.2 Traditional Oriental medicine and qi energy 2.3 Ayurvedic medicine, yoga and prana energy 2.4 Holographic model of microsystems 2.5 Neurophysiology of pain and pain inhibition 2.6 Endorphin release by auricular acupuncture 2.7 Embryological perspective of auriculotherapy 2.8 Nogier phases of auricular medicine 2.8.1 Auricular territories associated with the three embryological phases 2.8.2 Functional characteristics associated with different Nogier phases 2.8.3 Relationship of Nogier phases to traditional Chinese medicine 2.9 Integrating alternative perspectives of auriculotherapy Theories concerning anyaspect of medicine aregenerally useful for providing aframework anda structure which brings systematic order to diagnostic understanding and treatment applications. With aprocedure asseemingly illogical asauriculotherapy, acomprehensive theory becomes necessary tojustify whyauricular acupuncture should even beconsidered asavalid therapy. It does not seem common sense that itispossible totreat problems inthe stomach or on the foot by stimulating points on the external ear. While itisobservably evident that theear isanorgan for hearing, it isnot at all obvious that theear could relate toanyother health conditions. Even when shown repeated clinical examples of patients who have benefitted from auricular acupuncture, most persons still remain skeptical, andauriculotherapy may seem more like magic than medicine. The theories which arepresented inthissection arevaried, but they arenot mutually exclusive. It maybe acombination of all of these theories which ultimately accounts for the clinical observations which havebeen made. There isnopresent evidence which proves that oneof these theories ismore correct than another, but there ismore empirical support for theneuroendocrine perspectives. There may develop anew theoretical model which better accounts for the currently available data, but theviewpoints described below areagood beginning tounderstanding thisfield. 2.1 Micro-acupuncture systems Thefirst theory tobeconsidered isthe concept that auricular acupuncture isoneof several microsystems throughout the human body, aself-contained system within thewhole system. In Oriental thinking, there isasystematic correspondence of each part to thewhole. Themicrocosm of each person isinterrelated tothe macrocosm of the world that surrounds them. Even inthe West, medieval European philosophers described the relationship between organs of the microcosm of man tothe planetary constellations inthemacrocosm of the heavens. Modern medicine accepts that the microorganism of each cell within the body isinterrelated tothe macroorganism of thewhole body. Just aseach cell has aprotective membrane, flowing fluids, and aregulating center, so too does thewhole body have skin, blood, and thebrain. For thewhole of the organism tobeinbalance, each smaller system within that organism must beinbalance. Micro- versus macro-acupuncture systems: Dr Ralph Alan Dale(1976, 1985, 1999) of Miami, Florida, was one of thefirst investigators tosuggest that not only the ear, but every part of thegross anatomy can function asacomplete system for diagnosis and therapy. Dalehas spent several Theoretical perspectives 17 18 decades accumulating clinical evidence from China, J apan, Europe andAmerica about these multiple microsystems. Thetermmicro-acupuncture was introduced by Daleat the 1974Third World Symposium on Acupuncture and Chinese Medicine. Micro-acupuncture istheexpression of the entire body’s vital qi energy ineach major anatomical region. Helabeled them micro-acupuncture systems to distinguish themfrom thetraditional macro-acupuncture systems that connect the acupoints distributed throughout themeridians of thebody. Every micro-acupuncture system contains adistribution of acupoints that replicate theanatomy of the whole organism. Micro-acupuncture systems have been identified byDaleon theear, foot, hand, scalp, face, nose, iris, teeth, tongue, wrist, abdomen, back and on every long bone of the body. Each region isafunctional microcosm of the traditional energetics of the whole body. Every part of the body exhibits anenergetic microcosm through micro-acupoints and micro-channels that reiterate the topology of the body. Figure 2.1depicts the microsystems that have been identified on the scalp, the ear, the hand, themetacarpal andthe foot. Dalehas identified specific principles regarding these micro-acupuncture systems that are presented below. Remote reflex response: Every microsystem manifests neurological reflexes that areconnected with partsof thebody remote from theanatomical location of that microsystem. These reflexes areboth diagnostic and therapeutic. They maybeactivated bymassage, needle acupuncture, moxibustion, heat, electrical stimulation, laser stimulation, magnets or anymethod used inmacro-acupuncture. When pressure isapplied to areactive microsystem point, apronounced facial grimace or abehavioral withdrawal reflex isevoked. Distinct verbalizations of discomfort indicate that thereactive ear point is tender totouch. Thelocations of these distant tender spots arenot due to randomchance, but arein fact related toaneurological reflex pattern that iscentrally mediated. Somatotopic reiteration: Themicrosystem reflex mapof the body repeats the anatomical arrangement of thewhole body. Theterm’soma’ refers to theword body, and’topography’ refers to the mapping of the terrain of anarea. Microsystems aresimilar to thesomatotopic responses in the brain, where apicture of ahomunculus, a’littleman,’ can beidentified bybrainmapping studies. Figure 2.2shows thesomatotopic homunculus image that isrelated to different regions of the brain. It isnot the actual bone or muscle which isrepresented on thebrain. Rather, it isthe movement activity of that areaof the body which ismonitored bythe brain. Such isalso the case with microsystem points, which indicate the pathological functioning of anorgan, not the anatomical structure of that organ. Somatotopic inversion: Insome microsystems, the reflex topology directly corresponds to the upright position of the body, whereas inother microsystem maps, the body isconfigured inan inverse order. Inthe auriculotherapy microsystem, the reflex pattern resembles the inverted fetus inthewomb. With the hands pointed downwards and thetoes stretched out, thehandand foot reflexology systems arealso inverted. Thescalp microsystem isalso represented upside down, whereas the medial microsystems of the abdomen, back, face, nose andlips areall oriented inan upright pattern. Thetongue and teeth microsystems arepresented horizontally. Ipsilateral representation: Microsystems tend tohave bilateral effects, but they areusually more reactive when themicro-acupoint and theareaof body pathology areipsilateral toeach other, on thesame side of thebody. Only thescalp microsystem, which corresponds tothe underlying somatosensory cerebral cortex, exhibits reactive acupoints on theside of thescalp that iscontralateral totheside of body pathology. For theauricular microsystem, acondition on theright side of thebody would berepresented on theright ear, whereas aproblem on theleft side of thebody would be reflected on theleft ear. Actually, each region of thebody bilaterally projects toboth the right and left ear. Auricular representation issimply stronger on the ipsilateral ear thanthecontralateral ear. Bi-directional connections: Pathology inaspecific organ or part of thebody isindicated by distinct changes inthe skin at the corresponding microsystem point, while stimulating that point can produce changes inthecorresponding part of the body. Organo-cutaneous reflexes: Inthistype of reflex, pathology inanorgan of thebody produces an alteration inthecutaneous region where that corresponding organ isrepresented. Localized skin changes may include increased tenderness on palpitation, altered blood flow, elevated temperature, changes inelectrodermal activity, changes inskin color or alterations inskin texture. These skin reactions arediagnostically useful for all the microsystems, but because of therisks involved with treatment, the tongue, irisand pulse microsystems areused almost exclusively for diagnosis. Auriculotherapy Manual Scalp microsystem Ear microsystem 3 J eg // Body Arm ’1"l"’I ’I ".---Head 3 4 1 Foot reflexology microsystem Zhangmetacarpal microsystem Arm Neck" // Head/ Handreflexology microsystem Leg-_ Abdomen---› Chest- Chest - Abdomen Leg Arm --Chest ---- Neck ------ Head 1 1 Reflexology zone divisions Figure 2.1 Microsystems that have heen identified on thescalp, ear, hand, metacarpal hone andfoot, andthefivezones ofthebody used inreflexology. (From LifeARTS", Super Anatomy, 'Lippincott Williams & Wilkins, withpermission.) Theoretical perspectives 19 A Sagittal view Body Leg Arm Reticular formation Cerebral cortex B Frontal view Cerebral cortex Reticular formation 6 Leg Body Arm Head Leg ,- I / I , I , I I I I ---.... , I <, , , ’,I , ’I , \1 I I I I _______ I I I ---.. , I \\ I ’ " "’, Leg Thalamus ,’’’- d ’,’’’___ Bo Y .... Arm Head Arm ) Figure 2.2 Somatotopic organization ofthecerebral cortex, thalamus andreticular formation ofthebrain viewed sagittally (A) andfrontally (B). (From LijeART"’, Super Anatomy, 'Lippincott Williams & Wilkins, with permission. ) 20 Auriculotherapy Manual Cutaneo-organic reflexes: Stimulating the skin at amicrosystem acupoint produces internal homeostatic changes that lead tothe relief of painand the healing of the corresponding organ. This cutaneous stimulation triggers nervous system messages to the spinal cord and brain, activating bioenergetic changes, biochemical releases, and alterations of the electrical firingin neuronal reflexes. Interactions between systems: All of themicro-acupuncture system interact with the macro-acupuncture systems. Treatment byonesystem will produce changes inthebody’s functional patterns asdiagnosed bythe other systems. Treatment of theoverall macrosystem affects the functioning of the microsystems and treatment of anyof themicrosystems affects the functioning of the macrosystem and of theother microsystems. For instance, stimulating anear point can reduce the intensity of discomfort of atender trigger point on anacupuncture channel, whereas anelectrically reactive ear point will become less conductive if the patient begins to heal following abody acupuncture treatment. Mu alarm points and shu transport points: Thefirst micro-acupuncture systems originated in ancient China, but they were not consciously developed assuch. Thefront muand theback shu channels are 12-point diagnostic and therapeutic systems (Dale1985). Each of the 12acupoints on these midline meridians resonates with oneof 12principal organs, including the lung, heart, liver, spleen, stomach, intestines, bladder andkidney (Figure 2.3). Thefront mu points and back shu points aremore or less cutaneous projections from thevisceral organs that arefound deep beneath theskin. These ancient systems maybeseen asorgan-energy correspondences, whose acupoint loci on thebody surface arereiterative of the underlying anatomy. Themu andshu points for theheart arerespectively on the anterior chest and on theposterior spine at the level of the actual heart, whereas the mu andshu points for theliver arerespectively on the anterior body and theposterior body above theactual liver. Themu points alarmthebody about internal disorders and are sensitive to painwhen thereisacute or chronic visceral distress. Whilethe shu points that run along theposterior spine can also beutilized for diagnostic discoveries, these acupoints on theback are more often used for treatment of theunderlying organ disorder. Stimulating theback shu points is said toconvey thevital qi energy tothecorresponding internal organ. Microsystems along the body: In1913, Kurakishi Hirata, aJ apanese psychologist, postulated seven micro-acupuncture zones: thehead, face, neck, abdomen, back, arms, and legs. Each of the seven zones manifested 12horizontal sub-zones of organ-energy function: trachea-bronchi, lungs, heart, liver, gall bladder, spleen-pancreas, stomach, kidneys, large intestines, small intestines, urinarybladder and genitals. TheHirataZones were utilized both for diagnosis and for treatment. Beginning in1973, aChinese researcher, Ying-Qing Zhang(1980,1992) from Shandong University, published several books and articles, proposing atheory hecalled ECI WO (Embryo Containing the Information of theWhole Organism). Zhangdelineated micro-acupuncture systems for every long bone of thebody, which hepresented at theWorld Federation of Acupuncture Societies andAssociations meeting in1990. Zhangparticularly emphasized aset of microsystem points located outside the second metacarpal bone of thehand. Like Hirata, Zhang identified 12divisions that correspond to 12body regions: head, neck, arm, lungs and heart, liver, stomach, intestines, kidney, upper abdomen, lower abdomen, leg and foot. Bioholographic systems arranged inasomatotopic pattern were described for all the primary bones of the body, including the head, spine, upper arm, lower arm, hand, upper leg, lower leg, andfoot. Each of these skeletal regions was said tocontain the 12different body regions and their underlying internal organs. Foot and hand reflexology: Twoof the oldest microsystems arethose of the foot and thehand, both known inancient Chinaand ancient India. In1917, WilliamH Fitzgerald MD, of Hartford, Connecticut, independently rediscovered the microsystem of the foot aswell asthe hand(Dale 1976). Fitzgerald called these systems Zone Therapy. Thetopology of Fitzgerald’s microsystem points was derived from the projections of fivedistinct zones that extended bilaterally upthe entirelength of thebody, each zone originating from oneof the fivedigits of each handand each foot. Several other Americans, including White, Bowers, Riley and Stopfel, developed this procedure asreflexology, bywhich nameit iswidely known today. Inhandand foot reflexology, the fingers and toes correspond to the head, whereas thebase of the handand the heel of the foot represent the lower part of the body. Thethumb and large toe initiatezone I that runsalong the midline of the body, whereas the index finger and second toe represent zone 2, the middle finger Theoretical perspectives 21 A B Front mu points Lungs Pericardium Heart ~ i v r Gall Bladder Stomach Spleen 1------- Kidney Large Intestines ------Smallintestines i--- Sanjiao ------ Bladder Back shu points Lungs Pericardium Heart Liver Gall Bladder Stomach ------- Spleen Kidney Large Intestines ---- Small Intestines San[iao Bladder 22 Figure 2.3 Mupoints (A) found ontheanterior torso that represent theinternal organs beneath themandthe corresponding shu points (B) found ontheposterior torso ofthebody. Auricu/otherapy Manual and thirdtoe are found inzone 3, the ringfinger andfourth toe are located inzone 4, and thelittle finger and littletoedemark zone 5(see Figure 2.1). Thislast zone connects all peripheral regions of the body, including theleg, arm, and ear. Themidline of theback isinzone 1, whereas the hips and shoulders occur along zone 5. On thehead, thenose isinzone 1, theeyes inzones 2and3, and the ears areinzone 5. Thefoot reflexology micro system isshown inFigure 2.4, andthehand reflexology microsystem inFigure 2.5. Koryo hand therapy: TheKorean acupuncturist TaeWoo Yoo has described adifferent set of correspondence points for the hand(Yoo 1993) (see Figure 2.6). Inthis Korean microsystem, the midline of thebody isrepresented along themiddle finger and middle metacarpal, thearms are represented on the second and fourth fingers, andthelegs are represented on thethumb and little finger. Theposterior head, neck andback arefound on the dorsum of thehandandthe anterior face, throat, chest and abdomen arerepresented on thepalmar side. Beyond correspondences to the actual body, Koryo handtherapy also presents points for stimulating each of themeridian acupuncture points that runover theactual body. Themacro-acupuncture points of each channel are represented on thecorresponding micro-acupuncture regions found on the hand. Acupuncturists insert thin short needles just beneath theskin surface of these handpoints, usually using aspecial metal device that holds thesmall needles. That this Korean somatotopic pattern on thehandisso different from the American handreflexology pattern seems paradoxical, particularly since practitioners of both systems claimvery high rates of clinical success. Since there are also differences intheChinese and European locations for auricular points, abroader view is that the somatotopic pathways may have multiple microsystem representations. Face and nose microsystems: Chinese practitioners have identified microsystems on the face and the nose that are oriented inanupright position (see Figure 2.7). Thehomunculus for theface system places the head andneck inthe forehead, thelungs between theeyebrows, theheart between theeyeballs, the liver andspleen on thebridge of the nose, andtheurogenital system in the philtrumbetween the lips andnose. Thedigestive organs are located along themedial cheeks, theupper limbs across theupper cheeks, and thelower limbs are represented on thelower jaw. In the nose system, the midline points are at approximately thesame location asintheface system, the digestive system isat thewings of the nose, andthe upper and lower extremities are inthe crease alongside the nose. Scalp microsystem: Scalp acupuncture was also known inancient Chinaand several modern systems have subsequently evolved. Scalp micro-acupuncture has been shown to beparticularly effective intreating strokes and cerebrovascular conditions. While there are two scalp microsystems indicated by Dale(1976), theprincipal system divides thetemporal section of the scalp intothree parts (see Figure 2.8). A diagonal line isextended laterally from the top of the head to the areaof the temples above theear. Thelowest portion of thistemporal line relates to the head, themiddle area relates tothebody, arms, andhands, andtheuppermost region represents thelegs andfeet. This inverted body pattern represented on thescalp activates reflexes inthe ipsilateral cerebral cortex tothecontralateral side of the body. Tongue and pulse microsystems: Tongue examination andpalpating theradial artery of thewrist are two ancient Chinese diagnostic systems. While not initially intended assuch, thetongue and pulse can also beviewed asmicrosystems. For pulse diagnosis, theacupuncture practitioner places three middle fingers on thewrist of the patient. Thethree placements arecalled the cun or distal position, the guan or middle position, andthechi or proximal position. Thedistal position (nearest the hand) relates totheheart and lungs, themiddle position relates to thedigestive organs, and the proximal position (toward the elbow) relates to the kidneys (see Figure 2.9). Thepractitioner palpates thepulse to feel for such subtle qualities assuperficial versus deep, rapidversus slow, full versus empty and strong versus weak. Inthetongue microsystem, theheart isfound at thevery tip of thetongue, the lung inthefront, the spleen at thecenter, andthekidney at theback of the tongue. Theliver islocated on the sides of the tongue. Tongue qualities include observations asto whether itscoating isthick versus thin, thecolor of thecoating iswhite or yellow, andwhether the color of the tongue body ispale, red or purple. Dental microsystem: A complete representation of all regions of thebody on the teeth has been reported by Voll (1977), who associated specific teeth with specific organs. Theteeth themselves can beidentified byoneof several nomenclature methods. Onesystem involves first dividing the teeth intofour equal quadrants: right upper jaw, left upper jaw, right lower jawand left lower jaw. Theoretical perspectives 23 A Foot outstep MidBack Upper Back Head ~ Shoulder Upper Arm Elbow and Forearm Knee Ovaries and Testes Lower Leg Foot Hipand Upper Leg Dorsum of right foot Dorsum of left foot Right Leg B Right Arm Right Shoulder Right Side of Neck Left Leg Left Arm Left Shoulder Left Side of Neck c Right plantar foot Sinuses Eyes Ears Right Lung Liver Adrenal Gland Right Kidney Gall Bladder Large Intestines Appendix Sciatic Nerve Brain D Left plantar foot Eyes Ears Left Lung Stomach Spleen Adrenal Gland Left Kidney Large Intestines Cervical Vertebrae Foot instep Sacral Vertebrae Uterus and Prostate Gland Figure 2.4 Thefoot reflexology system depicted on theoutside (A), dorsum (B), plantar surface (C) andinstep (D) ofthefoot. 24 Auriculotherapy Manual Ear Shoulder Arm Hip Hand C Right hand dorsum Head Lungs Kidney Spleen Lumbar Spine Lower Back Pituitary Gland Adrenal Gland Thoracic Spine Pancreas Large Intestines Bladder Ovary and Testis Cervical Spine Uterus and Prostate Head and Skull Small Intestines Appendix Pancreas Ovary and Testis Gall Bladder Bladder Uterus Liver A Left palm Heart Large Intestines B Rightpalm Lung Thyroid Kidney Small Intestines Figure 2.5 Thehandreflexology system depicted on thepalmar surface oftheleft hand (A), theright hand (B), andon thedorsal surface oftheright hand (C). Theoretical perspectives 25 Cervical Spine Left Hand Left Wrist - Left Elbow Left Shoulder Left Foot Left Ankle Left Hip A Dorsal hand Forehead B Palmar hand Right Hand - Right Foot Right Lung Liver ~ ~ ~ _ Gall Bladder Right Kidney Intestines Genitals Occiput Right Hand Right Wrist Right Elbow Right Foot Right Ankle Right Knee Right Shoulder Right Hip <, Thoracic Spine Lumbar Spine Sacral Spine Throat Left Hand Chest Heart Left Lung Left Foot ~ p l e e n Pancreas Stomach Left Kidney Bladder 26 Figure 2.6 TheKorean handmicro-acupuncture system depicted on thedorsal (A) and palmar (B) sides ofthe hand. Auriculotherapy Manual A Frontal view Head----- Neck --- Lungs Heart ->: Liver.------- Large Intestines »> Spleen Bladder Genitals BSide view Lungs Heart ------ Liver ------ Spleen Genitals/ Large Intestines Kidney Gall Bladder Small Intestines Shoulder .i-> - Hand Kidney ---- Hip Leg Knee Foot Gall Bladder Small Intestines - Shoulder - Arm »>- Hand - Hip --- Leg - Knee __----Foot Figure 2.7 Theface microsystems viewedfrom thefront (AJ and theside (B). Theoretical perspectives 27 A Frontal view BSide view Thoracic organs Stomach and Liver Intestines Thoracic Organs Motor area Stomach and Liver Small and LargeIntestines I ---Head Somatosensory area ---Leg 28 Figure 2.8 Thescalp micro-acupuncture points related totheunderlying cerebral cortex viewed fromthefront (A) andtheside (B). Auriculotherapy Manual A Tongue microsystem Lower Jiao Middle [lao Upper Jiao Kidney Spleen _--- Stomach ---- Liver and Gall Bladder ----Lung ----Heart B Pulse microsystem Surface pulse Deep pulse Bladder ~ e e p pulse S ~ .. rface pulse Kidney Liver ~ - - - - - - - - Small Intestines ----Heart ’--_------ Gall Bladder Pericardium ~ ~ Spleen _______ Stomach San [lao Lung-----› Large Intestines _--------:i Figure 2.9 Internal organs represented on thetongue microsystem (A) arecontrasted with theacupuncture channels represented at the radial pulse (B). Theoretical perspectives 29 Table 2.1 Dental microsystem correspondences between teeth and body regions Tooth position Right upper andlower jaw quadrants Left upper and lower jaw quadrants I. Center incisor Right kidney, bladder, genitals, lumbosacral vertebrae, right knee and ankle, sinus, ear Left kidney, bladder, genitals, lumbosacral vertebrae, left knee and ankle, sinus, ear 2. Lateral incisor Right kidney, bladder, genitals, lumbosacral Left kidney, bladder, genitals, lumbosacral vertebrae, right knee and ankle, sinus vertebrae, left knee and ankle, sinus 3. Canine Liver, gall bladder, lower thoracic vertebrae, Liver, spleen, lower thoracic vertebrae, right hip, right eye left hip, left eye Left lung, large intestines, upper thoracic vertebrae, left foot Left lung, large intestines, upper thoracic vertebrae, left foot --- ---------- Spleen, stomach, left jaw, left shoulder, left elbow, left hand Pancreas, stomach, right jaw, right shoulder, right elbow, right hand Right lung, large intestines, upper thoracic vertebrae, right foot 4. First bicuspid 6. First molar 5. Second bicuspid Right lung, large intestines, upper thoracic vertebrae, right foot ----- 7. Second molar Pancreas, stomach, right jaw, right shoulder, right elbow, right hand -------- Spleen, stomach, left jaw, left shoulder, left elbow, left hand 8. Wisdom tooth Heart, small intestines, inner ear, brainstem, limbic brain, cerebrum, right shoulder, elbow, hand Heart, small intestines, inner ear, brainstern, limbic brain, cerebrum, left shoulder, elbow, hand ._--------------------_._--- -----_._-- The individual teeth arethen numbered from 1to8, beginning with the midline, front incisors at I, then progressing laterally to thebicuspids, and continuing more posteriorly tothe molars at 7or 8. Individuals who have had their wisdom teeth removed on aside of their jawwill only have seven teeth inthat quadrant. Urogenital organs and the lower limbs arerepresented on the more central teeth, whereas thoracic organs and theupper limbs arerepresented on the more peripheral molars (see Table2.1). 2.2 Traditional Oriental medicine and qi energy While theYellowEmperor’s classic ofinternal medicine (Veith 1972)andsubsequent Chinese medical texts included avariety of acupuncture treatments applied totheexternal ear, itwasnot until thelate 1950sthat anauricular micro-acupuncture system wasfirst described. Some traditionalists contend that ear acupuncture isnot apart of classical Chinese medicine. Nonetheless, both ancient and modern acupuncture practitioners recorded theneedling of ear acupoints for therelief of many health disorders. They also emphasized theimportance of selecting ear points based on the fundamental principles of traditional Oriental medicine. The aspect of body acupuncture that is most relevant totheapplication of auriculotherapy isthe use of distal acupuncture points. Needling acupoints on thefeet or hands haslong been used for treatingconditions indistant partsof thebody. There areothers who seek tomake auriculotherapy completely divorced from classical acupuncture, suggesting that it isanentirely independent system of trigger point reflexes. Theclinical application of certain points for ear acupuncture treatments, however, does not makeanysense without an understanding of Oriental medicine. Thepopularity of the fiveear points used intheNADA treatment protocol for addictions isonly comprehensible from theperspective of this ancient Asian tradition that isvery different fromconventional Western thinking. Influential English language texts on traditional Chinese medicine include Theweb that has no weaver byTed Kaptchuk (1983), Modem techniques ofacupuncture: apractical scientific guide to electro-acupuncture byJulian Kenyon (1983), Chinese acupuncture andmoxibustion from Foreign Languages Press (1987), Thefoundations of Chinese medicine byGiovanni Maciocia (1989), Between heaven andearth byBeinfeld & Korngold (1991),Acupuncture energetics byJ oseph Helms (1995), Basics ofacupuncture byStux & Pomeranz (1998), and Understanding acupuncture byBirch & Felt (1999). All of these books describe anenergetic system for healing that isrooted ina uniquely Oriental viewpoint of thehuman body. While all energy isconceptualized asaform of qi, there aredifferent manifestations of this basic energy substance, including the energy of yin and 30 Auriculotherapy Manual yang, an energy differentiated byfivephases, and anenergy distinguished byeight principles for categorizing pathological conditions. Everyday observations of nature, such asthe effects of wind, fire, dampness and cold, areused asmetaphors for understanding how this qi energy affects the internal conditions that lead todisease. Qi: This basic energy refers to avital life force, aprimal power, andasubtle essence that sustains all existence. TheChinese pictograph for qi refers tothenutrient-filled steam that appears while cooking rice. Qi isthe distilled essence of the finest matter. Similar images for qi include the undulatingvapors that rise from boiling tea, the swirling mists of fog that crawl over lowlands, the flowing movement of agentle stream, or billowing cloud formations appearing over ahill. These metaphorical pictures were all attempts todescribe thecirculation of this invisible energy. Different manifestations of the images of qi are shown inFigure 2.10. However, qi was not just Figure 2.10 TheChinese pictograph for qi energy isrelated totherising steam ofcooking rice (A). Other metaphors for qi include misty clouds (B), rushing waterfalls (C) andflowing rivers (D). ((B) fun Ma, (C), (D)'Lita Singer, withpermission.) Theoretical perspectives 31 considered ametaphor. Acupuncturists view qi asareal phenomenon, asreal asother invisible forces, likegravity or magnetism. Qi isboth matter and the energy forces that move matter. Comparable toWestern efforts toexplain light asunderstood inquantumphysics, qi isboth likea particle and likeawave. Oi permeates everything, occurs everywhere, and isthe medium bywhich all events arelinked toeach other inaninterweaving pattern. Thereisqi inthe sun, inmountains, inrocks, inflowers, intrees, inswords, inbowls, inbirds, inhorses, and inall anatomical organs. Oi invigorates theconsciousness andwillpower of ahuman being. As things change inthe macrocosm of the heavens, the microcosm of theearth resonates with corresponding vibrations, all related tothe movement and interconnectedness of qi. Certain types of qi animatelivingorganisms, with thegreatest focus placed on defensive qi andon nutritiveqi. Defensive qi (wei qi), also called protective qi, issaid to bethe exterior defense of thehuman body and isactivated when the skin surface and muscles areinvaded byexogenous pathogens. Nutritive qi (ying qi), also called nourishing qi, has thefunction of nourishing theinternal organs and is closely related toblood. Prenatal qi istransmitted byparents to their children at conception and affects that child’s inherited constitution. Oi isobtained from the digestion of food and isextracted from the air thatwebreathe. Rebellious qi occurs when energy flows inthewrong direction or in conflicting, opposing patterns. Inbody acupuncture, health isthe harmonious movement of qi throughout thebody, whereas illness isdue todisharmony inthe flow of qi. There can be deficiency, excess, or stagnation of theflow of qi within the meridian channels or between different organs. Theear hasconnections tothese channels, but it isnot apart of anyone of the classic meridians. Meridian channels: (lingLuo) The original English translations of the zigzag lines drawn on Chinese acupuncture charts were described asmeridians, alluding tothelines of latitudewhich circle theearth on geographic maps. Inacupuncture, meridians were thought tobeinvisible lines of energy which allow circulation between specific sets of acupuncture points. Later translations described these acupuncture lines aschannels, analogous to thewater canals that connected different cities inancient China. As with channels of water, theflow of qi inacupuncture channels could beexcessive, aswhen there isaflood; deficient, aswhen there isadrought; or stagnant, as when water becomes foul from the lack of movement. Needles inserted into specific acupuncture points were thought to reduce the flow of excessive qi, asindams which regulate the flow of water, toincrease theflow of deficient qi, asinthe release of flood gates of water, or to clear areas of qi stagnation, asinremoving the debris that can sometimes block water channels. Water has often been used tosymbolize invisible energies, and isstill thought of inthe West asaconvenient way to convey theproperties of electricity and the flow of electrical impulses along neurons. Acupoints were thought tobeholes (xue) inthe liningof thebody through which qi could flow, likewater through aseries of holes inasprinkler system. Tao: Thephilosophy of Taoism guides one of theoldest religions of China. Itsbasic tenet isthat thewhole cosmos iscomposed of two opposing and complementary qualities, yin andyang. The Taoist symbol shown inFigure 2.11reveals acircle that isdivided intoawhite teardrop and ablack teardrop. A white dot within theblack side represents theyang within yin, and the black dot within Tao 3it Yin Yang 32 Figure 2.11 TheTaoist symbol for theduality ofcomplementary opposites has ayin dark side andayang light side. Each halfcontains an element oftheopposite side. Auriculotherapy Manual Figure 2.12 A depiction ofyang asthesunny sideandyin astheshadyside ofa hill. (Based onphotograph of mountains byLita Singer, withpermission) thewhite side reflects theyin within yang. TheChinese character for yang referred to the sunny side of ahill that iswarmed bybright rays of sunlight, whereas the pictograph character for yin referred to the darker, colder, shady side of ahill. Figure 2.12depicts such ascene. Light and dark, day and night, hot andcold, male andfemale, areall examples of this basic dualism of the natural world. Yin andyang are always relative rather thanabsolute qualities. Thefront of thebody issaid tobeyin and theback of the body yang, yet the upper body ismore yang compared tothe lower body. Theouter skin of thebody and the muscles aremore yang, theinternal organs aremore yin. Theoretical perspectives 33 34 Box 2.1 Taoist qualitiesof yangandyin Yang qualities Yin qualities Sunny side Shady side Day Night Sun Moon Sky Earth Fire Water Hot Cold Hard Soft Order Chaos Rigid Flexible Active Passive Strong Weak Energetic Restful Movement Stillness Aggressive Nurturing Rational I ntuitive Intellect Emotions Head Heart Masculine Feminine Father Mother Disorders related tooveractivity aremore yang, diseases of weakness aremore yin. (Thedualistic aspects of yin and yang aresummarized inBox 2.1.) Thepsychologist Carl J ung (1964) and thehistorian J oseph Campbell (1988) have noted common archetypal images inthe ancient cultures of China, India, Egypt, Persia, Europe and amongst Native Americans. Inall these societies, the sky, thesun, and fire arereferred to as’masculine’ qualities, whereas the earth, the moon, andwater areassociated with ’feminine’ qualities. Taoist philosophers described this opposition of dualities inevery aspect of nature. There isatendency in Western culture to place greater value on the ’masculine’ qualities of being strong, active, rational, and orderly, and to devalue the ’feminine’ qualities of being passive, weak, or emotional. It is understandable that most people tend to prefer being strong, but it isstill important for themto acknowledge times when they feel weak. Taoism recognized the importance of balance and emphasized thevalue of ’feminine’ qualities of nurturance and intuition aswell asthe’masculine’ traitsof strength and intelligence. Yang qi: This energy islike thewarm, bright light of thesun. It issaid to bestrong, forceful, vigorous, exciting, controls active movement, and isassociated with aggressive ’masculine’ qualities. Yang meridian channels are thought tohave direct connections to ear acupuncture points. Yang qi flows down the meridians on the back side of the body, pervading skin and muscles and affecting defensive qi. Pathological conditions inthebody can be caused bythe excess or stagnation of yang qi, producing symptoms of restlessness, hyperactivity, tremors, stress, anxiety and insomnia. Tooverwork isto overindulge inyang qi, which usually leads to burnout of yin qi. In addition to the application of acupuncture needles, moxibustion and herbal remedies, yang qi can beactivated byvigorous physical exercise, athletic sports and the practice of martial artssuch as kungfu or karate. Yin qi: This energy islike the soft, gentle light of the moon that comes out duringthedarkness of night. It issaid to beserene, quiet, restful, nurturing, andisassociated with passive, feminine qualities. Yin isneeded to balance yang. Theyin meridians indirectly connect to theauricle through their corresponding yang meridian. Yin qi flows up acupuncture meridians on the front side of body and affects internal organs andnutritiveqi. Symptoms of sleepiness, lethargy, Auriculotherapy Manual depression and adesire to beimmobile may bedue to an excessive focus on craving yin qi. Insufficient yin qi isthought tobeat the root of most illness, thus acupuncture and herbs areused to restore this energy. Theflow of yin qi can beenhanced bymeditation, byrepeating the soothing sound of amantra, byvisualization of aharmonious symbol, or bythepractice of such physical exercises asqi gong, tai chi or yoga. TheChinese goddess Kuan Yin isthe manifestation of the Buddha infemale form, usually portrayed asacaring, nurturing, ageless woman who isdressed in long flowing robes. Yang alarm reactions: A reactive ear reflex point issaid toshow ayang reaction on the ear tosignal a stress reaction inthecorresponding areaof thebody. Inmodern times, anappropriate analogy would beafirealarmsignal inabuilding, indicating thespecific hallwaywhere afireisburning. An alarmina car can indicatewhen adoor isajar. Such alarms alert onetothespecific location of aproblem. Elevation of yang energy manifests intheexternal ear asasmall areawhere there islocalized activation of thesympathetic nervous system. Such sympathetic arousal leads toalocalized increase inelectrodermal skin conductance that isdetectable byanelectrical point finder. Sympathetic activation also induces localized regions of vasoconstriction intheskin of theauricle. Therestricted blood supply causes anaccumulation of subdermal, toxic biochemicals, thus accounting for the perception of tenderness andthesurface skin reactions often seen at ear reflex points. Ashi points: Inaddition to the 12primary meridian channels that runalong the length of the body, the Chinese also described extra-meridian acupoints located outside these channels. One category of such acupoints was the ashi points. Ashi means ’Ouch!’ or ’Thereit is!’, and there isa strong reflex reaction when atender region of the skin ispalpated and apatient says ’Ouch, that hurts!’. Theexclamation point highlights thegreat emotional excitement vocalized at the time an ashi point istouched. Sometimes needling of avery tender acupoint within one of the classic meridian channels produces this same verbal outburst. While the natural inclination isto avoid touching areas of the body that hurt, ancient acupuncturists and modern massage therapists have observed that there ishealing value inactually puttingincreased pressure on these sensitive regions. Theashi points have been suggested asthe origin of the trigger points which have been described byJ anet Travell inher work on myofascial pain(Travell & Simons 1983). Inauricular acupuncture, atender spot on the external ear isone of the definitive characteristics that indicate such apoint should bestimulated, not avoided. Five Oriental elements: Also referred to asthe fivephases, this Chinese energetic system organizes the universe intofivecategories: wood, fire, earth, metal and water. Theword ’element’ issimilar to the four elements of naturedescribed inmedieval European texts, the elements of fire, earth, air, andwater. Theword ’phase’ iscomparable to the phases of the moon, observed as sequential shifts inthe pattern of sunlight that isreflected from the moon. I tisalso related tothe phases of the sun asit rises at dawn, crosses overhead from morning to afternoon, sets at dusk, and then hides duringthe darkness of night. Thephases of the seasons inChinese writings were said to rotatefrom spring tosummer tolatesummer tofall towinter. These long-ago physicians found observations of natural elements, such asthe heat from fireor the dampness of water, were useful analogies asthey attempted todescribe themysterious invisible forces which affect health and disease. Many complex metabolic actions inthe humanbody arestill not understood bymodern Western medicine, even with the latest advances inblood chemical assays and magnetic resonance imaging equipment. Themetaphorical descriptions of fiveelement theory reflects thepoetry and rhythm of theChinese language intheir attempts tounderstand each individual who isseeking relief from some ailment. At thesame time, there arecertain aspects of thefivephases that seem likeanarbitraryattempt to assign all things togroups of five. TheWestern approach of dividing the four seasons asthespring equinox, summer solstice, fall equinox, andwinter solstice seem more aligned with naturethan the Chinese notion of adding afifth season labeled latesummer. Moreover, theapplication of five element theory totheenergetic aspects of anatomical organs often contradicts modern understanding of thebiological function of those organs. I tisdifficult for Western minds toaccept howtheelement metal logically relates tothelungorgan andthefeelings of sadness, whereas the element wood issaid tobeassociated with theliver organ and theemotion of anger. At some point, one must accept that these fivephases aresimply organizing principles tofacilitate clinical intuition intheunderstanding of complex diseases. Insome respects, itmight have been better tohaveleft the names of the meridian channels asChinese words rather than totranslate them intothe European Theoretical perspectives 35 names of anatomical organs whose physiological functions were already known. Theconflicts between theOriental energetic associations of anorgan andtheknown physiological effects of that organ can lead toconfusion rather thancomprehension. I fone thinks of these zang-fu organs asforce fields rather than organic structures, their associated function maybecome more understandable. Zang-fu organs: Each of the fiveelements isrelated to two types of internal organs: thezang organs aremore yin, thefu organs aremore yang. Theacupuncture channels arethe passages by which thezang-fu organs connect with each other. Thezang meridians tend torun along the inner side of the arms and legs and upthe front of the body. Thefu meridians run along the outer side of the limbs and down theback of thebody. Thezang organs store vital substances, such asqi, blood, essence, and body fluids, whereas thefu organs areconstantly filled andthen emptied. The Chinese character for zang alluded to adepot storage facility, whereas the pictograph for fu depicted ancient Chinese grain collection centers that were called palaces. Although Confucian principles forbade official dissections of the humanbody, anatomical investigations probably still occurred inancient China, asdidexamination of animals. Physical observations of gross internal anatomy reveal that thefu organs were hollow tube-like structures that either carried food (stomach, small and large intestines) or carried fluid (urinarybladder and gall bladder). In contrast, the zang organs seemed essentially solid structures, particularly the liver, spleen and kidneys. While the heart and lungs have respective passages for blood and air, onewould not describe these two organs ashollow, but ashaving interconnecting chambers. Thespecific characteristics of each zang-fu channel arepresented inTable2.2, which indicates the internal organ for which each channel isnamed, the international abbreviation for that channel Table 2.2 Differentiation of zang-fu meridian channels Zang fu Organ channels WHO code Other codes Channel location Element Primary acupoints ------ Lung LU Handtai yin Metal Zang LU I ,LU7, LU9 LI 4, LI 11 ST36, ST44 Fu Fu Metal Earth Handyang ming Foot yang ming LI ST Large Intestines Stomach Fire Earth Spleen SP Foot tai yin Handshao yin Zang ------ Zang SP 6, SP 9 HT7 Handtai yang Fire Fu SI 3,SI I 8 Foot tai yang Water Fu BL23, BL40, BL60 KI 3, KI 7 PC6 SJ 5 Fire Fire Water Zang Zang ------ Fu Foot shao yin Handjueyin ----- Handshao yang P TH,TE, TW PC SJ Pericardium SanJ iao (Triple Warmer) - -- ------------ Gall Bladder GB Foot shao yang Wood Fu GB20, GB34, GB40 Wood Liver Conception Vessel LR CV Liv Ren mai Footjue yin ------- Front-Mu yin Zang Governing Vessel GV Dumai Back-Shu yang GV 4, GV 14, GV20 Energy issaid tocirculate through these zang-fu channels inthe order presented, from Lung to Large Intestines toStomach toSpleen to Heart to Small Intestines toBladder to Kidney to Pericardium toSan J iao to Gall Bladder to Liver and back to Lung. Tai refers togreater yin or yang. shao refers to lesser yin or yang, ming describes brightness, and jue yin indicates absolute manifestation of yin. 36 Auriculotherapy Manual according to theWorld Health Organization, alternative abbreviations which have been used in various clinical texts, thelocation of each channel, and designation of theprimary element associated with that channel. Theacupoints which aremost frequently used inacupuncture treatments are also presented. Thesequential order of thechannels presented inTable 2.2 indicates thecirculation pattern inwhich energy issaid to flow. Thechannels are differentiated intothreeyin meridians andthreeyang meridians on thehandand threeyin meridians and three yang meridians on thefoot. InTable2.3, thezang-fu channels areregrouped according tothose meridians which aremore yang andthecorresponding channels which aremore yin. This tablealso describes therelationship of theanatomical location of each meridian that isshown on acupuncture charts ascompared tothe zone regions of thebody that areused infoot andhand reflexology. Thezang channels tend torunalong theinside of thearms or legs, whereas the corresponding fu channel typically runsalong theexternal side of thearms or legs. As seen inFigures 2.13and2.14, when thearms areraised upwards toward thesun, yang energy descends down theposterior side of the body along fu channels, whereas yin energy ascends the anterior side of the body along zang channels. Only thefu Stomach channel descends along the anterior side of the body. Since thefuchannels have acupuncture points located on thesurface of the head, these yang meridians aresaid to be more directly connected to theear. TheLarge Intestines channel crosses from theneck to thecontralateral face, theStomach channel branches across themedial cheeks andinfront ofthe ear, the Small Intestines channel projects across the lateral cheek, theBladder meridian goes over themidline of thehead, andboth theSan Jiao and theGall Bladder channels circle around the ear at theside of the head. Acupuncture points on the zang channels only reach ashigh asthechest, so they have no physical means to connect totheear. Another set of acupuncture channels, thefrontal Conception Vessel meridian (Ren mai) and the dorsal Governing Vessel meridian (Dumai) both ascend themidline of thebody to reach the head, asshown inFigure 2.15. Representation of the Conception Vessel andGoverning Vessel channels upon the tragus region of theexternal ear isshown inFigure 6.8of Chapter 6. TheChinese charts do not show how the external ear connects tothesix zangchannels. Dale (1999) has hypothesized that all micro-acupuncture systems function through micro-meridians, just asthemacro-energetic system functions through macro-acupuncture meridians. I tisfurther postulated that the entire macro-micro channel complex forms anextensive energetic network, Table2.3 Anatomical location of yang and yin meridian channels Yang Location Reflex Corresponding Direction of Reflex channels zones yin channels energy flow zones Large External handto 1-2 Lung Inner chest to Intestines armtoshoulder inner armand andface hand " SanJiao External handto 3-4 Pericardium Inner chest to 3 external armand inner armand head hand Small External handto 5 Heart Inner chest to 5 Intestines armtoshoulder inner armand andface hand -_._---_...-._.- Stomach Facetoanterior 2-3 Spleen Foot toinner leg 1-2 bodytoanterior leg toanterior body -_.,’-_ ..,--_.__.._._--------’-’----,._-- Gall Bladder External head to 5 Liver Foot toinner leg 1-2 external bodyandleg toanterior body Bladder Posterior head to 1-2 Kidney Foot toinner leg 1-2 back toposterior leg toanterior body Governing Midlineof buttocks Conception Midlineabdomen Vessel tomidlineback Vessel tomidlinechest (Dumai) tomidlinehead (Renmai) tomidlineface ----------- Theoretical perspectives 37 5T 45 LR 14 KI 21 LR 13 KI 11 Figure 2.13 Thedescent ofyang qi from thehead tothefeet viewed on theposterior (A) andanterior (B) side ofthebody. Theascent or yin qi from thefeet tothechest only occurs on theanterior side. Yangacupuncture channels along thebody include meridian acupointsfor theBladder (BL), Call Bladder (CB) andStomach (ST). Yinacupuncture channels include meridian acupoints for theKidney (KI), Spleen (SP) andLiver (LR). 38 Auriculotherapyfv1anual PC9 PC6 PC1 A Hand yin meridians B Hand yang meridians SJ 15 SI 15 SI 19 SJ 1 SI 8 Figure 2.14 Yinqi flows from thechest distally toward thehandyin meridians (A), whileyang qi flows fromthehandyangmeridians mediallv toward thehead (B). Theyin channels oftheinner arminclude theHeart (HT), Pericardium (PC) andLung(LV) meridians, whereas theyang channels oftheexterior arminclude theLarge Intestines (L1), San Jiao (SJ) andSmall Intestines (51) meridians. Theoretical perspectives 39 A Conception Vessel channel B Governing Vessel channel GV7 ,.----GV1 : ~ ~ G V 4 --------Gv21 CV2 ~ CV7 ~ = CV14 CV21 CV24 ~ ~ ~ ~ ~ ~ Figure2.15 TheConception Vessel meridian (Ren channel) isfound on themidlineoftheanterior torso (A), whereas theGoverning Vessel meridian (Du channel) isfound along themidlineoftheposterior spine ofthebody (B). perhaps similar tothewayveins, arteries and capillaries characterize thevascular network. Since both macro-acupuncture channels and micro-acupuncture meridians carry invisible forces of energy, theexact mechanisms remain mysterious. Metal: Themetaphor of metal isrelated tothe Bronze Age technique of heating theminerals of theearth to awhitehot intensity with fire, then cooling the object with water and shaping itwith wood. While metal ismalleable when it iswarm, itbecomes hardandrigid when itcools and contracts intoafixed shape. Theyin nourishing aspects of metal are represented by the ability to cook rice inametal pot, whereas theyang aggressive aspects of metal are demonstrated bythe creation of the sword andprotective suits of armor. Theacupuncture meridians related to metal are theLungchannel that descends from thechest distally down theinner armand ends on the palmside of the thumb, whereas theLarge Intestines channel isfound on the opposing side of the hand, beginning at theexternal, dorsum side of the second finger andtraveling uptheexternal side of the armtoward the body. Earth: Theyellow earth isthestable foundation upon which crops aregrown andcities arecreated. Thelatesummer qualities of earth allowone tobesolid andgrounded. Theacupuncture meridians related toearth aretheSpleen channel that begins on thelarge toe and travels upthe inner leg andthe Stomach channel that travels down theexternal body and external legtoend on thesecond toe. Fire: Thered flames of afirebringwarmth andcomfort toacold day, allowing one tomove about andfunction withgreater ease andspeed. Thesummer qualities of fire accompany atimewhen there isgreat activity andagathering of crops. Theacupuncture meridians related tofireinclude theHeart channel that descends from thechest distally down the inner armandends on the littlefinger, whereas theSmall Intestines channel begins on thelittle finger and travels uptheexternal armtoward thebody. Twoother channels also related tofirearethePericardium channel that travels distally down the inner armand theSan Jiao channel that travels upthe outer armfrom thehand. 40 Auriculotherapy Manual Yang meridians on right side of body connect to microsystem points on right ear Yang meridians Large Intestines (L1) Small Intestines (SI) Stomach (ST) Gall Bladder (GB) Urinary Bladder (BL) San [lao (SJ) Corresponding yin meridians Lung (LU) Heart (HT) Spleen (SP) Liver (LR) Kidney (KI) Pericardium (PC) Qi energy flow Right ear relieves pain on right side of body Figure 2.16 Theflow ofqi along ayangacupuncture channel up thearmtoward ear reflex points on thehead has theability to unblock theflow ofenergy along theispsilateral side ofbody. (From LifeARTfi, Super Anatomy. 'Lippincott Williams & Wilkins, withpermission.} Theoretical perspectives 41 A Surface view of zang organs B Posterior view of zang organs Kidney Heart Liver Liver Spleen Spleen Lung Lung Heart Kidney Figure 2.17 Localization ofthefivezangorgans represented on theanterior (A) andposterior (B) auricle. Water: Therefreshing coolness of blue waters quenches one’s thirst and provides thebody with oneof itsmost necessary elements. Associated with winter, the qualities of water arestillness, quietness, andatime for reflective meditation. Theacupuncture meridians related to water arethe Kidney channel that begins on the littletoe and travels up the inner leg to theabdomen, whereas theBladder channel begins on theforehead, crosses over the top of thehead to theback of the head, runsdown the back of the neck, down the spine, anddown the back of the leg to the foot. Wood: Theimage of wood isbest thought of asthe initial spring growth of new branches on a tree, each limb sprouting bright green leaves. Wood isassociated with new beginnings, new growth, and changing temperaments. Theacupuncture meridians related towood include theLiver channel that begins on thelarge toe andtravels upthe inside of the leg to thechest, whereas the Gall Bladder channel descends along theexternal side of the head andbody and down the external leg to the littletoe. Five zang organs: While all the internal organs aremore yin thanyang, apredominant focus in Chinese medicine isgiven to the importance of thezangorgans, which areeven more yin thanthe fu internal organs. Thefive principal zangorgans arethelung, heart, liver, spleen andkidney. The energetic functions of zangorgans are utilized inclassical acupuncture more often than the physiological functions of that organ. As previously noted, Western language translations of the acupuncture meridians might have been better left asChinese pinyin terms. Thediscrepancies between the anatomical function of these organs and their clinical use inOriental medicine has often lead to skepticism rather than understanding byWestern doctors. Thezangorgans represented on the external ear areshown inFigure 2.17. Lung (fei): Thethoracic organ of the lung, inthe upper jiao, dominates the qi ofrespiration, inhalingpureqi and exhaling toxic qi. I flung qi isweak, defensive qi will not reach theskin, thus the body will bemore easily invaded bypathogenic factors, particularly cold. Besides itsinclusion inthe treatment of respiratory disorders, the Lung point on the auricle isone of themost frequently used ear points for the detoxification from addictive substances, such asopium, cocaine and alcohol. Because the skin also connects to respiration and to the release of toxic substances through sweating, the auricular Lungpoint isalso used for the treatment of skin disorders. Heart (xin): This thoracic organ promotes blood circulation and supports vigorous heart qi. Heart qi issaid to beessential for forming blood andalso houses themind, emotions andthe spirit. 42 Auriculotherapy Manual In addition toitsapplication for coronary dysfunctions, the auricular Heart point isstimulated to relieve nervous disorders, memory problems, sleep impairment and disturbing dreams. Liver (gan): In Chinese thought, theliver issaid tostore blood and toincrease blood circulation for vigorous movements bynourishing the sinews, ligaments and tendons that attach muscles to bones. The liver isresponsible for unrestrained harmonious activity of all organs and maintains the free flow of qi. Stagnation of liver qi isassociated with resentment, bitterness, irritability, repressed anger, and mental depression, while excessive liver qi may cause headaches and insomnia. The auricular Liver point isused for myofascial pain and muscle tension duetorepressed rage. Spleen (pi): Of all thezang organs, the Chinese conceptualization of thespleen isprobably most different from Western understanding of this organ. This abdominal organ reportedly governs the transportation of blood and nourishes themuscles and thefour limbs. I fspleen qi isweak, the muscles will beweak. Excessive mental work or worried thinking issaid toweaken spleen qi. In Western anatomical texts, thespleen isconsidered apart of thelymphatic drainage system and has littleeffect on muscles or on mental worry. Some of the digestive functions that theChinese assigned to the spleen seem more appropriately delegated tothe nearby abdominal organs of the stomach andthe pancreas. Nonetheless, theChinese Spleen point on the ear isoften used very effectively for thetreatment of muscle tension andgeneral nourishment. Kidney (shen): Lower intheabdomen, thekidneys aresaid tostore thecongenital essence of the physical body that people inherit from their parents. Thekidney also affects growth, development, and reproduction. The kidneys dominate water metabolism andregulate thedistribution of body fluid. The kidney isalso said to nourish the spinal cord and the brain, andto bethe residence of willpower andvitality. Finally, thekidneys nourish hearing functions of theear. Pericardium (xinbao): A sixth zang organ isthe pericardium, which refers to theprotective membranes that surround the heart. This acupuncture channel has also been labeled theMaster of theHeart or asthecirculation-sex channel. The Pericardium meridian functions very similar to theHeart channel and runs along anadjacent region of the inside of the armasittravels distally toward the hand. This zang organ isnot often utilized inauriculotherapy. Six fu organs: Thefuorgans arenot asprominently discussed inOriental medicine asthezang organs, but the acupuncture channels associated with each fuorgan arevery important in acupuncture treatment plans. Twoof themost commonly used acupoints inall of Oriental medicine are LI 4(hegu or hoku) on theLarge Intestines meridian andST 36(zusanli) on the Stomach meridian. Stimulation of the Large Intestines channel can relieve pains inthe index finger, wrist, elbow, shoulder, neck or jawthat occur along theLarge Intestines channel. Needling theStomach channel can alleviate conditions intheface, neck, chest, abdomen, leg, knee or foot that areall skeletal structures found along the Stomach meridian. San Jiao: This termhas been translated asTripleWarmer, TripleHeater, TripleBurner andTriple Energizer. Members of aninternational nomenclature committee of theWorld Health Organization ultimately decided to keep the Chinese termfor this meridian, since San Jiao really has nocorrespondence inWestern anatomical thinking. Theclassical division of thebody was distinguished asthree regions: theupper jiao (thechest region that regulates circulatory and respiratory functions), the middle jiao (theupper abdominal region which affects digestive functions) and thelower jiao (the lower abdominal region which affects sexual and excretory functions). Theupper burner of San Jiao islike avaporous mist intheregion of the heart and lungs, themiddle burner islikefoam inthe region of thestomach andspleen and the lower burner islikeadense swamp inthe region of thekidneys, intestines and bladder. San Jiao refines the subtle essence of qi thewayagranary refines flour or abrewery distills alcohol. Thephysiological effects of San Jiao arepossibly related to thearousal actions of thesympathetic nervous system andthe release of circulating hormones bythe endocrine system. Spirit (shen): This substance serves asthevitality behind the animation of qi, theflow of blood and the instinctual processes related to individual essence (jing). Shen isassociated with human consciousness and the force of human personality to think, feel, discriminate and choose. I tis associated with aparticular behavioral style and it affects the choice of aparticular vocational path inlife. Oneof the most widely used points inall of auriculotherapy isthe Shen Men point in the triangular fossa. This Chinese ear point has aprofound effect on spirit, will andgeneral wellbeing. Theoretical perspectives 43 2.3 Ayurvedic medicine, yoga and prana energy While theancestral source of Chinese medicine isnot fully known, many of theconcepts used in acupuncture aresaid tocome from theVedic texts of ancient India. Theprinciples described inthe Vedas were developed inIndiaby1500BeE andhavebeen presented inrecent evaluations of complementary medicine for thedisciplines of yoga (Ross 2001) andayurvedic medicine (Manyam 2001). InSanskrit, ayu referred tolife, andveda referred toscience, thusayurveda denoted thescience of life. TheVedas included ascientific understanding of body, mind andspirit. Ayurveda wasa complete system of medicine, withseparate branches for surgery, internal medicine, toxicology, pharmacology, neurology andpsychology. TheYoga Sutras of Pantanjali were written in200BCE. This text wasone of thefirst documents todescribe thehealthcare practices of yoga. Pranayamas are specific types of breathing, asanas aredisciplined postural movements, dyanas arepractices of contemplative meditation, andsamadhi isblissful union withthesupreme existence of all things. Prana: A fundamental principle of this Indiantradition isthat the body iscomposed of energy, not just material substance. This energetic view of the human body isvery similar to Chinese medicine. Illness wassaid tobedue totheblockage of energy. Through different yoga disciplines, itwas possible toenhance thecirculation of energy inorder tofacilitate healing from adisease. Ayurvedic practitioners refer totheprimal energy asprana, which also means breath. Hinduand Buddhist teachings assert that the soul enters thebody with aninfant’sfirst breath and the soul leaves thebody with aperson’s last breath. Thesoul isthen ready for anew reincarnation, when theprocess of lifethrough breath isrepeated. While incarnated on this earth, aperson is challenged with many lessons for the soul’s evolution, including thechallenge of takingcareof the physical body. Karma isnot punitive retribution for past sins, asit isoften thought of inthe West, but isinstead aguide for educating the soul incorrecting previous mistakes inliving. I tisnot necessary to believe inthereligious philosophies of Hinduismor Buddhism inorder tofind benefit inthebreathing and postural practices of yoga or the herbs used byayurvedic practitioners. The energetic perspectives of the human body, though, are afundamental component inunderstanding how these spiritual traditions have been applied to ayurvedic clinical treatments. Nadis: Similar tothe acupuncture meridians, Vedic writings described channels of energy extending over the surface of thebody through which pranacan flow. InIndia, the channels were called nadis. Said tobeaconduit between thegross anatomical body and the subtle etheric body, thenetwork of 350000nadis resembles modern descriptions of nerves and nerve plexuses. Of the different energy channels inayurvedic medicine, the three most important were thesushumna, the ida and thepingala. Themainchannel was the sushumna, which rose from the tailbone upthe spine. Theida and the pingala spiral upthespine on each side of the sushumna. These three primary channels were depicted astwo coiled serpents spiraling upacentral staff, remarkably similar tothe Egyptian, Greek and Roman caduceus symbol of healing. Thesushumna has been said tocorrespond tothe central nervous system, the ida represents thesedative parasympathetic nervous system, and thepingala affects the fight-or-flight-related sympathetic nervous system. The location of the sushumna along the spine coincides with the midlinefront mu and back shu meridian channels of Chinese acupuncture. Inboth the Vedic sushumna channel and Chinese mu-shu channel, vital energy ascends the spine toward the head. FiveVedic elements: Just astherewere fiveprincipal elements or phases inOriental medicine, fiveprimary elements aredescribed inayurvedic medicine. Referred to asfivecategories of matter (panchamahabhutas), these basic elements included earth (prthvi), water (ap), fire (tejas), air (vayu) anduniversal etheric space (akasa). Theprimordial sound of ,Om’ was said to create air from etheric space, which generated friction asit moved. This friction created fireandheat, which ultimately cooled and manifested aswater, andfinally became earth. TheMateria medica of ayurveda contained alist of several hundred botanical herbs that employ the principles of these five elements inorder toheal various diseases, just asthemedical application of different Chinese herbs used the principles of fivephases. ThefiveVedic elements combined toform different constitutional types of mind-body interactions. These body types areknown asthe threedoshas, which arevatha, pitta andkapha. Figure 2.18 Images ofchakra motion arerepresented asachariot wheel (A), awagon wheel (B), thetop ofa whirlpool (C), awater wheel (D), theside viewofawhirlpool (E), or theswirlingpattern oftornados (F). (Bfrom Cellox, Reedsburg, WI, withpermission; D 'UtaSinger, withpermission; Ffrom NOAA/OAR/National Severe Storms Laboratory, Norman, OK.) 44 Auriculotherapy Manual Theoretical perspectives 4S A 7th B c Figure 2.19 Theseven chakras found along thevertical axisofthebody viewed from thefront (A) andtheside (B). Thecaduceus symbol (C), still used inmodern medicine, has ancestral roots inthenadis of Vedicscriptures which show thesushumna that rises upthespine surrounded bythesnake-like undulations oftheida andthepingala nadis. 46 Auriculotherapy Manual Vatha combines air with ether tocontrol the propagation of nerve impulses and the movement of muscles. Pittautilizes the element of fire, thus affecting physiochemical activities of general metabolism that produce heat and energy throughout the body. Kapha combines water and earth tomaintaincohesiveness inthe body byproviding itwith afluid matrix. An excess of kapha, however, can lead toslow metabolism, chronic lethargy, obesity or clinical depression. Thefive Vedic elements and the three doshas facilitate anintuitiveunderstanding of personal constitution and itseffects on health. Seven chakras: Natural sources for facilitating the flow of pranawere the chakras (pronounced shaw-kraws). Theword chakra refers to aspinning wheel, like the appearance of arapidly rotating, multi-spoked wheel on acarriage asit moves along aroad (Motoyama 1981, Tansley 1984). They areanalogous torotatingwater wheels andwindmills. Inmodern times, the rotatinggears of a motor engine or therapid rotation of the propeller on anairplane might beequivalent analogies. When viewed from the side, asopposed to afrontal perspective, the chakras appeared likea whirlpool, awhirlwind, or atornado (see Figure 2.23). Each chakra isavortex of circling, spiraling, swirling forces of invisible energy. These chakras arefound over specific regions of thebody, just as the spinning pattern of hurricanes occurs over specific regions of the earth asseen from modern satellites. Theswirling vortex of energy ascribed to the chakras isconsidered apossible explanation for themanner inwhich energy circulates at acupuncture points. Thereareminor chakras at each joint of the body, at the hands, thewrists, the elbows, theshoulders, the hips, the knees, the ankles and the feet. Vedic texts also described secondary chakras at the ears. Most of the focus in ayurvedic medicine, though, ison the seven primary chakras that ascend the midlineof the body. Theaxial position of these chakras runs along the sushumna. Theida and thepingala undulateup the spine inaspiral pattern, crossing each other at each chakra. All seven chakras areshown from afrontal and asagittal perspective inFigure 2.19. Thefirst chakra resides at the base of the spine, inthe region of themale genitals, and isthe initial source for the rise of thekundalini energy that is essential for survival. Thesecond chakra islocated within the lower abdomen, the thirdchakra within the upper abdomen, thefourth chakra within thechest and heart, the fifth chakra at the lower throat, the sixth chakra between theeyebrows, and the seventh chakra at the top of the head. Seen from the side, the chakras appear likefunnels, with the tipof these spinning cones of energy at the posterior spine and thebroader circular base of the cone toward the anterior body. Ancient texts pictured the chakras asmany-petaled lotus blossoms, with their stem toward the spine and theblossom petals toward thefront of the body. Thechakras were not limited to these cone-like configurations, but were actually broad fields of spiraling energy that could extend well beyond the physical body. Each of the seven primary chakras islocated next tothe anatomical position of anendocrine gland, and the force field of each chakra produces functional changes that aresimilar tothe effects of the hormone released bythat endocrine gland. Thefirst chakra isfound inthe scrotal region of the male genital organ, the testis, whereas the second chakra occurs inthepelvic region of the female genital organ, theovary. Testosterone produces afeeling of physical power, aggressive rage, and sexual excitement. The estrogen released bythe ovary induces feminine sexual receptiveness while the hormone progesterone facilitates maternal bonding. Thethirdchakra lies inthe region of the abdominal adrenal gland. Theadrenal inand cortisol released bythe adrenals mobilizes the energy todeal with stress andstrain. The primary endocrine gland found near the heart chakra isthe thymus gland at thecenter of the chest and ispart of theimmunesystem. Thefifth chakra is located at the base of the throat, near the thyroid and parathyroid glands. Thyroxin released bythe thyroid gland enhances general metabolism when elevated, but asense of fatigue and lethargy when diminished. Thesixth and seventh chakras that arecentered inthehead arefound inthe location of the pineal gland and thepituitarygland. Thepineal releases the hormone melatonin that regulates sleep-wake patterns, whereas thepituitaryreleases specific hormones that control other endocrine glands. The first chakra issaid totakethebase physical energy from the earth and transmute itsraw substance to amore refined essence for the body to assimilate. Thehigher chakras transform the energy of the lower chakras into even finer forms, similar to the Chinese descriptions of distillation bythethree burners of San Jiao. Thefirst and second chakras arevery similar tothe urogenital functions of the lower jiao, the thirdchakra tothe digestive functions of the middlejiao, and the fourth andfifth chakras to the circulatory aspects of the upper jiao. When representing the front of Theoretical perspectives 47 thechakras aslotus blossoms, the lower chakras areshown withjust afew petals andhigher chakras aredepicted with progressively more petals. Specifically, the flowers for thefirst chakra have four petals, the second chakra hassix petals, the thirdchakra has ten petals, the fourth chakra has 12petals, the fifth chakra has 16petals, the sixth chakra has 96petals, and the seventh chakra has 960petals. Thesixth chakra isoften pictured astwo large petals over the forehead region, looking almost likethe left and the right cerebral hemispheres, while the seventh crown chakra is referred to asthe thousand petaled lotus. These many-petaled lotus flowers metaphorically suggest that the spinning wheels of the chakras rotatefaster asone ascends the spine. Chakra colors: Inmetaphysical texts byBeasley (1978) and byBruyere (1989), the chakras are represented bythe colors of the rainbow. Red isassociated with the first chakra, from which the primordial energy of the kundalini begins itsascent up the spine. J ust asred isthe lowest frequency inthevisible spectrum, the kundalini chakra has the lowest vibration rate. Progressively higher frequencies of color that aredue to different wavelengths of light rays that are associated with progressively higher chakras spinning at progressively higher frequencies of revolution. The chakra colors progress from red at thebase chakra tothe slightly higher resonance rates of orange at the second chakra. Thestill faster color of yellow isassociated with the thirdchakra, green with thefourth chakra, blue with thefifth chakra, purple or indigo with the sixth chakra, and ultimately white andviolet with the seventh chakra. Thehigher frequencies of the higher chakras aresaid to represent higher planes of spiritual existence. This range of hues isactually anidealized version of thewaythe chakra colors would appear inaperfectly healthy person, but arainbow pattern is rarely thecolor spectrum seen on anactual person, particularly someone with anillness. Other descriptions of thechakras allude to adifferent set of colors at each location, such asgreen at the second chakra andyellow at the fourth chakra. Theauricular medicine perspectives that developed inEurope also emphasized seven basic frequencies that affect the seven different types of tissue inthebody. The lowest frequencies inauricular medicine characterized primitive instinctual processes, whereas the higher frequencies areassociated with higher neurological functioning. Many Western investigators considered the chakras tobemore symbolic thanreal. However, Western aswell asEastern physicians have reported that they can feel aswell assee these chakra forces. TheCalifornia physician Brugh Joy (1979) described hisobservations of thesubtle energy fields. Although hehad not read anyayurvedic writings, Joy could sense vibrational changes over a patient’s body which precisely corresponded tothe locations of the seven Vedic chakras. Electrophysiological research at UCLA byDr Valerie Huntfound that these chakra energy Table 2.4 Relationship of seven chakras to different functions Chakra name Location Gland Element Animal Lotus Color Function traits petals I. Base chakra Groin Testis Fire Serpent, 4 Red Survival instincts, rage, (Muladhara) dragon vitality, physical power 2. Pelvic chakra Pelvis Ovary Water Fish 6 Orange Deep emotions, sexual (Svahishthana) functioning - - --- - -- 3. Solar plexus Upper Adrenal Air Bird 10 Yellow Intellectual mind, (Manipura) abdomen personal will --------------- 4. Heart chakra Chest Thymus Earth Mammal 12 Green Empathy, love, (Anahata) compassion - --- ----------------- ------- ------ -----------_._ ..__. __._. __. ~ .._.------ 5. Throat chakra Throat Thyroid Ether Human 16 Blue Verbal expression, (Viahuddua) speech, creativity .’-’.- - - , , - ~ - - - - - . - ~ - _ . _ . _ - 6. Thirdeye Forehead Pineal Soul 96 Purple Intuition, psychic (Ajna) vision - ------------ 7. Crown chakra Vertex of Pituitary Spirit 960 White and Worldly wisdom, spiritual (Sahasrara ) head violet awareness --,--_ .. - - - ~ . _ ...- . 48 Auriculotberepy Manual patterns could bescientifically measured. Working with the aurareader and spiritual teacher Rosalyn Bruyere (1989), Huntrecorded specific electrophysiological changes invery high frequency waves of theelectromyogram (EMG). Surface EMG electrodes were placed over specific chakra locations on thebodies of humanvolunteers. As the aurareader reported distinct changes inthecolor and pattern of the auricenergy field at different chakras, the physiological equipment indicated specific changes inelectrophysiological frequency andvoltage amplitude. Thedifferent energy patterns reported bythe aurareader for each chakra position were found to correspond tospecific EMGpatterns recorded bythe electrophysiological equipment. Noother laboratory has attempted to replicate Hunt’sresearch, thus ascientific explanation for these experiences remains tobedetermined. Chakra acupuncture: TheGerman physician Gabriel Stux (1998) has described aprocedure called chakra acupuncture asanexpansion of the practice of traditional Chinese acupuncture. The chakra energy centers of ayurvedic medicine areactivated inamanner similar tostimulation of the Chinese zang-fu channels. Traditional Chinese acupuncture seeks to harmonize the flow of qi by dissolving the blockages inthechannels and organs, and there isasimilar aiminayurvedic medicine. Conditions of excess or deficiency can bebalanced byharmonizing theyin andyang forces of each of theseven chakra centers. Chakra acupuncture extends the traditional application of acupuncture totheVedic chakra system for both diagnosis andtreatment. Inchakra acupuncture, chakra points areneedled intheareaof theseven primary energy centers. Energy flow stimulated bythisneedling isreferred toas’opening of thechakras.’ Themost frequently used chakra acupoints areGV 20toactivate theseventh chakra, GV 15tostimulate thesixth chakra, and CV 17andGV 11tobalance thefourth chakra. Besides needling thechakra points on the body, Stux asks the patient toconcentrate deliberately on thebody areathat isbeing needled or electrically stimulated. After ashort time, the patient usually feels aslight tingling sensation or adiscreet, warmflowing sensation inthis chakra area. Thepractitioner focuses hisor her attention on this region too. When the flow through one energy center isclearly perceptible tothe patient, treatment proceeds tothe next energy center. The patient isasked tobreathe into thechakra area, to hold hisor her conscious awareness there, and toimagine opening thechakra until heor she feels asensation of wideness, charge and flow inthat region. Byattentively opening each energy center, the internal flow of lifeforce ispromoted. The individual brings awareness or mental focus on achakra region, then the person identifies the location, borders, size, temperature, color andemotions of that body area. The next step isto release the blocked or stagnant energy, thus transforming the density of theblockage through breathing consciously into that region. Chakras andauricular acupuncture: The Dutchphysician Anthony Van Gelder (1999) has suggested that thechakras arealso represented on the external ear. Thelocation of auricular areas associated with each of the seven primary chakras coincides with certain ear acupoints known as master points. Thefirst three chakras respectively correspond tothe auricular master points referred to asthe Sympathetic Autonomic point, theear point Shen Men, and Point Zero. The representation of theother chakra centers isnot so generally accepted, but inVanGelder’s work they arelocalized at theroot of the helix of the ear. An alternative correspondence system for the chakras correlates the upper chakras to theEuropean auricular points known asWonderful point, Thalamus point, Endocrine point, andMaster Cerebral point. Different possible representations of thechakras upon theexternal ear areindicated inFigure 2.20. 