Rim : canto, borde

(Next , an imaginary line is drawn by connecting the irritated point with Point Zero : this "line of treatment" is the examined for more irritated points)

What do your eyes reveal?

Bodily conditions. Inherent weaknesses. The transition that takes place in a person's body according to the way he

or she lives. They can register your emotional proclivities as well.

In terms of science, the experimentation of iris analysis is relatively new and should not be used in isolation but as a comprehensive system coupled with a medical history and other findings. It is not meant to diagnose diseases.

The purpose of Iridology is to determine the location of inflammation, the stage of inflammation, how it was caused, and the steps necessary to overcome it.

With this information a person can learn how to adopt a healthy lifestyle and diet.

These photos were taken with my Sony DSC707.

Terry Oleson .

geometric ear points at 30° angles : nogier and his colleagues discoverd that after treating correspondent ear points indicated by somatotopic maps, it was also possible to discern a series of reactive auricular points that ocurred along an imaginary straight line.These lines were referred to as geometric because the occurred at 30° angles to each other. The practtioner would first configure an imaginary line that extended from point zero to the corresondent point and outward to the peripheral helix that intersected with that line. Stimulation of any reactive ear points along this line was found to augment the treatment effects seen with auriculotherapy. In addition to treating the helix point 30° angles extending from this helix location were used to create additional imaginary lines that were also stimulated. These configurations are depicted . According to Bahr (1977) the application of these 30° angles may account fo the Chinese ear acupuncture points used for appendix disorders found in the scaphoid fossa and tonsil points found on the helix. There is also a 30° angle between the Chinese hypertension point on the tragus, and the european marvelous point, which is also used to treat high blood presssure. The technical

complexity of this geometric procedure, however, limits its usefulness to those clinical cases that not respond to more straightforward applications of auriculotherapy.

Precautions associated with auriculoterapy: the most common adverse side effect from auriculotherapy is that the ear may become red and tender to touch after the treatment. Inform the patient that this redness and tenderness are only temporary

Although it is very uncommon for patients to report adverse reactions to the auriculotherapy treatment this is a possibility, In this case, the practitioner should closely monitor the patient for several days after the treatment.

Administer antibiotics to patients if the ear becomes infected. Any bleeding after the insrtion of an acupuncture nnedle into the ear is usually very bief and rarely leads to an infection. However, staple-puncture techniques in which a surgical staple tack is left in place for several days , can possibly lead to infection.

Some patients may become sleepy or dizzy after a treatment and they may need to lie down for a while. This sedation effect has been attributable to the release of endorphins and is considered more beneficial than unwanted.

allow nervous, anxious, weak or hypertensive patients some time for a rest after the treatment. It is helpful to offer patients warm tea while they recover.

Avoid treating patients when they are excessively weak , anemic, tired , fasting, hypoglycemic or have just eaten a heavy meal. The treatment will not be as effective.

Do not treat any pain needed to diagnose an underlyng problem until that undrlying condition has been fully evaluated.

Do not relieve any pain needed by patients to limit them from engaging in inappropriate physical activity that could aggravate their condition.

Be cautious when treating pregnant women.This precaution is mostly required for malpractice reasons, rather than any known clinical evidence regarding possible harmful effects of auriculotherapy on a fetus or pregnant woman. Nonetheless Chinese studies have suggested that strong stimulation of the uterus and ovary on the external ear can possibly induce an abortion

Do not use electrical stimulation on patients with a cardiac pacemaker, even though the lectrical microcurrents used in auriculotherapy are delivered at extremely small intensity levels.

Do not use aggressive stimulation with children or elderly patients who may be particularly sensitive to strong auriculotherapy treatments.

Inform the patient to not use alcohol or recreational drugs before the auriculotherapy treatment because these substances may interfere with treatment efficay, At the same time, when auriculoterapy is ued for the treatment of substance abuse, auriculoterapy can be effective even while the patient is still using recreational substances.

Hindrances to treatment success: If a patient´s disorder persists after auriculoterapy treatment of the correspondent ear points there may be a therapeutic blockage due to a toxic scar or dental focus. The practitioner should inquire of the patient´s medical history and previous accidents or surgeries. Sometimes a hindrance to treatment is due to an allergy which is an excess of energy. Other times there is an obstacle to the transmission of the cellular information because of a region of energy deficiency. The loss of energy may be attributable to the aftereffects of an accident or surgery that caused a toxic scar and short-circuit in the energy of that person. A different type of toxic scar is a dental focus related to continued inflammation from a prior dental procedure. Silver amalgam in tooth fillings or chronic infection of the gingiva can also produce a dental focus.

Allow that some medical problems presented by a patient cannot be effectively treated by auriculoterapy because they are due to either (1) a structural imbalance that needs to be corrected by some physical therapy procedure or (2) psychological dysfunctions that need to be adressed by some type of psychotherapeutic intervention. Dr. Nogier often combined auriculoterapy with osteopathic manipulations in order to provide structural integration to the neuromosuclar changes that could be achieved with auriculoterapy. When the obstacle is due to an unresolved emotional state, stimulation of Point Zero can bring balance to the psychosomatic resistance.

Although psychosomatic disorders are often dismissed by physicians and patients alike, there is ample evidence that psychological factors have a profound impact on many physical conditions. Until emotional issues related to anxiety, depression,loneliness, resentment and shame are satisfactorily resolved, a patient´s unconscious motivations may defeat the most skillful of clinicians. Even when patients strongly vocalize that they want to be relieved of their physical suffering, those same individuals are not consciously aware of their own thoughts, attitudes, and behaviors that have the opposite effect. Gentle but firm confrontation regarding the possibility that such psychological barriers exist is often necessary before proceeding further with any medical treatment. Many practitioners are not comfortable addressing such issues with resistant patients but such confrontations are often very necessary for the eventual improvement of a person´s health problems.

Clinical pearls for auriculoterapy treatments:

Treat as few points as possible.

Only treat ear points that are tender to palpation or are electrically conductive.

treat a maximum of threee problems at a time, treating the primary problem first.

treat ipsilateral ear reflex points for unilateral problems, and treat both ears for bilateral conditions. if the patient exhibits a laterality or oscillation disorder, the Master Oscillation point should be treated first, and then correspondent points on both auricles should be stimulated.

