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Auricular Medicine
By Warren King L.Ac.

History, Theory and Scientific Basis

Auriculotherapy is a therapeutic intervention in which the auricle of the external ear is utilized to alleviate pain, dysfunction, and disease as represented and manifested throughout the body. The auricle of the ear is a complete micro system of the human body. All vertebra, sympathetic/parasympathetic nerves, spinal nerves, visceral organs, and the central nervous system, including all anatomical sites and many functional points, are represented on the ear. They total over 200 specific acupuncture points. Dr. Paul Nogier first developed the somatotropic correspondence of specific parts of the body to specific parts of the ear in France, however, auriculotherapy was originally based on the ancient Chinese practice of acupuncture.

History of Auriculotherapy

All systems of acupuncture began originally in China with The Yellow Emperor’s Classic of Internal Medicine, compiled in 500 BC. This text describes the connection of acupuncture meridians to the auricle of the ear. These ancient Chinese ear acupuncture points were scattered over the auricle of the ear. Hippocrates and Galen recorded clinical uses of earrings and other forms of ear stimulation for various problems, particularly in the treatment of sexual and menstrual disorders in ancient Egypt and Rome between 500 BC and 100 AD. After the fall of Rome, approximately 200 AD, ancient medical records were found in Persia where the medical treatment for sciatic pain was cauterization of the ear.

From 1500 - 1700 the Dutch East Indian Company, while merchant trading in China, brought many Chinese acupuncture procedures back to Europe, including the use of ear acupuncture. It was the Dutch East Indian Company that saw acupuncture being used in the Orient where medicine was placed next to the needle site. As a result, they developed the Western hypodermic needle from the example of the Chinese acupuncture needles. The use of ear cauterization to relieve sciatic pain was discussed in sporadic European clinical reports.

In 1957, Dr. Paul Nogier, a physician from Lyon, France, observed the occurrence of scars on the ears of a patient who was successfully treated for sciatic pain by French lay practitioners. Dr. Nogier then developed a somatotropic map of the ear based upon the inverted fetus concept. His work was first presented in France, then published by a German acupuncture society, and finally translated into Chinese. In 1958, a massive study was initiated by a Nanking Army ear acupuncture research team who verified the clinical accuracy of Dr. Nogier’s inverted man concept of the little man on the ear. The ‘barefoot doctors’ of China were taught the easy techniques of ear acupuncture during the Chinese Cultural Revolution, allowing them to bring healthcare to the masses.

In 1980, a double blind, experimentally controlled, research study was conducted by Richard J. Kroeuning, MD, PhD and Terry D. Oleson, PhD at the UCLA Pain Management Center, Department of Anesthesiology, UCLA School of Medicine. This study, reported in PAIN magazine, verified the scientific accuracy of auricular diagnosis. According to the study, there was a statistically significant level of 75 per cent accuracy achieved in diagnosing musculoskeletal pain problems in 40 pain patients. Specific areas of discoloration, tenderness and increased electrical activity on the ear predicted specific areas of the body where some pain or dysfunction would be identified, whereas the body free of pathology corresponded to non-active points on the ear.

Research that followed throughout the United States utilized both the Chinese and French auricular acupuncture points for the treatment of chronic pain problems and the withdrawal systems from narcotics, alcohol and nicotine. In 1990, International meetings of the World National Organization culminated in a standardization of names of names of auricular anatomy in location of ear reflex points and ear acupuncture in China. While classical acupuncture was first developed in China, its use diminished in the 1800’s when China was dominated by western European powers. With the cultural revolution of Mao Tse-tung, the Chinese, through the inverted fetus concept, rediscovered and identified auricular acupuncture as a potent diagnostic and therapeutic weapon. During a 1995 international symposium, Dr. Chen Gong-Sun, of Nanking Medical University, confirmed the great changes in the practice of ear acupuncture that had occurred in China and credited Dr. Nogier with systemizing ear acupuncture with the somatotropic pattern of the inverted fetus for auriculotherapy.

Much of the work of auricular therapy was delineated by Dr. Paul Nogier’s first textbook on the subject, The Treatise of Auriculotherapy, 1972. In 1950, Dr. Nogier was "intrigued by a strange scar a patient had in his external ear". He found that the scar was the result of a treatment for sciatica involving cauterization of the edge of the antihelix on the same side as the neuralgia that had previously been observed.

Patients were unanimous in stating that they had received relief for their sciatic pain within hours, and even minutes, from the procedure of ear cauterization. While discussing this antihelix cauterization point for sciatica with a colleague, Dr. Aman Thieu told Dr. Nogier, "Sciatica derives from a problem with the lumbrosacral hinge". Dr. Nogier then conjectured that the antihelix area being cauterized for sciatica could correspond to the lumbrosacral joint and the whole antihelix could represent the spinal column. He further hypothesized that the head could correspond to the lobe and the antitragius area. In this way, the ear would resemble an embryo in utero.