2.4 Holographic model of microsystems InTheholographic universe, Michael Talbot (1991) describes how thetechnology ofthe hologram can serve asamodel for many unexplained phenomena, including thesomatotopic microsystem found on the external ear. A hologram iscreated when alaser light issplit into separate beams. Angled mirrors areused tobounce the laser beamoff theobject being photographed. A second laser beamisbounced off the reflected light of thefirst laser beam. Thecollision of these reflected laser beams generates aninterference pattern on the holographic film. This interference pattern is the areawhere thetwolaser beams interact on thefilm. When thefilmisdeveloped, itlooks likea meaningless swirl of light anddark images, composed of crisscrossing lines, concentric circles and geometric shapes similar tosnowflakes. However, when the developed filmisilluminated by another laser beam, athree-dimensional image of the original object appears. Onecould actually Theoretical perspectives 49 A. Auricular Chakras described by Van Gelder 1st Chakra 5th Chakra 3rd Chakra 4th Chakra 2nd Chakra B. Auricular Chakras described by Oleson 3rd Chakra 6th Chakra 7th Chakra 2nd Chakra 4th Chakra so Figure 2.20 (A) Fiveoftheseven chakras havebeen depicted by VanGelder as located intheupperexternal ear. (B) All seven chakras areshown on theauricle fromadifferent perspective developed byOleson. Auriculotherapy Manual walk around this three dimensional image andview the hologram from different sides. For the purpose of this discussion, themore intriguingaspect of holograms isthat each part of the holographic filmcontains animage of thewhole object thatwas photographed. Instandard photography of aman, for instance, one section of the photographic negative would just contain theimage of the head and another section would just include the image of thefoot. Inholographic photography, all sections of thefilmcontain all theimages of the head, thefoot, andtheentire body inbetween. A diagramof holographic equipment isshown inFigure 2.21and aholographic image of man isshown inFigure 2.22. The respected Stanford University neurobiologist Karl Pribramused the model of the hologram to explain research experiments demonstrating that memory can bestored inmany partsof the brain. Pribramsuggested that individual neurons indifferent partsof the brainhave animage of what the whole braincan remember. According to thismodel, memories areencoded not inneurons, or even small groupings of neurons, but inpatterns of nerve impulses that crisscross theentirebrain. Thisbrainmap issimilar to thewaythat interference patterns of laser light crisscross theentire areaof apiece of holographic film. Theholographic theory also explains how the human brain can store so many memories inso little space. I thasbeen estimated that the human brainhas the capacity tomemorize something intheorder of 10billion bits of information duringthe average human lifetime. Holograms also possess anastounding capacity for information storage. Simply by changing the angle at which thetwo lasers strike apiece of photographic film, it ispossible to record many different images on thesame surface. I thas been demonstrated that onecubic centimeter of holographic filmcan hold asmany as10billion bits of information. Oneof themost amazing aspects about the human thinkingprocess isthat every piece of information seems instantly cross-correlated with every other piece of information, another feature intrinsic tothe hologram. Just asahologram has atranslating device that isable toconvert anapparently meaningless blur of freq uencies into acoherent image, Pribrampostulates that thebrainalso employs holographic principles to mathematically convert the neurophysiological information it receives from thesenses to theinner world of perceptions and thoughts. TheBritish physicist David Bohm hypothesized that theenergy forces which regulate subatomic particles could also beaccounted for bythe holographic model. In1982, aresearch teamled by physicist Alain Aspect, at the University of Paris, discovered that one of twotwinphotons traveling inopposite directions wasable tocorrelate theangle of itspolarization withthat of itstwin. Thetwo photons seemed tobenon-locally connected. Thepaired particles were abletoinstantaneously interact witheach other, regardless of thedistance separating them. I tdidnot seem to matter whether the photons were amillimeter awayor 13meters apart. Somehow, each particle always seemed toknow what theother wasdoing. Bohm suggested that thereason subatomic particles can remain incontact withoneanother isnot because they aresending some sort of mysterious signal back andforth. Rather, heargued that such particles arenot individual entities tobegin with, but areactually extensions of thesame, subatomic substance. The electrons inone atom areconnected tothesubatomic particles that comprise every other atom. Although human naturemay seek to categorize andsubdivide thevarious phenomena of the universe, all such differentiations are ultimately artificial. All of naturemaybelikeaseamless web of energy forces. Talbot (1991) concluded from thework of these twonoted scientists that thecosmos, theworld, the humanbrain, and each subatomic particle areall part of aholographic continuum: ’Ourbrains mathematically construct objective reality byinterpreting frequencies that areultimately projections from another dimension, adeeper order of existence that isbeyond both space and time.’ Just aseach part of the holographic negative holds animage of thewhole picture, Talbot further suggested that theauricular microsystem could hold animage of thewhole body. All microsystems might function liketheecho resonance, waveform interference patterns ina hologram, energy signals being transmitted from theskin tothe corresponding body organs. Similar tophotographic hologram plates, each part of theauricle might integrate energetic signals from all the partsof the human body. Ralph Alan Dale(1991,1999) inAmerica, Ying-Oing Zhang (1980, 1992) inChina, and Vilhelm Schjelderup (1982) inEurope have all used this holograhic paradigm to account for thesomatotopic pattern of acupoints found inevery micro-acupuncture system they have examined. The holographic model of microsystems isspeculative, but it iscongruent with thetraditional Chinese perspective that every organ inthebody isrelated tospecific acupoints on thesurface of Theoretical perspectives 51 A Conventional photography Object Sunlight Photographic film Camera Lens B Holographic photography Beam splitter Reference mirror Lens /\ ,/ !" / " / "" ! I" \ - / " \ , , \ ...................... ( ;A Reference beam Object Lens Laser beam Object mirror Laser source - coherent light Holographic plate- interference pattern Figure2.21 Conventional (A) and holographic (B) photographic equipment. S2 Auriculotherapy Manual A D B E Figure 2.22 In standardphotographic procedures, theoriginal object (A) isconverted toanegative imageonfilm(B). Whenitisdeveloped. a small portionofthatnegative onlycontains onepart ofthepicture(C). In holographic photography, theoriginal object (D) isconverted toa distorted imageofinteiference patterns (E). Aportion oftheholographic negative contains animageofthewholepicture(F). Theoretical perspectives 53 54 thebody. Inhisbook TheWebthat has no weaver, Kaptchuk (1983) states ’thecosmos itself isan integral whole, aweb of interrelated things andevents. Within thisweb of relationships and change, anyentity can bedefined only byitsfunction, and significance only aspart of thewhole pattern.’ Another Stanford scientist has also examined this perspective. Thephysicist William Tiller (1997, 1999) contends that there arenon-spatial, non-temporal energy waves functioning in various bandsof avacuum. Hisresearch showed that itwas possible to focus human intention to alter the physical properties of substances inasimple electronic device. Research participants ina focused meditative statewere able to induce anincrease or decrease inthe pH level of water bythe simple act of their intention. Therewas asmall but consistent alteration inthe pH level of water electromagnetically isolated inside acontainer within aFaradaycage. ThepH level changed ina -1.0negative direction when the meditators focused on lowering the pH andchanged ina+1.0 positive direction when themeditators focused on raising pH. According toTiller, theresults of these experiments suggest that there isatransfer of unconventional information inpreviously unknown frequency domains. This unconventional energy could serve asthe foundation for auricular medicine andother holographic microsystems. Theresearch investigations byTiller highlight the role of thehealing intention of the practitioner when working with apatient using any healthcare modality. Many inthe West arenot comfortable with theconcept of anebulous, invisible energy matrix, whether perceived from the orientation of Chinese medicine or from the speculations of quantum physicists. That such energetic viewpoints would bethe primary foundation for auriculotherapy is not reassuring tosuch individuals. A great split inthe European auricular medicine community occurred when Paul Nogier expounded thenotion of ’reticular energy’ asanexplanation for the clinical phenomena heobserved. Nogier proposed that ’reticular energy’ was avital force that flowed inall livingtissue andthat itpropagated theexchange of cellular information. Any stimulation of the smallest part of thebody bythis reticular energy was said tobeimmediately transmitted toall other regions. When asurvey was taken of professionals at the 1999 International Consensus Conference on Acupuncture, Auriculotherapy, and Auricular Medicine, most of the respondents indicated that they considered the holographic model more asauseful analogy thananactual entity. Nonetheless, the notion that one part represents thewhole applies to thebasic principles of microsystems aswell astothe phenomena of holograms. 2.5 Neurophysiology of pain and pain inhibition Classical Chinese medicine did not really include the role of the nervous system ascurrently conceived inWestern medical science. Even recent Chinese ear acupuncture charts contain just a few auricular localizations for thebrain. Incontrast, the auriculotherapy texts byNogier (1972) and Bourdiol (1982) predominantly focus on aneurological explanation for this auricular reflex system. There have been many advances inthe field of neuroscience inthe last several decades which have substantially altered basic understanding of pain pathways. I tisnow known that there aremechanisms bywhich the nervous system perceives pain and nearby neural circuits bywhich thebraincan suppress the pain experience. Neurophysiological research has also examined the role of both ear acupuncture and body acupuncture inaltering these same neurobiological processes of pain perception and pain modulation. Some investigators believe that all of the energetic qualities described inChinese medicine can ultimately beaccounted for byobservable electrophysiological and biochemical phenomena inthebrainand nervous system. Research studies demonstrating the different regions of thebrainthat affect thebasic mechanisms of acupuncture arereviewed inBirch &Felt (1999), Cho et al. (2001), Stux &Hammerschlag (200I) andWeintraub (2001). Neurons: Thefundamental units of the nervous system arethe individual neurons, long slender threads of nerve tissue which areone of the few types of cells that can carry electrical signals. Body acupuncture points occur at regions underneath the skin where there isanerve plexus or where a nerve innervates amuscle. Onefeature of myelinated neurons isthat the speed of neural impulses isincreased bythepresence of segments of high electrical resistance myelin separated bygaps of lower electrical resistance nodes of Ranvier. This aspect of neurons corresponds to the electrodermal feature of acupuncture points, aseries of low-skin-resistance gap junctions separated byregions of high-skin-resistance non-acupuncture points. Auriculotherapy Manual Nociceptors: Although it isthecause of much unwanted suffering, painisnonetheless a biological necessity. Painsensations trigger protective withdrawal reflexes essential for survival. Theinitiation of pain signals begins with theactivation of microscopic neuron endings intheskin, themuscles, thejoints, the blood vessels or theviscera. Since these sensory receptors areexcited by noxious stimuli, capable of damaging cellular tissue, they havebeen called nociceptors. Electric shock, intense heat, intense cold or pinching of theskin all lead toanincrease intheneuronal firingrateof nociceptors. Thenatural stimuli for nociception, however, seem tobean array of biochemicals released into theskin following injuryto acell. Subdermal acidic chemicals that activate peripheral nociceptors include prostaglandins, histamine, bradykinin and substance P. In contrast, those sensory neurons specifically responsive tosoft touch arecalled mechanoreceptors andthose skin receptors affected bychanges inheat or cold arecalled thermoreceptors. Insertion of acupuncture needles seems toactivate nociceptors indeep muscles for body acupuncture and the nociceptors intheskin for ear acupuncture. Peripheral nerve pathways: Afferent sensory neuron fibers travel inbundles of nerves that project from theperipheral skin surface or deep-lying muscles toward thecentral nervous system at themidlineof the body. Each neuron iscapable of rapidly carrying electrical neural impulses over long anatomical distances, such asfrom thefoot to thespine, or from the fingers tothe neck. Theneurons from mechanoreceptors, thermoreceptors and nociceptors all travel along together, liketheindividual copper wires inanextension cord. However, the type of neuron carrying each type of message isdifferent. Thecategories of neurons aredistinguished bythe size and the presence of myelin coating. Thethinnest neurons, which have nomyelin coating, arecalled TypeC fibers andtend tocarry information about nociceptive pain. The next larger group of neurons are called Type Bfibers, which arelarger and have some myelin coating. They typically carry information about skin temperature or internal organ activity. Neurons that have thethickest diameter arecalled TypeA fibers. TheTypeA neurons are myelinated and large insize, making themmuch faster conductors thantheTypeBandTypeC fibers. They arefurther subdivided intoTypeA betafibers, which carry information about light touch stimuli activated bymechanoreceptors, andTypeA delta fibers, which arenot aslarge nor as fast astheA beta fibers and carry information about nociceptive pain. TheA delta fibers arestill faster thantheTypeCfibers, which also areactivated bynociceptors. When one ishurt, there is initially the perception of first pain from information carried byA delta fibers and then the perception of second paincarried byCfibers. First pain isimmediate, sharp, and brief, like apin prick, whereas second painismore throbbing, aching, and enduring, aswhen one isburned or hits one’s handwith ahammer. Chronic painsensations seem more related toCfiber activity thanA delta fiber activity, asCfiber firingcan summate over time rather thanhabituate. Thefastest neurons areTypeA alpha fibers. These motor neurons carry electrical impulses from thespinal cord tothe peripheral muscles, thus completing asensory-motor reflex arc. TypeA gamma motor neurons areregulated byproprioceptive feedback from sensory organs inmuscle fibres that serve to regulate muscle tone. Dsyfunctional neural firing inthisproprioceptive feedback seems tobe thesource of the maintained muscle contractions which lead tochronic myofascial pain. Spinal cord pathways: Thespinal cord isdivided into central gray matter surrounded bywhite matter, so designated because the neurons inwhite matter aremore thickly coated withwhite fatty myelin. When cut into cross sections, thegray matter looks like abutterfly, with aleft and aright dorsal horn (posterior horn) and aleft and aright ventral horn (anterior horn). Sensory neurons carrying nociceptive signals synapse inthefirst andfifth layers of the ipsilateral dorsal horn, whereas messages concerning light touch synapse inthefourth layer of the dorsal horn. These different messages about touch versus pain arethen sent up tothe brainintwoseparate sections of thespinal white matter. Information about touch iscarried inthe dorsal columns of thespinal cord, while information about nociceptive pain iscarried inthe anterolateral (ventrolateral) tract of thespinal cord. Impulses along spinal neurons travel upthe respective regions of white matter tocarry information about touch or about pain tohigher braincenters. Higher brain processing centers: Theoverall organization of the brainisdivided into the lower brain, the intermediate brain, and the higher brain. Spinal pathways connect to the brainstem at themedulla, ascend tothepons andthen themidbrain. The reticular formation extends throughout thecore of thelower brain, receiving tactile andnociceptive messages from thespinal cord and activating higher braincenters toproduce general arousal. Theserotonergic raphenuclei Theoretical perspectives 55 56 that facilitate sleep and sedation are also found inthe medulla, pons andmidbrain. The intermediate brainconsists of the thalamus, the hypothalamus, the limbic system, andthe striatum or basal ganglia. Thethalamus somatotopically projects sensory messages to the cortex and modulates sensory information that ascends to consciousness. Thehypothalamus andthelimbic system affect sympathetic arousal and theemotional qualities of pain. Thehigher braincenter consists of the four lobes of the neocortex, the somatosensory parietal lobe, thevisual occipital lobe, the auditory temporal lobe, and themovement control centers inthe frontal lobe and prefrontal lobe. Gate control theory: Melzack & Wall (1965) proposed that inhibitory interneurons inthe dorsal horn of thespinal cord aredifferentially affected byinput from A fiber and C fiber neurons. The fast-conducting A betafibers, which carry information about light touch, excite inhibitory interneurons tosuppress the experience of pain. Slow-conducting C fibers, which carry information about pain, inhibit these same inhibitory interneurons. Theconsequence of inhibiting aneuron which isitself inhibitory results inafurther increase inneural discharges that ascend toward the braininthe spinal white matter. Thedorsal horn gating cells allow only brief neural excitation following input from tactile A beta fibers, whereas they allow prolonged neural excitation following activation of nociceptive C fibers. Theoccurrence of brief versus prolonged bursts of neuronal firing accounts for differences intheperception of touch versus pain. Supraspinal gating systems inthe brainwere theorized tosend descending input down to the spinal inhibitory neurons, which thus allowed thebraintosuppress theincoming pain message. Stimulation-produced analgesia: Empirical support for the existence of descending pain inhibitory pathways occurred inthe 1970swith research investigations at UCLA by Liebeskind and Mayer (Liebeskind et al. 1974; Mayer et al. 1971; Mayer & Liebeskind 1974). Electrical stimulation of the midbrain periaqueductal grey (PAG) was found to suppress behavioral responses to noxious heat or noxious electric shock. Oneof the most surprising findings was that this stimulation-produced analgesia could be antagonized bytheopiate antagonist, naloxone (Mayer et al. 1977). Although the periaqueductal grey was the most potent region to produce analgesia inrats and cats, brainstimulation research inmonkeys (Oleson & Liebeskind 1978; Oleson et al. 1980a) demonstrated that thethalamus was the most potent primatesite toyield stimulation-produced analgesia. Examination of deep brainstimulation inhuman patients has produced similar findings (Hosobuchi et al. 1979). Humanresearch has also confirmed that nociceptive painmessages activate positron emission tomography (PET) scan activity inthe periaqueductal grey, thalamus, hypothalamus, somatosensory cortex and prefrontal cortex of man (Hseih et al. 1995). These arethe same brainstem and thalamic areas that areable to suppress pain messages. While direct connections between auricular acupuncture points and these antinociceptive brainpathways has not yet been investigated, neurophysiological investigations of body acupuncture points suggest that theregions of thebrain related to pain inhibition arealso affected bythe stimulation of acupoints (Kho & Robertson 1997). Descending pain inhibitory systems: Themidbrain periaqueductal grey (PAG) was oneof the first brainregions where stimulation-produced analgesia was demonstrated. Itwas subsequently found also to beactivated bymicroinjections of morphine and to contain opiate receptors that respond to the beta-endorphins. Neurons inthe dorsal raphe nuclei andraphe magnus can be excited by PAG stimulation. These serotonergic raphe cells descend thespinal cord inthe dorsal lateral funiculus and synapse on gating cells inlayer II of thedorsal horn. Basbaum & Fields (1984) showed that lesions inthe descending, dorsolateral funiculus tract inthespinal cord blocked behavioral analgesia from deep brainstimulation. Theraphe neurons release serotonin to excite the spinal gating cells, which release enkephalin to inhibit afferent nociceptive neurons. A different descending pathway carries impulses from thereticular formation, releasing the neurotransmitter norepinephrine to activate the inhibitory gating cells inlayer III of thedorsal horn. Curiously, there isalso adescending pain facilitation system inthe central nervous system. Wei et al. (1999) have shown that destruction of descending, serotonergic pathways from the raphe magnus anddescending noradrenergic pathways from the locus ceruleus both lead to an increase inthe Fos protein activity of nociceptive spinal neurons. Conversely, destruction of descending reticular gigantocellular pathways leads to adecrease inthe Fos protein activity of nociceptive spinal neurons. Thepaininhibition system was selectively damaged bythe rapheandlocus ceruleus lesions, whereas the painfacilitation system was disconnected bythereticular lesion. Auriculotherapy Manual Neural pathways of acupuncture analgesia: There aretwo major CNS pathways that lead to acupuncture analgesia, an afferent sensory pathway andanefferent motor pathway. Stimulation of acupuncture points activates the afferent pathway that travels from peripheral nerves intothe spinal cord, and from the spinal cord up tothe brain. A specific circuit of brainnuclei connects the afferent pathway tothe efferent pathway, which then sends descending neurons down the spinal cord toinhibit the perception of pain andtosuppress nociceptive behavioral reflexes (Takeshige et al. 1992). Thetwo braincircuits have been revealed byaseries of experiments conducted by Takeshigi (2001) of J apan and Han(2001) inChinaandthe United States. Afferent acupuncture pathway: This afferent pathway begins with stimulation of an acupuncture point intheskin that sends neural impulses tothespinal cord. These signals then ascend through thecontralateral ventrolateral tract of thespinal cord to the reticular gigantocellular nucleus and the raphe magnus inthe medulla. Thesignal next goes tothedorsal periaqueductal gray (PAG). Low-frequency (2Hz) electrical stimulation of the muscles that underlie the acupoints LI 4(hegu or hoku) and ST 36(zusanli) produce behavioral analgesia. Theintensity of electrical stimulation at anacupoint must besufficient tocause muscle contraction, which thusleads to an increase inthe latency for the animal tomove itstail away from ahot light. Stimulation of other muscle regions does not produce this increase intail-flick latency. Brain potentials can beevoked specifically in the periaqueductal central gray bystimulation of the muscles underlying the LI 4andST 36 acupoints, but not bystimulation of other muscles. These evoked potentials inthePAG were blocked bycontralateral lesions of the anterolateral tract, byadministration of the antiserum to met-en kephalin, bytheopiate antagonist naloxone, but not bythe administration of antagonists to dynorphin. Moreover, lesions of the PAG abolished acupuncture analgesia, indicating that the anatomical integrity of the PAG isnecessary for producing pain relief from acupuncture stimulation. This afferent pathway projects from the PAG to the posterior hypothalamus, the lateral hypothalamus, andthe centromedian nucleus of the thalamus. These neurons project through thehypothalamic preoptic area tothepituitarygland, from which beta-endorphins are secreted intothe blood. Efferent acupuncture pathway: Thedescending pain inhibitory system begins inadifferent areaof the midbrain periaqueductal gray, which projects to dopaminergic neurons inthe posterior hypothalamic area and then totheventromedian nucleus of the hypothalamus. Thepathsplits into aserotonergic system andanoradrenergic system that descends down the spinal cord. Brain potentials inthe lateral PAG that are evoked bystimulation of non-acupoints areabolished by antagonists to theopiate neurotransmitter dynorphin; incontrast, they are not abolished by administration of antagonists toeither met-enkephalin or leu-enkephalin. Dynorphin isthus believed to be the neurotransmitter of thespinal afferent pathway for non-acupuncture-produced analgesia. Theafferent pathway for the efferent acupuncture system originates at non-acupoints and ends inthe anterior part of the hypothalamic arcuate nucleus. Neurons from theventral periaqueductal gray synapse inthe raphe magnus, which then travels down the spinal cord to release the neurotransmitter serotonin on tospinal gating cells. An alternative efferent pathway travels from the reticular paragigantocellularis nucleus down to spinal gating cells. Spinal interneurons produce either presynaptic inhibition or postsynaptic inhibition on theneuron that transmits pain messages to the brain, thusblocking thepain message. Opiates inacupuncture analgesia: Theafferent acupuncture pathway produces atype of analgesia that isnaloxone-reversible, disappears after hypophysectomy, persists long after stimulation of the acupoint isterminated andexhibits individual variation ineffectiveness. Inthis first pathway, electrical brainpotentials are evoked bystimulation of acupoints inthesame areas that produce analgesia. Incontrast, stimulation of brainareas associated with theefferent acupuncture pathway produces analgesia that isnot naloxone-reversible, isnot affected byhypophysectomy, and is produced only duringthe period of electrical stimulation. Since hypophysectomy only disrupts the activity of thefirst pathway, thesecond pathway can function without the presence of endorphin. Microinjection of either beta-endorphin or morphine intothe hypothalamus produces analgesia in adose-dependent manner, whereas microinjections of naloxone to thehypothalamic arcuate nucleus antagonizes acupuncture analgesia inadose-dependent manner. Neurotransmitters inacupuncture analgesia: Acupuncture’s painrelieving effects can be abolished byconcurrent lesions of theraphe nucleus and thereticular paragigantocellular nucleus. These are the known origins of the serotongergic andthenoradrenergic descending pain-inhibitory systems. Theoretical perspectives 57 58 Synaptic transmission from thearcuate hypothalamus to theventromedian hypothalamus is facilitated bydopamine agonists and isblocked bydopamine antagonists. Neurons inthe ventromedian hypothalamus which respond toacupoint stimulation also respond to microinjections of dopamine into that part of thebrain. Conversely, neurons inthe arcuate hypothalamus which do not respond toacupoint stimulation also do not respond to iontophoretically administered dopamine. Adrenal activityandacupuncture analgesia: Acupuncture analgesia andstimulation-produced analgesia areboth abolished after removal of the adrenal glands. Electroacupuncture produces significant increases of beta-endorphin and adrenocorticotropic hormone (ACTH) released bythe pituitarygland intotheperipheral blood stream. There isacontinual increase of both peptides for more than 80minutes after termination of acupuncture stimulation, although this increase gradually diminishes thereafter. Electroacupuncture applied toadonor rat wasable toinduce behavioral analgesia inacrossed-circulated recipient rat. An increase of endorphins inthe cerebrospinal fluid after electro acupuncture suggests that there may beacorrelation between cerebral and peripheral beta-endorphin levels. Beta-endorphin andACTH areco-released from thepituitarygland after ananimal isstressed. Endorphins aremost renowned for their pain relieving qualities, whereas ACTH andcortisol aremore associated with neurobiological responses tostress. They can reach levels high enough to activate long periods of stimulation of the acupuncture analgesia pathways. Electroacupuncture stimulation frequencies: The opiate peptides enkephalin and dynorphin, two subfractions of thelarger polypeptide molecule beta-endorphin, areactivated bydifferent frequencies of electroacupuncture. Analgesia produced bylowfrequency (2Hz) electro acupuncture wasfound byHan (2001) tobeselectively attenuated byenkephalin antibodies, but not bydynorphin antibodies. Incomparison, analgesia obtained byhigh frequency (100Hz) electroacupuncture wasreduced byantibodies todynorphin, but not byantibodies to enkephalin. Hanconcluded that 2-Hz electroacupuncture activates enkephalin synapses, whereas 100-Hzelectroacupuncture activates dynorphin synapses. Both forms of electroacupuncture produced more pronounced analgesia thanneedle insertion alone. Brainimaging and acupuncture stimulation: Themost direct evidence of the neurological effect of acupuncture stimulation on the human brain hascome from Dr ZH Cho (Cho & Wong 1998; Wong & Cho 1999;Cho et al. 2001) at the University of California at Irvine. Recording functional magnetic resonance imaging (fMRI) of the human cerebral cortex, these investigators showed that needles inserted into adistal acupuncture point on the leg used for visual disorders could activate increased fMRI activity intheoccipital lobe visual cortex, whereas needling adifferent acupuncture point on the leg that isstimulated torelieve auditory problems selectively activated thetemporal lobe auditory cortex. I fonly tactile nerves were relevant tostimulation of acupuncture points intheskin, anincrease infMRI activity should have only been observed inthe parietal lobe somatosensory cortex. Specificity of fMRI brainactivity toauricular stimulation has been demonstrated byAlimi et al. (2002). Stimulation of the handareaof the auricle selectively altered fMRI activity inthe handregion of thesomatosensory cortex, whereas stimulation of a different areaof theexternal ear didnot produce this response. Similar correspondent changes were obtained inbrainfMRI activity from stimulation of theelbow, knee, and foot regions of the auricle. Stimulation of specific areas of theauricle led toselective changes inthefMRI responses inthebrain(Alimi 2000). Thalamic circuits for acupuncture: Tsun-nin Lee (1977,1994) has developed athalamic neuron theory toaccount for reflex connections between acupuncture points and thebrain. According to thistheory, pathological changes inperipheral tissue lead tomalfunctioning firingpatterns inthe corresponding brain pathways. Thenatural organization of theconnections between peripheral nerves and theCNSiscontrolled bysites inthesensory thalamus that arearranged like a homunculus. The CNSinstitutes corrective measures intended to normalize the pathological neural circuits, but strong environmental stressors or intense emotions maycause the CNS circuitry to misfire. I fthe neurophysiological programs inthe neural circuits areimpaired, the peripheral disease becomes chronic. Painand disease are thus attributed tolearned maladaptive dysfunctional programming of these neural circuits. Stimulation of acupuncture points on the body or theear can serve toinduce afunctional reorganization of these pathological brainpathways. Thespatial arrangement of these neuronal chains within thethalamic homunculus issaid to AuriculotherapyManual account for the arrangement of acupuncture meridians inthe periphery. Theinvisible meridians which purportedly run over the surface of the body may actually beduetonerve pathways projected onto neuronal chains inthe thalamus. Theauricular acupuncture system ismore noticeably arranged inasomatotopic pattern on the skin surface of theexternal ear (Chen 1993). Nogier (1983) also proposed that for achronic illness to maintainitself, the disorder must be accompanied byaltered neurological reflexes that transmit pathological messages to higher nervous centers. Until this dysfunctional neural circuit iscorrected, somatic reflexes controlled by thebrainwill remain dysfunctional. Stimulation of corresponding somatotopic points on the ear sends messages tothebrainwhich facilitate the correction of this pathological brainactivity. Somatotopic brain map: Research byPenfield & Rasmussen (1950) demonstrated that when the brainof ahuman neurosurgery patient was electrically excited, stimulation of specific cortical areas evoked verbal reports of sensations felt inspecific partsof the patient’s body. Stimulation of the most superior and medial region of the somatosensory cortex elicited sensations from the feet; stimulation of themore inferior and peripheral region of the cortex produced the perception of tingling inthe head. Therest of thebody was represented inananatomically logical pattern. I fthe right cortex was stimulated, the patient reported asensation on the left side of the body, whereas if the left cortex was stimulated, thepatient felt asensation on the right side. Parallel research by Mountcastle & Henneman (1952) and Woolsey (1958) showed that asimilar pattern existed for animals. When electrical stimulation was applied tothefoot of ananimal, neurons inone region of the contralateral somatosensory cortex began firing, whereas when the legwas stimulated, a different but nearby region of thebrainwas activated. A systematic representation of the body has been found for neurons inthe cerebral cortex, inthe subcortical thalamus, and inthe reticular formation of thebrainstem (see Figure 2.1). This brainmap has the same overall pattern asthe map on the ear, representing thebody inaninverted orientation. Cerebral laterality: Thehigher braincenters aresplit into aleft cerebral cortex andaright cerebral cortex, each side with afrontal lobe, aparietal lobe, atemporal lobe and anoccipital lobe. A broad bandof neurons called the corpus callosum bridges thechasm between these two sides of thebrain. Theleft side of the higher brainreceives signals from and sends messages out tocontrol the right side of thebody, whereas the right side of the higher brainreceives signals from and sends messages out to theleft side of thebody. Besides controlling the ability towritewith the right hand, the left neocortex dominates our ability tounderstand language, toverbally articulatewords, to solve mathematical problems, toanalyze details and to report on our states of consciousness. Even left handed individuals tend toexhibit dominance for language on theleft side of thebrain.The right side of thecerebral cortex regulates adifferent set of psychological functions. Besides controlling the left hand, theright side of brainissuperior totheleft side of thebrain inrecognizing facial features, in perceiving inflections and intonations, andinunderstanding therhythms that distinguish different songs. Our recognition of negative emotional feelings ismore highly processed bytherelationship› oriented right brain than bythemore logically-oriented left brain. Box 2.2presents thedifferent qualities of theleft andright cerebral hemispheres inaTaoist dualistic perspective: theleft side of the brain ismore yang-like, whereas theright side of thebrain ismore yin-like. Both mathematics and language involve asequential linear series of letters or numbers that must becombined inalogical manner inorder toberationally understood. Theequation (5+4) x3=27 has adifferent result if thenumbers arerearranged to (3 +5) x4=32. Thephrase ’therays of sunlight rise over the mountains inthe east’ can not belogically comprehended bythe left cerebral cortex when thewords arerecombined to read ’theeast inthe rays rise of mountains over the sunlight.’ However, the right cerebral cortex isreadily able to recognize apicture of sunlight rising over some mountains, whether onefirst focuses on the mountains and then looks up at the sun, or one first focuses on the sun and then lowers one’s gaze tothe mountains. What isimportant to right brainperception isthe overall relationship of the parts to thewhole. Themore conscious left side of thebraintends tofocus on rationally solving problems, whereas the more emotionally sensitive right side of thebrainallows for empathetic understanding of unconsciously motivated feelings. Although information processed bythe left hemisphere isnecessary toremember someone’s name, the right brainisessential to recall hisor her face. Dominance for language is found in95%of the population, with only afew left handers exhibiting language dominance inthe right cerebral cortex. I tshould benoted that both the left side and the right side of the brainare actively used byeveryone, the two hemispheres constantly cross-referencing each other. However, there can be certain learning disorders where the communication between the left cerebral cortex Theoretical perspectives 59 Box 2.2 Taoist dualitiesintheleft andright cerebral hemispheres Yangleft brainactivity Logical Rational Thinking Name recognition Mathematical calculations Analyzes details Word recognition Verbal meaning Sequential Linear Literal Abstract conce pts Judgmental Critical Dominating Language Yinright brainactivity I ntuitive Emotional Feeling Facial recognition Musical rhythms Global impressions Spatial relationships Intonations and inflections Simultaneous Circular Symbolic Metaphorical images Accepting Compassionate Supportive Art 60 andtheright cerebral cortex creates confusion rather thanorder. An example would be dyslexia, thereversal of numbers, letters, or words. Thiscondition is10times more likely to be found in someone who isleft handed thaninsomeone who isright handed. In auricular medicine, problems of left hemisphere andright hemisphere interactions arereferred to as laterality disorders. Contralateral cortical criss-crossing: I tsometimes confuses beginning practitioners of auriculotherapy that different body regions arerepresented contralaterally inthebrain, but are represented ipsilaterally on theear. Theexplanation isthat nerves originating fromear reflex points arecentrally projected to thecontralateral side of thebrain, which subsequently sends descending projections back to theipsilateral corresponding organ. Signals from theleft ear cross to theright side of thebrain. They then cross back from theright side of thebrainto theleft side of thebody. Conversely, apoint on theright ear projects to theleft brain, which then processes the information andactivates homeostatic regulating mechanisms that lead to corrective neural impulses being sent to theright side of thephysical body. Thiscontralateral criss-crossing pattern isrepresented inFigure 2.23. Braincomputer model: A commonly cited analogy for understanding the brainistheexample of modern computers. I fthe brainiscompared toacomputer, then theear can beviewed asacomputer terminal, having peripheral access tothe body’s central microprocessor unit. Thisimage is represented inFigure 2.24. Needle or electrical stimulation of ear acupoints would belike typing a message on acomputer keyboard, whereas thecomputer screen would belike the appearance of different diagnostic signs onthe auricle. Losing or damaging theear would not necessarily be destructive tothe braincomputer, anymore thanlosing akeyboard would necessarily affect aphysical computer. Havingaperipheral terminal onthe external ear allows more ready access to thecentral braincomputer, thus facilitating cerebral reorganization of pathological reflex patterns. Somatic control of muscle tension: There aretwo main divisions of theperipheral nervous system, thesomatic nervous system andtheautonomic nervous system. Myofascial pain istypically produced by theactivation of somatic nerves exciting thecontraction of muscle fibers to form muscle spasms. These fixated muscle contractions will not release, nomatter what conscious efforts areexerted. This myofascial tension isthemost common type of chronic pain, including back pain, headaches, neck andshoulder pain, andjoint aches. A muscle will not initiatea movement or maintain any action by itself. Themuscle must first be stimulated by amotor neuron tocontract. I fone has rigidity andstiffness inalimb, neural reflexes arerequired to maintain that postural pattern. Thequestion becomes what factor would cause thebrainto tell spinal motor AuriculotherapyManual Right brain Activation of elbow area represented on right side of cerebral cortex ill Contralateral crossing of left ear to right brain Stimulation of elbow point on left ear Contralateral crossing of right brainto left side of body Electrical impulses along neurons Left body Treatment of painin left elbow Figure 2.23 Contralateral cortical connections that cross fromtheleft external ear totherightbrainandfromtheright brainback tothe left sideofthebody. (FromLifeART"’, Super Anatomy, 'Lippincott Williams& Wilkins, withpermission.) Theoretical perspectives 61 Brain computer microprocessor somatotopically monitors body =Painor pathology Painrelieved inbody by neural output frombrain Brain computer microprocessor regulates body Pathological areas of body transmit information to brain ( ..... / . "..’.. .. \ . .. (\J.•....•••••...•.•...•..•J,.. / V 7 . ’ " I 4 ,I G Somatotopic ear computer terminal stimulated to transmit information to braincomputer Activeear reflex points respond to braininput, actinglike computer monitor to indicateareas of body pathology B Auriculotherapy A Auricular diagnosis Figure 2.24 Braincomputer model indicatingperipheral connections fromthebodytothemicrochip circuitryofthebrain, represented likeacomputer monitor (A). Stimulation oftheauricle islikesending messages onacomputer keyboard (B) tothebrain, which subsequently regulates thebody. 62 Aur;culotherapyManual neurons tosustain muscle contraction inapathological state. The thalamic neuron theory of Lee andthewritings of Nogier suggest that such chronic painisdue toalearned pathological reflex circuit established inthebrain. I tisthat maladaptive braincircuit which unconsciously maintains chronic pain. Thepattern of neural firinginthese pathological braincircuits descends thespinal cord and activates motor neurons tocontract themuscles inamanner that isdesigned tobe protective against pain, but actually tends toexacerbate pain. Auriculotherapy can promote homeostatic balancing of that pathological brain-somatic nerve circuit. Sympathetic control of blood flow: Blood circulation andcontrol of other visceral organs is regulated bytheautonomic nervous system. Sympathetic arousal leads toperipheral vasoconstriction and areduction of blood flow tothearea. The localized skin surface changes sometimes seen with auricular diagnosis, such aswhite flaky skin, can beattributed to microvasoconstriction (Ionescu-Tirgoviste et al. 1991). Auriculotherapy stimulation produces peripheral vasodilation, which patients often feel asasensation of heat inthe part of thebody which corresponds tothe points being treated. This treatment can therefore beused for Raynaud’s disease, arthritis, and muscle cramps due torestricted blood circulation. Sympathetic control of sweat glands: Another system controlled bythe autonomic nervous system isthe sympathetic control of sweat glands. Sweat isreleased more when it ishot outside, or inresponse toanxiety or stress. An electrodermal discharge from sweat glands can be recorded from skin surface electrodes. Selective changes intheelectrical activity on the auricular skin surface can berecorded byanelectrical point finder. Such devices indicate localized increases in skin conductance that are produced bythe sympathetic nervous system which innervates thesweat glands (Hsieh 1998;Young & McCarthy 1998). Paradoxically, histological investigations of theskin overlying the auricle do not reveal thepresence of sweat glands, indicating that some other process must account for spatial differences inskin resistance at reactive ear reflex points. Stimulation of reactive auricular points leads toareduction inskin conductance recorded inthepalm, thus indicating reduced sympathetic arousal. Representation of theyang aspects of the sympathetic nervous system and theyin aspects of the parasympathetic nervous system areshown inFigure 2.25 and Box 2.3. Research on acupoint electrodermal activity: In 1980,Oleson and colleagues conducted thefirst double blind assessment toscientifically validate thesomatotopic pattern of auricular reflex points (Oleson et aI1980b). Forty patients with specific musculoskeletal pain problems were first evaluated byadoctor or nurse todetermine theexact body location of their physical pain. A second medical doctor who had extensive traininginauricular acupuncture procedures then examined each patient’s ear. Thissecond doctor had no prior knowledge of thesubject’s previously established medical diagnosis andwasnot allowed tointeract verbally with the patient. Therewas apositive correspondence between auricular points identified asreactive and the partsof thebody where therewas musculoskeletal pain. Reactivity wasdefined asauricular points thatwere tender topalpation and exhibited at least 50microamps (pA) of electrical conductivity. Non-reactive ear points corresponded topartsof the body from which therewas noreported pain. Thestatistically significant overall correct detection ratewas 75.2%. When the pain was located on only one side of thebody, electrical conductivity was significantly greater at the somatotopic ear point on the ipsilateral ear thanat the corresponding areaof thecontralateral ear. Another double blind evaluation of auricular diagnosis didnot occur until adecade later. Ear reflex points related to heart disorders were examined bySaku et al. (1993) inJapan. Reactive electropermeable points on theear were defined asauricular skin areas that hadconductance of electrical current greater than 50microamps, indicating relatively lowskin resistance. Therewas asignificantly higher frequency of reactive ear points at the Chinese Heart points intheinferior concha (84%) and on thetragus (59%) for patients with myocardial infarctions and angina pain thanfor acontrol group of healthy subjects (11%). Therewas nodifference between thecoronary heart disease group andthecontrol group regarding theelectrical reactivity of auricular points that didnot represent the heart. The frequency of electropermeable auricular points for the kidney (5%), stomach (6%), liver (10%), elbow (11%) and eye (3%) was thesame for coronary patients asfor individuals without coronary problems, highlighting the specificity of this phenomenon. Observations that acupuncture points exhibited lower levels of skin resistance thansurrounding skin surface areas were first reported inthe 1950sbyNakatani inJ apan andbyNiboyet inFrance (Oleson & Kroening 1983c). Inthe 1970s, Matsumoto showed that 80%of acupuncture points Theoretical perspectives 63 Taoist balance of autonomic nervous system Yang reactions Sympathetic activation Rapid heart beats Pupillary dilation Elevated GSR Rise inskin conductance Yin reactions Parasympathetic sedation Slowheart beats Pupillary constriction Decreased GSR Lowered skinconductance Figure 2.25 Physiological activity intheautonomic nervous system iscompared tothecomplementary qualities ofyangandyin. Ytmg› likesympathetic arousal increases heart rate, pupillary dilation, andskin conductance, whereas parasympathetic sedation has the opposite effects. (From LifeART", Super Anatomy, 'Lippincott Williams & Wilkins.) 64 Auriculotherapy Manual Box 2.3 Taoist dualities of thesympathetic andparasympathetic nerves Yin parasympathetic nervous system Selective sedation Conservation of energy Slow deep breathing Slow heart rate Lowered blood pressure Peripheral vasodilation Warm hands Dry hands Reduced skin conductance Pupillary constriction Increased salivation Improved digestion Constipation Facilitates muscle relaxation could be detected aslow resistance points. Theelectrical resistance of acupuncture points was found to range from 100to 900kilohms, whereas theelectrical resistance of non-acupuncture points ranged from 1100to 11700kilohms. Reichmanis et al. (1975, 1976) further showed that meridian acupuncture points exhibit even lower electrical resistance when there ispathology inthe organ they represent. For instance, electrodermal resistance on the lungmeridian islower when one has arespiratory disorder, whereas skin resistance on theliver meridian islower when one has aliver disorder. Those acupuncture points that were ipsilateral to the site of body discomfort exhibited alower electrical resistance thanthe corresponding meridian point on thecontralateral side of the body. This work corroborated earlier findings (Bergsman & Hart 1973; Hyvarinen & Karlsson 1977). Subsequent research on thedifferential electrodermal activity of acupoints has continued toverify these earlier studies. Xianglong et al. (1992) of Chinaexamined 68healthy adults for computerized plotting of low skin resistance points. A silver electrode was continuously moved over awhole areaof body surface, while areference electrode was fastened to thehand. Starting from the distal ends of thefour limbs, investigators moved the electrode along the known meridians. Theresistance of low skin impedance points (LSIP) was approximately 50kilohms, whereas theimpedance at non-LSI P was typically 500kilohms. A total of 83.3% of LSIPs were located within 3mmof achannel. Inonly afew cases could individual LSIPs befound in non-channel areas. Thetopography of low skin resistance points (LSRP) inratswas examined by Chiou et al. (1998). Specific LSRP loci were found tobe distributed symmetrically andbilaterally over theshaved skin of theanimal’s ventral, dorsal, andlateral surface. Thearrangement of these points corresponded to theacupuncture meridians found inhumans. TheLSRPs were hypothesized to represent zones of autonomic concentration, thehigher electrical conductivity due to higher neural andvascular elements beneath thepoints. TheLSRPs gradually disappeared within 30minutes after theanimal’s death. Skin and muscle tissue samples were obtained byChanet al. (1998) from four anesthetized dogs. Acupuncture points, defined byregions of low skin resistance, were compared to control points, which exhibited higher electrodermal resistance. Thepoints were marked for later histological examination. Concentration of substance Pwas significantly higher at skin acupuncture points (3.33nglg) than at control skin points (2.63ng/g) that did not exhibit low skin resistance. Concentration of substance Pwas also significantly higher inskin tissue samples (3.33ng/g) thanin the deeper, muscle tissue samples (1.8ng/g}, Substance P isknown to be aspinal neurotransmitter found innociceptive afferent C-fibers (Kashiba & Veda 1991). I tplays arole inpaintransmission, stimulates contractility of autonomic smooth muscle, induces subcutaneous liberation of histamine, causes peripheral vasodilation, and leads to hypersensitivity of sensory neurons. This Theoretical perspectives 65 66 neurotransmitter seems to activate asomato-autonornic reflex that could account for theclinical observations of specific acupuncture points that areboth electrically active and tender to palpation. Experimentally induced changes inauricular reflex points inratswere examined by Kawakaita et al. (1991). Thesubmucosal tissue of the stomach of anesthetized rats was exposed, then acetic acid or saline was injected into the stomach tissue. Skin impedance of the auricular skin was measured byconstant voltage, square wave pulses. A silver metal ball, the search electrode, was moved over the surface of therat’sear andaneedle was inserted intosubcutaneous tissue toserve asthe reference electrode. Injection of acetic acid lead tothe gradual development of lowered skin resistance points on central regions of the rats’ ears, auricular areas which correspond to the gastrointestinal region of human ears. Innormal rats and inexperimental rats before the surgical operation, lowimpedance points were rarely detected on the auricular skin. After experimentally induced peritonitis, therewas asignificant increase inlow impedance points (0-100kilohms) and moderate impedance points (100-500kilohms), but adecrease inhigh impedance points (greater than 500kilohms). Histological investigation could not prove the existence of sweat glands inthe rat auricular skin. The authors suggested that the lowimpedance points areinfact related to sympathetic control of blood vessels. Brainactivity related to auricular stimulation: Theareas of the brainwhich have been classically related toweight control include two regions of the hypothalamus. Theventromedial hypothalamus (VMH) has been referred to asasatiety center. When the VMH islesioned, animals fail torestrict their food intake. Incontrast, the lateral hypothalamus (LH) isreferred to asa feeding center, since stimulation of the LH induces animals tostart eatingfood. Asamoto & Takeshige (1992) studied selective activation of the hypothalamic satiety center byauricular acupuncture inrats. Electrical stimulation of inner regions of the rat ear, which correspond to auricular representation of thegastrointestinal tract, produced evoked potentials inthe VMH satiety center, but not inthe lateral hypothalamic feeding center. Stimulation of more peripheral regions of the ear did not activate hypothalamic evoked potentials, indicating the selectivity of auricular acupoint stimulation. Only the somatotopic auricular areas near the region representing the stomach caused these specific brain responses. Thesame auricular acupuncture sites that led to hypothalamic activity associated with satiety led to behavioral changes infood intake. Auricular acupuncture had no effect on weight inadifferent set of ratswho hadreceived bilateral lesions of VMH. These results provide acompelling connection between auricular acupuncture and apart of thebrainassociated with neurophysiological regulation of feeding behavior. Insupport of thisevoked potential research, Shiraishi et al. (1995) recorded single unit neuronal discharge rates intheventromedial (VMH) and lateral hypothalamus (LH) of rats. Neurons were recorded inthe hypothalamus following electrical stimulation of low resistance regions of the inferior concha Stomach point. Auricular stimulation tended tofacilitate neuronal discharges in the VMH and inhibit neural responses inthe LH. Out of 162neurons recorded inthe VMH, 44.4%exhibited increased neuronal discharge rates inresponse to auricular stimulations, 3.7%of VMH neurons exhibited inhibition, and 51.9%showed no change. Of224neurons recorded inthe LH feeding center of 21rats, 22.8%were inhibited byauricular stimulation, 7.1%were excited, and70.1%were unaffected. When the analysis was limited to 12ratsclassified asbehaviorally responding toauricular acupuncture stimulation, 49.5%of LH units were inhibited, 15.5%were excited, and 35%were not affected byauricular stimulation. A different set of rats wasgiven lesions of theventromedial hypothalamus, which led to significant weight gain. Inthese hypothalamic obese rats, 53.2%of 111LH neurons were inhibited by auricular stimulation, 1.8% showed increased activity, and 45%were unchanged. These neurophysiological findings suggest that auricular acupuncture can selectively alter hypothalamic brainactivity and ismore likely to produce sensations of VMH satiety thanreduction of LH appetite. Fedoseeva et al. (1990) applied electrostimulation to the auricular lobe of rabbits, an area corresponding to thejawand teeth inhumans. They measured behavioral reflexes and cortical somatosensory evoked potentials inresponse to tooth pulp stimulation. Auricular electro acupuncture produced asignificant decrease inboth behavioral reflexes andin cortical evoked potentials to tooth pulp stimulation. Thesuppression of behavioral and neurophysiological effects byauricular electroacupuncture at 15Hzwas abolished by intravenous injection of the opiate antagonist naloxone, suggesting endorphinergic mechanisms. AuriculotherapyManual Naloxone did not diminish the analgesic effect of 100Hz stimulation frequencies. Conversely, injection of saralasin, an antagonist for angiotensin II, blocked the analgesic effect of 100Hz auricular acupuncture, but not 15Hz stimulation. Theamplitude of cortical potentials evoked by electrical stimulation of thehind limb was not attenuated bystimulation of theauricular areafor the trigeminal nerve. 2.6 Endorphin release byauricular acupuncture Thenatural pain relieving biochemicals known asendorphins areendogenous morphine substances which arefound inthepituitarygland and partsof the central nervous system (CNS). Enkephalin isasubfraction of endorphin, aneurotransmitter occurring inthebrainat the same sites where opiate receptors have been found. Both body acupuncture and ear acupuncture have been found toraise blood serum andcerebrospinal fluid (CSF) levels of endorphins and enkephalins. As stated intheprevious section, naloxone isthe opiate antagonist which blocks morphine, blocks endorphins, and also blocks the analgesia produced bythe stimulation of auricular reflex points andbody acupuncture points. Thediscovery byWen & Cheung (1973) that auricular acupuncture facilitates withdrawal from narcotic drugs has led to aplethora of studies demonstrating the clinical use of this technique for substance abuse (Smith 1988, Dale1993). Auricular electroacupuncture has also been shown to raise blood serum and cerebrospinal fluid (CSF) levels of endorphins andenkephalins (Sjolund & Eriksson 1976; Sjolund et a1. 1977; Wen et a1. 1978, 1979;Clement-Jones et a1. 1979) and beta-endorphin levels inmice withdrawn from morphine (Hoet a1. 1978; Nget aI. 1975, 1981). Pomeranz (2001) has reviewed the extensive research on the endorphinergic basis of acupuncture analgesia and has substantiated 17arguments tojustify the conclusion that endorphins have ascientifically verifiable role inthe painrelieving effects of acupuncture. Mayer et a1. (1977) were thefirst investigators toprovide scientific evidence that there isa neurophysiological and neurochemical basis for acupuncture inhumansubjects. Stimulation of the body acupuncture point LI 4produced asignificant increase indental painthreshold. Acupuncture treatment raised dental painthreshold by27.1%, whereas an untreated control group showed only a6.9%increase indental painthreshold. A total of 20out of 35acupuncture subjects showed increased painthresholds greater than20%, while only 5out of 40control subjects exhibited a20% elevation of pain threshold. Statistically significant reversal of this elevated pain threshold was achieved byintravenous administration of 0.8mgof naloxone, reducing the subject’s pain threshold to the same level asthat of acontrol group given saline. A double blind study byErnst & Lee (1987) similarly found that therewas a27%increase inpain threshold after 30minutes of electroacupuncture at LI 4. Theanalgesic effect induced byacupuncture inthat study was also blocked bythe intravenous injection of 0.8mgof naloxone. Contradictory findings with regard tothenaloxone reversibility of acupuncture analgesia have been suggested byChapman et a1. (1983). Differences inexperimental design could account for some of the discrepancies, but amore probable explanation for the contrasting findings maybe due tothe lowsample size employed inChapman et a1.’sresearch. Their study examined only 7 subjects inthe experimental group given naloxone and 7inthe control group given saline. While all 14subjects didexhibit significant analgesia with acupuncture stimulation at LI 4, they failed to obtain astatistically significant reversal inpainthreshold by 1.2mgof intravenous naloxone. The mean decrease intheelectrical current levels needed to evoke painwas 4.8/-LA after naloxone administration, but only 0.4/-LA for the control group administered saline. While themean change inpain threshold difference between groups was small, it might have reached statistical significance with alarger sample size. The aforementioned studies all obtained acupuncture analgesia with body acupoint LI 4. Simmons & Oleson (1993) examined naloxone reversibility of auricular acupuncture analgesia to dental pain induced inhumansubjects. UtilizingaStirn Flex 400transcutaneous electrical stimulation unit, 40 subjects were randomly assigned tobetreated at either 8auricular points specific for dental pain or at 8placebo points, ear regions which have not been related to dental pain. All subjects were assessed for tooth painthreshold byadental pulp tester at baseline, after auriculotherapy, and then again after double blindinjection of 0.8mgof naloxone or placebo saline. Four treatment groups consisted of trueauricular electrical stimulation (AES) followed byaninjection of naloxone, trueAES followed byaninjection of saline, placebo stimulation of the auricle followed Theoretical perspectives 67 68 byaninjection of naloxone, or placebo stimulation of the auricle followed byaninjection of saline. Dental pain thresholds were significantly increased byAES conducted at appropriate auricular points for dental pain, but were not altered bysham stimulation at inappropriate auricular points. Naloxone produced aslight reduction indental pain threshold inthe subjects given trueAES, whereas thetrueAES subjects then given saline showed afurther increase inpain threshold. The minimal changes indental pain threshold shown bythe sham auriculotherapy group were not significantly affected bysaline or bynaloxone. Research byOliveri et al. (1986) and Krause et al. (1987) has also demonstrated statistically significant elevation of painthreshold bytranscutaneous auricular stimulation, while Kitade & Hyodo (1979) and Lin (1984) found increased pain relief by needles inserted into theauricle. These earlier investigations of auricular analgesia didnot test for theeffects of naloxone. Direct evidence of theendorphinergic basis of auriculotherapy was first provided bySjolund & Eriksson (1976) andbyAbbate et al. (1980). Assaying plasma beta-endorphin concentrations in subjects undergoing surgery, they observed asignificant increase inbeta-endorphins after acupuncture stimulation wascombined with nitrous oxide inhalation, whereas control subjects given nitrous oxide without acupuncture showed nosuch elevation of endorphins. Pert et al. (1981) showed that 7-Hzelectrical stimulation through needles inserted into theconcha of the rat produced anelevation of hot platethreshold, ananalgesic effect that was reversed bynaloxone. Thebehavioral analgesia toauricular electroacupuncture was accompanied bya60%increase in radioreceptor activity incerebrospinal fluid levels of endorphins. This auricular-induced elevation inendorphin level wassignificantly greater thanwasfound inacontrol group of rats. Concomitant withthese CSF changes, auricular electroacupuncture depleted beta-endorphin radioreceptor activity intheventromedial hypothalamus andthemedial thalamus, but not theperiaqueductal gray. Supportive findings inhuman back pain patients was obtained byClement-Jones et al. (1980). Low frequency electrical stimulation of theconcha led torelief of pain within 20minutes of theonset of auricular electroacupuncture and anaccompanying elevation of radioassays for CSF beta-endorphin activity inall 10subjects. Abbate et al. (1980) examined endorphin levels in6 patients undergoing thoracic surgery with 50%nitrous oxide and 50Hz auricular electroacupuncture. They were compared to6control patients who underwent surgery with 70% nitrous oxide but noacupuncture. The auricular acupuncture patients needed less nitrous oxide than thecontrols and acupuncture led toasignificant increase inbeta-endorphin immunoreactivity. Extending thepioneering work of Wen & Cheung (1973) on thebenefits of auricular acupuncture for opiate addicts, Kroening & Oleson (1985) examined auricular electro acupuncture inchronic pain patients. Fourteen subjects were first switched from their original analgesic medication toan equivalent dose of oral methadone, typically 80mgper day. An electrodermal point finder was used todetermine areas of lowskin resistance for theLung point andthe Shen Men point. Needles were bilaterally inserted into these two ear points and electrical stimulation was initiatedbetween twopairs of needles. After 45minutes of electroacupuncture, thepatients were given periodic injections of small doses of naloxone (0’(l4mgevery 15minutes). All 14patients were withdrawn from methadone within 2to7days, for amean of 4.5days. Only afew patients reported minimal side effects, such asmild nausea or slight agitation. It wasproposed that occupation of opiate receptor sites bynarcotic drugs leads to theinhibition of the activity of natural endorphins, whereas auricular acupuncture facilitates withdrawal from these drugs byactivating the release of previously suppressed endorphins. Other biochemical changes also accompany auricular acupuncture. Debrecini (1991) examined changes inplasma ACTH andgrowth hormone (GH) levels after 20-Hz electrical stimulation through needles inserted into theAdrenal point on the tragus of the ears of 20healthy females. While GH secretions increased after electroacupunture, ACTH levels remained thesame. This research supported earlier work byWen et al. (1978) that auricular acupuncture led toadecrease intheACTH andcortisol levels associated with stress. Jaung-Geng et al. (1995) evaluated lactic acid levels from pressure applied toear vaccaria seeds positioned over theLiver, Lung, San Jiao, Endocrine, andThalamus (subcortex) points. Using awithin-subjects design, pressure applied to ear points produced significantly lower levels of lactic acid obtained after physical exercise on a treadmill test thanwhen ear seeds were placed over the same auricular points but not pressed. Stimulation of auricular pressure points reduced the toxic build-up of lactic acid to agreater Auriculotherapy Manual Box 2.4 Taoist dualities of hormones andneurotransmitters Yin sedating or nurturingneurochemicals Endorphin Melatonin Parathormone Estrogen and progesterone GABA Acetylcholine Serotonin Yang arousing neurochemicals f-----’-------=---------------:=------="-----------I Adrenalin Cortisol Thyroxin Testosterone Glutamate Norepinephrine Dopamine degree thanthecontrol condition. Thereduced lactic acid accumulation was attributed to improved peripheral blood circulation. As indicated inBox 2.4and Figure 2.25, the dualistic principles of Taoismcan beused to distinguish the arousing and sedating qualities of different hormones and different neurotransmitters. Thepituitary andtarget glands that release adrenalin, cortisol, thyroxin and testosterone all induce general arousal and energy activation. Incontrast, the hormones endorphin, growth hormone, parathormone, estrogen and progesterone all promote arelaxation response. The neurotransmitter glutamate produces excitatory postsynaptic potentials (EPSPs) throughout thebrain, while the neurotransmitter gamma-aminobutyric acid (GABA) produces inhibitory postsynaptic potentials (IPSPs) throughout thebrain. Norepinephrine isreleased by postganglionic fibers intheadrenergic sympathetic nervous system to activate general arousal, while acetylcholine isreleased bypostganglionic fibers inthecholinergic parasympathetic nervous system tofacilitate physiological relaxation. Inthebrain, dopamine tends toincrease motor excitation and intensely pleasurable feelings, while serotonin facilitates calm, relaxing feelings that facilitate sleep. 2.7 Embryological perspective of auriculotherapy As part of hisexamination of the neurophysiological basis of auriculotherapy, Paul Nogier (1983) proposed that nervous system innervations of theexternal ear correspond to thethree primary types of tissue found inthedeveloping embryo. Nogier theorized that the distribution of thethree cranial nerves which supply different auricular regions isrelated tothree embryological functions, theectoderm, mesoderm, andendoderm. Leib (1999) has referred to Nogier’s embryological perspective asthree functional layers, each layer representing adifferent homeostatic system in theorganism. Most health disorders arerelated todisturbances inall three functional layers. Relationship of auricular regions to nerve pathways: There areactually four principal nerves, which innervate the human ear. Figure 2.26shows thedistribution of different nerves todifferent auricular regions. Since the entireauricle iscovered with athin skin layer containing extensively branching nerves, all anatomical areas of theexternal ear areinpart related toectodermal tissue. Somatic trigeminal nerve: Thefifth cranial nerve ispart of the somatic nervous system pathway that processes sensations from theface and controls some facial movements. The mandibular division of the trigeminal nerve isdistributed across theantihelix and thesurrounding auricular areas of the antitragus, scaphoid fossa, triangular fossa andhelix. This auricular region represents somatosensory nervous tissue associated withmesodermal organs. Somatic facial nerve: The seventh cranial nerve isanexclusively motor division ’of the somatic nervous system, controlling most facial movements. I tpredominately supplies the posterior regions of the auricle that represent motor nerve control of mesodermal tissue. Autonomic vagus nerve: The tenth cranial nerve isabranch of theparasympathetic division of the autonomic nervous system. I tprocesses sensations from visceral organs inthe head, thethorax, andtheabdomen and itcontrols thesmooth muscle activity of theinternal viscera. Vagus nerve fibers spread throughout theconcha of the ear and represent neurons associated with endodermal tissue. Theoretical perspectives 69 A. Vagus nerve Cervical plexus Nerve Connections to the Auricle B. Auriculo-temporalis trigeminal nerve D. Minor occipitalis nerve of cervical plexus C. Auricularis nerve complex of vagus nerve, facial nerve, and glossopharyngeal nerve Figure 2.26 Cranial andcervical nervesaredistributed separately todifferent regions oftheexternal ear (A). Theauriculo-temporalis division ofthetrigeminal nerveprojects totheantihelix, antitragus andsuperior helix(B), thevagusnerveprojects tothecentral concha (C), andthe minor occipital nerveofthecervical plexusprojects totheear lobe(D). Thefacial andglossopharyngeal nervesalsoproject totheconcha, tragus andmedial ear lobe. (Reproduced fromNogier 1972. withpennission.) 70 AuriculotherapyManual Cerebral cervical plexus nerves: Thisset of cervical nerves affects neuronal supply to the head, neck and shoulder. Thelesser occipital nerve and thegreater auricular nerve of the cervical plexus supply the ear lobe, tragus, andhelix tail regions of the auricle. These auricular regions correspond toectodermal tissue. Auricular representation of embryological tissue: All vertebrate organisms begin astheunion of asingle egg and asingle sperm, but this one cell soon divides tobecome amulticellular organism as shown inFigure 2.27. This developing ball of cells ultimately folds inon itself and differentiates into thethree different layers of embryological tissue. I tisfrom these three basic types of tissue that all other organs areformed. Theorgans derived from these embryological layers areprojected on todifferent regions of theauricle. Table2.5outlines these embryological divisions andthe corresponding auricular regions. Endodermal tissue: The endoderm becomes thegastrointestinal digestive tract, the respiratory system and abdominal organs such asthe liver, pancreas, urethra and bladder. This portion of the embryo also generates partsof theendocrine system, including the thyroid gland, parathyroid gland, and thymus gland. Deep embryological tissue isrepresented intheconcha, thecentral valley of theear. Stimulating this areaof theear affects metabolic activities and nutritivedisorders of the internal organs that originate from theendoderm layer of theembryo. Disturbances ininternal organs create anobstacle tothesuccess of medical treatments, so these metabolic disorders must becorrected before complete healing can occur. Egg and sperm union Dividing embryo Multicellular embryo Embryo primary germ layers Mesoderm Endoderm - ¥ n ~ Ectodermal tissue Endodermal ---f’===\,--,--\-:--\’ tissue Mesodermal tissue Figure 2.27 Thedivision ofembryological cells leads toaball oftissue thatfolds inon itself tobecome thethree dermal layers ofthe endoderm, mesoderm andectoderm. These embryological tissue layers arerepresented on three different regions oftheauricle. (From Life AR1’’’, Super Anatomy, 'Lippincott Williams & Wilkins, withpermission.) Theoretical perspectives 71 Table 2.5 Auricular representation of embryological tissue layers Endodermal tissue Innerlayer Mesodermal tissue Middle layer Ectodermal tissue Outer layer Viscera Skeletal bones Skin Stomach Striatemuscles Hair Tendons Fascia andsinews Sweat glands ---------------------- Peripheral nerves Large intestines Small intestines Lungs Tonsils Ligaments Hearts andcardiac muscle Spinal cord Brainstem Liver Blood cells and blood vessels Thalamus and hypothalamus Pancreas Bladder Lymphatic vessels ----- Spleen Limbic system and striatum Cerebral cortex --- ----- ------- Thyroid gland Kidneys Pineal gland Parathyroid gland Thymus gland Gonads (ovaries and testes) Adrenal cortex Pituitarygland Adrenal medulla Ear lobe, helix tail andtragus Outer ridge Cervical plexus region Ear antihelix andantitragus ----- Middle ridge Trigeminal nerve region Ear concha Central valley Vagus nerve region ----- Mesodermal tissue: Themesoderm becomes skeletal muscles, cardiac muscles, smooth muscles, connective tissue, joints, bones, blood cells from bone marrow, thecirculatory system, the lymphatic system, the adrenal cortex and urogenital organs. Musculoskeletal equilibration is regulated bynegative feedback control of somatosensory reflexes. Middle embryological tissue is represented on the antihelix, scaphoid fossa, triangular fossa and portions of the helix. Mobilization of body defense mechanisms isonly possible if the region of the middle layer is working normally. Ectodermal tissue: Thesurface layer originates from theectoderm of theembryo. Theectoderm becomes theouter skin, cornea, eye lens, nose epithelium, teeth, peripheral nerves, spinal cord, brainand theendocrine glands of the pituitary, pineal andadrenal medulla. This embryological tissue isrepresented on theear lobe and helix tail. Thesurface embryological layer affects the capacity for adaptation andcontact totheenvironment. It reveals psychological resistance reactions not only from theconscious mind, but also from the unconscious, deep psyche. This layer integrates inborn instinctive information with individual learned experiences. 2.8 Nogier phases of auricular medicine Insubsequent revisions of the somatotopic representation on the external ear, Paul Nogier (Nogier 1983) has described different auricular maps thanthe inverted fetus pattern heoriginally discovered. These alternative auricular microsystems varied considerably from ealier descriptions of thecorrespondence between specific organs of thebody and the particular regions of the ear where they were represented. Each anatomical areaof theexternal ear could thus represent more thanone microsystem pattern. Nogier referred to these different representations asphases. The use of this termisanalogous tothe phases of the moon, just asthe same surface of themoon reflects different degrees of reflected light. A round, white ball of light isrevealed at thefull moon, asemicircle of light at the half moon, andadark round image at thenew moon. Thedifferent auricular phases also allude tophase shifts inthefrequency of light asit passes through acrystal prism tocreate different colored beams. Thesame whitebeamof light can besent at different angles through aprism to reveal blue light, green light or red light on the same reflected surface 72 Aur;culotherapy Manual Phase I pattern Images of Nogier phases Phase 1/ and1/1 patterns Phase IVpattern Different phases of refracted light Inversion of image by optical lens Bluelight Green light Red light Original image Inverted image Figure 2.28 Somatotopic images ofthedifferent phases on theear arecharacterized byan upside down man in Phase I, an upright maninPhase II, ahorizontal maninPhase III, andan inverted manon theposterior auricle in Phase I VThedifferent phases can besymbolized byshifts inthefrequency ofwhite light as itpasses through a crystal prism tocreate different colors ofrefracted light. Thefirst phase iscomparable totheinversion ofan image byaconventional optical lens. (Fig. 2.28). Different auricular regions revealed byspecific colored light filters were mapped using the Nogier vascular autonomic signal (N-VAS). Changes inthe N-VAS pulse response to stimulation of agiven region of theear were found to selectively vary withcolors of light. Nogier proposed that differences between Chinese andEuropean charts may have originated from this unrecognized existence of many reflex systems superimposed on the same areas of the auricle. Theoccurrence of more thanone ear point that corresponds toagiven body organ mayseem to contradict thegeneral proposition that there isasomatotopic pattern on theear. Precedence for this phenomenon isfound bythepresence of multiple somatotopic maps that have already been plotted inthebrainof different animal species. As depicted inFigure 2.29, there areat least two somatosensory systems on thecerebral cortex of rats, cats andmonkeys: aprimary and asecondary somatosensory cortex. There isalso athirdregion of theassociation cortex that interconnects somatic, motor and multisensory input. Multiple projection systems arealso found for thevisual andauditory cortex. These different cerebral cortex representations may not beresponsible for the phases that Nogier has described for the external ear, but they do indicate that thebrainitself has similar multiple microsystem arrangements. 