Treat the front of the external ear for relieving the sensations of pain, and then treat the back of the ear for relieving muscle spasms that produce muscle tension and limit range of motion

Hold the external ear taught with one hand while using the other hand to hold a detecting probe to the ear or a treatment probe or acupuncture needle. After treating the anatomic points that correspond to the area of the bodily symptom, treat the master points. Lastly, treat supportive functional points.The most commonly used master points are point zero, shen men , autonomic sympathetic point, thalamus point. endocrine point, and master cerebral point --

anatomic points that are often used to alleviate other disorders include ear points for the occiput, the chinese kidney, the heart, the lung the liver and the stomach.---

the most communly used chinese functional points are Muscle relaxation point, appetite control point , brain (central rim) , windstream( lesser occipital nerve), and san jiao (triple warmer) ---

the most frequently utilized european functional points are antidepressantpoint, anti aggressiivity point, vitaly point and psychosoamatic point ---

treat Nogier phase II and Phase III points if successful results are not obtained with pahse I points or with chinese ear points. Phase II ponts are indicated for chronic deficient conditions , whereas Phase II ear points are indicated for chronic excess conditions.--- Evaluate the patient for the presence of physical hindrances or psychological obstacles that could interfere with the treatment. One might also notice if treating reactive points on the ear related to geometric, inverse or contrarly relationships improves the clinical effectiveness of the auriculoterapy treatment. ---

auriculoterapy works very well with other treatments modalities. It is quite common to combine ear acupuncture and body acupuncture in the same treatment session ----- Chinese herbs, moxibustion, homeoapthic substances and acupresssure massage can be effectively integrated with auriculotherapy as well as body acupuncture.

---Postural adjustments with osteoaptic or chiropractic manipulations serve to facilitate the reduction of muscle spasms attained with auricular stimulation.

--- biofeddback, hypnosis, meditation, and yoga all serve to augment the general relaxation effect seen with auriculoterapy.

--- patients with psychosomatic disturbances would probably benefit from psycoterapeutic interventions if they could accept the perspective that inconscious emotional conflicts could be a contribuiting factor to their physical health problem

--- any procedure used as standard medical practice for the condition being treated can be further enhanced by the use of auriculoterapy..

Precauciones asociados con auriculoterapia: el efecto secundario adverso más común de la auriculoterapia es que el oído puede ponerse roja y sensible al tacto después del tratamiento. Informar al paciente que este enrojecimiento y sensibilidad son sólo temporales

Aunque es muy raro que los pacientes informan de reacciones adversas al tratamiento auriculoterapia es una posibilidad, en este caso, el médico debe vigilar estrechamente al paciente durante varios días después del tratamiento

Administrar antibióticos a los pacientes si el oído se infecta. Cualquier sangrado después de la inserción de una aguja de acupuntura en el oído suele ser muy breve y rara vez conduce a una infección. Sin embargo, las técnicas de grapas-punzantes en el que una tachuela grapa quirúrgica se deja en su lugar por varios días, posiblemente, puede conducir a la infección.

Algunos pacientes pueden quedar dormidos o mareados después de un tratamiento y pueden necesitar acostarse por un tiempo. Este efecto de sedación ha sido atribuido a la liberación de endorfinas y se considera más beneficioso que el no deseado.permitir a los pacientes nerviosos, ansiosos, débiles o hipertensos algún tiempo para un descanso después del tratamiento. Es útil para ofrecer a los pacientes té caliente mientras se recuperan. Evite el tratamiento de los pacientes cuando son excesivamente débil, anémica, cansado, el ayuno, hipoglucémico o simplemente han consumido una comida abundante. El tratamiento no será tan eficaz.

.No tratar cualquier dolor necesario para diagnosticar un problema de fondo hasta que la condición subyacente ha sido evaluada. No aliviar cualquier dolor que necesitan los pacientes para limitar ellos de una actividad física inadecuada que podría agravar su condición. Tenga cuidado al tratar a las mujeres embarazadas. Esta precaución se requiere sobre todo por razones de negligencia, en lugar de cualquier evidencia clínica conocida respecto a los posibles efectos nocivos de la auriculoterapia en un feto o una mujer embarazada. Sin embargo los estudios chinos han sugerido que la fuerte estimulación del útero y ovario en el oído externo puede posiblemente inducir un aborto.

No utilice la estimulación eléctrica en los pacientes con un marcapasos cardíaco, a pesar de las microcorrientes eléctricas utilizadas en auriculoterapia se entregan a los niveles de intensidad extremadamente pequeñas.

. No utilizar la estimulación agresiva con los niños o los ancianos que pueden ser particularmente sensibles a los fuertes tratamientos auriculoterapia. Informar al paciente a no usar alcohol o drogas recreativas antes del tratamiento de auriculoterapia porque estas sustancias pueden interferir con la eficacia del tratamiento. Al mismo tiempo, cuando se utiliza auriculoterapia para el tratamiento de abuso de sustancias, auriculoterapia puede ser eficaz incluso mientras el paciente todavía está utilizando sustancias recreativas

Obstáculos para el éxito del tratamiento:

Si un trastorno del paciente persiste después del tratamiento con auriculoterapia de los puntos de la oreja correspondientes, puede haber un bloqueo terapéutico debido a una cicatriz tóxica o foco dental.

Perlas clínicas para tratamientos auriculoterapia:

Tratar a los menos puntos posibles. Sólo tratar puntos de la oreja que son sensibles a la palpación o eléctricamente conductora. tratar un máximo de tres problemas a la vez, tratar el problema principal primero. tratar los puntos reflejos del oído ipsilateral para problemas unilaterales, y tratar a ambos oídos para las condiciones bilaterales. si el paciente presenta un trastorno lateralidad u oscilación, el punto principal de oscilación debe ser tratado primero, y luego los puntos correspondientes en ambas aurículas debe ser estimulado. Tratar la parte frontal del oído externo para aliviar las sensaciones de dolor, y luego tratar la parte posterior de la oreja para aliviar los espasmos musculares que producen tensión muscular y el rango límite de movimiento.

Mantenga el oído externo enseñado con una mano mientras con la otra mano para sostener una sonda de detección para el oído o una sonda de tratamiento o aguja de acupuntura.