Nogier first experimented with cautery, then with a needle, and finally with electrical micro currents imperceptible to the patient. The micro currents were successful in relieving pain and caused no undue nervous upset to the patient as cauterization had. In 1955, Dr. Nogier mentioned his discoveries to the undisputed French master of acupuncture, Dr. Niboyet. As a result, Dr. Nogier presented his finding to the Mediterranean Society in 1956 at which Dr. Bachman of Munich, Germany was in attendance. Dr. Bachman subsequently published Dr. Nogier’s findings in an acupuncture journal with worldwide circulation, particularly in the Far East. It was because of the translations from German that the ear reflex system was soon well known by Chinese and Japanese acupuncturists. Dr. Nogier made the comment that, "each doctor needs to be convinced of the efficacy of this ear reflex method, by personal results, that he or she is right." "They are indeed fortunate people who can convince themselves simply by noting the improvement of a system they themselves have experienced." As Dr. Nogier says, "the first stages of learning the map of the ear consist of getting to know the morphology of the external ear, its reflex, cartography and that these points are found to treat simple pains of traumatic origins."

In 1966, Dr. Nogier discovered a change in the radial arterial pulse following tactile stimulation of the ear. This was referred to as the auricular cardiac reflex. This pulse change represented a modification of the pulse amplitude and way form, not related to the changes in pulse rate. The auricular cardiac reflex has been important in identifying each of the ear reflex points corresponding to particular parts of the body where there is pain or pathology. Dr. Nogier later revised the name of the auricular cardiac reflex to the vascular autonomic signal (VAS) when he realized that this was an involuntary arterial reflex, and was not limited to auricular stimulation, but was in fact a general vascular continuous reflex that could be achieved by tactile or electrical stimulation of many body areas. The use of a VAS is an integral part of auricular medicine. Besides using the mechanical pressure or electrical stimulation, light frequency filters and chemical substances on slides were put over the surface of the ear to demonstrate a VAS response wherever there was pathology in the corresponding area of the body. As of this date, Dr. Paul Nogier has retired and is living in Leon, France.

Comparison of Ear and Body Acupuncture

Both ear and body acupuncture take their origins from China. Body acupuncture, however, has remained essentially unchanged, whereas ear acupuncture has been greatly modified by the discoveries of Dr. Paul Nogier. In addition, further research is continuing to yield newer developments in auricular diagnosis and treatment.

Aculpuncture Meridians and Points

Body acupuncture is based upon a system of twelve meridians, six Yin and six Yang. The ear is a self-contained micro system that effects the whole body. Acupuncture points are anatomically defined in the areas of the skin. They are set at fixed specific locations in body acupuncture and can always be detected. In ear acupuncture, however, the auricular point can be detected only when there is a problem in the corresponding part of the body. The deqi that accompanies stimulation of the body acupuncture point is not observed in stimulation of the ear acupuncture point.

Electrodermal Skin Resistance

The points in both body and ear acupuncture are localized regions of lowered skin resistance or higher skin conductivity. The epidermal skin conductance of the acupuncture point is high when there is a pathology in an organ represented in the meridian point or the auricular point.

Ipsilateral Representation

Ear acupuncture points are ipsilateral, or same side as the pain or pathology. This representation on the ear is due to two contralateral projections from the ear to the opposite side of the brain and from the opposite side of the brain back to the opposite side of the body. Using traditional Chinese medicine theory, ear points are ipsilateral because Qi flows up the ipsilateral meridian.

Diagnostic Efficency

Ear acupuncture provides a more scientifically verified means of identifying areas of pain or pathology in the body than traditional Chinese medicine that employs such methods as tongue or pulse diagnosis. In auricular diagnosis, one can identify specific problems in the body by detecting areas of the ear that are discolored, flaky, tender or have high skin conductivity. This increased conductance is measured by a probe and is repeatable and verifiable. The subtle changes in auricular diagnosis may identify conditions of which the patient and the physician may only be marginally aware.

Acupuncture Treatment Approaches

Both ear acupuncture (auriculotherapy) and body acupuncture can be chemically utilized to relieve pain pathology. They can be used together or applied separately to achieve healing, not just pain relief. Both body and ear acupuncture points do not simply reduce the experience of pain, but also facilitate natural healing processes within the body. Auricular therapy facilitates the natural self-regulating homeostatic mechanisms of the body by diminishing overactive body functions and increasing under active physiological processes. Both body acupuncture and auricular therapy can have deep physiological and psychological effects.

Side Effects

The primary side effect of ear acupuncture (auriculotherapy) is that the ear itself can become tender and inflamed if treated with needles. Auricular therapy and acupuncture generally are not recommended for patients with pace makers or during pregnancy, but can safely be used to diagnose. While auriculotherapy does not require the use of needles, ear points may be sensitive to any applied stimulation through auriculotherapy treatment. Infection is almost never heard of in auriculotherapy and acupuncture. Also, if a patient is afraid of needles, auricular electrical stimulation or cold laser is the preferred treatment.