2.8.1 Auricular territories associated with thethree embryological phases A basic reason that Nogier emphasized theoccurrence of the phases isthat hebelieved that each type of primary embryological tissue has acertain resonance frequency. The phase shifts in Theoretical perspectives 73 Motor cortex Somatosensory cortex area 1 74 Somatosensory cortex area 2 Figure 2.29 Therearemultipleprojections ofthebodyto thesomatosensory cortex in animals, possibly relatingtothedifferent somatotopic phases described byNogier. different anatomical regions of theear arerelated todifferential activation of thefrequency resonance of thecorresponding tissue of thebody. Tobetter indicate how theear microsystems reflect these resonant phase shifts, theauricle isfirst divided into three territories (see Figure 2.30). Thelocation of the three territories isbased upon their differential innervation bythree nerves. Thetrigeminal nerve supplies Territory 1, thevagus nerve supplies Territory 2, and the cervical plexus nerves supply Territory 3. InPhase I, Territory 1represents mesodermal and somatic muscular actions, Territory 2represents endodermal and autonomic visceral effects, and Territory 3represents ectodermal and nervous system activity. Theembryological tissue represented byeach territory shifts asone proceeds from Phase I to Phase II toPhase III, asshown inFigure 2.31. The number of each phase corresponds tothe region that represents mesodermal tissue. There is actually afourth territory and afourth phase, which has not yet been described. Thefacial nerve supplies the posterior regions of the auricle, Territory 4, and it issaid to represent motor neuron control of mesodermal somatic tissue. Theshifts of phase aresummarized inTable2.6. 2.8.2 Functional characteristics associated with different Nogier phases The three primary colors of light arered, green and blue. These same three colors were used to determine discordant resonance responses related to the three phases discovered byNogier. Red #25Kodak-Wrattan filters elicited Nogier vascular autonomic signals (N-VAS) identified with the first phase, green #58Kodak-Wrattan filters elicited N-VAS responses identified with thesecond phase, and blue #44A Kodak-Wrattan filters elicited N-VAS responses identified with the third phase. Nogier found that there areseveral reflex systems superimposed upon the auricle, but ear points could react tovarying depths of pressure. I fanear point produced an N-VAS response with firmpressure, greater than 120g/rnm-, itwas said tobelong tothe deep layer. Ear points reacting toonly 5g/mm? were attributed tothe superficial layer, whereas ear points reacting to an intermediate pressure of 60g/mm- belonged tothe middle layer. Thedeep layer indicates the somatotopic region of theear that isthe most prominent reason for asymptom. The location of the ear point can reveal if theproblem isdue to thesame body areawhere thepatient reports pain, if it isdue toreferred pain, or if it isdue toanemotional problem, such asdepression. Nogier found that ear points found at the deep layers were most related toPhase I, points discovered at the superficial layer were most related toPhase II, and ear points discovered at the middle layer were most related toPhase III. PhaseI: Theinverted fetus pattern isused totreat the majority of medical conditions and ismost inconcurrence with the Chinese ear reflex points. Phase I represents thetissues and organs of the actual physical body. This phase istheprimary source for correcting somatic tissue disorganization that istheprincipal manifestation of most medical conditions. FromaChinese medical perspective, Phase I ear points indicate acute, yang excess reactions. Auriculotherapy Manual Territory1 f:J--’--r---E3LTerritory 2 Territory3 Figure 2.30 Nogier described threedifferent territories oftheauricle whicharerelated tothreedifferent phases that correspond todifferent somatotopic representations. Phase I Embryological phase shifts on auricle Phase /I Phase 11/ Mesodermal Ectodermal Endodermal Ectodermal Figure 2.31 Somatotopic correspondences shift withthethreeNogier phases between auricular Territory 1, Territory 2,and Territory 3. Table2.6 Shifts of Nogier phase on the external ear Territory 1 Territory 2 Territory 3 Dominant Depth of Antihelix area Concha Lobeand tragus color ear point Phase I Mesodermal Endodermal Ectodermal Red Deep layer --------_...- ---------- Phase II Ectodermal Mesodermal Endodermal Green Superficial layer Phase III Endodermal Ectodermal Mesodermal Blue Middle layer Theoretical perspectives 75 76 Phase II: Theupright man pattern isused totreat more difficult chronic conditions that have not responded successfully to treatment of the Phase I microsystem points. Phase II represents psychosomatic reactions and neurophysiological connections tobodily organs. This phase isuseful for correcting central nervous system dysfunctions and mental confusion that contribute to the psychosomatic aspects of pain and pathology of chronic illnesses. Phase II points aresaid to be related toyin degenerative conditions. Phase III: Thehorizontal man pattern isused the least frequently, but it can bevery effective for relieving unusual conditions or idiosyncratic reactions. Phase III affects basic cellular energy, and can correct theenergy disorganization that affects cell tissue. I tproduces subtle changes inthe electromagnetic energy fields which surround individual cells andwhole physical organs. Phase III points aresaid toindicate prolonged, yang excess, inflammatory conditions. Phase IV: Thesecond upside down manpattern isrepresented on the posterior side of the external ear andisessentially thesame microsystem represented by Phase I. The Phase IV points areused to treat muscle spasm aspects of acondition, whereas Phase I points indicate sensory aspects of pain. Both Phase I andPhase IV relate toacute pain or ongoing pathological reactions, whereas theother twophases appear with chronic pain. Phase IV ismost related to mesodermal muscular tissue represented on Territory 4, theposterior side of theauricle. 2.8.3 Relationship of Nogier phases totraditional Chinese medicine Nogier proposed histhree phases partly asanattempt toaccount for some of thediscrepancies between the European and theChinese ear acupuncture charts. Practitioners of auricular medicine suggest that thesomatotopic points described byNogier represent the actual physical organs, whereas theChinese ear points may relate to neurological or energetic connections to these organs. Thedifferent anatomical localizations on theear for theKidney, Spleen andHeart points areanexample of thisview. Nogier placed these three mesoderm-derived organs on the mesodermal region of the internal helix and theantihelix, whereas the Chinese ear charts show these same three organs on theendodermal region of thesuperior and inferior concha. The concept that themesodermal organs shifted from theantihelix totheconcha was awayof accounting for thisdivergent representation. Some of the uses of the Kidney point andtheHeart point inChinese acupuncture areoften more related to their zang-fu energetic effect thantheir biological function. Taoismdescribes theflow of qi energy from various states of yang energy and yinenergy, which can becompared tothebinary code used incomputers and to the active and resting states of aneuron. The Chinese symbolized yang asasolid lineandyin asabroken line: various combinations of threesuch lines formwhat isknown asatrigram. Helms (1995) has cited thework of theFrench acupuncturist Maurice Mussat inpresenting eight such trigrams rotating around theyin-yang symbol. Theyang trigrams arediametrically opposite totheir corresponding yin trigram. Each trigramcode reflects aspecific interaction of three basic components of the universe: matter, movement andenergy. From atripartitephase perspective, Nogier’s Phase I represents solid matter, Phase II represents thecontrol of movement bythe nervous system, and Phase III represents theecho reverberation of theenergy of thespirit. Disturbance of thedynamic symmetry of composition of these three functional interactions can result inanimbalance of energy. Dr Richard Feely of Chicago has suggested that these three energy states inChinese philosophy can becompared toNogier’s three microsystem phases. Sequential shifts in interactions from theinitial yang reactions manifested inPhase I, tothechronic degenerative states of Phase 11, tothe resonance reverberations of Phase III aredepicted inthetrigrampatterns inFigure 2.32. 2.9 Integrating alternative perspectives of auriculotherapy Therehas been great interest bysome investigators of alternative andcomplementary medicine in continued neurophysiological research that aims toprovide amore scientific basis for acupuncture and auriculotherapy. Thediscovery of endorphins inthe1970sprovided abiochemical mechanism which could account for the amazing observation that injecting theblood or cerebrospinal fluid from one laboratory animal toanother could also transfer the analgesic benefits of acupuncture to thesecond animal. Thesame neuroanatomical pathways that have nowbeen shown to underlie the descending pain inhibitory systems producing opiate analgesia also affect acupuncture analgesia, thereby providing aphysical foundation for acupuncture. ThefMRI studies of the human brain Auriculotherapy Manual Circular shifts in Chinese trigrams Maximum yang Yang symbol = Yin symbol = __ Greater yang Taiyang -- Middle yang Yang ming -- -- -- Lesser yang Shao yang -- -- -- Maximum yin Lesser yin [ue yi n -- Middle yin Shao yin -- -- -- -- Greater yin Tai yin Binary progression of trigrams -- 0 000 -- Maximum yin 001 Greater yin -- 2 010 - Middle yin 3 011 - Lesser yin -- 4 100 -- Lesser yang -- 5 101 Middle yang 6 110 Greater yang 7 111 Maximum yang Counter-clockwise shifts in auricular phases Upright man Breath oflife Phase I Phase II Horizontal man Phase III Phase IV ~ Invertedman ......I ------iI I E------1Phase III Qi ~ Phase I Inverted fetus Figure 2.32 Thecircular progression ofyin andyang relationships of Chinese trigrams are compared tothe different Nogier phases inauriculotherapy. The numeric, binary progression oftrigrams islistedfrom maximumyin tomaximumyang. demonstrate neural changes that depend upon stimulation of aparticular acupoint on thebody or on theear. At thesame time, many practitioners of the field of traditional Oriental medicine maintain adeep belief intheenergetic principles thatwere developed inancient times. Whether viewed asaself-contained micro-acupuncture system, aconduit to macro-acupuncture meridians, ashi points, trigger points, chakra centers, or even the quantumphysical explanations of holograms, there isreason tosuggest that anunconventional energy profoundly affects the healing effect of auricular acupuncture aswell asbody acupuncture. Western scientists seem toprefer the neurophysiological perspective, while those trained inOriental medicine more readily accept an energetic viewpoint. Theoretical perspectives 77 78 Thedifferences between the information processing styles of the left andright hemispheres of the cerebral cortex allow for this yin-yang duality. TheWestern mind prefers the rational order of the left side of the neocortex, with itsconscious ability to analyze details andcome to logical conclusions, whereas the Oriental mind seems toaccept the holistic perspective of the right side of theneocortex, which allows for the interactive relationship of all things. What isneeded to comprehend auriculotherapy isacorpus callosum which can integrate both perspectives as complementary viewpoints of avery complex system. This duality of Western and Chinese perspectives has also altered the ear acupuncture charts that have developed inAsia and Europe. After Nogier first discovered the inverted fetus map on the ear inthe 1950s, subsequent investigations of the inverted auricular cartography took divergent paths inEurope and China. While there isgreat overlap inthe corresponding points shown inthe Chinese and European auricular maps, there arealso specific differences. There isatendency bymany individuals tofeel the need tochoose one system over the other. Inmydiscussions on thesubject, I have promoted the acceptance and integration of both systems asclinically valid and therapeutically useful. I tseems paradoxical that two opposite observations could both becorrect, but such isthe naturein many parts of life, including our current view of subatomic particles. I tisprobably thearrogance of left brain thinking tosuggest that there isonly one truth. At the 1999meeting of the International Consensus Conference on Acupuncture, Auriculotherapy, and Auricular Medicine (ICCAAAM), I cited thework of agreat English author who hascommented on this paradox. Thefirst lineof Rudyard Kipling’s classic Theballad ofeast andwest iswell known, but the rest of theverse has even greater relevance to the understanding of the different theoretical views of auriculotherapy. Oh, East isEast, and West isWest, andnever thetwain shall meet, Till Earth andSky stand presently at God’s great J udgment Seat; But there isneither East nor West, nor Border, nor Breed, nor Birth, When two strong menstandface toface, tho’ they come from theends oftheearth. Auriculotherapy Manual I I Anatomy of t heauricle Aswith ot her areas of humananatomy, t hereare specific termsfor identifying opposi ng di recti ons of theear and for i ndi cati ngalternati ve perspectives. Because ot her texts on thetopi c of auri cular acupuncturehave used avariety of di fferent termsto descri be thesameregi ons of the ear, this section will define theanatomi cal termsused in thismanual . Takingthe time to l earn the convoluted structureof t heauricle facilitates adeeper underst andi ngof thecorrespondi ng connecti onsbetween specific regions of the ear to specific organsof t hebody. CONTENTS 3.1 Thespiral of life 3.2 Neuro-embryological innervations of the external ear 3.3 Anatomical views of the external ear 3.4 Depth view of the external ear 3.5 Anatomical regions of the external ear 3.6 Anatomical regions of the posterior ear 3.7 Curving contours of the antihelix and antitragus 3.8 Somatotopic correspondences to auricular regions 3.9 Determination of auricular landmarks 3.10 Anatomical relationships of auricular landmarks 3.11 Standard dimensions of auricular landmarks 3.1 The spiral of life Theear consists of aseries of concentri ccircles t hat spi ral from thecent er of the auri cle to aseries of curving ridges and deep valleys t hat spread outwardslike an undul ati ngwave. This confi gurati on isvery si mi lar to the ringsof water waves t hat radi ateout from asplash on apond. Such an image isdepi cted in Fi gure3.1. Soundwaves are si mi lar to waves on water, consisting of oscillating i ncreases t hendecreases in t hecompressi on of air molecules. Theexternal ear isshaped like afunnel to di rect thesesubtle moti onsof air into the ear canal. Focused sound waves then vi brate agai nst theeardrumlike abaton poundi ngagai nst abass drum. Aft er being amplified by Figure 3.1 Concentricringsofwater wavessymbolizetheoscillation ofsound wavestowhich theextemal ear conformsinringsofridgesand crevices. (Reproduced withpermissionfrom Reikifire, Calgary, Canada.) Anatomyof theauricle 79 B D Figure 3.2 Spiral imagesinnaturethat reiterate theshapeoftheauricleincludethedoublehelixofDNAstrands(A), theswirl ofcl oud [ ormations inahurricane(B), thespiralingcochleaoftheinner ear (C) and thecircular shapeofthecurvingembryo(D). (Fig. 3.2C reproducedfrom Sadler 2000Langman’.I ’Medical Embryology8edn, withpermissionfromLippincott Williams& Wilkins.) t heseri al acti vati on of t heossicle bonesof t hemi ddl eear, t hesound si gnal generat esa traveli ng wave t hat producesdefl ecti ons in t hebendi ngof membraneswi thi n t hesnai l - shaped i nner ear. Thebasic shapeof bot ht hei nner ear and theexternal ear rei teratest hespiral pat t ernt hat isa common archetypal symbol. Di fferent examples oft hi sspiral image areshown in Fi gure3.2, from t he doublehelix shapeof the DNAmolecule, to theswirl of cloud formati ons, to thecurving embryo. The Lati nword for theshapeof aspiral ishelix.Just ast hereare two spi rali ng helices which form the structureof DNA, thereare two helices for theauricle, an out er helix andan opposi ng antihelix. The ot her common pat t ernwhich isrepresent ed on theear ist hat of asea shell, and t het ermfor thedeep central regi on of theauricle istheconcha, which isLati nfor shell. Fromthedi fferent sea shells i ndi cated in Figure3.3, onecan recognize abasic spiral shapecommon to all of them. I n Thespiral of life, Michio Kushi (1978) hassuggested t hat thisspiraling pat t ernrelates to thecosmic order of the universe asseen from Ori ental medi ci ne, whereasfollowers of ayurvedic medi ci neemphasi zethe symbol of t hecoiled serpent. Theundulati ngimage of t hetwocobrasrepresent stherise of kundali ni forces of theidaand pi ngalaspiraling aroundthesushumnato energi ze theseven pri mary chakras. 80 AuriculotherapyManual Figure 3.3 Seashellsthat repeat thespiral patternoftheexternal ear. Thehelix-shaped, spiral tipsand theconcha-shaped, central crevices are I’ery distinctiveinthetwolarge conch shells, Figure 3.4 Cellular budsofthedevelopingembryo transformintotheexternal ear duringfetal development. Sixnoduleson theembryo migrate10 sixdifferentpositionsthat becometheauricle. Anatomyof theauricle 81 3.2 Neuro-embryological innervations of t he external ear Thebiological lifeof the humanembryo begins asthe uni on of cells t hat divide and multiply into a complex ball of embryoni c tissue. Theauri cle of theear resultsfrom thecoalescence of six buds which appear on the40th day of embryoni c development. Shown in Fi gure3.4isarepresent at i on of thecellular buds t hat transform into theexternal ear duri ngthefourth mont hof fetal development. Thesefetal buds are theexpression of mesenchymal prol i ferati on of thefirst two branchi al arches t hat subsequently develop into thecrani al nerves t hat ulti mately i nnervatethe auricle. Thesuperi or regi ons of theauri cle are i nnervated by the auri cul ar- t emporal branch of the mandi bul ar trigeminal nerve. Theconchaisi nnervated by the auri cul ar branch of thevagus nerve. A thi rdregi on issuppli ed by thelesser occipital nerve and thegreat auri cul ar nerve, bothbranches of thecervical plexus. Theseventh crani al nerve which regulates facial muscles sendsneuronal connecti onsto theposteri or side of the auricle. Bossy (1979) hassummari zed thestudi eswhich del i neatethet hreeterri tori esof the auricle. The superi or somestheti c regi on isi nnervated by thetri gemi nal and sympatheti c nerves, acentral visceral regi on isi nnervated by theparasympatheti cvagus nerve, and al obul ar regi on isi nnervated by thesuperficial cervical plexus. Thel obul ar area has no pronounced autonomi cnerve mani festati on. Thedi fferenti al di spersement of crani al nerves provi des an embryologi cal basis for thefuncti onal divisions between specific auri cular regi ons and correspondi ngpart sof thegross anatomy. Thesomatosensory tri gemi nal nerve i nnervates cut aneousand muscul ar regi ons of the actual face and also supplies theregi on of the auricle t hat correspondswith musculoskeletal functions. Theautonomi cvagus nerve i nnervates thoraci c and abdomi nal visceral organs and also Anteri or vi ew Superior Mi dli ne Superior Rightear t I t Leftear Rightear Leftear Peripheral Central Central Peripheral ....-- -------. ....-- -------.. Lateral Lateral ....-- -------.. I nferi or Medial Medial I nferi or ------.. ....-- Superior Superior Leftear Posteri or vi ew t Rightear Medial Medial -------.. ....-- Peripheral Centra l Central Peripheral ....-- -------.. Leftear Rightear ....-- -------.. Lateral Lateral + I nferi or I nferi or Figure 3.5 Anatomical perspectives ofthehead and theexternal ear inanterior and posterior surface views. Thesuperior, inferior, central and peripheral directionsoftheauricleareindicatedrelative toeach other. 82 AuriculotherapyManual supplies t hecentral regi on of theauricle associated with i nternal organs. Theconchaof theear is theonly regi on of thebody wherethevagus nerve comes to thesurface of theskin. Thecervical plexus nerves regulatebl ood supply to thebrai n and are associ ated with di encephali c and telencephali c brai n centersrepresented on thei nferi or ear lobe. Whileit seems logical t hat theauricle ispart of theaudi tory pathway, exami nati on of ot her animal species shows that theexternal ear isnot only used for thefunction of hearing. Bossy (2000) has observed t hat theears of animals are used to protect agai nst theel ementsand against predators. Thedesert hare, desert fox and desert mouseall havevery large auricles compared to thei r non› desert relatives, thepurposeof which isto facilitate heat loss throughtheskin over theears. African el ephantst hat live in thehot plains have larger ears than I ndi an elephantsfor asimilar purposeof heat exchange. Theseries of electroconducti ve poi ntst hat have been identified on the shaved skin of rodentssuggest that theoccurrence of body acupoi nts and ear poi ntsmay relate to thelateral line system offi sh. Thissame system bywhich fish sense t hesubtlemovementsof water may provi de theevoluti onary foundati on for acupuncturepoi ntson thebody and t heear. 3.3 Anatomical views of the external ear Torefer to any object in threedimensional space, theremust be certai n poi ntsof reference. Asa complex convoluted structure, theauricle must beviewed from di fferent angles and from di fferent depths. Specific terms will beused to i ndi catethesedi fferent perspecti ves of theear which are i ndi cated in Fi gure3.5. Surface view: Thefront side of theexternal ear iseasily available toview. Theauricle is diagonally angled from theside of theskull such t hat it extends from bot hthe ant eri or aspects and thelateral sides of thehead. Hiddenview: Vertical or underlying surfaces of t heexternal ear are not easy to view, thus the auricle must bepulled back by retractorsin order to reveal the hi dden regions. Posterior view: Theback side of theexternal ear faces themastoi d bonebehi ndtheear. External surface: I nternal surface: Superior side: I nferior side: Central side: Peripheral side: Thehigher regionsof theexternal ear form theexternal surface view. Thevertical or underlying surface regionsof theear form the hi ddenview. Thetop of theear isdi rected toward theupper or dorsal position. Thebottomof theear isdi rected toward thelower or ventral position. Themedial, proximal side of theear isdi rected inward toward the midline of thehead. Thelateral, distal sideof theear isdirected outwardfrom themidlineof thehead. 3.4 Depth view of the external ear Because two-dimensional paper can not adequately represent thethree- di mensi onal depthof the auricle, certai n symbols have been developed to represent changesin depth. I fone were to think of the rising and falling swells of awave or the ridges of ahill, thetop of thepeak isthe highest position, i ndi cated by an open circle, thedescending slope isi ndi cated by asquare, and thelowest depthsare shown as afilled circle. I n Fi gure3.6, thedeeper, central conchacontai nsareas represented by filled circles, thesurroundi ngwall of t heconchaisrepresent ed by squares, and the peaksof t heantihelix and anti tragusare shown with open circles. Raised ear point: Regionsof theear which are elevated ridges or are flat surface protrusi ons. Representedbyopen circle symbols. 0 Deeper ear point: Regions which are lower in theear, like agroove or depressi on. Represented bysolid circle symbols. Hiddenear point: Regions of theear which are hi ddenfrom view because they are perpendi cul ar to thedeeper, auri cular, surface regionsor they are on the i nternal, undersi deof theauricle. Some texts use abroken circle symbol to represent thesehi ddenpoints. Represented bysolidsquaresymbols. Posteri or ear point: Regionsof theback side of theear t hat face toward themastoi d bone. Represented byopensquaresymbols. 0 Anatomyof theauricle 83 Surface view of l eft ear I nferior Raised ...... ...... ... . .. ... U.. ,.,.;.•.11;!//U// Deeppoint - e ./// i .... t m i i / Superior 1 - - - +› Peripheral External surface surface Hiddenview of l eft ear I nferior Superior › Peripheral 84 Figure3.6 A depthviewoftheear withthesymbolsusedtorepresent raised regions(0), deepregions(e), and hiddenregions (_) oftheauricle. 3.5 Anatomical regions of t he external ear Classi c anat omi cal texts have present ed specific anat omi cal t ermsfor cert ai n regi ons of the ext ernal ear. Thi sappendageisalso known as t hepi nnaor auri cle. Lat i nt ermswere used to descri be desi gnat ed regi ons of t heear as well as speci fi c t ermst hat were devel oped at t hemeet i ngs of t heWorl dHeal t hOrgani zat i onon acupunct urenomencl at ure. Someregi ons of t heext ernal ear are descri bed in auri cul ar acupunct uretexts, but are not di scussed in convent i onal anat omy books. Theofficial t ermsfor t heexternal ear t hat were descri bed in t heNomi naanatomi ca (I nt ernat i onal Congressof Anat omi st s1977) i ncl uded 112 di fferent t ermsfor t hei nt ernal ear (Auri s i nt erna), 97 t ermsfor mi ddl eear (Auri smedi a), but only 30 t ermsfor t heext ernal ear (Auri s ext erna). The ni nepri mary auri cul ar st ruct urest hat were i dent i fi ed in Woerdeman’s(1955) classi c anat omy text i ncl uded t hehelix, anti heli x, tragus, ant i t ragus, fossa tri angul ari s, scapha, l obul e, conchaand Darwi n’st ubercl e. Thereare two addi t i onal subdi vi si ons for t hel i mbsof t heanti heli x, t hesuperi or crus and t hei nferi or crus, and two subdi vi si ons of t heconcha, asuperi or cymba conchaand an i nferi or cavum concha. Del i neat i onof t heant i t rago- hel i ci nefissure, which separat es t he ant i t ragusfrom t heanti heli x, bri ngst het ot al to 14auri cul ar t ermsfor t hel at eral view of t he auri cl e and 12addi t i onal t ermsfor t hemast oi d view of t heear. Subsequent anat omy books, such as Hi l d’s(1974) Atlasofhumananatomy or Cl ement e’s(1997)Anatomy: a regional atlas ofthehuman body, basi cally concur wi th t heseearl i er desi gnat i onsfor t heext ernal ear. Anat omi st si nt erest ed in auri cul ar acupunct urehave t husconsi dered suppl ement al t ermi nol ogy to del i neat e t hest ruct ures of t heauri cl e t hat are used in t hecli ni cal pract i ce of auri cul ot herapy. Theout er ri dgeof the auri cl e isreferred to as t hehelix, whi ch ist heLat i nt ermfor a spi ral pat t ern. A mi ddl eri dgewi thi n thi sout er rim iscal l ed t heanti heli x. Thehelix issubdi vi ded i nt oacent ral helix root, an archi ngsuperi or helix, and t heout ermost helix tail. Thecauda, or tail, refers to a long. trai l i ng hi ndport i on, like t hetail of acomet . Thesubsect i ons of t heanti hel i x i ncl ude an anti heli x tail at t hebot t omof the mi ddl eri dge, an anti hel i x body in t hecent er, and two li mbs t hat extend from t heanti hel i x body, the superi or crus and t hei nferi or crus. A fossa in Lat i nrefers to a Auricu{otherapyManual fissure, or groove. Between thetwolimbsof theantihelix lies asloping valley known asthe tri angular fossa, whereas t hescaphoid fossa isalong, sl ender groove t hat separates the hi gher ridges of theantihelix from the helix tail. Adjacent to theface and overlying theaudi tory canal isaflat section of theear known asthe tragus. Opposi teto thetragusisanot her flap, labeled theantitragus. Thel atter isacurving conti nuati onof theantihelix, forming aci rcular ridge t hat surroundst hecentral valley of theear. A promi nent crease separates theantihelix from theanti tragus. Below theanti tragusisthesoft, fleshy ear lobe, and between theanti tragusand thetragusisaV- shapedcurve known asthe i ntertragi cnotch. Thedeepest region of theear iscalled theconcha, i ndi cati ngitsshell-shaped structure. Theconchaisfurther divided into an i nferi or conchabelow and asuperi or concha above. Whilemost anatomi cal texts (Cl emente1997; Woerdeman1955) respectively refer to these Superior helix Anti heli x superior crus Anti heli x i nferi or crus Anti heli x body Helix t ai l Helix root Tragus Anti heli x t ai l I ntertragic notch I nferi or concha I nternal helix Figure 3.7 Termsusedfor specificanatomical regionson theexternal ear: helix, antihelix, tragus, antitragus, triangular fossa, scaphoidfossa, superior concha and inferior concha. Anatomyof theauricle 85 86 two areas as thecymba conchae and the cavum conchae, the 1990nomencl at urecommi t t eeof the World Heal t hOrgani zati on(WHO1990a) concl uded t hat superi or conchaand i nferi or concha were more useful desi gnati ons. Thesetwo major divisions on the conchaare separat ed by aslight mound. Thisprol ongati onof the helix ont otheconchafloor isi denti fi ed in thistext as theconcha ridge. A vertical elevati on t hat surroundsthewhole conchafloor has been desi gnated ast he conchawall. Thishi ddenwall area of t heauri cle isnot i denti fi ed in most anatomi cal texts. Two ot her hi dden areas of the external ear i ncludet hesubtragusunderneat hthe tragus and the i nternal helix beneat h the helix root and superi or helix. On theback side of theear isawhole surface referred to as t hepost eri or side of t heauricle. I t lies across from the mastoi d boneof theskull. Thisregi on issubdi vi ded i nt oapost eri or groove behi nd theanti heli x ridge, apost eri or lobe behi nd the ear lobe, apost eri or conchabehi nd t hecentral concha, aposteri or tri anglebehi ndthetri angul ar fossa, and thepost eri or peri phery behi ndthe scaphoi d fossa and helix tail. Takingthe time tovisually recogni ze and touch thesedi fferent contoursof theear assists practi ti onersof auri cul otherapy in underst andi ngthesomat ot opi c correspondences between the external ear and specific anatomi cal structures. Di agramsof specific anatomi cal regions of t heauri cle are shown in Fi gure3.7. Earcanal (audi tory meatus): Thefunnel - shaped orifice t hat leads from the external ear to the mi ddleear and i nner ear isan elliptical oval t hat separat es t hei nferi or conchafrom the subtragus. Helix: Thisoutermost, ci rcular ridge on the external ear provi des afolded, carti lagi nous rim around t heauricle. I t looks like aquesti on mark (?). Helixroot: Theinitial segment of the helix ascends from thecent er of the ear up toward t he face. Superi or helix: Thehi ghest secti on of thehelix isshaped like abroad arch. Helixtail: Thefinal regi on of the helix descends vertically downward along t hemost peri pheral aspect of t heear. Antihelix: ThisY- shapedridge is’ant i ’ or opposi teto the helix ri dge and forms an i nner, concentri c hill t hat surroundsthecentral conchaof t heauricle. Superi or crus of t heantihelix: Theupper arm and vertical extensi on of the antihelix. I nferior crus of t heantihelix: Thelower arm and hori zontal extensi on of the antihelix. This flat-edged ridge overhangs thesuperi or conchabelow it. Antihelix body: A broad sloping ri dge at thecent ral thi rdof t heantihelix. Antihelixtail: A narrow ridge at t hei nferi or t hi rdof the antihelix. Tragus: Thetragusof the auri cle isavertical, trapezoi d shaped areajoi ni ng t hecar to the face, projecti ngover theear canal. Antitragus: Thisangl ed ridge is’ant i ’ (opposi teto) t hetragust hat rises above t helowest port i on of t hei nferi or concha. I t has adi sti nct groove that separat es the anti tragusfrom t heanti heli x tail above it and aless di sti nct crevice where the anti tragusmeetst hei ntertragi cnotch below it. I ntertragi cnotch: This U- shapedcurve superi or to t hemedi al ear l obe separat es the tragusfrom the anti tragus. l obe: Thissoft, fleshy tissue isfound at the most i nferi or part of t heexternal ear. Scaphoid fossa: A crescent - shaped, shallow valley separati ng the helix and the antihelix. ’Fossa’ refers to afissure, groove, or crevice, whereas ’scaphoi d’ refers to t hescaffolding used to form theout er structureof aboat or bui ldi ngwhile it isunder constructi on. Triangular fossa (navi cular fossa): Thistri angul ar groove separat es thesuperi or crus and the i nferi or crus of the antihelix. I t isshaped like an arch on t hewi ndow of aGot hi ccathedral . Concha: A shell- shaped valley at thevery cent er of t heear, concharefers to t heconch sea shell. Superi or concha: Known as thecymba concha in classical anatomi cal texts, t heupper hemi conchaisfound i mmedi ately below the i nferi or crus of t heantihelix. AuriculotherapyManual Concha Concha wal l Posterior concha Cutaway viewofposterior ear Anti hel i x Posterior groove Posterior tri angl e Posterior groove Posterior lobe I CLl - U- - - -Posterior concha Posterior peri phery ----".. Figure 3.8 Termsused toidentifyspecificareas oftheposterior regionsoftheexternal ear. I nferi or concha: Formally known as thecavum concha in classical anatomi cal texts, the lower hemi conchaisfound i mmedi atel y peri pheral to t heear canal. Concha ridge: This rai sed ridge divides t hesuperi or conchafrom t hei nferi or concha. I t ist he anat omi cal prol ongat i on of the helix root ont ot heconchafloor. Concha wall: Thehi dden, verti cal regi on of the ear rises up from the conchafloor to the surroundi nganti heli x and anti tragus. Theconchawall adj acent to t heanti heli x isacurving, verti cal surface which rises from t hefloor of theconchaup to the anti heli x ri dge. Theconcha wall adj acent to t heanti tragusisaverti cal regi on underneat hthe anti tragusri dge t hat l eans over the lower i nferi or conchafloor. Subtragus: Thisundersi deof the tragusoverli es t heear canal. I nt ernal helix: Thishi dden, undersi deport i onoft hebri mof t hehelix spi rals from the cent er of the helix to the t opof t heear and aroundto the helix tail. 3.6 Anatomi cal regions of t he posterior ear (Fi gure3.8) Posterior lobe: Thi ssoft fleshy regi on behi nd t helobe occurs at thebot t omof t hepost eri or ear. Posterior groove: A long vertical depressi on along thewhole back of theposteri or ear which lies i mmedi ately behi ndtheY- shapedantihelix ridge on thefront side of the auricle. Posterior tri angle: Thesmall superi or regi on on t hepost eri or ear whi ch lies bet ween the two armsof t heY- shapedpost eri or groove. Posterior concha: Thecentral region of theposteri or ear found i mmedi ately behi ndtheconcha. Posterior peri phery: Theout er, curved regi on of the post eri or ear behi ndt hehelix and the scaphoi d fossa. I t lies peri pheral to t hepost eri or groove. 3.7 Curving contours of t he anti heli x and antitragus Thecont oursof theear have di fferent shapes at di fferent levels of the anti heli x and t heanti tragus astheconchawall rises up to meet them. Thesedi fferences in cont our areuseful in distinguishing Anatomyof theauricle 87 Depth vi ew of auricle Contours of t he anti hel i x and anti tragus Antihelixinferior crus Superior concha Antihelixbody Concha wal l Superior concha Antihelixtail I nferi or concha Tri angular fossa Scaphoid fossa Antitragus Concha l ~ \ \ I nferi or concha ~ 88 Figure 3.9 A depth view showschanges in thecurving contoursoftheanti heli x descendi ngfrom theinferior crus to theanti heli x body, antihelix tail and antitragus. AuriculotherapyManual different anatomi cal features on theear which relatetodi fferent correspondences tobody regions. Thesedepthviews are presented inFi gure3.9. Dept h vi ew of the i nferi or crus of anti heli x: At thislevel of theantihelix, theconchawall exhibits asharp overhang beforeit curves back underneat hand t hendescends down into the superi or concha. Thei nferi or crus itself issomewhat flat, beforegradually descendi ng into the tri angular fossa. Thetop surface of thissection of the antihelix correspondsto the lumbosacral vertebrae, whereas theconchawall below it represents thesympatheti c nerves affecting bl ood supply to the lower spine. Depth vi ew of the ant i hel i x body: At thislevel of theantihelix, theconchawall exhibits agradual slope before it descends down into the superi or concha. Theanti heli x body islike abroad, gentl e moundbefore it curves down peri pherally into thescaphoi d fossa. Theconchaside of this section of theantihelix correspondsto thethoraci c spine, whereas t heconchawall below this regi on representsthesympatheti c nerves affecting bl ood supply to t heupper back. Depth vi ew of t he ant i hel i x tail: At thislevel of theantihelix, theconchawall exhibits asteep slope before it descends down into the i nferi or concha. Theanti heli x tail islike along narrow ridge beforeit curves down peri pherally into thescaphoi d fossa. Theconchaside of thisi nferi or section of the antihelix correspondsto thecervical spi ne, whereas t heconchawall below this regi on representsthesympatheti cnerves affecting bl ood supply to the neck. Depth vi ew of t he antitragus: At thislevel of theanti tragus, theconchawall forms an angled vertical wall, which curves downward from theanti tragusto the i nferi or concha. Theanti tragus correspondsto theskull, whereas theconchawall representsthethal amusof thebrai n. 3.8 Somatotopic correspondences to auricular regions I n auriculotherapy, an active reflex poi nt isonly detectedwhen thereispathology, pain or dysfunction inthecorrespondi ngpart of thebody. I fthereisno bodily problem, thereisnoear reflex point. An active reflex point isidentified asan area of theear which exhibitsincreased sensitivity toapplied pressure and increased electrodermal skin conductivity. Theanatomical organ healthdisorders commonly associated with each part of theauricle are presentedbelow (see Figures 3.10and 3.11). Helix: Anti -i nflammatorypoi ntsand t reat ment of allergies and neuralgi as. Hel i x root: External genitals, sexual di sorders, urogeni tal dysfunctions, di aphragm. Superior helix: Allergies, arthritis, and anti -i nflammatoryprocesses. Hel i x tail: Representi ngthedorsal horn, sensory neuronsof t hespinal cord and thepre› ganglionic sympatheti c nervous system, thisregi on isused for peri pheral neuropat hi esand neuralgi a. Antihelix: Main t runkand torso of thebody t hat ispart of the musculoskeletal system. Superior crus: Lower extremi ti esof leg and foot. I nferi or crus: Lumbosacral spine, buttocks, sciatica, low back pain. Anti hel i x body: Thoraci cspine, chest, abdomen, upper back pain. Anti hel i x tail: Cervical spine, t hroat muscles, neck pain. Lobe: Cerebral cortex, lobes of thebrai n, sensati on oft heface, eye,jaw, and dental analgesia. Theear lobe represents condi ti onedreflexes, psychological resi stances and emoti onal blocks. Tragus: Corpuscallosum, appeti tecontrol, adrenal gland. Antitragus: Skull, head, and t reat ment of frontal, t emporal and occipital headaches. I ntertragi c notch: Pi tui tarygland, control of endocri neglands, hormonal di sorders. Scaphoid fossa: Upper extremities, such astheshoulder, arm, elbow, wrist, hand and fingers. Triangular fossa: Lower extremities, such as thehip, knee, ankle, foot, uterusand pelvic organs. Concha: Visceral organ di sorders. Superior concha: Abdomi nal organs, such asthespleen, pancreas, kidney and bladder. Anatomyof theauricle 89 A B - - - - - - Hel i x- - - - - - - - - - - - Ant i hel i x- - - - - - - - - -Superior concha - - - - - - - - - Concharidge - - - - - .- - - - - - I nferi or concha - - - - - Intertragic notch - - - - - - - - - -Lobe - - - - - - Darwin’s tubercle Scaphoid fossa Triangular fossa Su perior crus I nternal helix I nferior crus Antihelix body Antihelix tail Tragus Subtragus Concha wall Intertragic notch Antitragus Figure 3.10 Photographsoftheanterior surfaceoftheexternal ear showingthecircular ridges and crevicesofdifferent anatomical areas. 90 Auriculotherapy Manual A B c Figure 3.11 Photographsoftheposterior surfaceoftheexternal ear highlighttheauricular regions behindthehelixand theconchaofthe left ear (A), therightear (B), and theposterior surfacepulled back (C). I nferi or concha: Thoraci corgans, such astheheart and lungs, and also substance abuse. Concha ridge: Stomach and liver. Concha wall: Thalamus, brain, sympatheti cnerves, vascular circulation, general control of pain. Subtragus: Laterality problems, audi tory nerve, i nternal nose, throat. I nt ernal helix: I nternal genital organs, kidneys, allergies. Posteri or ear: Motor involvement with body problems, such as muscle spasms and motor paralysis. Posteri or lobe: Mot orcortex, extrapyrami dal system, limbic system. Posteri or groove: Mot or control of muscle spasms of paravertebral muscles. Posteri or tri angle: Mot orcontrol of leg movement, leg muscle spasms, and leg mot or weakness. Posteri or concha: Mot orcontrol of i nternal organs. Posterior peri phery: Mot or neuronsof spinal cord, mot or control of arm and handmovements. 3.9 Determi nati on of auricular landmarks Oneprocedurefor identifying thesame region of theauricle from oneperson to thenext isto examine t heear for distinguishinglandmarks. Whilethesize and shapeof theear may greatly vary between di fferent individuals, theauri cular landmarksare fairly consi stent across most pati ents. They are depi cted in Fi gure3.12, represented by asolidtriangle. Theselandmarksare distinguished by thebeginningor theend of thedi fferent subsecti ons of theexternal ear. The name and numberi ngof t he18landmarksbegins with LM0because it isat thesame location as a pri mary master poi nt on theauricle, Poi nt Zero. Thisfirst landmark, also called ear center, is distinguished as apronouncednotchwhere thehelix root rises up from theconcharidge. I t is found at thevery center of theear and isapri mary reference poi nt to compareto thelocati on of ot her regionsof theauricle. Thesecond landmark, LM 1, islocated on thehelix root where the helix crosses thei nferi or crus of theantihelix and wheretheauricle separates from theface. Anatomyof theauricle 91 92 LM 7 Figure 3.12 Thelocation ofauricular landmarkson theexternal ear arerepresented in a surfaceviewand ahiddenview. Conti nui ngup thehelix to thetop of the ear isLM 2. Thenext two landmarks, LM 3 and LM 4, are two notchest hat define the uppermost and lowermost boundari esof Darwi n’stubercle. Thisbulge on theout er helix isqui tedistinctive in some persons, but it isbarely visible in others. Following theperi pheral helix tail downwards towardstheear lobe, LM 5occurs wherethe helix takes a curving t urnand LM 6isfound where thecarti lagi nous helix meetst hesoft fleshy lobe. The bottomof t heear, which follows astrai ght linefrom LM 2, at theear apex, throughLM 0, hasbeen desi gnated LM 7. Thejuncti on of theear lobe to the lower jaw islabeled LM 8. Thei ntertragi c notch hasalready been distinguished as aseparate regi on of theear and isi denti fi ed as LM 9. Hi gheron the auricle, t hereare two promi nent protrusi onsor tubercleson thetragus, which have been labeled LM 10and LM 11. Therearetwo comparabl e protrusi onson the anti tragus, referred to asLM 12and LM 13.Thel andmark LM 13isdi sti ngui shed asthe apex of theanti tragus. Above theanti tragus- anti hel i xgroove thereisaprotrudi ngknob on thebase of the anti heli x tail which hasbeen labeled LM 14. Following thecentral side of the antihelix tail up to the anti heli x body, thereisasharp angle which divides thetail and body of theantihelix, which isl abel ed LM 15. Conti nui ngupward, along thecurving central side of t heantihelix body, adistinct notch isfound, AuriculotherapyManual LM 16,which i ndi catest hebegi nni ngof t heflat, l edged- shaped i nferi or crus of t heantihelix. The final l andmark, LM 17, occurs at anot chwhich divides t heperi pheral and central halves of the antihelix i nferi or crus. Thisnotch represent st hesciatic nerve and ist heauri cul ar poi nt used to t reat sciatica and low back pain. LM 0- Earcenter: A di sti nct notchisfound at t hemost central posi ti on of the ear, where the hori zontal conchari dgemeet sthevertically rising helix root. I t can be det ect ed easily with a fingernail or ametal probe. LM 0ist hemost common l andmark to reference ot her anatomi cal regi ons of the auricle. Reacti ve ear poi ntson theperi pheral helix rim are oft en found at 30 angles from aline connecti ng LM 0to the auri cul ar poi nt which corresponds to t hearea of body pathology. Thisregion of the helix root representst heaut onomi csol ar plexus and the umbilical cord, bri ngi ngany body dysfunctions towards abal anced state. LM 1- Helix i nserti on: Theregi on of t heear where t hehelix root separat es from t heface and crosses over thei nferi or crus of the antihelix. Thehelix root, which extendsfrom LM 0 to LM 1, represent sthegeni tal organs. Theexternal geni tali a are found on t heexternal surface of the helix root and i nternal geni tal organsarefound along t hehi dden surface of the i nt ernal helix root. LM 2- Apex of helix: Themost superi or poi nt of t heear iscalled t heapex and lies along aline t hat isvertically above LM O. Thispoi nt representsfuncti onal cont rol of allergi es and isthepoi nt pri cked for bl ood- l etti ngto dispel toxic energy. LM 3- Superi or Darwin’stubercle: Thenotch i mmedi atel y superi or to t heauri cul ar tubercle, separati ng Darwi n’stubercl e from the superi or helix above it. This regi on has poi ntsfor the t reat ment of anti - i nflammatoryreacti ons and tonsillitis. LM 4- I nferi or Darwin’stubercle: Thenot ch i mmedi ately i nferi or to t heauri cul ar tubercle, dividing Darwi n’stubercl efrom thehelix tail below it. On t hemoreperi pheral surface of this prot rudi ngl andmark, t hereisacrevice in the carti lage which separat es t hesuperi or helix from the helix tail. Thehelix tail extendsfrom LM 4 down to LM 5, represent i ngt hespi nal cord. LM 5- Helixcurve: Thehelix tail curves centrally and i nferi orly t oward t helobe. Thisarea represent sthe cervical spinal cord. LM 6- Lobular-helix notch: A subtle notchwherecarti l agi nous ti ssue of t hei nferi or helix tail meetst hesoft, fleshy ti ssue of thelobe. Thisarea represent st hebrai nst emmedul l aoblongata. LM 7- Baseof lobe: Themost i nferi or poi nt of the l obelies vertically below a strai ght line passing through LM 2, LM 0 and LM 7. I t represent s i nfl ammatory problems. LM 8- Lobular i nserti on: Themost i nferi or poi nt of t helobe t hat at t achesto thejaw. The posi ti on of thisl andmark varies consi derably. I n somepeopl e, LM 8 isi nferi or to LM 7, whereas in ot her individuals, LM 8issuperi or to LM 7. Thisregi on represent s the limbic system and cerebral cortex. I t affects nervousness, worry, anxiety and neurast heni a. LM 9- I nt ert ragi cnotch: Thecurving notchwhich divides the tragusfrom the anti tragus. I t represent spi tui tary gland control of hormonesrel eased by ot her endocri neglands. LM 10- I nferi ort ragusprotrusi on: Theprot rudi ngknob on t helower tragus, opposi tethe top of t heanti tragus. I t represent s adrenal glandsand isused in t het reat ment of vari ous stress rel ated di sorders. LM 11- Superi or t ragus protrusi on: Theprot rudi ngknob on t heupper tragus, opposi t eto the helix root. I t affects thi rst andwat er regul ati on. LM 12- Ant i t ragusprotrusi on: Theprot rudi ngknob at t hebase of t he’I nvert ed of t hecurving ridge of t heanti tragus, superi or to the lobe. I t represent sthe forehead of theskull and isused for the t reat ment of headaches. LM 13- Apex of anti tragus: Theprot rudi ngknob at t hetop of the curving ridge of the anti tragus, opposi teto LM 12. I t represent sthe templ esof theskull and isused for t het reat ment of mi grai ne headaches and for asthma. LM 14- Base of antihelix: A round knob at the base of t heanti heli x tail, rising above the anti tragal - anti hel i xgroove. Thisgroove divides t heperi pheral anti tragusfrom t heantihelix tail. Theknob at LM 14represent stheupper cervical vert ebrae near t heskull. Theanti heli x tail, Anatomyof theauricle 93 94 which extendsfrom LM 14up to LM 15, represents all seven cervical vert ebrae and isused in the t reat ment of neck pain. LM 15- Ant i hel i xcurve: A slight notch t hat divides t hecentral anti heli x body from the anti heli x tail. Thisl andmark isl ocated above t heconcharidge, hori zontally across from LM 0, and divides the lower cervical vert ebrae from the upper thoraci cvertebrae. Theanti heli x body, which extendsfrom LM 15up to LM 16, represent s all 12thoraci cvert ebrae and isused for t reat ment of upper back pain. LM 16- Ant i hel i xnotch: A distinct notch which divides t heflat curving ledge of t heanti heli x i nferi or crus from the anti heli x body. Thisnotch divides thesomat ot opi crepresent at i on of the lower thoraci cvert ebrae from the upper l umbar vert ebrae. Theperi pheral i nferi or crus of the anti heli x isused for t het reat ment of low back pain. LM 17- Midpoint of i nferi or crus: Thisnotchon the t opsurface of t hei nferi or crus of the antihelix divides the i nferi or crus i nt otwo halves. Thi snotchseparat es the lower l umbar vertebrae from the upper sacral vertebrae. Thisl andmark was the ear poi nt used for the t reat ment of sciatica, first i denti fi ed by Dr Nogi er, t hat led to the discovery of t hei nverted fetus somatotopi cmap on t heear. 3.10 Anatomical relationships of auricular landmarks Auricular quadrants: Twoi nterconnecti ngstrai ght lines can be drawn which form across dividing the ear i ntofour equal quadrants, with LM 0at itscent er (Fi gure3.13A). A verti cal line can connect l andmarks LM 2, LM 0, LM 13and LM 7. A hori zontal line can connect the l andmarks LM 11, LM 0, and LM 15. Theactual hori zontal level of the ear dependsupon t hevertical ori ent at i onof theperson’shead, which can be held ei t her slightly forward or bent slightly back. For thepurposesof theseear di agrams, the hori zontal level isset relati ve to itsperpendi cul ar relati onshi p to thevertical linewhich runs from LM 2to LM 7. Auricular grid coordi nates: Subdivisions of approximately one centi meter square allow for the linear division of thewhole surface of theexternal ear into ninecolumns, labeled 1-9, and 14rows, labeled A- Nin Figure3.13A. Thewidth and length of an average ear are shown in Fi gure3.13B as goingfrom 0-45 cmacross when progressing from medial to peri pheral auri cular regions and going from 0- 70cmdown when progressing from superi or to inferior areas of theexternal ear. 3.11 Standard dimensions of auricular landmarks Tosubstanti atethe relati ve proport i onsof thest andardi zed ear chart used in thiswork, the l andmark locati ons on t heexternal ears of 134vol unteerswere measured to est i mat et herelative di stances between landmarks. Volunteerswere recrui ted by st udent sat two acupunct ureschools in Sout hernCali forni a. Ei ght eenl andmark poi ntswere marked with afelt pen and mul ti pl e measurement swere madeof the di stances between two sets of l andmarks(see Fi gures3.14, 3.15). Themeans, st andard devi ati ons and rangesof the measurement swere t hencomput ed. Analyses of vari ance and correl ati on coefficients bet ween the di stances between specific l andmarkswere also performed. I n addi ti on, measurement sof thewi dth and length of t hehead, hand and foot were also recorded. Thehei ght of t hehead was measured from the chin to t hetop of the forehead, whereas t hewidth of the head was desi gnated as the di stancebet ween the ears. Thelength of the hand was comput ed between thewrist and t hemi ddlefinger, while t hewi dth of t hehandwas measured between the t humband the li ttlefinger. Thelength of the foot was assessed between t he heel and the longest toe, and thewi dth of thefoot was measured bet ween thebig t oeand the little toe. All of thesemeasurement swere used to det ermi net heconsi stency of using t heauri cul ar zone system descri bed in thispaper with actual persons. Thesample of 134vol unteers cont ai ned equal numbersof male and female subjects, with amean average age of 39.7years (SD = 14). Theethni cfrequency of theseparti ci pantsconsi sted of 96 Caucasi ans (71.6%),26 Asi ans (19.4%),7 Hi spani cs(5.2%), and 5 blacks (3.7%). Accordi ng to t he U.S. CensusBureau for 1999, the relati ve represent at i on of theseet hni cgroupsin Cal i forni a would be49.9% Caucasi an, 11.4%Asian, 31.6% Hi spani c, and 6.7% black (Nel son & O’Rei lly 2000). Theoverrepresent at i on of whi tesand Asi ans in thissampl e probabl y reflected thesocial network of studentsattendi ngacupunct urecolleges in the LosAngel es area, from whom vol unteers for thisstudy were recrui ted. I t was not i nt endedt hat t heexternal ears measured in this Auricu{otherapyManual Auri cular quadrants and auri cular grid coordi nates Average measurements of the ear ( in mi l l i met ers) V I .--- 21---.. A LM / \ k- 1 lA- B / / / / / \ 1\ C LM 3 / Jl,J II / LM 1 D I Lfv 4 / .. l M / E I LM 6",. 7 --- / F \ / ’ \ 15/ 0,/ V1 G LM -""""""’I \ \ \ -I k- 4 AL 11 H \ V 1\ \ \ \ 1P I 1\ LM14 Lr f:;J ’\ LM 5 A .f.\ J \ W <, \ J / K LM6 \ <; 0 LM9 L \ M \ J. -, V LM8 N <, ----- -r- , LM2 1/ <, A -r- , t-, / I \ -, L"11 \ \ A \ \ \ \ ....... -6,.LM 6 \ <, " - , <, ............... \15 J II MO LM 1 A r----- ,.. / II r--...... J .. 1/ 1/ 1/ / M 0/ L f M 14 / <: A LM5 \ VLM / .. ) M6 LM9 V / \ I LM8 ."" [ 7 r....... B A 9 8 7 6 5 LM 7 4 3 2 00 05 10 15 20 25 30 35 40 45 50 55 60 65 70 05 10 15 20 LM 7 25 30 35 40 45 Fi gure 3.13 Theexternal ear di vi ded into quadrants andx- ygrid coordi nates (A). Hori zontal secti onsare numbered1to 9goingfrom center toperiphery, while vertical secti onsare labeled A toNfrom superior to inferior edges oftheear. Theaveraged value ofactual measurement (in mi lli meters) oftheexternal ears ofdi fferent i ndi vi duals isalso shown (B). study were representati ve of thegeneral populati on, only t hat therebe alarge cross sampling of theauricles of di fferent individuals. Earsfrom two such parti ci pantsare shown in Fi gure3.16, whereas t heaccumulated mean data from themultipleobservati ons of di fferent auricles are presented in Box 3.1. Thisindicates the relative mean distancesbetween each l andmark and thecentral l andmark LM 0, and between each landmark and thesubsequent landmark. Theset of measurementsprovi des an overall indication of theshapeand size of di fferent ears. Acupuncturepracti ti onersand studentsasked to identify the 18landmarkson these134parti ci pantswere readily able to distinguish each l andmark on each subject, indicatingt hat theseauri cular demarcati onsare reliably observed on most individuals. Therelatively lowstandard deviations for thesemeasurementssuggests t hat thelandmarks examined on many di fferent ears isareliable procedurefor recognizing thespecific areas of the auricle. A series of analyses of variance (ANOYA) computati onscompared auri cular measurementsbetween male and female parti ci pants. Correl ati oncoefficients were also obtai ned across all subjects for all measurements. I n hisTreatiseofauriculotherapy, Nogier (1972) report edt hat thevertical axisof the auricle varied from 60to 65 mmand t hat thehori zontal axisvaried between 30 and 35mm. Slightly larger measurementswere found in thepresent study. Themean height of the auricle, measured between thetop of theear apex at LM 2and thebot t omof theear lobe at LM 7, was 68.4mm. Themean width of theauricle, measured between the helix root as it leaves theface at LM 1and themost Anatomyof theauricle 9S LM2 LM 7 LM 1 LM 2 LM 7 A B 96 Figure 3.14 Specific lines ofmeasurement between auricular l andmarks i ndi catethebasis for data collectedji-O/11 participants in theear measurement study. Connecti onsbetween LM0andperipheral l andmarks (A); connecti ons between LM0and central landmarks, and between successive pairs ofl andmarks (B). Figure 3.15 A mi lli meter ruler was used tomeasure thedistance between auricular landmarks. AuriculotherapyManual A B Figure 3.16 Photographsofexternal ears from twopeopl eshowtheconsi stent location ofauri cular l andmarks despite variations in the actual pattern ofdifferent ears. peri pheral part of Darwin’stubercleat LM 4, was33.8mm. I nthe assessment of thelength and width of thehead, hand, and foot, males were found to have significantly larger measurementst hanfemales (p < 0.05). Thisresult was not surprising, since men are typically larger thanwomen. Men also have significantly larger external ears than women, and all ear measurement segmentswere larger in males thanin females, with statistically significant di fferences found for thedistancesof LM 1to LM 4and LM 2to LM 7. Therelati onshi p of thesizeof di fferent regionswas also examined. Only correlati on coefficients great er t han0.40were consi dered meaningful. Thelengthof thefoot was significantly correl ated with thelength oft hehand (r = 0.44) and thewi dth of thehand (r = 0.42). Thewidth of thefoot was also correlated with theheight of the head (r =0.42). Curiously, thelength of thesebody areas was not ashighlycorrel ated with thewi dthof thei r respective body region. For example, t herewasonly asmall correlati on (r =0.39) between thelength of thefoot and thewidth of thefoot, even lessbetween thelength and width of thehand (r = 0.34), and was lowest between the height and width of thehead (r = 0.22). Of all theauri cular measurements, theonly distances to correl atesignificantly with thefoot, hand, or head were t hecorrelati onsbetween thewidth of the head and t hedistancebetween LM 0and LM 12(r =0.41) and thecorrel ati on of thewi dthof the head with thedistancebetween LM 0and LM 17(r = 0.42). Theauri cular measurementsthat correlated best with each ot her were of thedistancesbetween the center of theauricle, LM 0, tothemore peri pheral regions of theear, LM I to LM 7. Si gni fi cant correl at i ons t hat ranged from r =0.44 to r =0.89 were found for t hemeasurement sof LM 0 to LM 1, LM 0 to LM 2, LM 0 to LM 3, LM 0 to LM 4, LM 0 to LM 5, LM 0to LM 6, LM 0to LM 7, LM0to LM 8, and LM 0 to LM 12. Thegreat est number of si gni fi cant correl at i ons bet ween t he di stances of two auri cul ar l andmarkswere found for t hedi stances of LM 0to LM 2, LM 0 to LM 7, and LM 0 to LM 12. Themorecentral l andmarkson t heear probabl y had fewer significant correl ati ons to ot her auri cul ar areas because they were smal l er in length and thusdid not vary as Anatomyof theauricle 97 98 Box 3.1 Measurements between auricular landmarks (LM) Landmarks Mean SD Landmarks Mean SD distance distance i nmm i nmm --- __.,- - --- - - - - - - - - LMO-LM 1 22.6 5.3 LM 1- LM 2 22.6 5.5 LMO-LM2 32.5 5.0 LM2- LM 4 26.7 6.8 LMO-LM3 27.9 4.8 LM4- LM 5 28.6 6.3 LMO-LM4 25.1 5.2 LM5- LM 6 9.2 3.8 LMO-LM5 23.0 4.2 LM6- LM 7 20.8 4.8 LMO-LM6 25.6 5.0 LM7- LM8 10.2 3.7 LMO-LM7 35.9 5.3 LM8- LM 9 10.9 4.1 LMO-LM8 32.3 5.5 LM9- LM 10 12.2 4.6 LMO-LM9 23.9 4.9 LM 10- LM 11 8.7 Z.7 LMO-LM 10 14.1 2.7 LM12- LM 13 8.3 2.5 LMO-LM 11 10.7 2.9 LM13- LM 14 6.5 2.4 LMO-LM 12 19.5 3.5 LM14- LM 15 10.8 3.8 LMO-LM 13 13.4 2.5 LM 15- LM 16 14.0 4.2 LMO-LM 14 12.3 2.8 LM16- LM 17 7.7 2.7 LMO-LM 15 11.0 2.6 LMO-LM 16 10.8 2.8 LMO-LM17 12.4 3.9 LM2- LM 7 68.4 10.2 LM1- LM4 33.8 6.3 Ear hei ght 68.4 10.2 Earwi dt h 33.8 6.3 Head hei ght 193.3 22.7 Head wi dt h 163.9 28.4 Hand length 171.8 27.9 Hand wi dt h 101.9 16.7 Foot length 235.8 30.8 Foot wi dt h 93.5 14.5 much from one person to thenext. Of the di stances between sequenti al auri cul ar landmarks, only thedi stanceof LM 2to LM 4was significantly correl at ed with moret hanfour ot her measurements. Thepurposein obtai ni ngtheseauri cul ar measurement swas primarily to demonstratet hat thesespecific l andmarkson theexternal ear can be reliably observed on many individuals and are asconsistently found astherelati onshi p between thefingers and base of the hand or between thetoes and heel of the foot. Whilethe external ears do vary consi derably from oneperson to thenext, t hereisageneral consistency in thedistinctive pat t ernof the auri cle and therelative size of di fferent anatomi cal sections. AuticulothetepyManual Auri cul ar zones 4.1 Overview of the auricular zonesystem 4.2 I nternational standardization of auricular nomenclature 4.3 Anatomical identification of auricular zones 4.4 Somatotopi ccorrespondences to auricular zones 4.5 Representation of Nogier phases inauricular zones 4.5.1 Auricular zones for different phases of mesodermal myofascial tissue 4.5.2 Auricular zones for different phases of internal organ tissue 4.5.3 Auricular zones for different phases of ectodermal neuroendocrinetissue 4.5.4 Nogier phases related to auricular master points 4.6 Microsystem pointsrepresented inauricular zones 4.6.1 Helixzones 4.6.2 Antihelixzones 4.6.3 I nternal helixzones 4.6.4 Lobezones 4.6.5 Scaphoid fossa zones 4.6.6 Triangularfossa zones 4.6.7 Traguszones 4.6.8 Antitraguszones 4.6.9 Subtragus zones 4.6.10 I ntertragicnotch zones 4.6.11 I nferiorconcha zones 4.6.12 Concharidgezones 4.6.13 Superior concha zones 4.6.14 Conchawall zones 4.1 Overvi ew of t he auricular zone system I n order to provi de asystemati c met hodfor l ocati ng t hepreci se posi t i on of apoi nt on t heear, a zonesystem was devel oped whi ch uses t heproport i onal subdi vi si on of maj or anat omi cal regi ons of t heauri cle. A set of two l et t ersand anumber represent each ear zone, in concurrencewi th gui del i nes est abl i shed by t heWorl d Heal t hOrgani zat i onacupunct ure nomencl at urecommi t t ee (Akerel e 1991; WHO1990b). Thi szonesystem ismodi fi ed from t heauri cul ar zonesystem first devel oped in 1983 at t heUCLAPain Management Cent er (Ol eson & Kroeni ng 1983b). The ori gi nal zonesystem devel oped at UCLAisshown in Fi gure4.1, wherei n asi ngle l et t er was used to desi gnat e each area of t heauri cul ar anat omy and anumber desi gnat ed each subdi vi si on of t hat area. A di fferent zonesystem t hat was suggest ed by Paul Nogi er (1983) ispresent ed in Fi gure4.2. TheNogi er zonesystem di vi ded thewhol e auri cl e i nt oa rect angul ar gri d pat t ernof rows and columns. Thecapi tal l et t ersA to 0 i dent i fi ed t hehori zont al axis, whereas t hel ower case l et t ersato z i ndi cat ed t heverti cal axis. Whi l esuch agri d pat t ernissi mpl e to use on flat, two di mensi onal paper, it isnot easily adapt abl e to the t hree- di mensi onal dept hsof t heauri cle. Thecurvi ng cont oursof t heear do not conform well to t heconfi gurat i on of basi c squares and t hereisno means for i ndi cati nghi ddenor post eri or regi ons of t heauri cle. Moreover, as t heear measurement s present ed in Chapt er3 i ndi cat ed, t herearemarkedvari at i ons in t hesize of di fferent areas of t he auri cle, even t hought herel ati ve proport i onsremai n t hesame. Thedi st ancefrom l andmark 0 to t he ear apex at LM 2 ranged from 20 mm to 50 mm, and t hemeasured l engt hsof t hesubjects’ ear lobes Auricular zones 99 H Helix 0 I I nner rim of helix A Anti hel i x 0 S Scaphoid fossa F Triangular fossa C Concha T Tragus 0 R Subtragus N Anti tragus 0 G Wall of antitragus W Wall of anti heli x L Lobule 0 Surface symbols o Raised surface Depressed surface Vertical or hidden surface H13 Figure 4.1 Theoriginal auricular zonesystem developed in the1980s at UCLAsubdi vi ded each anat omi cal region oftheexternal ear referenced witha single letter and a number. varied between 15mmand 45mm. A gridwork of rows and columnsof fixed length can not easily accommodatesuch discrepancies insize. Theauri cul ar zone system devel oped at UCLA desi gnated each section of theear based upon theproporti onal size of theauri cul ar regi on of each individual, not theabsolute sizeof thewhole ear. Therevised UCLAnomencl aturesystem (Oleson 1995) shown inFi gure4.3 provides aconsi stent logical order for thenumberi ngof each anatomi cal subdivision of theexternal ear. Thelowest numberscorrespond to t hemost i nferi or and most central zone of that anatomi cal part of the ear. Thenumbersascend from 1to 2to 3, etc., progressing from i nferi or to superi or zonesof that anatomi cal area and from central to peri pheral zones. I ni nternati onal communi cati onsabout thelocati on of ear acupoi nts, theregi on of theear referred to can be listed by itsanatomi cal zone desi gnati on, rat her t hanitsorgan correspondence. 4.2 I nternati onal standardization of auricular nomenclature Thefirst concerted effort to create ast andardtermi nology for humananatomywas developed by a group of Germanscientists in 1895(I nternati onal Congressof Anatomi sts1977). TheBasle nomi na 100 AuriculotherapyManual ONMLKJ I HGFEDCBA ABCDEFGHI JKLMNO t 5 v u y p c k j b a e q d x w a n m J \ ,) 1/ ( \1 Hi t...--L.::’: :, 1::’::’:1:’--., z VSJa3:l 9HI r)l l WNO 1/ - .[ 7 v-" 1 T\I r"f\ . .\ 18 .... 19 I .;;,;. 1 l \ 20r- - - - .r" 9 ll_ "i \ ’r t vr Q ’\ I l .l r7 " \.J7’ , \ J "- _ IA ...... V I : tl 1/ r’\ 2 [ \ T\-'':'' [\ II -.,11 J 1\’ 7 ’( 9 b...... , 1\ 1 J.- , ’\ ..... 1\ 1D ) ( I ." 8l 1\: I .. 1\ 1- - - I - - - +6l l----- 8l »> 02 l II if:-’rvr4 1 ... ’\ Ol 6 yr""l 1\ t Ir" 1 /L ’I l-I A T 1"1.1’ " v/ 1/1-’-- ".’ i\ 1/ ’ I .;V r’\ 10 N W 11)1 r I H 9 :l 3 a J S V z ) p q eI -r rr " - - ..... ! Figure 4.2 Theauricular zonesystemfirst proposedbyDr Paul Nogier: arectangular gridreferencedwithcapital lettersfor thehorizontal axisand lower caselettersfor thevertical axis. (ReproducedfromNogier1983, withpermission.) anatomica (RNA)wasfirst adopt edin Germany, I taly, USA, and l ater in Great Britain. I n 1950, an i nternati onal congress of anatomi stsmet in Oxford, Engl and, to discuss revisions in the earli er anatomi cal nomencl aturesystem. A newNomi naanatomica was accepted by theSixth I nternati onal Congressof Anatomi stsmeeti ngat Paris in 1955. Most phraseswere adopt edfrom theoriginal RNA,with all anatomi cal termsderi ved from Lati n, employingwordst hat were simple, informative and descriptive. ChangestoNomi naanatomica were madeby subsequent nomencl aturecommi tteesin an at t empt to simplify unnecessari ly complex or unfami li ar terms. Whileit was thestrongopi ni on of thei nternati onal nomencl aturecommi t t eet hat only official Lati ntermsshould beemployed in scientific publications, it was also recogni zed t hat many scientific data- retri eval systems accept vernacul ar anatomi cal terms. Engli shwords in parti cul ar are commonly used in comput er searches since Englishiscurrently themost widely used scientific language at i nternati onal meeti ngsand on thei nternet. TheWorld Heal thOrgani zati on(WHO)sought to form an i nternati onal consensus on the terminology used for acupuncturepoi ntsby holdingaseri es of i nternati onal meeti ngsof distinguished acupuncturi sts. Dr Olayiwola Akerel e (1991) present ed thefindingsby theWHO working group t hat had been convened to specify thecri teri afor thestandardi zati onof acupuncturenomencl ature. Thefirst WHOworking group meeti ngon thistopi cwas held in Manila, Philippines, in 1982, with general acceptance of ast andardnomencl aturefor 361classical acupuncturepoints. Acupunctureprogramsin Australia, Chi na, HongKong, Japan, Korea, New Zeal and, Phi li ppi nesand Vi etnamadopt edthismeri di an acupuncturesystem. Theconclusions of theWHOregi onal working groupwere publi shed in 1984astheStandard acupuncture nomenclature(Wang1984). Auricularzones 101 Surface, hidden, and posterior auricular zones Surface viewof auricular zones Posterior viewof auricular zones Posterior Lobe Posterior Groove Posterior Triangle Posterior Concha Posterior Periphery Hiddenviewofauricular zones Auricular zonecodes HX Helix AH Anti heli x LO Lobe TG Tragus AT Anti tragus I T I ntertragi c Notch SF Scaphoid Fossa TF Triangular Fossa SC Superior Concha I C I nferi or Concha CR Concha Ridge CW Concha Wall ST Subtragus I H I nternal Helix 102 Figure 4.3 Revisionsof theauricular nomenclaturesystem originally developed byOleson were based upon the recommendati onsofthe 1990 WHOnomenclaturecommi ttee. Different zones are referenced with two lettersand a numbet: Theprogression ofnumbersgoesfrom bottomtotop andfromcenter toperiphery. AuricuiotherepyManual Alphanumeri ccodes to designate di fferent acupuncturepoi ntswere labeled with two l etter abbreviations (Helms1990). ThusLUwas used for the Lungmeri di an and LI for t heLarge I ntestinesmeridian. Some authorsuseonly one l etter to represent ameri di an, such as Pfor the Peri cardi ummeridian i nstead of PC, or H for Heart meri di an i nstead of HT.Theleast agreed upon English desi gnati onwas t hetermTripleEnergi zer and itsabbrevi ati on TE. TheHancharacter for thismeri di an isoften transl ated asTripleWarmer or TripleHeater, but some membersof the nomenclaturecommi tteefelt that thismeri di an should have been left with itsChi nesename, San Jiao. Consequently, thismeri di an channel isnowabbrevi ated SJ. Representati ves from each countrywho were at thismeeti ngwere encouraged tocommuni catetojournals, textbook publishersand universities in thei r country to use only theofficial WHOtwol etter designationsfor zang-fu meridiansand for acupuncturepoints. Thesecond WHOworking groupwas held in HongKong, in 1985(WHO1985). Representati ves reportedgeneral acceptance of theStandardAcupunctureNomenclaturefrom nineAsian countries. Revisions were suggested for standardi zati onof extra meri di an poi ntsand for new points. Twodocumentswere presented at thisWHOmeeti ngto guide standardi zati onof ear acupuncturenomenclature, thetext Ear acupunctureby Hel enHuang(1974) and ajournal article writtenby myself and Dr Ri chard Kroeni ng (Oleson & Kroeni ng 1983a). However, all decisions about auri cular acupuncturenomencl aturewere deferred to al ater meeting. Thethi rdWHO WorkingGroupmet in Seoul, Korea (WHO1987). Having already arri ved at aconsensus regardi ng classical meri di an points, thefinal areaof discord waswith thenomencl aturefor auri cular points. Asthemeeti ngwas organi zed by theWHORegional Officefor theWesternPacific, most of the representati ves were from Asia. Only Dr Raphael Nogi er of Francerepresented aEuropean perspective. Standardnomenclaturewas adoptedfor 43auri cular points, each poi nt desi gnated by one or twolettersand by anumber. I n addi ti onto thestandardnomencl atureaccepted for 43 auri cular poi ntsidentified asCategory 1points, anot her 36ear poi ntswere identified asCategory2 points that needed further study for verification. All ear poi ntswere preceded by thelettersMA to designate Microsystem Auricular. For example, MA- H1i ndi cated t helocati on for t heEar Cent er poi nt on thehelix and MA-TF 1i ndi cated thelocation for theShen Men poi nt in t hetri angular fossa. Theonly ot her approved desi gnati on for amicrosystem was thedesignation MSfor Microsystem Scalp. Noagreement was madeon thetwo main schools of auri cular points, theone i ni ti atedby Paul Nogier of Franceand theot her one utilized by Chi nesepracti ti onersfor ear acupuncture. Thefinal WHOGeneral WorkingGroupon Auri cular AcupunctureNomencl aturemet in Lyons, France(WHO1990a). Themeetingwas led by Raphael Nogi er and Jean Bossy of France, by c.T. Tsiangof Australia, andby Olayiwola Akerele representi ngtheWorld Heal thOrgani zati on. I nternati onal parti ci pantsat thismeeti ngincluded representati ves from Australia, Austria, Chi na (PR), Columbia, Egypt, Finland, France, Germany, I taly, Japan, Korea (DPR),NewZealand, Norway, Spain, Switzerland, Venezuela and theUSA. Hi roshi Nakajima, Di rector- Generalof the WorldHeal thOrgani zati on, proclai med to thegatheri ngthat ’auri cul ar acupunctureisprobably themost developed and best documented, scientifically, of all themicrosystems of acupunctureand isthemost practical and widely used.’ Hefurther acknowledged that ’unli keclassical acupuncture, which isalmost entirely deri ved from anci ent China, auri cular acupunctureis, to alarge extent, a more recent development that hasreceived consi derable contri buti onsfrom theWest.’ I n hispersonal address to theaudience, Paul Nogier observed that: thestudiesbyDrNiboyethaveprovedthat theear points, liketheacupuncturepoints, can bedetected electrically. Wealso knowfromthestudiesbyProfessor DurinianoftheUSSRthat theauricle, by virtueofitsshort nervelinkswiththebrain, permitsrapid therapeutic action that cannot otherwisebe explained. Thetimehascometoidentifyeach major reflex siteintheauricle, and I knowthat someof you arebusyonthis. Thisidentificationseemstometobeessential so that therecan beacommon language inall countriesfor therecognition oftheear points. Threequalitieswere emphasized: (1) ear poi ntsthat have i nternati onal and common namesin use; (2) ear poi ntsthat have proven clinical efficacy; (3) ear poi ntswhose localization in theauri cular area are generally accepted. Auricularzones 103 Thegroup agreed t hat each anatomi cal area of theear should bedesi gnated by two letters, not one, toconformto thebody acupuncturenomenclature. Theabbrevi ati on for helix became HX rat her than H and thedesi gnati on for lobe became LOrat her thanL. Terminologywas also added for poi ntson theback of theear, each area to begin with the initial l etter P, asin PPfor posteri or peri phery, and PL for posteri or lobe. TheChi nesehave also developed arevised auri cular zone system based upon therecommendati onsof the 1990WHOauri cular nomencl aturecommi ttee (Zhou1995,1999; see Fi gure4.4). Thepri mary difficulty at thisWHOnomencl atureconferencewas the discrepancy between the Chineseand Europeanlocationsfor an ear point. For example, the Knee poi nt islocalized on the superi or crus of theantihelix in theChi nesesystem and in thetri angular fossa in theEuropean system. Noconcurrent agreement on thisissue was determi ned. Thegroup did adopt a standardi zed nomencl aturefor 39auri cular points, but deci ded t hat anot her 36ear poi ntsdid not asyet meet thethreeworking criteria. TheCategory 1and Category2ear poi ntsdescri bed by the 1987WorkingGroupfrom theWestern Pacific Division of theWHOare respectively similar to the ’agreed upon’ and ’not agreed upon’ auri cular poi ntslisted by the 1990WHOmeeti ng. Thetwo listsof ear poi ntsare respectively presented inTables4.1 and 4.2. Duri ngthecourse of discussions, many divergent poi ntsof view emerged concerni ngbot h thelocalization and termi nology of auri cular points. After afree exchange of ideas and opinions, theWHOworking group agreed t hat apriority of futureactivity should be thedevel opment of ast andardreference chart of theear. This chart should provide acorrect anatomi cal i llustrati on of theear, an appropri at eanatomi cal mappi ngof topographi cal areas, consultati onwith experts in anatomy and auri cul ar acupuncture, illustrationsof correct zones in relati on to auri cular acupuncture, and the actual deli neati on and localization of ear points. A subsequent commi tteedi rected by Akerel e (WHO1990b) developed specific anatomi cal drawings of theear and specific termi nology for the auricle. - -(1i *) ----Ie Figure 4.4 Thezonesystem developed in Chinaafter the 1990 WHOauricular nomencl aturemeeti nghas been described by Dr Li - QunZhou(reproduced withpermission). 104 AuriculotherapyManual Table 4.1 WHO1990 standard nomenclature for auricular points, accepted points English name Pinyin name Ear Center Erzhong Urethra Ni aodao External Genitals Wai shengzhi qi Anus Ganmen - - - - - - - Ear Apex Erj i an Heel Gen Ankle Huai Knee Xi PelvicGirdle TunKuan - - - - - - - Sciaticnerve Zuogushenj i ng Autonomicpoint Ji aogan Cervical Vertebrae Ji ngzhui Thoracic Vertebrae Xi ongzhui Neck Ji ng Thorax Xi ong Fingers Zhi Wrist Wan Elbow Zhou Shoulder Girdle Ji an - ~ _ _ _ - - - - - - - EarShenMen Ershenmen External Nose Waibi Apex of Tragus Pi ngj i an Pharynxand Larynx Yanhou MA- HX4 MA- HX5 MA- AH3 MA- TG3 MA- AHI - - - - MA- AH2 MA-SFI MA- SF2 - - - - - - - MA- SF3 MA- SF4 - - - MA- TFI MA- TGI MA- AH10 MA- TG2 - - - -- - - - - - - - - - - - - - - - - - - - - - - - Anatomical Alphanumeric ~ Helix MA- HXI MA- AH5 MA- AH4 MA- AH8 MA- AH9 MA- AH6 MA- AH7 Antihelix MA- HX2 ~ MA- HX3 - - - - - - - - - - Scaphoid fossa Triangular fossa Tragus Antitragus I ntertragic notch I nferior concha MA-AT MA- I T MA- I CI Lung Fei Qi guan - - - - Nei fenmi San Ji ao Kou Trachea Hypothalamic-PituitaryAxis TripleEnergizer Mouth - - - - - - - - - - - - - - - - - - - - - - MA- I C6 Esophagus Shi dao MA- I C7 Cardia Bennen Superior concha MA- SCI MA- SC2 MA- SC3 Duodenum Small I ntestines Appendix MA- SC4 LargeI ntestines Dachang MA- SC5 Liver Gan MA- SC6 - - - - - - MA- SC7 MA- SC8 Pancreas-Gall bladder Ureter Yi dan Lobe MA- LOI Eye Mu Auricularzones 105 Table 4.2 WHO1990 standard nomenclature for auricular points. not yet considered Pinyinname Nei shengzhi qi Shangergen - _ . _ . _ ~ . . - - - - - - - _....... ,._- _._- - - - - Xi aergen Ermi gen - - - - - - - - - - - - Zuzhi English name MA- HX I nternal Genitals MA- HX Upper ear root Alphanumeric - - - - - - - - - - - - - - - MA- HX Lower ear root ._- - - - MA- HX Root of ear vagus MA- AH Toe Antihelix Anatomical Helix MA- AH MA- AH Lumbosacral Spine - - - - - ’- - - - - - Abdomen Yaodi zhui ~ Fu Pelvis Scaphoid fossa Triangular fossa Tragus Antitragus WindStream or Occipital Nerve Middletriangular fossa - - - - - - Superior triangular fossa Adrenal Gland Nie MA-AT MA-AT Apex of Antitragus Dui pi ngj i an - - - - - - - - =- - . = ~ MA-AT Central Rimor Brain Yuanzhong _ . ~ . MA-AT Occiput Zhen --------- = ~ Temple MA-AT Forehead E I ntertragic notch ~ ~ . _ _ . _ _ .._- - - I nferior concha MA- I T MA- I C Heart Xi n MA- I C Spleen Pi Superior concha MA- I C MA-SC MA-SC Stomach Kidney Angleof superior concha Wei ~ Lobe MA-LO MA-LO MA- LO Tooth Tongue Jaw She He MA-LO Eye Yan MA- LO - ~ ~ _ .._-_._..._- _._- - - ,._._,- - _.