El profesional debe consultar la historia clínica del paciente y los accidentes o cirugías previas.A veces un obstáculo al tratamiento es debido a una alergia, que es un exceso de energía.Otras veces, es un obstáculo para la transmisión de la información celular debido a una región de la deficiencia de energía. La pérdida de energía puede ser atribuible a las secuelas de un accidente o cirugía que causó una cicatriz tóxica y cortocircuito en la energía de esa persona. Otro tipo de cicatriz tóxico es un foco dental relacionada con la inflamación

continuada de un procedimiento dental anterior. La amalgama de plata en los empastes dentales o infección crónica de las encías también puede producir un foco dental.

Permitir que algunos problemas médicos presentados por un paciente no pueden ser tratados eficazmente por auriculoterapia porque son ya sea debido a (1) un desequilibrio estructural que necesita ser corregido por algún procedimiento de

terapia física o (2) las disfunciones psicológicas que necesitan ser conducidas por alguno tipo de intervención psicoterapéutica.Dr. Nogier combina a menudo con auriculoterapia manipulaciones osteopáticas con el fin de proporcionar una integración estructural a los cambios neuromusculares que podrían lograrse con la auriculoterapia. Cuando el obstáculo se debe a un estado emocional no resuelto, la estimulación del Punto Cero puede traer equilibrio a la r Aunque los trastornos psicosomáticos muchas veces son rechazados por los médicos y pacientes por igual, hay amplia evidencia de que los factores psicológicos tienen un impacto profundo en muchas condiciones físicas. Hasta tanto los problemas emocionales relacionados con la ansiedad, la depresión, la soledad, el resentimiento y la vergüenza se resuelvan satisfactoriamente, unos correspondientes del paciente, las motivaciones inconscientes pueden derrotar al más hábil de los médicos.

Incluso cuando los pacientes vocalizan fuertemente que quieren ser aliviados de su sufrimiento físico, esas mismas personas no son conscientes que sus pensamientos, actitudes y comportamientos que tienen el efecto contrario.La confrontación suave pero firme en cuanto a la posibilidad de que existan estas barreras psicológicas a menudo es necesaria antes de seguir adelante con cualquier tratamiento médico.

Muchos médicos no se sienten cómodos abordar estas cuestiones con pacientes resistentes pero tales confrontaciones a menudo son muy necesarias para la eventual mejora de los problemas de salud de la persona.

.

Después de tratar los puntos anatómicos que corresponden a la zona del síntoma en el cuerpo, use los puntos maestro.Por último, trate los puntos funcionales de apoyo.

Los puntos de maestros más utilizados son el punto cero, shen men, punto simpático autonómica, punto tálamo, punto endocrino, y el punto cerebral maestro-- puntos anatómicos que se utilizan a menudo para aliviar otros trastornos incluyen puntos de la oreja para el occipital, el riñón chino, el corazón, el pulmón el hígado y el estómago.--- Los puntos funcionales chinos más utilizados son el punto Relajación muscular, punto de control del apetito, el cerebro (llanta central), Windstream (nervio occipital menor), y san jiao (triple calentador) --- los puntos funcionales europeos utilizados con mayor frecuencia son punto antidepresivo, punto de agresividad anti, punto vitalidad y punto psicosomático---tratar puntos Fase Nogier II y Fase III si los resultados exitosos no se obtienen con puntos de fase I o con puntos de la oreja chinos. Puntos Fase II están indicados para deficientes condiciones crónicas, mientras que los puntos de la Fase II del oído están indicados para condiciones de exceso crónicas.--- Evaluar al paciente para detectar la presencia de obstáculos físicos u obstáculos psicológicos que podrían interferir con el tratamiento. También se podría notar si el tratamiento de los puntos de reactivos en el oído relacionada con geométrica, inversa o relaciones contrarias mejora la eficacia clínica del tratamiento auriculoterapia.--- Obras auriculoterapia muy bien con otras modalidades de tratamientos. Es bastante común combinar la acupuntura oreja y cuerpo en la misma sesión de tratamiento----- Hierbas chinas, moxibustión, sustancias homeopáticas y masaje y digitopuntura pueden integrarse eficazmente con auriculoterapia y acupuntura corporal. --- ajustes posturales con manipulaciones osteopáticas ,quiroprácticas sirven para facilitar la reducción de los espasmos musculares obtenidos con la estimulación auricular. --- Biofeedback, la hipnosis, la meditación y el yoga todos sirven para aumentar el efecto de relajación general que se observa con la auriculoterapia. --- Pacientes con trastornos psicosomáticos probablemente se beneficiarían de intervenciones psicoterapéutico si podían aceptar la perspectiva de que los conflictos emocionales inconscientes podría ser un factor de que contribuye a su problema de salud física--- Cualquier procedimiento utilizado como práctica médica estándar para la condición a tratar puede mejorarse aún más por el uso de auriculoterapia .. Master oscillation point (laterality point) Location : found on the underside of the subtragus, underneath the inferior tragus protrusion at LM_10 Function : this master point balances laterality disorders related to dysfunctional interactions betwenn the left and the right cerebral hemispheres.It anatomically represents the corpus callosum and the anterior commisure which hoins the two sides of the brain, This point is often active in individuals who are left handed or mixed dominant in handedness.