Medical Problems Treated

Both body and ear acupuncture (auriculotherapy) are used for a broad variety of clinical dysfunction and diseases including headaches, chronic backaches, hypertension, asthma, dental disorders, addiction, etc.

The theoretical understanding of auriculotherapy can be perceived from knowledge of standard anatomical and neurophysiological treatises and theories, and additionally from the use of Chinese energetic theories. The neurological basis for auriculotherapy is based upon a somatotropic map wherein a complete map of the brain exists in neurons on the cerebral cortex, through the thalamus, and the brain stem. This brain map is similar to the auricular map exhibiting an inverted fetus orientation.

The ear is intervened by the auricular temporal nerve formed by the mandibular ranus of the trigeminal nerve, cranial nerve V. The major and minor auricular nerves are formed by the nerves of the cervical plexus C2, C3, and finally the auricular rami of the facial nerve, cranial nerve VII and the glossopharyngeal nerve, cranial nerve IX and the vagus nerve, cranial nerve X. This dense enervation of five different afferent nerves of somatic and visceral nature give abundant intervention via the ear.

Through the basis of this neural anatomy and embryological and comparative autonomy, auricular reflex therapy was composed and utilized by Reuben Durinjan. In the therapy developed by Melzack and Wall in 1965, date control theory, the inhibitory interneuron in the spinal cord differentially effected A fiber and C fiber input. Fast conducting A fibers carry information about touch, affecting inhibitory interneurons in the spinal cord to suppress the experience of pain.

Acupuncture stimulation tends to activate C fibers thus activating super spinal gating systems that in turn send descending input to the spinal inhibitory neurons, suppressing the pain message. Secondarily, stimulation produced analgesia is a pain inhibitory system that has been demonstrated by brain stimulation by the periactiductal central gray matter which reduces the responses to pain in rats, cats, monkeys, and humans. This peripheral stimulation of ear acupuncture points may peripherally activate the pain inhibitory system.

Embriological Basis for Auricular Therapy

Dr. Paul Nogier noted that the ear was composed of tissue from each of the three primary types of tissue in the developing embryo. His theory is that each type of embryological tissue on the ear accounts for a different somatotropic function related to the auricle. Ectodermal tissue, or superficial tissue, is found in the helix tail of the ear lobe. The ectoderm become the skin, hair, sweat glands, cornea and lens of the eye, nose, epithelium, teeth, nerves, spinal cord, subcortex of the brain, cerebrum and pituitary gland, pineal gland and the adrenal medulla. The mesodermal tissue, or the middle tissue, is found in the antihelix scaphoid fossa, the triangular fossa. The mesoderm become the musculoskeletal system of muscles, joints, bones, cardiac muscles, smooth muscles, connective tissue, blood cells from the bone marrow, lymphatic tissues, genital organs, kidney and the adrenal cortex. The third type is the endodermal tissue, or deep tissue, which is found in the concha. The endoderm becomes the gastrointestinal digestive tract, the lungs, tonsils and the respiratory system. It also becomes the internal organs like the liver, pancreas, bladder and urethra.

Hormonal Basis for Auriculotherapy

The neurotein system (natural pain relievers, endorphins, and enkephalins) are indigenous morphine chemicals that are found within the pituitary gland and other parts of the central nervous system, and encephalon is a sub factor of endorphin. These neurotransmitters occur in the brain at the same site where opiate receptors are found. Both body and ear acupuncture have been found to raise the blood serum and cerebral spinal fluid levels of endorphins and enkephalins. Naloxone is an opiate antagonist that blocks morphine endorphins.

Simons and Oleson (UCLA, 1993) and Mayer, et al (1977) were the first investigators to provide scientific evidence that there was a neurophysiological and neurochemical basis for acupuncture and auriculotherapy in human subjects. They demonstrated that the acupuncture stimulation of the body, through the four points associated with the large intestine, led to a significant increase in pain threshold. They were then able to yield statistically significant reversal of elevated pain threshold by intravenous administration of 0.8 mg of an opiate, Naloxone. The acupuncture had raised the dental pain threshold by over 27 per cent. There was a treatment control group that showed a 6.0 per cent in dental pain threshold. A total of 20 of 35 acupuncture subjects showed increased pain threshold greater than 20 percent, contrasted with only five out of forty subjects in the controlled condition exhibiting a 20 per cent elevation of pain threshold. Naloxone given to acupuncture subjects reduced the pain threshold to the same level as the control group. Abbot, et al provided direct evidence of endorphinogenic response to auricular therapy in 1980. They observed a significant increase in endorphins after acupuncture stimulation was combined with nitric oxide inhalation. Whereas the controlled subjects, who were given nitric oxide without acupuncture, showed no elevation of the endorphins.