__.. _ . _ _ . _ . ~ MA- LO MA-LO I nternal ear Cheek Tonsil Nei ’er Mi anj i a - - - - - - - - - - - - - - - - - - - Bi ant aoui Posterior lobe MA-LO MA- PL Anteri or Ear Lobe Chui qi an Posterior peripheral MA- PP Posterior intermediate Posterior central MA-PI MA-PC Grooveof posterior surface Heart of posterior surface MA-PC MA-PC Spleen of posterior surface Liver of posterior surface Erbei pi - - - - Erbei gan MA-PC MA-PC Lungof posterior surface Kidneyof posterior surface Erbei fei Erbei shen 106 Auriculotherapy Manual 4.3 Anatomical identification of auricular zones Each auri cular zone isbased upon theproporti onal subdivision of theprincipal anatomi cal regions, such asthehelix and theantitragus. I nconcurrencewith thesystem establi shed by the 1990WHO auri cular nomencl aturemeeting, each zoneisidentified by atwo l et t er abbrevi ati on for each anatomi cal region and anumber indicatingthat parti cul ar subsecti on of that anatomi cal area. Auricular zones on theanterol ateral and theposteri or sides of theear are shown in Fi gure4.5. The lowest numbersfor each auri cular areabegin at themost i nferi or and most central zone of t hat anatomical region. Thenumbersthenascend to hi gher digitsasone progresses to superi or and morelateral sectionsof t hat anatomi cal region. Theauri cular l andmarksare useful in distinguishingwheresome zones end and thenext one begins. A dept hview of thezonesisshown in Fi gure4.6. Thefirst zoneof thehelix, HX I , begins at l andmark LM 0, thenproceedsto hi gher numbers, HX 2 and HX 3, as one rises to l andmark LM 1hi gher on the helix root. Thesenumbersconti nuefrom HX 4to HX 7asone rises even hi gher to theapex of theauricle, LM 7. Thehelix numbersprogress hi gher asonedescends from thesuperi or helix to thebot t omof thehelix tail, endi ngin HX15. The first zone of theantihelix, AH 1, begins on thecentral side of thebot t omof the antihelix tail, LM 14, then rises to theantihelix body at LM 15, curves around to thei nferi or crus at LM 16, where the antihelix numbersconti nuefrom AH 5to AH 7. Theantihelix numbersconti nueagain on the peri pheral side of theantihelix tail, at AH 8, progressi ng to hi gher numbersasoneascends hi gher toward thesuperi or crus, ultimately to AH 18. Thedeeper valleys of thescaphoi d fossa and the tri angular fossa are divided into six equal parts. Thezonesfor the scaphoi d fossa rise from SF 1 near theear lobe to SF 6toward thetop of theear, while thezonesfor thetri angul ar fossa i ncrease from TF 1at thelower tip of thetri angular fossa to TF 6toward thet opof the ear. A series of five vertical zones divides thetragus, rising from TG1near thei ntertragi cnotchtoTG5, wherethe tragusmeetsthehelix root. Thel andmark LM 10separatesTG2from TG3, while t hel andmark LM 11divides TG3from TG4. Theanti tragusisdivided into t hreezones, begi nni ngwith AT I at thei ntertragi cnotch, rising in number and in locati on at AT 2, and peri pherally at AT 3. Thereare twozones for the i ntertragi c notch. ThezoneI T 1isfound hi gher toward thesurface of theauricle, whereas t hezone I T 2occurs on thewall of thei ntertragi cnotch, and isvertical to I T 1. Thezones for thei nferi or conchabegin at I C 1and I C2 at thei ntertragi cnotch. Thezone numbers thenrise on asecond concharow t hat begins with I C3andconti nuesperi pherally on theconcha floor to I C5 near theconchawall. Subsequent i nferi or conchasecti ons are found on athi rdrow which begins at I C6below the helix root and progresses peri pherally below theconcharidge to I C 8. Thezonesfor thesuperi or conchabegin with SC 1i mmedi ately above thecentral concharidge and ascend to hi gher concharegions at SC4. Thesevalues for thesuperi or conchazonesthen circle back peri pherally to SC8, found above themoreperi pheral concharidge. Theconcharidge itself is divided i ntotwozones, thecentral zone CR 1and theperi pheral zoneCR2. Thedi fferent auri cular zonesof theposteri or auricle each begin with thel et t er P. They rise from lower to hi gher numbersas anatomi cal subdivisions progressfrom acentral to peri pheral di recti on and from an i nferi or to superi or di recti on. Thereare di fferent zonesfor theposteri or lobe (PL), theposteri or concha(PC), and theposteri or peri phery (PP), behi nd thehelix rim and thescaphoi d fossa. The most promi nent zones arefor theposteri or groove (PG),which isthe deep crevice directly behi nd theantihelix ridge. Thei ntenti onin providing such adetai l ed and complex auri cular zonesystem isto be able to label specific auri cul ar reflex poi ntswith the actual areaof theexternal ear on which an auri cul ar poi nt is found duri ngclinical detecti on. Both Chi neseand Europeanear chartslabel the auri cular acupoi ntswith thesomatotopi cbody organ t hat they represent. Thestandardi zati onof zone terminology for verbally desi gnati ngdi fferent anatomi cal regions of the ear can provi de auniversal system to facilitate i nternati onal communi cati ont hat isbased on ear anatomy, not ear correspondences. Whilephotographsand i llustrati onsof theauri cle arevery useful in depicting various regi onsof theexternal ear, verbal descri pti onsof thesepi cturesare often i nadequat ein precisely determi ni ngthe auri cular area indicated. Box 4.1shows the auri cular locati onsof the principal reflex poi ntsused in ear acupunctureby thiszonecodi ngsystem, rat her t hanby pictures. Further i ndi cated in Box 4.1are thedi fferences between thelocati on of auri cular poi ntsas descri bed by Chi neseauri cular acupuncturi sts, denot edby thesuffix ’C,’ and theauri cul ar zones del i neated by Europeanpracti ti onersof auri cular medicine, i ndi cated by thesuffix ’E.’ Auricular zones 107 Somatotopic map on front side of ear Somatotopi c map on back side of ear Auricular zones on front side of ear Auricular zones on back side of ear 108 Figure 4.5 Auri cul ar zonesseen fromanterior andposteri or views oftheear, and their relationship to the somatotopi c mapon theear. AuriculotherapyManual Auricular zones at antihelix tail o L06 Auricular zones at antitragus Auricular zones at tragus Auricular zones at helixroot Auricular zonesat inferior crus AH 5 TF1 Figure 4.6 A depth viewoftheauricular zones showi ngtheascent from theconcha totheconcha wall tothe antihelix, and also thelocation ofhi ddenzones. 4.4 Somatotopi c correspondences t o auri cular zones Thesomatotopi crepresentati on of thecervical spine issaid to be in zonesAH 1and AH 2in Europeancharts, but on themoreperi pheral zone AH 8in many Chi neseear charts. TheChi nese further report t hat theLumbar Spine isfound on theanti heli x body in zones AH 11andAH 12, while the Europeansmai ntai nt hat theLumbar Spine islocated on the i nferi or crus in zones AH 5 and AH6. A pri mary di fference between theEuropeanand Chi neseauri cul ar chartsisthelocati on of poi ntsfor theleg. Thekneeissaid to be found on t hesuperi or crus zone AH 15in Chi neseear charts, but theknee isrepresented in the tri angular fossa zone TF4 in Europeanear charts. I nternal organs are also found in di fferent auri cular regi ons in thesetwo systems. For example, the uterusisfound in thetri angular fossa zoneTF6 intheChi nesesystem, but the uterusisfound underneat hthehelix root in theEuropeansystem, in zoneI H 3. Some ear poi ntsare moreeasily identified once one knows thisauri cul ar zone system. Depi cti ng thelocati on of theSympatheti c(Autonomi c) poi nt or t heThal amus(Subcortex) poi nt isoften confusing because thesetwo auri cular poi ntsare hi ddenfrom aconventi onal view of theear. The Sympatheti cAutonomi cpoi nt isfound in zone I H 4, which isunderneat hthehelix and near the tri angular fossa, whereas theThal amuspoi nt isfound in zone CW2, which isbehi ndthe anti tragus and near thei nferi or concha. Thesezone identificationsdistinctly reveal thespecific localization of thesetwo ear poi ntsmoreclearly thanmany pi cturesof thesepoints. I t isalso possible to show the Auricular zones 109 110 Box4.1 Primary auricular points represented in different auricular zones Zone Auricular point Zone Auricular point Zone Auricular point -----_._---_.. ,,-_.,---.- ...._------. _ . _ _ ~ _ _ ~ . _ .._- - - - - _.-- AH1-2 Cervical Spine.E LO1 Master Cerebral I C1 Pituitary Gland AH3- 4 Thoracic Spine.E LO2 Aggressivity point I C2 Lung2 AH5-6 Lumbar Spine.E LO3 Master Sensorial I C3 Trachea, Larynx.E AH7 Sacral Spine.E LO5 Trigeminal Nerve I C4 Heart.C, Lung1 AH8 Cervical Spine.C, L06 Antidepressant, I C5 Lung1 ThyroidGland.C Limbicsystem I C6 Mouth,Throat AH9- 10 Thoracic Spine.C LO7 Teeth, Lower jaw I C7 Esophagus AH11-12 Lumbar Spine.C L08 TMj,Upper jaw I C8 Spleen.C AH13 Hip.C HX1 Point Zero CR 1 Stomach AH15 Knee.C HX2 Diaphragm.C CR2 Liver AH17 Ankle.C, Foot.C HX3 Rectum.C SC 1 Duodenum TF 1 Hip.E HX4 External Genitals.C SC 2 Small I ntestines TF2 Shen Men HX7 Apex of Ear SC 3 Large I ntestines TF 3- 4 Knee.E, Leg.E HX12 Lumbar Spinal Cord SC 4 Prostate.C TF 5- 6 Ankle.E, FootE HX13 Thoracic Spinal Cord SC 5 Bladder SF 1-2 Shoulder HX14 Cervical Spinal Cord SC6 Kidney.C SF 3- 4 Elbow,Arm HX15 Brainstem.E SC 7 Pancreas SF 5 Wrist,Hand I H1 Ovary/Testis.E SC 8 Spleen.E SF 6 Fingers I H2 Prostate/Vagina.E I T2 Endocrine point AT1 Forehead I H3 Uterus.E CW2 Thalamus point AT2 Temples, Asthma I H4 Sympathetic Autonomic point CW3 Brain.C A13 Occiput I H5- 6 Kidney.E, Ureter.E CW4 Brainstem.C TG 3 Adrenal Gland.C I H7 Allergy point CW5 Thyroid Gland.E TG 2 Tranquilizer point I H11 WindStream CW6 Thymus Gland.E TG 1 Pineal Gland.E ST 2 Master Oscillation CW7 Adrenal Gland.E S13 Larynx.C, Throat.C differential location of ot her poi ntsfound on theconchawall. TheChi neseBrain poi nt isfound in zone CW3 and theBrai nstemin CW4. TheEuropeanlocationsfor theThyroi dGl andare localized in zone CW4/CW5, theThymusGl andin CW 6, and theAdrenal Gl andin zone CW7. Understandi nghowthecontoursand landmarkson theear can assist thei denti fi cati on and compari son of such ear poi ntsisan attai nabl egoal. 4.5 Representation of Nogier phases in auricular zones I n subsequent revisions of thesomatotopi crepresentati on of thebody on theexternal ear, Paul Nogier haspostul ated two addi ti onal auri cular microsystems t hat are distinct from theoriginal inverted fetus pattern. Eachanatomi cal region of theexternal ear can represent morethanone microsystem point. Asnot ed in Chapt er 2, thethreedi fferent Nogi er phases represent embryological tissue in t hreedi fferent terri tori eson the auricle. Territory1consists of theantihelix. theantitragus, and areas adjacent to the antihelix, such asthescaphoi d fossa, tri angul ar fossa and helix. Territory2consists of theconcha, includingthesuperi or concha, thei nferi or concha, the concharidge and theconchawall. Territory3consists of thelobe, the tragus, thei ntertragi c notch and themost i nferi or region of thehelix tail. Thephasenumber for representati on of mesodermal tissue concurswith thenumber for each territory. Phase I mesodermal tissue isrepresent ed in Territory 1, Phase I I mesodermal tissue isrepresented in Territory2, and Phase I I I mesodermal tissue isrepresented inTerritory3. Theendodermal tissue for different phasesshiftsfrom Territory 2in Phase I , to Territory 3in PhaseI I , toTerritoryI in PhaseI I I .Theectodermal tissue for di fferent phasesshifts from Territory3in PhaseI , toTerritory1in PhaseI I , to Territory3 in PhaseI I I . Functionally, Phase I poi ntsare moreassoci ated with representati on of acutesomati c reacti ons and AuriculotherapyManual PhaseI I poi nt saremorereflective of chroni c, degenerat i ve condi ti ons. PhaseI I I poi nt sseem to reflect subacut e syndromes t hat arenot as seri ous aspathol ogi cal st at esrepresent ed in PhaseI I , but are the most sali ent poi nt sin pat i ent swith underlyi ng obstacl es to t reat ment success. 4.5.1 Auri cular zones for di fferent phases of mesodermal myofasci al tissue Vertebral column: For bot hthe Chi nesesystem and t heNogi er PhaseI system, thevert ebral col umn isfound in Terri tory 1, along the medi al side of t heantihelix. TheChi nesest at ein t hei r texts t hat t hewholevert ebral col umn isli mi ted to thebody and tail of t heantihelix. Nogi er has i ndi cated t hat the PhaseI Cervical Vertebrae arefound on the anti heli x tail, t heThoraci c Vertebrae arefound on t heanti heli x body, and theLumbosacral Vert ebraeextend ont othe i nferi or crus of the antihelix. TheChi nesechartsdo show the But t ocksand Sciatic poi nt son the i nferi or crus, but do not i nclude thel ower vert ebrae t here. I n Nogi er’sPhaseI I , the Lumbosacral Vertebrae arefound on t hehelix root, whereas theThoraci cand Cervi cal Vert ebrae extend peri pheral l y ont otheconcharidge, in Terri tory2. I n PhaseI I I , TheCervi cal, Thoraci c, and Lumbosacral Vertebrae occur along the surface of the tragusin Terri tory3. Upper and l ower limbs: TheChi nesepl aced the Hip, Knee, and Foot on t hesuperi or crus of the anti heli x of Terri tory1. Nogi er pl aced t hePhaseI l ower limb poi ntsin t henearby tri angul ar fossa Table4.3 Mesodermal ti ssuefor di fferent phasesfound inauri cular zones No. Anatomical region Chinese PhaseI PhaseI I PhaseI I I PhaseI V 10 Cervical Spine AHI AH1-2 CR2 TGI - 2 PG1-2 11 ThoracicSpine AH2- 3 AH3- 4 CRI TG2- 3 PG3- 4 12 Lumbosacral Spine AH4 AH5- 6 HXI TG4- 5 PG5- 6 18 Chest andRibs AHI O AHI O SCI TG3 PG3 19 Abdomen AHI I AH11 I H 1 TG4 PG4 - ~ - - - - - - - - ~ - 21 HipandButtocks AH13 TFI I C1-2 AH I ,AT3 PT I ~ - - - - _ . - - - - - ~ - - - ~ - - - - - - - - - ~ - ~ ~ - - - - - - . _ . _ .._._- 23 KneeandThigh AH 15 TF4 I C2/4 AT2 PT2 - - - - - - - _.._- - - - - - - - - _._- - - - - - - - - _._- - - _._- ". 25 AnkleandCalf AHI 7 TF5 I C5 AT1 PT3 - - - - - - - - - - ~ 26 Foot, Heel,Toes AHI 7 TF5- 6 I C8 I T1 PT3 30 HandandFingers SF6 SF6 SC8 L01 PP9- 10 - - - - - - _.._- - - - - - - - 32 WristandForearm SF5 SF5 SC7 L03 PP7- 8 34 ElbowandArm SF4 SF4 SC5- 6 L05 PP5-6 36 Shoulder SF2 SF2 SC4 L07, SF1 PP3- 4 -" - - - _........__._. __. 38 HeadandScalp AT1-3 I H7- 9 SC3 L04 PL4 49 Tongue L04 HX8-11 I C7 L02 PL5 53 Skin SF6 HX12-15 SC4 L04 69 Heart I C4 AH3,11 SC7 L08 PP5 76 Diaphragm HX2 AH 11 SC2 TG4 - - - - - - - - _ ..- - - - - - - - - - - - - - - - 81 Spleen I C8 CW9 SC8 L08 PC3 84 KidneyandUreter SC6 I H5,6 I C7-8 AHl ,8 PP10 88 Prostate SC4 I H3- 4 I CI L02 .- - - - - - - - - 89 Uterus TF5/6 I H3- 4 I C2 L02 -_.._,.,- - - - - 91 OvarieslTestes CWI I H 1-2 I C4- 5 L04 92 Adrenal Gland TG2/3 HX2- 7 I C3,6 L06 PG5 Auricular zones 111 38.F3 Head 49.Fl Tongue 40.C Forehead 38.C Occi put 39.C Templ es 49.C Tongue 10.CCervical Spine 18.C & 18.Fl Chest 53.C Skin Chinese earpoints and Phase III points Thoraci c Spine 13.C Sacral Spine 19.C & 19.Fl Abdomen 7i :.’....L_\ - - ..- t - - - - Ji 12.CLumbar Spine 53.Fl Skin 10.F3 Cervical Spine 53.F3 Skin 39. Temples 11. Thoracic Spine 13. Sacral \ Spine 14. Buttocks ___38. Occi put Phase I and Phase /I points Phase IVpoints 13. Fl Sacral Spine 38. F2_- - - ’....- - ; Head 12. F2_- - - ror: Lumbar Spine 11.F2 Thoracic Spine 10. F2 Cervical Spine 18.F2 Chest 11.Fl Thoracic Spine 18.Fl Chest 10.Fl Cervical Spine 18. F4 Chest 38. F4 Occi put 39.F4 Temples 40.F4 Forehead 49.F4 Tongue Figure 4.7 Phases for mesodermal vertebral spine andheadpoi nts. 112 AuriculotherapyManual Chineseear points, Phase I arm, andPhase /I Ipoints 25.F3 Ankle 21.F3 Hip 32.( & .F1 Wri st 23.F3 Knee 31.C & .F1 Hand & Fingers 28.C Toes r.J-f-+-- 36.C & .F1 Shoulder Phase I Vpoints 26.C Heel 25.C Ankle 27.F3 Foot 25. Ankle 23.C1 34. Elbow Knee 34.C & .F1 21. Hip Elbow 21.( 32. Wri st Hip _++-_ 36. Shoulder ..__ 23. Knee Phase I legandPhase" points Fingers 23.F4 Knee 31.F4 Hand 34.F4 - +- - ’\ 1 El bow 36. F4 - - ;- - - - - +- 1 Shoulder 23.F1 Knee 31.F2 Hand 25.F1 Ankle 36.F3 Shoulder 27.F3 Foot 34.F3 Elbow 23.F3 Knee 32.F3 31.F3 Wri st Hand 27.F1 Foot 25.F2 Ankle Elbow Figure 4.8 Phases for mesodermal upper limb and lower limb points. Auricular zones 113 of Territory 1. I nboth the Chi nesesystem and Phase I of Nogi er’ssystem, theShoulder, Elbow, and Handare found in identical areas of the scaphoi d fossa. I n Nogi er’sPhaseI I , theupper limbsshift to thei nferi or conchaand thelower limbs are found in thesuperi or concha. Both limbs are thus located in Territory2. I n PhaseI I I , theear poi ntsfor the upper and lower limbs shift to thelobe and antihelix of Territory 3. Faceand skull: Theauri cular poi ntsfor head areas like theSkull, Jaw, Eye, and Ear are found on theanti tragusof Territory1. I n Phase I I , thepoi ntsfor thehead are found with ot her musculoskeletal poi ntson theconchawall of Territory2. I n PhaseI I I , thehead isfound at themost i nferi or level of thetragusin Territory 3. 4.5.2 Auricular zonesfor di fferent phasesof i nt ernal organ t i ssue Endodermal i nternal organs: Almost all ear reflex poi ntsfor theendodermal i nternal organsarc found in theconchaof Territory2for both theChi nesesystem and for PhaseI of Nogi er’ssystem. ThePhase I i nternal organ poi ntsincludeear reflex poi ntsfor thedigestive system, such as the Stomach and I ntestines, respi ratory poi ntssuch asthe Lungsand Bronchi , abdomi nal organssuch astheBladder, Gall Bladder, Pancreas, and Liver, and theendocri neglands such as theThymus, theThyroid, and theParathyroi d. All of theseendodermal poi ntsshift to thelobe and thetragusof Territory 3 in Phase I I , and to thehelix and antihelix areas of Territory1in PhaseI I I . Mesodermal i nternal organs: Whilemost cells which develop from t hemesodermal layer of the embryo becomepart of themusculoskeletal system, some mesodermal tissue di fferenti ates into visceral organs. Thesemesodermal i nternal organs i nclude theHeart , theSpleen, the Kidneys, the Ureter, theAdrenal Glands, and Geni tal organs, such astheVagina, theUterus, the Prostate, the Ovariesand theTestes. I n the Nogi er phases, thisset of i nternal organsisfound in the same terri tori esthat themusculoskeletal tissue isfound. I n PhaseI thesepoi ntsare found in Territory I , in PhaseI I they are found in Territory 2, and in PhaseI I I they are found in Territory3. Table4.4 Endodermal ti ssuefor different phasesfound inauricular zones 64 Duodenum 65 Small I ntestines No. Anatomical region PhaseI I PhaseI I I Phase I V LO 1 HX1 PC2 ..-.. ~ _ L03 HX2- 5 PC2 L05 TF4 PC3 - - - _._._.... _.._"- - - - - - - - - - L04 I H3- 9 PC3 ATl - 3 HX10-14 PC4 - - _._- - - - _._- - - - - I TI HXI 5 PC4 _.. --_.-,,_.--_._-.---.-_._-_._-- CWI - 3 CW9- 10 PG2- 5 L08 SF 2-3 PC2 L07 SF 1 PC2 L08 AH4 PC2 I C3 I C4,5 CW4- 8 STI SC3,4 I H3 I C4 I C6 ST4 SC3 ._- - - - - - - - - - - - HX3 ~ _ _ ~ ~ ~ ~ _ _ Chinese PhaseI I C7 I C6 .. _ ~ _ ..__. CRI I C7,CR1 - - - - - - SC1 SC1 SC2 SC 1-2 Bronchi Larynx Lungs Circulatory System Large I ntestines Rectum 74 67 66 68 70 71 61 Esophagus 63 Stomach L07 SF4,5 PC3 L02 AH 13, 14 PC3 LO1 TF3,4,5 PC3 LOI ,L03 SF6 PC3 AHI 8 - - - - - - - - - ---_.._- - -- - - - L01 TF6 PC3 L05 HX6- 8 PG4 AH1,8 AH2 PG3 HX 15 AHI PG I I C2 - - - - - - - - I C1 SC4 I C8 SC7 SC5- 6 CR2, SC8 SC8 HX4 AH8 CR2 SC8 SC7 - - - - - - - - - - - SC5 Liver Bladder Urethra ThymusGland Gall Bladder Thyroid Gland Parathyroid Gland 97 94 87 96 79 82 83 Pancreas - - - 86 114 Aur;culotherapy Manual 79.F2 Liver 64.F2 Duodenum 94.F2 ThymusGland >+-"'-';="'r/-- 96.( ThyroidGland 96.F2 ThyroidGland 70.F2 Lung 71.F2 Bronchi NogierPhase /Iear points Chineseear pointsand NogierPhase I ear points 83.( & .F1 Pancreas 82.( & .F1Gall Bladder 63.( and .F1Stomach 86.F2 Bladder 67.( Rectum 82.F3 Gall Bladder 82.F2 Gall Bladder 79.F3 Liver 67.F3 Rectum 66.F3 Large I ntestines 70B Lungs :’- - 1- +- - 1- - 1- - -79.c& .F1 Liver 94.F3 Thymus 64.F3 Duodenum 86.F3 Bladder 86.( & .F1 Bladder 83.F3 Pancreas 97.F1 Parathyroid 74.F1 Larynx 71.F1 Bronchi 96.F3 Thyroid 87.F3 Urethra 63.F3 Stomach 65.F3 Small I ntestines 61.F3 Esophagus 97.F3 Parathyroid 74.F3 Larynx ..... Figure 4.9 Phases for theendodennal i nternal organs. Auricular zones 115 81.F4 Spleen 81.F3 Spleen 92.F3 Adrenal Gland 81.C Spleen 69.F3 Heart Chinese ear points and Phase III points 84.F4 Kidney '/\Jr-...T-----I'--_ 84.F3 Kidney 69.C n Heart 69.F1 Heart 76.F1 Di aphragm 76.F2 Di aphragm 69.F2 Heart 89.C Uterus 91.C Ovari es or Testes 91.F3 Ovaries or Testes 91.F2 Ovaries or Testes 92.F1 Adrenal Gland 88.C 84.C Prostate Kidney 76. C Di aphragm 76.F3 Di aphragm 92.C - - - - - "I - - - i Adrenal Gland 89.F3 Uterus 88.F3 Prostate 81. Spleen Nogier Phase I and Phase /I points 89. Uterus 84.F1 Kidney 91.F1 Ovaries or Testes 89.F2 Uterus 88.F2 Prostate Figure 4.10 Phasesfor themesodermal internal organs. 116 AuriculotherapyManual 4.5.3 Auricular zones for different phases of ectodermal neuroendocrine tissue Chinese neuroendocrine points: TheChi nesehave i denti fi ed only afew neuroendocri nesystem poi ntson theconchawall of Territory2, whereas theEuropeanauri cul ar chartshave i ndi cated many areas of theauricle which represent thebrai n and spinal cord. Thereisconcurrencebetween the Ori ental and Westernsystems for thosefew ear poi ntsthe Chi nesehave recognized. The master poi nt t hat Nogi er and hiscolleagues first i denti fi ed astheThal amuspoi nt was labeled the Subcortex poi nt by theChi nese. Whilethe Chi neseear chartsdo descri be thelocati on of the PituitaryGl andin asimilar locati on astheEuropeanear charts, the Chi nesedo not go into as much detai l regardi ng theperi pheral endocri neglands t hat are regul ated by thepi tui tarygland. Table 4.5 Ectodermal tissue for different phases found in auricular zones No. Anatomical region Chinese Phase I Phase I I Phase I I I Phase I V 54 Eye L04 L04 AHl l I C3 PL4 59 External Ear TG5 L01 TG5 SC6 95 98 99 109 110 113 VagusNerve AH10 I C1 I H4 L01 TG1 I T 2, I C I CW2 CW3 CW1 HX7- 9 HX1 AH 15-18 HX 13-14 HX15 HX12 I C1 SC5 CW1 CRl - 2 CR2 CR1 PG3 PC1 PG3- 6 PG7 PG1 124 Spinal Cord AH8,SF1 AH8,9 SF 1, 2 I C5 PP2,4,6 Brainstem MedullaOblongata Reticular Formation CW4 L07 L08 HXl - 3 AH 10, 12 SF3-4 SC1 I C8 PP2 PL6 133 134 Red Nucleus SubstantiaNigra L06 L06 CWl O I H1 I C6 I C7 PL4 PL4 135 Striatum (Basal Ganglia) L04,AT1 HX9- 11 I C3,4 PL4 PL2 PG1 PL2 PL2 I C4 CWl - 3 I C6 I C7 AH3 AHl l CW9 CW8 L06 AT2-3 L02 LO2, I T 1 CW2 Hypothalamus Thalamus(Subcortex, Brain) Hippocampus Amygdala - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 137 138 140 141 143 145 CingulateGyrus Cerebellum I T 1 AT3,AH1 CW7 HX4- 6 I C6 SC8 PL2 PP1 147 Occipital Cortex L07 SF4 AH12 SC7 PL4 - - - - - - - - - - - - - - - - - - - - - - - - - - - 148 149 Temporal Cortex Parietal Cortex L05 L05 SF5 AH14 SF6 AH 16, 18 SC6 SC6 PL4 PL3 150 Frontal Cortex L03 TF1-2 AH13 SC5 PL2 151 Prefrontal Cortex LO1 TF3- 4 AH 15-17 SC4 PL1 Auricularzones 117 95.C Mammary Gland 124.Fl Spinal Cord 13Ul Reticular Formation 127.Fl Medulla Oblongata 134.F1 SubstantiaNigra 133.Fl Red Nucleus 135.F1 Striatum 127.C Brainstem 110.Fl Parasympathetic Nerves 109.Fl Sympathetic Nerves 113.Fl VagusNerve 143.F1 u- - _- CingulateGyrus 140.Fl Hippocampus 95.Fl MammaryGland 141.F1Amygdala 145.Fl Cerebellum 147.F1 Occipital Cortex 149.Fl Parietal Cortex 148.Fl Temporal Cortex 54.Fl Eye 150.Fl Frontal Cortex 138.C Brain 138.Fl Thalamus 137.Fl Hypothalamus 98.Fl Pineal Gland 99.Fl PituitaryGland 59.Fl External Ear 151.Fl Prefrontal Cortex 118 Figure 4.1 1 PhaseI neuroendocrineand Chineseear points. AuriculotherapyManual 145.F2 Cerebellum 127.F2 Medulla Oblongata 59.F2 _--f'-J External Ear 98.F2 Pineal Gland 131.F2 Reticular Formation 99.F2 PituitaryGland 151.F2 Prefrontal Cortex 150.F2 Frontal Cortex 133.F2 Red Nucleus 140.F2 ---''<I'' Hippocampus 141.F2 Amygdala 143.F2 CingulateGyrus 134.F2 SubstantiaNigra Figure 4.12 PhaseI l neuroendocrineear points. Auricularzones 95.F2 MammaryGland 135.F2 Striatum 54.F2 Eye 110.F2 Parasympathetic Nerves 109.F2 Sympathetic Nerves 113.F2 VagusNerve 124.F2 Spinal Cord 148.F2 TemporalCortex 147.F2 Occipital Cortex 138.F2 Thalamus . I . ~ d 137.F2 Hypothalamus 119 59.F3 External Ear 127.F3 Medulla 98.F3 Obl ongata Pineal Gland 109.F3 Sympatheti c 113.F3 Vagus Nerve Nerves 110B 140B Parasympatheti c Hi ppocampus Nerves 141.F3 131.F3 Amygdal a Reticular 143.F3 Formation Ci ngulate Gyrus 134.F3 54.F3 Substantia Nigra Eye 124.F3 95.F3 Spinal Cord Mammary Gland 145.F3 - - ++- 1- +› Cerebellum 137.F3 __- = ~ ~ I . - Hypot hal amus 138.F3 Thalamus 151.F3 Prefrontal Cortex ~ 150B Frontal Cortex ~ __ 149.F3 Parietal Cortex 148.F3 Temporal Cortex 147.F3 Occi pi t al Cort ex 135.F3 St ri at um 99.F3 Pi t ui t ary Gland Figure 4.13 PhaseI I I neuroendocrineear points. 120 Aur;culotherapyf\1anual Phase I neuroendocri ne poi nts: Thenervous system and theendocri nesystem arefirst represent ed on thelobe of Territory3in PhaseI of Nogi er’ssystem. I n all t hreephases, t heNogi er system allows for di fferent auri cul ar locali zati ons for pi tui tary control of endocri nehormones, ascont rast edwith the actual pl acement of the peri pheral endocri negl and itself. TheThal amusand Hypot hal amusare found on the external surface of theanti tragus, whereas they were previ ously descri bed on the conchawall and i nferi or concha. TheCerebral Cortexisstill represent ed on the ear l obe Phase I I neuroendocri ne poi nts: Theect odermal neuroendocri nesystems shift to t hehelix, the antihelix, and the tri angul ar fossa regi ons of Terri tory 1in PhaseI I . ThePi tui tarypoi nt for geni tal control in PhaseI I isl ocat ed in the t ri angul ar fossa regi on, near the Chi neseUt eruspoi nt. The Frontal Cort exin PhaseI I corresponds to the auri cul ar l ocati on for t heChi nesemast er poi nt Shen Men. TheCerebral Cort exin PhaseI I isfound along t hesuperi or helix, l eadi ng to the Spi nal Cord l ocated on t hehelix tail. Phase I I Ineuroendocri ne poi nts: Theneuroendocri nesystems shift to the conchain Terri tory2in PhaseI I I . Thecorti cal areas arel ocated in thesuperi or conchaand t hesubcorti cal areas in the i nferi or concha. Thel ocati on of the PhaseI I I Ant eri or Hypot hal amusand Post eri or Hypot hal amus in thei nferi or conchacoi nci des with the locati on of t heChi neseLungpoi nt sused in t het reat ment of narcoti c detoxi fi cati on and drug abuse. 4.5.4 Nogier phases related to auricular master points Thereare cert ai n poi ntson the auri cle used in bot h Chi neseear acupunct ureand European auri cul ar medi ci net hat do not rel ateto onespecific anat omi cal organ but affect abroad rangeof physiological functions. Theseear poi ntsarereferred to asmast er poi nts, the two pri nci pal examples bei ng the Chi neseear poi nt Shen Menand t heNogi er auri cul ar locus i denti fi ed as Poi nt Zero. Thesetwo functi onal poi ntsdo correspond to specific anat omi cal organswhen viewed from the perspecti ve of the Nogi er phases. Frank (1999) has not edt hat Shen Menisi denti fi ed at t heauri cul ar l ocati onsconsi stent with the Phase I Spl een projecti on, the PhaseI I Thal amusprojecti on, and PhaseI I I Liver projecti on. The spl een deal s with i nfl ammatory cellular el ement sand isthusreasonabl y seen in many i nfl ammatory condi ti ons. Thethal amusisasignificant central nervous system st ruct ureinvolved in the modul at i onof pai n signals from t hespi nal cord to the cerebral cortex. I t isreasonabl e, therefore, to find thiszonereacti ve wi th chroni c, degenerati ve, pai nful condi ti ons. Theliver isassoci ated with hepatobi l i ary physiology and t hereforethiszonewoul d reasonabl y be active in subacut eor chroni c pai n or dysfuncti onal probl ems. Poi nt Zerolies in thehelix root areai nnervated by thevagus nerve t hat suppli es theendodermal organ structuresrepresent ed in PhaseI at thesuperi or and i nferi or concha. Vagusnerve activity is commonly seen with physiologic stress and painful experi ences. PhaseI I locati on at t heregi on where Point Zeroisfound isconsi stent with locati on of theCerebel l um. Specific cerebel l ar functi ons includecoordi nati onof somati c mot or activity, regul ati on of muscle tone, and thebalanci ng mechani smsof equi li bri um. Withsuch significant i mpact on thebody’s coordi nati onfunctions, it is not surpri si ng t hat thispoi nt isreactive in many chroni c degenerati ve PhaseI I condi ti ons. ThePhase I I I poi nt for theCorpusCallosumisl ocated at theanatomi cal posi ti on of Poi nt Zero. Thisneural bridgebetween theleft and right cerebral cortex isacritical relay for proper neurophysi ologi c function. PhaseI I I di sturbancesat thispoi nt may mani fest as at t ent i ondeficit di sorder, stutteri ng, dyslexia, confusi on with di recti onsand visual and audi tory processi ng di sturbances. 4.6 Microsystem points represented in auricular zones Eachanatomi cal part of t hehumanbody and each heal thcondi ti onarerepresent ed in theauri cular microsystem codes by an ear reflex poi nt desi gnated by a number and al et t er extensi on. The numbersconti nuefrom 0.0 to over 200.0, each number desi gnati ngadi fferent part of human anatomy. Thel et t er extensi ons following thedeci mal poi nt shown in Box 4.2 i ndi catewhet her t hat ear reflex poi nt belongsto theChi neseear acupuncturemicrosystem, ’.C’, theEuropean auri cul otherapy microsystem, ’.E’, or whet her it isauniversally accepted location. I n somecases, thereismoret hanoneChi neseor Europeanear reflex poi nt for agiven body area. I n those instances, t herecan be several extensions, such as .Cl , .C2, and .C3. Box 4.2 also shows how the Nogi er PhasesI - I I I are i ndi cated by .Fl - .F3and .F4for thefourth phaseon the post eri or side of theear. Auricular zones 121 4.6.1 Helix zones HX1 Point 0, Point of Support, Solar Plexus, Umbi li cal Cord, External Genitals.E, Penis or Clitoris, Sexual Desire. HX2 Diaphragm.C. HX3 Rectum.C,Anus, Urethra.C, Weather point. HX4 External Genitals.C. HX5 Psychosomatic point, Psychotherapeutic point, Reactional poi nt (Point R). HX6 Omega 2. HX7 Allergy point, Apex of Ear. HXB HX9 Tonsil 1. HX 10 LiverYang 1. HX11 Darwin’s point, Liver Yang 2, Helix 1. HX12 Lumbosacral Spinal Cord,Alertness. HX13 Thoracic Spinal Cord, Helix 2. HX 14 Cervical Spinal Cord,Tonsil 2, Helix 3. HX15 Medulla Oblongata, Tonsil 3, Helix 4, Sexual Compulsion. Helix auricular zones Box 4.2 Auricular microsystem codes .0 .C .E .F1 .F2 .F3 .F4 Universal ear reflex point Chinese ear reflex point European ear reflex point Nogier Phase I point Nogier Phase I I point Nogier Phase I I Ipoint Nogier Phase I Vpoint 188.E Omega 2 183.E2 Psychosomatic Point 90.C External Genitals.C 198.E Weather 87.C Urethra.C 67.C Rectum.C 76.C Diaphragm 90.E External Genitals.E 184.E Sexual Desire 179.C Apex of ear 75.C1 Tonsil 1 80.C1 LiverYang 1 200.E Darwin’s Point 180.C1 Helix 1 \ .....- <- - - _ 80.C2 Liveryang 2 194.E Alertness 124.E Lumbosacral Spinal Cord 125.E Thoracic Spinal Cord 75.C2 Tonsil 2 126.E Cervical Spinal Cord 185.E Sexual Compulsion 127.E MedullaOblongata 75.C3 Tonsil 3 122 Figure 4.14 Helixzonesand corresponding auricular points. AuriculotherapyManual 4.6.2 AH 1 AH2 AH3 AH4 AHS AH6 AH7 AH8 AH9 AH10 AH 11 AH12 AH13 AH14 AH1S Ant i hel i x zones Upper Cervical Vertebrae, Cerebellum. Lower Cervical Vertebrae, Torticollis. Upper Thoracic Vertebrae, Heart.E, Mammary Gland.C. LowerThoracicVertebrae. LumbarVertebrae.C,Abdomen. Upper LumbarVertebrae, Buttocks. Lower LumbarVertebrae. Sciatic Nerve, Sciatica, I schium. Sacral Vertebrae, Autonomic point, Sympathetic point. Upper Anterior Neck Muscles, Torticollis. Cervical Spine.c. Lower Anterior Neck muscles, Clavicle.E, Thoracic Spine.C, Scapula.E, ThyroidGland.C. Chest and Ribs, Thorax, Pectoral Muscles, Breast, Mammary Gland.C, Lumbar Spine.C. Abdomen, Lumbago (lumbodynia) point, Heat point. Abdomen. AH16 Thumb.E. Hip.C. AH 17 Heel.C,Ankle.C. Knee joint.C2. AH 18 Toes.C. Knee.C1. Antihelix auricular zones 168.C Heat point 14.0 Buttocks 13.E Sacral Spine 107.0 Sciatic Nerve 12.E LumbarSpine HE ThoracicSpine 69.E HeartE 95.C Mammary Gland.C 10.E Cervical Spine 145.E Cerebellum 26.C Heel.C 28.C Toes.C 25.C Ankle.C 23.Cl Knee.Cl 29.E Thumb 21.C Hip.C 23.C2 Knee.C2 158.Cl Lumbago 19.0 Abdomen 18.0 Chest 17.0 Breast 16.E Clavicle.E 96.C ThyroidGland.C 15.0 Neck Figure 4.15 Anti hel i xzones and corresponding auricular points. Auricularzones 123 4.6.3 I H1 I H2 I H3 I H4 I HS I H6 I H7 I H11 I H12 Internal helix zones Ovaries or Testes.E. Vagina or Prostate.E. Uterus.E. Sympathetic Autonomic point, Ureter.E. Kidney.E, Hemorrhoids.C 1. Kidney.E. Allergy point. Wind Stream, Lesser Occipital Nerve. Lumbar Sympathetic Preganglionic Nerves. 174.C Hemorrhoi ds 8S.E Ureter.E 2.0 Sympatheti c Aut onomi c poi nt 89.E Uterus.E 88.E Vagina or Prostate.E 124 Figure 4.16 I nternal helixzonesand corresponding auricular points. AuriculotherapyManual L03 L04 4.6.4 lobe zones LO1 Master Cerebral point, Master Omega point, Nervousness, Neurasthenia, Fear, Worry, Psychosomatic point, Prefrontal Lobe, Optic Nerve, Analgesic point, DentalAnalgesia 2 (Tooth extraction anesthesia, lower teeth), LimbicSystem 1, Prostaglandin point 1. LO2 External Nose.E, Frontal Cortex, LimbicSystem 2, Rhinencephalon, Septal Nucleus, Nucleus Accumbens, Olfactory Bulb, Olfactory Nerve, Amygdala, Aggressivity point, I rritabilitypoint, DentalAnalgesia 1 (Toothextraction anesthesia, upper teeth). Face, Cheeks, Lips, Tonsil 4, Helix6, Parietal Cortex. Master Sensorial, Eye, Frontal Sinus, Tongue.C, Palate.c. LO5 I nternal Ear.C, Tongue.E, MidbrainTegmentum, Trigeminal Nerve, Helix 5. LO6 Upper jaw, Maxilla,Vertex, Hippocampus, Temporal Cortex,Auditory Line, Parietal Cortex. LO7 Lower jaw, Mandible, Chin, Pons. LO8 TMj,Teeth, Antidepressant point, Sneezing point, Salivary Gland (parotid gland). 140.E Hi ppocampus 148.E Temporal Cortex 49.C Tongue.C 41.E Frontal Sinus 182.E Aggressi vi ty 139.E2 Limbic System 2 47.C1 Dental Analgesia 1 57.E External Nose.E 47.C2 Dental Analgesia 2 9.0 Master Cerebral 86.E Master Omega 139.E1 Limbic System1 150.E Frontal Cortex 50.E 8 0 Lips Master 54.0 18q.C6 Sensorial Eye Hel i x 6 Tonsil 4 42.C Vert ex 43.E TMJ 190.E Anti depressant 51.E 46.0 Teeth 44.0 Lower Jaw 45.0 Upper Jaw 180.C5 Hel i x 5 49.E Tongue.E 58.C I nternal Ear.C 149.E Parietal Cortex Figure 4.17 Lobezonesand corresponding auri cular points. Auricular zones 125 126 4.6.5 Scaphoid fossa zones SF 1 Master Shoulder, Clavicle.C, Appendix Disorder 3. SF 2 Shoulder, Chinese Shoulder joint. SF 3 Upper Arm, Chinese Shoulder, Appendix Disorder 2. SF 4 Elbow, Forearm. SF 5 Wrist, Hand, Skin Disorder.C, Urticaria point. SF 6 Fingers, Appendix Disorder 1. 78.C1 Appendix Disorder 1 30.0 Fingers 31.0 Hand 53.C Skin Disorder.C (Urticaria point) ~ __ 32.0 Wrist 195.E1 Insomnia 1 33.0 Forearm 34.0 Elbow 78.C2 Appendix Disorder 2 35.0 Arm 36.0 Shoulder 195.E2 Insomnia 2 37.E Master Shoulder 16.C Clavicle.C 78.C3 Appendix Disorder 3 Figure 4.18 Scaphoi dfossa zonesand correspondi ng auri cular poi nts. AuriculotherapyManual 4.6.6 Triangular fossa zones TF1 Hip.E, Pelvic Girdle. TF2 Shen Men(Spirit Gate, DivineGate). TF3 Thigh, Constipation,Antihistamine. TF4 Knee.E, Hepatitis 1. TF5 Heel.E, Calf.E,Ankte.E, Uterus.c. TF6 Toes.E, Hypertension 1 (Depressing point). 28.E Toes.E 27.E FootE 25.E Ankle.E 26.E __I-- Heel.E,......_... 24.E Calf.E 154.C Consti pati on 156.C1 Hypert ensi on 1 89.C Uterus.C 155.C1 Hepat i t i s 1 153.C Ant i hi st ami ne 1.C Shen Men 20.0 Pelvic gi rdl e Figure 4.19 Triangular fossa zonesand corresponding auricular points. Auricular zones 127 4.6.7 Tragus zones TG1 Pineal Gland, Epiphysis, Point E, Eye Disorder 1 (Mu 1). TG2 Tranquilizer point, Hypertension 2 (HighBlood Pressure point), ValiumAnalog, Relaxation point. Maniapoint, Nicotine point. Corpus Callosum. TG3 External Nose.C,Appetite Control (Hunger point),Adrenal Gland.C (Suprarenal Gland), Stress Control point, Corpus Callosum. TG4 Vi tali ty point. Viscera, Thirst point, Corpus Callosum. TG5 External Ear.C,Apex ofTragus, Heart.C2 (Cardiac point). 4.6.8 Antitragus zones AT1 Forehead. Thyrotropin (TSH), Eye Disorder 2 (Mu2). AT2 Temples, Asthma (PingChuan),Apex of Antitragus. AT3 Occiput. Atlas, Occipital Cortex. 146.E Corpus Callosum 92.C Adrenal Gland 192.E NicotinePoint 191.E Mania Point ~ __178.C Apex of Antitragus 38.0 Occiput 147.E Occipital Cortex 152.C Asthma 39.0 Temple 59.0 External Ear.O 69.C2 Heart.C2 177.E Apex of Tragus 193.E Vitality Point 162.C Thirst Point 57.C External Nose.C 161.C Appetite Control 7.0 Tranquilizer Point 55.C1 Eye Disorder 1 98.E Pineal Gland 143.E Cingulate Gyrus 157.C Hypotension 40.0 55.C2 Forehead Eye Disorder 2 Figure 4.20 Tragusand antitraguszonesand corresponding auricular points. 128 AuriculotherapyManual 4.6.9 Subtragus zones ST1 Adrenocorticotropin (ACTH),Surrenalian point. ST2 Reticular Formation, Vigilance, Postural Tonus, I nner Nose.C (Nasal cavity). ST3 Master Oscillation point, Auditory Nerve, Deafness, I nner Ear.E, Mutism (Dumb). Reticular Formation point. ST4 Larynx and Pharynx.C, Skin Master point. 4.6.10 Intertragic notch zones I T1 Eye Disorder 1 (Mu1). Cingulate Gyrus, Hypotension point. I T2 Endocrine point. I nternal Secretion. Thyrotropins, Thyroid Stimulating hormone (TSH), Parathyrotropin. 5.0 Endocrine poi nt (I nternal Secretion) 114.E Audi t ory Nerve.E 56.C I nternal Nose.C 55.C1 Eye Disorder 1 143.E Cingulate Gyrus 102.E Thyrotropi ns (TSH) 157.C Hypotensi on Figure 4.21 Subtragusand intertragic notchzonesand corresponding auricular points. Auricularzones 129 4.6.11 Inferior concha zones I C1 Anterior Pituitary, Adeno-Hypophysis, San Jiao (TripleWarmer), Prolactin. I C2 Lung2, I psilateral Lung,Anterior Hypothalamus. I C3 Posterior Pituitary, Neuro-Hypophysis, Trachea, Larynx and Pharynx.E, Vagus Nerve, Bronchi. I C4 Lung, Heart.C, Bronchi, Tuberculosis point. I C5 Lung1, Contralateral Lung, Posterior Hypothalamus, Toothache 3. I C6 Mouth, Throat, Parasympathetic Sacral Nerves, Eye Disorder 3. I C7 Esophagus, Eye Disorder 3 (new Eye point), Cardiac Orifice. I C8 Spleen.C (left ear), Muscle Relaxation point. 62.0 Cardiac Orifice 137.E Posterior Hypothalamus 159.C Muscle Relaxation '--J:..---- 81.C Spleen.C ~ 70.01 Lung 1 46.C3 Toothache 3 72.0 Trachea 60.0 Mouth 73.0 Throat 71.C Bronchi 113.E Vagus Nerve - - +- - 100.E Posterior Pituitary 69.C 99.0 Heart.C Anterior Pituitary 70.02 136.E Lung 2 Anterior Hypothalamus Figure 4.22 I nferior concha zonesand corresponding auri cular poi nts. 130 AuriculotherapyManual 4.6.12 Concha ridge zones eR 1 Stomach. eR 2 Liver, Cirrhosis, Hepatitis. 4.6.13 Superior concha zones se1 Duodenum,Appendix. se2 Small Intestines, Appendix, Omega 1,Alcoholic point. se3 Large Intestines, Colon, Hypogastric Nerve. se4 Prostate Gland.C, Urethra.E, Hemorrhoids.C2. se5 Urethra.E, Bladder. se6 Kidney.C, Ureter.c. se7 Pancreas, Ascites point. se8 Gall Bladder (right ear), Spleen.E (left ear). 67.E Rectum.E 77.0 Appendi x 65.0 Small I ntestines r- ,,_...... 163.C Alcoholi c poi nt 64.0 Duodenum Figure 4.23 Superior concha and concha ridgezones and auricular points. Auricularzones 86.0 Bladder 85.C Ureter.C 84.C Kidney.C 172.C Ascites 8U L- +- -Spleen.E 131 4.6.14 Concha wall zones ew 1 Gonadotropins (FSH. LH),Ovaries or Testes.c. ew2 Thalamus point, Subcortex (Dermis), Thalamic Nuclei. Excitement point, Salivary Gland. ew 3 Brain (Diencephalon), Central Rim, Dizziness, Vertigo. Toothache 2. ew4 Parathyroid Gland, Brainstem, Superior and MiddleCervical Sympathetic Ganglia. ew 5 ThyroidGland.E, Wonderful point, I nferior Cervical Sympathetic Ganglia. ew6 Mammary Gland.E, Thoracic Sympathetic Ganglia. ew 7 ThymusGland, Thoracic Sympathetic Ganglia. ew8 Adrenal Gland, Lumbar Sympathetic Ganglia. ew9 Lumbar Sympathetic Ganglia. ew 10 Sacral Sympathetic Ganglia. 109.E Sympatheti c Postganglionic Nerves 3.0 Thalamus (Subcortex) 46.C 2 Toothache 2 l OU Gonadotropi ns 91.C Ovaries or Testes 165.C 106.C Exci tement Salivary Gland 94.E Thymus Gland 95.E Mammary Gland i i i Sf:::::::=--- 79.0 Liver 68.E - - 1- - - _Ci rcul at ory System 96.E Thyroi d Gland 97.E Parathyroid Gland 127.C Brainstem 176.C Central Rim 130.C Brain 132 Figure 4.24 Concha wall zonesand corresponding auri cular poi nts. Auriculotherepy fvlanual 12.F4 Lumbar Spine 84.F4 Kidney 27.F4 Foot 23.F4 Knee 13.F4 Sacral Spine 86.F4 Bladder 66.F4 Large I ntestines 83.F4 Pancreas 65.F4 Small I ntestines 81.F4 n.- - - - +- - - -Spleen 63.F4 Stomach 79.F4 Liver 60.F4 Mouth 70.F4 Lung 38.F4 Occiput 39.F4 Temples 40.F4 Forehead 45.F4 Upper Jaw 36.F4 - - +- - u Shoulder 31.F4 Hand 32.F4 Wrist 21.F4 Hip 43.F4 - - - - t - - l ,J TMJ 44.F4 Lower Jaw 10.F4 Cervical Spine 34.F4 Elbow 69.F4 - - \ - - - - - - l c- - - n Heart 11.F4 Thoracic Spine 49.F4 Tongue Figure 4.25 Posterior auri cular zonesfor thesomat ot opi cbody. Auricular zones 133 LM2 LM 1 134 LM 7 LM Al LM Al LM Al LM 0 HX 1/ CR1 LM 6 HX 15/ LO 7 LM 12 AT 1 / AT 2 LM 1 HX 4 / HX 5 LM 7 LO1 / LO3 LM 13 AT 2 / AT 3 LM 2 HX 7 / HX8 LM 8 LO1 / Face LM 14 AT 3 / AH 1 LM 3 HX 10 / HX 11 LM 9 I T 1 / TG 1 LM 15 AH 2 / AH 3 LM 4 HX 11 / HX 12 LM 10 TG2 / TG3 LM 16 AH 4/ AH 5 LM 5 HX15 LM 11 TG4 / TG5 LM 17 AH 6 / AH 7 Figure 4.26 Relationship ofauri cular l andmarks to auri cular zones. AuriculotherapyManual Auri cul ar diagnosis procedures 5.1 Visual observation of skin surface changes 5.2 Tactile palpati on of auricular tenderness 5.3 Electrical detecti on of ear reflex poi nts 504 Nogi er vascular aut onomi c signal (N-VAS) 5.5 Auricular diagnosis guidelines 5.6 Assessment of osci llati on and l ateral i ty disorders 5.6.1 Physical tests for the presence of l ateral i ty disorders 5.6.2 Scoring l ateral i ty tests 5.7 Obstructi ons from t oxi c scars and dental foci 5.8 Scientific investigations of auricular diagnosis 5.1 Vi sual observation of skin surface changes Just asclassical acupuncturistshave observed distinct changesin thecolor and shape of thetongue and inthesubtle qualitiesof theradial pulse, practi ti onersof ear acupuncturehave emphasi zed the diagnostic value of visually examining theexternal ear (Kvirchishvili 1974, Romoli & Vet toni 1982). Thoughnot asroutinely observed asot her diagnostic indicatorsof reactive ear points, promi nent physical attri butesof theauri cular skin surface have been associated with specific clinical conditions. Thisvisual inspection of theauricle should beconductedbefore theear surface iscleaned or mani pulatedfor ot her auri cular procedures. Dark colored spots: Shiny red, purpl eor brown spots at di sti nct regi ons on the ear surface usually i ndi cateacut ei nflammati ons. Bri ght red t endsto i ndi catean acute reacti on t hat ispai nful, whereas dark red isseen with pati entswho have along history of di sease. Darkgrey or dark brown can i ndi catetissue dedi fferenti ati on or t umorscoul d be found in thecorrespondi ng organ. These col ored spotsare not to be confused with ordi nary freckles t hat do not necessarily i ndi catea di agnosti c condi ti on. I f pressure isappl i ed to thesecol ored regi ons of t heauri cle, t hat spot isoft en painful to touch. Absence of thesespots does not i ndi catet heabsence of any medi cal probl em, but the occurrence of col ored regions on t heear doessuggest t hehigh probabi l i ty of some type of pathology in the correspondi ngpart of t hebody. Thesecol ored spotsonly gradually go away when theheal th of the rel ated body area improves. White skin: Whi teflakes, crusty scales, peeli ng skin, sheddi ngand dandruff- l i keareas of desquamat i on always i ndi cateachroni c condi ti on. Whi tenesssurrounded by redness in theheart regi on i ndi cates rheumat i cheart disease. A close i nspecti on of t heear of many pat i ent si ndi cates t hat t hereisadryness on locali zed regi ons of theskin. I ft heauri cle iscl eaned, thewhi teflaky regi onswill reappear wi thi n several days unless the correspondi ngcondi ti on ist reat ed. I fa t reat ment iseffective for heal i ng agiven condi ti on, flaky regi ons do not reappear. Physical protrusions: Specific areas of t heauri cul ar skin surface can exhibit spot-li keprotrusi ons, slight depressi ons, rough thi ckened skin or bli ster-li ke papul es prot rudi ngabove t hesurface. The papul es aresmall, ci rcumscri bed solid elevati ons of skin t hat could be col ored red, whi teor awhi te papul esurrounded by redness. Someti mest hereisadark grey papul e. Ear lobe creases: Di agonal folds in the skin over the ear l obe have been correl at ed with certai n types of heal th di sorders. Lichstein et al. (1974) and Meht a& Hornby(1974) bot hpubl i shed Diagnosis procedures 135 Groove of t i nni t us - - """";111 Groove of hypertensi on - - -......, Tumor-specific area I by Huang - - -Tumor specific area I I by Huang .........,.’- - - - Groove of coronary heart disease Figure 5.1 Photograph ofan ear lobe crease related to coronary problems. Figure 5.2 Representation offunct i onal regions on theear i denti fi edby Dr Li ChunHuangthat havebeen associ ated with tumorsand cardi ovascular disorders. 136 studi es in theNewEngl andJournal ofMedi ci net hat demonst rat edsignificant correspondences between ear lobe creases and coronary problems. Thesedoubl ebl i nd clinical studi esshowed t hat thepresence of acrease runni ngdiagonally from the i ntertragi cnotch to t hebot t omof the lobe was morepredi cti ve of t heoccurrence of acoronary probl emt hanei t her bl ood pressure level or serum cholesterol level. Huang(1996, 1999) has report ed t hat ot her ear lobe creases are associ ated with thei nci denceof cancer. 5.2 Tactile palpation of auricular tenderness Themost readily available techni quefor determi ni ngthe reactivity of auri cul ar reflex poi ntsisto apply localized pressure to specific areas of the auricle. Pati entsare oft en very surpri sed t hat pal pati on of one area of t heexternal ear isso much morepai nful t hani denti cal pressure appl i ed to anearby auri cul ar regi on. Even moreamazi ng ishow t hespecific areaof the ear had been previously recogni zed on ear reflex chartsas indicative of pathologi cal probl emst hat the pat i ent is experi enci ng. General reactivity: Check broad regi ons of the external ear by using long stroki ngmovements with your fingers and by applying general i zed pi nchi ngpressure to given regi ons of t heauricle. Det ermi neareas of i ncreased ear sensitivity of thepat i ent to appl i ed pal pati on with the t humbon thefront of the ear and t heindex finger on the post eri or side of the auri cle. Ask if t hepat i ent noticeswhet her one regi on ismoret ender than anot her. Moni t orfacial gri maces in response to your tacti le pressure. Gentlypinch the two sides of t heauri cle at di fferent areas. I t isi mport ant to develop tacti leawareness of thedi fferent contoursof t hecarti lagi nous anti heli x and thecurving ridges around the helix. Oneshould pull down on the fleshy ear lobe and feel t hroughout the depthsof the concha. Not eareas of skin surface that may be rough, bumpy, scaly, waxy, dry, oily, cold or warm. Especially sensitive pati entsexperi ence t endernessfrom even light touchi ngof broad areas of the auricle, and it isi mport ant to proceed slowly and gently with t hat individual. For less sensitive pati ents, moreselective pal pati on can be appl i ed with afingernail. Auriculotherapyfv1anual Specific tenderness: Locali zed t ender areas on theexternal ear are i nvesti gated with along metal probewith around, blunt smoothtip approxi mately 1.5mmin di ameter. Such probesare available from acupuncture, medical or dental equi pment suppliers. Some art supply storesoffer similarly effective tools for use bygraphi c artists, spri ng- loaded metal devices with asmall, spheri cal tip. Firmly stretch out theauri cle with one hand, while holdi ngthe probewith theot her hand. Slowly glide theprobeover theear surface, stoppi ngon small regi ons t hat the pati ent statesare sensitive to lightly appli ed pressure. Palpateauri cul ar areas t hat you suspect of being reacti ve by thei r correspondence to thepartsof thebody wherethepat i ent has report ed pai n or pathology. I f several poi ntson theear are found to be tender, selectively exami ne each poi nt to det ermi newhich isthemost pai nful of thegroup. Thedegree of tendernessusually rel ates to theseverity of the condition. Themoresensitive thepoi nt, themoreseri ous thedi sorder. Tendernessappearswithin 12hoursaft er ahealthprobl em occurs, becomes moresensitive if the condi ti onworsens, and di sappears within 7days aft er theprobl em iscorrected. Thereisal earned clinical skill in knowing thelevel of pressure needed to di scri mi natethemost accurate poi nt t hat exhibits the highest intensity of tenderness. Avoid overly stressing thepat i ent with unnecessari ly severe di scomfort while conducti ngatactileexami nati on oft heauricle. Behavioral monitoring: Thepracti ti oner should ask t hepat i ent to rat ethe degree of sensitivity t hat isfelt at each poi nt on theauri cle when pressure isapplied. Liket heashi poi ntsin body acupuncture, one could simply have thepat i ent say ei t her ’Ouch’ or There’ when aregi on is especially tender. Alternatively, one can use arangeof numeri cal or verbal responses to i ndi cate thedegreeoft enderness. A value ofT or ’Slight’ could i ndi catelow level tenderness, ’2’ or ’Moderat e’ could i ndi catemi ddlelevel tenderness, ’3’ or ’Strong’ could i ndi catehigh level tenderness, and ’4’ or ’Very Strong’ could i ndi cateextremely high level tenderness. Spontaneous, facial gri mace reacti onsor behavi oral flinches in response to appl i ed pressure should also be noted. A noti ceablewince by thepati ent when you pal pat easpecific poi nt on theear may not be comfortabl efor thepati ent, but it isone of thebest predi ctorst hat you are on an active reflex poi nt t hat isappropri at efor treatment. Nogi er referred to thecontracti on of face muscles in response to auri cular pal pati on asthe’sign of thegri mace,’ themost reli able i ndi cati on t hat a’real ’ ear reflex poi nt hasbeen located. TheChi nesehave developed asi mi lar gradi ng system where thedegree of facial gri maces and verbal expressions israt ed asfollows: (- ) for no pai n, ( +) for flinching or saying ’Ouch,’ (++) for frowning, ( +++) for wincing, and ( ++++) for dodgingaway or saying ’t hepain isunbearabl e.’ 5.3 Electrical detecti on of ear reflex poi nts Of all themethodsfor conducti ngauri cul ar diagnosis, exami nati on of theauri cle with an electrical poi nt finder isthemost reli able and least aversive. Even small changesin el ectrodermal skin resistance can be det ermi nedby electrical detecti on procedures. For many practi ti oners, themain consi derati onsare ei t her thecost of aquality poi nt fi nder or the extra time taken to first determi ne themost reactive points. Whileboth of theseobjecti ons have thei r validity, thei ncrease in accuracy of discovering themost appropri at eear poi nt for diagnosis and t reat ment of t hat cli ent isworth the expense and effort. Familiarity allows even inexpensive but less sophi sti cated equi pment to be used in an effective manner. Clean skin: Toexamine the ear with an electri cal poi nt finder, first clean theear with alcohol to remove sources of el ectrodermal skin resi stance. High electri cal resi stance i mpai rst heelectrical poi nt fi nder’s ability to di scri mi nateactive ear reflex poi ntsfrom normal regi ons of the auricle. Sources of such unwanted skin resi stance could i nclude earwax, flaky skin, dust from theair, make-upfrom theface, or hai rspray i ngredi ents. Point finder: Use an electrical poi nt finder desi gned for the ear by bot h itssize and itselectrical amperage. Someprobesdesi gned for thebody are i nappropri at efor t heear because they are too bigor use t oo high an electrical detecti ngvoltage. Ear poi ntsare smaller, closer to the surface and have lower el ectrodermal skin resi stance than do body acupoi nts. Thepoi nt finder should be a spri ng-loaded, constant pressure rod with asmall ball at theend. Even moreselective are concentri c bi pol ar probeswith asmall rod in themi ddleand an out er barrel. Bi pol ar detecti ng probes use di fferenti al ampli fi cati on of thevoltage di fference between thetwo adjacent electrodes. Thisprocedureallows for maxi mum di scri mi nati on of the di fference in el ectrodermal Diagnosis procedures 137 A B c D Figure 5.3 Pressure palpati on devices that are used on theauricle are shown on Point Zero (A) and theSympatheti cAut onomi cpoi nt (R). A triangular stylus can beused to discern thei ndentati on at l andmark zero (C), and a spri ng-loaded stylus can mai nt ai n constant pressure whiledetectingreactive ear poi nt s(D). 138 AuriculotherapyManual skin resi stance between adjacent skin areas. Theauri cul ar probeisappl i ed to theear by the therapi st, while anot her lead isheld in t hepati ent’shand. Electrodermal measurement: Thepracti ti oner moni torsdecreased skin resi stance, or inversely stated, i ncreased skin conductance, ast heprobeisgli ded over theskin with onehandwhile the ot her hand stretchesout the auricle. El ect rodermal activity has also been desi gnated asthe galvanic skin response (GSR), ameasureof thedegree of electrical current t hat flows throughthe skin from the detecti ngprobeto thehandheld neutral probe. Electri ci ty must always flow between twopoints, thusfor some poi nt finders t hat do not utilize ahand held probe, it isi mperati ve t hat thepracti ti oner touch the skin of thepat i ent at theear. Usually alight or asound from thepoi nt finder i ndi cates achangein skin conductance. Dependi ngon the equi pment ’sdesign, achangein theel ectrodermal measurementsleads to achange in audi tory or visual signals to i ndi catethe occurrence of reactive auri cular points. Threshold settings: Some equi pment requi res an individual thresholdto beset for each pati ent before assessing ot her ear points. Toset thethreshold, place theprobeon theShen Men point or Point Zero, increase thedetecti on sensitivity until thesound, lightsor visual met er on theequi pment indicate that thereishighelectrical conductance. Next, slightly reduce thesensitivity until theShen Menpoi nt or Point Zeroisonly barely detected. I t shouldbepossible to find these two master points in all personsexamined, and they are usually reactive because they i ndi catetheeffects of everyday stress in aperson’slife. Shen Men and Point Zeromay not be themost electrically active pointson a pati ent’sear, but they are thetwopointsmost consistently identified in most people. Probe procedures: Slowly glide theear probeacross all regions of t heauri cle to det ermi ne localized areas of i ncreased skin conductance(decreased skin resi stance). Moving the probetoo quickly can easily missareacti ve ear poi nt. Applying t oo much pressurewith theprobecan create false ear poi ntsmerely because of the i ncreased electri cal contact with theskin. Hol dthe auri cul ar probeperpendi cul ar to the stretched surface of theear, and gently glide theprobeover theear, A B Figure 5.4 Different electrical poi nt fi nder devices havebeen developed in Chi na(A) and in Europe(B). Astheproheglides over the surface of/ heear, changes in electrodermal ski n conduct ance are shown bya variation in therate ofafli ckeri ng light or in thefrequency of soundfeedback: Diagnosis procedures 139 140 using firmbut not overly strongpressure. Do not lift and pokewith t heprobe. Theot her hand supportstheback of thepati ent’sear. I t isi mportant to follow thecontoursof the auri cle while applying theprobe, checking both hi ddenand posteri or surfaces aswell asthefront external surface of the auricle. Theback of theear isoften less electrically sensitive than the front of the auricle, but theposteri or side of theear isusually moret ender to appl i ed pressure t han isthefront. Tomorereadily find an ear poi nt on theposteri or surface, first det ect thepoi nt on thefront of the auricle, t henput afinger on that spot and bend theear over. I t isnow easi er to search theback of theear for theidentical regi on on theant eri or and the posteri or surface. 5.4 Nogier vascular autonomic signal (N-VAS) Theauricular cardiac reflex wasfirst described by Paul Nogi er (1972), and wasonly l ater renamed the Nogier vascular autonomi csignal (N-VAS).Thepracti ti oner touchescertai n partsof theexternal ear while monitoringtheradial pulse for ei ther adecrease or an increase in pulse ampli tude. Thepulse may seem to diminish and collapse, or it may seem to becomesharper and morevibrant. The modification of thepulse can occur anywhere from thesecond pulse beat up to thet ent hpulse beat following auricular stimulation. Thischangein theN-VAScan last for 2to4pulse beats. Thestimulus could betactile pressure to theskin, but it could also be provided by holding amagnet over theear surface, by pulsed laser stimulation, by placing acolored plastic filter over theauricle, or by usinga slidethat containsaspecific chemical substance. Theart of thistechni queisin learni ng tofeel the subjective subtletiesof theradial pulse. Classical pulse diagnosis aspracti ced in Ori ental medicine usesthethreemiddlefingers lightlyplaced on theradial artery at thewrist (see Fi gure5.5A). The Nogier pulse techniquerequi resplacement of only thethumbover theradial artery (see Figure 5.5B, 5.5C). Rat her than feeling for steady statequalities of thepulse, N-VASisachange in pulse amplitudeand pulsevolume that occurs in responsetosti mulati onof theauricle. Mastery of this techniquerequi resmany practicesessions with someonealready skilled in theprocedure. Ackerman (1999) hasproposed that N-VASexists asa specific autonomi cbiophysical response system consti tuti ngone of theprincipal coordi nati ngand i ntegrati ngsystems of t hebody. At the same time, N-VASisapathway by which thecentral nervous system receives i nformati on and modul atessympatheti coutflow for preci se modul ati onof thebl ood vascular system. N-VASis thought to occur in every artery of thebody and isexpressed throughchangesin smoot hmuscle tone and bl ood influx. Thisvascular system iscontrol l ed by endothel i um- deri vedfactors, mainly by thevasodi lator nitricoxide (NO). NOacts directly on vascular smoothmuscle cells to regulate vascular tone. Therelease of NOismodul at ed bywall shear stress, frequency of pulsati le flow, and ampli tudeof pulsatile flow. Fromthe standpoi nt of i nformati ontheory, theautonomi ccontrol l ed blood vascular supply could be represented asan analog system, contrary to theneuronst hat operat eas adigital system consisting of on- or- off neural impulses. Asan analog system, thevascular system isregul ated by thestrengthof flow, wavelength vari ati ons in itsstrengthand thedi recti on of flow. Theadapti ve capability of thevascular system results from mechani cal stimuli such aswall shear stress and transmural pressure that ismodul ated by vascular muscle tone. 5.5 Auricular diagnosis guidelines Ear as finaL guide: Theauri cul ar chartsdepi cti ngdi fferent organsof the body aresomatotopi c maps t hat i ndi catethegeneral area inwhich aparti cul ar ear reflex poi nt could befound. However, it isthemeasured reactivity of specific sites on the auri cle which serves asthebest det ermi nant of theexact locati on of an appropri ateear poi nt. By moni tori ngthehei ghtenedt endernessto appli ed pressure and thei ncreased electrical conductanceat aspecific locus, oneisable to select the most relevant ear poi ntst hat represent body pathology. Theear chartsi ndi cateaterri tory of theauri cle wherethecorrect poi nt may befound, but t hereare several possible spotswithin t hat regi on to choosefrom. Only themost reactive ear poi ntsdefinitely represent the actual l ocati on of the somatotopi csite. I fthereisno reactive ear poi nt in aregi on of the auricle, t hereisno body pathology i ndi cated for treatment. I ft hereisno pathology in thecorrespondi ngbody area, there will be no tendernessor electrical activity at therel ated microsystem poi nt on theear. When choosing between di fferent ear poi ntsto treat, whet her it isin theChi nesesystem or the European system, whet her it isin the Nogi er first phaseor second phase, thisfundamental principle, that t he ear itself isthefinal guide, should always befollowed. Aur;culotherapyManual A B Diagnosisprocedures c Figure 5.5 I nOri ental pul sediagnosis (A), three fingers arepl aced on each wrist to detect differences in theposi ti on, depth and qualities ofthesteady pulse. Practitioners ofauri cular medi ci nein Europehol dthe wrist at only oneposi ti on (B) andfeel for changes in theampl i t udeand waveform oftheradial pulsein response tosti mul ati on oftheear by light passi ng through afilter (C). 141 142 Al ternati ve poi ntswi thi n an area: Theactual auri cul ar poi nt consi sts of asmall site wi thi n a general area of the auri cle i ndi cated by t hesomat ot opi cauri cul ar map. Theear reflex poi nt representi ngapart i cul ar part of the body can be found in oneof several possi ble l ocati onswithin thisarea. I n some individuals, theear poi nt will be found in oneauri cul ar locati on, whereas in ot her persons, it will be found in anearby but di fferent auri cul ar locati on. Thel ocati on of apoi nt may changefrom oneday to the next, thusit isessenti al t hat onechecks for t heear poi nt t hat exhibits t hehi ghest degree of reactivity at the ti mesomeoneisexami ned. I psi lateral ear reacti vi ty: I n 80- 90%of individuals, reacti ve ear reflex poi nt sare found on the same ear as theside of body where t hereispai n or pathology. I n t heremai ni ng 10- 20%of cases, the represent at i on iscont ral at eral , and t hemost active ear poi nt isfound on theopposi t eside of the body. Since most clinical probl emshave abi l ateral represent at i on, it iscommon to t reat bot h the right and the left ears on apati ent. I ftreati ngj ust oneear of apat i ent , it isusually best to sti mul atet heear which isi psi lateral to t heside of t hebody with t hegreat est degree of di scomfort. Thosefew personswho exhi bi t cont ral at eral auri cul ar represent at i on of abody probl em are referred to as l ateral i zers or osci llators, and need speci al consi derati on. 5.6 Assessment of oscillation and laterality disorders Personswho have difficulties with neural communi cati onbetween theleft and theright sides of the brain are referred to ashaving problemswith laterality or oscillation in the Europeanschool of auriculotherapy. Thiscrossed-laterality condi ti onissometi mesidentified as’swi tched’ or ’cross-wired’ incertai n Ameri can chi ropracti c schools. I t isasif thetwocerebral hemi spheresare competi ngfor control of thebody rat her than working in acompl ementary fashion. Laterali ty probl emsare typically found in the 10- 20%of thepopulati onwhich exhibits hi gher electrically conductivity at ear reflex poi ntson thecontralateral ear thanon theipsilateral ear. Usually thesepati entsshow high electrical conductanceat the Master Oscillation point, but not everyone who has an active Mast er Oscillation point isan oscillator. Oscillation can also bedue to severe stress or dental foci. TheMast er Oscillation poi nt inpati entswith laterality di sordersneedsto becorrected with acupressure, needli ngor electrication stimulationbefore that pati ent can receive satisfactory medical treatment. I t isbelieved that many functi onal di sorders are due to dysfunctions in thei nterhemi spheri c connecti onsthroughthecorpuscallosum, theanteri or commi sureand the reti cular formati on of the brain. Thereisi nappropri atei nterferenceof oneside of thebrai n by theot her side of thebrain. Global relati onshi pst hat should be processed by the right cerebral hemi sphereare analyzed by the left cerebral cortex. Verbal i nformati ont hat should be processed by theleft cerebral hemi sphereis processed by theright cerebral cortex. Such individuals frequently exhibit dyslexia, l earni ng disabilities, problemswith ori entati onin space and aresuscepti ble to i mmunesystem di sorders. Peoplewith laterality problemsreport t hat they often hadprobl emsin el ementary school with poor concentrati on, stutteri ng, spelling mistakes, attenti ondeficit, and feeling ’di fferent’ from others. As adolescents, they experi enced frequent anxiety, hyperactivity, gastroi ntesti nal dysfunctions and they often mi sgauged di stancesor tri ppedover things. Oneway aperson may recogni ze t hat they are an oscillator isthat they have overly sensitive or rat her unusual reacti onsto prescri pti on medications. Dysfunctionsof laterality and oscillation are found moreoften in l eft- handedor in ambi dextrous persons. Theproporti onof dyslexia and ot her learni ngdi sordersissignificantly hi gher in left› handerst hanin right -handers. Laterali ty problemsare rarely noti ceablebefore theage of two, but cerebral organi zati on begins to be definitely laterali zed by theage of seven, the’ageof reason.’ I t is from thisage t hat di sordersof laterality may first appear. 5.6.1 Physical t est sfor t hepresence of laterality disorders Handwri ti ng: Haveaperson wri tesomethi ng. Whi chhand did they use, the ri ght handor the left hand?Many individuals were t rai ned to wri tewith t hei r ri ght handwhen they were chi ldren, even though they were natural l y left handed. For t hat reason, someof thefollowing tests may be a more aut hent i capprai sal of t hei r actual l ateral i ty preference. Handclap: Haveaperson clap t hei r handsas if they were giving pol i teappl ause at asocial functi on, with onehand on t opof theot her hand. Whi chhand ison t op? Handclasp: Have aperson clasp thei r hands, with thefingers i nterlocked. Whi cht humbison top? Armfold: Have aperson fold t hei r arms, with onearmon top of t heot her. Whi charm ison t op? Thehandt hat touchest hecrease at theopposi t eelbow isconsi dered the arm t hat ison top. AuriculotherapyManual Foot kick: Have aperson pret endto kick afootball. Whi chfoot do they kick with, t heright or the left foot? Eye gaze: Haveaperson open bot heyes and t henline up t herai sed t humbof t hei r out st ret ched handtoward asmall poi nt on the opposi tewall. Alternati vely, have t heperson make aci rcular hole by pi nchi ngt hei r mi ddlefinger to t hei r thumb, thenl ook at thespot t hroughthe hole. I nei t her case, next have t hemclose first one eye, open again, t henclose t heot her eye. Closi ngoneeye produces agreat er shift in al i gnment with theobject on t heopposi t ewall t hanclosing the ot her eye. I fthe object shifts moreon closing t heright eye, t hen the ri ght eye isdomi nant; if the poi nt shifts moreon closing the left eye, t hent heleft eye isdomi nant. Al ternati vel y have someonenoti ce which eye they would leave open and which they would close if they were to i magi ne shooti nga target with arifle. Theeye used for ai mi ng the rifle would be t hedomi nant eye. 5.6.2 Scoring laterality tests Each of theabove behavioral assessments isscored asei ther right or left. I faperson scores 4or moreon theleft side, that individual islikely tohave alaterality dysfunction. Theymight also have problemswith spatial orientation, dyslexia, learning difficulties, allergies, immunesystem disorders and unusual medical reactions. Laterality doesnot necessarily produceamedical problem, asmany individualslearn tocompensatefor thisimbalance over thecourse of their lifetime. At thesame time, they may have certain vulnerabilities that conventional medicine doesnot allowfor. Thedosage and incidence of side effectsof Westernmedications are based on theaverage responseby alarge group of people, but do not takeintoaccount theidiosyncratic reactions of unusual individuals. Personswithlaterality dysfunctions must bevery careful about thetreatmentsthat theyare given because of their highlevel of sensitivity. 5.7 Obstructions from toxi c scars and dental foci I naddi ti on to i di osyncrati c probl emsattri butabl eto laterali ty di sorders, ot her factors may also i nterferewith subsequent pathologi est hat have alongstandi ngnat ure. Thefai lure to completely heal from onecondi ti on may act as asource of di sequi li bri um t hat blocks t heallevi ati on of newer heal th problems. Twosuch sources of obstructi on are (1) toxic scars from old woundsor previ ous surgeri es, and (2) damaged tissue from invasive dent al procedures. Toxicscars coul d occur on the skin surface or in deeper structures, creati ng aregi on of cellular di sorgani zati on t hat emi ts abnormal electri cal charges. Thispathologi cal tissue generat es adi sharmoni ousresonance causi ng chroni c stress and i nterferencewith general homeostati cbalance. Abnormal sensati ons, such as itching, numbness, pain or soreness, oft en occur in the regi on of toxic scars. Besides checki ng the regi on of t heexternal ear t hat correspondsto abody area t hat was previ ously i njured, also exami ne theskin di sorder regi on of the external ear. Dent al procedures, such as removi ng decayed t eet h or drilling aroot canal, are beneficial for dent al care, but they may also leave adent al focus that i nterfereswith general heal t h mai ntenance. Dent al foci may follow dent al surgery, be rel ated to bacteri al foci under afilling, or result from an abscess or gum di sease. Theremay also be pathogeni c responses to mercury fillings. Pati entsthemselves are oft en unaware of having such a di sorder, since the consequence of these previ ous scars may not necessari ly be experi enced at a conscious level. Thesepathologi cal regi ons may be electri cally det ect ed at the auri cul ar area that correspondsto thesite of t hetoxic scar or dental focus. Theymay also be di scovered by moni tori ng the N-VASresponse to sti mul ati on of t heaffected regi on of the body. Only when this toxic scar regi on issuccessfully t reat edcan ot her heal t hcareprocedures be effective. Sometimesone’sown personal experience isthemost impressive sourceof confi rmati onfor accepting anewconcept inhealthcare. WhenI wasan adolescent, I dislocated my right shoulder duri nga skateboard accident. I also had mywisdom teethremoved by an oral surgeon. AsI became an adult, thechronic stress of everyday livingwas most strongly manifest asdiscomfortingshoul der aches, but I never experienced jaw pain. Frequent massages, chiropractic adjustments, acupuncturesessions and auri culotherapy treatmentsall produced temporary reli ef of theshoul der pain, but therewas no stable resolution. Myears were recently examined byaGermanphysician who practices auri cular medicine. Dr BeateStri ttmatterrevealed atoxicscar at thelocation of thewisdom toothat theleft lower jaw. Theinsertion of aneedleat apoi nt on theleft ear lobewhich corresponded to theleft mandi blewas added tostimulationof theShoulder poi nt on theright auricle. Thist reat ment of thedental obstruction aswell asthecorrespondi ngShoulder poi nt on theauricle led to an i mmedi atecorrection of ashoulder conditionthat had been aproblemfor years. Diagnosis procedures 143 144 5.8 Scientific investigations of auricular diagnosis Auri cular diagnosis ismostly used for det ect i on of active poi ntson t heear which need to be treated, rat her t hanas apri mary meansof di agnosi ng apati ent. Nonethel ess, findings from auri cular diagnosis can reveal aclinical probl em mi ssed by ot her medi cal exami nati on procedures, or verify aprobl em only suspected from ot her di agnosti c tests. Physical auri cul ar reacti ons may appear before thebody symptomsappear or reveal apermanent reacti ve mark of pathology in the correspondi ng body organ. Theauri cul ar poi ntschangewith thevari ous stages of an illness or injury, including the initial occurrence, cont i nueddevel opment, and ul ti materesoluti on. Reacti ve auri cul ar poi ntsreflect t heongoi ngi nformati on about adi sease, not only t heheal t h condi ti on occurri ng in the present. I t can i ndi catethestateof an illness or injury in the past or in the near future. Positive auri cular poi ntsmay have adi fferent appearance in di fferent stages of adi seases and i ndi catewhen apathology iscompletely healed. At the 1995I nternati onal Symposium on Auricular MedicineinBeijing, China, several scientific studies indicated that auri cular diagnosis hasbeen used to detect mali gnant tumors, coronary heart disease and pulmonary tuberculosis. Onestudy found t hat 36of 79cases of colon cancer showed dark red capillaries inthesuperi or concha, 54of 78cases of lung cancer revealed brown pi npoi nt depressions scattered inpatchesinthei nferi or concha, and 16of 31cases of uteri necancer showed spotteddepressions intheinternal genitals area of theconchawall. Nosuch changesin thecolor or themorphology of correspondi ngear pointswere found innormal control subjects. Anot her investigation showed that 116pati entsout of 1263hospitalized pati entshad reactive Liver pointson theear. Further examination of these 116pati entsrevealed 80cases of hepatitis. Still anot her study found that of 84cases diagnosed withultrasoundto have gall bl adder disease, 81%showed adark red region inthegall bladder areaof theauricle. I n93%of cases of chronicgastritis, thestomach and duodenumauricular regions appeared white, shiny and bulgy when therewas no acuteinfection. I n contrast, these twopointsappeared deep red when therewas an acute gastric disorder. Theresults of usingpressure or electronic detecti onwere essentially thesame asvisual observation. Dr Michel Mari gnan (1999), of Marseilles, France, report ed on hisi nvesti gati ons with digital thermographyof theear at the I nternati onal ConsensusConferenceon Acupuncture, Auri culotheraphy, and Auri cul ar Medi ci ne(I CCAAAM).Skin t emperat ureradi ati onsfrom the auri cul ar surface were measured with an i nfrared camera. Thephot ographyequi pment was cool ed with liquid ni trogen and acomput er was especially adapt ed for thisprocedure. Thet emperat ure vari ati ons of radi ati on across the humanear changed in responseto sti mul ati onof vari ous areas of theear pavilion. Mari gnansuggested t hat reactive auri cul ar poi ntsare dueto mi croscopi c t hermal regulati on. Theevi dence of correspondence between anatomi cal locali zati on and t heauri cul ar thermal reacti on provi ded ascientific basis for auri cul otherapy. At t hesame I CCAAAM conference, Edward Dvorki n (1999) of I srael exami ned ’acti ve’ auri cul ar poi ntsfrom skin sampl es obtai ned in humansundergoi ngsurgery. Someskin sampl es correspond to ear poi ntst hat were detected before surgery by moni tori ngt heNogi er vascular aut onomi csignal and by electri cal detecti on. Small pi eces of skin were taken from healthy tissue at thesurgical edges of auri cul ar regions correspondi ng to theThal amuspoi nt, theAllergy poi nt, t heAnt i depressant poi nt and the Aggressivity point. A neut ral part of the auri cular skin of each pat i ent was also t aken for compari son exami nati on. El ectron microscopy exami nati on of ul t rat hi nsecti ons of all thestudi ed zones revealed the following findings: thick nerve bundleswith myeli nated aswell as non- myel i natednerve fibres; solitary thi nbundlesof non- myeli nated nerve fibres; mast cells rel ated to bl ood vessels and nerves; numerousveins wi thout i nnervati on; solitary arteri eswi thout i nnervati on. However, no specific ul trastructureor morphologi cal subst rat umwas found in Dvorki n’sstudy for ’acti ve’ ear reflex poi ntscompared to neut ral ear poi nts. Thedistinctive characteri sti cs of active auri cular poi ntsmust thusbebased on physiological rat her t hananatomi cal st ruct ural di fferences. Theresearch by Mari gnansuggests that peri pheral sympatheti c nerve control of bl ood vessels supplying t heauri cle can bet t er account for active auri cul ar poi nts. AuriculotherapyManual I I Auri culotherapy t reat ment procedures 6.1 Auricular acupressure 6.2 Ear acupuncture needling techniques 6.3 Auricular electroacupuncture sti mulati on (AES) 6.4 Transcutaneous auricular sti mulati on (TAS) 6.5 Auricular medicine 6.6 Seven frequency zones 6.7 Semipermanent auricular procedures 6.8 Selection of auricular acupoints for treatment 6.9 Tonification and sedation in auriculotherapy 6.10 Relationship of yin organs to ear acupoints 6.11 Geometric ear points 6.12 Inverse and contrary relationships of the ear and body 6.13 Precautions associated wi t h auriculotherapy 6.14 Hindrances to treatment success 6.15 Overall guidelines for auriculotherapy treatments 6.1 Auricular acupressure I . General massage: Strokebroad regi ons of the external ear by rubbi ngthet humbagainst the front of the auricle, while the tip or length of theindex finger ishel d agai nst theposteri or side of theear for support. First strokedown the traguswith the thumb, then spread thestrokes across the ear lobe to i nduceageneral calming effect. Next, strokefrom thebegi nni ngof thehelix root at l andmark zero and rise up and around thecurving helix, endi ngat t hebase of the helix tail. Proceed by stroki ngacross theantihelix tail, begi nni ngat thebase, t henwork up the antihelix. I n each case massage across the i nner ridge of the anti heli x outward toward thescaphoi d fossa and helix rim. Endwith gentlestrokest hroughout thesuperi or concha, concharidge, and i nferi or concha. I fpati entsare taught to do thisprocedureon themselves, t hei r index finger isused on front of theear and thei r t humbisplaced on theback of theear. 2. Specific massage: Apply ametal styluswith asmall ball at theend (see Figure 6.1) to theauricle. Palpatethemost reactive ear poi nt determi nedduring auri cular diagnosis. You could also use the eraser end of apencil or afingertip. Hold theauricle t aut with theopposi tehand. Micromassageof an ear poi nt may first lead to an increase in pain at that point, but thetendernesscan gradually diminish and di sappear asthemassage iscontinued. Thedirection of massage can vary. Adopt the one that isleast tender and most tolerablefor thepati ent. For neck, back and shoulder tension, apply firmbut gentlepressure on theantihelix tail, antihelix body, i nferi or crus and scaphoi d fossa. For headaches, specific pressure isapplied to theantitragusand antihelix tail. Visceral dysfunctions are treatedwith thestylusprobepressed against specific regions of theconcha. 3. Auriculopressure techni ques: Massage each t ender ear poi nt for 1to 2mi nutes, repeati ng the process once or twice daily. Apply massage with acircling moti on, first noticingwhich di recti on producesthe least discomfort. A morelongi tudi nal massage along t heout er helix or antihelix reduces muscle tensi on and sympathomi meti cexcess excitation. Descendi nglongi tudi nal strokes tend to tonify muscles and excite sympatheti c activity, while ascendi ng longi tudi nal strokestend to relax muscles and enhanceparasympatheti c tone. A radi al centri fugal massage away from l andmark zero across theconchaenhancesparasympatheti csedati on and visceral relaxation. Treatmentprocedures 145 146 Figure 6.1 Ear acupressure massagecan beactivated withametal stylusapplied tospecificpartsoftheauricle whiletheopposinghand providesback pressure. Massaging the tragusdownward and outward, from superi or to i nferi or, can augment cellular reacti onsand i nterhemi spheri ccommuni cati on, whereas massaging t hetragusupward and inward, from i nferi or to superi or, tendsto slow down metaboli sm and calm i nterhemi spheri c communi cati on between thetwo sides of t hebrai n. 6.2 Ear acupuncture needling techniques 1. CLean ear: After conducti ngany visual i nspecti on necessary for auri cul ar diagnosis, clean the ear with alcohol. Thissteri li zes theskin and removes wax, oils, sweat, grease, make- upand hairspray. Besides itsanti septi cvalue, removi ng oily substances from theskin surface of theear i mproves t heability to det ect auri cul ar poi ntswith electri cal poi nt finders. 