Inverse relationships of the external ear to the psysical body : when treating the muscles attached to the spinal vertebrae, and the peripheral limbs, ti has been found in both auriculoterapy and manipulative terapies that it is possible to treat opposing regions of the musculoskeletal body. by this technique one can stimulate reactive points on the cervical spine to relieve a condition in the lumbosacral spine or one can treat the foot to affect pain relief in the shoulder. These specific relation ships are presented in TbFor example one would serach for a reactive point on the part of the auricle that represents the sixth cervical vertebrae to affect the fifth lumbar vertebrae and one would treat the first lumbar verterae

to affect the third thoracic vertebrae. One colud treat the region of the auricle representing the right wrist in order to alleviate a dysfunction in the left ankle or treat the ear point representing the left hip to relieve tension in the right shoulder. The occurrence of these reciprocal relationships may explain the observation of some reactive ear points at auricular areas not related to the correspondent body organ

Ear Acupuncture- By Kajsa Landgren

Differences acupuncture between ear and body acupuncture :

The word acupuncture derivs fro m the latin words acus and pungere. Acus means needle , pungere , to pierce. Ear acupuncture and boy acupuncture are two forms of treatment that resemble one another in that both involve pricking the skin with needles. To the uninitiated Westerner, the techniques in body and ear acupuncture may seem to a large degreee the same. Impulses from acupuncture needles influence the nervous system and ,no matter whether the needle is placed in the ear or the body, neurotransmitters and hormones are influenced in a similar way. However there are certain clear differences between the two forms of acupuncture. We shall look at some of the most obvious of these in this chapter

Historic differences :

Traditional Chinese medicine, of which body acupuncture forms a part is thousands of years old. However the acupuncturists of ancient China knew of only a few ear acupuncture points and had no idea as to the system in which they were arranged. Seen from a historical perspective, ear acupuncture in the form described in this book is relatively new phenomenon a reflex science developed in the 1950 s

Diagnostic differences : Active points: Body acupuncture points are always measurable at the same place. Draw an electrical point detector over the skin and it give an indication of all the acupuncture points on the body , whether the persona being examined is healthy or sick. The points on the body are always measurable because they are part of the constant flow of energy in the meridians. This is not the case with the points in the ear. THey are aither on or off. Ear acupuncture points may be measured with a point detector only when they are on wich is to say when they are active because there is something wrong with the corresponding part of the body. Ear acupuncture is a reflex science: each part of the body has a point or zone in the ear where a malfunction in the corresponding body part registers. This malfunction may then be treated. A completely healthy human being in perfect balance should have no active points in the ear. (there are a few exceptions to this rule. Some so called masterpoints can be found with an electrical point detector even on a healthy person : see Ch 6 the ear : its parts an acupuncture points.)

Differential diagnosis:

Because the points in the ear are active only when there is something wrong in the corresponding oran, an examination of the ear can be used either to confirm or rule out a diagnosis. The research team from Nanking cites acute abdominal pain as an example in their book (Huang 1974) If pain an other symptoms are atypical, making the diagnosis uncertain, the team says that by searching in the ear for active point, the examining doctor can decide with a considerable degree of certainty if the cause of pain in the patient is a cyst on the ovary, a kidney stone , an inflamed appendix or a gallstone.

Other techniques : semi- permanent needles : Body acupuncture makes use of acupuncture needles that stay in place for 20-40 minutes. In the ear on may use the same technique but semi-permanent needles may also be used. These remain in place , stimulating the acupuncture point for several days. In ear acupuncture this technique has been found to be effective for up to 2-3 weeks. Semi-permanent needles are used only in the ear.

auricular medicine is a developed and more technical form of regular ear acupuncture, auricular therapy

Pellets : (balines, micro esferas de metal)

it is also possible to treat the ear without pricking it with a needle. A small metal pellet or a little seed is taped with band- aid to a specific point in the ear- The pellet or seed puts pressure on the point ,generating what is known as acupressure. This can be a good alternative for patients with a fear of needles, with a blood infection or who may be too young for acupuncture. Pellets are often used in the ear, but only exceptionally on the rest of the body (see su jok , CH 4, other microsystems)

Technical equipment:

A skilled body acupuncturist needs no point detector or other electrical apparatus to find acupuncture points. The points can be located by measuring the distance to fixed "landmarks" such as joints and other features of the skeletonThe body´s acupuncture points are always at the same place. In the ear the points are extremely close together. In ear acupuncture only active points are treated , so it´s important to locate them correctly. The acupuncturist may make use of a mechanical point detector, or a presssure feeler , but many choose to equip themselves with an electrical point detector for still greater precision. If, after your studies in auricular therapy (the regular ear acupuncture described in this book) you decide to go on and learn auricular medicine, this will entail the use of more advanced technical instruments, for example laser equipment...

Differing ideas concerning energy :

The meridians :

The TCM concept of body acupuncture is based on acceptance of a belief that there are energly channels - the meridians_ which permeate the body in a fixed pattern. The acupuncture points lie alonng these. An acupuncture point is a place on the meridian where it is easier to reach the energy and influence it by puncturing, warming or massaging the point. Chinese literature on acupuncture takes it for granted that meridians are also represented in the ear and that a stagnation in a meridian can give rise to an active point in the part of the ear corresponding to the parto of the body in which the meridian is located. According to Paul Nogier (the french doctor who discovered auricular therapy) there are around 180 acupuncture points in the ear . These may be either reflex points(a reflection of a part of the body) or functional points( stimulation of the point influences a definite function) Nogier had a Western mind set. He saw the body´s structure (skeleton, muscles, etc) as being pictured in the ear, but did not recognise meridians. Neither did he describe acupuncture in terms of qi( the nergy which the Chinese say flows through the meridians) or yin and yang, two other central concepts in Chinese medicine.

-stagnation of energy is the opposite to a free flow energy

De qi :

"de qi" the feeling around the needle wich is sought after in the body acupuncture- and regarded as being crucially important in achieving a good result- is not to be found in the same way in ear acupuncture. In body acupuncture the acupuncturist stimulates the needles by rotating or moving them in such a way that the patient experiences feelings of tickling, pressure or radiation around the needle. It is this feeling that is called "de qi". In ear acupuncture the patient may experience a needle insertion as painful for a few secondes (particulary if semi-permanent needles are used) but once the needle is in a place, the patient seldom has a clear feeling of it being there. Only exceptionally is there any discomfort. In treatment of the ear with regular acupuncture needles, the patient may sometimes experience the feeling that the ear has become larger and warmer tha usual The ear may also redden. Such phenomena may be described as "de qi". However contrarly to body acupuncture practice, in ear acupuncture needles are not stimulated to generate the feeling

Advantages for the acupuncturist :

It takes a long time to learn body acupuncture .Several years of study are necessary in order to understand the classic Chinese system. Ear acupuncture is built on simpler foundations. Because the reflex points in the ear are divided into zones corresponding to the upside-down figure of a man, it is possible to learn the fundamentals in a few days. This means that a course in ear acupuncture is considerably cheaper than that for body acupuncture

Saving time : It does not a gresat deal of time to place needles in the ear. The aptient can sit during treatment and need only remain in the clinic for the time needed for examination and the insertion of the needles. Body acupuncture takes much longer. The patient must undress, lie down and be cushioned with pillows and blankets. The needles stay in for 20-40 minutes and are stimulated several times during treatment. When the treatment is finished, the patient must get dressed again. All this takes time. If the body acupunctirst needs to make use of points on both sides of the body the sesion will have to be divided into two stages. As a result the patient must change position halfway through and treatment takes even longer. In ear acupuncture points corresponding to both sides of the body can be treated at the same time. This saves time both for the patient and the acupuncturist.