2. Prepare needLes: Unpack at least 5sterilized 0.5inch (15mm) needles, tobe i nserted ipsilaterally or bilaterally. Shorter needlesare preferred, sincelonger needlestendto fall out too easily. Thi cker needle di ameter sizesof30gauge (0.30mm), 32gauge (0.25mm) or 34gauge (0.22mm) are preferred for theear, since thi nner needlestend tobendon insertion. Stainless steel needlesare appropri atefor most clinical purposes, althoughbetter results are someti mesobtai nedby usinggold needleson one ear and silver needles on theopposi teear. Knowledge of theNogier vascular autonomi csignal is necessary to determi newhether gold or silver needles are moreappropri atefor which ear. 3. Determine treatment pLan: Exami nethespecific t reat ment planslisted in the last secti on of thistext to select the auri cul ar poi ntswhich are most appropri at efor thecondi ti on being treated. A typical t reat ment i ncludes thecorrespondi ng anatomi c poi nts, selective mast er poi ntsand supporti ve poi ntslisted for that condi ti on. You shoul d not t reat all of the ear poi ntslisted, only thosewhich are the most t ender and show the hi ghest electri cal conductance. 4. SeLect ear points: Det ect 2to 6 poi ntson each ear with an electri cal poi nt fi nder, selecti ng only the most reacti ve poi nts. Thepoi nt fi nder should be spri ng- l oaded andwill leave abri ef AuriculotherapyNanual Figure 6.2 Needleinsertion techni quesdemonstratedon a rubber model ear. i ndentati onat theear poi nt if stronger pressure isappli ed when areacti ve ear poi nt isdetected. Use that i ndentati onfor identification of theregion of the auricle where theneedleshould be inserted. Theorder in which auri cular poi ntsare needl ed dependsmoreon thepractical convenience of thei r locati on t hanon the priority of thei r i mportancefor treati ngt hat specific condition. Needlesare first i nserted into ear poi ntswhich are located in morecentral or hi dden regions of theauricle because needles in moreperi pheral areas of theear would get in theway. 5. Needle insertion: First stretch out t heauricle with one handwhile using theot her hand to hold theneedleover theappropri ateear poi nt (see Fi gure6.2). Avoid doing one- handedear acupuncture, only using the hand holdingtheneedle. I nsert theneedl ewith aquick j ab and atwist to adepthof 1to 2mm. Theneedleshouldjust barely penet rat etheskin, but it isacceptable if it touchesthecartilage. Theneedleshould be i nserted deep enough to hold firmly, but not so deep that it pi erces throughto t heot her side (see Fi gure6.3). Becareful not to let theneedl epi erce the handthat isstabilizing thepati ent’sear. I t isusually morecomfortablefor thepati ent if theneedl eisi nserted on thepati ent’si nhalati on breath. Thepati ent may gasp or chokewhen aneedleisi nserted into a particularly sensitive region. Even thoughtheneedle may producei ntensedi scomfort on first insertion, thisadverse effect isshort lived and t hepain quickly subsides. Theintensityof pai n at an auri cular poi nt is usually asign that thepoi nt isappropri atefor treatment. Gui detubest hat are often used to insert needles into body acupuncturepoi ntsare not needed because of theshallow depthof ear points. I t isbet t er to locate theneedl eby sight precisely over an ear poi nt previously i denti fi ed by skin surface i ndentati onfrom apoi nt finder. I nsert all theneedl esyou pl an to use at one time and leave them in place. You may periodically twirl theneedles to mai ntai n afirm connecti on and to further sti mulatet hat auri cular poi nt. Bleeding may occur when aneedle iswithdrawn from theear, but gentle pressure appli ed to thepoi nt usually stops thebleedi ngwithin afew seconds. 6. Treatment duration: Leave all theinserted needles in place for 10-30minutes, then remove and placetheused needles inan approved container. Someneedlesfall out beforethesession isover, whichtendstoindicatethat theparticular needle insertion point had received sufficient stimulation. Treatmentprocedures 147 148 Figure6.3 Half-inchneedles inserted into theauricular acupoi nts Shen Men, Point Zero, and Thal amuspoint. 7. Number of sessi ons: Treat 1- 3t i mesaweek for 2- 10weeks, t hengradual l y space out t he t reat ment sessi ons. A gi ven condi t i on may requi re as few as 2 or as many as 12sessi ons, dependi ng on t hechroni ci t y and severi ty of t heprobl em and on t hepat i ent ’senergy level. I f aft er 3 sessi ons t hereis no i mprovement in t hecondi t i on, ei t her use a di fferent set of ear poi nt sor try anot her form of t herapy. 6.3 Auricular electroacupuncture stimulation (AES) 1. Ear needl i ngt echni ques: For el ect roacupunct ure, first use needl i ng t echni quesdescri bed in t heprevi ous sect i on to det ect t heappropri at eear poi nt sand to i nsert t heneedl es. 2. Tapeneedl es: I n order to hol d t hei nsert ed needl es securel y in pl ace, t apet heneedl es across t heear wi t h medi cal adhesi ve t ape. At t achi ngt hest i mul at i ngel ect rodes will t end to pull out t he needl es, unl ess they are first fast ened wi th prot ect i ve t ape. 3. At t ach el ect rodes: Use mi crogat or clips to connect t hei nsert ed needl es to t heel ect rode l eads of an el ectri cal st i mul at or (see Fi gure6.4). Because t hesemoveabl e clips may pull out t hei nsert ed needl eswhen at t ached, makesure t hat t heneedl es are first securel y t aped in pl ace. I t isal so wise to fasten t heel ect rode wi res to a secure anchor so t hat t hewi res will not drag on t heneedl es and pul l t hemout . 4. El ectrodepairs: I t isalways necessary to st i mul at ebet ween two needl es, as el ectri ci ty flows from aposi ti ve to a negat i ve pol e. I t does not usually mat t er whi ch pol e of t hest i mul at or is at t ached to which ear poi nt , but if t hepat i ent report sany i ncrease in pai n, try swi tchi ng t he el ect rode l eads to t heopposi t epol ari ty. 5. Frequency paramet ers: Preset t heel ect ri cal frequency rat e to ei t her a sl ow 2 Hz or 10 Hz frequency, or to a paramet er known as dense- di sperse, where 2 Hzfrequenci es are al t ernat ed wi t h 100 Hzfrequenci es (see Fi gure6.5). Lower frequenci es, 10 Hzor l ess, affect enkephal i ns, endorphi ns, and vi sceral and somat i c di sorders, whereas hi gher frequenci es, 100 Hz or hi gher, affect dynorphi nsand neurol ogi cal dysfunct i ons. AuriculotherapyManual A B Figure 6.4 Alligatorclipelectrodes attachedtoneedlesinsertedintotheShenMenand Lungpointsoftheauricle(A). Electroacupuncture stimulationequipmentisshownwithelectrode wires leadingtoneedlesinarubberear model (B).Needlesinthisfigurearenot showntapedto theear toallowgood visualizationoftheattachment ofelectrodes to theacupunctureneedles, hut theywould typically hetapedsecurely in place. Treatmentprocedures 149 Hz 5 Hz frequency 20 llA current i ntensi ty 1.0 s stimulus duration 10 Hzfrequency 40 llA current i ntensi ty 2.0 s stimulus durati on 1.0 s Figure 6.5 Thesti mulati onparameters used in activating auri cular acupoi nts can vary byfrequency in cycles per second, byintensityin current amplitude, and by duration in thenumberofsecondsapoi nt isstimulated. 6. Current i ntensi ty: Gradual l y raise the electri cal current i ntensi ty to apercept i bl e level and t hen reduce it to asubpai n threshol d. Theelectri cal sti mul ati on i ntensi ty shoul d not be pai nful. 7. Treat mentsessi ons: Aswith auri cul ar acupunct urewi thout electri cal sti mul ati on, leave the needlesin place and mai ntai nthesti mulati oncurrent for 10- 30mi nutes. Treat thepat i ent onceto t hreetimes aweek, for 2to 10weeks. Whilemorecumbersometo apply t hanneedl e i nserti on alone, el ectroacupuncture istypically morepowerful and moresuccessful in relieving pain and alleviating theproblemsof addi cti on. 6.4 Transcutaneous auricular stimulation (TAS) I . Overview: I nthis t reat ment met hod, the t herapi st det ect sand sti mul ateseach ear poi nt with the sameelectri cal probe. Theauri cul ar poi nt isdet ect ed and t heni mmedi atel y t reat edwith mi crocurrent sti mul ati onbefore movi ng on to the next ear poi nt. I t isaform of t ranscut aneous electri cal nerve sti mul ati on (TENS)or neurost i mul at i on and can be medi cally bi lled as such. Beforebegi nni ngauri cul otherapy, it isbest to have t hepat i ent repeat t hosemovements, or mai ntai n thosepostures, which most aggravate hisor her condi ti on. I t isalso useful for the pract i t i oner to put physical pressure on t hosebody areas which are pai nful. Onecan thusestabli sh abehavi oral baseli ne from which t herecan be seen achangeas aresul t of t het reat ment . Thesame movements, postures, or appl i ed pressures are repeat ed following t het reat ment . Thi spracti ce t endsto el i mi natedoubt sabout the procedurewhich oft en occur when only subjecti ve i mpressi ons are elicited. A facial gri mace by the pat i ent duri ngmovements, or in response to pressure, ismuch moreconvi nci ng t hanverbal assessments t hat ’it hurt s.’ 2. Clean ear: Cl ean t heexternal ear with alcohol to el i mi nateskin oil and surface flakiness. Havi ngacl ean auri cul ar surface isvery i mport ant for det ermi ni ngt heaccuracy of reacti ve ear poi ntst hat will be t reat edwith t ranscut aneousauri cul ar sti mul ati on. 3. Determi net reat ment plan: Aswith ot her auri cul ar procedures, consul t the specific t reat ment plansli sted in last secti on of this text to select t heauri cul ar poi ntswhi ch seem most appropri at efor the condi ti on bei ng t reat ed. Fi rst t reat local anat omi cpoi ntscorrespondi ng to specific body symptoms. I ft hereismoret hanonelocal poi nt, only t reat the most t ender and most electri cally conducti ve local poi nts. Next t reat mast er poi ntsand supporti ve poi nts. 150 AuriculotherapyManual A B Figure 6.6 Transcutaneous sti mulati on oftheskin surface ofan auricular acupoi nt and thehandheld reference probe (A). StimFlex equi pment that provi des aprobe for both auricular detection and auricular sti mul ati on (B), one ofseveral possible electrical sti mulati on devices. Treatmentprocedures 151 152 4. Threshold setting: Somei nst rument srequi re t hepract i t i oner to first set a t hreshol dlevel by raising the sensitivity of t heuni t to allow electri cal det ect i on of the Shen Menpoi nt or Poi nt Zero. Most reacti ve correspondi ngpoi ntsare typically moreelectri cally conducti ve t han Shen Menor Poi nt Zero, but t hesetwo mast er poi ntsaremoreconsi stently active in amajori ty of clients. Someti mes, by first sti mul ati ngoneof t hesetwo mast er poi nts, ot her auri cul ar poi nt sbecome morei denti fi ablefor detecti on. Thisprocess iscalled ’l i ghti ngup t heear.’ 5. Auricular probe: Appl y theauri cul ar detecti ngand sti mul ati ngprobeto the external ear, stretchi ngthe skin tightly to reveal di fferent surfaces of t heear. Thepract i t i oner’sot her hand support sthe back of the ear so t hat bot h it and the probeare steady. Gent l yglide t heauri cul ar probeover the ear, holdi ngthe probeperpendi cul ar to t heear surface. Do not pick up the probe and jab at di fferent areas of the ear. Thepat i ent usually holdsacommon l ead in oneof t hei r hands in order to compl eteafull electri cal circuit. El ectri ccurrent flows from t hesti mul ati ngequi pment to the el ect rodel eads to t heear probehel d to the pat i ent ’sauri cle. Current t henpasses t hrough the pat i ent ’sbody to the pat i ent ’shandto the metal common lead. Finally, the current goes t hrought heret urnel ect rodewires and back to the el ectroni c equi pment . I ft hereissomeprobl em with sti mul ati on, be sure t hat all part sof the ci rcui t are compl ete. Therecould be a break in el ect rodewires or the pat i ent may fail to cont i nuehol di ngt hecommon lead. 6. Detecti on mode: Di agnosi sof reacti ve ear poi ntsisachi eved with low level di rect current (DC). Themi crocurrent levels used for detecti on are usually only 2mi croamps in st rengt h. The detecti ngcycle isusually i ndi cat ed by achangein acont i nuoust oneor by alight t hat flashes when a reacti ve poi nt isdet ect ed. 7. Sti mulati on mode: Reacti ve ear poi nt sdi scovered duri ngauri cul ar di agnosi s are t reat ed with alternati ngcurrent (AC). Themi crocurrent levels used for t reat ment aretypically 10- 80mi croamps in strength. Thet reat ment cycle isusually i ndi cated by apul sati ng t oneor aflickering light. I t is usually necessary to press abut t onon t heauri cul ar probewhile it ishel d in pl ace at areacti ve ear poi nt. Det ect and sti mul ateoneear poi nt before proceedi ng to the next ear poi nt. 8. Sti mulati on frequency: Preset the frequency rat eof sti mul ati on, measured in cycles per second or Hert z(Hz), by the specific zoneof the ear to be st i mul at ed or by the type of body tissue to be t reat ed. Al thoughAsi an el ectroni c equi pment isoft en suppl i ed with only onefrequency, usually 2Hz or 10Hz,Ameri can and Europeanel ectroni c equi pment comeswith a rangeof frequency ratesto choose from. Thespecific frequenci es devel oped by Nogi er are as follows: 2.5 Hzfor the subtragus, 5 Hzfor theconcha, 10Hzfor the antihelix, anti tragusand superi or helix, 20 Hzfor t hetragus and i ntertragi cnotch, 40 Hzfor t hehelix tail, 80 Hzfor the peri pheral ear lobe, and 160 Hzfor the medi al ear lobe. Thetype of organ tissue bei ng t reat ed isalso afactor, with 5 Hzused for visceral di sorders, 10 Hzfor muscul oskel etal di sorders, 40 Hzfor neuralgi as, 80 Hzfor subcorti cal dysfuncti ons and 160 Hzfor cerebral dysfuncti ons. 9. Sti mulati on intensity: Set thei ntensi ty of sti mul ati on by the pat i ent ’spai n t ol erance, usually rangi ng from 10- 80mi croamps. Lower t hecurrent i ntensi ty if the pat i ent compl ai nsof pai n from the auri cul ar sti mul ati on. I feven the lowest i ntensi ty isexperi enced as pai nful, t henonly auri cul ar acupressure should be used at t hat ear poi nt. A maj or probl emwith el ectri cal sti mul atorst hat arc desi gned for treati ngthe body aswell as t heear ist hat the skin surface on t hebody has a much hi gher resi stance t han does theear. Consequentl y, electri cal current levels t hat are sufficient to activate body acupoi ntsare too i ntensefor sti mul ati ngauri cul ar poi nts. Pract i t i onersshoul d be cl ear not to confuse sti mul ati on frequency with sti mul ati on i ntensi ty. Frequency refers to the number of pulses of current in aperi od of ti me, whereas i ntensi ty refers to the ampl i t udeor strengthof theelectri c current . Only i ntensi ty isrel at ed to percei ved pai n, whereas frequency is rel ated to the pat t ern of el ectri c pulses. 10. Stimulation duration: Treat each ear poi nt for 8- 30seconds, someti mestreati ngfor aslong as 2mi nutesin chroni cconditions, addi cti onsor very severe symptoms. Anat omi cpoi ntsare usually t reat edfor over 20seconds, whereas mast er poi ntsmay only requi re 10secondsof sti mulati on. 11. Number of ear points: Treat 5 to 15 poi ntsper ear, using as few auri cul ar poi nt sas possible. Usually t reat the external ear i psi lateral to the correspondi ngbody areawhere t hereispathology. 12. Bilateral sti mulati on: Aft er t reat i ngall the poi nt son the i psi lateral ear, st i mul at epoi ntson theopposi t eear if the probl em isbi l ateral , i.e. in most heal t h probl ems. Even when the probl em is localized on oneside of the body, it isoft en useful to t reat the mast er poi ntson bot h ears. AuriculotherapyManual 13. Tenderness ratings: Theprecise ear poi ntsdet ect ed and thelevel of sti mul ati onintensity used dependspartly on the degree of tendernessexperi enced by thepati ent. Ratingsof tenderness could beaverbal descri ptor or could be numberson ascale of 1to 10or ’0, 1,2,3’ levels of increasing discomfort. Ask thepati ent to moni tor theareaof bodily di scomfort while you sti mulate theear. Conti nuetreati ngan ear poi nt l onger if the symptomstartsto diminish, or i ft hepati ent notices sensati onsof warmth in thearea of thebody wherethe symptom islocated. I fno symptom changes are noti cedwi thi n 30seconds, sti mul ateanot her point. 14. Number of sessions: Twoto ten auriculotherapy sessions are usually requi red tocompletely relieve acondition, but significant improvement can benoticedwithin thefirst twosessions. By monitoringperceived pain level in abody region, and bydetermi ni ngtherange of movement of musculoskeletal areas, onecan more easily determi netheprogress of theauriculotherapy treatments. Thesebehavioral assessments should beconductedbeforeand after an auri culotherapy session. For internal organs and neuroendocri nedisorders, thereisoften nospecific symptom to notice, so one must wait to observe achange in thepati ent’scondition. Even for musculoskeletal problems, there may not beamarked relief of pain for several hours, so thepati ent should continuetomoni tor thei r symptomsfor thenext 24hoursafter asession. 15. Laser sti mul ati on: Theexact proceduresdescri bed above can be appl i ed to l aser sti mulati on aswell asto electrical sti mulati on. Both laser sti mulati on and transcutaneouselectri cal sti mulati on are non-invasive procedures and they seem toyield si mi lar results. However, at thepresent time, the USFood and DrugAdmi ni strati on(FDA) has not approved theuse of laser sti mulati on for auri cul otherapy in theUni t edStates. Surface electri cal sti mulati on of theexternal ear isFDA approved as aform of transcutaneouselectrical nerve sti mulati on. 16. Medi cal billing: Tobill for auri culotherapy asTENS,assign theCPTCode64550for peri pheral nerve neurosti mulati onor CPTCode97032for electrical stimulationwith constant therapi st attendance. CPTCode97781for acupuncturewith electrical sti mulati oncan also beused. 17. St i mul at i on equi pment: Various Ameri can, Europeanand Asi an manufacturersproduce electroni c equi pment desi gned for auri cul ar sti mulati on, ranging in pri cefrom $80to $8000(US). Amongtheunits available in the Uni tedStatesare theAcuscope, Acumati c, Alpha-Sti m, Stim Flex 400, Hibiki 7, Neuroprobeand Poi nter Plus. Addresses and t el ephonenumbersfor these manufacturersare found at theback of thisbook. 6.5 Auricular medicine Europeandoctorswho moni t or theNogi er vascular autonomi csignal (N-VAS)to det ermi newhich ear poi ntsto sti mulaterefer to thisclinical procedureas auri eul ar medi ci nerat her t han auri culotherapy. Thesomatotopi ccartography of the auri cle isverified by apositive or anegative changein radi al pulse ampl i tudefollowing tactilepressure at specific poi ntson theauricle. N-VAS can also be acti vated by thepositive or negative poles of amagnet. Di fferent sides of atwo-prong polari zed probeare used to elicit thechangein pulse quali ti eswhich i ndi catethereactivity of specific areas of theear. Needl esare then i nserted into the identified ear points, or someti mesthey are t reat edwith laser sti mulati on. Asthe focus of thisbook isthe descri pti on of auri cul otherapy procedures, rat her t hanauri cul ar medicine, further expl anati on of thismoreadvanced techni que isomi ttedhere. 6.6 Seven frequency zones Nogi er identified seven specific regions of thebody t hat resonat ed with seven basic frequenci es. Thespecific frequency associ ated with each body regi on was det ermi nedby holdi ngdi fferent col ored transparency slides over theauri cle and noti ngwhet her t hat col or could bal ance di sturbancesof N-VASresponse. Alternatively, Nogi er would sti mul atethe ear or thebody with di fferent frequenci es of aflashing white strobelight. Thebody regi onswere di fferenti ated with lettersA t hroughG (see Fi gure6.7). Eachl et t er also i ndi cated certai n types of heal th condi ti ons t hat were rel ated to thetype of tissue of t hat organ regi on. Thecolor and number of aKodak› Wrattenfilter that relates to each frequency zone of t hebody ispresent ed in thesecond and thi rd columnsof Table6.1. I ndividual colors have di fferent frequenci es of oscillating phot onsof light, progressi ng from thelowest frequency of red to progressively hi gher frequenci es in arai nbow or prism. Nogi er determi ned t hat theeffects of progressively short er wavelengths of di fferent colored Treatmentprocedures 153 I nternalorgans zoneB 5 Hz Musculoskeletal body zoneC 10 Hz Frequency rates for body regions Cerebral cortex zoneG 160 Hz Subcortical brain zoneF 80 Hz Intercellular core zoneA 2.5 Hz Frequency rates for auricle regions Corpuscallosum zoneD 20 Hz Antihelix zoneC 10 Hz Concha zoneB 5 Hz Subtragus zoneA 2.5 Hz Tragus zoneD 20 Hz Helix tail ,.""’__- - -zoneE 40 Hz Peripheral lobe ~ I f : r zoneF 80 Hz Central lobe zoneG 160 Hz Figure6.7 Seven frequency zones ofthebody are desi gnated bythelettersA for 2.5Hz, Bfor 5Hz, Cfor 10Hz, Dfor 20 Hz, £for40 Hz, F’[or 80 Hz, and Gfor 160 Hz. Thesesamefrequencies are related to different regions oftheauricle and different typesofsomati c tissue. 154 AuriculotherapyManual Table6.1 Color, electrical and laser stimulation frequencies Zone Color Wratten Electrical Exact Laser Correspondingauricular areas filter frequency rate frequency (Hz) (Hz) (Hz) A Orange #22 2.5 2.28 292 Subtragus B Red #25 5.0 4.56 584 Concha C Yellow #4 10.0 9.12 1168 Antihelix, Anti tragus, Helix D Red Orange #23 20.0 18.25 2336 Tragus, I ntertragi cnotch - - - _ . ~ - . _ .._._" ... ~ _ .. - E Green #44 40.0 36.50 4672 Helix tail F Blue #98 80.0 73.00 9334 Peri pheral ear lobe G Purpl e #30 160.0 146.00 18688* Medi al ear lobe "I nclinical practice, theharmonicresonancefrequency of 146 HZ isusedfor laser stimulation because sucharapid frequency rateof 18kHztendstooverheat thelaser equipment. light filters on body tissue could also be found with progressively hi gher frequenci es of flashing light, faster frequencies of electrical pulses, or hi gher frequenci es of laser stimulation. Theelectri cal frequenci es for each zoneof thebody are present ed in col umn 4of Table6.1 and theexact body resonance rates are present ed in col umn 5. Eachrat eis twice the rat eof the frequency below it. Conchaand visceral di sorders are sti mul ated at 5 Hz, anti heli x and musculoskeletal di sorders are sti mul ated at 10Hz, and t hehi ghest frequenci es of 160Hzrel ate to cerebral and learni ng di sorders. Thecorrespondi ng frequenci es for l aser sti mul ati on are present ed in column 6, with the last col umn reserved for the areas of auri cul ar anatomy rel at ed to each frequency zone. Somepract i t i onersof auri cul ar medi ci ne have suggested t hat these seven resonant frequenci es are rel at ed to theenergi es of t heseven pri mary chakras of ayurvedic medi ci ne. I n someenergeti c systems, each chakraisassoci ated with the di fferent colors of the spectrum, from red to orangeto yellow to green to bl ue to vi olet to whi telight. Anatomical zones and energy expressions of different frequencies ZoneA- Cellular vitality: Thiszone runsup themidlineof thephysical body like the acupuncture channelsof theConcepti onVessel and Governi ngVessel in Ori ental medi ci neand like the sushumnanadi of ayurvedic medicine. Theauri cular areafor this2.5-Hzzone isthesubtragus. I t affects primitive reti cular energy and thepri mordi al forces t hat affect cellular organi zati on. This frequency often occurs at thesiteof scars and tissue di sturbanceand rel ates to theembryonic organi zati on of cellular tissue. I t isused to t reat cellular hyperactivity, cellular proli ferati on, inflammatory processes, neoplasti c cancers, tumorsor tissue dedi fferenti ati on. Zone B- Nutritional metabolism: Thiszone affects i nternal organs. Thefrequency of 5Hzisthe opti mal rat efor sti mulati ngpoi ntsin t heconchaof theauricle. Affectingvagal nerve projecti onsto visceral organs, the5 Hzfrequency isused to t reat nutri ti onal di sorders, assimilation disorders, tissue malnutri ti on, neurovegetati ve dysfunctions, organi c allergies, consti tuti onal dysfunctions and parasympatheti c imbalance. When treati ngendodermal visceral organ poi ntsrel ated to the Nogi er second and thi rdphase, the5Hzfrequency moves with the terri tory rel ated to that phase. ZoneC- Kinetic movements: Thiszone affects propri ocepti on, ki neti c movementsand the musculoskeletal body. Theresonant frequency for thezone is10Hz, which isthefrequency used to t reat auri cular poi ntson the antihelix and thesurroundi ngareas of theauricle, such asthe scaphoid fossa and tri angular fossa. Thiszone affects myofascial pai n, sympatheti cnervous system arousal, somati zati on disorders, cutaneousallergies, mot or spasms, muscle pathology and any di sorder aggravated by kinetic movement. Whentreati ngmesodermal musculoskeletal poi nts related to the Nogier second and third phase, the10Hzfrequency moves with theterri tory rel ated to that phase. Zone D- Global coordination: This20-Hzzone representsthecorpuscallosum and theanteri or commissurewhich coordi nateassociations between t hetwo sides of t hebrain. I t isrepresented on Treatmentprocedures 155 Acupuncture microsystems on zone 0 of tragus Right ear Conception Vessel Governing Vessel Leftear Right ear I nternal Musculoskeletal organs body Genitals Coccyx Bladder Sacral Spine I ntestines Lumbar Spine Stomach ThoracicSpine Heart ThoracicSpine Lungs Cervical Spine Throat Cervical Spine Mouth Head Figure 6.8 TheConceptionVessel channel i sfoundon thetragus oftherightauricle, whereastheGoverningVessel meridian isfound Oi l thetragus oftheleft ear. Similarly, theinternal organsrepresented bythefront mupointsarefound on thetragusoftheright ear, whilerear shupointsareshownall thetragus oft heleft ear. 156 AuriculotherapyManual theexternal tragus of theauricle that liesimmediately above thesubtragal zone A. I t correspondsto crossed-laterality dysfunctions, problemsof cerebral symmetry versus divergence, incoordinationof thetwosidesof thebody, symmetrically bilateral dysfunctions or midline pain problems. This frequency affects symmetrically bilateral pain problemsand strictly medi an pain problems. I naright› handedperson, theright tragus correspondsto theanteri or sideof thebody Concepti onVessel and theleft tragus correspondsto theposteri or body GoverningVessel (see Figure 6.8). For al eft- handed person or an oscillator, the opposi teisthecase. Theleft traguscorrespondsto theant eri or side of thebody and theright traguscorresponds to theposteri or side of thebody. I neach case, thebody is represented upside down, with the upper body toward the i nferi or tragusand thelower body toward the superi or tragus. Zone E- Neurol ogi cal i nteracti ons: Thiszone representsthespi nal cord and peri pheral nerves and corresponds to thehelix tail of theauricle. The40Hzfrequency isused for spinal disorders, skin di sorders, dermati ti s, skin scars, neuropathi es, neuralgi as and herpeszoster. Zone F- Emoti onal reactions: This80-Hzzone representsthebrai nstem, thalamus, limbic system, and stri atumand isrepresented on theperi pheral lobe of the auricle. I t correspondsto problemsrel ated to unconsci ous postures, condi ti oned reflexes, tics, muscul ar spasms, stammeri ng, headaches, facial pain, overly sensitive sensati ons, clinical depressi on and emoti onal di sturbances. Whentreati ngectodermal neuroendocri nepoi ntsrel at ed to the Nogi er second and thi rdphase, the80Hzfrequency moves with theterri tory rel ated to t hat phase. Zone G- I nt el l ect ual organi zati on: Thiszone representspsychological functi onsaffected by the frontal cortex t hat are represent ed on the medi al lobe of theauricle. The160Hzsti mulati on frequency isused for pyrami dal system dysfunctions, memory di sorders, i ntellectual dysfunctions, psychosomatic reactions, obsessive nervousness, chroni cworry, malfuncti oni ngcondi ti oned reflexes and deep- seated psychopathology. Whentreati ngect odermal cerebral cortex poi nts rel ated to the Nogi er second and thi rdphase, the 160Hzfrequency moves with theterri tory rel ated to t hat phase. Thepl acement of colored filters or theselecti on of electrical or laser sti mul ati onfrequenci es is based on the type of di sorder and theregi on of the ear t hat correspond to each zone(see Box 6.1). Box 6.1 Stimulation frequencies for specific auricular points Auricular point Master Osci l l ati on poi nt Point Zero Shen Men Sympatheti c Aut onomi c poi nt Allergy poi nt Endocrine poi nt Tranquilizer poi nt Thalamus poi nt Master Sensorial poi nt Master Cerebral poi nt Muscle Relaxation poi nt Wi nd Stream San Jiao (tri pl e warmer) Appeti te Control poi nt Vi t al i t y poi nt Antidepressant poi nt Aggressivity poi nt Psychosomatic poi nt Treatmentprocedures Stimulation frequency (Hz) 2.5 10 10 10 10 20 20 80 160 160 5 10 20 20 20 80 80 160 Auricular point Gastroi ntesti nal Organs Lung and Respiratory Organs Abdomi nal Organs Urogenti al Organs Heart Muscle Act i vi t y Musculoskeletal Spine Musculoskeletal Limbs Musculoskeletal Head Sensory Organs Endocrine Glands Peripheral Nerves Spinal Cord Brainstem Thalamus and Hypot hal amus Li mbi c System and Stri atum Corpus Callosum Cerebral Cortex Stimulation frequency (HZ) 5 5 5 10 10 10 10 10 10 20 40 40 80 80 80 20 160 157 158 Therise in resonance frequenci es going from zone A to zone G reflects the i ncreasi ng evoluti onary complexity of organi c tissue organi zati on. Asone ascends from basic cellular metaboli sm to visceral organsto musculoskeletal tissue to peri pheral nerves to subcorti cal brai n structuresto the hi erarchi cal structureof the cerebral cortex, thefrequenci es t hat rel ateto each successive zone become progressively faster. Thisrise in frequenci es when going from primitive tissue to more recently evolved neurologi cal tissue corresponds to the increasingly faster rot at i onof chakra vortices descri bed in Chapt er 2.3. 6.7 Semi permanent auricular procedures Ear pellets: Small stainless steel ballsor small seeds soaked in an herbal solutioncan beplaced on a specific ear point and held therebyan adhesive strip. Ear acupoi nt pellets are also called ear seeds, ion spheres, semen vaccaria grains, otoacupoi nt beads or magrain pellets. Thesmall adhesive stripsused to holdtheseeds arebest placed withforceps or tweezers indifficult-to-reachareas of theear. I n Chineseear acupuncture, theripeseeds from thevaccaria plant havebecomeapopul ar replacement for ear needles, and are nowused asthesole methodof auricular stimulation. Theseeds can beas effective asneedles and have lesschance of leading toinfections. Even after needleinsertion treatments, ear pellets are left inplace at reactive ear pointsinorder to sustain thebenefits of auricular acupuncture. Theyshould not beleft on theauricle for longer than aweek. Spontaneous sweating on theear surface and dailybathi ngmay make it difficult for ear pellets tostay attached. Whilepatientsare often encouraged toperiodically press on thepellets during theweek, thisadded procedurerunstherisk of knockingthepellet out of place. Ear magnets: Thesemagnetsappear similar to the acupoi nt pellets, but consist of small magnets held ont othe auri cular surface with an adhesive strip. Press needles and ear tacks: Thesearesmall, semi permanent needl es or indwelling thin tacks that are i nserted into theear to be left in place for several days. Thesetypes of needl e provi de stronger sti mulati on t hanear pellets. Staple puncture: A surgical staplegun isused to apply staple needl es into theskin at specific ear points. Thisprocedurehas been most commonly used for thet reat ment of weight loss by astaple i nserted into theStomach and Esophaguspoints. Aqua puncture: Novocaine, saline, vitaminsor an herbsoluti on can be subcutaneously i njected into aspecific region of the ear. Thesubdermal pressure aswell ast hei ngredi entsof the i njected solution provides prol onged sti mulati onof an ear poi nt. 6.8 Selection of auricular acupoints for t reat ment Theselection of ear poi ntsfor t reat ment isbased on the following cri teri a: I . Byreference tothecorrespondingareaon thebody which exhibitspain or pathology. 2. Selective reactivity, as i ndi cated by abnormal color or shape, t endernessor i ncreased el ectrodermal response at theear. 3. Reactivity based on changesin the N-VASpulse. 4. Di fferenti ati onsof zang- fu syndromes rel ated to TCMtheory and theflow of qi in acupuncture channels. 5. Modernphysiological understandi ngof theneurobi ologi cal mechani smsunderlyi ng amedical di sorder. 6. Thefuncti on of an ear poi nt as based uponclinical writings and scientific studi es. 7. Presenti ngclinical symptoms, requi ri ng ageneral medi cal diagnosis of thepat i ent to di fferenti atesuperficial complai ntsfrom underlyi ng pathology. 8. Personal clinical experi ence. Some auri cular loci are found to elicit t herapeut i ceffects for acertai n di sease t hat seem to have nothingto do with ei ther conventi onal Westernmedi ci neor tradi ti onal Chi nesemedi ci ne. 6.9 Tonification and sedation in auriculotherapy Positive gold tonification: TheChi neserefer to toni fi cati on asthe acti vati on or augmentati onof areas with weak energy. Use bri ef (6-10seconds durati on) positive electri cal polari ty for acti vati ng weak functions. Master poi ntsand functi onal poi ntsare often toni fi edwith thisbri ef sti mulati on. AuriculotherapyManual A B c o Figure 6.9 Earpelletsappliedtotheauricular skinsurfacetapedontotheauricularlow back region (A), and theauricular neck region (C). A small goldhall can heappliedtothetragus withforceps(B), whereas semipermanent needlesareshowninsertedintotheear lobe(D). Treatmentprocedures 159 160 I n auri cular acupunctureneedling, tonify by insertinggold needles into theear ipsilateral to the problem, turni ngtheneedlein aclockwise rotati on. Gol dactivates thesympatheti cnervous system, so tonification proceduresare used to t reat parasympatheti c disorders, hyporeacti ons and energeti cvacuums. I t isusual to t reat thedomi nant side of thebody. Any complai nt which is aggravated by rest will often indicatethe need for agold needle. Negati ve silver sedation: TheChi neserefer to sedati on as thedi spersi on of excessive energy to diminish itsoveractivity. Use negative electri cal polari ty, of 12- 30seconds durat i on, to di mi ni sh overactive organsor excessive reacti ons due to stress or tensi on. Onetypically sedat es local poi ntsrepresenti ngaspecific area of t hebody by t reat i ngt hemwith moreprol onged sti mulati on, from 10seconds to several mi nutes. I n auri cul ar acupuncture, one may sedat e by i nserti ngsilver needl es i nto the reacti ve ear poi nt, turni ngthe needl e in acounterclockwi se rotati on. Silver activates the parasympatheti c nervous system. Most reacti ve poi ntson the ear requi resedati ve procedures, since they represent muscle tensi on, sympatheti c arousal, stressful reacti ons, and excessive energy use. For some individuals, it may also be necessary to t reat the ear cont ral at eral to the area of thebody where t hereisaprobl em, t henon- domi nantside. A pai n which isaggravated by movement or exercise suggests the need for asilver needl e. Onecan sti mulatea poi nt with astrongsti mulusover ashort peri od of time or aweak sti mulusover a prol onged peri od of time. 6.10 Relationship of yin organs to ear acupoints Theprincipal organsused tobalance theacupuncturechannelsin Ori ental medi ci necan also be activated by stimulationof thecorrespondi ng auri cular points. Recent revisions of t heChi neseear acupuncturechartshave emphasi zed therepresentati onof the Lung, Heart, Liver, Spleen and Kidney poi ntson theposteri or surface of theauricle aswell asin theconchaof theanterol ateral surface (see Figure 2.17). I . Lung point: Affects respi ratory disorders, drug detoxification and skin diseases. 2. Heart point: Producesmental calming, relieves nervousness, and improves memory. 3. Liver point: Affects blood, muscles, tendons, inflammations, sprains, and eye diseases. 4. Spleen point: Affects di gesti on, reduces muscle tensi ons, and faci li tates physical relaxati on. 5. Kidney point: Affects urinary disorders, bonefractures, back pain, and heari ngdisorders. 6.11 Geometri c ear points Nogi er and hiscolleagues di scovered t hat aft er t reat i ngcorrespondi ng ear poi nt si ndi cated by somatotopi c maps, it was also possi ble to di scern aseri es of reacti ve auri cul ar poi ntst hat occurred along an i magi nary strai ght line. Theselines were referred to as geomet ri c because they occurred at 30 angles to each ot her (see Fi gure6.10). Thepract i t i oner woul d first confi gure an i magi nary line t hat ext ended from Poi nt Zeroto t hecorrespondi ng auri cul ar poi nt. Theline was t hen cont i nued out ward to t heperi pheral helix t hat i nt ersect ed with t hat line. Sti mul ati on of any reacti ve ear poi ntsfound al ong this line were found to augment the t reat ment effects seen with auri cul otherapy. I n addi t i on to t reat i ngthe helix poi nt itself, 30 angles extendi ng from this helix l ocati on were used to creat e addi ti onal i magi nary lines which were also sti mul ated. Theseconfi gurati ons are depi ct ed in Fi gure6.10. Theappl i cati on of these30 angles has been suggested by Bahr (1977) to account for the Chi neseear acupunct urepoi ntsused for Appendi x di sorders found in t heScaphoi d Fossa and Tonsil poi nts found on t hehelix. Thereisalso a30 angle bet ween t heChi neseHypert ensi onpoi nt in the tri angul ar fossa, asecond Hypert ensi onpoi nt on t hetragus, and t heEuropeanMarvel ous poi nt, which isalso used to t reat high bl ood pressure. Thecomplexi ty of thisgeomet ri c procedure, however, limits itsusefulness to thoseclinical cases which do not respond to more strai ghtforward appl i cati ons of auri cul otherapy. Dr Bahr has also descri bed al i near rel ati onshi p of i mport ant functi onal ear poi ntshe descri bed as t heOmegapoi nts. Fi gure6.11 shows the verti cal al i gnment of the Mast er Omegapoi nt, Omega1, and Omega2 along the medi al aspects of the auri cle. Auriculotherapy Manual A Geometric ear points C Chinese Appendix ear points Helix extension of Elbow point Elbow point B D Chinese helix ear points Ear apex Helix 6 Chinese Tonsil ear points Tonsil 1 Appendix 2 Tonsil 4 Figure 6.10 Geometri cear poi ntsoccur at .10 angles from a line that extendsfrom Point Zero to thehelix (A). Chi neseear acupuncture poi ntsal sofound at 30 angles are l ocated on thehelix (8), for Appendi xDisorder acupoi nts in thescaphoi d fossa (C) and Tonsil poi nts on thehelix (D). Treatmentprocedures 161 Omega points Master Omega Figure 6.11 Omegapoi nt sforma vertical line along themedi al aspects oftheexternal eat; i ncl udi ngMaster Omega, Omega1, and Omega2points. 6.12 Inverse and contrary relationships of the ear and body When treati ngthemuscles at t ached to t hespinal vert ebrae and t heperi pheral limbs, it has been found in both auri cul otherapy and mani pulati ve t herapi esthat it ispossi ble to t reat opposi ng regions of the musculoskeletal body. This techni quecan be used to sti mul atereacti ve poi ntson the Box 6.2 Opposing relationships between inverse and contrary body regions 162 Upper spine region Cervical spine 1 Cervical spine 2 Cervical spine 3 Cervical spine 4 Cervical spine 5 Cervical spine 6 Cervical spine 7 Thoracic spine 1 Thoracic spine 2 Thoracic spine 3 Thoracic spine 4 Thoracic spine 5 Thoracic spine 6 Thoracic spine 7 Thoracic spine 8 AuriculotherapyManual Inverse region of lower spine Sacral spine 5 Sacral spine 4 Sacral spine 3 Sacral spine 2 Sacral spine 1 Lumbar spine 5 Lumbar spine 4 Lumbar spine 3 Lumbar spine 2 Lumbar spine 1 Thoracic spine 12 Thoracic spine 11 Thoracic spine 10 Thoracic spine 9 Thoracic spine 8 Right side of body Right hand Right wrist Right elbow Right shoulder Right hip Right knee Right ankle Right foot Contrary side of opposing body Left foot Left ankle Left knee Left hip Left shoulder Left elbow Left wrist Left hand cervical spine to relieve acondi ti on in t helumbosacral spine or to t reat thefoot to provide pain reli ef in theshoulder. Thesespecific relati onshi psare present ed in Box 6.2. For example, one would look for areactive poi nt on thepart of theauricle which representsthesixth cervical vertebra to affect thefifth lumbar vertebra and onewould t reat thefirst l umbar vertebra to affect thethi rdthoraci cvertebra. Onecould t reat theregi on of theauricle representi ngthe right wrist in order to alleviate adysfunction in theleft ankle or t reat theear poi nt representi ngtheleft hip to relieve tensi on in theright shoulder. 6.13 Precautions associated wi t h auriculotherapy Do not t reat any pain needed to di agnose an underlying problem. Do not relieve any pain that warns apati ent against engaging in i nappropri atephysical activity t hat could aggravate thecondition. Becauti ouswhen treati ngpregnant women. Thisprecauti on ismostly requi red for malpracti ce reasons, rat her thanany known clinical evidence regardi ng possible harmful effects of auri culotherapy upon afetus or pregnant woman. Nonetheless, Chi nesestudi eshave suggested that strongsti mulati on of theUterusand Ovary poi ntson theexternal ear can possibly induce an aborti on. Donot useon patientswith acardiac pacemaker, even though theelectrical microcurrentsused in auriculotherapy aredelivered at extremely small intensity levels. Donot use aggressive sti mulati onwith chi ldren or elderly pati entswho may beparti cularly sensitive to strongauri culotherapy treatments. Avoid treati ngpati entswhen they are excessively weak, anemic, ti red, fasting, hypoglycemic or havejust eaten aheavy meal. Thet reat ment will not be as effective. Allow nervous, anxious, weak or hypertensive pati entssome timefor arest after the treatment. I t ishelpful to offer pati entswarm tea while they recover. I nformthe pati ent not to use alcohol or drugs before theauri cul otherapy treatment. Some pati entsmay become sleepy or dizzy after at reat ment and they may need to lie down for a while. Thissedati on effect hasbeen attri butedto the release of endorphi ns. Themost common adverse side effect from auri culotherapy ist hat theear becomes red and t ender after thetreatment. I nform the pati ent that thistendernessisonly temporary. Treat pati ent with antibioticsif theear becomes i nfected. 6.14 Hindrances t o t reat ment success I fapati ent’sdi sorder persists after auri culotherapy t reat ment of thecorrespondi ng ear points, theremay be atherapeuti cblockage due to atoxic scar or dental focus. I nqui reabout thepati ent’s medical history and previous accidents or surgeries. Someti mesahi ndranceto t reat ment isdue to an allergy, which isan excess of energy. At ot her times, thereisan obstacle to thetransmi ssi on of thecellular i nformati onbecause of aregi on of energy deficiency. Theloss of energy may be attri butabl eto theafter-effectsof an acci dent or surgery which caused atoxic scar and ashort› circuit in t hepati ent’senergy. A di fferent type of toxic scar isadental focus rel ated to conti nued inflammation from apri or dental procedure. Mercury amalgam in t oot hfillingsor chroni c infection of thegingivacan also produceadental focus. Accept t hat some medi cal probl emspresent ed by apat i ent can not be effectively t reat ed by auri cul ot herapy because t hereis(1) ast ruct ural i mbal ance t hat needs to be correct ed by some physical t herapy procedure, or (2) apsychological dysfuncti on t hat needs to be addressed by some type of psychotherapeuti c i nterventi on. Nogi er oft en combi ned auri cul ot herapy with ost epat hi c mani pul at i onsin order to provi de st ruct ural i ntegrati on to the neuromuscul ar changes t hat could be achi eved with auri cul otherapy. Whent heobstacl e isdue to an unresol ved emot i onal st at e, sti mul ati on of Poi nt Zerocan bri ng bal ance to t hepsychosomati c resi stance. Whilepsychosomatic di sordersare often dismissed by physicians and pati entsalike, thereisample evidence to suggest that psychological factors have aprofoundi mpact on many physical conditions. Until emoti onal issues rel ated to anxiety, depressi on, loneliness and shameare satisfactorily resolved, apati ent’sunconscious motivationsmay defeat themost skilled clinician. Even when pati entsstrongly vocalize t hat they want to be relieved of thei r physical suffering, they may not beconsciously aware of thei r own thoughts, atti tudesand behavi ors t hat have theopposi te Treatmentprocedures 163 164 effect. Gent l ebut firmconfrontati on regardi ng thepossibility t hat such psychological barri ersexist isoften necessary before proceedi ng further with any medi cal t reat ment . Many practi ti onersare not comfortable addressi ng such issues with resi stant pati ents, but such confrontati onsare often very necessary for theeventual i mprovement of t hat person’sheal th problems. 6.15 Overall guidelines for auriculotherapy treatments 1 Treat asfew ear poi ntsas possible. 2 Only t reat ear poi ntst hat are t ender to pal pati on or are electrically conductive. 3 Treat amaximum of t hreeprobl emsat atime, treati ngthepri mary probl em first. 4 Treat ipsilateral ear reflex poi ntsfor uni lateral probl emsand t reat both ears for bi lateral conditions. 5 I fthepati ent exhibits alaterali ty or oscillation di sorder, the Mast er Osci llati on poi nt should be t reat ed first, thencorrespondi ng poi ntson bot hauri cles should be sti mulated. 6 Treat thefront of the external ear for relieving the sensati onsof pain, t hen t reat theback of the ear for relieving muscle spasms which produce muscle tensi on and limit rangeof moti on. 7 After treati ngtheanatomi cpoi ntst hat correspond to thearea of thebodily symptom, next treat t hemaster points, and lastly t reat supporti ve functi onal points. Themost commonly used master poi ntsare Poi nt Zero, Shen Men, Sympatheti cAutonomi c poi nt, Thal amuspoi nt and Mast er Cerebral poi nt. Anatomi cpoi ntst hat are often used assupporti ve poi ntsto alleviate ot her di sorders include ear poi ntsfor theOcci put, theChi neseAdrenal Gland, theChi neseKidney, theChi nese Heart, the Lung, t heLiver and the Stomach. Themost commonly used Chi nesefuncti onal poi ntsare Muscle Relaxati on poi nt, Appet i t e Control point, Brai n (Central Rim), WindStream (Lesser Occi pi tal nerve), and San Jiao (TripleWarmer). Themost frequently used Europeanfuncti onal poi ntsare Vitality poi nt, Anti depressant poi nt, Aggressivity poi nt and Psychosomatic poi nt. 8 Treat Nogi er Phase I I and Phase1I I pointsif successful results are not obtai nedwith Phase I pointsor with Chineseear points. Phase I I pointsare indicatedfor chronicdeficiency conditions, whereas PhaseIII ear pointsare i ndi cated for chroni cexcess condi ti ons. 9 Evaluatethepati ent for thepresence of physical hi ndrancesor psychological obstacles that could i nterferewith thetreatment. Onemight also noti ceif treati ngreactive poi ntson the ear rel ated to geometri c, inverse, or contrary relati onshi psi mproves theclinical effectiveness of theauri cul otherapy treatment. i 0 Auriculotherapyworksvery well with other treatment modalities. I t isquitecommon tocombine ear acupunctureand body acupunctureinthesame treatment session. Chi neseherbs, moxibustion, homeopathi cmedi ci nes and acupressure massage can be effectively i ntegratedwith auri cul otherapy aswell asbody acupuncture. Postural adjustmentswith osteopathi cor chi ropracti c mani pulati onsserve to facilitate the reducti on of muscle spasms attai nedwith auri cul ar sti mulati on. Biofeedback, hypnosis, medi tati onand yoga all serve to augment thegeneral relaxati on effect seen with auri cui otherapy. Pati entswith psychosomatic di sturbanceswould probably benefi t from psychotherapeuti c i nterventi onsif they could accept theperspecti ve t hat unconsci ous emoti onal conflicts could be acontri buti ngfactor to thei r physical health problem. Any procedureused asstandard medical practi cefor thecondi ti onbei ngt reat edcan be further enhanced by theuse of auri cui otherapy. AuriculotherapyManual Somatotopi c representations ont heear 7.1 Master points on the ear 7.2 Auricular representation of the musculoskeletal system 7.2.1 Vertebral spine and anteri or body represented on the anti hel i x 7.2.2 Legand foot represented on the superior crus and tri angul ar fossa 7.2.3 Arm and hand represented on the scaphoid fossa 7.2.4 Head, skull and face represented on the anti tragus and lobe 7.2.5 Sensory organs represented on the lobe, tragus and subtragus 7.2.6 Auri cular landmarks near musculoskeletal poi nts 7.3 Auricular representation of i nternal visceral organs 7.3.1 Digestive system represented in the concha region around the helix root 7.3.2 Thoracic organs represented on the i nferi or concha 7.3.3 Abdomi nal organs represented on the superior concha and helix 7.3.4 Urogeni tal organs represented on the superior concha and i nternal helix 7.4 Auricular representation of endocrine glands 7.4.1 Peripheral endocrine glands represented along the concha wall 7.4.2 Cranial endocrine glands represented at the i ntertragi c notch 7.5 Auri cular representation of the nervous system 7.5.1 Nogi er phase representation of the nervous system 7.5.2 Peripheral nervous system represented on the ear 7.5.3 Spinal cord and brainstem represented on the helix t ai l and lobe 7.5.4 Subcortical brain nuclei represented on the concha wall and lobe 7.5.5 Cerebral cortex represented on the ear lobe 7.6 Auri cular representation of functi onal condi ti ons 7.6.1 Primary Chinese functi onal poi nts represented on the ear 7.6.2 Secondary Chinese functi onal poi nts represented on the ear 7.6.3 Primary European functi onal poi nts represented on the ear 7.6.4 Secondary European functi onal poi nts represented on the ear Over 20bookson auri cular acupuncturehave been consulted to det ermi netheanatomi cal location and somatotopi cfunction of specific regions of t heear. Textswhich focus on t heidentificationof Chi nese ear acupuncturepoi ntsinclude: Huang(1974), Wexu(1975), Nahemki s& Smith (1975), Lu (1975), VanGel der (1985), Grobglas& Levy (1986), Chen& Cui (1991), Zhaohaoet a1. (1991), Konig & Wancura(1993), Shan et al. (1996) and Huang(1996). Journal articles and conference presentati onsby Zhou(1995, 1999) have addressed themost recent Chi nesepublicationsfor thestandardi zati onof auri cular points. A Europeanperspective on thecorrespondi ngrepresentati onsof thegross anatomy on theexternal ear beginswith thepi oneeri ngwork of Paul Nogi er (1972,1983,1987,1989). Thel atter textspresent thethreephasesof theauri cular microsystem asdel i neated by Nogier. Ot herbookswhich havedescri bed thesomatotopi clocalization of auri cular poi ntsin theEuropeanschools of auri culotherapy and auri cular medicineinclude thefollowing: Bahr (1977), Bourdi ol (1982), Kropej (1984), Van Gel der (1992), Bucek (1994), Pesikov & Rybalko (1994), Stri ttmatter(1998,2001) and Rubach (2001). I nformati onfrom all of thesetextswas combi ned to det ermi nethelocation and function of theauri cular poi ntsdescribed by theChi neseand theEuropeanschools of auri culotherapy. I n general , t hereismorecongruence t handi spari ty bet ween t heChi neseand European somat ot opi c mapsfor t heauri cle. Even when t herearenot i ceabl e di fferences bet ween t hetwo systems, t hecorrespondi ngpoi nt sareoft en l ocat ed on adj acent regi ons of t heext ernal ear. The lower extremi ti es are l ocat ed on t heanti hel i x superi or crus in t heChi neseear charts, but t helegs are l ocal i zed to t het ri angul ar fossa in t heEuropeancart ography. Thesetwo auri cul ar areas lie Somatotopicrepresentations 165 Overview of auricular microsystem somatotopic maps Master poi nts Represented throughout auricle ~ - - - - Sensory Organs Auricular representation of the musculoskeletal system and sensory systems - - - - - Spinal Vertebraeand Ant eri or Body Represented on antihelix _ Legand Foot Represented on tri angular fossa and superi or crus Arm and Hand Represented on scaphoi d fossa Headand Skull Represented on anti tragus Face, Jaw, Teethand Tongue Represented on lobe ..--..._- - - - - - - - - Represented on lobe, tragus, and subtragus Represented on i nferi or concha _ ~ ~ Represented on superi or conchaand concharidge - - - - - - - - - - - - - Represented on superi or conchaand i nternal helix Represented on conchawall Urogeni tal Organs Endocri neGlands Abdomi nal Organs Auricular representation of internal organs ~ ~ ~ ~ ~ Represented on concha around helix root Digestive Organs Thoraci cOrgans ~ Auricular representation of the nervous system Somatic peri pheral nerves Represented on antihelix - - - - - - - - - Sympatheticperi pheral nerves Represented on conchawall Spinal Cordand Brai nstem Represented on helix tail and lobe Subcortical Brain Nuclei Represented on anti tragusand conchawall - _._- - - - - - - - Cerebral Cortex Represented on lobe ~ ~ .... _ ~ ~ Auricular representation of functional conditions - - - - - - - - - - - Chinesepri mary functional poi nts - - - - - - - - - - - - - - - - Chinesesecondary functional points Europeanprimary functional poi nts Europeansecondary functional poi nts next to each other, and in each case t hehip isfound toward thei nferi or tip of the tri angular fossa and thefeet are found toward thetop of theear. TheChi neseassert t hat the kidney isfound in the superi or conchaand thespleen in thei nferi or concha, whereas Europeantexts mai ntai nthat the kidney islocated underneat hthehelix root and thespleen isfound above theconcharidge. I neach case, though, thekidney isfound toward theupper regionsof theauriclewherebot hschools locate thebl adder and thespleen isfound on each side of t heLiver point, which isalso in thesame areaof theconchain bot hschools. A general impression ist hat theEuropeanear poi ntsdel i neatethe musculoskeletal points and neuroendocri nepoi ntsmoreprecisely, whereas theChi nesecharts seem to indicatethelocation of thei nternal organsmoreaccurately. That so much of Ori ental medicineisfocused on t heconsti tuti onal factors establi shed by thei nternal organs, and that each acupuncturechannel isnamedfor an i nternal organ, may provide good reason for thisdifference. Europeanapproaches to auri culotherapy have placed greater emphasi son theneurophysiological control of themusculoskeletal system and therelati onshi p of each organ to theembryological tissue from which it originates. TheNogi er system of threedi fferent phasesrel at ed to three different terri tori eson theauricle may at first seem overly complex and confusing, but theclinical applicability of these phasesbecomes easi er with conti nuedpractice. 166 AuriculotherapyManual 7.1 Master points on t he ear Themaster poi ntsare so identified because they are typically active in most pati entsand they are useful for t het reat ment of avariety of heal th disorders. Thepracti ti oner should first sti mulatethe appropri atecorrespondi ngpoi ntsfor agiven anatomi cal organ, and t hensti mulatethemaster poi ntsalso i ndi cated for t hat medical condi ti on. Each auri cular poi nt presented in thistext isi denti fi edwith anumber, thepoi nt’spri nci pal name, alternati ve names, and t heauri cular zone (AZ) where it isfound. I fan auri cular zone location includes aslash (I), theear poi nt occurs at thejuncti on of twozones. Thelocati on of each ear poi nt isdescri bed with regard to aspecific region of auri cular anatomy and the nearest auri cular landmark (LM). Thephysiological function of thecorrespondi ngorgan or theheal th di sorders affected by aparti cular ear poi nt are presented after t helocati on of t hat ear point. Musculoskeletal body represent ed on t heear I nternal organs represent ed on t heear Spinal vertebrae and anteri or Legand Foot Armand Hand Urogenital Organs__+ Digestive System -----,<L Thoracic Organs - - - - 1h Pituitary Gland Abdominal Organs Nervous syst em represent ed on t heear Terri tori esof t heear Spinal Cord Territory Territory 2 ..... Cerebral Cortex e: Subcortical Nuclei Territory 3- - - I ++H+++t - .l Figure 7.1 Overview of themuscul oskel etal body, i nternal organs and thenervous system represented on the external ear. Al so i ndi cated are thethreepri mary territories oftheauricle. Somatotopicrepresentations 167 No. 0.0 AuricuLar microsystem point (Alternativename) Point Zero (Ear Center, Point of Support, Umbilical Cord, Solar Plexus) [Auricular zone] [ HX1/ CR1] Locati on: Notchon t hehelix root at LM 0, just as theverti cally ascendi ng helix rises from the morehori zontal concha ridge. Function: Thismast er poi nt isthegeometri cal and physiological cent er of thewhole auri cle. I t bri ngs thewhole body towards homeostasi s, produci ngabal ance of energy, hormonesand brai n activity. I t support sthe acti onsof ot her auri cul ar poi ntsand ret urnsthebody to the i deali zed st at ewhich was present in thewomb. On the auri cul ar somat ot opi c map, Poi nt Zeroisl ocated where the umbi li cal cord would rise from the abdomen of t hei nverted fetus pat t ernfound on the ear. As the sol ar plexus poi nt, Point Zeroserves as the ’aut onomi cbrai n’ t hat cont rol svi sceral organs t hrough peri pheral nerve ganglia. 1.C Shen Men (Spirit Gate, DivineGate) [TF 2] Locati on: Superi or and central to the tip of the t ri angul ar fossa, bet ween thej unct i on of the superi or crus and the i nferi or crus of the antihelix. I t isnot at the tip of the t ri angul ar fossa, but slightly i nward and slightly upward from where the tri angul ar fossa descends from the superi or crus toward deeper regi ons of the t ri angul ar fossa. Function: Thepurposeof Shen Men isto tranqui l i zethe mind and to allow a harmoni ousconnect i on to essenti al spi ri t. Thismaster poi nt allevi ates stress, pai n, tensi on, anxiety, depressi on, i nsomni a, restlessness, and excessive sensitivity. TheChi nesebeli eve t hat Shen Men affects exci tati on and i nhi bi ti onof t hecerebral cortex, which issi mi l ar in functi on to Nogi er’ssecond phaseThal amuspoi nt locali zed to the same area of the ear. Uti l i zed in al most all t reat ment plans, includingauri cular acupunctureanalgesi a for surgery. Shen Menwasoneof thefirst poi ntsemphasi zed for the detoxification from drugs and thet reat ment of alcoholism and substance abuse. I t isalso used to reduce coughs, fever, i nflammatory diseases, epilepsy and high bl ood pressure. Whenit isdifficult to find t ender or electrically active car points, sti mulati on of ei t her Shen Men or Point Zeroincreases thereactivity of ot her auri cul ar points, maki ng it easi er to detect them. 2.0 Sympathetic Autonomic point [I H4/AH 7] Locati on: Junct i on of the morevertically rising i nt ernal helix and the morehori zontal i nferi or crus, di rectly below LM I . I t iscovered by the brim of the helix root above it, t husmaki ng this ear poi nt difficult to view di rectly from the external surface of the car. I t can be found on thevertically rising i nt ernal helix wall, on the flat ledge of the i nferi or crus or at thejuncti on where the two meet. Function: Thismast er poi nt bal ances sympatheti c nervous system acti vati on with parasympat het i c sedati on. Thi spoi nt isthe pri mary ear locus for di agnosi ng visceral pain and for i nduci ngsedat i on effects duri ngacupunct ure. I t i mproves bl ood ci rcul ati on by faci li tati ng vasodi lati on, corrects i rregul ar or rapi d heart beats, reduces angi napai n, allevi ates Raynaud’s di sease, reducesvisceral pai n from i nternal organs, calms smoot h muscle spasms and reduces neurovegetati ve di sequi li bri um. I t isalso used for the t reat ment of ki dney stones, gall stones, gastri c ulcers, abdomi nal di stensi on, ast hmaand dysfuncti ons of the aut onomi c nervous system. 3.0 Allergy point [I H7 or HX7] Locati on: I nternal and external sides of the apex of the ear, below or at LM 2. Function: Thismast er poi nt leads to ageneral reducti on in i nfl ammatory reacti ons rel at ed to allergi es, rheumat oi d arthri ti sand asthma. I t isused for the el i mi nati on of toxic substances, the excreti on of met abol i c wastes and t reat ment of anaphylacti c shock. I n Ori ent al medi ci ne, the top surface of theAllergy poi nt ispri cked with a needl e to reduce excess qi or it ispi nched to di mi ni sh allergic reacti ons. 4.0 ThaLamus point (Subcortex, Brain, Pain Control point) [CW2/I C 4] 168 Locati on: Base of the conchawall which lies behi nd the anti tragus. Todet ect thispoi nt , follow averti cal ridge which descends down theconchawall from the apex of the ant i t ragus(LM 13). I t isl ocated on the i nternal surface behi nd the anti tragus, where theconchawall meet sthe floor of the i nferi or concha. Function: Thismaster point represents thewhole di encephalon, includingthethalamusand thehypothalamus. I t affects thalami crelay connecti onsto thecerebral cortex and hypothalami c regulati on of autonomi cnerves and endocri neglands. Thethalamusislikeapreampli fi er for signals sent to thecerebral cortex, refining theneural message and eli mi nati ng meaninglessbackground noise. Thethalamusisthehighest level of thesupraspi nal gate control system, and so isused for AurlculotherspyManual No. Auricular mi crosystem poi nt (Alternativename) [Auricular zone] [I TZ] [ST 3] [TG Z] 6.0 6.E 7.0 most pain disorders, acute and chronic, and isfrequently used for auricular acupunctureanalgesia. I t also reduces neurasthenia, anxiety, depression, schizophrenia, over-excitement, sweating, swelling, shock, hypertension, coronary disorders, cardiac arrhythmias, Raynaud’sdisease, gastritis, nausea, vomiting, di arrhea, constipation, liver disordersand gall bladder dysfunctions. I nTCM,theThalamusSubcortex point tonifiesthebrain and calms themind. I n theNogier phase system, thePhaseI I Thalamusislocated intheregion of Shen Men and Phase I I I Thalamusislocated intheregion of the Lung.Thesethree points, Thalamus, Shcn Menand Lung, are all used for drug detoxification. Endocrine poi nt (Internal Secretion, Pituitary Gland) Location: Wall of the i ntertragi c notch, below LM 9. Function: Thismaster point brings endocri nehormonesto thei r appropri at ehomeostati clevels, ei t her raising or lowering glandular secreti ons. I t functionsby activating thepi tui tarygland below thebrai n. Thepi tui tary isthemaster gland controlli ng all ot her endocri neglands. I t relieves hypersensitivity, rheumati sm, hyperthyroi di sm, di abetes mellitus, i rregular menstruati on, sexual dysfunction and urogeni tal di sorders. I t has antiallergic, anti rheumati c, and anti -i nflammatoryeffects. I n TCM treatments, it reduces dampnessand relieves swelling and edema. Mast er Osci llati on poi nt (Laterality point,Switchingpoint) Location: Undersi deof thesubtragus, i nternal to the i nferi or tragusprotrusi on, LM 10. Function: Thismaster poi nt balances laterality di sorders rel ated to the left and right cerebral hemi spheres. Anatomi cally it representsthecorpuscallosum and the ant eri or commi ssure. Thepoi nt isactive in thosepersonswho are left handedor mixed domi nant in handedness. Whereas80% of individuals show i psi lateral represent at i on of body organs, 20% of pati entsexhibit contral ateral representati on of body organs. Theseindividuals are viewed asoscillators in theEuropeanschool of auri culotherapy, and thislaterali ty dysfunction islabeled ’swi tched’ in some chi ropracti c schools. Sti mulati onof thisauri cular poi nt in oscillators isoften necessary before any ot her auri cul otherapy t reat ment can be effective. Aft er sti mulati on of the Master Osci llati on poi nt, auri cul ar poi ntst hat were initially moreelectrically active on thecontral ateral ear may become more conducti ve on thei psi lateral ear. Thispoi nt isused to alleviate dyslexia, learni ng disabilities and at t ent i ondeficit di sorder. People who have unusual or hypersensitive reacti ons to prescri pti on medi cati onsor aut oi mmuneproblemsoft en need to be t reat edfor oscillation. - - - - - - - - - - - - - - - - - - - - - - - Tranquilizer poi nt (ValiumAnalogpoint,Hypertensivepoint) Location: I nferi or tragus as it joins the face, lying halfway between LM 9and LM 10. Function: Thismast er poi nt produces ageneral sedati on effect, facilitating overall relaxati on and relieving generali zed anxiety. I t also reduces high bl ood pressure and chroni cstress. 8.E Mast er Sensorial poi nt (Eyepoint) [L04] [LO1] 9.0 Location: Mi ddleof the lobe, vertically i nferi or to LM 13and vertically superi or to LM 7. I t isfound at thesame site as theEye point. Function: Thismaster point controlsthesensory cerebral cortex areas of the pari etal lobe, the t emporal lobe, and the occipital lobe. I t isused to reduce any unpl easant or excessive sensati on, such as tactile paresthesi a, ringing in theears and bl urred vision. Mast er Cerebral poi nt (fvfaster Omega,Nervousness, Neurasthenia, Worry) Location: Wherethemedi al ear lobe meetstheface. I t liesvertically i nferi or to the i ntertragi cnotch. Function: Thismast er point represents theprefrontal lobe of thebrai n, thepart of the cerebral cortex which makes decisions and initiatesconscious action. Sti mulati onof thisauri cul ar poi nt diminishesnervous anxiety, fear, worry, lassitude, dream- di sturbedsleep, poor memory, obsessi ve-compulsi ve di sorders, psychosomati c di sorders, and the negative pessimistic thi nki ngwhich often accompani es chroni cpain problems. Somatotopicrepresentations 169 Superior helix 1.( Shen Men (Spirit Gate) 0.0 Point Zero 4.0 Thalamus poi nt (Subcortex) Antitragus Conchawall Internal ridge behindconcha wall T atamus point In erior concha 3.0 Allergy poi nt 8.E Master Sensorial poi nt Helixroot - - - - 2.0 Sympatheti c Aut onomi c poi nt Tragus f- - - - - - -6.E Master Osci l l ati on point ’- - - - - - - - - 5.0 Endocrine point (Internal Secretion) 9.0 Master Cerebral point Figure 7,2 Hi dden view of auricular master points. TheTranquilizer poi nt is not shown in Figure 7.2because thispoi nt on theexternal tragus isonly visiblefrom a Surface View,as i ndi cated in Figure7.3. 170 Auriculotherapyfvlanual 8.E Master Sensorial poi nt ~ ~ / . , \ ! \ c l ~ > 4.0 Thalamus poi nt (Subcortex) 3.0 Allergy poi nt 9.0 Master Cerebral poi nt 1.0 Shen Men (Spirit Gate) 7.0 Tranquilizer poi nt 6.E Master Osci llati on poi nt 2.0 Sympathetic Autonomi c poi nt 5.0 Endocrine poi nt (Internal Secretion) Figure 7.3 Surfaceviewofauricular masterpoints. Somatotopicrepresentations 171 A B c D Figure 7.4 Photographsofthemasterpoints:PointZero(A),ShenMen(B), SympatheticAutonomicpoint (C),Allergypoint and Thalamus point (D). 172 AurieulotherapyManual A B c D Figure 7.5 Photographsofthemuster points: Endocri nepoi nt (A), Master Oscillation poi nt (B), Tranquilizer poi nt (C), Master Sensorial poi nt and Master Cerehral poi nt (D). Somatotopicrepresentations 173 174 7.2 Auricular representation of t hemusculoskeletal syst em Theanatomi cal location of all auri cular poi ntspresented in thistext are descri bed verbally and are also i ndi cated by thei r zone location. I fdi fferent auri cular regions represent asingle correspondi ng part of thebody, asseen in Chineseand Europeanear points, or differences in the Nogier phaselocation of apoint, thefunction of t hat ear poi nt ispresent edwith thefirst ci tati on of that point. Thenomenclaturesystem descri bed in Chapt er4will be used with each auri cular microsystem point. Chi neseear poi ntswill be represented by theextensi on .C, Europeanear points by .E, and ear poi ntst hat are thesame in both systems by .0. Thethreephasesof theNogier (French) system will bedesi gnated by theextensions .FI , .F2, and .F3. Each anatomi cal areaof the body and each functional condi ti on isdesi gnated by adi fferent Arabi c number. Whet herthe musculoskeletal point isfound inTerritory I in PhaseI , Territory2in PhaseI I , or Territory3 in Phase I I I , theopti mal electrical sti mulati onfor that ear poi nt will be 10Hz. Musculoskeletal auri cular points represent theskin, muscles, tendons, ligamentsand skeletal bone structuresof thecorrespondi ngbody area, aswell asblood vessel ci rculati on to that area. These ear reflex poi ntsrepresent somatic nervous system reflexes controlli nglimb and postural movementsand autonomi csympathetic reflexes affecting vascular supply to abody region. Most pain problemsare due to myofascial pain rel ated to chroni c resti mulati onof sensory neuron feedback. A muscle in spasm reactivates i nterneuronsin thespinal cord to resti mulatemotor neuron excitation, which leads to moreneural impulses going to themuscle, causing themuscle to stay inspasm. Muscles do not stay in spasm wi thout aneuron causing t hemto contract and auri cular sti mulati onserves to di srupt thefeedback loop between sensory neuron and mot or neuron. Clinical problemst reat ed by ear reflex poi ntsinclude reli ef of muscle tension, muscle strains, muscle tremors, muscle weakness, tendoni ti s, sprai ned ligaments, bonefractures, bonespurs, peri pheral neuralgias, swollen joints, arthritis, shingles, sunburns, skin i rri tati onsand skin lesions. For all ear reflex points, theanteri or surface of theear isused to t reat thesensory neuron aspects of nociceptive pain sensati on, whereas the posteri or surface of theear isused to t reat themotor neuron aspects of muscular spasm. Theconsensus for theChi neselocation of thevertebral column isnot clear. Some Chi nesecharts concur with Europeanmaps that thespine islocated on theconchaside of theantihelix ridge, whereas ot her Chinesechartsput it on thescaphoid fossa side of theantihelix ridge. ThePhaseI location of ear pointsfor thecervical, thoraci c and l umbar vertebrae, desi gnated .FI , are most similar to theChi neseidentification of t heregions of theauricle which correspond to thespine. ThePhaseI V locati on for thevertebrae and for ot her musculoskeletal tissue isfound on the posteri or regi on of theauricle immediately behi ndthe PhaseI location. For thespine, these poi nts are located on theposteri or groove. AuriculotherapyManual 15. Neck 17. Breast 19. Abdomen 39. Temporal muscles 10. Cervical muscles 11. Thoracicmuscles 36. Shoulder muscles Sacral muscles 14. Buttocks 22. Thigh ___24. Calf 39. Temple Pelvic girdle 23. Knee 25. Ankle rM’"..fooiI 1--- 11. Thoracic spine Antihelix Anterior Posterior muscles 40. Forehead muscles 10. Cervical muscles Concha 17. Breast 11. Thoracicmuscles 19. Abdomen 13. Sacral muscles 14. 20. Buttocks Pelvic 23. muscles Knee 24. Calf 25. Ankle Figure 7.6 Overview ofthemuscul ar and skeletal systems. Somatotopicrepresentations 175 7.2.1 Vertebral spine and anterior body represented on the antihelix No. 10.C Auricular microsystem point (Alternative name) Cervical Spine.C Location: Ridge and scaphoi d fossa side of the anti heli x tail. Function: Relieves neck strai n, neck pain, torticollis, headaches, TMJ. [Auricular zone] [AHB] 1OJ1 Cervical Spine.F1 (CervicalVertebrae, PosteriorNeckmuscles) [AH1, AH2, PG 2] Location: Conchaside of the anti heli x tail, between LM 14and LM I S. TheCl vert ebra lies central to the anti tragus- anti hel i xgroove and runs along the narrow ridge of theanti heli x tail up to C7 above theconcharidge. Function: I mproves range of moti on of tight muscles along the neck, i ncreasi ng flexibility and ci rculati on. 10.F2 10.F3 11.C Cervical Spine.F2 Location: Peri pheral concha ridge below LM I S, where theconchafloor lies next to the conchawall. Cervical Spine.F3 Location: I nferi or regi on of the tragus, between LM 9and LM 10. Locat ed at theTranqui li zer poi nt. Thoracic Spine.C Location: Ridge and scaphoi d fossa side of theanti heli x body. Function: Relieves upper back pain, low back pain, shoul der pain, arthri ti s. [CR 2] [TG 2] [AH9,AH 10] 11.F1 Thoracic Spine.F1 (Upper Back, Dorsal Spine, Thoracic Vertebrae) [AH3,AH 4, PG 3, PG 4] Location: Conchaside of theanti heli x body, between LM 15and LM 16. TheTl vert ebra lies above the concha ridge, across from LM D. Theot her thoraci c vert ebrae are sequenti ally found along theslopi ng antihelix as it curves upward and medially toward the i nferi or crus. 11.F2 11.F3 Thoracic Spine.F2 Location: Medial concharidge, just peri pheral to LM O. Thoracic Spine.F3 Location: Middle regi on of the tragus, between LM 10and LM 11. [CR 1] [TG 3,TG4] 12.C Lumbar Spine.C (LowerBack, LumbarVertebrae, Sacroiliac) [AH11] Location: Upper regi on of theanti heli x body. Function: Representi ngsacroiliac muscles and ligaments, this poi nt reli eves low back pain, sciatica pain, peri pheral neuralgi a, back strai n and disc degenerati on. 12J1 Lumbar Spine.F1 [AH5,AH 6, PG 5, PG 6] Location: Topsurface of theanti heli x i nferi or crus, between LM 16and LM 17. TheL1vert ebra occurs at LM 16, where thei nferi or crus begins, and proceeds along theflat ledge of the i nferi or crus to L5at LM 17. 12.F2 12.F3 176 Lumbar Spine.F2 Location: Rising helix root, above LM D. Lumbar Spine.F3 Location: Superi or regi on of the tragus, above LM 10. AuriculotherapyManual [HX 1] [TG 5] No. Auricular microsystem point (Alternativename) [ Auri cular zone] 13.Fl Sacral Spine.F1 (Coccyx) [AH 7, PG 7) Location: Topsurface of theantihelix i nferi or crus, between LM 17and LM 1. TheS1vertebra occurs at themi dpoi nt of thei nferi or crus, at LM 17,while S5isfound below theLung point. Function: Relieves low back pain, sciatica pain. 14.0 15.0 Buttocks (Gluteusfvlaximusmuscles) Location: Topsurface of theantihelix i nferi or crus, near LM 16. Function: Relieves pain in buttocksmuscles, lowback pain, sciatica, hip pain. Neck (Anterior Neckmuscles,Throat muscles, Scalene muscles) Location: Scaphoid fossa side of theantihelix tail, superi or to LM 14. Function: Relieves neck tension, sore throats, torticollis, hyperthyroidism. [AH 5, PG 5] [AH 8,AH 9, PP 1, PP3] 16.( 16.E Clavicle.C (Collarbone) Location: I nferi or scaphoi d fossa groove peri pheral to theNeck point. Function: Relieves clavicle fracture, shoul der pain, arthri ti cshoulder, rheumati sm, upper back pain. Clavicle.E (Collarbone, Scapula, Shoulder Blade) [SF 1] [AH 9, PP3] Location: Antihelix region near thescaphoi d fossa which lies peri pheral to theNeck and Chest points, at thejuncti on of theantihelix body and antihelix tail at LM 15. 17.0 18.0 Breast Location: Scaphoid fossa side of theantihelix body, superi or to LM 15. Function: Relieves premenstrual breast tenderness, breast cancer. Chest (Thorax, Ribs, Sternum, Breast, Pectoral muscles) Location: Antihelix body, superi or to LM 15and near the Breast point. Function: Relieves chest pain, chest heaviness, i ntercostal pain, angina pectoris, cough, asthma, hiccups. [AH 10] [AH 10, PP3] 19.0 20.0 Abdomen (Abdominal muscles, OutsideAbdomen) Location: Superi or side of theantihelix body. Function: Relieves abdomi nal pain, lowback pain, hernias. Pelvic Girdle (Pelvis, Pelvic Cavity) Locati on: Tipof thetri angular fossa, superi or to LM 16and below theShen Men poi nt. Function: Relieves groin pain, lowback pain, hernias, digestive disorders. Somatotopicrepresentations [AH 11,AH 12, PP 5] [TF 2, PG 8] 177 20.0 Pelvic Gi rdl e 19.0 Abdomen 12.C Lumbar Spine 18.0 Chest and Ribs 17.0 Breast 11.C Thoraci c Spine - - .::::::l : 16.E _ Clavicle.E 15.0 Neck 10.C Cervi cal Spine Clavi cle.C 12.F4 Lumbar Spine 11.F4 Thoraci c Spine 10.F4 Cervi cal Spine Post eri or ear 11.F2 Thoraci c Spine 10.F1 Cervi cal Spine 178 Fi gure 7.7 Hidden viewofthemusculoskeletal spinerepresented on theantihelix. (From Li feARrfi, Super Anatomy, ' Li ppi ncott Williams& Wilkins, withpermission.) AuriculotherapyManual 14. But t ocks 13. Sacral Spine 12. Lumbar Spine 11. Thoraci c Spine 19.0 Abdomen 18.0 Chest and Ribs 17.0 Breast 12.C Lumbar Spine 11.C Thoraci c Spine 14.0 But t ocks 12.F1 Lumbar Spine 16.C Cl avi cl e.C 18. Chest 17. Breast 16. Cl avi cl e 15./ H Neck 19. Abdomen 20.0 Pelvic Gi rdl e 16.E Clavicle.E _- +-__ 10.C Cervi cal Spine 15.0 Neck 13.F1 Sacral Spine 10B Cervi cal Spine 12.F3 Lumbar Spine 11.F3 Thoraci c Spine 11.F1 Thoraci c Spine Figure 7.8 Surface viewofthemusculoskeletal spinerepresented on theantihelix. (From Li feARt J9,Super Anatomy, ' Li ppi ncott Williams& Wilkins, withpermission.) Somatotopicrepresentations 179 7.2.2 Leg and foot represented on the superior crus and triangular fossa No. 21.C 21.F1 21.F2 21.F3 22.0 23.C1 23.C2 23.F1 23.F2 23.F3 24.E 25.C AuricuLar microsystem point (Alternativename) Hip.C Location: Lower regi on of the anti hel i x superi or crus, peri pheral to t heShen Menpoi nt . Function: Reli eves hip pai n. low back pai n. Hip.F1 (Coxofemoraljoint) Location: Peri pheral tip of the t ri angul ar fossa, i nferi or and cent ral to t heShen Menpoi nt . Hip.F2 Location: Fl oor of t hel ower i nferi or concha. inthe regi on of the i nt ert ragi c notch. Hip.F3 Location: Peri pheral ant i t ragusand t hei nferi or ant i hel i x tail and scaphoi d fossa. Thigh (Upper Leg, Quadricepsmuscles, Femur) Location: I nferi or t ri angul ar fossa. i mmedi at el y above the But t ockspoi nt . Function: Reli eves upper leg pai n. pul l ed hamst ri ngmuscles. Knee 1 (Kneejoint. Kneearticulation) Location: Mi ddl eregi on of the anti hel i x superi or crus, al ongsi de the t ri angul ar fossa. Function: Reli eves knee pai n. st rai ned knee, broken knee. Knee 2 (Genusof Knee) Location: Peri pheral regi on of the anti hel i x superi or crus. al ongsi de t hescaphoi d fossa. Knee.F 1 (Patella) Location: Mi ddl eof t hedept h of the t ri angul ar fossa, cent ral to the Shen Men poi nt. Knee.F2 Location: Fl oor of t hei nferi or concha. in the regi on of the Thal amuspoi nt . Knee.F3 Location: Mi ddl erange of the ant i t ragusri dge. i nferi or to LM 13. Calf.E (Lower Leg. Gastrocnemiusmuscle.TibiaandFibula bones) l ocat i on: I nfcri or, medi al regi on of t het ri angul ar fossa. Function: Reli eves l ower leg pai n. Ankle.C Locution: Superi or aspect of the anti hel i x superi or crus. Function: Reli eves ankl e pai n, swollen ankl es. [Auricularzone] [AH13] [TF 1, PT 1] [IC l I C2] [AT3,AH1] [TF 3, PT 1] [AH15] [AH14] [TF 4. PT 2] [ I C2,I C4] [AT2,CW 2] [TF 5. PT 3] [ AH17,PP12] 180 AuriculotherapyManual No. 25.Fl 25.F2 25.F3 26.C Auricular microsystem point (Alternativename) Ankle.F1 Location: Central region of thetri angular fossa. Ankle.F2 Location: Fl oor of theperi pheral i nferi or concha, below thelower antihelix tail. Ankle.F3 Location: Central rangeof theanti tragusridge. HeeL.C Location: Highest region of theantihelix superi or crus, covered by the superi or helix brim. Function: Relieves heel pain, foot pain. [Auricular zone] [TF 6, PT 3] [IC5] [AT 1] [AH 17, PP 12] - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 26.E HeeL.E (Tarsus) [TF 5, PT 3] Location: Most central region Ofthetri angular fossa, covered by thesuperi or helix brim. I t isi mmedi ately adjacent to themedi al end of thei nferi or crus and to theSympatheti cAutonomi cpoint. 27.Fl 27.F2 27.F3 28.C Foot.F 1 (Metatarsals) Location: Triangular fossa, covered by thesuperi or helix brim. Function: Relieves foot pain, peri pheral neuralgi ain thefeet. Foot.F2 Location: Floor of theperi pheral i nferi or concha, near theconcharidge and theconchawall. Foot.F3 Location: I ntertragi cnotch. ~ - - .--. --. - _._- - - - - - - - - - - ~ _ _ _ _ _ _ _ Toes.C [TF 5 & TF 6, PT 3] [IC5] [I T1, I T2) [AH 18, PP 12] Location: Superi or crus, covered by thesuperi or helix brim. Thetoes are moreperi pheral thanthepoi ntsfor theheel. Function: Relieves pain in toes, strai ned toe, inflamed toe, frostbite, peri pheral neuralgi a in thefeet. 28.E Toes.E [TF 6, PT 3] Location: Triangular fossa, covered by thesuperior helix brim. Thelarge toe isthehighest poi nt on thetri angular fossa, close tothetopof thesuperi or crus of theantihelix. somatotopicrepresentations 181 28.C Toes ,leo , 23.C1 Knee 1 21.C Hip 23.C2 Knee 2 25.F2 Ankle Posterior ear 25.F4 Ankle 23.F4 Knee 21.F4 Hip 21. F1 Hip 24.E Calf 23.F1 Knee 22.0 Thigh 27. Foot 26. Heel 25. Ankle 24, Calf 23. Knee 22. Thigh .....- - 1- _ 21 . Hip 182 Figure 7.9 Hidden viewoft helegand foot represented on theauricle. (From Li t’eARrfi, Super Anatomy, ' Li ppi ncott Williams& Wilkins, withpermission.) Auricu/otherapyManual 26.C Heel 28.C Toes r - - , L __ .I Region hidden by hel i x bri m 25. F1 Ankle 27.F1 Foot 23.F1 Knee 26.E Heel 24.E Calf 22.0 Thigh 27. F2 Foot 25.F2 Ankle 23.F2 Knee 27. 26. Foot Heel 24. Lower leg 22. Upper leg 21. Hip 27.F3 Foot 25.F3 Ankle 23.C2 Knee 2 21.F1 Hip 28. Toes 27. Foot 24. Calf 23. Knee 22. Thigh 21. Hip Figure 7.10 Surface viewofthelegand foot represented on theauricle. (From Li feARfJi !, Super Anatomy, ' Li ppi ncott Williams& Wilkins, withpermi ssi on.i Somatotopicrepresentations 183 7.2.3 Arm and hand represented on the scaphoid fossa No. Auricular microsystem point (Alternativename) [Auricular zone] . _.- - - _._.... _ _ ~ - - - - - - - - - - - - - - - _._._- - - - - - - - 29.0 30.0 Thumb Locati on: Antihelix superi or crus, alongside thescaphoi d fossa. Function: Relieves pain of sprai ned thumb. Fingers (Digits, Phalanges) Locati on: Uppermost scaphoid fossa, covered by thesuperi or helix brim. Function: Relieves pain, swelling, peri pheral neuralgi a, frostbite, and arthri ti sinfingers. [AH16 &AH 18, PP 9] [SF 6, PP 10] - - - - - - - - - - - - _._.,,- - - - - - - - - - - 31.0 31.F2 Hand (Palm, Carpals, Metacarpals) Locati on: Upper scaphoi d fossa, central to LM 3and Darwi n’stubercle. Function: Relieves pain and swelling in hand. Hand.F2 [SF 5 &AH 14, PP 9] [SC 8] 31.F3 Locati on: Hand.F3 Floor of theperi pheral superi or concha, above theconcharidge and near theconchawall. [LO1] 32.0 32.F2 Locuti on: Central ear lobe, near theMaster Cerebral point. Wrist Locati on: Scaphoid fossa, central to LM 4of Darwi n’stubercle. Function: Relieves pain, strain, and swelling in thewrist, and reduces symptomsof carpal tunnel syndrome. Wrist.F2 Locati on: Floor of theperi pheral superi or concha, below LM 16. [SF 5, PP 7] [SC6] 32.F3 Wrist.F3 Locati on: Central ear lobe, near theMaster sensorial point. [LO3] 33.0 34.0 34.F2 Forearm (Ulna andRadiusbones,Brachioradialis muscle) Locati on: I n thesuperi or scaphoid fossa, inferior to theWrist point. Function: Relieves pain and spasms in forearm, tenni selbow. . ~ - - - - - - - - ’- _ .. _._- - - - Elbow Locati on: I nthescaphoid fossa, directly peri pheral to theantihelix i nferi or crus. Function: Relieves pain, strain, soreness, and swelling in elbow joint, tenni selbow. Elbow.F2 Locati on: Onthefloor of thesuperi or concha, below themiddle of the i nferi or crus. [SF 4, PP 7] [SF 3, PP 5] [SC 5] 34.F3 184 . - - - - - - - - - - - - - _._- - ’_._- ’- - ’- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Elbow.F3 Locati on: Peri pheral car lobe. AuticuiotherepyManual [LO5] No. 35.0 36.0 Auricular microsystem point (Alternativename) Upper Arm (BicepsandTricepsmuscles, Humerusbone,ChineseShoulder) Location: I n thescaphoi d fossa, superi or to theShoul der point. Function: Relieves pain and spasms in upper arm. Shoulder (Pectoral Girdle, Deltoidmuscles, ChineseShoulderjoint) [Auricular zone] [SF 3, PP 5] [SF 2, PP3] Locati on: I nthescaphoid fossa, peripheral toLM0and LM I S,where theantihelix region representingtheneck meets theantihelix region representi ng theupper baek. Function: Relieves pain, tenderness, swelling and arthri ti sin theshoulder. 36.F2 36.F3 37.0 Shoulder.F2 Location: Floor of thesuperi or conchanear thei nternal helix and the conchawall. Shoulder.F3 Location: I nferi or regions of thescaphoi d fossa and thehelix tail. Master Shoulder point (Scapula, Trapeziusmuscle, ChineseClavicle) Location: I n thei nferi or scaphoi d fossa, i nferi or to Shoul der point, central toLM 5. Function: Relieves pain, tenderness, strai n and swelling in shoulder. [SC 4] [SF 1,HX 15] [SF 1, PP 1] Overview of upper limb representation: Thescaphoi d fossa can be divided into equal thirds. The handand fingers are represented on the upper third, theforearm, elbow, and upper arm are represented on themi ddlethird, and theshoul der isrepresented on thelower thi rdof thescaphoi d fossa. Unli kethedifferences between t heChi neseand Europeanauri cular systems representi ng thelower limbs, bothsystems of auri culotherapy concur with regard to thelocati on of theupper limbs. Physical support of the scaphoid fossa: Because thescaphoi d fossa isagroove on themost peri pheral part of theexternal ear, it tendsto flap back and forth when theear isscanned for an active reflex point. I t isnecessary toprovide firmback pressurewhile probi ngtheskin to detect a point for auri cular diagnosis or auri culotherapy treatment. Thetherapi st’sown thumbprovides back pressurewhile stretchi ngtheear with theindex finger. Todetect apoi nt on theposteri or surface of theear, bend t heear over slightly, revealing theback of t heear. Treat the identical posteri or region detected on theanteri or surface of theauricle in order to relieve themuscle spasms t hat may accompany thesensory aspects of pai n in alimb. somatotopicrepresentations 185 32.F2 Wri st 31.F3 Hand 34.F2 Elbow 30. Fingers 31. Hand 34. Elbow 32. __---11""" Wri st 33. Forearm 32.F3 Wri st 29.0 Thumb 30. Fingers 29. Thumb Wri st 36.F4 Shoulder 36.F3 32.F4 Shoulder Wri st 31.F4 Hand 34.F4 Elbow 37.0 Master Shoulder .... 32.0 Wri st 31.0 Hand 35.0 Arm 34.0 Elbow - - -’c.,,• 33.0 Forearm 36. Shoulder Posterior ear 34. Elbow Figure 7.11 Hi ddenview ofthearm and handrepresented on theauricle. (From Li feARrfi, Super Anat omy, ' Li ppi ncott Williams& Wilkins, withpermi ssi on.t 186 AuriculotherapyManual 33.0 Forearm 34.0 Elbow 36.F3 Shoulder 34.F3 Elbow 32.F3 Wrist r - - , Region hidden by L. __ .J helix bri m 31. F3 Hand 31.F2 Hand 32.F2 Wri st 34.F2 Elbow 36. Shoulder 31. Hand 36.F2 Shoulder _01,- \ - -35. Arm .l t oi & >r- - 34. Elbow .--I!';''------33. Forearm _- - - 1110- +-32. Wri st ~ / 35. Arm 33. Forearm 34. Elbow 29. Figure 7.12 Surface viewofthearm and handrepresented on theauricle. (From Li feARTW, Super Anatomy. ' Li ppi ncott Williams& Wilkins, withpermission.] somatotopicrepresentations 187 7.2.4 Head, skull and face represented on the antitragus and lobe No. Auricular microsystem point (Alternativename) [Auricular zone] [AT3, PL 4] [AT2, PG 1] [AT 1, PL 2] 38.0 39.0 40.0 Occiput (Occipital Skull,Back ofHead, AtlasofHead) Locati on: On theperi pheral superi or antitragus, near theanti tragus- anti heli xgroove. Function: Relieves occipital headaches, tension headaches, facial spasms, stiff neck, epileptic convulsions, brain seizures, shock, dizziness, sea sickness, car sickness, air sickness, vertigo, impaired vision, insomnia, coughsand asthma. I nTCM,the Occiput point isutilized for all nervous disorders, calmsthemind, clears heat, dispelswind and nourishes liver qi. Temple (Temporoparietal Skull, Tai Yang, Sun point) Location: Onthemiddle of theanti tragus, i nferi or to LM 13, theapex of theanti tragus. Function: Relieves migraineheadaches, temporal headaches, tinnitus, and di sorders rel ated to blood circulation to the head. I nTCM,thispoi nt affects thebody acupoi nt Tai Yang and dispels wind. Forehead (FrontalSkull) Location: Lower anti tragus, near LM 12and thei ntertragi cnotch. Function: Relieves frontal headaches, sinusitis, dizziness, i mpai red vision, insomnia, distractibility, neurastheni a, anxiety, worry, depression, lethargy, disturbingdreamsand hypertensi on. 411 42.C 43.E 44.0 Frontal Sinus Location: Central lobe, inferior to the anti traguspoi nt for theforehead. Function: Relieves frontal headaches, sinusitis, rhinitis. Vertex (Chinese Top ofHead, ApexofHead) Location: Peri pheral superi or lobe, below theOcci put point. Function: Relieves pain at thetop of thehead. TMJ (Temporomandibularjoint) Locati on: Peripheral lobe, i nferi or to thescaphoi d fossa, central to LM 6. Function: Relieves jaw tension, toothaches, TMJ, bruxism. Lower Jaw (fvlandible, fvlasseter muscle, LowerTeeth) [LO1] [ L06] [LO8, PL 4/PL6] [LO7, PL6] Locati on: Peri pheral lobe, i nferi or to theTMJpoint. Function: Relieves lower jaw tension, toothaches, TMJ, bruxism, anxiety, pain from dental procedures. Used for acupunctureanalgesia for toothextraction. 45.0 Upper Jaw (fvlaxilla, UpperTeeth) [LO8, PL 4] Location: Peri pheral lobe, inferior to theTMJpoi nt and central to the Lower Jaw point. Function: Relieves upper jaw tension, toothaches, TMJ, bruxism, anxiety, pain from dental procedures. TheJaw poi nts are used for acupunctureanalgesia for toothextraction. ~ ~ ~ ~ ~ _ _ ~ ~ ~ ~ ~ ~ ~ ~ _ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ _ _ ~ _ 46.C1 46.C2 Toothache 1 Location: Peri pheral lobe. Function: Relieves toothaches, toothdecay. Toothache 2 Location: Conchawall behi ndanti tragus. Function: Relieves toothaches. [ L08] [CW3] 188 Auriculotherapyfvlanual No. 46.C3 47.C1 47.C2 Auricular microsystem point (Alternativename) Toothache 3 Location: I nferi or concha, below anti tragus. Function: Relieves toothaches. Dental Analgesia1 (ToothExtractionAnesthesia1,UpperTeeth) Location: Central lobe, inferior to i ntertragi cnotch and superi or to the Master Cerebral point. Function: Used for pain reli ef during dental procedures, gum disease, toothdecay. Dental Analgesia 2(ToothExtractionAnesthesia2, Lower Teeth) [Auricular zone] [IC5] [LO2] [LO1] Location: Central lobe, i nferi or to theDental Analgesi a I poi nt and near theMaster Cerebral point. Function: Used for pain relief duri ngdental procedures, gum disease, toothdecay, and peri odontal inflammations. 48.C1 48.C2 49.C 49.E 50.E Palate 1 (UpperPalate) Location: Upper cent er of lobe, i nferi or to LM 12on anti tragus. Function: Relieves sores, ulcers, and infectionsin thegums of lower mouth. Palate 2 (Lower Palate) Locati on: Cent er of thelobe, i nferi or to LM 13on apex of antitragus. Function: Relieves sores, ulcers, and infectionsin thegums and lining of upper mouth. Tongue.C Location: Cent erof the lobe, between Palate1and Palate2. Function: Relieves pain and bleeding of tongue. Tongue.E Locati on: Peri pheral lobe, i nferi or to ear reflex poi ntsfor Jaw. Function: Relieves pain and bleeding of tongue. Lips Location: Peri pheral lobe, between LM 6and LM 7. Function: Relieves chapped lips, cold sores on lips. [ L04] [ L04] [ L04] [LO5, PL 5, PL 6] [LO3, PL 5] - - - - - - -- - - - - 5l.E 52.C Chin Location: Peri pheral lobe, near LM 6. Function: Relieves skin sores and scrapes on chin. Face (Cheek) Locati on: Peri pheral lobe. Function: Relieves facial spasms, tics, paresthesi a, trigeminal neuralgi a, acne, facial paralysis. [ L08] [LO3, PL 5] Overvi ew of head and face representati on on t he ear: Theface muscles are represented on the lobe, separatefrom theanti traguspoi ntsfor theskull. Theangled anti traguscan be divided into equal thirds, with theocciput represented on theupper, out er thi rdof theantitragus, thetemples represented on themiddlethird of theantitragus, and theforehead represented on thelower, medial thi rdof theantitragus. Aswith therepresentati onof theupper limbs, boththe Chineseand Europeansystems of auri culotherapy concur with regard to thelocation of thehead. Somatotopicrepresentations 189 46.C3 Toothache 3 46.C2 Toothache 2 48.C1 Palate 1 49.C Tongue.C 52.C Face 50.E Lips 45.0 Upper Jaw 46.C1 Toot hache 1 49.E Tongue.E 44.0 Lower Jaw 52. Face 51. Chin Ji 50. ,.{/i 51. i Chin 42. Vertex 40. Forehead 39. Temple 44.0 Lower Jaw 40. 39 1 . ( ’\ Forehead Temp e I( (\ 45. - \ " . •.. •.. Upper Jaw \fEi’IN- - - Figure7.13 Hidden viewof thehead and face represented on theauricle. (From LifeARTJ9,Super Anatomy, ' Li ppi ncott Williams& Wilkins,withpermission.) Physical support of t heanti tragus: Because theanti tragusisaridge on theperi pheral aspect of theexternal ear, it tendsto flap back and forth when scanni ng theear for an ear reflex point. I t is necessary to provide firm back pressurewhen detecti ngahead poi nt for auri cul ar diagnosis or auri culotherapy treatment. Thepracti ti oner’sown thumbprovides back pressurewhile stretchi ng theear with theindex finger. Whendetecti ngapoi nt on theposteri or surface of the ear, bend the ear over slightly, revealing theback of the ear. Treat t heidentical post eri or region det ect ed on the anteri or surface of theauri cle in order to relieve themuscle spasms t hat may accompany the sensory aspects of headaches. 190 AuriculotherapyManual 48. Palate 49. Tongue 46.C3 Toothache 3 38.0 Post eri or ear Occi put 46.C2 Toothache 2 39.0 Templ e 40.0 Forehead 42.C Vert ex 44.0 41.E Lower Jaw Frontal Sinus 45.0 47.C1 Upper Jaw Dental Analgesia 1 46.C1 Toothache 1 47.C2 Dental Analgesia 2 49.E Tongue.E 43.F4 48.C1 TMJ Palate 1 48.C2 52.C 38.F4 49.C Palate 2 Face 44.F4 Occi put Tongue.C Lower j aw 45.F4 39.F4 Upper Temple j aw 49.F4 40.F4 Tongue Forehead 41. Frontal sinus Figure 7.14 Surface viewof thehead and face represented on theauricle. (From LifeAR’J’E!,Super Anatomy, ' Li ppi ncott Williams& Wilkins. withpermission.) Somatotopicrepresentations 191 7.2.5 Sensory organs represented on the lobe, tragus and subtragus - - - - - =- - - - - - - - No. 53.C 53.F1 Auricular microsystem point (Alternativename) _ ~ _ _ - - - - - - _.._- - - - - - - - Skin Disorder.C (Urticaria) Location: Superi or scaphoi d fossa, central to LM 3and located near theHandpoint. Function: Relieves dermatitis, urticaria, eczema, hives, poison oak. Skin Disorder.F1 Location: All along helix tail. [Auricular zone] [SF 5] [HX12- HX 15] 53.F2 53.F3 Skin Disorder.F2 Location: Superi or concha. Skin Disorder.F3 Locati on: Central lobe below thei ntertragi cnotch. [SC 5] _ _ ~ [LO2] 54.0 Eye (Retina, Master Sensorial point) Location: Center of lobe, at thesame location as Master Sensorial point. Function: Relieves poor eyesight, bl urred vision, eye i rri tati on, glaucoma, stye and conjunctivitis. [LO4] .- - - - - - - - - - - - - - _ .. - _._- - - - - - - - - - - - - - - - - - - - - - 55.C1 EyeDisorder 1 (Mu 1) Location: Central side of i ntertragi cnotch. Function: Relieves bl urred vision, eye irritation, glaucoma, retinitis, myopia, astigmatism. [IT 1] - - - - - - - - ~ - - - - - - - - - - - - - - - - - - - - 55.C2 55.C3 Eye Disorder 2 (Mu2) Location: Peri pheral side of i ntertragi cnotch. Eye Disorder 3 (NewEyepoint) Locati on I nferi or concha, below helix root. [AT 1] [I C6] 56.C I nner Nose (Internal Nose, Nasal Cavity) [ST 2] Location: Middleof subtragus, underneathi nferi or tragus protrusi on, LM 10. Function: Relieves runni ngnose, chroni c sneezing, common colds, flu, sinusitis, rhinitis, nasal bleedi ng, profuse nasal discharge, nasal obstructi on, and allergies. I t eli mi natespathogeni cwind-cold and wi nd-heat in thelungs by removing obstructi onsin thenose. 57.C External Nose.C (OuterNose) Location: Middleof tragus. Function: Relieves pain from broken nose, sunburned nose, rosacea. [TG 3] _ _ ~ - - - - _.- - - - - - - - - - - 57.E 58.C 5B.E 59.C 192 External Nose.E Location: Central side of inferior lobe. I nner Ear.C (Internal Ear) Location: Peri pheral lobe, inferior to the antihelix tail. Function: Relieves deafness, heari ngi mpai rment, tinnitus, dizziness, vertigo, Meni ere’sdisease. . ~ _ I nner Ear.E (Internal Ear, Cochlea) Location: Middleof subtragus, near Chi neseI nner Nose. . ~ _ _ External Ear (OuterEar, Auricle, Pinna) Location: Superi or tragus. Function: Relieves pain and infectionsof external ear, deafness, tinnitus, ear infections. ~ ~ ~ _ ~ AuriculotherapyManual [LO1] [LO5] [ST 3] [TG5] Inferior crus 12. F1 Lumbar Spine 12.F4 Low Back Spasms Posterior groove behindantihelixtail Concha floor Posterior groove Antihelixtail 10.F4 NeckTension Paravertebral muscles 10.F1 Cervical Spine 11.F4 Mid Back Spasms Antihelixbody Posterior groove behindantihelixbody Ligamentsandstructural muscles Muscle tension Figure 7.15 Depthviewofthemuscul oskel etal spine represented on theauricle. Theshape ofdi fferent spi nal vertebrae oftheinverted somatotopi cbody corresponds to changes in theshape ofthecontoursoftheantihelix. Thesechangesin antihelix contourscan beused to distinguish di fferent levels of t hevertebral column represented on t heauricle. They are also used to distinguish auri cular regi onswherethe hip, shoul der and head extend from thespine. somatotopicrepresentations 193 53.C Skin Di sorder.C 53.F1 Skin Disorder. F1 59 . ~ External Ear 54. Eye 58.C I nner Ear.C 54.0 Eye 58. I nner Ear 55.C3 Eye Di sorder 3 58.E I nner Ear 56.C I nner Nose 55.C1 Eye Di sorder 1 55.C2 Eye Di sorder 2 5l .E External Nose 56. I nner Nose 194 Figure 7.16 Hi ddenviewoft hesensory organs represented on theauricle. (From LileARTJI !, Super Anat omy, ' Li ppi ncott Williams& Wilkins, withpermi ssi on.) AurieulotherapyManual 57.E External Nose 53.F 2 Skin Disorder.F 2 55.C3 Eye Di sorder 3 59.e External Ear 57.e External Nose 58.E I nner Ear 56.e I nner Nose 55.c1 Eye Di sorder 1 55.C2 Eye Di sorder 2 53.F3 Skin Disorder.F 3 53. Skin Di sorder ~ 5 Eye (reti na) 54.0 Eye 54. Eye 53.e Skin Di sorder.e 53.Fl Skin Di sorder.Fl 53. Skin dermat omes Figure 7.17 Surface viewofthesensory organs represented on theauricle. (From LifeARTJf!, Super Anatomy, ' Li ppi ncott Williams& Wilkins, withpermi ssi on.) Somatotopicrepresentations 195 7.2.6 Auricular landmarksnear musculoskeletal points LM 1 Helix i nserti on: Thel ower Sacral Vert ebrae are l ocat ed on the anti hel i x i nferi or crus bel ow this l andmark on the helix root. LM2 Apex of ear: TheThumbpoi nt isl ocat ed on t heanti hel i x superi or crusj ust bel ow this l andmark on t hesuperi or helix. - -_.._-----_... _ _ ~ ~ Superi or Darwi n’st ubercl e: TheHandpoi nt in t hescaphoi d fossa isfound central l y wi thi n this l andmark. - _ _ ~ _ _ _ I nferior Darwi n’stubercl e: TheWrist poi nt in the scaphoi d fossa isfound central l y wi thi n this l andmark. LM3 LM4 LM 5 Helixcurve: TheMast er Shoul der poi nt in the scaphoi d fossa isl ocat ed central l y wi thi n this l andmark. LM 6 Lobular-Heli xJuncti on: TheLower Jaw and TMJare l ocat ed central l y wi thi n LM 6. LM 7 Bot t omof lobe: TheLips arel ocat ed superi or to LM 7. LM 8 Lobular i nserti on: TheEuropeanExt ernal Noseisl ocat ed superi or to LM 8. LM 9 I ntertragi cnotch: TheMu 1Eye Di sease poi nt isl ocat ed j ust cent ral to this l andmark, whereas t heMu 2 Eye Di sease poi nt is l ocat ed j ust peri pheral to it. LM 10 LM 11 LM 12 LM 13 I nferi or t ragusprotrusi on: TheChi neseExt ernal Noseisl ocat ed halfway bet ween LM 10and LM 11. Superi or t ragusprotrusi on: TheChi neseExt ernal Ear isl ocat ed j ust superi or to this l andmark. Ant i t ragusprotrusi on: TheForeheadon the ant i t ragusisl ocat ed near this l andmark. Apex of ant i t ragus: TheTempleson t heant i t ragusarefound i nferi or to this l andmark. TheEye 1poi nt , at t hecent er of the lobe, iseven furt her bel ow LM 13. - - - - - - - - - - - - - LM 14 Base of anti heli x: TheUpper Cervi cal Vert ebrae arel ocat ed j ust superi or to this l andmark, t heUpper Neck muscles just peri pheral to it. TheOcci put on t heant i t ragusisfound i nferi or and cent ral to LM 14. .. ~ LM 15 LM 16 Anti heli x curve: Thedivision of t heupper Thoraci cVert ebraefrom t hel ower Cervi cal Vert ebrae isl ocat ed at this l andmark. TheShoul der poi nt isl ocat ed j ust peri pheral l y in the scaphoi d fossa. ~ ~ _ _ _ _ Anti heli x notch: Theupper Lumbar Vert ebrae are l ocat ed above this l andmark. TheEl bowpoi nt isl ocat ed more laterally in t hescaphoi d fossa. LM 17 Mi dpoi nt of i nferi or crus: Thedivision of t heupper Sacral Vert ebraefrom t hel ower Lumbar Vert ebrae isl ocat ed at this l andmark. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _._- - - - - 196 AuriculotherapyManual A B Sacral Spine Lumbar Spine Cervical Spine Occiput Temples Forehead c o Master Shoulder European Foot and Leg Wrist Elbow Shoulder Fingers and Hand Chinese Foot and Leg Thoracic Spine Figure 7.18 Auricular regions corresponding to theheadand neck (A), lowerspine(B), thoracicspine(C) and upper and lower limbs(D). Somatotopicrepresentations 197 198 7.3 Auricular representation of internal visceral organs Thearrangement of thelocati on of i nternal organson the auricle isbased upon the same anatomi cal organi zati on astheorganst hat are found in thei nternal body, only they are upsi de down. Theauri cular poi ntsrepresent physiological di sturbancesin theseorgans, not theactual anatomi cal organsthemselves. Digestivesystem: Thegastroi ntesti nal system or ali mentary canal converts food t hat has been eat en into smaller fragments, allowing basic nutri entsto be absorbed into t hebody to make energy and to form thebasic buildingblocks for muscles, bonesand i nternal organ tissue. Mouth: Thissoft tissue lining of theoral cavity or buccal cavity i ncludes thegums, palate, tongue, and salivary glands, where food isinitially tasted aswell asbroken down. Esophagus: Thegullet isalong tubethat delivers food from themouthto thestomach, joining the stomach at thecardiac orifice, asmooth muscle sphincter that closes off gastric juices from inducing reflux back intotheesophagus. Stomach: Thishollow organ isatemporary storaget ank for food. Throughmechani cal churni ng and gastric acid chemicals, food received from themout hisfurther broken down. Small intestines: Thisvery long tube winds back on i tself many times, allowing for t hegradual absorpti on of food nutri entsinto thebody. I t begins at theduodenumconnected to the stomach and ends at theileum connected to thelarge i ntesti nes. Large intestines: Thisfinal tube progresses from theascendi ng colon to thetransverse colon to the descendi ng colon, endi ngin therectum. Thecolon wi thdrawswater from indigestible food. Ci rcul atory syst em: Thi shydrauli c system begi nswith t hecardi ac muscle in t hethorax, which sendsoxygen-ri ch bl ood t hroughthe art eri es to deli ver it to all part sof t hebody, and recei ves oxygen-defi ci ent bl ood from t heveins. Thel ymphati c vessels col l ect excess fluid, metabol i c wastes, and i mmunesystem breakdown product s. Heart: Thispri mary cardi ac muscle pumpsblood to all partsof thebody. Respiratory system: Thetubul ar organsof thissystem allow exchange of air and carbon dioxide. Lungs: Thisorgan for exchange of air gases includes bronchi al tubesand alveoli sacs. Throat: Thi sopeni ngto the respi rat ory system i ncl udes t hemout h, pharynx, and larynx. Tonsils: Theselymphatic organsin the oral cavity surroundi ngthet hroat serve to gat her and eli mi natemi croorgani sms t hat ent er the throat. Diaphragm: Thissmoothmuscle membranebelow t hethorax allows i nhal ati onto occur. Accessory abdomi nal organs: Organsin the abdomen t hat functi on with ot her systems. Liver: Thisaccessory gastroi ntesti nal organ lies next to thestomach. Theliver converts blood glucose into glycogen, i ncorporatesami no acids into protei ns, releases enzymes to metaboli ze toxic substances in theblood, and producesbile. Thebile isrel eased into thesmall i ntesti nes, where it facilitates di gesti on of fats. Gall bladder: Thismuscular sac storesbile created by theliver. Pancreas: Thisaccessory endocri ne- exocri negland producesdigestive enzymes, t hehormone insulin to facilitate energy inside cells, and thehormoneglucagon to raise bl ood sugar levels. Spleen: Thisaccessory lymphatic organ next to thestomach filters t hebl ood and removes defective blood cells and bacteri a. I t isasite for produci ngaddi ti onal i mmunecells. Appendix: Thispouch at t ached to thelarge i ntesti nescontai nslymphati c tissue. Urogenital organs: Abdomi nal and pelvic organsof t heuri nary and reproducti ve systems. Kidney: Thispri mary uri nary organ filters toxic substances from thebl ood and releases it into the urine. I t may retai n or release body fluids and mi neral salts. Bladder: Theurinary bl adder receives uri nefrom the uret er and ki dney and holds it for release. Urethra: Thefinal tube which connectsthebl adder and gonadsto theoutsi deworld. AuriculothersoyManual Prostate: Theaccessory reproducti ve organ in males which contri butesmilky substances to the semen. Uterus: Thisreproducti ve organ in females potenti ally holds thefertilized egg or discharges its vascular lining during the menstrual peri od. External genitals: Thepeni sin themale and theclitoris in thefemale aroused duri ngsexual performance. 60. Mout h 106. ... Salivary Glands 64. Duodenum 67. Rectum 61. Esophagus 62. Cardiac Ori fi ce - - - +- - - - \ -63. Stomach 65. Small I ntesti nes 66. Large I ntesti nes 68. Ci rcul at ory System l i A+- i - \ - \ - - - 69. Heart 72. Trachea 76. Di aphragm 75. Tonsil -A-_-r- 70. Lung 71. - - ""’- - Bronchi 73. Throat ---.lfl'-- (pharynx) 74. Larynx 79. Liver \ 81. Spleen 83. 86. Pancreas Bladder 84. 88. Kidney Prostate 85. Uret er 87. 86. Urethra Bladder 90. 87. External Urethra Geni tals 77. (penis) Appendix Uterus Figure 7.19 Overview ofthei nternal visceral organs. (From Li feAR’fJ9, Super Anat omy, ' Li ppi ncot t Wi lli ams& Wilkins, with permi ssi on.) Somatotopicrepresentations 199 7.3.1 Digestive system represented inthe concha region around the helix root ~ ~ ~ ~ ~ ~ ~ ~ No. Auricular microsystem point (Alternativename) [Auricular zone] 60.0 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Mouth (Fauces, SoftPaiate) Location: I nferi or concha, next to the ear canal and below the helix root. Function: Representi ngthesoft tissue lining of the i nner mouth, gums, and tongue, thisear poi nt relieves eati ng disorders, mouthulcers, cold sores, glossitis. [I C6] ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ [IC 7] [IC 7] 61.0 62.0 Esophagus Location: I nferi or concha, peri pheral to the Mouthpoi nt. Function: Representsthe long tube which connectsthe mouthto thestomach. Relieves indigestion, reflux, difficulty swallowing, epigastric obstructi ons, hiccups, sore throats. Thispoi nt issometi mesi ncluded with theStomach poi nt in weight control plans. Cardiac Orifice Location: I nferi or concha, below LM 0 and thecentral concharidge. Function: Representstheopeni ngbetween theesophagus and thestomach. Relieves indigestion, reflux, heartburn, hiatal herni as, nausea, vomiting, difficulty swallowing, epi gastri c obstructi ons. 63.0 Stomach [CR 1, PC 2] Location: Medial concharidge, just peri pheral to LM O. Control of thesmooth muscle activity of thestomach isalso affected by stimulating theposteri or concharegion behi nd theconcharidge. Function: Representsthegastric chamber which churnsmasti cated food into chyme. Relieves eati ngdi sorders, overeati ng, poor appeti te, di arrhea, indigestion, nausea, vomiting, stomach ulcers, gastritis, and stomach cancer. I t also alleviates toothaches, headaches, and stress. I t isthemost commonly used auri cul ar poi nt for appeti tecontrol and weight reducti on. However, treati ngthiscar poi nt only diminishesthephysiological craving for food when following adiet plan and does not overri de thepati ent’swill if thereisnot consci enti ous effort to reducefood i ntakeand i ncrease physical exercise. I n TCM,thispoi nt reduces stomach fire excess. 63.F2 63.F3 64.0 Stomach.F2 Location: Thisendodermal Phase I I poi nt isfound on theperi pheral ear lobe of Terri tory3. _.__ _ _ _ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Stomach.F3 Location: Thisendodermal Phase I I I point isfound on the medial superi or helix regi on of Territory 1. Duodenum [LO4 & LO5] [ HX4&HX 5] [SC 1, PC 3] [SC 2, PC 3] 65.0 Location: Superi or concha, i mmedi ately above theconcharidge Stomach point. Function: Representstheopeni ngbetween thestomach and thesmall intestines. Relieves duodenal ulcers, duodenal cancers, di arrheaand issometi mesused for eati ngdi sorders. Small I ntesti nes(jejunum, Ileum) Location: Medial superi or concha, below the i nternal helix root. Function: Representsthe longwinding tubeswhich absorb di gested food. Relieves di arrhea, indigestion, abdomi nal distension. 65.F2 200 Smalllntestines.F2 Location: Thisendodermal Phase I I poi nt isfound on themi ddleregi ons of the ear lobe in Territory3. - ~ ~ ~ AuriculotherapyManual [LO4 & LO6] No. 65.F3 AuricuLar microsystem point (Alternativename) Smalllntestines.F3 Location: Thisendodermal PhaseI I I point isfound on thesuperi or i nternal helix in Terri tory 1. [Auricular zone] [I H6- I H 10] [SC 3& SC4, PC 4] 66.0 Large I ntestines (Colon) Location: Central narrow porti on of the most medi al superi or concha. Function: Represents theascending, descendi ng and transverse colons t hat regul ate the amount offl ui d released or ahsorhed from di gested materi al. Relieves di arrhea, consti pati on, colitis, hemorrhoi ds, dysentery, enteri ti s, loose howels. 66.F2 66.F3 Large Intestines.F2 Location: Thisendodermal PhaseI I poi nt isfound on themedi al anti tragusaspects of Territory3. Large Intestines.F3 Location: Thisendodermal Phase I I I poi nt isfound on themi ddlerangeof the helix tail of Territory 1. [AT 1&AT 2] [HX12 & HX13] ._- - - - - - - - - - - - - - - - - - - - - - - - _ .._- - - - - - - 67.C Rectum.C (Anus, LowerSegmentofRectum) Location: External surface of thehelix root, above the I ntesti nespoi nts. Function: Representsthefinal porti on of thecolon. Thisear poi nt relieves di arrhea, consti pati on, rectal sores, hemorrhoi ds, herni as, colitis, fecal i nconti nence, dysentery. [HX2] 67.E Rectum.E (Anus, Hemorrhoidpoint) Location: I nnermost aspect of superi or concha, where thei nternal helix and the i nferi or crus meet at a tip. [SC 4, PC4] Auricular microsystem reflex points and macrosystem yang meridians All yang meri di ans connect directly to theear and vice versa. Sti mulati onof the Stomach, Small I ntesti nesand Large I ntesti nespoi ntson theear can alleviate stagnati on, deficiency, or over activity of qi energy flowing throughthe respective meri di an channelsfor Stomach, Small I ntesti nesand LargeI ntesti nes. Somatotopicrepresentations 201 62.0 Cardiac Orifice 61.0 Esophagus e..- - - 65.0 Small I ntesti nes 65.F3 Small I ntestines.F3 63.F2 Stomach.F2 65.F2 Small I ntestines.F2 66. - - - -Large i ntesti nes 61. Esophagus 63. Stomach _62. Cardiac Orifice 65. Small i ntesti nes Figure 7.20 Hi ddenviewofthedigestivesystem represented on theconcha. (From LifeARTJf!,Super Anatomy, ' Li ppi ncott Williams& Wilkins, withpermi ssi on.) 202 AuriculotherapyManual 63.F3 Stomach.F3 67.E Rectum.E 67.C Rectum.C 60.0 Mout h 61.0 Esophagus 62.0 Cardiac Ori fi ce 66.F2 Large I ntestines.F2 65.F2 Smal l l ntesti nes.F2 63.F2 Stomach.F2 66.0 Large I ntesti nes 65.0 Small I ntesti nes 64.0 Duodenum 63.0 Stomach 66.F3 Large I ntestines.F3 65. __ Small I ntesti nes 64. Duodenum 61. Esophagus 60. Mout h Figure 7.21 Surface viewofthedigestivesystem represented on theconcha. (From LifeARTEJ,Super Anatomy, ' Li ppi ncot t Williams& Wilkins, withpermi ssi on.) Somatotopicrepresentations 203 7.3.2 Thoracic organs represented on the inferior concha No. Auricular mi crosystem poi nt (Alternativename) [ Auri cular zone] [ CW2- CW9] [I C4] 6S.E 69.C1 Ci rculatory System (Bloodvessels) Location: All along the conchawall below the anti heli x and the ant i t ragusridge. Function: Represent speri pheral art eri es and veins and the sympatheti c nerves t hat control vasoconstri cti on and vasodi lati on. Auri cul ar represent at i on of specific i nt ernal art eri es and veins are found as follows, all extendi ng from the conchawall: thecaroti d artery to thebrai n extendsover the helix tail to the lobe; the brachi al and radi al art eri es to the arm and hand extend over the anti heli x body to the scaphoi d fossa; the femoral art ery to the leg and foot extendsover thetri angul ar fossa. Thi sset of auri cul ar poi ntsreli eves coronary di sorders, heart attacks, hypertensi on, ci rculatory probl ems, cold hands, cold feet. Heart 1 Locati on: Deepest , most central area of the i nferi or concha. (I t oft en looks like ashiny spot on the concha.) Function: Relieves post - heart - at t ackdysfuncti ons, chest pain, angi na, hypertensi on, hypotensi on, pal pi tati ons, tachycardi a, arrhythmi aand poor bl ood ci rculati on. I n TCM,Heart functi onsto tranqui l i zethe mind and calm the spi ri t. Theauri cul ar Heart poi nt can thus be used to relieve anxiety, i nsomni a, neurast heni a, poor memory, perspi rat i on, night sweats, regul ate bl ood and reduce heart fire excess. 69.C2 69.C3 69.F1 Heart 2 (Cardiac point) Locati on: Superi or tragus. Heart 3 Locati on: Mi ddleregi on of the post eri or concha. Heart.F1 [TC5] [PC 2] [AH4, PC4] Locati on: Thismesodermal PhaseI poi nt isfound on the mi ddlerange of the anti hel i x body of Terri tory I . ThePhase I V control of cardi ac muscle isrepresent ed on the post eri or groove (PO4) i mmedi atel y behi nd the Phase I Heart poi nt on the anti heli x body (AH 4). 69.F2 Heart.F2 [I C4] Locati on: Thismesodermal Phase I I poi nt isfound on the peri pheral i nferi or conchaof Terri tory2, in the same locati on as the Chi neselocati on for the Heart . While Nogi er (1983) report ed t hat t hePhaseI I Heart was in the i nferi or concha, hissubsequent text (1989) rel ocat ed the Heart to the peri pheral superi or concha, in zone SC 7. 69.F3 70,(1 Heart.F3 Location: Thismesodermal PhaseI I I poi nt isfound on the peri pheral ear lobe of Terri tory3. Lung1 (Contralateral Lung) [LOS] [I C7] 204 Locati on: Peri pheral regi on of the i nferi or concha, below the concha ridge. Nogi er l ocated the Lungs t hroughout the i nferi or concha. Function: Relieves respi ratory di sorders, like asthma, bronchi ti s, pneumoni a, emphysema, coughs, flu, tuberculosi s, sore throats, edema, chest stuffiness and night sweats. I n TCM,the lungs arc rel at ed to detoxi fi cati on because they release carbon dioxide with each exhal ati on. Theauri cul ar Lung poi nt can thus faci li tate detoxi fi cati on from any toxic substance, includingwi thdrawal from narcoti c drugs, alcohol, and ot her forms of substance abuse. TheLung poi nt is i ncluded in t reat ment pl ansfor alcohol abuse, heroi n addi cti on, opi at ewi thdrawal, smoki ng wi thdrawal, cocai ne and amphet ami neaddi cti on. Ori ent al medi ci nealso associ ates the lungs with the skin, since we breat het hroughour skin as well as our lungs. Treati ngthe Lung poi nt can t herefore allevi ate bot h skin di sorders and hai r di sorders, i ncludi ng dermati ti s, uticaria, psoriasis, herpeszoster, shingles. TheLung poi nt isan essenti al analgesi c poi nt used for auri cul ar acupunct ure analgesi a. Finally, thispoi nt isused to di sperse lung qi and di spel wind. AuriculotherapyManual No. 70.C2 Auri cul ar mi crosyst em poi nt (Alternativename) Lung 2 (ipsilateral Lung) [Auricular zone] [I CZ& I C4] Locati on: Lower regi on of the i nferi or concha, i nferi or to t heChi neseHeart poi nt . Nogi er st at est hat t hewhol e i nferi or concha represent s t heLungs. Function: Like t heChi neseLung I poi nt , this second ear poi nt for t hel ungs rel i eves probl ems rel at ed to respi rat ory di sorders, addi ct i on di sorders and skin di sorders. Al t houghsome texts st at et hat t heChi neseLung1poi nt is moreoft en used for respi rat ory di sorders and t heChi neseLung2 poi nt ismoreoft en used for addi ct i on di sorders, bot h Lungpoi nt s seem to be equal l y effecti ve for ei t her t ype of heal t h probl em. Themorecri ti cal vari abl e iswhi ch Lungpoi nt is more el ectri cal l y reacti ve. 70.C3 70.F1 Lung 3 Locati on: Superi or port i on of t hepost eri or peri phery. Lung.F1 Locati on: Thi sendodermal Phase I poi nt isfound t hroughout t hei nferi or conchaof Terri t ory2. [PP9] [I C4 & I C7] 70.F2 Lung.F2 - - - - - - - - - - - - - - - - [LO7 & HX15] 70.F3 Locati on: Thi sendodermal Phase I I poi nt isfound on t heperi pheral regi ons of t heear l obe in Terri t ory3. Lung.F3 [SF 2 & SF 3] 71.C Locati on: Thi sendodermal PhaseI I I poi nt isfound on t hemi ddl erangeof t hescaphoi d fossa in Terri t ory 1. Bronchi [I C3] Locati on: Upper regi on of t hei nferi or concha, near t heEsophaguspoi nt . Function: Thi sear poi nt isconsi dered at hi rdChi neseLungpoi nt . I t is used to rel i eve bronchi t i s, bronchi al ast hma, pneumoni a, and coughs and hel psdi spel excess phl egm. 72.0 Trachea (Windpipe) [I C3] Locati on: Cent ral regi on of t hei nferi or concha, near t heear canal . Function: Reli eves sore throats, hoarsevoice, laryngitis, commoncold, coughswith profuse sput um. I t also di spels phl egm. 73.C Throat.C (Pharynx, ThroatLining) Locati on: Subt ragus, underneat hsuperi or t ragus prot rusi on, LM 11, above ear canal . Function: Rel i eves sore t hroat s, hoarsevoice, pharyngi t i s, tonsi lli ti s, ast hma, bronchi t i s. [ST 4] 73.E - - - - - - - - - - - - - - - - - - - - - - Throat. E(Pharynx, Throat Lining, Epiglottis) Locati on: Cent ral i nferi or concha, next to t heear canal . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - [I C6] 74.C 74.E 74.F2 Larynx.C Locati on: Undersi deof subt ragus, i mmedi at el y above t heear canal . Function: Rel i eves l aryngi ti s, sore t hroat s. Larynx.E Locati on: Thi sendoderrnal PhaseI poi nt isfound on t hei nferi or conchancar t heear canal in Terri t ory 2. - - - - -- - - - - - - - - - - - - - - - - - - - - - Larynx.F2 Locati on: Thi sendodermal PhaseI I poi nt isfound on upper, peri pheral ear l obe of Terri t ory3. - - - - - - - - Somatotopicrepresentations [ST 4] [I C3] [L06] 205 - - - - - - - - -- - - - - - - - - - - - No. Auricular microsystem point (Alternativename) [Auricular zone] .. __._- _._- - - - - - - - - - - - - - - - - - - - - 74.F3 75.C1 Larynx.F3 Location: Thisendodermal Phase I I I poi nt isfound on themi ddleof the antihelix body of Territory 1. Tonsil 1 [AH4] [ HX9] Location: On top of superi or helix, peri pheral to LM 2. Function: Relieves tonsillitis, sore throats, laryngitis, pharyngitisand acut e i nflammati ons. Thewhole peri pheral helix rim isused in Chi neseauri cul ar t reat ment plans for alleviating i nflammatory condi ti ons. 75.C2 75.C3 75.C4 76.C 76.E 206 Tonsil 2 Location: Mi ddleof helix tail, peri pheral to LM 15. Tonsil 3 Location: Curve of helix tail, where it joi nsthe lobe. Tonsil 4 Location: Bottomof the lobe, near LM 7. Diaphragm.C (Hiccupspoint) Location: Helixroot, above LM O. Function: Relieves hiccups, di aphragmati cspasms, visceral bleeding, skin disorders. Diaphragm.E Location: Peri pheral i nferi or conchaand theconcharidge. AuriculotherapyManual [HX14] [HX15] [L03] [ HX2] [ I C8& CR2] A Heart.E Large Intestines Diaphragm.C Small I ntestines Lung 1 Stomach Mouth Bronchi Heart.C Lung 2 B C D Kidney.E Uterus.C External Genitals.C Uterus.E Pancreas Appendix Bladder Gall Bladder Kidney.C Liver External Genitals.E Spleen.E Spleen.C Figure 7.22 Auricular regions corresponding todigestivesystem(A), thoracicorgans(B), abdominal organs(C) and urogenital organs(D) Somatotopicrepresentations 207 72.0 Trachea 69.C1 Heart.C1 76.C Diaphragm 71.C Bronchi 73.E Throat.E 74.E Larynx.E 73.C Throat.C 74.C Larynx.C 70.C2 Lung2 68.E Circulatory System 72. Trachea 70. Lung 71. Bronchi 74. Larynx 70B Lung.F3 70.C1 Lung 1 69.F1 Heart.F1 76.E _- =:p;;;;j Diaphragm.E Figure 7.23 Hidden viewofthethoracic organs represented on theconcha. (From Li feARrfi, Super Anatomy, ' Li ppi ncott Williams& Wilkins, withpermission.) 208 AuriculotherapyManual Post eri or ear 70.C1 Lung 1 69.F1 Heart.F1 70.C3 Lung 3 69.F4 Heart.F4 70.C2 Lung 2 75.C3 Tonsi l 3 70.F4 Lung.F4 69.C3 Heart.C3 76.E Diaphragm.E 70B J ~ Lung.F3 75.C2 Tonsil 2 70.F2 Lung.F2 75.C1 Tonsil 1 69.F3 Heart.F3 75.C4 Tonsil 4 69. Heart 73.C Throat.C 74.C Larynx.C 73.E Throat.E 74.E Larynx.E 72.0 Trachea 69.C1 Heart .Cl 76.C Diaphragm.C 71.C Bronchi 69.C2 l ~ r Heart.C2 Figure 7.24 Surfaceviewofthethoracic organs represented on theconcha. (From Li feARrfi, Super Anatomy, ' Li ppi ncott Williams& Wilkins, withpermission.) Somatotopicrepresentations 209 7.3.3 Abdomi nal organs represented on t he superi or concha and hel i x No. 77.0 78.C1 78.C2 78.C3 79.0 Auri cul ar mi crosyst em poi nt (Alternativename) Appendi x (Primary Appendixpoint) Location: Superi or helix, between the Small I ntesti nesand the Large I ntesti nesear poi nts. Function: Relieves acute and chroni c appendi ci ti s. Appendi x Disease 1 Location: Superi or scaphoi d fossa, near ear poi ntsfor Fi ngers. .~ ~ ~ ~ ~ ~ ~ _ _ _ ~ _ _ .. _._- _._._- - - _.. Appendi x Disease 2 Location: Mi ddlescaphoi d fossa, near car poi ntsfor Shoul der. Appendi x Disease 3 Location: I nferi or scaphoi d fossa, near Mast er Shoul der poi nt. Liver [Auricular zone] [SC 2] [SF 6] [SF 3] [SF 1] [CR 2] Location: Peri pheral concharidge and conchawall, peri pheral to theSt omach poi nt. Function: Relieves hepati ti s, ci rrhosi s of liver, jaundi ce, alcoholism, gall bl adder probl ems, regul ates bl ood di sorders, hypertensi on and anemi a. I nTCM, the liver affects tendons, sinews, and li gaments, and the Liver ear poi nt isused to heal joi nt sprains, muscles strains, muscle spasms, myastheni aparalysis and soft tissue injuries. TheLiver poi nt also improves bl ood ci rculati on, enri ches blood, i mproves eyesight, relieves fainting, digestive di sorders, convulsi ons and paralysis due to astroke. Theauri cul ar Liver poi nt isused for hypochondri ac pain, dizziness, premenst rual syndrome and hypertensi on. Accordi ng to Ori ent al thought, the liver nouri shesyin and restrai nsyang by purgi ngliver fire. 79.C2 79.F2 79.F3 Liver.C2 Location: A second Chi neseLiver poi nt isfound on the mi ddle range of the post eri or peri phery. Liver.F2 Location: Thisendodermal Phase I I poi nt isfound on the peri pheral lobe of Terri tory3. Liver.F3 Location: Thisendodermal Phase I I I poi nt isfound on thesuperi or scaphoi d fossa of Terri tory 1. [PP6] [LO7] [SF 4& SF 5] [HX10] 80.C1 Li verYang 1 Location: Superi or helix, at LM 3, superi or to Darwi n’stubercle. Function: Relieves liver di sorders, hepati ti s, and allevi ates i nflammatory condi ti ons. I n TCM,the Liver Yang poi nts calm the liver and suppress yang excess and hyperactivity. 80.C2 Liver Yang 2 Location: Helix tail, at LM 4, i nferi or to Darwi n’stubercle. [HX12] [IC8] 81.C1 210 Spleen.C 1 (Foundonleft ear only) Location: Peri pheral i nferi or concha, i nferi or to the Liver poi nt on the concharidge. Function: Relieves lymphatic di sorders, bl ood di sorders, and anemi a, abdomi nal di stensi on and menstruati on. I n TCM, the spleen nouri shes muscles, thus the Spleen poi nt isused to relieve muscle tensi on, muscle spasms, muscular atrophy, muscular dystrophy. I n Chi nesethought, thespl een governs the t ransport at i onand t ransformat i onof food and fluid, thus it affects digestive di sorders, indigestion, gastritis, stomach ulcers and di arrhea. TheChi nesesti mul atethis point to strengthen bot h spleen qi and stomach qi and to regulate the mi ddlejiao. AuriculotherapyManual No. 81.C2 81.F1 Auricular microsystem point (Alternativename) Spleen.C2 Location: Posteri or concha, peri pheral to theposteri or ear point for theLung. Spleen.F1 (Foundonleft ear only) [Auricular zone] [PC 3] [ SC6,CW9] Location: Superi or conchaand conchawall below thei nferi or crus. Because thespleen isof mesodermal origin, early Nogier chartsindicated that thespleen was inone of two positions on theear, thisone for Phase I and thenext region for PhaseI I . Function: Western medicinefocuses on therole of thespleen in thelymphatic and i mmunesystems, thusEuropean doctors usetheSpleen poi nt for itsphysiological function rather than itsenergeti c effects asused in Ori ental medicine. 81.F2 Spleen.F2 [SC 8] Location: Peri pheral superi or concha, superi or to theLiver point on theconcharidge. Even thoughthespleen isof mesodermal origin, theearli er localization of thespleen organ by Nogi er was placed at thisPhase I I position. The development of thephase model helped Nogier to account for thediscrepancies in theidentificationof di fferent correspondi ng regions of theexternal ear that were said to represent thespleen. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 81.F3 82.0 Spleen.F3 Locati on: Thismesodermal Phase I I I poi nt for thespleen isfound on theperi pheral lobe of Territory 3. Gall Bladder (Foundonrightear only) [L08] [SC 8, PC 3] Location: Peripheral superi or concha, between thePancreasand Duodenumpoints. TheChineselocalization of the Gall Bladder and theNogier Phase I representati onoft hi sorgan are thesame. Function: Relieves gall stones, gall bl adder inflammations, deafness, tinnitus, migraines. 82.F2 82.F3 Gall Bladder.F2 Locati on: Thisendodermal Phase I I poi nt isfound on themedial lobe of Territory 3. Gall Bladder.F3 [L02] - - - - -- - - - - - - - - - - - - - - [AH13 & AH14] Location: Thisendodermal Phase I I I poi nt isfound on thebase oft heantihelix superi or crus of Territory 1. 83.0 Pancreas [SC 7 & CW7, PC 4] Location: Peripheral superi or concha and theadjacent concha wall. TheChinese localization of the Pancreasisthe same astheNogier PhaseI representati onof thisorgan. Function: Relieves di abetes mellitus, hypoglycemia, pancreatitis, dyspepsia. 83.F2 83.F3 Pancreas.F2 Location: Thisendodermal Phase I I poi nt isfound on themedial lobe of Territory 3. Pancreas.F3 [LO1] [TF 4] Location: Thisendodermal Phase I I I poi nt isfound on thetri angular fossa region near theantihelix i nferi or crus of Territory 1. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - .. ~ Somatotopicrepresentations 211 82.F2 Gall Bladder 83.F2 Pancreas 79.F2 Liver 79. Liver Right ear 82.F3 Gall Bladder 79.F3 83.F3 Liver Pancreas 83.0 Pancreas 82.0 77.0 Gall Bladder Appendix 79.0 Liver 82. Gall Bladder 83. Pancreas 77. Appendix ~ ... ’.... "’.".’. u l \ I Figure 7.25 Hidden viewoftheabdomi nal organs represented on theauricle. (From Li feARTJ9,Super Anatomy, CD Li ppi ncott Williams& Wilkins, withpermi ssi on.) 212 AuriculotherapyManual 77. Appendi x 83.0 Pancreas 71.F3 Liver.F3 Left ear 81.F2 Spleen.F2 Posterior ear 78.C2 Appendi x Disease 2 79.0 Li ver - - - - 78.Cl Appendi x Disease 1 79.C2 Liver 2 79.F2 Liver.F2 81.C2 Spleen 2 81. Spleen 83.F2 Pancreas.F2 79. Liver 82. Gall Bladder 81.Cl Spleen 1 78.C3 Appendi x Disease 3 81.Fl Spleen.Fl 83.F3 Pancreas Figure 7.26 Surface viewoftheabdomi nal organs represented on theauricle. (From Li feARfE!,Super Anatomy, ' Li ppi ncott Williams& Wilkins, withpermission.) Somatotopicrepresentations 213 7.3.4 Urogenital organs represented on the superior concha and internal helix No. 84.C1 Auricular microsystem point (Alternativename) Kidney 1 [Auricular zone] [ SC6& CW8] Location: Superi or concha, bel ow LM 16 and superi or to t heSt omach poi nt. I t isoft en difficult to view this poi nt because it ishi ddenby t heoverhangi ng l edge of t hei nferi or crus. Function: Reli eves ki dney di sorders, ki dney stones, uri nat i on probl ems, nephri ti s, di arrheaand pyelitis. I n TCM,the ki dney rel at es to t hebones, audi t ory funct i on and hai r condi ti ons, so it is used for bonefractures, t oot hprobl ems, low back pai n, ear di sorders, deafness, ti nni tus, bl eedi ng gums, hai r loss and stress. TheChi neseKi dney poi nt toni fi es ki dney qi deficiency, regul at es fluid passage, and enri chesessence. 84.C2 84.F1 84.F2 84.F3 85.C 85.E Kidney 2 Location: Superi or regi on of t hepost eri or lobe. Kidney.F1 Location: Thismesodermal PhaseI poi nt isfound on t hemedi al i nt ernal helix of Terri tory 1. Kidney.F2 Location: Thismesodermal PhaseI I poi nt isfound on t hei nferi or concharegi on of Terri tory2. Kidney.F3 Location: Thi smesodermal PhaseI I I poi nt isfound on t heanti hel i x tail regi on of Terri tory3. Ureter.C Location: Superi or concha, bet ween t heKi dney and Bl adder poi nts. Function: Reli eves bl adder dysfuncti ons, uri nary t ract i nfecti ons, ki dney stones. Ureter.E Location: I nt ernal helix regi on which overli es t heanti hel i x superi or crus. [PL 4] [ I H4& I H5] [I C7 & I C8] [LO1&SF 1] [SC 6] [I H4] 86.0 Bladder (Urinary Bladder) Location: Superi or concha, bel ow LM 17, superi or to Small I nt est i nespoi nts. Function: Reli eves bl adder dysfuncti ons, cystitis, frequent uri nat i on, enuresi s, dri ppi ngor ret ent i onof uri ne, bedwetti ng, pyelitis, sci ati ca, mi grai nes. I n TCM,the bl adder cl ears away damp heat and regul at es t hel ower ji ao. [SC 5] - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 86.F2 86.F3 87.C 87.E 214 Bladder.F2 Location: Thisendodermal PhaseI I poi nt isfound on t helowest l obe regi on of Terri tory3. Bladder.F3 Location: Thisendodermal PhaseI I I poi nt isfound on t heupper scaphoi d fossa regi on of Terri tory 1. Urethra.C Location: Helix root , i nferi or to LM 1. Function: Reli eves pai nful uri nat i on, uret hral i nfecti ons, urethri ti s, uri nary i ncont i nence, bl adder probl ems. Urethra.E Location: Most medi al tip of the superi or concha. - - - - - - - - - - - - - - - - AuriculotherapyManual [LO3] [SF 6] [HX3] [SC 4] No. Auricular mi crosystem poi nt (Alternativename) [Auricular zone] - -- - _._- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 88.C Prostate.C [SC4] Location: I nnermost tip of superi or concha, at same site asthe EuropeanUret hrapoi nt. Function: Relieves prostati ti s, prost at ecancer, herni as, i mpotency problems, painful uri nati on, premat ureejaculati on, nocturnal emission, uri nary tract infection. 88.E 89.C 89.Fl Prostate.E or Vagina.E Location: Undersi deof i nternal helix. Uterus.C Location: Central regi on of tri angul ar fossa. Function: Relieves premenst rual problems, i nflammati onsof uteral l i ni ng, i rregul ar menstruati on, dysmenorrhea, uteri nebleeding, sexual dysfunctions, infertility, pregnancy problems, miscarriages, and can i nduceearly chi ldbi rth deliveries. I n TCM,thispoi nt repleni shes kidney qi and nouri shesessence. Uterus.F1 (Fallopian Tubes) Location: Thismesodermal PhaseI poi nt isfound on the undersi deof the i nternal helix root of Territory 1. [1HZ] [TF S] [IH3] 89.FZ Uterus.F2 [I C1& I CZ] Location: Thismesodermal Phase I I poi nt isfound on the lower i nferi or conchaof Terri tory2. ThePhaseI I poi ntsfor theProstateand Vagina are at thesame locati on asthe PhaseI I Ut eruspoi nts. 89.F3 Uterus.F3 Location: Thismesodermal PhaseI I I poi nt isfound on the medi al lobe of Territory3. ThePhaseI I I poi ntsfor the Prostateand Vagina areat thesame locati on as thePhaseI I I Ut eruspoi nts. [LOZ] [HX4] 90.C External Genitals.C Location: Helix regi on which leaves the face, at LM 1. Function: Relieves scrotal rashes, groi n pain, impotency, lowback pai n, impotency, and premat ureejaculati on, and facilitates sexual desire. I n TCM,thispoi nt clears away heat and dampness. 90.E External Genitals.E (Penisor Clitoris, Boschpoint) Location: Helix root areawhich isadjacent to thesuperi or tragus. Somatotopicrepresentations [HX1] 215 89. Uterus 88.E Prostate or Vagina.E 84.F1 Kidney.F1 85.E 86.0 Bladder 85. Uret er 87. .- .- - - - -Urethra 84. Kidney 86.F3 Bladder.F3 89.C Uterus.C 86.F2_- - - - - - ’’P Bladder.F2 84.F3 Kidney.F3 84.F2 Kidney.F2 84.C1 Kidney 1 85.C Ureter.C Figure 7.27 Hidden view of urogenital organs represented on the auricle. (From LifeART’J9.Super Anatomy. ' Lippincott Williams& Wilkins.withpermission.) 216 AuriculotherapyManual 84.F1 Kidney.F1 85.E Ureter.E 90.C External Genitals.C 89.F1 __........"..,. Uterus.F1 88.E Prostate or Vagina.E 90.E External Genitals.E 89.F2 Uterus.F2 88. Vagina 89. Uterus 86. , Bladder 85./ \ 90. External Geni tals 87. Urethra 86.F2 Bladder.F2 88. Prostate 86. Bladder 86.F3 Bladder.F3 85.C Ureter.C 84.C1 Kidney 1 84.F2 Kidney.F2 84.F3 Kidney.F3 Posterior ear Figure 7.28 Surface view of urogenital organs represented on the auricle. (From LifeARTI D,Super Anatomy, ' Li ppi ncott Williams& Wilkins,withpermission.) Somatotopicrepresentations 217 218 7.4 Auricular representation of endocrine glands Theendocri neglands are referred to as t hei nternal secreti on system, since hormones manufact ured and rel eased by theseglands are secret ed directly i ntot heci rculatory system. The hormonesarecarri ed by t hebl ood to all ot her part sof t hebody where they exert someselective effects on specific target cells. Chemi cal substances rel eased by the hypothal amusat thebase of the brai n are sent to cells in t hepi tui tarygl and beneat h t hehypothal amus. Thepi tui tary gland subsequently releases tropi chormonest hat have selective acti on on t arget glands in thebody. The target glandsare di rected to release t hei r own hormones, dependi ngon t helevel of tropi c hormonerecei ved from t hepi tui tary. Sensors in t hehypothal amusmoni t or t hebl ood levels of each target hormoneci rculati ng in t hebl ood and det ermi newhet her the hypothal amusdi rectsthe pi tui tary to release moreor less tropi c hormonesto acti vate or suppress the activity of the target glands. Hypothalamic-pituitary axis (HPA): Thist ermrefers to t hecentral rol eof t hehypothal amust hat control st heant eri or pi tui tary to release hormonest hat control t het arget endocri neglands. Anterior pituitary: Theant eri or part of t hepi tui tarygl and contai nsonly chemi cal secretory cells, which can rel ease adrenocorti cotropi ns(ACTH),thyrotropi ns(TSH),gonadot ropi ns(FSH, LH), endorphi ns, or growth hormone. Posterior pituitary: Theposteri or part of t hepi tui tary gland contai nsspecial neuronswhich descend from the hypothal amusand secrete anti di ureti chormoneor oxytocin i ntot heblood. The anti di ureti chormone(ADH)di rectst hekidneys to reabsorb morewat er from uri neand ret urn t hat wat er to t hegeneral bl oodst reamto i ncrease overall fluid level. Oxytocin i nduces ut eri ne contracti onsduri ngchi ldbi rth. Pineal gland: Thisgl and lies above t hemi dbrai n and below t hecerebral cortex, rel easi ng mel atoni nat night to faci li tate sleep and i nducet heregul ati on of day- ni ght ci rcadi an rhythms. Deficiencies in mel atoni n are someti mesrel at ed to depressi on. Thyroid gland: Thisgl and lies at thebase of thet hroat and releases thyroxin hormonein response to t herelease of pi tui tary thyrotropi nhormone. Thyroxin accel erates the rat eof cellular metaboli sm t hroughout t hebody, affecti ng virtually every cell of thebody by sti mul ati ngenzymes concerned with glucose oxi dati on. I rondeficiency reduces t heability of t hethyroi d gl and to producethyroxin, thus leadi ng to goi ter. Hyperthyroi dactivity can l ead to Graves’ di sease, an aut oi mmunesystem di sorder t hat causes el evated metabol i c rat eand nervousness, whereas hypothyroi di smproduces symptomsof lethargy and depressi on. Parathyroid gland: Thisgland lies at t hebase of thet hroat next to t hethyroi d gl and, and rel eases parat hormonei ntothebl ood when it sense decreasi ng calci um levels in t heblood. By faci li tati on of the availability of calcium, parat hormoneaffects nervous system excitability. Mammary gland: Thisgl and in t hebreastsaffects milk producti on in nursi ngwomen. Thymus gland: Thisgland lies behi ndt hest ernumin thechest and affects the di fferenti ati on of basal white bl ood cells madein thebonemarrow i ntoactive i mmunecells. Specific di fferenti ated i mmunecells can become T-helpercells, T-suppressor cells or T-killer cells. Thymusgl and activity isrel ated to AI DS/ HI Y,cancer and aut oi mmuneprobl ems. Pancreas gland: Thisgl and lies next to the stomach and releases the hormonei nsuli n to faci li tate the t ransport of glucose from t hebl oodst ream i ntoi ndi vi dual cells, whereglucose can t hen become available as energy. Thepancreas also rel eases t hehormoneglucagon to promot ehi gher bl ood glucose levels. Adrenal gland: Thisgland lies at the t opof the abdomen, on top (ad- ) of each ki dney (-renal). I t isdivided i ntothei nner adrenal medul l a, which rel eases t hehormoneadrenal i n in response to activation by sympatheti c nerves, and t headrenal cortex, which rel eases corti sol and ot her stress› rel ated hormonesin response to pi tui tary adrenocort i cot ropi n hormone(ACTH). Gonads: Thesesex glandslie at thebase of t hebody. Theovari es in women lie in t hepelvic cavity and sequenti ally release est rogen and progest eronein response to pi tui tarygonadot ropi n hormonesFSH and LH. Thetestesin men rel ease the hormonet est ost eroneto i ncrease sex drive, energy level and aggressiveness. AuriculotherapyManual 100. Posterior Pituitary 99. Anterior Pituitary o Connection to circulatory system 136. Hypothalamus 106. Salivary Gland 95. Mammary Gland 91. Testis 91. Ovary 91. Ovary fff:!lr..... 92. Adrenal Gland 83. Pancreas e:o 96. rv 94 Thyroid rf\.A Gland Gland 97. Parathyroid Gland Figure 7.29 OvelViewoftheendocrine glands. (FromLi feARrfi, Super Anatomy, ' Li ppi ncott Williams& Wilkins, withpermission.) Somatotopicrepresentations 219 7.4.1 Peripheral endocrineglandsrepresentedalongtheconchawall No. 91.C Auricular mi crosyst em poi nt (Alternativename) Ovaries.C orTestes.C (SexGlands, Gonads, Internal Genitals) [Auricular zone] [ CW1] Location: Conchawall near the i nt ert ragi cnotch. Locat ed t oward t hebot t omof the auri cl e, this Chi nesepoi nt is i nconsi stent with ot her poi nt srefl ecti ng an i nverted fetus ori ent at i on, but isconsi st ent with t heNogi er l ocat i on for t he pi tui tary gonadal hormonesFSHand LH. Thesetwo pi t ui t ary hormoneswoul d be appropri at el y found on t hei nferi or part of the external ear t hat represent s t hehead, where t heactual pi t ui t ary gl and isl ocat ed. Function: Reli eves sexual dysfuncti ons, testi ti s, ovari ti s, i mpotency, frigidity. 91.F1 Ovaries.F1 orTestes.F1 [I H1] Location: This mesodermal PhaseI endocri negl and isfound under t hei nt ernal helix root of Terri tory 1. The correspondence of the sex gl ands to this auri cul ar area makes logical sense for t hei nvert ed fetus model as this helix root regi on of the ear general l y represent surogeni t al organsfound l ower in the body, thushi gher in t heear. ~ ..- .. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ __ ~ 91.F2 Ovari es.F2orTestes.F2 Location: Thismesodermal PhaseI I endocri negl and isfound on t hel ower i nferi or conchaof Terri tory2. [ I C2] .. _.. ~ ~ ..... - - - - - - - - - - - - - - - - _ .. ~ 91.F3 92.C Ovari es.F30rTestes.F3 Location: Thismesodermal PhaseI I I endocri negl and isfound on t hel ower medi al l obe of Terri tory3. ... - - - - - - - ... _- - - Adrenal Gland.C(Suprarenal Gland) [ L02] [TG3] Location: Thepromi nent knob of the i nferi or tragusprot rusi on at LM 10. As this l ower tragal and i nt ert ragi c notch regi on of the auri cl e general l y represent s t ropi chormonesrel eased by t hepi tui tary gl and, t heChi neseAdrenal gl and may actually correspond to the pi tui tary hormoneACTHt hat regul at es the adrenal cortex. Nogi er report ed t hat several poi ntson the auri cl e represent t herel ease of the adrenal hormonecorti sol ; oneof t hosel ocati ons occurs at t hesame regi on of t hetragusas t heChi neselocati on for t headrenal glands. Function: Affects adrenocort i cal hormonest hat assist onein deal i ng with stress. Reli eves st ress- rel at ed di sorders, fevers, i nfl ammatory di sorders, i nfecti ons, hypersensi ti vi ty, rheumat i sm, allergi es, coughs, ast hma, skin di sorders, hypertensi on, hypotensi ve shock, profuse menst ruat i onand bl ood ci rcul at i on probl ems. I t is used for di st urbanceof adrenocort i cal functi on, such asAddi son’sdi sease and Cushi ng’ssyndrome. This poi nt isused in ear acupunct ure t reat ment pl ansal most as frequentl y as many mast er poi nts. 92.E Adrenal Gland.E [ CW?] Location: Conchawall, bel ow LM 16, near l ocati on for Chi neseKi dney poi nt. Theact ual adrenal gl ands in the body sit on top (ad- ) of each ki dney (- renal ). Al t houghsome auri cul ar medi ci ne pract i t i onerscont i nuedto mai nt ai n t hat the upper conchawall corresponded to the adrenal cortex, Nogi er changed t heposi ti on of t herepresent at i on of this gl and as he devel oped the t hreephase model . 93.Fl 93.F2 Corti sol 1 Location: Thismesodermal Phase I adrenal hormoneisfound on t heanti hel i x body of Terri tory 1. Function: A cort i cost eroi d adrenal hormonet hat isuti li zed to deal with stress. Corti sol 2 [SF 2&AH 9] [SC 6] Location: Thismesodermal PhaseI I adrenal hormoneisfound on the superi or conchaof Terri t ory2, near ear poi nt s for the EuropeanAdrenal Gl andand t heChi neseKi dney. 93.F3 Corti sol 3 [TG 2] 220 Location: Thi smesodermal PhaseI I I adrenal hormoneisfound on t hel ower t ragusof Terri tory3, near t heChi nese Adrenal Gl andand t heMast er Tranqui l i zer poi nt. AuriculotherapyManual No. Auricular microsystem point (Alternativename) [Auricular zone] [CW6] 94.E Thymus Gland.E Location: Thisendodermal endocri negland isfound on theperi pheral conchawall near thePancreas point. Function: Thethymusgland affects thedevelopment of ’l-cells of thei mmunesystem. Thisear poi nt isused for the common cold, flu, allergies, cancer, HIY, AI DS, and autoi mmunedisorders. 95.C 95.E 96.C Mammary Gland.C Locati on: Each side of theantihelix body, just superi or to theantihelix tail. Function: Thispoi nt isused to treat problemswith milk secreti on, breast development, or breast cancer. Mammary Gland.E Location: Conchawall above concharidge, central to Chi neseMammaryGl andpoints. Thyroid Gland.C Location: Antihelix tail, alongside thescaphoi d fossa. Function: Thyroxin released by thethyroid gland affects overall metaboli c rat eand general arousal. Relieves hyperthyroidism, hypothyroidism, goiter, sore throats. [AH10] [CW6] [ AH8] - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 96.E Thyroid Gland.E [CW5] Location: Thisendodermal Phase I endocri negland isfound on theconchawall of Territory2, above thejuncti on of the concha ridge and thei nferi or concha. 96.F2 Thyroid Gland.F2 [ AH8] Location: Thisendodermal Phase I I endocri negland isfound on theantihelix tail of Territory3, i denti cal to theregion where theChi neseThyroidGl andisfound. 96.F3 Thyroid Gland.F3 [CW1/I T2] 97.E Locati on: Thisendodermal Phase I I I endocri negland isfound at thei ntertragi cnotch, also associ ated with the pituitary hormoneTSH,which regulates therelease of thyroxin by thethyroi dgland. Parathyroid Gland.E Location: Conchawall, inferior to EuropeanThyroid Gl andpoint. Function: Theparathyroi d gland affects calcium metabolism. Thispoi nt relieves muscle cramps, muscle spasms. Somatotopicrepresentations [CW4] 221 7.4.2 Cranial endocrineglands represented at t heintertragicnotch No. Auri cul ar mi crosyst em poi nt (Alternativename) [Auricular zone] [TC 1] [IC 1] 98.E 99.0 Pi neal Gl and(Epiphysis, Point E) Location: Themost i nferi or aspect of thetragus, at LM 9. Function: Pineal gland releases melatoni n hormoneto affect ci rcadi an rhythm and day- ni ght cycles. Relieves jet lag, i rregular sleep patterns, insomnia, depression. Ant eri or Pi t ui t ary(Adenohypophysis, Internal Secretion. MasterEndocrine) Location: Most i nferi or part of i nferi or concha, below i ntertragi cnotch. Function: Anteri or pituitary isthemaster endocri negland, releasing pi tui tary hormonestocontrol t herelease of hormonesfrom all ot her endocri neglands. Thisear poi nt relieves hypersensitivity, allergies, rheumati sm, skin diseases, reproductive disorders, diseases of bl oodvessels, digestive disorders. 100.E Post eri or Pi t ui t ary (Neurohypophysis) Location: I nferi or conchanear i nferi or side of ear canal. [IC3] [cw 1] [IT2] [IT2] l OU 102.E 103.E Function: Posteri or pituitarycontai nsneuronsfrom the hypothalamus, which releases hormonesinto thegeneral bloodstream. Theposteri or pituitary releases anti di ureti chormoneaffecting thirst, i nternal water regulati on and salt metabolism. Gonadot ropi ns(FollicleStimulatingHormone, FSH; Luteinizing Hormone,LH) Location: Conchawall near i ntertragi cnotch. Function: Gonadal pi tui tary hormonesFSH and LH regulate release of sex hormonesby theovaries or testes. This point relieves sexual dysfunctions, lowsex drive, infertility, i rregular menstruati on, premenstrual syndrome, testitis, ovaritis, fatigue, depressi on, eye troubles. Thyrot ropi n(ThyroidStimulatingHormone,TSH) Location: Wall of i ntertragi cnotch, midway between tragusand antitragus. Function: Thyroidal pi tui tary hormoneTSH regulates therelease of thyroxin hormoneby thethyroid gland. Reduces metabolic rate, hyperthyroidism, hypothyroidism, hyperactivity and Graves’ disease. Parat hyrot ropi n (ParathyroidStimulatingHormone, PSH) Location: Most central part of wall of i ntertragi cnotch, below LM 9. Function: Parathyroi d pituitary hormonePSH regulates parat hormonerelease by theparathyroi d gland. Thispoi nt facilitates calcium metabolism, reduces muscle tetanus. 104.Fl ACTH1 [LO7] Location: ThisPhase I pituitary hormoneisfound on theperi pheral ear lobe of Territory3. Function: Thepi tui tary hormoneACTHregulates therelease of cortisol and ot her corti costeroi d hormonesby the adrenal cortex to alleviate stress and stress-related disorders. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - .. _ ~ ~ 104.F2 104.F3 222 ACTH2 Location: ThisPhase I I pituitary hormoneisfound on theupper scaphoi d fossa of Territory 1. ACTH3 (Adrenocorticotrophin,Surrenalian point, AdrenalControl point) Location: ThisPhase I I I pituitarygland hormoneisfound near thei ntertragi cnotch and i nferi or to the Chinese Adrenal point. AuriculotherapyManual [SF 6] [ST 1] No. Auricular microsystem point (Alternativename) [Auricular zone] 10S.E Prolactin (LTH) [IC 1] Location: I nferi or regi on of i nferi or concha, peri pheral to i nferi or ear canal. Function: Thispi tui tary hormoneregulates theactivity of themammary glands, initiatinglactati on and milk secretion. 106.C Salivary Gland.C (Parotid Gland) Location: Conchawall just behi ndthe apex of anti tragus, LM 14. Function: Salivary glands are regulated by activation of theparasympatheti c nervous system in response tofood. Relieves mumps, salivary gland inflammations, skin diseases. [CW2] - -- - - - - - - - - 106.E Salivary Gland.E (Parotid Gland) Location: Peri pheral region of lobe, next to theLower Jaw point. Function: Relieves mouthdryness, mumps, salivary gland inflammations. Thesalivary glands are actually exocrine glands rat her than endocri neglands. [LOB] 100.E Posterior Pituitary Gland 106.E Salivary Gland.E 98.E Pineal Gland 99.0 Anterior Pituitary Gland 137. Hypothalamus 10S.E Prolactin 104.E ACTH 1 ~ _ l OU Parathyrotropin 102.E Thyrotropin l OU Gonadotropin 100. Posterior Pituitary Gland 99. Anterior Pituitary Gland 138. Thalamus 106. Salivary Glands Figure 7.30 Cranial endocrine glands represented on the auricle. (From LifeARTJi!, Super Anatomy, ' Lippincott Williams& Wilkins,withpermission.) Somatotopicrepresentations 223 91. Ovaries 104.F3 ACTH 3 103.E Parathyrotropin 102.E Thyrotropin 96.F3 ThyroidGland.F3 l OU Gonadotropins(FSH, LH) 91.C Gland or Testes.C 94. I Thymus Gland 96.F2 ThyroidGland.F2 106.C Salivary Gland.C 104.Fl ACTH 1 106.E Salivary Gland.E 104.F2 ACTH 2 92.E Adrenal Gland.E 94.E Thymus==:::::;:;:;; Gland 95.C Mammary Gland.C 95.E Mammary Gland.E 93.Fl Cortisol 1 95. Mammary Gland 106. Salivary Gland 96. I Thyroid Gland DB Figure 7.31 Hidden viewof theendocrineglands represented on theauricle. (From Li feARY@,Super Anatomy, ' Li ppi ncott Williams & Wilkins,withpermission.] 224 AuriculotherapyManual 95.E Mammary Gland.E 104.F2 ACTH2 92.E Adrenal Gland.E 93.Fl Corti sol 1 95.C Mammary Gland.C 96.Fl Thyroi d Gland.Fl 96.C Thyroi d Gland.C 97. E Parathyroi d Gland 96.F2 Thyroi d Gland.F2 104.Fl ACTHl 106.E Salivary Gland.E 91. Testes 91.F2 Ovari es or Testes.F2 106.C Salivary Gland.C 92.F3 Adrenal Gland.F3 91. Ovaries 93.F2 Corti sol 2 91.F3 Ovaries or Testes.F3 105.E Prolactin 91.Fl Ovaries or Testes.Fl 93.F3 Corti sol 3 - - - 104.F3 ACTH3 99.0 Ant eri or Pi t ui t ary 98.E Pineal Gland 102.E Thyrot ropi n 92.C Adrenal Gland.C 100.E Posteri or Pi t ui t ary l OUGonadotropi ns (FSH, LH) 91.C Ovaries or testes.C Figure 7.32 Surface view of theendocrine glands represented on theauricle. (From LifeARTI D,Super Anatomy, ' Li ppi ncott Williams& Wilkins, withpermission.) Somatotopicrepresentations 225 226 7.5 Auricular representation of t he nervous system Thenervous system isprimarily represent ed on the helix and lobe, but isfound t hroughout all partsof the external ear because thenervous system connectsto every part of thebody. Central nervous system (CNS): Thecoreof the nervous system consists of thebrai n and spinal cord, which make thepri nci pal decisions regardi ng theregulati on of all ot her partsof thebody. Peripheral nervous system: Theperi pheral nerves consi st of sensory neuronswhich send messages to thespinal cord from theskin, muscles andvisceral organs, or mot or neuronswhich travel from thespinal cord out to themuscles and organsof thebody. Somatic nervous system: Thisdivision of theperi pheral nervous system consists of sensory neuronswhich receive afferent messages from theskin and themuscles and mot or neuronswhich control the activity of skeletal muscles. Thesomati c nerves arevoluntari ly control l ed by themore conscious aspects of thepyrami dal system of themot or cortex descendi ng to al phamot or neurons that send out impulses to contract stri atemuscles. Subtleshifts in the manner of movement and in muscle toneare regul ated by gammamot or neuronst hat aremodul at edby the less conscious subcortical extrapyrami dal system. Sensory somati c neuronsent er the dorsal root of the spinal cord and ascend thedorsal columnsof thespinal whi temat t er to synapse in thebrai nstem, the thalamus, and ultimately arrive at thesomatosensory cortex on thepostcentral gyrus of thepari etal lobe. Thesomati c nerves mai ntai nthepathologi cal reflexes which producethechroni c muscle tensi on t hat leads to myofascial pain. Autonomic nervous system: Thisdivision of theperi pheral nervous system consists of those nerves which connect the spinal cord to thevisceral organsof t hebody. Thissystem isregulated unconsciously by thesubcorti cal hypothalamusin thebrai n. All aut onomi cnerves leaving theeNS have pregangli oni c nerves which travel from thespi nal cord to aperi pheral gangli on and which synapse ont opostganglionic nerves t hat travel from t hat ganglion to avisceral organ. Every i nternal organ sendssensory neuronsto thespinal cord or brai n, which t hensend thevisceral message to thehypothalamus. Eachvisceral organ also receives descendi ngmot or messages from thehypothalamus. Sympathetic nervous system: Thissubdivision of the autonomi cnervous system consists of those autonomi cnerves which leave thespi nal cord in theregi on of thethoraci c and l umbar vertebrae and travel to achain of ganglia alongside thespinal vertebrae. Fromthissympatheti cchain, postganglionic nerves branch out to i nternal organs. Sympatheti cnerves cause exci tati on and arousal of bodily energy in timesof stress, strongemot i onor physical exercise. Thissystem leads to an i ncrease in heart rate, blood pressure, vasoconstri cti on, sweating, and pupi llary di lati on, and is accompani ed by therelease of thehormoneadrenal i n from theadrenal medul l agland. Sympatheti cpostganglionic nerves are adrenergi c, utilizingtheneurot ransmi t t er norepi nephri ne. Parasympathetic nervous system: Thissubdivision of the autonomi cnervous system consists of those autonomi cnerves which leave the central nervous system from ei t her thecrani umor from thesacral vertebrae. Thesepregangli oni c nerves travel out i ntothebody and synapse on postganglionic nerves near avisceral organ. Parasympatheti cnerves l ead to sedati on and conservati on of bodily energy. They cause decreases in heart rat eand bl ood pressure, while produci ng increases in vasodilation, pupi llary constri cti on, salivation and di gesti on of food. Parasympatheti csynapses are cholinergic, employing t heneurot ransmi t t er acetylcholine. Sympathetic preganglionic nerves: Theseautonomi cnerves travel from thet horaci c- l umbar spine to the sympatheti cchain of ganglia outsi det hespinal vertebrae. Sympathetic postganglionic nerves: Theseautonomi cnerves travel from the sympatheti c chain of ganglia outsi dethespinal vert ebrae to theactual visceral organ. Splanchnic nerves: Theseperi pheral , sympatheti c nerves connect to lower visceral organs. Vagus nerve: Thispri mary parasympatheti c nerve connectsto most visceral organs. Sciatic nerve: Thissomati c nerve travels from thel umbar spinal cord down to t heleg. Trigeminal nerve: Thissomati c nerve affects sensati onsof theface and facial movements. Facial nerve: Thissomati c nerve controlsmajor facial movements. Oculomotor nerve: Thissomati c nerve controlseye movements. AuriculotherapyManual Optic nerve: Thiscrani al nerve respondstovisual sensati onsfrom theeye. Olfactory nerve: Thiscranial nerve responds to smell sensati onsfrom thenose. Auditory nerve: Thiscrani al nerve responds to heari ngsensati onsfrom theear and affects the sense of physical balance and equilibrium. Central nervous system regions of the brain Cortical brain regions: Thehighest level of thebrai n determi nestheintellectual processes of thinking, learni ng and memory. Thecerebral cortex i ni ti atesvoluntary movements and is consciously aware of sensati ons and feelings. Prefrontal cortex: Thismost evolved region of the humancortex initiatesconscious decisions. Frontal cortex: Thisanteri or cortical regi on contai nstheprecentral gyrus mot or cortex which initiatesspecific voluntary movements. I t activates upper mot or neuronsin thepyrami dal system that send di rect neural impulses to lower motor neuronsin thespi nal cord. Parietal cortex: Thisposteri or regi on contai nsthe somatosensory cortex on the postcentral gyrus. Thisregion consciously perceives thesensati onsof touch and thegeneral awareness of spatial relationships. Temporal cortex: Thisposteri or and lateral cortical regi on contai nsthe heari ngcentersof the brain. Theleft temporal lobe processes theverbal meani ngof language and therati onal logic of mathemati cs, whereas the right temporal lobe processes thei ntonati onand rhythmof sounds and music. Occipital cortex: Thismost posteri or cortical regi on processes conscious visual percepti ons. Theleft occipital lobe can consciously read words, whereas theright occipital lobe isbet t er at recognizing faces and emoti onal expressions. Corpus callosum: Thisbroad band of myelinated axon fibers connectstheleft cerebral hemi spherecortical lobes with thei r respective lobe on the right cerebral hemi sphere. Cerebellum: Thisposteri or region beneat htheoccipital lobe and above theponsispart of the extrapyramidal system control of semivoluntary movementsand postural adjustments. Subcortical brain regions: Theseregionsof thebrai n serve as an i ntermedi ary between the cerebral cortex above and thespinal cord below, operati ngoutsi deof conscious awareness. Thalamus: Thisspherical nucleus relays sensory messages from lower brai nstemregions up to aspecific locus on thecerebral cortex. Thethalamusalso contai nsneuronswhich parti ci patein thesupraspi nal gating of pain and in general arousal or sedati on. Anterior hypothalamus: Thisnucleus liesbelow the thalamus, where it connectsto thelimbic system, t hepi tui tarygland and theparasympatheti c nervous system. Thisnucleus produces general sedati on. Posterior hypothalamus: Thisnucleus connectsto thelimbic system and thepi tui tarygland. I t activates thesympathetic nervous system, produci ngbrai n arousal and behavi oral aggression. Limbic system: Thiscollection of subcortical nuclei affects emoti onsand memory. Cingulate cortex: Thispaleocortex limbic regi on lies i mmedi ately beneat hthehi gher neocortex. Hippocampus: Thissemicircular limbic structurelies beneat ht heneocortex, but outsi dethe thalamus. I t affects attenti onspan, long termmemory storage and emoti onal experiences. Amygdala nucleus: Thisspherical limbic nucleus lies under thel ateral temporal lobe and modulatesincreases or decreases in aggressiveness, irritability and mania. Septal nucleus: Thismedi al limbic structureisinvolved in pl easure sensati ons and reward. Nucleus accumbens: Thismidline nucleus occurs next to theseptal nucleus and isthepri mary dopami nergi ccontrol cent er for thereward pathways of thebrain. I t plays asignificant role in thebrai n’sresponse to all substances t hat are addictive in nature. Neuronsin thisnucleus are excited by alcohol, opi um, cocaine, and methamphetami ne.Sti mulati onof thisnucleus produces strongpl easure cravings. Somatotopicrepresentations 227 228 Striatum: Thesebasal ganglia nuclei lie along thelimbic system, and outsi det hethalamus. The specific stri atal nuclei include thecaudate, put amenand globus pallidus, all of which are part of theextrapyramidal system control of semivoluntary movements. Brainstem: Thistermrefers to themedullaoblongataof thebrai nstem. I t affects basic, unconscious control of body metabolism, respi rati on and heart rate. Pons: Thisbrai nstemregi on liesbelow thecerebellum and affects REMsleep and dreams. Midbrain tectum: Thissuperi or part of themi dbrai n contai nscolliculi for sensory reflexes. Midbrain tegmentum: Thisi nferi or part of themi dbrai n affects basic metaboli sm and pain. Reticular formation: Thisregion within themi dbrai n tegmentumactivates general arousal. Red nucleus and substantia nigra: Thisregion within themi dbrai n tegmentumaffects the extrapyramidal system and thestri atum, regulatingsemivoluntary movements. AuriculotherepyManual 7.5.1 Nogier phase representati onof t henervous system Neurol ogi cal poi nt s for Phase I Thecent ral nervous system isrepresent ed on the ear lobe of Terri tory3 in PhaseI of Nogi er’ssystem. TheThal amusand Hypot hal amusarefound on the external surface of the anti tragus, whereas they were previ ously l ocat ed on t heconchawall and i nferi or concha. TheCerebral Cortexisstill represent ed on t heear lobe. Neurol ogi cal poi nt s for Phase I I Theect odermal cent ral nervous system shifts to t hehelix, the antihelix, scaphoi d fossa and thetri angular fossa regionsof Territory1in PhaseI I . TheThal amusin PhaseI I correspondstot heauri cular locati on for theChi nesemast er poi nt Shen Men. TheCerebral Cortexin PhaseI I isfound along theantihelix superi or crus, scaphoi d fossa, and tri angular fossa. Neurologi cal poi nts for Phase I I I Thecentral nervous system shiftstot heconchaof Territory2 in PhaseI I I . Thecortical areas are located in thesuperi or concha, while subcortical limbic and striatal areas are found in thei nferi or concha. Thelocation of thePhaseI I I Thal amusoccurs with itsoriginal desi gnati on on theconchawall, while the Hypothalamust hat isfound in thei nferi or conchacoincides with thelocati on of theChi neseLungpoi ntsused in thet reat ment of narcoti c detoxification and drug abuse. Table 7.1 Auri cular zone representati on of nervous system poi nts for each Nogi er phase No. Neurological representationsonear PhaseI PhaseI I PhaseI I I Territory3 Territory 1 Territory2 54 Eye L04 AH11 I C3 58 Ear LO 1 TG5 SC6 98 Pineal Gland (epiphysis) TG 1 HXl SC5 99 Pituitary Gland (hypophysis) I T2, I C1 AH17,AH18 CWI 109 Sympathetic nerves CW2 HX12,HX13 CRl ,CR2 110 ParasympatheticSacral nerves CW3 HX15 CR2 113 Vagusnerve CWI HX12 CRI 124 Spinal Cord HX 14,HX15 AH9,SF2 I C5 127 Brainstem(MedullaOblongata) L07,L08 HX2 SC1 131 Reticular Formati on L08 AH 12,SF3 I C8 ~ ~ 133 Red Nucleus L06 CWl O I C6 134 SubstantiaNigra L06 I H 1, I H2 I C7 135 Stri atum(Basal Ganglia) L04,AT1 HX9,HXl O I C3,I C4 137 Hypothalamus L06 AH3,AH4 I C4 138 Thalamus(Subcortex, Brain) AT2,AT3 AHl l CW2,CW3 140 Hippocampus L02 CW9 I C6 ~ _ 141 Amygdala L02,I TI CW8 I C7 142 Septal Nucleusand Nucleus Accumbens L02 HX7 I C1 143 CingulateGyrus I T 1 CW7 I C6 145 Cerebellum AT3,AHI HX5,HX6 SC8 147 Occipital Cerebral Cortex L07 AHI 2,SF4 SC7 148 Temporal Cerebral Cortex L05 AH 14, SF5 SC6 149 Parietal Cerebral Cortex L05 AH 18, SF6 SC6 ~ ~ - - - - ~ - ~ 150 Frontal Cerebral Cortex L03 AH 13, TF2 SC5 151 Prefrontal Cerebral Cortex L01 AH 15,TF3 SC4 Somatotopicrepresentations 229 Brain Spinal cord Peripheral nerves Spinal cord whitematter Autonomicnervoussystem Sympathetic postganglionic nerves Somaticnervoussystem Spinal cord gray matter Dorsal root sensory neurons Ventral root motor neurons Spinal cord Spinal vertebra Cranial nerves originating frombrainstem Opticnerve Oculomotor nerve Auditory nerve Vagus nerve Figure 7.33 Overview oftheperipheral nervous system and thespi nal cord. (From LifeARTFJ,Super Anatomy, ' Li ppi ncott Williams& Wilkins, withpermission.) 