Group treatment : Ear acupuncture can, especially in cases of treatment for drug addiction, with drawal symptoms or stress , be given to a group of people. This makes it extremely cost effective. Both time and space are saved in treating a group of sitting, fully dressed patients. Another advantage of group treatment is that it can be less stressful for patients with high anxiety. In ear acupuncture the patient can move during treatment. In body acupuncture the patient must lie still for 20-40 minutes Ear acupuncture allows patients who may be worried and filled with anxiety, or may be in such pain that they cannot lie still for long periods, to expericence more easily the benefits of acupuncture.

An ear acupuncturist can give several such group sessions an hour. (if you are making use of a standardised form of ear acupuncture sucha as Nada, 20 or so persons may be treated per hour. See Ch. 13 NADA- using ear acupunctures to fight addiction in the beginning..) Often existing premises such as ordinary rooom in a house or office, a waiting room or a dining room can be used. No expensive and bulky examination benches are needed. Ear acupuncture can administered in simplified forms. The Nanking Army ear acupuncture Research team summed this up in the 1960s: Whether indoors, outdoors, in open field, factory workshop, battlefield, trenches or classroom, ear acupuncture can be applied.

Making it easier for the patient :

Local points : it is commonplace in body acupuncture to make use of local points. ie points in the area where the pain is located. an advantage of ear acupuncture is that you can,without pricking the part of the body that is in pain, effect it in a poisitive way by pricking the corresponding part of the body that may be off - limits for the body acupuncturist, for example because they are in plaster, badly swollen or causing severe pain

Two complementary treatments :

ear acupuncture and body acupuncture can be used separately or in combination. Ear acupuncture can be an excellent complement to body acupuncture. The body acupuncturist can improve on results by making use of ear acupuncture both to treat the points in the ear correspondig to the organs or body parts that need treatment and to reduce stress and muscular tension in the patient However, ear acupunture need not be administered in conjuntion with body acupuncture. It can be the only form of acupuncture treatment

Who can benefit from ear acupuncture?

In addition to patients, many health care professionals may have use for ear acupuncture: -body acupuncturists can add a good many more acupuncture points to their repertoire, and gain a complement to the form of acupuncture. they already practise.

Chiropractors, oteopaths, and naprapaths can use ear acupuncture as a means of getting muscles to relax , making- to take one example- spinal manipulation far easier. If ear acupuncture is given to relieve pain, deep trigger point massage may be possible on a patient who might otherwise be in no condition to tolerate this painful but extremely beneficial form of massage

Dentists can make use of ear acupuncture both as a form of anaesthetic and to calm otherwise anxious patients. Patients in a truly calm state can withstand a higher pain threshold.

Doctors , nurses and midwives may fin ear acupuncture an effective solution in alleviating pain , in aiding diagnosis and as a treatment for many different conditions

Various professionals working with patients who have alcohol or drug addiction problems can use ear acupuncture as an aid both during withdrawal and in the long rehabilitation phase, in which it can prevent relapse. It may also be used as treatment in the event of relapse.

Therapists who treat stress, exhaustion, depression ,patients with a high level of anxiety or with sleeping problems can make successful use of ear acupuncture.

Physiotherapists often find ear acupuncture an excellent complement to other methods and treatments for easing pain.

psychologists and psychoterapists can use ear acupuncture as an aid in getting patients to calm down and focus, and become more open to therapy, cutting down consultation times.

Auriculotherapy-By Raphael Nogier

The two types of ear points:

the concept of auriculotherapy is based on an understanding of the nature of the points. It seems that on the ear there are two kinds of points:

1. points linked directly to the nervous system (the pressure points) These points are located with a pressure probe, and are painful when an organ is diseased. In therpy the points are treated with needles or massage.

2. Neurohumoral-type points These points are located by leectrodetection and they are formed by specific structures- the neurovascular complexes. These points are treated with infrared lasers.A disorder in the body generates a pathological zone or point on the ear. using the pain response to locate a pathological point on the ear (pressure probe) using the diascope to locate a pathological point on the ear (locating the neurovascular complexes)

Indications for auriculotherapy : Pain : Metabolic, traumatic, neurological Functional disorders : Tachycardia ,constipation, irritable bowel syndrome, chronic fatigue, menstrual problems such as amenorrhea or dysmenorrhea. Disorders of dependency : Tocacco addiction, benzodiazepine (tranquilizer use) antidepressant use Psychological disorders : reactive depresssion, anxiety Dermatologic disorders: eczeema, psoriasis, alopecia. Contraindications : pregnancy

In my opinion , every smoker is a depressive person who is unaware of their depression. Nicotine is an antidepressant.

Tobacco addiction treatment protocol.

Treatment : Evaulate the level of dependence on tobacco. Only treat somoker who are motivated and emotionally stable. Decline to treat any individual who is clearly unbalanced or psychotic See the patient in the morning before they have smoked the first cigarette of the day. Treat the right ear in right -handed and the left ear in left-handed individuals. Locate the points with an electrodetector Instruct the patientto stimulate the needles and to eat a healthy diet see the patient on a regular basis to prevent possible weight gain , relapse or psychological problems.

Result : it is not that hard to stop smoking the real challenge is not starting smoking again. We have observed the following rate of success after : - 1 month : 85% -1 year: 36% -2 year:15%

Sciática :

"Sicatica is not an inevitable disease" It is frequently the result of articular constriction between the vertebrae, initiated by postural problems. However, we know that human posture is linked to tension in the paravertebral muscles which are themselves dependent

on information received from various receptors, principally in the: - eyes, -jaw- feet- skin A problem with any of these receptors (ocular movement disorder , malocclusion,flat feet, scars, etc) can initiate spams in the paravertebral muscles , which over the long term develop regional constrictions. treatment: in a case of sciatica : treat the pain with : Point L5-S1 -Point zero - Point O´ Treat the cause with : - eye point jaw point scar point treat the consequences with: - the cervical points in particular (first cervical is often affected)

fibrocystic breast disease and mastodynia(painful breasts)

Mastopathies are very common in Western countries . In France, 1 in 10 women will develop breast cancer , whereas in China this figure is 1 in 80. Many women suffer with fibrocystic breast disease and mastodynia treatment : the points to treat are: liver : on the right ear, located by electrodetection hypothalamus: rignt or left ear, located with electrodetection Hypophysis: concha base, right or left ear, located by electrodetection breast: on the lobe, located by pressure probe ovary located by electrodetection the treatmente should be given every month. Remember to prescribe a dietary regimen: foods to be avoided : milk, cheese, yoghurt, and other dairy -related foods ; beef and veal ; and coffee and tea

Depressive disorders:

three types of depression are amenable to treatment by auricular refloxotherapy :

1 -Reactive depression

treatment:

reactive depression needs early treatment. The points needled are: E points : they are needled in rapid succession , the needles are retained for 1 second Point O´: right and left ear with semipermanent needles prefrontal cortex point: with semipermanent needles

2- seasonal affect depression (SAD)

SAD is primarily encountered during the winter, manifesting as sadness and weight gain treatmente: the hypophysis point on the right or left ear using a semipermanent needle. The patient is prescribed 30 minutes of exposure to strong bright light daily at a regular fixed time

Postpartum depresssion :

popularly known as the "baby blues" postpartum depression is frequently the result of a toxic scar on the perineum Treatment is by two needles tangential on the ascending limb of the helix fig 32 c

first rib syndrome :

Keep in mind:

strictly speaking the syndrome is not an indication for auriculotherapy-it is considered actually an obstacle to auricular treatment. The head of the first rib is displaced following some trauma or physical strain and mechanically irritates the stellate ganglion, giving rise to a wide range of pathologies:

Frequent urgent diarrhea (due to accelerated intestinal transit) headaches visual problems blood pressure problems thoracic oppressiontrigeminal neuralgia reflexive algodystrophy of the upper limbs

Diagnosis : a diagnosis of first rib syndrome is based on threeee criteria: existence of a probable cervical trauma pain on palpation of the first rib asymmetry in the right and left radial pulses. This is due to arterial stress induced by adrenergic impulses.

Treatment : the first rib should be repositioned either manuallly or by prescribed exercises. Location of the auriculotherapy points : on the posterior aspect of the auricle- the first rib point on the anterior aspect of the antihelix wall, right side radius vector C7 - the stellate ganglion point.

cerebral laterality disorders : each auricle corresponds to the opposite cerebral hemispher.

Basic concepts: In a right -handed person, the left hemisphere of the brain controls logical, abstract and mathematical thinking. the right hemisphere controls vision, hearing, and artistic and empirical thinking. 90% of people are true right-handers- their language centre is in the left hemisphere. 1% are true left handers - their language center is in the right hemisphere 9% are poorly lateralized left handers- their language center is in the left hemisphere. animals do not display hemispherical lateralization asymmetry is an anatomic concept. laterality is a functional concept

Pathology : Hyperactivity of the right hemisphere: - Hypersensitivity , hyperactivity, anxiety, anguish, and depresssion may be seen foolwing psychologic trauma, trauma to the frontal area of the brain, or after giving up cigarette smoking.

- hyperactivity of the left hemisphere: -abstract thinking divorced from practical reality , the manic phase in bipolar disorder , psychotic states

psoriasis :

viewed as neurodermatitis by some and dermoneurosis by others, psoriasis remains an enigma in terms of its physiopathology

treatment: treatment by auriculo-acupuncture can sometimes produce remarkable results.The patient should be treated weekly for a total of 30-40 sessions. It usually takes at least 15 treatments before improvement is seen. points to check and treat : Point 0´ liver point psychic scars helix rim points The helix rim points should be needled slightly in posterior position as shown in 37 a

Microsystems Acupuncture: The Complete Guide: Ear - Scalp - Mouth - Hand By Hans-Ulrich Hecker, Angelika Steveling

●Point searching: in point searching the ear is first assessed visually . In diseases of the organism we often find responses in the region of the auricula in the form of peeling , blisters, cracks, or changes in color. The inspection of the auricula is therefore also of diagnostic value.

In a second stage the auricula can be examined for pressure sensitivity.

"Irritated" organs or segments can simetimes be demonstrated as a corresponding trigger point.

The third option of searching for points by means of a resistance meter is simpler and faster. Similar to body acupuncture, auricular acupuncture points have reduced skin resistance. However, activity in the auricular acupuncture point only occurs in the case of a corresponding disease. Active auricular acupuncture points can therefore be found with the aid of a resistance meter.

(local infection of the auricula with perichondritis)

Pricking technique:

For the pricking technique the needle is usually inserted perpendicularly with the needle lying intracutaneaously and sparing the cartilage.Disinfection, as is usual for injections, is taken for granted. The number of needles should be kept to a minimum. As a guideline, a total of no more than six to seven acupuncture points should be needled.

Duration:

Auricular acupuncture, like body acupuncture, lasts 20-30 minutes. The treatment interval depends on the complaints. In the case of acute diseases, needling may be performed frequently i.e. possibly even daily, in the case of chronic diseases at greater intervals, for example once a week.

The use of permanent needles must be given critical consideration.When using permanent needles, there is always the risk of the development of perichondritis. This admittedly rare complication can, among other things have cosmetically devastating effects. As there has not been any scientific study to date proving the therapeutic superiority of using permanent needles over disposable needles, the use of permanent needles should be rejected or subjected to critical analysis. Forensic aspects should be taken into consideration when formulating such questions.