230 Auriculotherapy fvlanual / Thalamus-+-------;1"------ Striatum Coronal crossviewofanteriorbrain Occipital cortex Cerebellum Parietal cortex Brainstem- - - - - - - ""\ medulla oblongata Sagittal sideviewofbrain Frontalcortex Prefrontal cortex Midsagittal sideviewofbrain Coronal crossviewofposteriorbrain Frontal cortex Septal nucleus/ Nucleusaccumbens Brainstem medulla oblongata Cingulatecortex Corpuscallosum Thalamus Striatum Midbrain tectum - +I - - ’f...- - """’’- - - ’- ’’’’’’’’,,- f- - Midbrain tegmentum Cerebellum Reticular formation Horizontal viewacross brain Hippocampus Red nucleus Substantianigra Horizontal viewofbottomofbrain Thalamus Brainstem __ medulla - oblongata Striatum Frontal cortex Olfactory bulb Cerebellum d?_..- ff- - - .+- - Temporalcortex Pons Occipital cortex Figure 7.34 Overview of the central nervous system. (From LifeAR’J’fi, Super Anatomy, ' Lippincott Williams & Wilkins, with permission. ) Somatotopicrepresentations 231 7.5.2 Peripheral nervous system represented on the ear No. 107.0 108.E Auricular microsystem point (Alternativename) Sciatic nerve (Sciatica, Ischium, Ischialgia) Location: A notch at the midpoint of thetop surface of theantihelix i nferi or crus, at LM 17. Function: Relieves sciatic neuralgia, lower limb paralysis, post-poli osyndrome. Sympathetic Preganglionic nerves Locati on: Along thelength of thehelix tail asit joins thegutter of thescaphoi d fossa. Function: Relieves reflex sympathetic dystrophy, vasospasms, neuralgias. [Auricular zone] [AH6] [HX12- HX 14] [ CWS- CW9] 109.E Sympathetic Postganglionic nerves (Paravertebral Sympatheticchain) Location: Along thelength of theconchawall above theconcharidge and superi or concha. Function: Relieves back pain, reflex sympathetic dystrophy, neuralgias, vasospasms, poor blood ci rculati on. . ~ .. ~ .. _----_.._- - - - - - _._- - - - - _._- - - - - - - - - - - - - - - - - - - - - - - - - - 110.E 1 110n Parasympathetic Cranial nerves Locati on: I ntertragi cnotch region of thei nferi or concha. Function: Relieves autonomi cnervous di sorders affecting theupper body and thehead. Parasympathetic Sacral nerves (Pelvic Splanchnicnerve) Location: I nferi or concha, superi or to theear canal. Function: Relieves abdomi nal visceral control, pelvic pain, sexual desire. [I C1] [I C6] [SC 4] [HX1] [I C1, I C3, I C6] 111.E 112.E 113.E Hypogastric plexus (Lumbosacral Splanchnicnerves) Locati on: Central region of thesuperi or concha. Function: Thisplexus distributesl umbar sympathetic nerves to therectum, bladder, uret er and genital organs. Relieves pelvic dysfunctions, rectal, ureter and bl adder control. Solar plexus (Celiac plexus, ThoracicSplanchnicnerves, AbdominalBrain) Location: Helix root, above Point Zeroand LM O. Function: Relieves abdomi nal dysfunctions, gastroi ntesti nal spasms and pathology in theviscera of upper abdomi nal organs, such asthestomach, liver, spleen, pancreas and adrenal glands. - - - - - - - - - - - - - - - - - - - - - - - - - Vagus nerve (TenthCranial nerve, Xn., Cranial Parasympathetic nerves) Locati on: I nferi or concha, next to theear canal, and spreadsthroughout theconcha. Function: Vagusnerve affects parasympatheti c nervous system control of most thoraci c and abdomi nal organs. This point relieves di arrhea, heart palpi tati ons, anxiety. 114.E 11S.E Auditory nerve (EighthCranial nerve, VIII n.,Cochleovestibular nerve) Location: Undersi deof thesubtragus. Function: Affects heari ngand vestibular disorders, deafness, tinnitus, equilibrium i mbalance. Facial nerve (SeventhCranial nerve, VII n., NucleusofSolitary Tract) Locati on: Peri pheral region of theposteri or ear lobe. Function: Relieves facial muscle spasms, tics, facial paralysis. [ST 3] [PL 6] 232 AuriculotherapyManual No. 116.E 117.E 118.E 119.E 120.E 121.E Auricular microsystem point (Alternativename) Trigeminal nerve (FifthCranial nerve, Vn.) Location: Peri pheral edge of theear lobe. Function: Relieves trigeminal neuralgi a, dental analgesia. Oculomotor nerve (ThirdCranial nerve, III n.) Location: Peri pheral edge of theear lobe. Function: Affects control of eye movements, relieves eye twitches. Optic nerve (SecondCranial nerve, II n.) Location: Central side of theear lobe, i nferi or to thei ntertragi cnotch, LM 9. Function: Relieves visual disorders, eyesight dysfunctions. Olfactory nerve (First Cranial nerve, I n.) Location: Central side of theear lobe, i nferi or to thei ntertragi cnotch, LM 9. Function: Relieves problemswith smell sensations. ~ _ ~ _ I nferior Cervical ganglia (Stellateganglion, Cervical-Thoracic ganglia) Locati on: Juncti on of the inferior concharidge and conchawall. Function: Affects thoraci c sympathetic control, migraines, whiplash. Middle Cervical ganglia (Wonderfulpoint,fv1arvelous point) Location: Juncti on of theinferior conchaand conchawall. [Auricular zone] [LO5, PL 5] [PL 3] [LO1] [L02] [CW5] [CR2/CW4] Function: Balances excessive sympatheti c arousal, reduces hypertensi on, affects bl ood vascular regulati on, relieves muscle tension. 122.E Superior Cervical ganglia Location: Juncti on of i nferi or concha and conchawall, below LM 14. Function: Affects crani al sympathetic control. [CW4] [I H10/SF 5] 123.C Lesser Occipital nerve (fv1inor Occipital nerve, WindStream) Location: Juncti on of thei nternal helix with thesuperi or scaphoi d fossa. Function: Alleviates migraineheadaches, occipital headaches, blood vessel spasms, posttraumati cbrai n syndrome, arteriosclerosis, neuralgias, numbness, spondylopathy, neurastheni aand anxiety. I t isused in Chi neseear acupuncture likeamaster poi nt to tranqui li zethemind and clear zang-fu meri di an channels. - _._- - - _._- - _.._ ~ Somatotopicrepresentations 233 122.E Superior Cervical ganglia 123.C Lesser Occipital nerve 108.E Sympathetic Preganglionic nerves 109.E Sympathetic Postganglionic nerves 120.E Inferior Cervical ganglia 121.E Middle Cervical ganglia 115.F4 Facial nerve 117.F4 Oculomotor nerve ___- 116.F4 Trigeminal nerve 110.E2 Parasympathetic Sacral nerves 114.E Auditorynerve 113.E Vagusnerve 110.E1 Parasympathetic Cranialnerves 119.E Olfactory nerve 118.E Opticnerve 234 Figure 7.35 Hidden view of theperipheral nervous system represented on the auricle. (From Li feARl fID , Super Anatomy, ' Lippincott Williams& Wilkins,withpermission.) Aur;culotherapy Manual Back of ear r , 120.E I nferi or Cervical ganglia 121.E Mi ddle Cervical ganglia 122.E Superior Cervical ganglia 123.C Lesser Occi pi tal nerve 117.F4 Ocul omot or nerve 108.E Sympatheti c Preganglionic nerves .- oof- - - l 09.E Sympatheti c Postganglionic nerves 115.F4 Facial nerve 116.E Tri gemi nal nerve Peripheral nerves Cranial nerves 118. Opt i c nerve 119. Ol fact ory nerve 117. Ocul omot or nerve 116. Tri gemi nal nerve 114. Audi t ory nerve 113.E Vagusnerve 110.El Parasympathetic Cranial nerves 119.E Ol fact ory nerve 115. Facial nerve 114.E Audi t ory nerve 118.E Opt i c nerve 110.E2 Parasympathetic Sacral nerves 112.E Solar plexus 107.0 Sciatic nerve 111.E Hypogastri c plexus 113. Vagusnerve .. .I Figure 7.36 Surface view of theperipheral nervous system represented on theauricle. (From Li feARTW, Super Anatomy, ' Li ppi ncott Williams& Wilkins, withpermission.) Somatotopicrepresentations 235 7.5.3 Spinal cordandbrainstemrepresentedonthehelix tail andlobe No. 124.E Auricular microsystem point (Alternativename) Lumbosacral Spinal Cord [Auricular zone] [HX12, PP8] [HX13, PP6] [HX14, PP4] [CW4] 125.E 126.E 127.C Location: Superi or helix tail, below Darwi n’stubercle, LM 4. Function: Theanteri or side of helix tail representsthe sensory dorsal horncells of thelumbosacral spi nal cord, whereas posteri or sideof helix tail representsmot or ventral horncells of thelumbosacral spinal cord. Thispoi nt relieves peri pheral neuralgias in theregion of thelower limbs. I t isalso used effectively to treat pati entswho have neuralgic side effects from AI DSor cancer medi cati on, or for di abeti c pati entswith poor circulation to thefeet. ThoracicSpinal Cord Location: Helix tail, peri pheral to theconcharidge and LM O. Function: Ant eri or side affects sensory neuronsof thoraci cspinal cord, whereas theposteri or side affects mot or neuronsof thoracic spinal cord. Relieves shingles, sunburns, poison oak or poison ivy on body or arms. Cervical Spinal Cord Location: I nferi or helix tail, above LM 5. Function: Relieves sunburnedneck, neuralgias, shingles, poison oak on neck. Theanteri or side of thehelix tail affects sensory cervical neurons, whiletheposteri or side affects mot or cervical neurons. Brainstem(MedullaOblongata) Locati on: Central side of concha wall, just below thebase of antihelix, LM 14. Function: Affects body temperature, respi rati on, cardi ac regulation, shock, meningitis, brai n trauma, hypersensitivity to pain. Thispoi nt tonifies thebrain, invigorates thespirit, arrests epi lepti c convulsions, reduces overexci tement, abates fever and tranquilizesendopathi cwind. 127.E MedullaOblongata(Brainstem) Location: I nferi or helix tail, between LM 5and LM 6. Function: Affects body temperature, respi rati on, cardi ac regulation. [HX15, PP2] [LO7, PL6] 128.E Pons Location: Peri pheral lobe. Function: Affects sleep and arousal, paradoxical REM sleep, emotionally reparati ve dreams, and relieves insomnia, disturbingdreams, dizziness and psychosomatic reactions. 129.E MidbrainTectum Location: Peri pheral ear lobe. Function: Themi dbrai n tectumincludes thesuperi or colliculus and i nferi or colliculus, which respectively affect subcortical reflexes for visual stimuli and auditory stimuli. [L06] [LO5, PL 5] 130.E MidbrainTegmentum(Mesolimbicventral tegmentalarea) Location: Peri pheral ear lobe. Function: Mi dbrai ntegmentumcontai nsred nucleus and substanti anigra nuclei which affect extrapyrami dal control of semivoluntary muscles and motor i ntegrati onof voluntary movements. Thispoi nt relieves Parki nsoni an tremors, torticollis, writer’scramp. 131.E Reticular Formation [LO8, 5T 3] Location: Peri pheral ear lobe at thebase of thescaphoi d fossa and i nferi or to theanti tragus, and also isrepresented on thesubtragus. Function: Thereti cular activating system (RAS) of thebrai nstem activates arousal, attenti on, alertness, vigilance, i ntegrati onof nociceptive input, and affects brain laterality. 132.E TrigeminalNucleus Location: Peri pheral ear lobe. Function: Relieves symptoms of trigeminal neuralgia, dental pain, facial tremors. [LO7,PL 5] 236 AuriculotherapyManual 7.5.4 Subcortical brain nuclei represented on the concha wall and lobe No. Auricular microsystem point (Alternativename) [ Auricular zone] - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 133.E 134.E Red Nucleus Location: Superi or region of ear lobe, below theperi pheral antitragus. Function: Regulatessemivoluntary acts and relieves extrapyramidal muscle tremorsand spasms. - - - - - - Substantia Nigra Locati on: Superi or region of lobe, below theperi pheral antitragus. Function: Regulates semivoluntary acts and relieves extrapyramidal muscle tremorsand spasms. - - - - - - [LO6, PL6] [LO6, PL6] [LO4, PL4] 135.E Striatum (Basal Ganglia, Extrapyramidal motorsystem) Location: Superi or region of ear lobe, below themedial antitragus. Function: Affects muscle tone, elaborati on of automati cand semi automati c movements, and inhibitionof involuntary movements. Relieves Parkinsonian disease, tremors, spasms. [CW3] 136.E 137.E 138.C Anterior Hypothalamus Locati on: I nferi or concharegion near theintertragicnotch. Function: Affects parasympatheti csedati on, diuresis. Posterior Hypothalamus Location: Peripheral i nferi or concha, below theantitragus, near theThalamuspoint. Function: Facilitates sympathetic arousal and relieves hypertensi on and cardiac acceleration. Affects secreti on of adrenal in, vigilance, wakeful consciousness and decreases digestion. Brain (Thalamicnuclei, Diencephalon, Central Rim) Location: Upper edge of theconcha wall, behi ndtheocciput on anti tragusexternal surface. Function: Alleviates deficiency of blood supply to thebrain, cerebral concussion, restlessness, cerebellar ataxia, epilepsy, attenti ondeficit disorder, hyperactivity, addictions, clinical depression, asthma, sleep di sturbanceand poor intellectual functioning. I t also affects hypothalamiccontrol of pituitary gland, endocri neglands, relieving glandular disturbances, i rregular menstruati on, sexual impotence, diabetesmellitus and pituitary tumors. [IC2] [IC5] 138.E Thalamic Nuclei (Brain, Diencephalon) Location: Conchawall behind thewhole antitragusridge, above theThalamuspoint. Function: Affects all thalamic relay sensory connectionsto theposteri or cerebral cortex. [CW1- CW3] [LO1, PL 1] 139.E Limbic System (Rhinencephalon, Reactional Brain, Visceral Brain) Location: Bottomof thejuncti on of theear lobe and thejaw, at LM 8. Function: Affects memory, amnesia, retenti onof lived-throughemoti onal experiences, sexual arousal, aggressive impulses, compulsive behaviors. 140.E Hippocampus (MemoryBrain, Fornix, Ammon’sHorn) Location: Superi or ear lobe immediately inferior to thelength of theantitragus. Function: Thislimbic nucleus affects memory, amnesia, retenti onof lived-throughemoti onal experiences. Somatotopicrepresentations [LO4, PL 6] 237 No. Auricular microsystem point (Alternativename) [Auricular zone] [LO 2] 141.E Amygdala Nucleus (EmotionalBrain, Aggressivitypoint) Location: Notch on the superi or lobe as it joins theperi pheral i ntertragi cnotch. Function: Thislimbic nucleus affects anger, irritability, excessive aggressiveness, mani a, sexual compulsi ons, sexual dramas. ... ~ .. _- - - - - - - - _. ~ ~ ~ ~ .. - - - - - - - - - 142.E Septal Nucleus/Nucleus Accumbens (Sexual Brain, Pleasure Center) Location: Central ear lobe, just i nferi or to i ntertragi cnotch. Function: Thislimbic nucleus affects pleasure, rei nforcement, instinctive responses and seems to be the pri mary contri buti ngbrai n regi on to substance abuse and addi cti on. [ L02] - - - - - - - - - - - - - - - - - - - - - _ ...__.. ~ 143.E Cingulate Gyrus (Paleocortex) Location: Central i ntertragi cnotch. Function: Thislimbic nucleus affects memory and emoti ons. [IT 1] ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 138.E ThalamicNuclei 141.E Amygdala Nucleus 133.E Red Nucleus 139.E1 Limbic System 1 134.E SubstantiaNigra 137.E Posterior Hypothalamus 136.E Anterior Hypothalamus 132.E Trigeminal Nucleus 131.E 1 Reticular Formation 127.E Medulla Oblongata 138.C Brain 128.E Pons 127.C _- - - - V’ Brainstem 125.E Thoracic Spinal Cord 124.E Lumbosacral Spinal Cord 126.E Cervical Spinal Cord 129.E MidbrainTectum Figure 7.37 Hiddenviewof thesubcortical central nervoussystemrepresented on theauricle. (FromLij’eARTQfJ, SuperAnatomy,' LippincottWilliams& Wilkins, withpermission.) 238 AuriculotherapyManual 124. Lumbosacral spinal cord 138. Brain 125.E Thoracic Spinal Cord 124.E Lumbosacral Spinal Cord 133.E Red Nucleus 131.E Reti cular Formation 132.F4 Tri gemi nal Nucleus neurons 127.F4 Medulla Obl ongata 131.F4 Reticular Formati on 125.F4 Thoracic mot or neurons 126.F4 P j ~ __127.E Medulla Obl ongata 128.E Pons 132.E Tri gemi nal Nucleus 134.E Substantia Nigra 124.F4 Lumbosacral mot or neurons 135. Stri atum Cervical mot or 141. Amygdala ,- - - - ...:1.- 140. Hi ppocampus 127.C Brainstem 137.E Posterior Hypothal amus 138.C Brain 131.E2 Reticular Formation 136.E Ant eri or Hypothal amus 138.E Thalamic Nuclei 143.E Ci ngulate Gyrus 142.E Septal Nucleus 141.E Amygdala 135.E Stri atum 142. Septal Nucl eus/ Nucleus Accumbens Posterior hypothalamus Figure 7.38 Surface view of the subcortical central nervous system represented on the auricle. (From LifeAR’fF!, Super Anatomy, ' Lippincott Williams& Wilkins,withpermission.) Somatotopicrepresentations 239 7.5.5 Cerebral cortex represented on the ear lobe No. 144.E Auricular microsystem poi nt (Alternativename) Ol fact ory Bulb Location: Central ear lobe asit meets theface, midway between LM 8 and LM 9. [Auricular zone] [LO2] Function: Affects sense of smell. [AH1, PL 4] [TG1-TG 5] 14s.E 146.E Cerebellum Location: I nferi or antihelix tail and theposteri or lobe. Function: Affects mot or coordi nati on and postural tonus. Relieves i ntenti onal tremors, spasms, semi automati c movements, coordi nati onof axial movements, postural tonus, perfecti on of i ntenti onal, cortical movements, vertigo, vestibular equilibrium and clinical depression. Corpus Callosum Location: Wholelength of vertically ascending tragus. Function: Affects brai n laterality of left and right cerebral hemi spheres. Thei nteracti onsbetween the two sides of the brain are represented on thetragus in an i nverted pattern. Thecallosal radi ati onsto thefrontal cortex are projected ont o theinferior tragus, near LM 9; thetemporal- occi pi tal cortex radi ati ons are projected ont othemiddle of thetragus, between LM 10and LM 11; thepari etal cortex radi ati onsare projected ont othesuperi or tragus. Thetragusalso represents theanteri or Concepti onVessel (Ren mai channel) and posteri or Governi ngVessel (Du mai channel ) in an inverted position, thehead down toward TG 1and thebase of thebody up toward TG5. Cerebral laterality Theleft ear inaright-handedperson representsthelogical, linguistic, left cerebral cortex and theright ear representstherhythmic, artistic right cerebral hemisphere. These representati onsare reversed in some left handed individualsand inpati entswithoscillation problems. Thusan oscillator would have theleft cerebral cortex projected onto theright ear and theright cerebral cortex represented on theleft ear. Theleft hemispherecontrols theright sideof the body, ismoreconscious, drawslogical conclusions, analyzes specific details, understandstheverbal content of language and can rationally solvemathematicsproblems. Theright hemi spherecontrolstheleft sideof thebody, tendstooperate unconsciously, perceives theworld withglobal impressions, and holdsemoti onal memoriesmorestrongly. 147.E 148.E 149.E Occi pi tal Cortex (Occipital Lobe, Visual Cortex) Location: Peri pheral anti tragusand theear lobe below it. Function: Affects visual neurological disorders, blindness, visual distortions. Temporal Cortex (AcousticLine, Temporal Lobe, Auditory Cortex) Location: Peri pheral ear lobe. Function: Affects audi tory disorders, musical tone discriminations, audi tory i mpai rment, deafness. Pari etal Cortex (Postcentral Gyrus, ParietalLobe, Somatosensory Cortex) Locati on: Middleof ear lobe. Function: Affects tactile paresthesi a, musculoskeletal pain and somestheticstrokes. [AT 3, La 8] [ L06, L08] [LO5, La 6] - - - - - - - - - - - - - - - - _._- _ .. _._- - - - - - - - - - - i so.t isu Frontal Cortex (Precentral Gyrus, FrontalLobe, Pyramidal Motor System) Locati on: Central ear lobe. Function: I nitiatesmotor action. Relieves motor paralysis, alters muscle tonus. Prefrontal Cortex (MasterCerebral point) Location: Central ear lobe asit joins face. Function: I nitiatesdecision making. Relieves poor concentrati on, obsessions, worry. [LO3, PL 3] [La 1, PL 1] 240 AuriculotherapyManual - - - - - - - - - - - - - - - - - - - _._- - - - - - - - - 146.E Corpus Callosum 144.E Olfactory Bulb 151.E Prefrontal Cortex 150.E Frontal Cortex 151. Prefrontal Cortex 150. - "’0- - - ,.› Frontal Cortex 145. Cerebellum 147. Occipital Cortex Parietal Cortex 150. Frontal Cortex 147.E Occipital Cortex 148.E Temporal Cortex 150.F4 Frontal Cortex 151.F4 PrefrontaI Cortex Figure 7.39 Surface view of the cortical central nervous system represented on the auricle. (From Li feARrfi, Super Anatomy, ' Li ppi ncott Williams& Wilkins,withpermission.) Somatotopicrepresentations 241 7.6 Auricular representation of functi onal conditions 7.6.1 Primary Chinese functional points represented on the ear - - - - - - - No. 152.( 153.( 154.( Auricular microsystem point (Alternativename) Asthma (Ping Chuan) Location: Apex of the anti tragus, at LM 13. Function: Relieves symptomsof asthma, bronchitis, coughs, difficulty breathi ng, itching. - - - - - -- - - - - - _.. Anti hi stami ne Location: Mi ddleof the tri angular fossa, near the EuropeanKnee poi nt. Function: Relieves symptomsof colds, allergies, asthma, bronchitis, coughs. . ..... ......- ... _- - - - - - - - - - - - - - Constipation Location: I nferi or tri angul ar fossa, superi or to LM 17on the anti heli x i nferi or crus. Function: Relieves consti pati on, indigestion. [Auricular zone] [AT 2] [TF 4] [TF 3] 155.(1 155.(2 156.(1 156.(2 156.C3 157.( Hepati ti s 1 Location: Superi or aspects of thetri angul ar fossa as it curves up to the antihelix superi or crus. Function: Reduces liver dysfunctions, liver inflammations. Hepati ti s 2 (Hepatomeglia, Cirrhosis) Location: Peri pheral i nferi or concha, at the Liver point. - - - _._- - _._- _. Hypertension 1 (Depressing point, Lowering BloodPressure point) Location: Central, superi or tri angul ar fossa, near the Europeanpoi ntsfor theToes. Function: Reduces high bl ood pressure, inducesrelaxation. Hypertension 2 (HighBloodPressure point) Location: I nferi or tragus, at theTranqui li zer point. Hypertension 3 (Hypertensive groove) Locati on: Superi or region of theposteri or groove, behi ndthe upper anti heli x body. Hypotension (Raising BloodPressure point) Location: Central i ntertragi cnotch, between Eye Di sordersMu 1and Eye Di sordersMu2. Function: Elevates abnormally low bl ood pressure. [TF 4] [IC 5] [TF 3] [TG 2] [PG 4 & PG 8] [I T1] 158.( Lumbago (Lumbodynia, Coxalgia) Location: Mi ddleof antihelix body. Function: Relieves the functional or psychosomatic aspects of lowback pain. [AH 11] 159.( Muscle Relaxation [I C7/I C8] 242 Location: Peri pheral i nferi or concha, near theChi neseSpleen poi nt and the Liver points. Function: Thispoi nt isone of themost clinically effective poi ntson the auricle for reduci ng muscle tensi on, with almost thestatusof amaster poi nt because it isused so often to reduce pain and stress. AuriculotherapyManual No. 160.C Auricular microsystem point (Alternativename) San Jiao (TripleWarmer, TripleHeater, TripleBurner, TripleEnergizer) [Auricular zone] [IC 1] Location: I nferi or concha, near thePi tui taryGl andpoint, thegland which regulates anti di ureti chormonethat controls fluid levels released in urine. Function: Affects diseases of thei nternal organs and theendocri neglands. Affects thecirculatory system, respi ratory system, and thermoregulati on. I t relieves indigestion, shortnessof breath, anemi a, hepati ti s, abdomi nal distension, consti pati on and edema. San Jiao regulates water ci rculati on and fluid di stri buti on rel ated to thelower jiao, middlejiao, and upper jiao. 161.C Appetite Control (Hungerpoint,WeightControl) Location: Middleof tragus, between LM 10and LM 11. [TG 3] [TG4] [SC 2] 162.C 163.C Function: Diminishesappeti te, nervous over-eating, overweight di sorders, hyperthyroidism and hypertension. Thisear point can bevery effectively combi ned with sti mulati on oft heStomach poi nt for reducti on of thefood cravings that may accompany commi tment to adiet plan and exercise program. However, it does not replace theneed for willpower to maintain commi tment to acomprehensi ve weight reducti on program. Thirst point Location: Tragus, just medial and i nferi or to thesuperi or tragus protrusi on, LM 11. Function: Diminishesexcessive thirst rel ated todi abetesinsipidus and di abetesmellitus. I nTCM,it nouri shesyin and promotestheproducti onof body fluids to reduce thirst. - - - - - - - - - - - - - - - - - - - - - - Alcoholic point (Drunkpoint) Location: Superi or concha, between theSmall I ntesti nespoi nt and the Chi neseKidney point. Function: Relieves hangovers, assists t reat ment of alcoholism. Just astheAppeti teControl poi nt can only facilitate but not overrule theeffects of willpower for weight reducti on, thisAlcoholic poi nt can only facilitate but not override conscious volition. An alcoholic pati ent must commi t to alifeof sobriety and some type of support and empowerment group, such asa12-step program. 164.C 165.C Nervousness (Neurasthenia, fVIaster Cerebral point) Location: Central ear lobe, near LM8 and theMaster Cerebral point. Function: Relieves anxiety, worry, neurosis, neurastheni a. Excitement point Location: Conchawall below theapex of anti tragusand above theThal amuspoint. Function: Thispoi nt i nducesexcitation of thecerebral cortex to relieve drowsiness, lethargy, depressi on, hypogonadism, sexual i mpai rment, impotency, and obesity. somatotopicrepresentations [LO1] [CW2] 243 158.C Lumbago 159.C Muscle Relaxation 165.C Excitement 156.(1 Hypertension 1 155.C1 Hepati ti s 1 153.C Anti hi stami ne 163.C Alcoholic poi nt 162.C Thi rst poi nt _161.C Appeti te Control 160.C \ San [iao 156.C2 Hypertension 2 157.C Hypotensi on 164.C Nervousness 244 Figure 7.40 HiddenviewofprimaryChinesefunctional conditionsrepresented on theauricle. AuriculotherapyManual 164.C Nervousness Figure 7.41 SurfaceviewofprimaryChinesefunctional conditionsrepresented on theauricle. somatotopicrepresentations 245 7.6.2 Secondary Chinese functional points represented on the ear Secondary functi onal poi ntsare only distinguished from t hepri mary functi onal poi ntsby being less commonly used as theprimary ear reflex points. Even thisdi sti ncti on isnot completely accurate, asmorerecent clinical work by the Chi nesehasemphasi zed theuse of parti cul ar secondary ear reflex poi ntslike WindStream and Cent ral Rim. No. 166.C 167.C Auricular microsystem point (Alternativename) - - - - - - - - - - - - - - - - - - - - - Tuberculosis Location: I nferi or concha, at center of theLungpoi nt region. Function: Relieves tuberculosis, pneumoni a, breathi ngdifficulties. Bronchitis Location: I nferi or concha, at theBronchi point, inward from theLung poi nt region. Function: Relieves bronchitis, pneumoni a, breathi ngdifficulties. [Auricular zone] [IC S] [IC 7] [AH11] 168.C Heat poi nt Location: Antihelixbody, at thejuncti on of thei nferi or and superi or crus. Function: Producesperi pheral vasodilation, reduci ngvascular i nflammati on and sensati on of being warm or feverish. I t isused for acute strains, lowback pain, Raynaud’s disease and phlebitis. 169.C 170.C Cirrhosis Location: Peripheral concha ridge, within theLiver poi nt region. Function: Relieves cirrhosis damage to theliver and hepatomegli a. Pancreatitis Location: Peripheral superi or concha, within the Pancreaspoint region. Function: Relieves inflammation and deficiencies of thepancreas, di abetes, indigestion. [CR 2] [SC 7] 171.C Nephritis Location: Function: I nferi or helix tail asit meets thegutter of the scaphoid fossa, near LM 5. Reduces kidney inflammations. [HX 1S] 172.C 173.C 174.C1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Ascites point Location: Superi or concha, between theDuodenumpoi nt and Chi neseKidney point. Function: Reduces excess abdominal fluid, cirrhosis, flatulence. Mutism (Dumbpoint) Location: Undersi deof subtragus, superi or totheI nner Nosepoint. Function: Used to assist problemswith speaking clearly or with stutteri ng. Hemorrhoids 1 Location: Undersi deof thei nternal helix, near theEuropean Kidney point. Function: Alleviates hemorrhoi ds. [SC 6] [ST 3] [IH S] 174.C2 Hemorrhoids 2 Location: Central superi or concha, near theChinese Prostatepoint. - - - -- - - - - - - - - - - - - - - - - - - - - [SC 4] 246 AuriculotherapyManual No. 175.C Auricular mi crosystem poi nt (Alternativename) Wind Stream (Lesser Occipital nerve, MinorOccipital nerve) [Auricular zone] [I H10] Location: Peri pheral i nternal helix asit joins superi or scaphoi d fossa. Thisear reflex poi nt was previously referred to in Chi nesetextsastheMi nor Occipital nerve. Function: Alleviates allergies, bronchi al asthma, allergic rhinitis, coughs, dermati ti s, urti cari a, and allergic constitutions. Thispoi nt isutilized in Chi neseear acupuncturetreatmentsto reducethe effects of pathogeni cwind. .. - - -...._- - - - - - - _._- - 176.C Central Rim (ChineseBrain point) [ CW3] [TG 5] 177.C Location: Portionof conchawall below thejuncti on of theantihelix tail and theanti tragus. Thisear reflex poi nt was previously referred to in Chi nesetextsas theBrain poi nt or Brai nstempoint. Function: Alleviates basic metaboli c symptoms of stress, neurological problems, and addi cti on disorders. I nTCM,it replenishes spleen qi and kidney qui, nouri shesthebrai n, and tranqui li zesthemind. Apex ofTragus Location: Tragussuperi or protrusi on, at LM 11. Function: Reduces inflammation, fever, swelling, arthri ti cpain. I t has analgesic, antipyretic, and anti-inflammatory properti es. 178.C Apex of Anti tragus Location: Anti tragussuperi or protrusi on, at LM 13. Function: Reduces inflammation, fever, swelling. [AT 2] [HX7] [HX11] 179.C 180.C1 Apex of Ear (Tipof Ear, Ear Apex,Apexof Auricle) Location: Topof thesuperi or helix, at LM 2. Function: Antipyretic point to reduce inflammation, fever, swelling, andblood pressure. Thispoi nt isoften used for blood-letti ngby pricking thetop oft heear to reducefever, blood pressure, i nflammati on, delirium, and acutepain. This point has analgesic, antipyretic, and anti-inflammatoryproperti es. I nTCM,thispoi nt clears away heat and toxic substances, calms liver qi and reduceswind. - - _._- - - - - Hel i x 1 (Helixpoints) Location: Peri pheral helix, at Darwi n’stubercle, between LM 3and LM 4. Function: Antipyretic point toreduce inflammation, fever, swelling, blood pressure (same function for all Helixpoints). 180.C2 Helix 2 Location: Helix tail, within theregion of theLumbosacral Spinal Cord. [HX13] 180.C3 Helix 3 ._- _.... _- - - - - - - - - - - - - - - - - - - - _._- - - - - - - - - - [HX14] 180.C4 180.C5 180.C6 Location: Helix tail, within theregion of theCervical Spinal Cord. Helix 4 Location: Helix tail, where thehelix meetsthelobe at LM 6, superi or to theChi neseTonsil 3point. - - - - - - - ". - - - - - - - - - - - - - - - - - - - - - - - Helix 5 Location: Peri pheral ear lobe, midway between LM 6and LM 7. Helix 6 Location: Bottomof theear lobe, at LM 7, i nferi or to theChi neseTonsil 4point. [HX14] [LO7] [LO3] I mportant ear points: Themost commonly used Chi nesefuncti onal poi ntsare Muscle Relaxation poi nt, Appeti te Control point, Brain (Central Rim), and WindStream(Lesser Occipital nerve). TheNervousness poi nt isidentical to the Master Cerebral poi nt and theHypertensi on2poi nt overlaps theTranqui li zer poi nt. Somatotopicrepresentations 247 175.C Wind Stream 180.C1 Helix 1 168.C Heat poi nt 180.C2 Helix 2 169.C Cirrhosis 180.C3 -----''rr Helix 3 176.C Central Rim 171.C Nephri ti s 180.C4 Helix 4 180.C5 Helix 5 179.C Apex of Ear 174.C1 Hemorrhoids 170.C Pancreatitis 167.C Bronchitis 166.C Tuberculosis 178.C Apex of Anti tragus 180.C6 Helix 6 248 Figure 7.42 Hi ddenviewofsecondary Chi nesefuncti onal condi ti onsrepresented on theauricle. AuriculotherapyManual 179.C Apex of Ear - - - - - - - - - =.....::::::::A 174.C1 Hemorrhoi ds 168.C Heat poi nt 174.C2 Hemorrhoi ds 172.C Ascites 177.C Apex of Tragus 173.C Muti sm 178.C Apex of Anti tragus 180.C6 Helix 6 175.C Wi nd Stream 180.C1 Helix 1 170.C Pancreatitis 180.C2 Hel i x 2 180.C3 Helix 3 167.C Bronchitis 166.C Tuberculosis 180.C4 Hel i x 4 180.C5 Hel i x 5 Figure 7.43 Surface viewofsecondary Chinesefuncti onal condi ti onsrepresented on theauricle. Somatotopicrepresentations 249 7.6.3 Primary European functional points represented on the ear - - - - - - - - - - - - - - - - - - - - No. 18l.E Auricular microsystem point (Alternativename) Auditory Line [Auricular zone] [L06] 182.El Location: A horizontal lineon theear lobe, i nferi or to theantitragus, in theauri cular regi on that correspondsto the auditory cortex of thetemporal lobe. Thereissecond audi tory line on the neck, below the ear lobe. Function: Theaudi tory linerepresentstheauditory cortex on thetemporal lobe, with sti mulati onof high frequency sounds more present on thecentral part of thisline and representati on of lowfrequency soundsmorepresent on the peri pheral part of thisline. I t isused to relieve deafness, tinnitusand ot her heari ngdi sorders. Aggressivity 1 (Aggression Control, Anti-aggressivity, Irritability) [LO2] Location: Notch at thejuncti on of themedial anti tragusand medial ear lobe. I t islocated at same auri cular region as thelimbic Amygdala Nucleus which regulates aggressive behaviors. Function: Reduces irritability, aggression, frustration, rage, mania and drug withdrawal. 182.E2 182.E3 Aggressivity 2 Location: Superi or tragus. Aggressivity 3 [TG 5] [IC2] Location: I nferi or conchanext toconchawall region behi ndtheanti tragus. [ HX4] 183.E 1 Psychosomatic point 1 (Psychotherapeutic point,Point R, Bourdiol point) Locati on: Superi or helix root, asit joins theface at LM 1. I t islocated near Chi neseear reflex poi nt for External Geni talsand external to theAutonomi cpoint. Function: Alleviates psychological disorders, and can help psychotherapy pati entsremember long-forgottenmemori es and repressed emoti onal experiences. I t also facilities theoccurrence of vivid i ntensedreams. 183.E2 Psychosomatic point 2 [LO1] Location: I nferi or lobe asit joins theface, superi or to LM8, in region for thei ntellectual Prefrontal Cortexregion of ear. I t isalso near Master Cerebral, Neurastheni a, and Nervousness. ~ .... _ ~ _ 184.E Sexual Desire (Bosch point,Libidopoint) [HX1] Location: Helix root asit joins thesuperi or edge of tragus, at the Europeanear poi nt for theExternal Geni tals, Penis and Clitoris. Function: I ncreases libido, enhancessexual arousal. 185.E Sexual Compulsion (jeromepoint,Sexual Suppression) Locati on: Helix tail as it joins theear lobe, near LM5, at theEuropeanMedullaOblongata. Function: Lowers libido, calms sexuality, alleviates insomnia. [HX15] 186.E Master Omega (Master Cerebral point,Psychosomaticpoint,Worrypoint,Angst) [LO1] Location: I nferi or ear lobe near theface, superi or to LM 8. I t isthesame poi nt astheEuropean Mast er Cerebral point and theChi neseNervousness or Neurastheni apoints. I t isin theregion of theear reflex poi nt for thePrefrontal Cortex. A vertical linecan bedrawn between thisMaster Omegapoi nt and thefunctional points Omega1and Omega2. Function: Affects psychological stress, such asobsessive-compulsive di sorders, fear, worry, rumi nati ngthoughts, angst, psychosomatic di sorders and general analgesia. 250 - . . - ~ - - - - AuriculotherapyManual _ _ ~ - - - - - - - - - - - - - - - - - - - - - - _. No. 187.E 188.E Auricular microsystem point (Alternativename) Omega 1 Location: Superi or concha, central to theSmall I ntesti nespoint. Function: Affects vegetative stress, such asdigestive di sordersand visceral pain. Omega 2 Location: Superi or helix, central to theAllergy poi nt at LM 2. Function: Affects somatic stress, reducing rheumatoi darthritis, i nflammati onsof thelimbs. [Auricular zone] [SC 2] [HX6] [CR2/CW4] 189.E Marvelous point (Wonderfulpoint,MiddleCervical plexus) Location: Peri pheral concharidge, in region of theLiver point. Function: Balances excessive sympatheti c arousal, reduces hypertensi on. Affects bl oodvascular regulati on, relieves muscle tension. 190.E 191.E 192.E Antidepressant point (Cheerfulness, Joypoint) Location: Peri pheral ear lobe, below theperi pheral anti tragusand below theOcci put point. Function: Relieves endogenousdepressi on, reactive depressi on and dysphoric mood. Mania poi nt Location: I nferi or tragusedge that lies above thei nferi or concha, between LM 9and LM 10. Function: Relieves hyperactive manic behavi or that often accompani es addictions. Ni coti ne point [L08] [TG 1] [TG2] Location: I nferi or tragus edge t hat isover theconcha, superi or to theMani apoi nt and i nferi or to theChi neseAdrenal Gland point. Function: Used to reduce nicotinecraving inpersonswithdrawingfrom smoking. 193.E 194.E 195.E1 195.E2 196.E Vi t al i t y point Location: Superi or tragus, central to LM 11. Function: Affects i mmunesystem di sorders, AI DS, cancer. Alertness point Location: Helix tail, below theDarwi n’stubercle, near LM 4. Function: I nducesarousal, activation, alertness. I nsomnia 1 (Sleeppoint) Location: Superi or scaphoi d fossa, near theWrist point. Function: Relieves insomnia, nervousness, depressi on. I nsomnia 2 (Sleeppoint) Location: I nferi or scaphoi d fossa, near Master Shoul der point. Function: Relieves insomnia, sleep difficulties, nervous dreams, inability to dream. - - - - - -- - - - - Dizziness (Vertigo) Location: Conchawall, below theOcci put and Cervical Spinepoints. Function: Relieves dizziness, vertigo. - - - - - - - - - - - - - - - - - - - - -- - - - Somatotopicrepresentations [TG2] [HX12] [SF 4] [SF 1] ._- - - - - - - - - [CW3] 251 183.E1 Psychosomatic o poi nt 1 19S.E1 I nsomnia 1 19S.E2 _ I nsomnia 2 18S.E Sexual Compulsion 190.E Antidepressant poi nt 181.E1 Audi t ory line \ 181.E2- - - \ Audi t ory line \ 188.E Omega 2 187.E Omega 1 184.E Sexual Desire 193.E Vi t al i t y 182.E3 Aggressivity 3 191.E Mania poi nt 182.E1 Aggressivity 1 186.E Master Omega 183.E2 Psychosomatic poi nt 2 252 Figure 7.44 Hi ddenviewofpri mary European functi onal condi ti onsreprr-ented on theauricle. AuriculotherapyManual 188.E Omega 2 183.El 0 Psychosomatic point 1 187.E Omega 1 182.E2 Aggressivity 2 184.E - - - 14 Sexual Desire 193.E Vi t al i t y poi nt 196.E Dizziness - - - - - I f- - _ 192.E Ni coti ne poi nt 191.E Mania poi nt 182.El - - - - - I l l ! Aggressivity 1 186.E - - - - - \ {J Master Omega 183.E2 Psychosomatic / poi nt 2 181.E2 ~ Audi tory U", 2 / 195.El I nsomnia 1 194.E Alertness 189.E Marvelous point 195.E2 I nsomnia 2 ) ...........,.., 185.E Sexual Compulsion 190.E Antidepressant poi nt 181.El Audi t ory line 1 Figure 7.45 Surface viewofprimary European functi onal condi ti onsrepresented on theauricle. Somatotopicrepresentations 253 7.6.4 Secondary European functional points represented on the ear Aswith theChi nesesecondary functi onal points, theEuropeansecondary functi onal poi ntsare di sti ngui shed from the Europeanpri mary functional poi ntsonly because they are not ascommonly used. No. Auricular microsystem point (Alternativename) [Auricularzone] - ~ ~ ~ ~ ~ ~ ~ ~ ~ - - - - - - - - - - - - - - - - - - - - - - 197.E 198.E 199.E 200.E 201.E 202.E Sneezing point Location: Peri pheral ear lobe, near the location for EuropeanTrigeminal Nucleuspoi nt. Function: Reduces sneezing, allergies. Weather point Location: Helix root, superi or to the Chi neseRectumpoi nt and above the European Prostatepoi nt. Function: Alleviates any symptomsdue to changes inweather. Laterality point Location: Si deburnsareaof theface, central to LM 10. Function: Facilitatesbal ance of left and right cerebral hemi spheres, reduces oscillation. Darwin’s point (BodilyDefense) Location: Darwi n’stubercle on theperi pheral helix, between LM 3 and LM 4. Function: Relieves all types of pain in the lower back and lower limbssince it representsthespinal cord. Master point for Lower Limbs Location: Helix root, above theEuropeanExternal Geni tal spoint. Function: Relieves pain and swelling in legs and feet. Master point for Upper Limbs Location: Helix tail, in theregion of the European MedullaObl ongata. Function: Relieves pain and swelling in arms, hands, and fingers. [LO5j [HX3] [Face] [HX11] [ HX2] [HX15] ~ - - - - . ~ ~ ~ ~ - - - - - - - - - - 203.E 204.E Master point for Ectodermal Tissue Location: I ntertragi cnotch, i nferi or to the Pineal Gl andand EyeDi sorderspoints. Function: Affects t reat ment of ectodermal tissue of skin and nervous system. Master point for Mesodermal Tissue Location: I nternal helix, near the European Kidney and Uret er points. Function: Affects t reat ment of musculoskeletal di sorders. [IT 1] [I H4] - - - - - - ~ - - - .. - - - - ~ - - - - - ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ _ . - ~ ~ ~ - ~ ~ ~ - 205.E 206.E 254 Master point for Endodermal Tissue Location: I nternal helix, ncar the EuropeanOvary and Testespoints. Function: Affects t reat ment of i nternal organ and endocri nedi sorders. -- - - - - - - -.. ~ - - _ . - - . _ - - - ~ _ . Master point for Metabolism Location: Peri pheral ear lobe. Function: Affects t reat ment of any metaboli c di sorder. AuriculotherapyManual [IH 1] [LO7] No. 207.E 1 207.E2 208.E 209.E 210.E 211.E 212.E 213.E Auricular mi crosystem poi nt (Alternativename) Prostaglandi n 1 Location: Undersi deof ear lobe, where actual ear joi nslower jaw. Function: Reduces i nflammati onsand pain. Prostaglandi n2 Location: Head, superi or to theApex of Ear and LM2. Function: Reduces i nflammati onsand pain. Vi tami nC Location: Head, superi or to theApex of Ear and LM2. Function: Relieves stress and symptomsof colds or flu. Vitamin E Location: Superi or helix, peri pheral to theAllergy poi nt. Function: Used to amplify effects of taki ng Vitamin E. Vitamin A Location: Neck, i nferi or to theear lobe. Function: Used to amplify effects of taki ng Vitamin A. . - - - - - - _._- - ._- - - - - - - - - - - MercuryToxicity Location: Superi or concha, near theBl adder poi nt. Function: Used to relieve effects of metal toxicity reacti ons. Analgesia Location: Superi or concha, near theDuodenumpoi nt. Function: Used to facilitate pain reli ef for surgeries. Hypnotic Location: Helix tail, hori zontally across from LMO. Function: Used to tranqui li zeand sedate. [Auricular zone] [LO 1] [Head] [Head] - - - - - - - - - - - .. _- - - - [ HX9] [Neck] [SC 6] [SC 7] [HX13] - - - - - - - - - - - - - - - - - - - - - - - - 214.E 1 214.E2 214.E3 Memory 1 Location: Central ear lobe, in regi on of the Prefrontal Cortexpoi nt. Function: Facilitates i mprovement in memory and attenti on. - - - - - _.- .... _. - - - - Memory 2 Location: Superi or ear lobe, in regi on of theHi ppocampuspoint. Function: Facilitates i mprovement in memory and attenti on. Memory 3 Location: Posteri or ear lobe, in regi on of the Prefrontal Cortexpoint. Function: Facilitatesi mprovement in memory and attenti on. [LO 1] [L04] [PL 2] I mportant ear points: Themost frequently utilized Europeanfunctional points are Aggressivity 1, Psychosomatic Reactions 1,Anti depressant point, and Vitality point. Master Omegapoi nt isidentical to Master Cerebral point. somatotopicrepresentations 255 208.E - - - - - - - - - - 10 Vi tami n C 209.E Vi tami n E 200.E Darwin’s poi nt 211.E Mercury Toxi ci ty 212.E Analgesia 213.E Hypnoti c 206.E Master poi nt for Metabolism 197.E Sneezing poi nt 0)- - - - - - - - 207.E2 Prostaglandin 2 204.E Master poi nt for Mesodermal Tissue 205.E Master poi nt for Endodermal Tissue 201.E Master poi nt for Lower Limbs 199.E Laterali ty poi nt - - 0 203.E Master poi nt for Ectodermal Tissue 207.E1 Prostaglandin 1 256 Figure 7.46 Hi ddenviewofsecondary European functi onal condi ti onsrepresented on theauricle. AuriculotherapyManual 207.E2 _- - - - 0 Prostaglandin 2 204.E Master poi nt for Mesodermal Tissue 198.E Weather 20S.E Master poi nt for Endodermal Tissue 201.E Master poi nt for Lower Limbs ~ 9 9 E Laterality poi nt 203.E - - - - " Master poi nt for Ectodermal Tissue 214.E2 Memory 2 214.E 1 Memory 1 207.E1 Prostaglandin 1 0- - - - - - - - - 208.E Vi tami n C 209.E Vi tami n E 200.E Darwin’s poi nt 211.E Mercury Toxi ci ty 212.E Analgesia 213.E Hypnoti c ....,nf---__ 202.E Master poi nt for Upper Limbs _____ 206.E Master poi nt for Metaboli sm 197.E Sneezing poi nt 0 210.E Vi t ami n A Figure 7.47 Surface viewofsecondary European functi onal condi ti onsrepresented on theauricle. Somatotopicrepresentations 257 258 Clinical casestudies of auriculotherapy CONTENTS 8.1 Relief of nausea 8.2 Myofascial trigger points 8.3 Back pain 8.4 Peripheral neuropathy and neuralgia 8.5 Weight control 8.6 NADA addiction protocol 8.7 Alternative addiction protocols 8.8 I nternational Consensus Conference on Acupuncture,Auriculotherapy, andAuricular Medicine (ICCAAAM) 8.9 Auriculotherapy Certification I nstitute Mypersonal experiencewithauriculotherapybeganat theUCLA PainManagement Clinicin 1975.As alicensed psychologist workinginaninterdisciplinarypainclinic, I wasoften asked tosee thechronicpainpatientswho hadnot benefitedfromprevioustrialsof opiatemedications, antidepressants,localized nerveblocks or trigger pointinjections. Clientswere referredtomeby other doctorsintheUCLA Medical Center for biofeedback trainingor auriculotherapy. Biofeedback therapyallowed patientstolearntoreducetheirpathological muscle spasms andtoimprovevascular circulation.Patientswere referredfor auriculotherapyasamoredirect procedurefor immediatelyalleviatingchronicpain. Whilelicenced acupuncturistsactivate acupuncturepointswiththeinsertionof needles, myclinical practicewithauriculotherapyhas employed transcutaneousmicrocurrentstimulationof ear reflex points. Electronicequipment that wasused at UCLA includedtheStirnFlex, theAcuscope, andtheHMRstimulator.An electrical detectingprobeisguidedover specific regionsof theauricletoidentifyreactivepointsanda buttonon thesamebipolarprobeispressed tobrieflystimulatethesameear points. Thereisno invasionof theskinwithneedles, so thisapproachtendstobeless painful thanother forms of auricularstimulation.I alsoworkedwithphysicians, nurses, andacupuncturistswho didinsert needles intotheear. WhenI wasfirst learningauriculotherapy,itwasvery helpful tohaveawall chartof ear acupuncturepointsimmediatelyabovethetreatmenttablewherepatientswere seen. Electronic equipment, acupunctureneedles, or ear pelletswere availableon anearbystand. Whilethe invertedfetus concept facilitatesaneasy comprehension of which portionsof theauriclerelate toaparticularpatient’sproblem, andtheauricularacupointsused inmost treatmentplansare quicklylearned, itisuseful tohaveavisual reminderof less frequentlyused ear pointsandtheir precisepointlocation. It isnot necessary for patientstolieon atreatmenttable, since they canbetreatedeasilyinanordinarychair. It isbest, however, for thepractitionertoeither standor sit ateye level above thepatient’sear. It isimportantthatthepractitioner’sarmisnot excessively strainedwhen holdinganelectronicprobeagainst theauricleor when insertinga needle. Comfort for thepractitioneraswell asthepatientisimportantwhen seeing many patients. Thefirst several years of mypracticeof auriculotherapyrequiredmetosuspend myskepticism stemmingfromthelack of scientific explanationsfor thisprocedure. I would repeatedlysee significant improvementsinthehealthstatusof patientswithpreviously intractablepain, but my internaldisbelief remained. I wasencouragedbyreadingthewords of Nogier (1972), who stated that Auriculotherapy Manual any method should not be rejected out ofhand merelybecauseit remains unexplainedand does not tie up withourpresentscientificknowledge. A discovery is rarely logicaland oftengoes againstthe conceptions then infashion. It is often the resultofa basicobservationwhichhas been sufficiently clearand repeatable for it to be retained. Nogier furthercommented that the spinal column, like the limbs, isprojectedclearly and simply in the externalear. The therapeutic applicationsarefreefrom ambiguityand ought to allowthe beginnerto achieveconvincingresults. Each doctor needs to be convincedofthe efficacyofthe method bypersonal results, and he is right. I neededmanyobservationsof theclinical effectiveness of auriculotherapybeforeI wasconvinced. Thesestatementsof Nogier remindedmeof myreadingsinthebiofeedback literatureof the pioneeringresearchonstress byHansSelye. Inhisclassic text, The stressoflife (1976), Selye described theinitialscientific oppositiontohisconcept of a’non-specific’ factor thatcontributesto disease inadditiontothe’specific’ pathogensfirst discovered byLouis Pasteur.Selye relatedthe storythatonesenior professor whomheadmired’remindedmethatfor monthsnowhehad attemptedtoconvince methatI must abandonthisfutilelineofresearch.’ Fortunately,Selye persevered inhisresearchanddiscovered thatchronicstress leads toanenlargement of the adrenalglands, atrophyof thethymus glands andulcers inthegastrointestinal tissue. These organicchanges arenowwidelyrecognized asreliableindicationsof thebiological response toa varietyof non-specific stressors. Pasteurhimself hadtoovercome considerableoppositiontothe germtheorypostulatethatinvisiblemicroorganismscouldbethesourceof anillness. Manyof Pasteur’scolleagues scoffed at thesupposed dangersof theseinvisibleagents, but today, sterilizationtechniquesinsurgery andinacupunctureoriginatefromPasteur’sproposals. Alternativetheoriesandtherapiesoftenrequirepatienceandpersistencebeforethey become widelyaccepted bythemedical profession asawhole. Inthissection, I haveincorporatedmyown clinical findingswiththatof other healthcare practitionerswhotreatauricularacupuncturepointswithneedles or who usetheNogier vascular autonomicsignal indiagnosis andtreatment.I haveendeavoredtoselect cases thatprovideinsight intotheunderlyingprocesses affecting auriculotherapyaswell asexamples of typical clinical results onemight expect fromsuch treatments.Theorder of presentationof specific clinical cases will first focus onpainconditionsrelatedtointernalorgans, thenuponmyofascial pain disorders, andlastlywill examineneuropathicpainproblems. Theuseof auriculotherapyfor addictionsandother healthcaredisorderswill alsobediscussed. Finally, theresultsof clinical surveys conductedbyskilled practitionersinthisfieldwill bepresentedtoindicatewhich auriculotherapytreatmentplanshavebeenfound tobethemost effective for particularhealth conditions. 8.1 Relief of nausea As Nogier suggested, whatmaybemost persuasivefor abeginningpractitioneristherelief of a symptom thathehimself hasexperienced. I hadworkedwithDrsRichardKroeningandDavid Bresler at theUCLA Medical Center for manymonthsconductingresearchon auriculardiagnosis. I myself, however, hadnever received anyauricularacupuncturetreatment.At oneof thefirst lecturepresentationsof our auriculardiagnosis research, I hadthefirst handopportunitytoassess theclinical effectiveness of ear acupuncture.I hadeatensomethingfor breakfastthatbeganto greatly disagreewithme. Bythetimethelecturewasset tobegin, thediscomfortingstomach sensationsweregettingworse. I toldthistoDr Kroening, who noticedtheunpleasantgrimaces uponmyface. Hepromptlypulledasterilizedneedleoutof thepocket of hislabcoat andinserted itintotheStomachpointonmyleft ear. Tomyunexpected surprise, thenauseainmystomach disappearedwithinoneminute. Sincetheskeptical scientific sideof mypersonalitywondered whether thissuddenrelief of painwassimplyaplaceboeffect, I removed theneedle. The uncomfortablenauseousfeelings immediatelyreturnedandI almost startedtovomit. Somewhat embarrassedbymylack of faithinhismedical skills, I hadtoask DrKroeningtoreinsertthe acupunctureneedleinmyear. Hesmiled andcompliedwithmyrequest. Almost immediatelyafter hereplacedtheacupunctureneedle, theabdominaldiscomfort quicklysubsided. Onlyafter leavingtheneedleinplacefor 20minuteswasI abletoremoveitwithoutnauseareturning. Clinical casestudies 259 260 Whatthisexperience clearlytaughtmewas thatauriculotherapycouldbevery fast acting, but withoutsufficient stimulationof theappropriateear acupuncturepoint, thebenefitscouldrapidly fade. Thechanges innauseasensationsweredirectlyrelatedtotheinsertion, theremoval, thenthe reinsertionof theacupunctureneedle. Since thisinitialobservation, I haveused theStomachpoint for myself andmanyclientsI haveworkedwith. Bothneedleinsertionandtranscutaneous electrical stimulationcanquickly relievestomachaches, not onlyinresponse todisagreeablefoods, but also fromthesideeffects of variousmedications. It isalso possible toproduceamoregradual reductioninnauseousfeelings fromjust thetactilepressureof rubbingone’sown finger over the Stomachpoint. Acupressure isnot asrapidaselectrical stimulation,usuallyrequiringseveral minutesof maintainedpressureagainsttheear points, butit allows patientstohelpthemselves withoutanyequipment. Paincomplaintsrelatedtointernalviscera arerepresentedinadifferent region of theear thanare musculoskeletal complaints. Thecentral concha zoneisassociatedwithdiffuserepresentationof thevagus nervecontrol of internalorgans. Thesurroundingridgeof theantihelixandantitragus areassociatedwithmoreprecisecontrol of musculoskeletal movements. For thatreason, abroad areaof concha pointsaffectingthestomachcan befound, butthereareonly asmall set of specific antihelixpointsthatcould affect thethoracicspine. Auriculotherapyisvery effective for therelief of gastrointestinaldistresswhich isnot successfully alleviatedbyconventional treatments. I have nowtreatednauseainmanypatientswithAI DS who arebeingadministeredantiviralmedication or cancer patientswho areundergoingchemotherapy. Inmost of thesecases, stimulationof the auricularStomachpointdramaticallyalleviatestheirgastrointestinal reactions. Therearenow over 20controlledclinical trialsdemonstratingthatneedlingof thebodyacupuncturepoint PC 6 on thewrist hasasignificant antiemeticeffect. Therelief of nauseabystimulatingtheauricular Stomachpointcan bejust asprofound. PL wasa28-year-oldgaymalewho hadbeen diagnosedwithHI Vdisease6yearsbeforeI sawhim. Theadvent of triplecombinationtherapyhadyielded agreat improvement inhisT-helper cell count andadramaticdropinviral load, yet PL continuedtosuffer fromagonizingstomach discomfort relatedtohisHI Vmedications. Weekly treatmentof theStomachpoint (5Hz, 40/-LA, 30s) andmaster points(10Hz, 40/-LA, 10s) on bothearsallowed PL tofeel substantiallymore comfortablefor thenext several months. However, auriculotherapystimulationof hisThymus Glandpointdidnot reversetheprogressive deteriorationof hisimmunesystem. Heonlystopped comingfor treatmentsintheseveral weeks beforehisdeath,when hewastooweak toget out of bed. Another AI DS patientreportedasimilarpositiveexperiencewithauriculotherapy.LR wasa 30-year-oldgaymalewho continuedtolose weight fromhislack of appetite. HisHI V medications gave himsuch severe stomachaches thatheneededtostopthemperiodicallyso thattheside effects of thesedrugsdidnot compromise hishealth. WhenhedidtakehisHI Vmedications, LR reportedthattheauriculotherapytreatmentwastheonly medical procedurethatprovidedhimany sense of comfort. Hehascontinuedtopositively respondtostimulationof theStomachpoint, to theauricularmaster pointsShen Men andPointZero, andtostimulationof theVitalitypointon theupper tragusof theear. AS wasa47-year-oldfemalewho hadbeenpreviouslydiagnosedwith liver cancer. Her healthhad not improvedafter threedifferent trialsof chemotherapy. Shealsowasgreatlydistressed by nauseafromthechemotherapymedicationsshewastaking. Stimulationof theStomachpointon theconcha ridgeof theear producedpronouncedalleviationof her chronicstomachaches. Electrical detectionindicatedabroadspreadof reactivepointsrelatedtotheStomachregion of theear, notjust asingle point. As indicatedpreviously, determinationof auricularpointsfor internalorgansdoes not requirethesameprecisionastheidentificationof musculoskeletal ear points. Whenusingmicrocurrenttranscutaneousstimulation,theconcha region of theear is stimulatedat 5Hzfor 30seconds, whileneedles areleft inplacefor 30minutes. For bothformsof stimulation,thetreatmenteffect isaugmentedbytheplacement of ear seeds over theStomach pointthatareleft inplacefor thenext week. Oleson & Flocco (1993) conducted acontrolledclinical trial thatdemonstratedthatpremenstrual symptoms weremoresignificantlyreducedinagroupof women who weregiven acupressureat appropriateauricularreflex pointsascontrastedwithadifferent set of women who weregiven shamreflexology sessions over asimilartimeperiod. Auriculotherapy Manual 8.2 Myofascial trigger points As ateachinghospital, theUCLA Medical Center exposes beginningdoctorstoavarietyof educational experiences. Residents intheUCLA Departmentof Anesthesiology wereoffered traininginthePainManagementCenter asoneof theirelective rotations.Theseresidentswere routinelyshown demonstrationsof trigger pointinjectionsasanalternativeproceduretothenerve blocks thatanesthesiologists conventionallyusetotreatchronicpain. Myofascial paincanbe alleviatedbytrigger pointstimulationwhen intravenousinjectionof alocal anestheticintoa specific muscle region blocks thereflex arcthatmaintainsmuscle spasms. Ononeoccasion, a groupof UCLA residentsfirstobserved theprimaryclinicphysician palpatethetrapeziusmuscle of patientCN, whowassufferingfromshoulder pain. Hypersensitivetrigger pointswereidentified onthepatient’sright trapeziusmuscle, andCN hadsignificant limitationintherangeof motionof hisright arm. Theattendingphysician suggested thattheresidentsobserve ademonstrationof auriculotherapypriortotheirpracticewithtrigger pointinjections. I examinedthepatient’sright ear andreactivepointswerefound on theshoulder regionof theauricle. Electrical stimulationof these reactiveear pointsled toanimmediatereductioninthepatient’ssubjectivesense of discomfort. Therangeof motioninhisarmwasnolonger limited. Whentheoriginal physician againpalpatedCN’strapeziusmuscle, hecould nolonger objectively identifythepreviously detected trigger points. Thesuccess of theauriculotherapyeliminatedtheneedfor anyother treatment.Sincethepresenceof thetrigger pointshadbeenevaluatedbyanotherdoctor whowas not present when theauriculotherapywasconducted, thisobservationwascomparabletoa double-blindassessment of patientimprovement. Oneof themost common conditionsrecentlyseen inmanypainclinicsisthediagnosisof fibromyalgia, literallydefinedasthepresenceof paininmanygroupsof muscle fibers. JM wasa43› year-oldfemale whoreportedpaininmultiplepartsof her body. Sheexhibitedhypersensitive trigger pointsinher jaw, neck, shoulders, upperback, hips, andlegs. Reactiveauricularpoints wereevidenced throughouttheear. Theauricularpointscorrespondingtothejaw, cervical spine, thoracicspine, shoulders, andhipswere electricallystimulatedat 10Hz, onboththeanteriorand posterior regionsof theexternal ear. BilateralstimulationwasalsoappliedtoPoint Zero, Shen Men, Thalamus,EndocrineandMuscle Relaxation. After each auriculotherapytreatment,JM reportedfeeling veryrelaxedandexperienced aprofounddecreaseinher variouspainsymptoms. Unfortunately,theaches inher spineandinher limbsgraduallyreturnedseveral daysafter the treatment.Biofeedback relaxationtrainingandindividualpsychotherapy were alsointegral tothe progressive improvement over 14weeks of treatment.Complex paindisorders, such as fibromyalgia, requiremorethanthealleviationof nociceptivesensations. Successful treatmentof fibromyalgia alsorequiresattentiontothemanagementof dailystressors andhelpingthe individual toresolve deeper psychodynamic emotional conflicts. Someonewho didnot respondso favorablytointerdisciplinarytreatmentwasEJ, a45-year-old mother of twoadolescent children. Shecomplainedof chronicpaininmanypartsof her bodyand reluctantlydiscussed thatshesuffered distressfromproblemsinher marriage.Shehadbeen referredtomebyafibromyalgia supportgroupthatmeets inahospital inLos Angeles. EJ reportedtendernessanddiscomfort at trigger pointsfoundinvariouspartsof her body, andfor each of themultiplesitesof painperceptioninthebody therewerecorrespondingtender pointson her external ear. Stimulationof theelectricallyreactiveauricularpointsled toreducedlevels of perceived painandenhancedfeelings of comfort andrelaxation.EJ seemed grateful for the immediaterelief, but thetreatmenteffects onlylastedseveral days. Shewasconstantlyinconflict regardingher marriageandafraidof beingleft alone. At thesame timeshewasfrustratedbythe continuedlack of attentionfromher husband.Thestress of thisindecisionseemed toreinitiateher fibromyalgia paineachweek. Besides themusculoskeletal andmaster pointsthataretypicallyused for pain, EJ alsoreceived stimulationof theear acupointsrelatedtopsychosomatic disorders, nervousness, anddepression. Whenitwassuggested inthecourseof therapythatshe might consider theoptionof assertingherself withher husband,shebecamedefensive andquiet. Shedid not returnfor anyother sessions, insistingthatsheonlywantedtofocus on her painproblemand not these other issues inher life. Several monthslater, shewasstill inthefibromyalgia support group, still sufferingfromchronicpain.Therearecertainpatientswho arenot readytofully engage intheactivitiesthatwould reducetheirphysical painwhen itrequiresthatthey alsoaddress thesources of their emotional discomfort. Clinical casestudies 261 262 8.3 Back pain Oneof themost frequent applicationsof auriculotherapyisfor thetreatmentof backpain. OF, a 43-year-oldmarriedmother of twoadultchildren, hadbeen injuredon theplaygroundatthe elementaryschool whereshetaught. Variousmedical proceduresbyfour other doctorsat UCLA led topartialbut inconsistent relief of her back pain.Auriculotherapytreatmentproduceda markedreleaseof thetightnessinher back, but her paingraduallyreturnedafter eachsession. Despitethepersistent achinginher back, OFcontinuedtogo toworkregularlyasanelementary teacher andtodothehousehold chores andcookingfor her husband,andher adultson, andher daughterwhen shegot home. I twasnot until OFalsolearnedbiofeedback relaxationand assertiveness skillsthatthepainsubsidedfor longer periods. Sheneeded strongencouragement to ask her familyfor theassistanceshe needed aroundthehouseandtotaketimefor herself torelax. Sometimes apainproblemispresent for secondarygain issues thatmust becorrected beforethe effects of auriculotherapycanbesustained. Auriculotherapycandramaticallyalleviateback pain, but thepatient’slifestylethatputsadditionalstress on thatindividualmust alsobeaddressed. CJ wasa38-year-oldmaleairlinepilot who attributedhischronicback paintothe2-hourcommute fromhishomeinSantaBarbaratohisairlinebaseatLos Angeles I nternationalAirport. The patient’sdrawingsof thelocationof hisdiscomfort indicatedthathispainwaslocalizedtohisleft buttocks. Whiletherewere several reactiveacupointson CJ’s right andleft external ears, the ButtocksandLumbagopointsontheleft earshowed themost tendernessandelectrical conductivity. Even thoughhisjobstress remainedunchanged, fiveauriculotherapytreatmentsled topronouncedrelief of thepaininhisbuttocks. CJ alsocametogreater acceptanceregardinghis divorce, incidentallydescribinghiswifeasa’painintheass.’ Several weeks after thepaininhis lower backwasgone, CJ noticedanewpainproblemon theleft sideof hisneck. Sometimes, successful treatmentof aprimaryproblemallowsasecondaryissuetosurface. CJ alsocommented onastressful weekend withhisnewgirlfriend, andsuggested she hadbeena’real painintheneck.’ WhiletheButtocksandLowBack pointsontheearwere nolonger tenderon palpation,theNeck region of theleft auriclehadbecomeverysensitive. I trequiredonlytwoauriculotherapysessions to ease thepainandtightnessinCJ’s neck. Treatmentprimarilyconsisted of electrical stimulationof theNeck point(10Hz, 60ftA, 20s). Themaster pointsShen Men, PointZero, Thalamuspointand Muscle Relaxationpointwere alsostimulated.I twasfurthersuggested thatheneededtodiscuss his angryfeelings withhisnewgirlfriendratherthanunconsciously somatizinghisemotions. Whilehisoriginal motivationtoseek treatmentwasfor generalizedanxiety, AC hadcalled to cancel anappointmentbecauseof acuteback pain. A 33-year-oldmalepublicrelationsexecutive, AC could notget upout of hisbed thedayafter hehadbeen inanaccident. Hehadalready missed twodaysof work on thedayhecontactedmeabouthiscondition. I wasabletosee himin hishomewithaportable, electronicdevice. Auricularstimulationwasappliedtoextremely tender andelectricallyreactivepointsontheanteriorantihelixpointsandon theposterior groove points thatcorrespondtothelumbarspine. Stimulation(10Hz, 20ftA, 30s) of theseauricularacupoints on theright andleft external earswasaccompaniedbytreatmentof themaster pointsShenMen, Point Zero, Thalamus,andMaster Cerebral point. Theresponse tothistreatmentwasimmediate andprofound. At theconclusion of theauricularstimulationprocedures, AC wasabletoget up fromhisbed withoutanydiscomfort inhisback. Hecouldbendandturninwaysthatwere impossible just 15minutesearlier.Because thecauseof hisproblemwasso recent, auriculotherapy treatmentled todramaticimprovement injust asingle session. Auricularpelletswereplacedon thefront andtheback of theLumbarSpinepoints. Bythenext day, hewasabletoreturntowork. Theearpelletswereremoved after onedayandhisbackproblemswere gone. Sciaticaisthemedical conditionwhichfirst brought thepossibilitiesof auriculotherapytothe attentionof Paul Nogier inthe1950s.As notedbyhimover 50years ago, andasobserved bymany ear acupuncturistssince, sciaticapaincanbegreatlyalleviatedbyauricularacupuncture.BHwasa 23-year-oldmalewithcomplaintsof sciaticaandshootingpainsdown theleft hipandleft leg. When pressurewasappliedtotheL5-S1 pointon theinferiorcrusof theleft antihelix,BHfound it excruciatinganditwasalsothemost electricallyresponsive regionof hisleft ear. Reactivepoints werealsofoundinthetriangularfossa, theauricularregionwhich Nogier correlatedwiththe locationfor theleg. Electrical stimulationof reactivepointsonthefront andback of theauricleled toan85%reductioninpainlevel thatBHrecordedon avisual analogscale. Earseeds were placed on theSciaticapointandon theNogier Leg pointtosustainthetreatmenteffects. Auriculotherapy Manual MJ, anormallyveryathletic26-year-oldmalepatient,hadbecome incapacitatedbysevereback pain. Duringthefirst auriculotherapysession for hisbackpainproblems, I also noticedthatMJ hadanopenscar ontheregionof thehelix root thatadjoinstheface. Twomonthsof antibiotic medicationsprescribedbyhisprimaryphysician hadfailed toheal thisscar. Thescar waslocated on apartof theexternal earwhereChineseauricularchartsdepict theexternal genitals. For MJ ’s back pain, bipolarelectrical stimulationwasappliedtotheLumbosacral pointson theantihelix inferiorcrusof hisleft auricle. Tofacilitatewoundhealing, monopolar probeswere placedacross theedges of thescar ontheear. Thepatientwastold thatelectrical stimulationcouldpotentially heal skinlesions aswell asrelieve back pain. At hisappointmentaweek later, MJ cameintothe treatmentroomvery upbeat.Hewasamazednot onlybyadecreaseinhisback pain,but also becausehispreviouslyundisclosed scrotal painhaddiminished- asurprisefor bothof us. These resultsareexplainedbymicrosystemtheoryasorganocutaneousreflexes producingthemysterious scar on MJ ’sear andtreatmentof thatscar activatedacutaneo-organicreflex thatalleviated discomfort inthegenital region. Whileitisimpressive toobservethemanypatientssuccessfully treatedwithauriculotherapy,itis alsoimportanttodistinguishthesources of treatmentfailures. Twodifferent cases of back pain illustratethelimitationsof thisprocedure. RT wasa33-year-oldmaleartdealer andEEwasa 41-year-oldmaleexecutive at aHollywood moviestudio. They bothsuffered fromrecurrentback painthatwasattimes manageable, but at other times preventedthemfromgoing towork. Both menhadreceived nerveblocks andphysical therapy. Onlyperiodictreatmentwithopiate medicationsproducedtemporaryalleviationof their discomfort. Bothmenwere contemplating surgeryfor theremoval of bonespurs alongthespine, uncoveredbyMRI scans. RT andEE both expressed interestintryingauriculotherapybeforeundergoingpossibly riskysurgical procedures. They were each given several auriculotherapysessions wherereactivepointsthatrepresent the back wereelectricallystimulated.RT reportedthattheauricularstimulationproducedabrief reductionof hisback pain, but anybody movement reactivatedintensediscomfort. WhileEE did not initiallyreportverysevere pain, healso didnot exhibit muchrelief fromthatpainafter receiving auricularstimulation.Bothmenultimatelyunderwentsurgical procedurestoremovethe bonespurs andtheirback conditionswere almost completely relieved. Fromthesetwoexamples, itcanbeseen thatauriculotherapyisnotparticularlyeffective when thereisanunderlyingphysical structurecausingpain, intheseinstancesabonespur. Auriculotherapycanbemorehelpful whentheproblemisduetomuscletensionandthe pathological functioningof neuromuscularcontrol of muscle spasms. Failuretoprovide satisfactorypainrelief toanothermalepatientwasaccountedfor bythepresenceof adifferent structuralproblem. MBwasa34-year-oldcomputer graphicsartistwho hadbeentofour different physicians for chronicneck painbeforebeingreferredtome. After fivesessions where auriculotherapydidnot alleviatehispainproblem, MB discontinuedtreatment.A year laterhe contactedmetoinformmethatasubsequent physicianhaddiagnosed aconstrictioninhiscervical spinethatwascorrected bysurgery. I twasonlyafter thissurgerythathispersistent neck painwas alleviated. Whileosteopathicsurgerycan sometimes leadtofurthercomplicationsof achronic paincondition, itisatother times theonly effective solution. 8.4 Peripheral neuropathy and neuralgia Differentregions of theauricleanddifferent stimulationfrequencies areused for neuropathicpain thanfor musculoskeletal or internalorganconditions(Oleson 1998). Muscular atrophyand persistent paininhisleft armwereattributedby57-year-oldJJ tostress andstrainrelatedtowork activities. Reactive ear pointswereelectricallydetected ontheauricleattheCervical Spineregion alongtheantihelixtail andattheElbow andWristpointsonthescaphoidfossa of theleft ear. Microcurrentstimulationatthesethreepointswasaccompaniedbyanimmediatewarmtingly sensationthroughoutJ J ’sleft armandhand. IntheNogier school of auriculotherapy, musculoskeletal disordersarestimulatedwithafrequencyof 10Hz, usuallyat40j.1A for 20s. Moreover, becausemuscle tensionor weakness isrelatedtoapathological disturbancewithin motor neurons, thecervical posterior groove andtheposterior trianglewere alsostimulated.These posterior ear pointslieimmediatelybehindtheacupointsfoundonthefront surfaceof theauricle. After only3weekly sessions, JJ reporteda70%reductioninpain, asmeasuredbythevisual analog Clinicalcase studies 263 264 scale, andwasabletoreturntohispositionasanaccountantfor arestaurantchain. Whilethe alleviationof painhadbeenfairlyrapid, theimprovement inmuscular atrophywasinitiallyjust slight. Satisfactoryimprovement inmotor function required8moreweeks of auriculotherapy. TM wasa28-year-oldmalegraduatestudentwho hadbeenseverely injuredbyfaultywiringina piece of electronicequipment. A lethal jolt of electricityflowed fromthewall cordof the equipment uphisleft hand,spreadingtohisheadanddown theleft sideof hisbody. Hisshoe was completely meltedaroundhisleft foot. WhenI first sawhim, hewalkedwithalimp, dragginghis partiallyparalyzedleft leg, andhecould not fullyusethefingers of hisleft hand. Auriculotherapy treatmentof hisleft external ear includedpointscorrespondingtothehand, thearm, thelegand thebrain.Thesesessions werecontinuedfor over 3months. Thereductioninpainsensationsinhis handandtheenhancement of hismotor abilitiesandhismemorywasgradual,butsteady. Bythe last session, auriculotherapyhadassisted TM inbeingabletowritemorelegibly andwithout feeling paininhisfingers. Hislegmovementswere morefluidandhecould remember moredetails of theacademictopics hehadstudiedbeforetheaccident. Hewasbynomeanscompletely healed, astheneurological damagehehadsuffered seemed toresult inpermanentmotor dystrophy. Nonetheless, auriculotherapyhadled tofar greater improvementsthananyof hismedical doctors hadexpected. Oneof themost distinctivedemonstrationsthatI hadever witnessed of thespecificity of auriculotherapywaswiththetreatmentof a46-year-oldfemale diabeticpatientwithperipheral neuropathy.HRhadaccumulatedthreevolumes of UCLA medical recordsthatdescribed indetail her multipletreatmentsfor multipleconditionsresultingfromalifehistoryof diabetesmellitus. In additiontothesevere paininher feet, HRexperienced severe glaucoma, chronicback painand feelings of bitternessanddespair. Shehaddeveloped aratherresentful, pessimistic andhostile attitudetowardthemedical profession for failingtoprovideadequaterelief of her variedsources of discomfort. Her negativereactionstowardconventional medical treatmentsmadeitseem unlikely thatshewould respondanymorefavorablytoalternativetherapies, butauriculotherapywas recommended nonetheless. When HRenteredtheUCLA painclinic, shewalkedwithalimp, requiringtheassistance of her husband, andtherewasapronouncedscowl upon her face. After the initialinterview, shelaydownupontheexaminationtableandher external earswere scannedfor areasof decreased electrical resistance. Therewerereactivepointson her right earinauricular regions thatcorrespondedtothefeet. Theseauricularpointsfor thefoot wereelectrically stimulatedfirst (10Hz, 40fLA, 30s), followed bystimulationof themaster pointson theright ear identifiedasShen Men (10Hz,40fLA, 10s), PointZero(10Hz, 40fLA, 10s), andThalamus(80Hz, 40fLA, 20s). Within2minutesof thecompletion of thisstimulationof acupointsontheright auricle, amarkedchange appearedupon thepatient’sface. Her negativefrownswere replacedby analmost peaceful countenance. HRquietlyexclaimed thatthepaininher right foot was completely gone- for thefirst timeinover 7years. Interestingly, thepaininher left foot andon the left sideof her backwasapproximatelythesame. I twasnot until after reactivepointson theleft external earwerestimulatedthattherewasareductionof paininher left foot andleft back. Thesignificance of thisdifferential effect observed inHRwasprofound. I ftheauriculotherapy wereduetoageneral systemic effect, such asfromamorphineinjection, thepainrelief should havebeen experienced equallyinbothfeet. I fHRhadbeengiven anintravenousinjectionof morphineitwould not havetakeneffect so quicklybut would havetaken10-20minutesfor her to noticesignificant analgesia. Numerousscientific studiesinhumansandanimalsindicatethatthere isasystemic releaseof endorphinsfollowing auricularacupuncture.Localized painrelief inonly onefoot of HRsuggests thatspecific neurological reflex circuitsmoreappropriatelyaccount for thisselective actionof auriculotherapyratherthangeneral endorphinrelease. PatientHR continuedtoimproveover thenext several monthsof weekly treatments.Thepaininboth her feet graduallyreturnedtosome degree, but witheachsuccessive auriculotherapytreatmentit diminishedfor longer periodsof time. Her back painandher abilitytowalkwithoutassistancealso improved, andtherewasapronouncedenhancement of her mood. Bysession 15,therewasonly minimal recurrentpaininher feet andinteractionswithHRbecamemorepleasant. Shereported feeling optimisticabouther health, even thoughshe still suffered fromdiabetesandglaucoma. Auriculotherapyhasbeen used effectively for neuropathicpainbothfromdiabetesandfromHI V disease. JT wasa37-year-oldmandiagnosedwithAI DS andsufferingfromneuropathicpaininhis feet andlower legs for over 8months, whereasRB wasa58-year-oldmanwho hadperiodically Auriculotherapy Manual suffered fromdiabeticneuropathyaffectinghisfeet. Even thoughthesourceof their neuropathy wasverydifferent, theauriculartreatmentof theneuropathicpainwasalmost identical.For both JT andRB, reactiveear pointswere identifiedon theuppermost regionsof theauricle,which represent theChineseandEuropeanlocalizationsof theFeet. Ear acupointswere also stimulated ontheuppermost region of thehelixtail,which correspondstotheLumbarSpinal Cord. The somaticregionof theauricle, representingcontrol of themusculoskeletal tissues of thefeet, is stimulatedat 10Hz.Thehelixtail region thatrepresentsneurological spinal tissue isstimulatedat 40Hz. Higher frequencies of stimulationareused for neurological tissuethanmuscular tissue accordingtoamodel first proposed byNogier (1983). SimilartothefindingsfromMRI scans, resonantwaveforms occur at different frequencies for different types of tissue. Morerecently evolved tissue, such asthatof thenervoussystem, issaidtorespondmoreoptimallytohigher resonancefrequencies thanmoreprimitivetissue, such asmuscles andinternalorgans. Stimulationof theFoot pointsandtheLumbarSpinal Cordpointson theauriclecontributedto thecomplete eliminationof theperipheral neuralgiapaininthefeet. BothJT andRB reported maintainedrelief of their peripheral neuralgiaaftersixsessions of auriculotherapy. Herpeszoster, or shingles, isadifferent typeof neuropathicpainthatisfoundinmanyAIDS patientsaswell aspatientswithdiabetes. TP wasa32-year-oldmandiagnosedwithAI DS 5years priortomyfirst examininghim. Hewasinitiallyseen for relief of thestress andanxietyassociated withhisHI V infection. At agrouptherapysession, TP becameextremely distressed after he revealedhisHI V+status. Even thoughthegroupwasverysupportive, TP felt enormousshame andadeep sense of rejection. Thenext dayhecamedown withshingles. Theacuteinflammation of theT4dermatomeabruptlyappearedon theright sideof hischest, upper abdomenandupper back. Reactive ear pointswere found on hisantihelixbody, which representsthechest, andonthe thoracicspinal cord regionof thehelixtail. After thefirst session of auriculotherapy,not onlyhad thepainsensationsinthebodybeeneliminated,but therewasarapidreductioninthebumpy swellingandrednessof theskin. After 2furtherweekly auriculotherapysessions, therewasno furtherpresenceof theherpesreaction. An almost identical responsewasexhibitedbyEO, a76-year-oldwomanwho becameaffected by shingles asareactiontoher antihypertensivemedication. Theherpeszoster affected theLl dermatomeon her right side, manifestedbyblotchy red hypersensitive skin. Shewasgiven bipolar auricularstimulation(10Hz,40/-LA, 60s) totheantihelixcrusandantihelixbody regions, which represent themusculoskeletal tissueof thelower spine, andfaster frequency auricularstimulation (40Hz, 40/-LA, 60s) tothelumbarspinal cord region foundon theupper helixtail. Monopolar electrodes were also held oneachsideof thedermatomalzonethatwasinflamed. Lowfrequency stimulationwasappliedacross theskinof thebody for afurther 10minutes. Therewasagradual lessening of heightened sensitivity, andafter 2daysher blotchy redskin hadalmost completely returnedtonormal. Combiningbody stimulationwithauriculotherapyisaveryeffective procedurefor treatingbothneuropathiesandneuralgia. Several case studieson theeffect of auriculotherapyfor healinglegwoundswere reportedbyFred Swingat the 1999I nternationalConsensus ConferenceonAcupuncture, Auriculotherapy, and Auricular Medicine(lCCAAAM). JC wasa68-year-oldmaleadmittedtoaTexashospital for sepsis, pneumoniaandmultiplelargeulcersonbothlower legs. Becauseof thesensitivity of the woundson thepatient’slegs, onlyear acupuncturewasallowed. Thedayafter auriculotherapy, increasedpresence of fluidsandredness inthewoundareaswasobserved bytheattendingnurse, thefeet werewarmer, andthepatientreportedgreater sensationsinhislower legs. Auriculotherapyandtraditionalwoundcaretreatmentwere continuedfor thenext 4months. After 50eartreatments,theright legwascompletely healedandtheleft legwassufficiently improvedtopermitsuccessful skingrafting. Theear acupointsfor theLeg, Shen Men, SympatheticAutonomic, Lungs, andpointsfor dermatological disorderswere activatedbyboth needles aloneandbyelectrical stimulation.Sincewoundhealingrequiressufficient oxygen and body nutrientsdelivered tothewoundsite, auriculotherapycan improvevasodilationof thesmall arteriolesthatlead todelivery of oxygen tothelower legs. Thetotal numberof pointstreatedineachclinical case canvaryfrom5-10ear points, depending uponhowmanyanatomicandmaster pointsarestimulated.Thewholeauricleisfirst examined withapointlocator, oftenrevealingmorethan20reactiveear points. Onlythemost electrically conductiveandmost tenderof thepointsthatspecifically correspondtothepatient’scomplaints arefinallyused. Withtranscutaneouselectrical nervestimulationon theauricle, eachpointis stimulatedwith20-40/-LAs for only 10-30s. Thepractitionerthenmoves ontothenext point. Clinical case studies 265 266 Needles insertedintotheselected ear pointsareleft inplacefor approximately20minutes, similar tobody acupuncture.Treatmentsareoffered twiceaweek for several weeks andthenspaced out to once aweek for several moreweeks until thereissatisfactoryimprovement insymptoms. Both practitionersandpatientscontinuetobeamazedthatthesedifferent sites on theearcanhavesuch aprofoundpainrelievingeffect oncomplaintsfromother partsof thebody. 