Needle material:

The selection of needle material is assessed differently in the various schools. In China, steel needles are used for acupuncture in the main. The French school uses gold and silver needles analogous to the measurable different potentials of the acupuncture points. An elegant method is the use of laser acupuncture. This provides various frequencies for different diseases. From TMC we know that gold needles have an overall tonifying effect, while silver needles have an overall sedative effect.In acordance with these experiences, but above all also with the electric reading the needles are also used in the ear. In cases of debility where tonifying is useful a gold needle is used in the main, in conditions of excess a silver needle is mainly used for sedation. According to Bahr, painful points are mainly found as gold points. The same applies to the treatment of inflammations and infections. Organ insufficiencies are also treated with a gold needle as a rule, in contrast to this are yang conditions or organ hyperfunctions. These are treated with silver needles. The corresponding findings via Nogier´s Reflex are always a decisive factor, however.

Furhermore , Bahr states that the points pertaining to the focus of irritation- in the sense of neuraltherapy- are always to be found as gold points. We would like to point out again that in different schools there are also different views about the question of gold and silver needles .Schools wich do not measure the different potential by means of point searching devices use only steel needles.

Indications :

As in body acupuncture the following applies:

NOTE. The more acute the disease, the greater the prospect of success, the more chronic the disease the more difficult the treatment (here fields of disturbance are often involved which the experienced auricular acupuncturist can also find an treat via the auricular surface)

In principle ,all illnesses where the body is still able to regulate itself can be treated. Experience shows that acute painful conditions can be treated particularly well via auricular acupuncture. But chronic and functional illnesses can also be treated via auricular acupuncture. Auricular acupuncture ca be very successfully combined with other natural

remedies, in particualr chiropractic and neural therapy are frequently used accompanying therapies

Principles of Ear Acupuncture: Microsystem of the Auricle By Axel Rubach

●History:

Origin. Contrary to common belief, ear cupuncture is not a more recent form of therapy than body acupuncture. Already in Huang Di Nei Jing, the 2100- year-old book of Tradicitonal Chinese Medicin we find evidence of reflex relationships between the outer ear and individual regions of the body. Old records show that these relationships were also therapeutically being used in Persia, Egypt and Greece about 2000 years ago. It will remain a mystery in which culture these reflex relationships were first discovered, mainly because we have only a few medical records up to the 17 th century. As a result, certain elements of this method of treatment owe their survival predominantly to oral transmission from generation to generation in the Middle East and in parts of Africa (for example, cauterization in the upper auricular region for treatment of sciatic pain) .In the 17 th century, evidence accumulated both in the arts and in medical treatises that the auricles´s reflex relationship were well known in Europe as well. First and foremost should be mentioned the famous painting by Hieronymus Bosch (1450-1516) called The garden of lust. The right wing of this triptych altar shows a symbolic illustration of Hell and - among other things- an auricle on which certain relationships between the ear and the rest of the body are depicted in great detail. The area in the upper auricle , which is pierced by one of the two spears is identical to the zone of cauterization mentioned for sciatic pain. In a case description from the year 1637, the Portuguese physician Zaratus Lusitanus reported on sciatic pain treatment by ear cauterization and , in 1717 , Valsalva described in his book De Aura humana Tractatus, an auricular area which had been cauterized for toothache. From the 19 th century we have interesting medical records on auricular cauterization for sciatic pain syndrome, such as the one by the physician Luciano of Bastia, as well as the documented observations of the surgeon Valette at the Charité in Paris in the year 1850.

The French /Western School. The different localizations of cauterization zones on the auricular helix, which were described in those documents, demonstrate that a systematic approach to ear reflexology did not yet exist at that time. It was not until the 1950´s , that the French physician Paul Nogier- to whom we also owe the rediscovery of the above -mentioned documents of medical history- developed the systematic fundamentals of ear acupuncture on the basis of accidental observations during years of meticulous research. In some of his patients he had noticed scars in the upper part of the auricula stemming from therapeutic cauterization to relieve symptoms of the sciatic pain syndrome. All of these

patients had found relief- some in Africa, some through a lay healer in Marseilles- after Western medical art had proved to be unsuccessful. The lay healer had learned this form of healing from her father, who had been a physician in Indochina for many years. Nogier first presented his work under the title Auriculotherapy at a conference on acupuncture in Marseilles, in 1956. Hence, he is the undisputed founder of today´s ear acupuncture. This very first lecture- translated into German by Bachmann and subsequently published in the Deutsche Zeitschrift fur Akupuntktur (German Journal of Acupuncture)- prepared the ground for this method of tretament.

The Chinese school. Nogier´s knowledge also reached China where his publications caused reconsideration of Chinese traditions that go back thousand of years, this stimulating extensive and intensive research. More recent Chinese finding confirmed and complemented his work to a great extent. Nevertheless, Nogier is widely acknowledged as the discoverer of today´s ear acupuncture, even in China. The Chinese school of ear acupuncture gained international recognition through it Austrian interpreters, Georg Konig and Ingrid Wancura, and because of its good results with acupuncture - induced analgesia.

Both forms- the so- called Chine ear acupuncture and the auriculoterapy of Nogier- have much in common, although on ocassion the localization of points may differ. Nowadays, the sensible objective is to integrate any confirmed knowledge from both schools under one roof and to use it for the benefit of the patiens.

Competing research activities of various schools and mutual verification of their findings guarantee some reliabiliy of the studies and keep the discussion going. Russian researchers have also contributed significantly to this field since the 1970s, with Durinjan ,Portnov, and Velchover being the leading authors.

The Term "Microsystem":

The term "microsystem" defines the phenomenon of circumscribed body areas that reflect the entire organism in the form of functional interrelationships. Through these body areas it is possible to utilize well defined reflex relationships to external or internal regions of the body for diagnostic clues or therapeutic measures.

(see Fig 3) This helps us to understand that there are different microsystems in the body which are interconnected , each one representing an independntly funcioning system of inividual inherent laws with its own characteristic and special diagnostic and therapeutic possiblities: According to Gleditsch (1984), the overlapping of different microsystems reminds us of several sports fields painted above one another in a gymnasium: depending on the markings one sport or another will be played. In this sense, the functional coexistence and interaction of the reflex zones of the tongue, mouth , nose, hand sole or auricle can be understood within the overall picture of the human body or the system of

body acupuncture. Of the above- mentioned synonyms, the term "microsystem" best describes the concentrated form of whole-body projections within the scope of their organized systematic reflex relationships.