8.5 Weight control An intriguingpotential of auricularacupuncturehasbeenitsclinical applicationinweight control. Clinical studiesdemonstratingthevalueof auricularacupuncturefor thetreatmentof obesity date back tothe 1970s(Cox 1975;Giller 1975).Sun& Xu (1993) treatedobesity patientswith otoacupointstimulation,anothertermfor ear acupressure. All patientswere alsogiven body acupuncturefor the3-monthperiodof thestudy. Theacupuncturegroupconsisted of 110patients diagnosedas20%or moreaboveideal weight. They werecomparedto51obesity patientsina control groupgiven anoral medicationfor weight control. An electrical pointfinder wasused to determinethefollowing auricularpoints: Mouth, Esophagus, Stomach, Abdomen, Hunger, Shen Men, LungandEndocrine. Pressurepelletsmadefromvaccariaseeds were appliedtothe appropriatepointsof bothears. Body acupuncturepointsneedledincludedST 25, ST 36,ST 40, SP 6, andPC6. Theacupuncturegroupexhibitedanaveragereductioninbodyweight of 5kg, whichwassignificantlygreater thantheaverage2kgreductionof bodyweight measuredinthe control group. Thepercentageof bodyfat wasreducedby3%intheacupuncturegroupandby 1.54%inthecontrol group, whilethetriglyceridebloodlipidlevels were diminished67unitsinthe acupuncturegroupand38unitsinthecontrol group. A randomizedcontrolledtrial byRichards& Marley(1998) alsofoundthatweight loss was significantlygreater for women inanauricularacupuncturegroupthaninacontrol group. Women intheauriculargroupwere given surfaceelectrical stimulationtotheear acupointsfor Stomach andShen Men, whereaswomen inthecontrol groupweregiven transcutaneouselectrical stimulationtothefirstjointof thethumb.Auricularacupuncturewastheorizedtosuppress appetitebystimulatingtheauricularbranchof thevagal nerveandbyraisingserotoninlevels, both of which increasesmooth muscle toneinthegastricwall. Rather thanexaminechanges inweight measurements, Choy & Eidenschenk (1998) examinedtheeffect of tragusclipsongastric peristalsisin13volunteers. Thedurationof singleperistalticwaveswasmeasuredbeforeandafter theapplicationof ear clips tothetragus. Thefrequency of peristalsiswasreducedbyonethirdwith clipsontheear andwasreturnedtonormal levels withclips off. Theearclipswere saidtoproduce inhibitionof vagal nerveactivity, leadingtoadelayof gastricemptying, whichwouldthenlead toa sense of fullness andearlysatiety. Theseobesity studieson humansubjects havereceived potential validationfromneurophysiological researchinanimals. Clinical observationsbyNiemtzow(1998) showed thatbloodassays in42patientssufferingfrom obesity showed asignificant decreaseinphysiological measuresof lipidlevels aswell assignificant reductionsinphysical weight. Thepatientswererequiredtomaintainahigh proteindiet whilethey werereceivingtheweekly auricularacupuncturetreatments.Needles were insertedintothe followingear points: AppetiteControl, Shen Men, PointZero, andTranquilizer.Theneedles were held inbothearsfor aperiodof 15minutes. Over a12-week period, meanweight decreased significantlyfrom206poundsto187pounds, triglycerides changedsignificantly aswell, andthere wasamarkedbut statisticallysignificant reductionintotal cholesterol. Patientinterviews conductedafter thestudywascompleted suggested thatcomparedtoother timeswhen attempting todiet, auriculotherapyseemed tohelp themfeel morecomfortablewhiletheywere tryingto disciplinethemselves intheireating. 8.6 NADA addiction protocol Oneof thefastest growingapplicationsof auriculotherapyinthehealthcarefieldistheuseof ear acupuncturepointsfor thetreatmentof variousaddictions.TheNationalDetoxificationand AddictionAssociation (NADA) wasfoundeduponthepioneeringworkof Dr HL Wenof Hong Kongandtheearlyapplicationof thisprocedurebyDr Michael Smithof NewYork City. Wen (Wen& Cheung1973,Wen1977)foundthatplacingoneneedleintheLungpointalonewas sufficient towithdrawaheroinaddictfromhisaddiction,but healsoneedledtheShen Men pointto producegeneral calming. DrMichael Smith(Smith1979,1990;Smithet al. 1982)developed a 5-pointprotocol for substanceabuserecovery thatincludedtheLung, Shen Men, Sympathetic Autonomic, KidneyandLiver pointsontheear. NADA wasformed in1985(Brewingtonet al. 1994) Auriculotherapy Manual toalloworganizationandtrainingopportunitybeyondthatoffered bySmithatLincolnHospital. Thefirstopenmeetingof NADA washeldinWashingtonDCandtheNADA boardwasformed. Thefirst NADA conference occurredinMiami in1990becausemanypeoplewereinterestedin seeing theDrugCourtthathadbeendeveloped inMiami in1989.Similar drugcourtsthat incorporatereferral toNADA practitionershavenowbeendeveloped inmanyother states. NADA’s official websiteishttp://www.acudetox.com. Controlledclinical trialshaveshown thatthefiveear pointsused intheNADA protocol areeffective inthetreatmentof alcoholism(Bullock et al. 1989), cocaine addiction(Margolinet al. 1993a,1993b),andmorphinewithdrawal(Yang& Kwok 1986). ToobtaintrainingandcertificationinNADA, thereisa70-hourcourse. Thistrainingincludes30 didactichoursof instructionand40clinical hoursworkingwithclients. Trainingalso includes attendanceat 12-step meetings. Greatemphasisisplacedon clinical experienceso thatNADA practitionerscanbecome comfortableworkingwithanaddictpopulation.At Lincoln Recovery Center, most traineesarechemical dependency counselors. They spendmuchof theirtimegetting comfortablewithdoingacupunctureasaphysical procedure. Studentslearnaboutthe’yinnature of theNADA atmosphere,’ which isintendedtobesupportiveandnon-confrontational.For acupuncturists,thetrainingcovers definitionsof addictionandmental healthtreatments.They are instructedtospeak thesamelanguageasthechemical dependency counselors, thecriminaljustice system, andmedical professionals inthoseenvironments. Oneof themost importantlessons thatbothacupuncturistsandcounselors havetolearnistobe quietandlet theacupunctureneedles do thework. Bothgroupsareused tospendingtimetalking toevaluatepatientprogress. TheNADA protocol encourages anon-verbal approachtotreatment. Substanceabusersoftenfeel shame, guilt, anger or other issues thatthey donot knowhowtocope withverbally. Withoutacupuncture,theonlytherapyavailableistalktherapy, either individually or inagroupsetting. NADA trainingalso includeslearningaboutvariousdrugs, their pharmacological effects andvarioustypes of settingintowhich acupuncturehasbeenintegrated. As agrassrootsmovement, most NADA programswerestartedbecausedoorswere knocked on andadministratorswere convinced of thevalue. Over 4000practitionersthroughouttheworld havebeentaughtthisprotocol for thetreatmentof varioustypes of substanceabuse. 8.7 Alternative addiction protocols Whilethe5-pointNADA protocol hasbecome themost commonly employed treatmentprogramin theUnitedStates, itisnottheonlyauriculotherapyproceduretobedeveloped. Theearpointsused for NADA treatmentareprincipallybasedonChineseearcharts, but additionalauricularpointsfor addictionhavebeenderivedfromEuropeantreatmentplans. Orientalmedicinefocuses uponthe useof theauricularLungpointfor detoxification, theKidney pointfor yindeficiency, andtheLiver pointfor nourishment.TheShen Men andSympatheticAutonomicpointsareintendedtoalleviate psychological distress andimbalanceof spirit. Europeanpractitionersof auricularmedicinefocus upontreatingearpointsthatactivatetheNogier vascular autonomicsignal (N-VAS). Repeated experiencewithmanysubstanceabusepatientshasled tothediscovery of earpointsadditionalto those developed atLincolnHospital. DrsJayHolder (Holder et al. 2001) andKennethBlum (Blumet al. 2000)wereinstrumentalindevelopingtheAmerican College of Addictionology and CompulsiveDisorders(ACACD) basedinMiami Beach, Florida.TheACACD protocol includesa total of sixauricularpoints: PointZero, Shen Men, SympatheticAutonomic, Kidney, Brain, and LimbicSystem. Twoaddictionaxislineswereemphasizedthatconnect thesedifferenttreatment points. A primaryaxiscouldbeverticallydrawnbetween theShen Men, Kidney, PointZero, and Brainpoints, whereasasecondaryaxislinecould beindicatedwhichconnected theSympathetic AutonomicpointandLimbicpoint.TheACACD approachemphasizes thatonlyreactiveearpoints aretobestimulated.Therehasbeennocontrolledscientific researchtoverifywhether theNADA protocol or theACACD treatmentismoreeffective inworkingwithaddicts. Whilesmokingcessation hasbeen treatedfrequentlywithear pointsLungandShenMen (Regrena et al. 1980),other ear pointshavealsobeensuccessful (Oleson 1995). 8.8 International ConsensusConference on Acupuncture, Auriculotherapy, and Auricular Medicine (ICCAAAM) In1999,notedauthoritiesinthefieldof auricularacupuncturefromChina,EuropeandAmerica weregatheredinUnitedStatestoarriveat aconsensus on internationalperspectives of auriculotherapy.Fortyspeakerswithprofessional expertiseinthefield discussed varying Clinical casestudies 267 268 Box 8.1 Survey of professional opinions on auriculotherapy % ~ ~ ~ ~ ~ _ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Conditionsbettertreatedwithauriculotherapythanbodyacupuncture Smoking cessation 68 Substance abuse 53 Weight control 53 Anxiety 43 Nausea 38 Insomnia 38 Depression 35 Allergies 35 Musculoskeletal pain 28 Attention deficit disorder 25 Neck and shoulder tension 25 Conditionsnot effectively treatedwithauriculotherapy AIDSand HIVdisease 45 Cancer or tumors 43 Schizophrenia 38 Nerve impairment 35 Strokes 33 Spinal spurs 30 Deteriorated disks 28 viewpoints beforeanaudienceof over 400attendeesat theI CCAAAM meetinginLasVegas, Nevada. RepresentativesfromChina, J apan,France, Germany, Belgium, Holland, Israel, Canada andtheUnitedStatesdiscussed bothOrientalandWesternapproachestotheauricular microsystem andauricularacupuncturetreatments.Participantsat thisconferencewere asked to complete asurveyof their experiencewithauriculotherapyandtocomment on different theoretical perspectives of thisprocedure. A summaryof some of theseresultsispresentedin Box8.1.Otherpartsof thisconsensus questionnairearedescribed inthetext thatfollows. A total samplesizeof 42professionalscompleted the100items on thequestionnaire.Therewere24males and18females, withameanageof 50.2years. Theirmeannumberof years of auriculotherapy practicewaslOA years. Thedataarepresentedaspercentagescores. Themajorityof respondents, 70%, felt thatauriculotherapycould becombinedwithbody acupunctureor used alone, whereas20%of thesurveyparticipantsthought itwasbetter to combineauriculotherapywithbodyacupunctureinmost circumstances. Most of thepractitioners, 45%, felt thatauricularstimulationproducedfaster painrelief thanbody acupuncture,andan equal numberof respondentsbelieved thatthelongtermbenefitsof auriculotherapywereequal to bodyacupuncture.Most healthconditionswerethought tobealleviatedwithinthreetofive sessions of auriculotherapy,withtreatmentsessions typicallyonevisit per week. Theusual durationof anauriculotherapysession wassaidtolast 21to30minutes. Themost common fee for such sessions wasthought tobe$40to$55.Electrical pointlocatorswerethought toprovidethe most accurateprocedurefor findingreactiveauricularpointsby73%of theprofessionals, whereas 20%statedthatuseof theN-VAS isthemost accuratemeansfor conductingauriculardiagnosis. Orientalpulsediagnosis wasused by45%of thesurveyed practitionersandwasseen tobea valuablecomplement toauriculardiagnosis. A majority(53%) of respondentsbelieved thatthe auricularmicrosystem interactswiththemacro-acupuncturemeridiansof classical Chinese medicine, and63%believed thatthereisaninvisibleenergy such asqi thatisaffected by auriculotherapy.At thesame time, 63%of theprofessionals believed thattheeffectiveness of auricularpointsisduetotheirconnectionstocentral nervoussystem pathwaysand65%thought that theinvertedfetus patternontheear isconnected tothesomatotopicorganizationof thebrain. Auriculotherapy Manual Box8.2 Conditionssuccessfully treatedbycertifiedprofessionals inthe AuriculotherapyCertificationI nstitute Health condition Chronic pain Back pain, sciatica, hippain Pain inleg, arm,wrist, elbow, knee, foot Neck andshoulder pain Migraines andtension headaches Dental pain,TMJ, teeth, gums, facial tics Fibromyalgia, general body aches Osteoarthritis or rheumatoid arthritis Neuropathy, peripheral neuralgia, shingles Cancer pain Substance abuse Smoking cessation Obesity, weight reduction, anorexia Alcohol abuse Cocaine, methamphetamine abuse Heroin,morphineabuse Psychological disorders Anxiety or stress Sleep disorders, insomnia Depression, mood disorders Chronicfatiguesyndrome Attention deficit disorder, dyslexia Childhood problems, bedwetting I nternal organ disorders Asthma, bronchitis, sinusitis, hiccups, coughing Allergies, common cold, flu,sore throat Dysmenorrhea, PMS, menopausal problems Gastrointestinal pain,constipation, diarrhea Nausea, vomiting, stomach cramps Kidney, bladder or prostate problems Coronary disorder, angina, cardiac arrhythmias Hypertension, blood pressure problems Infertility,labor, postpartum pain AIDS, HIVdisease Sexual dysfunctions, impotency Liverdisease, gall bladder, appendicitis Neurological disorders Sensorineural deafness, tinnitus, vertigo Dermatological, skindisorders Visual impairment, eye disorder Epilepsy, palsy, Parkinson’s, motor tremors Stroke, head injury,muscular dystrophy, polio Olfactory disorders, drymouth Clinical casestudies Number of cases 216 174 155 76 42 36 12 11 10 51 26 10 8 5 62 48 24 17 6 5 54 46 28 28 19 16 13 9 6 6 5 5 45 26 9 6 6 5 269 270 8.9 Auriculotherapy Certification Institute (ACI) An internationalnon-profitorganizationfor trainingandcertifyingpractitionersof auriculotherapywasestablishedinLos Angeles, Californiain1999.Thewebsite isat www.auriculotherapy.org. As partof thecertificationrequirements, applicantsareaskedto describe20clinical cases inwhichthey haveused auriculotherapyor auricularacupuncture.The most common conditionswhich 16different practitionersreportedthatthey havesuccessfully treatedarepresentedinBox8.2. Inmost cases, effective alleviationof thehealthconditionwas achieved withinfiveauriculotherapysessions. Themost common conditionsthatweretreated wereback pain, painintheextremities, andneck andshoulder pain. Headaches, smoking cessation, stress, anxiety, andrespiratorydifficultieswerethenext most frequentlytreated problems. Therewereanumberof other disordersthatwereseen less frequently, butstill could be effectively treatedbyauriculotherapy.Applicantsfor certificationalso needtopass awrittenexam whichcovers academicknowledge of auricularanatomyandthelocationandfunctionof different earacupointsused intheChineseandEuropeanschools of auriculotherapy.A practicumexam withanACI certifiedprofessional isgiven todeterminethehands-oncapabilityof theapplicant. All individualswhofulfil therequirementsof certificationarelisted on theACI website. Auriculotherapy Manual I I Auriculotherapy treatment protocols CONTENTS 9.1 Addictivebehaviorsanddrugdetoxification 9.2 Acuteandchronicpaininupper and lower limbs 9.3 Backpainandbodyaches 9.4 Headandneck pain 9.5 Dental pain 9.6 Neurological disorders 9.7 Stress-relateddisorders 9.8 Psychological disorders 9.9 Eyesight disorders 9.10 Hearingdisorders 9.11 Noseandthroatdisorders 9.12 Skinandhairdisorders 9.13 Heartandcirculatorydisorders 9.14 Lungandrespiratorydisorders 9.15 Gastrointestinalanddigestivedisorders 9.16 Kidneyandurinarydisorders 9.17 Abdominal organdisorders 9.18 Gynecological andmenstrual disorders 9.19 Glandulardisordersandsexual dysfunctions 9.20 Illnesses, inflammationsandallergies Standard treatment plans: Thefollowing treatmentplansindicatethoseearreflex pointsthathave previouslybeenused for effective treatmentof thathealthcondition.Thisselection of earpointswas originallyderivedfromtreatmentplansdeveloped inChina,butwasmodifiedbyauriculotherapy discoveries inEurope. Practitionersof auricularacupunctureshouldnottreattheentireearpoints listed for agiven disorder. Onlystimulatethosereactiveearpointswhich areappropriatefor that patient’ssymptoms andunderlyingconditions. Consider theearpointslisted for eachtreatmentplan asguidelines, not definiterequirementsthatmust berigidlyfollowed. Moreover, somepatientsmay haveother earpointsneedingtreatmentthatarenot listedon thesepages. Earpointsfor eachplan aredesignatedbyoneof thefollowing twocategories: primaryearpointsandsupplementalearpoints. Primary ear pointsaretheinitialset of pointson theauriclelisted immediatelyunderthenameof the treatmentof adisorder inaparticularbodyorganor aspecific physiological dysfunction. Primaryear pointsfor agiven conditionareindicatedon theearchartsbyunderlining. Supplemental pointsarethoseareasof theearfor alternativetreatmentof agiven conditionor for facilitationof theactionof theprimaryear points. Reactive ear reflexpoints: For all of thetreatmentplanslisted, thepractitionershouldlimit the treatmenttothoseauricularpointsthataremost reactive, asindicatedbyincreasedskin conductance or heightened tendernesstoappliedpressure. I fapointwhich islisted intheseplansisneither electrically reactivenor tendertotouch, thenitshouldnot beincludedinthetreatmentplan. Treatment protocols 271 272 9.1 Addictive behaviors and drug detoxification (Figure9.1) 9.1.1 Alcoholism Primary: Alcoholic point, Liver, Lung1, Lung2, Brain,Occiput, Forehead, Kidney.C, Point Zero, ShenMen, Lesser Occipital nerve. Supplemental: Thirstpoint, SympatheticAutonomicpoint, Endocrinepoint,Tranquilizerpoint, Master Cerebral, Master Oscillation, LimbicSystem, Aggressivity, Antidepressant point. 9.1.2 Drug addiction, drug detoxification, substance abuse Primary: Lung1,Lung2, Shen Men, SympatheticAutonomicpoint, Liver, Kidney.C, Brain. Supplemental: Occiput, Adrenal Gland.C,LimbicSystem. 9.1.3 Nervous drinking Primary: Alcoholic point,Thirst point, Kidney.C, Brain,Shen Men, SympatheticAutonomicpoint, PointZero, Endocrinepoint, Thalamuspoint, Master Cerebral,Tranquilizerpoint, Nervousness. 9.1.4 Smoking cessation Primary: Nicotinepoint, Lung1,Lung2, Mouth, PointZero, ShenMen, SympatheticAutonomic point, Brain. (ElectricallytreatLungpointsat80Hzfor 2minutes, or needlefor 20minutes.) Supplemental: Adrenal Gland.C,Aggressivity, Limbic System. 9.1.5 Weight control Primary: AppetiteControl, Stomach, Mouth, Esophagus, Small I ntestines, Shen Men, PointZero. Supplemental: Thalamuspoint, Master Sensorial, Master Cerebral, Endocrinepoint, Antidepressant point,Adrenal Gland.C,Brain, SanJ iao. AuriculotherapyManual Shen Men Brain Smoking cessation Mouth Adrenal Gland.C Nicotine point Point Zero Limbic _ System Sympathetic Autonomic point Aggressivity----+--=:u NADA addiction protocol Sympathetic Autonomic point Lung Liver Kidney.C Shen Men Addiction axis lines Weight control Shen Men Kidney.C Primary axis I Secondary axis Sympathetic Autonomic point Small Intestines Point Zero Mouth Esophagus Appetite Control Adrenal Gland.C San Jiao Endocrine point Master Cerebral Shen Men Stomach Occiput Antidepressant point Thalamus point Master Sensorial Figure 9.1 Addictive behaviors and drug detoxification treatment protocols. Treatment protocols 273 274 9.2 Acute andchronic pain inupperandlower limbs (Figures9.2and9.3) Corresponding body area Thisphrasereferstoear reflex pointsfor thehip, knee, ankle, heel, toes, shoulder, elbow, wrist, handor fingerswhichcorrespondtothepartof theactual bodywhere thepatientexperiences some pain, pathology, tensionor weakness. I fthereisonlylimited treatmentsuccess for relievingtheprobleminaparticularlimb, thepractitionershouldstimulate PhaseII andPhaseIII pointsandalsoexaminefor obstacles, toxicscars anddental foci. 9.2.1 Bone fracture Primary: Correspondingbodyarea,Shen Men, Kidney.C, Adrenal Gland.C, ParathyroidGland. 9.2.2 Dislocated joint Primary: Correspondingbodyarea,Shen Men, Thalamuspoint, Adrenal Gland.C,Liver, Spleen.C. 9.2.3 Joint inflammation,jointswelling Primary: Correspondingbody area, Endocrinepoint, Kidney.C, Adrenal Gland.C,Point Zero, ShenMen. Supplemental: Allergy point,Apex of Ear,Apex of Tragus, Omega2, Helix1,Helix 2, Helix3, Helix4, Helix5, Helix6, Occiput, Prostaglandin1,Prostaglandin2. 9.2.4 Muscular atrophy, muscular dystrophy, motorparalysis Primary: Correspondingbodyarea, Spinal Motor Neurons, FrontalCortex, Cerebellum, Spleen.C, ParathyroidGland. 9.2.5 Muscle spasms, muscle tension, muscle cramp Primary: Correspondingbodyarea, Muscle Relaxationpoint,Thalamuspoint, PointZero, Shen Men. 9.2.6 Muscle sprain, sports injuries Primary: Correspondingbodyarea, Heatpoint, PointZero, Shen Men, Thalamuspoint, Adrenal Gland.C,Liver, Spleen.C, Kidney.C. 9.2.7 Peripheral neuralgia Primary: Correspondingbodyarea, Spinal Sensory Neurons, Thalamuspoint,PointZero, ShenMen. Supplemental: Brain,Sympatheticchain,Adrenal Gland.C,Master Sensorial. 9.2.8 Shoulder pain, frozen shoulder, bursitis Primary: Shoulder, Shoulder PhaseII, Master Shoulder, Clavicle.C, Clavicle.E, Cervical Spine, ThoracicSpine. Supplemental: Point Zero, Shen Men, Thalamuspoint, Muscle Relaxationpoint,Adrenal Gland.C,Kidney.C, Lesser Occipital nerve. 9.2.9 Tennis elbow Primary: Elbow PhaseI, ElbowPhaseII, Elbow PhaseIII, Forearm,Arm, ThoracicSpine, Point Zero, Shen Men, Thalamuspoint, Muscle Relaxationpoint,Adrenal Gland.C,Kidney.C, Occiput. 9.2.10 Carpal tunnel syndrome, wrist pain Primary: WristPhaseI, WristPhaseII, WristPhaseIII, Forearm,Hand,ThoracicSpine, Point Zero, Shen Men, Thalamuspoint. AuriculotherapyManual Shen Me Shen Me PointZer Muscle Relaxation Adrenal Gland.C Shoulder pain Kidney.C Lesser Occipital nerve Thoracic Spine Clavicle.E Shoulder ’r-r--/----I -._ Cervical Spine Master Shoulder Clavicle.C Thalamus point Hand and fingers PointZer Muscle Relaxation Adrenal Gland.C Elbow and wrist pain Wrist.F2 Wrist.F1 Elbow.F1 ~ k . r Thoracic Spine Arm Occiput Thalamus point Elbow.F3 Wrist.F3 Posterior armpoints Shen Men Fingers.F1 Hand.F4 Wrist.F4 Elbow.F4 Arm.F4 ---f--- Thoracic Spine.F4 Shoulder.F4 Figure 9.2 Upper limb treatment protocols. Treatment protocols 275 Hippain Knee pain Shen Men Kidney.C ... PointZero Muscle --t-....... Relaxation Lumbar Spine Knee.E PointZero Muscle Relaxation Adrenal ---1-_.1>" Gland.C Knee.F2 Thalamus point Knee.C1 Shen Men Knee.C2 Kidney.C Thalamus point Knee.F3 Posterior leg points Foot.C 4 Lumbar Spine.F4 Ankle.F4 Hip.C4 -+----n Lumbar Spinal Motor Neurons Knee.C4 Ankle.F3 Shen men Ankle.C --:r-+-I---- Toes .F2 Foot and ankle Kidney.C PointZero Thalamus point Muscle Relaxation Figure 9.3 Lower limb treatment protocols. 276 Auriculotherapy Manual 9.3 Back pain andbodyaches (Figure9.4) 9.3.1 Abdominal pain, pelvic pain Primary: Abdomen, Pelvis, Vagusnerve, SympatheticAutonomicpoint, Shen Men, Point Zero. 9.3.2 Amyotrophic lateralsclerosis Primary: Correspondingbodyarea, Spinal Motor Neurons, MedullaOblongata,Brain, Brainstem, Shen Men, Point Zero, SympatheticAutonomicpoint, Endocrinepoint, Occiput, Kidney.C, SanJiao. 9.3.3 Back pain Primary: ThoracicSpine, Lumbosacral Spine, Buttocks, Sciaticnerve, Lumbago, LumbarSpine PhaseII on concharidge, LumbarSpinePhaseIII on tragus, PointZero, Shen Men, Thalamus point. Supplemental: Darwin’spoint, Muscle Relaxationpoint, Liver, Bladder,Adrenal Gland.C. 9.3.4 Fibromyalgia Primary: ThoracicSpine, Lumbosacral Spine, Muscle Relaxationpoint,Antidepressant point, Psychosomatic Reactions 1, PointZero, Shen Men, Thalamuspoint. Supplemental: Abdomen, Kidney.C, Sympatheticchain, Master Oscillationpoint, Vitalitypoint, Tranquilizerpoint. 9.3.5 Intercostal neuralgia Primary: Chest, ThoracicSpine, ThoracicSpinal Cord, PointZero, ShenMen, Thalamuspoint. Supplemental: Occiput, Liver, Gall Bladder,Lung1, Lung2. 9.3.6 Osteoarthritis, osteoporosis Primary: Correspondingbodyarea, ParathyroidGland,Parathyrotropin,PointZero, Shen Men. Supplemental: Endocrinepoint,Adrenal Gland.C,Adrenal Gland.E,ACTH, Omega2,Allergy point, Apex of Ear. 9.3.7 Rheumatoid arthritis Primary: Correspondingbodyarea, Omega2,Prostaglandin1, Prostaglandin2,Allergy point, Adrenal Gland.C,PointZero, Shen Men, Thalamuspoint,Endocrinepoint. Supplemental: Master Oscillationpoint, Kidney.C, Spleen.C, Occiput, SanJiao, Apex of Ear, Helix1, Helix2, Helix3, Helix4, Helix5, Helix6. 9.3.8 Sciatica Primary: Sciaticnerve, Buttocks, Lumbago, LumbarSpine, Hip.C, Hip.E, Thigh, Calf, Point Zero, Shen Men, Thalamuspoint,Adrenal Gland.C,Kidney.C, Bladder. Supplemental: Tranquilizerpoint. 9.3.9 Sedation Primary: Tranquilizerpoint, Point Zero, Shen Men, Thalamuspoint, Forehead, Occiput, Master Cerebral, Heart.C,Kidney.C. 9.3.10 Surgical anesthesia Primary: Chest, Abdomen, Stomach, Lung1, Lung2, Point Zero, ShenMen, Thalamuspoint, Occiput, External Genitals.C. Treatment protocols 277 Point Zero Muscle Relaxation ShenMen Sympathetic chain Antidepressant point Abdomen \.:""--_-+--I --j’-Thoracic Spine Fibromyalgia SacralSpine LumbarSpine Darwin’s point Kidney.C Vitality point Master--› Muscle Oscillation RelaxationThalamus I’oint Thalamus point Back painandsciatica Shenmen Hip.C Buttocks Lumbago Abdomen Calf SacralSpine Sciaticnerve LumbarSpine Bladder Kidney.C ThoracicSpine PointZero Adrenal Gland.C Tranquilizer point Rheumatoidarthritis Osteoarthritis Fingers Wrist Adrenal Gland.E ,.""I-----.L Elbow ;.... Parathyroid Gland Apex of Ear Omega2 Knee.E ShenMen PointZero Parathyrotropin_-v....., Kidney.C Master Spleen.C Oscillation Adrenal Gland.C ACTH o Prostaglandin2 Allergy point ShenMen Adrenal Gland.C Apex of Ear Omega 2 PointZero SanJiao Endocrine point Thalamus point Prostaglandin1 Master Oscillation Helix 6 Figure9.4 Back pain and body aches treatment protocols. 278 AuriculotherapyManual 9.4 Headand neck pain (Figures9.5and9.6) 9.4.1 Facial nerve spasms Primary: Trigeminal Nucleus, Facial nerve, Face, Occiput, Temples, Forehead, Liver, PointZero, Shen Men, Thalamuspoint, Master Sensorial, Cervical Spine, Lesser Occipital nerve, Stomach. Supplemental: Muscle Relaxation,Adrenal Gland.C,Master Cerebral,Tranquilizerpoint. 9.4.2 Facial paralysis Primary: Trigeminal Nucleus, Face, Occiput, PointZero, Shen Men, Thalamuspoint, Lesser Occipital nerve, Liver, ParathyroidGland. Supplemental: Muscle Relaxation,Adrenal Gland.C,Master Cerebral,Tranquilizerpoint. 9.4.3 Migraine headaches Primary: Temples, Lesser Occipital nerve, Vagusnerve, Shen Men, Kidney.C, Thalamuspoint, Cervical Spine. Supplemental: SympatheticAutonomicpoint, PointZero, Tranquilizerpoint, Master Oscillation, Master Sensorial, Master Cerebral, Muscle Relaxation. 9.4.4 Sinusitis Primary: I nnerNose, FrontalSinus, Forehead, Occiput, Point Zero, Shen Men, Adrenal Gland.C. Supplemental: ACTH, Adrenal Gland.E,Asthma, Antihistamine,Allergy point. 9.4.5 Tension headaches Primary: Occiput, Forehead, Cervical Spine, Point Zero, Shen Men, Thalamuspoint, Shoulder, Master Shoulder, Tranquilizerpoint, Master Cerebral, Muscle Relaxation, Psychosomatic Reactions. 9.4.6 Temporomandibular joint (TMJ) dysfunction and bruxism Primary: TMJ , Upper Jaw, Lower Jaw, Cervical Spine, Trigeminal nerve, Occiput. Supplemental: Master Cerebral, Point Zero, Shen Men, Thalamuspoint, Master Sensorial, San Jiao, Muscle Relaxation, Psychosomatic Reactions. 9.4.7 Torticollis, neck strain Primary: Cervical Spine, Neck, Occiput, Clavicle.C, Clavicle.E, PointZero, Shen Men. Supplemental: Thalamuspoint, Endocrinepoint, Trigeminal Nucleus, MuscleRelaxation. 9.4.8 Whiplash Primary: Neck, Cervical Spine, Clavicle.C, Clavicle.E, Shoulder, PointZero, Shen Men. Supplemental: Muscle Relaxation, Thalamuspoint, Master Cerebral. Treatment protocols 279 Tensionheadaches Migraineheadaches MasterCerebral Forehead Muscle Relaxation Kidney.C ShenMen Lesser Occipital nerve MasterSensorial Thalamuspoint Cervical 1,--...1 ,L-..I --r- Spine Vag\Jd nerve Master Oscillation Tranquilizer_ .... ,--..1 point ShenMen Sympathetic Autonomic point Cervical Spine Master Shoulder Occiput Master Cerebral Muscle Relaxation Tranquilizer point Thalamus point Facialparalysisor facial nervespasms Posterior ear pointsfor facial nerve ShenMen PointZero Muscle Relaxation Adrenal Gland.C ParathyroidGland Tranquilizerpoint Thalamuspoint Forehead MasterCerebral Lesser Occipital nerve Stomach :L_-+--+-r- Liver ...II. 11---1----,1----1-- CervicaI Spine Occiput Temples Facialnerve, lJ:.igeminal Nucleus Face MasterSensorial Facial._+-__ nerve Wgeminal Nucleus Shoulder Cervical Spine Occiput Forehead Figure9.5 Head andface pain treatment protocols. 280 Auriculotherapy Manual TMJ dysfunction andbruxism Torticollis andneck strain Clavicle.E Neck Clavicle.C CervicalSpine __ Trigeminal Nucleus Thalamus----1r----f--JL--llII---""----› point Endocrine point MasterSensorial TMJ Lower Jaw UpperJaw Irigeminal nerve PointZero ShenMen SanJiao Thalamus point Muscle Relaxation Psychosomatic Reactions1 MasterCerebral Whiplash Posterior ear pointsfor neck andjawpain Shoulder Cervical Spine \ __ OcciRut Fadal -+_---1 nerve Trigeminal Nucleus Shoulder Clavicle.E CervicalSpine Neck Clavicle.C PointZero ShenMen Muscle Relaxation--+-.....----4f’j Thalamus Point MasterCerebral Figure9.6 TMJ and neck pain treatment protocols. Treatment protocols 281 282 9.5 Dental pain (Figure9.7) 9.5.1 Dental Analgesia Primary: DentalAnalgesia 1,DentalAnalgesia 2, Upper Jaw, Lower Jaw, Toothache1, Toothache2, Toothache3, Trigeminal nerve. Supplemental: TMJ , PointZero, Shen Men, Thalamuspoint,Tranquilizerpoint, Stomach, Master Sensorial, Occiput, Kidney.C. 9.5.2 Dental surgery Primary: Upper Jaw, Lower Jaw, Toothache1,Toothache2, Toothache3, Trigeminal nerve, Point Zero, Shen Men, Palate. 9.5.3 Drymouth Primary: SalivaryGland.C,SalivaryGland.E,Thirstpoint, Mouth, Posterior pituitary,Point Zero, Shen Men, SympatheticAutonomicpoint. 9.5.4 Gingivitis, periodontitis, gum disease, bleeding of gums Primary: Upper Jaw, Lower Jaw, Mouth, Palate,Adrenal Gland.C. Supplemental: PointZero, Shen Men, Kidney.C, Spleen.C, Diaphragm,Stomach, Large I ntestines. 9.5.5 Mouth ulcer Primary: Mouth, Tongue.C, Tongue.E, Face, PointZero, ShenMen. 9.5.6 Toothache Primary: Toothache1,Toothache2, Toothache3, Upper Jaw, Lower Jaw, Dental Analgesia 1, DentalAnalgesia 2,Trigeminal nerve, Shen Men. Supplemental: Occiput, Kidney.C, PointZero, Cervical Spine, Master Sensorial. 9.5.7 Trigeminal neuralgia, facial neuralgia Primary: Trigeminal nerve, Face, Upper Jaw, Lower Jaw, Mouth, Occiput, Shen Men, SanJiao. Supplemental: Point Zero, Thalamuspoint, Master Sensorial, Master Cerebral, Temples, Shoulder, Brainstem, Liver, Lesser Occipital nerve, Master Oscillation, WindStream. Auriculotherapy Manual Dental analgesia Drymouth Salivary Gland.E Posterior Pituitary Salivary Gland.C Thirst point ShenMen Sympathetic Autonomic point PointZero Kidney.C TMJ Lower Jaw Toothache1 .upp-er Jgw Trigeminal nerve PointZero ShenMen Stomach Tranquilizer ......./---l---t--t- Toothache3 point Toothache2 Thalamus--\---l:’--I--a’>!::’HrT/L.--Occiput point Dental Analgesia 1 Dental Analgesia 2 MasterSensorial Toothache Trigeminal neuralgiaandfacial neuralgia ShenMen PointZero Dental Analgesia 1 J MasterSensorial Kidney.C Cervical Spine Toothache3 Toothache2 Occiput Toothache1 Trigeminal nerve UpperJaw ShenMen Mouth Master Oscillation Temples Cerebral Master Sensorial Lesser Occipital nerve WindStream Liver __-+---r-, ,.4--4-- Shoulder "-IIi----f-.......f--r-- Brainstem __ Occiput lY"’F--- Lower Jaw Jaw Trigeminal nerve Thalamuspoint Figure9.7 Dentalpain treatmentprotocols. Treatment protocols 283 284 9.6 Neurological disorders (Figure9.8) 9.6.1 Attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) Primary: Hippocampus, Amygdala, Thyrotropin,ThyroidGland.C,ThyroidGland.E,Shen Men, PosteriorShen Men, Master Oscillation. Supplemental: Master Cerebral,Point Zero, Kidney.C, Brain, Brainstem,Occiput. 9.6.2 Bell's palsy Primary: Face, Forehead, Facial nerve, Point Zero, Shen Men, Thalamuspoint. 9.6.3 Cerebral palsy Primary: Brainstem, Point Zero, Shen Men, Thalamuspoint, Master Cerebral. 9.6.4 Concussion Primary: Brain, Brainstem, Master Cerebral, Forehead, Occiput, Adrenal Gland.C,Lesser Occipital nerve, PointZero, Shen Men, Thalamuspoint, Heart.C,Kidney.C. 9.6.5 Encephalitis, brain trauma Primary: Brainstem, Forehead, Occiput, Lesser Occipital nerve, Point Zero, Shen Men, Kidney.C, Thalamuspoint, Master Cerebral, Heart.C. 9.6.6 Epilepsy, seizures, convulsions Primary: Amygdala, Temporal Cortex, Forehead, Brain, Brainstem,Occiput, Heart.C,Spleen.C. Supplemental: PointZero, Shen Men, Thalamuspoint, Master Oscillation, Stomach, Liver, Lesser Occipital nerve. 9.6.7 Facial tics Primary: Face, Forehead, Upper Jaw, Cervical Spine, Point Zero, Shen Men, Thalamuspoint, Master Cerebral,Stomach, Liver. 9.6.8 Laterality dysfunction Primary: Master Oscillation, Lateralitypoint, CorpusCallosum, PointZero, Shen Men, Reticular Formation,Yintangpointon forehead. 9.6.9 Meningitis Primary: Brainstem, Point Zero, Shen Men, Thalamuspoint, Occiput, Forehead, Kidney.C, Stomach, Heart.C,Lesser Occipital nerve, Thymus Gland,Vitalitypoint. 9.6.10 Multiple sclerosis Primary: Correspondingbodyarea, Brainstem, MedullaOblongata,Master Oscillation, Point Zero, Shen Men, Thalamuspoint, Occiput, ThymusGland,Vitalitypoint. Supplemental: Lesser Occipital nerve. 9.6.11 Parkinsonian tremors Primary: MidbrainTegmentum, Striatum,Adrenal Gland.C,ACTH, PointZero, Shen Men. 9.6.12 Polio and post-polio syndrome Primary: Correspondingbodyarea, Spinal Motor Neurons, MedullaOblongata,Master Cerebral, Point Zero, Posterior Shen Men, Endocrinepoint. Supplemental: Thalamuspoint, Adrenal Gland.C,Occiput. 9.6.13 Stroke orcerebral vascular accident Primary: Correspondingbodyarea, Brain, Adrenal Gland.C,Adrenal Gland.E,ACTH, Shen Men, SympatheticAutonomicpoint, Master Cerebral, Endocrinepoint. 9.6.14 Tremors Primary: Spinal Motor Neurons, Striatum,Cerebellum, Point Zero, Shen Men. Auriculotherapy Manual Attentiondeficit hyperactivitydisorder ShenMen Posterior ShenMen PointZero Brainstem Master Oscillation Brain Thyrotropin MasterCerebral Multiplesclerosis Shenmen Forehead Epilepsy, seizures or convulsions ’----+---+-+_ Liver '----1-+-+-1--- Spleen.C Brainstem ~ ~ ~ ~ Occiput Brain Temporal Cortex Polioandpost-poliosyndrome ShenMen PointZero Vitalitypoint Thalamus point Lesser Occipital nerve .--+-’-I ------,/- Brainstem ’J ->’--- Medulla Oblongata Occiput $Rinal Motor Neurons Medulla--.4.-I Oblongata Occiput Posterior ShenMen Adrenal Gland.C Thalamus point Endocrine point Master Cerebral Figure9.8 Neurological disorders treatmentprotocols. Treatment protocols 285 286 9.7 Stress-related disorders (Figure9.9) 9.7.1 Autonomic excessive activity Primary: SympatheticAutonomic point, Sympatheticchainonconchawall, Thalamuspoint, External Genitals.C, External Genitals.E, Kidney.C. 9.7.2 Chronic fatigue syndrome Primary: Vitalitypoint, Antidepressant point, Brain,ACTH, Adrenal Gland.C,Adrenal Gland.E,Point Zero, Shen Men, Master Oscillation, Master Cerebral. 9.7.3 Drowsiness Primary: Excitement point,Alertness, I nsomnia1, I nsomnia2. 9.7.4 Heat stroke Primary: Thalamuspoint, Occiput, Heart.C,Heatpoint,Adrenal Gland.C,Adrenal Gland.E, Lesser Occipital nerve. 9.7.5 Hyperhydrosis or excessive sweating Primary: Fingers, Hand,Forehead, Sympatheticchainonconchawall, SympatheticAutonomic point, Endocrinepoint, PointZero, Shen Men, Adrenal Gland.C,Adrenal Gland.E,Occiput, Heart.C. 9.7.6 Hysteria, hysterical disorder Primary: Correspondingbodyareafor perceived problem, Point Zero, Shen Men, Thalamus point, Brainstem, Brain, Occiput, Heart.C,Stomach, Kidney.C, Heart.C,Lesser Occipital nerve. 9.7.7 Insomnia Primary: I nsomnia1,I nsomnia2, Pineal Gland,Heart.C,Master Cerebral, Point Zero, Shen Men, Thalamuspoint, Forehead, Occiput, Brain, Kidney.C. 9.7.8 Jet lagor circadian rhythmdysfunction Primary: Pineal Gland,I nsomnia1,I nsomnia2, Point Zero, Shen Men, Endocrinepoint. 9.7.9 Psychosomatic disorders Primary: Psychosomatic Reactions 1,Psychosomatic Reactions2, Master Cerebral, Point Zero, Shen Men, SympatheticAutonomicpoint,Thalamuspoint, Occiput. Supplemental: Heart.C,External Genitals.C, External Genitals.E, Endocrinepoint. 9.7.10 Reflex sympathetic dystrophy Primary: SympatheticAutonomicpoint, Sympatheticchain, Point Zero, Shen Men, Thalamus point. 9.7.11 Shock Primary: Brain, Lesser Occipital nerve, Thalamuspoint, Adrenal Gland.C,Occiput, Heart.C. Supplemental: Shen Men, PointZero, Liver, Spleen.C, Kidney.C, Gall Bladder. 9.7.12 Stress and strain Primary: Adrenal Gland.C,Adrenal Gland.E,ACTH, Tranquilizerpoint, Point Zero, Shen Men, Master Cerebral, Muscle Relaxation, Psychosomatic Reactions 1,Psychosomatic Reactions2. Supplemental: Endocrinepoint,Anterior Hypothalamus, Occiput, Posterior Hypothalamus. AuriculotherapyManual Chronic fatigue syndrome I nsomnia Insomnia 2 I nsomnia 1 Forehead Kidney.C Brain Master Cerebral Thalamus point Pineal Gland Shen Men Point Zero Master Cerebral Point Zero Vitality point Master Oscillation Adrenal Gland.C ACTH Shen Men Psychosomatic disorders Stress and strain Tranquilizer point ACTH Psychosomatic Reactions 1 b Adrenal Gland.E Muscle Relaxation Posterior Hypothalamus Anterior Hypothalamus Adrenal Gland.C Shen Men Point Zero Endocrine point Master Cerebral Psychosomatic Reactions 2 Thalamus point Point Zero Shen Men Psychosomatic Reactions 1 External b Genitals.C Sympathetic Autonomic point External Genitals.E Heart.C Psychosomatic Reactions 2 Endocrine point Master Cerebral --_.L.’-.,. Figure 9.9 Stress-related disorders treatment protocols. Treatment protocols 287 288 9.8 Psychological disorders (Figure9.10) 9.8.1 Anxiety Primary: Nervousness, Master Cerebral,Tranquilizerpoint, Occiput, Heart.C,PointZero, Shen Men, SympatheticAutonomicpoint. Supplemental: Stomach, Adrenal Gland.C,Vagusnerve. 9.8.2 Depression Primary: Antidepressant, Brain, Excitement point, Pineal Gland,Master Cerebral,Shen Men, SympatheticAutonomicpoint. Supplemental: PointZero, Endocrinepoint, Master Oscillation, Occiput, External Genitals.C, External Genitals.E. 9.8.3 Irritability Primary: Aggressivity, Master Cerebral,PointZero, Shen Men, Thalamuspoint, Heart.C. 9.8.4 Mania Primary: Maniapoint,Amygdala, Master Cerebral,Tranquilizerpoint, Point Zero, Shen Men. 9.8.5 Memory problems, poor concentration Primary: FrontalCortex, Hippocampus, Memory 1,Memory2, Master Cerebral, Heart.C,Point Zero, Shen Men. 9.8.6 Neurasthenia, nervous exhaustion Primary: Nervousness, Thalamuspoint, Occiput, Heart.C,Kidney.C, Shen Men, Tranquilizer point. Supplemental: PointZero, Master Cerebral, Brainstem, Stomach. 9.8.7 Nightmares, disturbing dreams Primary: Pons, Psychosomatic Reactions1,Psychosomatic Reactions2, Nervousness, Master Cerebral,Thalamuspoint,Heart.C,Shen Men, Point Zero, I nsomnia1, I nsomnia2, Reticular Formation. 9.8.8 Obsessive-compulsiveness Primary: Master Cerebral, FrontalCortex, Point Zero, Shen Men, Thalamuspoint, Heart.C, Occiput. 9.8.9 Repressed emotional experiences Primary: Psychosomatic Reactions 1,Psychosomatic Reactions2, Hippocampus, ShenMen, Heart.C. 9.8.10 Schizophrenia and psychosis Primary: Master Cerebral, Brain,Thalamuspoint, Occiput, Heart.C,Kidney.C, Stomach, Brainstem, Lesser Occipital nerve. Supplemental: PointZero, Shen Men, Nervousness, Forehead, Liver, Apex of Ear. Auriculotherapy Manual Anxiety Depression Shen Men Sympathetic Autonomic point Point Zero Vagus nerve Adrenal Gland.C Tranquilizer p-oint Master Cerebral Nervousness Shen Men External Genitals.C Sympathetic Autonomic point External Genitals.E Point Zero Master Oscillation Excitement p-oint Pineal Gland Endocrine point Master Cerebral Occiput Antidepressant point Memory problems or poor concentration Schizophrenia and psychosis Apex of Ear Lesser Occipital nerve Occiput Kidney.C e:.....i:t:--I---+---J- Stomach Liver Brain ...-----.f-+--+- Brainstem Heart.C Thalamus ----1r-t--I -__1’ point Forehead Master Cerebral Shen Men Point Zero Nervousness Hippocampus Frontal Cortex Shen Men Heart.C __-1-_+............... Point Zero Memo!Y..1 Master Cerebral Figure 9.10 Psychological disorders treatmentprotocols. Treatment protocols 289 290 9.9 Eyesight disorders (Figure9.11) 9.9.1 Astigmatism Primary: Eye, Eye Disorders2, Opticnerve, Kidney.C, Liver, Occiput, ShenMen. 9.9.2 Blurred vision, poor eyesight Primary: Eye, Eye Disorders2, Eye Disorders3, Opticnerve, Occipital Cortex. Supplemental: Shen Men, Master Sensorial, Brain, Occiput, Kidney.C, Liver, Lung2. 9.9.3 Conjunctivitis Primary: Eye, ShenMen, Liver, SkinDisorders.C, Occiput, Adrenal Gland.C,Adrenal Gland.E. 9.9.4 Eye irritation Primary: Eye Disorders1,Eye Disorders2, Shen Men, Endocrinepoint. 9.9.5 Glaucoma Primary: Eye, Eye Disorders1,Eye Disorders2, ShenMen, Occiput, Kidney.C, Liver, Apex of Ear. 9.9.6 Myopia Primary: Eye, EyeDisorders2, Eye Disorders3, Opticnerve, Occiput, Forehead, Shen Men, Kidney.C, Liver, Spleen.C, Apex of Ear. 9.9.7 Stye Primary: Eye, Shen Men, Liver, Spleen.C, Spleen.E. Auticuiotherspy Manual Blurred vision and poor eyesight Conjunctivitis Skin Disorders.C Occiput Adrenal Gland.C Shen Men Kidney.C Occipital Cortex Master Sensorial Liver Shen Men . ../----1(.........-I-T- Lung2 Brain--t-----jL--_.. ""’\ Optic nerve __ Disorders 2 Disorders 3 ---j---.... Glaucoma Myopia Kidney.C Liver Occiput Spleen.C Forehead _--::"’"-",.,,_---- Apex of Ear Optic nerve Disorders 3 Disorders 2 ---Y’---tc\ ..J Kidney.C Apex of Ear Shen Men Disorders 2 Disorders 1 Figure 9.11 Eyesightdisorders treatment protocols. Treatment protocols 291 292 9.10 Hearingdisorders (Figure9.12) 9.10.1 Dizziness, vertigo Primary: Dizzinesspoint, I nnerEar.C, I nnerEar.E, Cerebellum, Occiput, Lesser Occipital nerve, Point Zero, Master Sensorial. Supplemental: Shen Men, Thalamuspoint, Forehead, Liver, Kidney.C. 9.10.2 Ear infection, earache Primary: I nnerEar.C, I nnerEar.E, External Ear.C, Kidney.C, PointZero, Shen Men. Supplemental: Master Oscillation, Master Cerebral,Adrenal Gland.C,Occiput, SanJiao, Apex of Ear. 9.10.3 I mpaired hearing Primary: I nnerEar.C, I nnerEar.E, External Ear.C, Kidney.C, Occiput, Point Zero, Shen Men. 9.10.4 Motionsickness, car sickness, sea sickness Primary: I nnerEar.C, I nnerEar.E, Stomach, Occiput, Point Zero, Shen Men, Lesser Occipital nerve, Master Oscillation. 9.10.5 Mutism, stuttering, difficultyspeaking Primary: Mutism, I nnerEar.C,Tongue.C, Tongue.E, Kidney.C, Master Oscillation, Point Zero, Shen Men, Thalamuspoint, Heart.C. Supplemental: External Ear.C, Master Cerebral. 9.10.6 Sensorineural deafness Primary: I nnerEar.C,External Ear.C, Auditorynerve, Temporal Cortex, Auditoryline, Adrenal Gland.C,Adrenal Gland.E,Kidney.C, Shen Men, PointZero, Master Sensorial, Occiput, SanJiao. Treatthefour wallsof theear canal directlywithaprobeor needle, or fill theear canal withsaline andplaceamonopolar auricularprobeintothesaline. Witheither method, treatarangeof frequencies, from1Hzto320Hz, stimulatingeach pointat 150f.LA for 30seconds. Also treatactiveear reflex pointsalongtheauditorylineon thelobeinferiortotheantitragus,and 8pointson theareaof theskull whichsurroundstheear. Patientssufferingfromdeafness needto makeaminimumcommitment to20sessions of 3D-minutetreatments. 9.10.7 Sudden deafness Primary: I nnerEar.C, I nnerEar.E, Brain, Brainstem, PointZero, Shen Men, Thalamuspoint. 9.10.8 Tinnitus Primary: I nnerEar.C, External Ear.C, Auditorynerve, Kidney.C, PointZero, Shen Men, Master Sensorial, SanJiao. Supplemental: Cervical Spine, Master Oscillation, Adrenal Gland.C,Adrenal Gland.E,Occiput, Shoulder, Lesser Occipital nerve. Auriculotherapy Manual Sensorineural deafness and tinnitus Surface view Sensorineural deafness and tinnitus Hidden view Shen Men Point Zero External Ear.C Adrenal Gland.C _+--{ Occiput Temporal __ Cortex Master Sensorial Cervical Master Spine 0 ’11 . SCI ation San [lao Inner Ear.C Lesser Occipital nerve ’.+-1__ Shoulder Dizziness and vertigo Mutismand stuttering Shen Men Point Zero Inner Ear.E Dizziness __ point Thalamus point Forehead Master Sensorial Figure 9.12 Hearingdisorders treatment protocols. Treatment protocols Lesser Occipital nerve Kidney.C External Ear.C Liver Master Oscillation Cerebellum Occiput Inner Ear.C Tongue.C Master Cerebral Shen Men Kidney.C Point Zero .........’----f.......4----1-- Heart.C __ point Inner Ear.C 293 294 9.11 Nose and throat disorders (Figure9.13) 9.11.1 Allergic rhinitis Primary: I nnerNose, Apex of Ear, Adrenal Gland.C,Forehead, Endocrinepoint, LungI, Lung2, Kidney.C, Spleen.C, Allergy point, Diaphragm.C. 9.11.2 Broken nose Primary: External Nose.C, External Nose.E, Point Zero, Shen Men, Thalamuspoint. 9.11.3 Hoarseness Primary: Throat.C,Throat.E,Trachea,Point Zero, Shen Men, Endocrinepoint, Heart.C,Lung1, Lung2. 9.11.4 Laryngitis Primary: Larynx.C, Larynx.E, Tonsil 1,Tonsil 2, Tonsil 3, Tonsil 4, PointZero, ShenMen, Endocrinepoint, Palate,Lung1,Lung2. 9.11.5 Nose bleeding Primary: I nnerNose, Forehead, Lung1,Lung2,Apex of Ear, Shen Men, Adrenal Gland.C. 9.11.6 Pharyngitis Primary: Throat.C,Throat.E,Point Zero, Shen Men, Endocrinepoint, Lung1,Lung2,Adrenal Gland.C. 9.11.7 Rhinitis, running nose Primary: I nnerNose, External Nose, PointZero, Forehead, Kidney.C, Shen Men, Endocrine point,Adrenal Gland.C,Lung1,Lung2, Spleen.C, Allergy point. 9.11.8 Sneezing Primary: Sneezingpoint, I nnerNose, Apex of Ear,Asthma, Antihistamine,Allergy point, Point Zero, Shen Men. 9.11.9 Sore throat Primary: Throat.C,Throat.E,Mouth, Trachea,Tonsil 1,Tonsil 2,Tonsil 3, Tonsil 4. Supplemental: Lung1,Lung2, Adrenal Gland.C,Adrenal Gland.E,Point Zero, Shen Men, Thalamuspoint, Prostaglandin1,Prostaglandin2, Master Oscillation. 9.11.10 Sunburned nose Primary: External Nose.C, External Nose.E, SkinDisorder.C,SkinDisorder.E, PointZero, Shen Men, Thalamuspoint,Lung1,Lung2. 9.11.11 Tonsillitis Primary: Throat.C,Throat.E,Laryngitis.C, Palate,Tonsil 1,Tonsil 2, Tonsil 3, Tonsil 4. Supplemental: Point Zero, Shen Men, Apex of Ear, ThyroidGland.C,ThyroidGland.E. Auriculotherapy Manual Thalamus point Sore throat o Prostaglandin 2 Tonsil 1 Adrenal Gland.E Shen Men Point Zero Mouth ThroatE Tonsil 2 Throat.C Thyroid Trachea Gland.E Thyroid Adrenal Gland.C Gland.C Tonsil 3 Master Oscillation Shen Men Laryngitis and tonsillitis Apex of Ear Tonsil 1 Endocrine point Palate Point Zero bill:)tnx.E ThroatE lir,ynx.C Throat.C Lung 1 Lung 2 Apex of Ear Allergy point Sneezing Shen Men Antihistamine point Rhinitisand allergic rhinitis Apex of Ear Allergy point Kidney.C Shen Men Diaphragm.C Point Zero External Point Zero Nose Inner Nose Spleen.C Inner Nose Lung 1 Adrenal Gland.C Lung2 Asthma Endocrine Forehead point Figure 9.13 Nose and throat disorders treatment protocols. Treatment protocols 295 296 9.12 Skin and hairdisorders (Figure9.14) 9.12.1 Acne Primary: Face, SkinDisorder.C,SkinDisorder.E,Lung1,Lung2,PointZero, Shen Men. Supplemental: External Genitals.C, External Genitals.E, Gonadotropins,Endocrinepoint. 9.12.2 Boil, carbuncle Primary: Correspondingbody area, Lung1,Lung2, Occiput, Endocrinepoint, PointZero, Shen Men, Adrenal Gland.C,Adrenal Gland.E. 9.12.3 Coldsores (herpes simplex) Primary: Lips, Mouth, Lung1,Lung2, Occiput, SalivaryGland.C,SalivaryGland.E,Point Zero, Shen Men. Supplemental: Adrenal Gland.C,Adrenal Gland.E,ACTH, SkinDisorder.C, SkinDisorder.E. 9.12.4 Dermatitis,hives, urticaria Primary: Correspondingbodyarea,SkinDisorder.C, SkinDisorder.E, Endocrinepoint, Shen Men. Supplemental: Adrenal Gland.C,Kidney.C, Lung1,Lung2, Occiput, Point Zero, Master Sensorial, ThyroidGland.C,ThyroidGland.E,Apex of Ear. 9.12.5 Eczema, itching, pruritus Primary: Correspondingbody area,SkinDisorder.C,SkinDisorder.E, Lung1,Lung2. Supplemental: Occiput, LargeI ntestines, Adrenal Gland.C,Point Zero, ShenMen, Endocrine point, Psychosomatic Reactions 1,Psychosomatic Reactions2. 9.12.6 Frostbite Primary: Correspondingbody area,Occiput, Heatpoint,Adrenal Gland.C,Adrenal Gland.E. Supplemental: Point Zero, Shen Men, Lung1,Lung2, Spleen.C, Spleen.E. 9.12.7 Hairloss, baldness, alopecia Primary: Occiput, Endocrinepoint, Lung1,Lung2, Kidney.C, PointZero, Shen Men. 9.12.8 Poisonoak, poison ivy Primary: Correspondingbody area,SkinDisorder.C, SkinDisorder.E, Lung1,Lung2, Point Zero, Shen Men, Endocrinepoint, Apex of Ear, Allergy point. 9.12.9 Postherpeticneuralgia Primary: Chest, ThoracicSpine, SkinDisorder.C,SkinDisorder.E, PointZero, Shen Men, Endocrinepoint, Kidney.C. 9.12.10 Rosacea Primary: External Nose.C, External Nose.E, Lung1, Lung2, Endocrinepoint,Adrenal Gland.C, Adrenal Gland.E,Spleen.C, Apex of Ear. 9.12.11 Shingles (herpes zoster) Primary: Correspondingarea,Chest, ThoracicSpine, SkinDisorder.C,SkinDisorder.E, Endocrine point, Lung1,Lung2,Occiput, Adrenal Gland.C,Adrenal Gland.E,Kidney.C. Supplemental: Point Zero, Shen Men, Anterior Pituitary,Apex of Ear,Allergy point. 9.12.12 Sunburn Primary: Correspondingbodyarea,SkinDisorder.C,SkinDisorder.E,Thalamuspoint, Kidney.C. Supplemental: Shen Men, Endocrinepoint, Adrenal Gland.C,Lung1,Lung2. AuriculotherapyManual Dermatitis, hives, urticariaand eczema Sunburn Shen Men Psychosomatic Reactions 1 0 Kidney.C Large I ntestines Point Zero Adrenal ---I ------\ --I J Gland.C Endocrine point Psychosomatic ~ Reactions 2 Shen Men Skin Disorder.C Kidney.C Skin Disorder.E Lung 1 Lung2 Adrenal Gland.C Thyroid Gland.E Thyroid Gland.C Occiput Skin Disorder.C Thoracic Spine Skin Disorder.E Thalamus point Face Shen Men Adrenal Gland.E Skin Disorder.E Skin Disorder.C Lung] u n ~ Occiput Salivary Gland.E Salivary Gland.C Cold sores (herpes simplex) Adrenal Gland.C (ACTH) Point Zero Mouth _ __>__---. Skin Disorder.C Thoracic Spine Skin Disorder.E Occiput Herpes zoster and postherpetic neuralgia Apex of Ear Allergy point Adrenal Gland.E Adrenal Gland.C Shen Men Anterior Pituitary Endocrine point Kidney.C Point Zero Lungj Lungl Figure 9.14 Skin and hair disorders treatment protocols. Treatment protocols 297 298 9.13 Heart and circulatory disorders (Figure9.15) 9.13.1 Anemia Primary: Heart.C1,Heart.C2,Heart.E,Liver, Spleen.C, Spleen.E, Endocrinepoint, Stomach, Small I ntestines, Diaphragm.C,Kidney.C. 9.13.2 Angina pain Primary: Heart.C1,Heart.C2,Heart.E,Vagusnerve, SympatheticAutonomicpoint, PointZero, Shen Men, Thalamuspoint, Lung1,Lung2, Stomach. 9.13.3 Bradycardia, pulselessness Primary: Heart.C1,Heart.C2,Heart.E,SympatheticAutonomicpoint,Thalamuspoint, Kidney.C, Liver, Adrenal Gland.C. 9.13.4 Cardiac arrest Primary: Heart.C1,Heart.C2,Heart.E,Adrenal Gland.C,Adrenal Gland.E,Shen Men, Thalamuspoint, Liver, Spleen.C, Spleen.E. 9.13.5 Cardiac arrhythmias Primary: Heart.C1,Heart.C2,Heart.E,Chest, SympatheticAutonomicpoint, ShenMen, Vagus nerve, Adrenal Gland.C,Adrenal Gland.E,Thalamuspoint. Supplemental: PointZero, Kidney.C, Liver, Stomach, Small I ntestines. 9.13.6 Heartattack, coronary thrombosis Primary: Heart.C1,Heart.C2,Heart.E,SympatheticAutonomicpoint, Endocrinepoint, Point Zero, Shen Men, Thalamuspoint, Small I ntestines, Kidney.C, ACTH. 9.13.7 Hypertension (high blood pressure) Primary: Hypertension1,Hypertension2, Hypertensivegroove, Heart.C1,Heart.C2,Heart.E, Marvelouspoint, SympatheticAutonomicpoint, PointZero, Shen Men, Sympatheticchain. Supplemental: Vagusnerve, Thalamuspoint,Adrenal Gland.C,Apex of Ear. 9.13.8 Hypotension (lowblood pressure) Primary: Hypotension, Heart.C,Heart.E,Vagusnerve, Thalamuspoint,Endocrinepoint,Shen Men, SympatheticAutonomicpoint, PointZero. Supplemental: Adrenal Gland.C,Liver, Spleen.C, Spleen.E. 9.13.9 Lymphatic disorders Primary: Spleen.C, Spleen.E, ThymusGland,PointZero, ShenMen, Vitalitypoint. 9.13.10 Myocarditis Primary: Heart.C1,Heart.C2,Heart.E,SympatheticAutonomicpoint, Shen Men, Occiput, Small I ntestines, Spleen.C. 9.13.11 Premature ventricular contraction Primary: Heart.C1,Heart.C2,Heart.E,SympatheticAutonomicpoint,Thalamuspoint, Small I ntestines. 9.13.12 Tachycardia, heart palpitations Primary: Heart.C1,Heart.C2,Heart.E,SympatheticAutonomic point,PointZero, Shen Men, Thalamuspoint, Small I ntestines, Adrenal Gland.C,Adrenal Gland.E. 9.13.13 Raynaud's disease, vascular circulation problems, cold hands, cold feet Primary: Heart.C1,Heart.C2,Heart.E,Heatpoint, SympatheticAutonomicpoint, Endocrine point,Adrenal Gland.C,Adrenal Gland.E,Lesser Occipital nerve. Supplemental: Shen Men, Thalamuspoint, Sympatheticchain, Occiput, Liver, Spleen.C, Auriculotherapy Manual Hypertension Hypotension Apex of Ear !::!yp.ertension 1 ShenMen Autonomic point Sympathetic chain PointZero Heart.C2__ Heart.Cl Adrenal Gland.C__+-_r)I Hypertension 2----t-( Vagus nerve Anginapain ShenMen Sympathetic Autonomic point PointZero HeartE Vagusnerve Adrenal Gland.C Endocrine point t:!yp-otension Thalamuspoint rr:....,..-...J L Spleen.E Liver Spleen.C Heart.C Thalamuspoint Cardiacarrhythymias ShenMen Sympathetic Autonomic point PointZero Heart.C2 Lung1 Vagus nerve__-+-_ Heart.Cl Lung2 ShenMen $YlDp-athetic Autonomic p-oint Small Intestines PointZero Heart.C2 Heart.E nerve---"""1f--› Stomach AdrenalGland.C Thalamuspoint Kidney.C Adrenal Gland.E ,----.N- ()--t---=t--t Heart.,1. Chest Stomach Liver Heart.Cl Thalamuspoint Figure9.15 Heart and circulatory disorders treatment protocols. Treatment protocols 299 300 9.14 Lung and respiratory disorders (Figure9.16) 9.14.1 Asthma Primary: Asthma, Antihistamine, Lung1,Lung2, Bronchi, SympatheticAutonomicpoint, Point Zero, Shen Men, Allergy point,Apex of Ear. Supplemental: Adrenal Gland.C,Tranquilizerpoint, Master Cerebral, Kidney.C, Occiput, Spleen.C, Spleen.E, Psychosomatic Reactions1. 9.14.2 Bronchitis Primary: Bronchi, Trachea,Asthma, Antihistamine,Shen Men, PointZero, Adrenal Gland.C, Adrenal Gland.E,SympatheticAutonomicpoint, Occiput. 9.14.3 Bronchopneumonia Primary: Asthma, Antihistamine, Bronchi, PointZero, Shen Men, SympatheticAutonomic point, Adrenal Gland.C,Adrenal Gland.E,Endocrinepoint, Occiput. 9.14.4 Chest pain, chest heaviness Primary: Lung1,Lung2, Chest, Heart.C,Asthma, Adrenal Gland.C,SympatheticAutonomic point, Point Zero, Shen Men. 9.14.5 Cough Primary: Asthma, Antihistamine,Throat.C,Throat.E,Lung1, Lung2,Adrenal Gland.C, Adrenal Gland.E. Supplemental: SympatheticAutonomicpoint, Shen Men, PointZero, Trachea, Occiput, Spleen.C, Spleen.E. 9.14.6 Emphysema Primary: Lung1,Lung2, Bronchi, Chest, Asthma, Antihistamine, Point Zero, Shen Men, SympatheticAutonomicpoint,Adrenal Gland.C,Adrenal Gland.E,Occiput. 9.14.7 Hiccups Primary: Diaphragm.C,Diaphragm.E,ParasympatheticCranialnerves, SanJiao. Supplemental: PointZero, Shen Men, Thalamuspoint, Esophagus, Liver, Occiput. 9.14.8 Pleurisy Primary: Lung1, Lung2, Chest, PointZero, Shen Men, Endocrinepoint,Adrenal Gland.C, Adrenal Gland.E,SanJiao. 9.14.9 Pneumonia Primary: Lung1,Lung2, Chest, Adrenal Gland.C,Adrenal Gland.E,Endocrinepoint, Point Zero, Shen Men, Thalamuspoint, SanJiao. 9.14.10 Shortness of breath, breathing difficulties Primary: I nnerNose, Lung1,Lung2, Chest, Forehead, Adrenal Gland.C,Adrenal Gland.E, Shen Men. 9.14.11 Tuberculosis Primary: Tuberculosis, Lung1,Lung2, Point Zero, Shen Men. 9.14.12 Whooping cough Primary: Asthma, Antihistamine, Bronchi, Adrenal Gland.C,Adrenal Gland.E,Sympathetic Autonomic point, Occiput. AuriculotherapyManual Asthma Cough ShenMen Sympathetic Autonomic point Antihistamine ShenMen Adrenal Gland.E Occiput Asthma Spleen.E Trachea Adrenal Gland.C Apex of Ear Allergy point -,----jr...-I-..f- LungJ Kidney.C PointZero Throat.E ""'lw,J'--+---Tt- Spleen.C Throat.C Tranquilizer --Td point Antihistamine Master ---, Cerebral PointZero Psychosomatic Reactions 1 b Sympathetic Autonomic point Adrenal Gland.C --f----{ Emphysema Hiccups Liver ShenMen Thalamuspoint PointZero fl’::>""d-----I H-r Esophagus Parasympathetic ->---T""’_ Cranialnerves Adrenal Gland.E Chest Sympathetic Autonomic point Bronchi __+-_ PointZero ShenMen Antihistamine Adrenal Gland.C Figure9.16 Lung and respiratory disorders treatmentprotocols. Treatment protocols 301 302 9.15 Gastrointestinal and digestive disorders (Figure9.17) 9.15.1 Abdominal distension Primary: Stomach, Small Intestines, LargeIntestines, Abdomen, PelvicGirdle, Ascites. Supplemental: Solar plexus, PointZero, Shen Men, SympatheticAutonomicpoint, SanJiao. 9.15.2 Colitis, enteritis Primary: Small I ntestines, Large I ntestines, Point Zero, Shen Men, SympatheticAutonomic point, Stomach. Supplemental: Rectum.C, Shen Men, Spleen.C, Occiput. 9.15.3 Constipation Primary: Constipation,LargeI ntestines, Rectum.C, Rectum.E, Omega 1,Abdomen. Supplemental: Thalamuspoint, SanJiao, Stomach, Spleen.C, SympatheticAutonomicpoint. 9.15.4 Diarrhea Primary: Small Intestines, LargeIntestines, PointZero, Shen Men, SympatheticAutonomicpoint. Supplemental: Rectum.C, Rectum.E, Omega 1,Spleen.C, Kidney.C, Occiput. 9.15.5 Dysentery Primary: Small Intestines, LargeIntestines, Rectum.C, Shen Men, SympatheticAutonomicpoint. Supplemental: Endocrinepoint, Lung1, Lung2, Occiput, Adrenal Gland.C,Kidney.C, Spleen.C, Vitalitypoint. 9.15.6 Flatulence, ascites Primary: Ascites, LargeI ntestines, Small I ntestines, Abdomen, SympatheticAutonomicpoint, SanJiao. 9.15.7 Fecal incontinence Primary: Rectum.C, Rectum.E, LargeI ntestines, Shen Men. 9.15.8 Gastritis, gastric spasm Primary: Stomach, Abdomen, Point Zero, Shen Men, SympatheticAutonomic point, Spleen.C. Supplemental: LargeI ntestines, Liver, Lung1,Lung2, Lesser Occipital nerve. 9.15.9 Hemorrhoids Primary: Hemorrhoids.C1, Hemorrhoids.C2, Rectum.C, Rectum.E, LargeI ntestines, Spleen.C, Thalamuspoint, PointZero, Shen Men, Adrenal Gland.C. 9.15.10 Indigestion Primary: Stomach, CardiacOrifice, Small I ntestines, SympatheticAutonomicpoint, Pancreas, Spleen.C, Shen Men, PointZero, Omega 1,LargeI ntestines, Abdomen, SanJiao, Liver, Occiput. 9.15.11 Irritable bowel syndrome Primary: Small I ntestines, LargeI ntestines, Rectum.C, Rectum.E, Abdomen, Omega 1, Constipation,Point Zero, Shen Men, Stomach. Supplemental: SympatheticAutonomicpoint, Pancreas,Occiput, SanJiao. 9.15.12 Nausea, vomiting Primary: Stomach, Esophagus, Omega 1,Point Zero, Shen Men, SympatheticAutonomic point, Thalamuspoint, Occiput. 9.15.13 Stomach ulcer, duodenal ulcer Primary: Stomach, Duodenum,Small I ntestines, Abdomen, Shen Men, SympatheticAutonomic point, Point Zero. Supplemental: Psychosomatic Reactions1,Thalamuspoint, Master Cerebral, Aggressivity, Occiput, Spleen.C, Lung1,Lung2. Auriculotherapy Manual Stomach ulcer or duodenal ulcer I rritablebowel syndrome and colitis Shen Men Psychosomatic Reactions 1 o Sympathetic Autonomic point Small Intestines Duodenum Point Zero Stomach Lung1 Lung2 Aggressivity __ Master ---’r\ J Cerebral Constipation Sympathetic Autonomic point San Jiao Sympathetic Autonomic point Abdomen Rectum.C Rectum.E Omegi!J Small Intestines San Jiao Thalamus point Hemorrhoids.C2 Constipation Shen Men Larg§ Intestines Abdomen ").-+o......-f-;- a---+--+---jr Pancreas Point Zero Stomach Occiput Hemorrhoids Shen Men Figure 9.17 Gastrointestinal and digestive disorders treatmentprotocols. Treatment protocols 303 304 9.16 Kidney and urinarydisorders (Figure9.18) 9.16.1 Antidiuresis, waterimbaLance Primary: Bladder, Kidney.C, Kidney.E, SanJiao, Posterior Pituitary,Occiput. Supplemental: Point Zero, Shen Men, SympatheticAutonomicpoint, Heart.C,Spleen.C, Spleen.E, Adrenal Gland.C,Adrenal Gland.E. 9.16.2 Bedwetting Primary: Bladder,Kidney.C, Kidney.E, Urethra.C,Urethra.E,Occiput, Excitement, Shen Men. Supplemental: PointZero, Thalamuspoint, Brain, Hypogastricnerve, Spleen.C, Liver, SanJiao. 9.16.3 BLadder controL probLems Primary: Bladder,Kidney.C, Kidney.E, Urethra.C,Urethra.E,Ovariesor Testes.C, Ovariesor Testes.E, Brain, Thalamuspoint, Shen Men, Point Zero, Spleen.C, Liver. 9.16.4 Diabetes insipidus Primary: Kidney.C, Kidney.E, Bladder, Urethra.C,Urethra.E,Thirstpoint, Brain, Posterior Pituitary,SympatheticAutonomicpoint,Adrenal Gland.C,Adrenal Gland.E,Spleen.E. Supplemental: PointZero, Shen Men, Endocrinepoint, Spleen.C, Liver. 9.16.5 Frequent urination, urination probLems Primary: Kidney.C, Kidney.E, Bladder, Urethra.C,Urethra.E,Excitement point, Thalamus point. Supplemental: Endocrinepoint, PointZero, Shen Men, Adrenal Gland.C,Adrenal Gland.E. 9.16.6 Kidney pyelitis Primary: Kidney.C, Kidney.E, Bladder, Urethra.C,Urethra.E,Point Zero, Shen Men, Thalamus point, Adrenal Gland.C,Adrenal Gland.E,Spleen.C, Liver. 9.16.7 Kidney stones Primary: Kidney.C, Kidney.E, Ureter.C, Ureter.E, Bladder,Point Zero, Shen Men, Sympathetic Autonomic point, Thalamuspoint. 9.16.8 Nephritis Primary: Nephritispoint, Kidney.C, Kidney.E, Bladder,Occiput, Endocrinepoint, Sympathetic Autonomic point,Adrenal Gland.C,Adrenal Gland.E,Spleen.C, Liver. Supplemental: Shen Men, PointZero, Spleen.E, Thalamuspoint. 9.16.9 Uresiestesis Primary: Urethra.C,Urethra.E,Bladder, Kidney.C, Kidney.E, Shen Men, SympatheticAutonomic point,Thalamuspoint,External Genitals.C, External Genitals.E. 9.16.10 Urinary disorders Primary: Kidney.C, Kidney.E, Bladder, Ureter.C, Ureter.E, Urethra.C,Urethra.E,Sympathetic Autonomic point, Shen Men, Occiput. Supplemental: External Genitals.C, External Genitals.E,Adrenal Gland.C,Adrenal Gland.E. 9.16.11 Urinary incontinence, urinary retention Primary: Kidney.C, Kidney.E, Bladder,Urethra.C,Urethra.E,Ureter.C, Ureter.E, Endocrine point, External Genitals.C, External Genitals.E, SanJiao. 9.16.12 Urinary infection, cystitis Primary: Bladder, Urethra.C,Urethra.E,Ureter.C,Ureter.E, Kidney.C, Kidney.E, Shen Men, Occiput. Supplemental: Point Zero, SympatheticAutonomicpoint,Adrenal Gland.C,Adrenal Gland.E. Auriculotherapy Manual ShenMen Kidney.E Ureter.E Sympathetic Autonomic point External Genitals.C Urethra.E Urethra.C External Genitals.E PointZero Adrenal Gland.C Thalamus point Urinarydisorders Adrenal Gland.E Thalamuspoint Kidneystones Bladder ShenMen Ureter.C Adrenal Gland.E Spleen.C Occiput Thalamuspoint r----t--+---I---- Liver Nephritis Endocrine point Adrenal Gland.E Bladder Spleen.E PointZero . .,---j.--.,.I ---,f.-- Liver Diabetesinsipidus Bladder ShenMen KidneYi Kidney£ Sympathetic Autonomic point KidneY•I- Posterior --- Pituitary Endocrine point Adrenal --4-_, Gland.C ShenMen PointZero f ~ ~ Thirstpoint ----I -( Sympathetic Autonomic point Urethra.E Urethra.C _ ~ _ ~ Figure9.18 Kidneyand urinary disorders treatmentprotocols. Treatment protocols 305 306 9.17 Abdominal organ disorders (Figure9.19) 9.17.1 Appendicitis Primary: Appendix, Appendix Disorder 1,Appendix Disorder2, Appendix Disorder3, Large I ntestines, SympatheticAutonomicpoint. Supplemental: Abdomen, SanJiao, Point Zero, Shen Men, Thalamuspoint. 9.17.2 Cirrhosis Primary: Hepatitis,Liver, Liver Yang1, Liver Yang2, SympatheticAutonomicpoint, Spleen.C, ShenMen. Supplemental: Gall Bladder,Stomach, Ovariesor Testes.C, Ovariesor Testes.E. 9.17.3 Diabetes mellitus Primary: Pancreas,Pancreatitis,Brain, SanJiao, AppetiteControl, PointZero, ShenMen, Endocrinepoint, Liver, Spleen.C. 9.17.4 Edema Primary: Kidney.C, Kidney.E, Bladder,Heart.C,Liver, SympatheticAutonomicpoint, Endocrinepoint. 9.17.5 Gall stones, gall bladder inflammation Primary: Gall Bladder,Endocrinepoint,Point Zero, Shen Men, SympatheticAutonomicpoint, Liver, Lung1,Lung2,SanJiao. 9.17.6 Hepatitis Primary: Hepatitis1,Liver, Liver Yang1,Liver Yang2, Point Zero, Shen Men, Thalamuspoint, SympatheticAutonomicpoint,Abdomen, SanJiao, Adrenal Gland.C. Supplemental: Endocrinepoint, Kidney.C, Gall Bladder,Stomach. 9.17.7 Hernia Primary: Abdomen, LargeI ntestines, Prostate.C, Prostate.E,Point Zero, Shen Men, Endocrine point,Thalamuspoint, Spleen.C. 9.17.8 Hypoglycemia Primary: Pancreas, Stomach, SympatheticAutonomicpoint, Thalamuspoint, Adrenal Gland.C, Kidney.C, Kidney.E, Liver, PointZero, Shen Men, Heart.C,Spleen.C, Spleen.E. 9.17.9 Jaundice Primary: Hepatitis,Liver, Liver Yang1, Liver Yang2, SympatheticAutonomicpoint, Spleen.C. Supplemental: Gall Bladder,Stomach, Ovariesor Testes.C, Ovariesor Testes.E. 9.17.10 Liver dysfunction Primary: Liver, Liver Yang1,Liver Yang2, SympatheticAutonomicpoint, Endocrinepoint, Adrenal Gland.C. Supplemental: PointZero, Shen Men, Spleen.C, Spleen.E, Kidney.C, Kidney.E, Gall Bladder, Stomach, Ovariesor Testes.C, Ovariesor Testes.E. 9.17.11 Pancreatitis Primary: Pancreas,Pancreatitis,PointZero, Shen Men, Endocrinepoint, Sympathetic Autonomic point. Auriculotherapy Manual Abdomen Appendix Disorder1 Appendix Disorder 3 Thalamus point I ."f--+- Appendix Disorder2 Appendicitis San[iao Endocrine point Sympathetic Autonomic point Intestines Appendix Kidney.C PointZero ’’’_.J .----Adrenal Gland.C Hepatitisandliver dysfunction Hepatitis1 ShenMen Stomach Liver Yang1. Abdomen Gall -\ ---1---4--4_ Bladder Thalamus point Gallstones andgall bladder inflammation Diabetesmellitusandpancreatitis GallBladder Liver ShenMen Sympathetic Autonomic point PointZero Appetite Control SanJiao Endocrine point Pancreas Y\ ----iH--.f----I - Pancreatitis ---1--1--.,1- Liver Spleen.C Brain Figure9.19 Abdominal organ disorders treatment protocols. Treatment protocols 307 308 9.18 Gynecological andmenstrual disorders (Figure9.20) 9.18.1 Breasttenderness Primary: MammaryGland.C,MammaryGland.E,Chest, Endocrinepoint, Shen Men, Thalamus point. Supplemental: PointZero, Adrenal Gland.C,Adrenal Gland.E,Brain, Occiput. 9.18.2 Breast tumor, ovarian cancer Primary: MammaryGland.C,MammaryGland.E,Chest, Ovary.C, Ovary.E, Shen Men. Supplemental: PointZero, Endocrinepoint,Thalamuspoint,ThymusGland.E,Vitalitypoint. 9.18.3 Dysmenorrhea, irregular menstruation Primary: Uterus.C, Uterus.E, Ovary.C, Ovary.E, Abdomen, Endocrinepoint, External Genitals.C, External Genitals.E, Prostaglandin1, Prostaglandin2. Supplemental: PointZero, Shen Men, SympatheticAutonomicpoint, Thalamuspoint,Adrenal Gland.C,Brain, Kidney.C. 9.18.4 Endometriosis Primary: Uterus.C, Uterus.E, Ovary.C, Ovary.E, Shen Men, Endocrinepoint, PointZero, Abdomen, Adrenal Gland.C,Adrenal Gland.E. 9.18.5 Infertility Primary: Uterus.C, Uterus.E, Ovary.C, Ovary.E, Point Zero, Shen Men, External Genitals.C, External Genitals.E, Endocrinepoint,Adrenal Gland.C,Kidney.C, Abdomen, Brain. 9.18.6 Inflammation of uterine lining, uterine prolapse Primary: Uterus.C, Uterus.E, Ovary.C, Ovary.E, Gonadotropins,PelvicGirdle, Endocrinepoint. Supplemental: External Genitals.C, External Genitals.E, Lung1,Lung2. 9.18.7 Labor induction Primary: Uterus.C, Uterus.E, Abdomen, PointZero, Shen Men, SympatheticAutonomic point, Thalamuspoint, LumbarSpine, Spleen.C, Spleen.E. 9.18.8 Lactation stimulation Primary: Prolactin,MammaryGland.C,MammaryGland.E,Endocrinepoint, Spleen.C, Kidney.C. 9.18.9 Mammary gland swelling Primary: MammaryGland.C,MammaryGland.E,Chest, Endocrinepoint,Adrenal Gland.C. 9.18.10 Menopause Primary: Ovary.C, Ovary.E, Uterus.C, Uterus.E, Endocrinepoint, Shen Men, Kidney.C, Liver. 9.18.11 Postpartum pain Primary: Uterus.C, Uterus.E, Abdomen, External Genitals.C, External Genitals.E, Point Zero, Shen Men, SympatheticAutonomicpoint, Thalamuspoint, LumbarSpine, Spleen.C. 9.18.12 Premenstrual syndrome Primary: Uterus.C, Uterus.E, Ovary.C, Ovary.E, Endocrinepoint, Shen Men. Supplemental: Point Zero, SympatheticAutonomic point,Thalamuspoint,Adrenal Gland.C, Brain, Kidney.C, Abdomen. 9.18.13 Vaginismus Primary: Vagina, Ovary.C, Ovary.E, Point Zero, Shen Men, Endocrinepoint. Supplemental: Adrenal Gland.C,Lung1,Lung2, Brain, Occiput, Kidney.C, Abdomen. Auriculotherapy Manual Shen Men Thalamus point Premenstrual syndrome Uterus.C Endocrine point Point Zero Thalamus point Adrenal Gland.C Uterus .E Endocrine __ point __ .... External Genitals.E Dysmenorrhea. irregular menstruation o Prostaglandin 2 Uterus .C Shen Men Sympathetic Autonomic point External Genitals.C Breast tumor. ovarian cancer I nfertility Mammary Gland.C Shen Men Brain Endocrine point Uterus.C External Genitals.C Mammary Gland.E Thalamus point Thymus Gland.E Vitality !’oint PointZero Shen Men Endocrine point Figure 9.20 Gynecological and menstrual disorders treatment protocols. Treatment protocols 309 310 9.19 Glandular disorders andsexual dysfunctions (Figure9.21) 9.19.1 Calcium metabolism Primary: ParathyroidGland,Parathormone,Endocrinepoint, ShenMen. 9.19.2 Dwarfism Primary: Anterior Pituitary,Kidney.C, Kidney.E, PointZero, Shen Men, Endocrinepoint. Supplemental: Ovariesor Testes.C, Ovariesor Testes.E, Brain. 9.19.3 Goiter Primary: ThyroidGland.C,ThyroidGland.E,Thyrotropin,Point Zero, Shen Men, Endocrine point. 9.19.4 Hypergonadism, hypogonadism Primary: Ovariesor Testes.C, Ovaryor Testes.E, PointZero, Shen Men, Endocrinepoint, Brain. 9.19.5 Hyperthyroidism, hypothyroidism Primary: ThyroidGland.C,ThyroidGland.E,Thyrotropin,Point Zero, Shen Men, Endocrine point, Brain, Master Oscillation,Apex of Ear. 9.19.6 Impotency, frigidity, lacking sexual desire Primary: Sexual Desire, External Genitals.C,External Genitals.E, Ovariesor Testes.C, Ovaries or Testes.E, Uterus.C, Uterus.E, Point Zero, Excitement point. Supplemental: ShenMen, Brain,SympatheticAutonomicpoint,Endocrinepoint, Master Oscillation,Master Cerebral,Kidney.C, PelvicGirdle, Forehead. 9.19.7 Premature ejaculation Primary: Sexual Compulsion, Testes.C, Testes.E, External Genitals.C, External Genitals.E, Thalamuspoint. Supplemental: Shen Men, Point Zero, Endocrinepoint. 9.19.8 Prostatitis Primary: Prostate.C,Prostate.E,Testes.C, Testes.E, PelvicGirdle,ShenMen, Endocrinepoint. Supplemental: PointZero, Adrenal Gland.C,Bladder,Occiput, SkinDisorder.C,Skin Disorder.E. 9.19.9 Scrotal rash Primary: External Genitals.C, External Genitals.E, SkinDisorder.C,SkinDisorder.E, Master Sensorial. 9.19.10 Sexual compulsion Primary: Sexual Compulsion, Aggressivity, Excitement point, Ovariesor Testes.C, Ovariesor Testes.E, Point Zero, Shen Men, Tranquilizerpoint, Master Cerebral,Thalamuspoint. 9.19.11 Testitis Primary: Testes.C, Testes.E, External Genitals.C, External Genitals.E, PelvicGirdle,Shen Men. Supplemental: Prostate.C,Prostate.E, Point Zero, Endocrinepoint,Adrenal Gland.C,Hip.C, Hip.E, Occiput, Liver. Auriculotherapy Manual Ovariesor Testes.C Endocrine point External Genitals.C Brain Ovariesor Testes.C Impotency, frigidity, lackingsexual desire Prostatitisandtestitis Bladder ShenMen Prostate.C Uterus.C External Genitals.C Sympathetic Autonomic point Uterus.E External Genitals.E Sexual Desire Master Oscillation Excitement point Endocrine point MasterCerebral Sexual compulsion, prematureejaculation Hyperthyroidism, hypothyroidism External Genitals.C Ovariesor Testes.C Genitals.E Tranquilizer point Excitement point Endocrine point Master Cerebral Apex of Ear ShenMen PointZero Thalamuspoint Ovariesor Testes.C Brain Figure9.21 Glandulardisorders and sexualdysfunctionstreatmentprotocols. Treatment protocols 311 312 9.20 Illnesses, inflammationsandallergies (Figure9.22) 9.20.1 AIDS, HIVdisease Primary: Thymus Gland,Vitalitypoint, Spleen.C, Spleen.E, Point Zero, Shen Men, Endocrine point, Thalamuspoint, SympatheticAutonomicpoint, Heart.C,Occiput, ThyroidGland.E. 9.20.2 Allergies Primary: Apex of Ear, Allergy point, Omega2, I nnerNose, Asthma, Antihistamine,Thymus Gland,Point Zero, Shen Men, SympatheticAutonomicpoint, Endocrinepoint. Supplemental: Adrenal Gland.C,ThyroidGland.C,ThyroidGland.E,Kidney.C, SanJiao, Lung1,Lung2, Brain,Spleen.C, Spleen.E. 9.20.3 Anaphylaxis hypersensitivity Primary: Asthma, Lung1,Lung2, LargeI ntestines, ThymusGland,Shen Men, Endocrinepoint, Thalamuspoint,Adrenal Gland.C,Adrenal Gland.E. 9.20.4 Antiinflammatory Primary: Apex of Ear, Allergy point, Omega2, Occiput, Point Zero, Shen Men, Sympathetic Autonomicpoint,Thalamuspoint, Adrenal Gland.C,Adrenal Gland.E. 9.20.5 Antipyretic Primary: Apex of Ear, Omega2, Liver, Large I ntestines, Adrenal Gland.C,Shen Men. 9.20.6 Cancer Primary: Correspondingbodyarea, ThymusGland,Vitalitypoint, Heart.C,Point Zero, Shen Men, ThyroidGland.E. 9.20.7 Chicken pox Primary: Lung1, Lung2, Point Zero, Shen Men, Endocrinepoint, Adrenal Gland.C,Occiput. 9.20.8 Common cold Primary: I nnerNose, Throat.C,Throat.E,Forehead, Lung1, Lung2,Asthma, Antihistamine, Prostaglandin1, Prostaglandin2,Apex of Ear. Supplemental: PointZero, Shen Men, Adrenal Gland.C,Adrenal Gland.E,Occiput, Thalamus point, ThyroidGland.C,ThyroidGland.E. 9.20.9 Fever Primary: Vitalitypoint, Occiput, Point Zero, Shen Men, Thalamuspoint, Endocrinepoint, Adrenal Gland.C,ACTH, Apex of Ear,Omega2, Prostaglandin1, Prostaglandin2. 9.20.10 Influenza Primary: Forehead, Lung1,Lung2, PointZero, Shen Men, Adrenal Gland.C,ThymusGland, Apex of Ear. Supplemental: Apex of Tragus, Helix1, Helix2, Helix3, Helix4, Helix5, Helix6, Omega2, Prostaglandin1,Prostaglandin2. 9.20.11 Lowwhiteblood cells Primary: Liver, Spleen.C, Heart.C,Kidney.C, Adrenal Gland.C,Endocrinepoint, Shen Men. Supplemental: Diaphragm,Occiput, SympatheticAutonomicpoint, Vitalitypoint. 9.20.12 Malaria Primary: Thalamuspoint, Endocrinepoint,Adrenal Gland.C,Liver, LargeI ntestines, Spleen.C. 9.20.13 Mumps Primary: Face, SalivaryGland.C,SalivaryGland.E,Thalamuspoint, Endocrinepoint. 9.20.14 Weather changes Primary: Weather point, PointZero, Shen Men. Auriculotherapy Manual Apex of Ear Common cold o Prostaglandin 2 Apex of Ear I nfluenza o Prostaglandin 2 Antihistamine Point Zero Throat.E Throat.C Inner Nose __---H. Adrenal Gland.C Asthma Forehead Shen Men Adrenal Gland.E Thyroid Gland.E LungJ Thyroid Gland.C Lungl Occiput Thalamus point Point Zero Adrenal Gland.C Apex of Forehead Shen Men Helix 1 Thymus Gland Helix 2 LungJ I ’r-r--Helix 3 Helix4 Helix6 Allergies Apex of Ear AIDS, HI Vdisease, and cancer Shen Men Thalamus point Thyroid Gland.E Th)’mus Gland Spleen.E Heart.C Endocrine point Spleen.C Thyroid Gland.C Asthma Brain Allergy point Shen Men Kidney.C Sympathetic Autonomic point Adrenal Gland.C Lung 1 Lung 2 Point Zero San [lao Endocrine point Antihistamine Sympathetic Autonomic point Figure 9.22 Illnesses, inflammations and allergies treatment protocols. Treatment protocols 313 Wrist Arm Elbow Master Shoulder Fingers Hand TMJ Lower Jaw Upper Jaw Inner Ear.C Face Chest __--1-_ Shoulder .......,._l-_Neck Nogier Phase I andChinese ear points Toes.C Knee.C Hip.Fl Ankle.Fl Knee.Fl Heel.Fl Eye Cervical Spine.Fl__-1-_ Occiput Temples --+-+..,..".4› Forehead __ :, j Eye Disorder 1 Eye Disorder 2 Sacral Spine.Fll--l Lumbar Spine.Fl Thoracic Spine.Fl __---P_- External Ear.C Nogier Phase 11/ andChinese ear points Foot.F3 Cervical Spine.F3 External Genitals.C Diaphragm.C External Genitals.E Lumbar Spine.F3 Thoracic Spine.F3 Nogier Phase" and11/ ear points Nogier Phase IVear points Hip.F2 Hand.F3 f------l.........I -1-Cervical Spine.F2 "--’--j.+-I --J -._ Foot.F2 Ankle.F2 Shoulder.F3 Fingers.F4 Wrist.F4 Elbow.F4•_-,-_ Shoulder.F4 Foot.F4 Knee.F4 Lumbar Spine.F4 Hip.F4 Thoracic Spine.F4 Cervical Spine.F4 Head.F4 Figure 9.23 Earpoints and correspondingbodyareas. 314 Auriculotherapy Manual