●Needling technique and choice of needles.

In ear acupuncture, it is a rule to needle with as little trauma as possible in order to prevent infections. Therefore, it is essential to consider certain aspects regarding the choice of needles as well as the needling technique.

Choice of needles : Only the finest needles with a maximum diameter of 0.3 mm should be used; they correspond to the facial needles used in body acupuncture. The needle and its handle should measure approximately 3 cm in total. The handle may be covered with plastic (disposable needles) or have a good grip provided by roughening or braiding (steel needles which can be sterilized repeatedly). In the case of steel needles, it should be kept in mind that the tip of the needle will become blunt after multiple use or may be bent like a hook during improper handling or sterilization, rendering the needle useless because of an increased risk of traumatic needling .These disadvantages, including the risk of infection caused by germs remaining after improper sterilization do not exist when using disposable needles. The use of steel needles is quite satisfactory. Today, needles made of steel are exclusively used also in China. Arguments in favor of using silver or gold needles, especially for the ear, are usually derived from the school of auriculotherapy. They are essentially based on the postulate that the different electrical potentials of these precious metals toward the tissue provides a more differentiated and effective application of the stimulus. However ,there is no objetctive confirmation of this. On the contrary the predominating disadvantages are totally unjustified; the large needle diameter (up to 1mm) results in a wide stab wound, the increased needle weight requires a deeper stab to fix the needle and the risk of oxidation calls for more elaborate sterilization techniques (the founder of the method of using gold and silver needles was the french acupuncturist Gearge Soulé de Morant)

Needling techniqe. It should be noted here that the ear should be needled perpendicularly to the skin and not too deep. After penetrating the membrane of the perichondrium, the tip of the needle should find just a slight support in the cartilage. The technique of "threading" several points subcutaneously, as favored by some authors, and the penetration of cartilage are not recommended. The associated traumatization is considerable: it increases the risk of infection and is not proportional to the supposedly improved effectivenees or practicability. In this connection, we advise against the use of permanent needles of any kind. Here too, effectiveness and risk are out of proportion to each other. In case of complications cause by infections of the auricle (in extreme cases, perichondritis) such criteria will play a major role during forensic analysis. Some authors prefer the "tangential

stab technique" to avoid the traumatization of cartilage and the associated increase in the risk of infections. While doing so, the tip of the needle is supposed to be passed through the perichondrium toward the cartilage but without injuring the latter. It should be countered that, even here, traumatization of the cartilage is hardly avoidable, perhaps not so much as a result of direct traumatization, but rather through disturbing the trophism of the corresponding cartilage area, in this case originating from the perichondrium. Considering the delicacy of the ear points, a major disadvantage of this technique lies particularly in the relative inaccuracy of targeting the irritated zones. Thus, the approach will have to be restricted to the inaccessible regions of the auricle, for example, beneath the brim of the ascending helix. There are no convincing arguments, let alone test results for the tonifying and sedating techniques recommended by auriculotherapy, particularly not for those using the selective application of gold and silver needles and for the postulate that the rules of classical needle choice should be reversed in case of the auricle. The same holds true for the idea of reversing the energetic relationships between front and back of the ear and for the more detailed rules derived from it. The corresponding tonifying and sedating techniques of the Chinese school of ear acupuncture are derived from traditional body acupuncture and are transferred to the microsystem of the auricle. It must be critically questioned as to what extent such a transfer to the conditions of a microsystem may be feasible and effective and also whether the accompanying considerable traumatization of perichondrium and cartilage convincingly justifies the supposedly greater effectiveness.

Practice tutorial 3 : Methods of stimulation used in ear acupuncture

●Needling and electrical stimulation:

For insertion of the needle the "very point technique" of guiding the needle in a tapping and supported way may be applied. This method allows one to locate points accurately in a calm and safe way. The precise localization of the "active point" and the applied target- specific stimulus are decisive in obtaining therapeutic results. It is obviously easier and at the same time more precise to carry out localization with a needle stimulus and in some cases , by means of a laser. The fine facial needles or ear needles , which have a maximal diameter of 0.3 mm are inserted right in the center of the successfully located irritted point. Only a few needles are used per treatment session, i.e. only the major points are needled to address the real cause of the illness. Usually three needles per auricule are inserted; even if several irritated areas have been located, the maximum number of needles per auricle should not exceed five .

The following principle applies:

The therapeutic result is determined by the targeted , precisely localized needle stimulus and not by the number of needles.

The needles are left in place for at least 20 minutes but no longer than 40 minutes while the patient reclines; they can then be easily removed. In case of acute painful diseases (cephalalgia, neuralgia) longer periods of rest may prove practical.Experience has shown that subsiding of pain may take up to 45 minutes in coming. No additional effect has been observed with longer treatment periods. Even in case of an immediate onset of relief (i.e. immediate freeedom of pain, such as the elimination of pain within seconds seen in neural therapy) the needles should nevertheless be left in place for at least 20 minutes. Removal of the needles is usually easy and painless. Prematurely lost needles may be replaced if the patient was resting only for a brief period; later , this is no longer effective. Some authors interpret the early loss of a needle as particularly quick response to the respective needle, i.e., the needle would be set "free" because of precise targeting of another reflex point. However there is no clinical proof for this.

The removal of needles may be carried out by an assistant. He/she should be advised that the occasional minor bleeding may be stopped by lightly pressing a pad against the bleeding spot- something the patient can usually take care of. An exception to this are those points for which bleeding acts as microphlebotomy, for example in case of the Allergy Point (78) at the tip of the ear, where bleeding should be allowed to continue until it stops spontaneously.

Electrical stimulation : In both body acupuncture and ear acupuncture, the inserted needles may be additionally stimulated by means of a low - frequency direct current in rectangular pulses.Stimulation frequency is selected at 10 Hz, while the intensity of the current depends on the relative sensitivity of the patient. To determine the patient´s tolerance, the current is gradually increased until the patient indicates the sensation of a slightly stabbing, well -tolerated pulse. While doing so, the patient should be instructed that this sensation should not reach the pain threshold and that , due to adaptation, the slightly stabbing sensation will subside during the period of rest without losing its effectiveness. That is why the current intensity should not be readjusted.The positive and negative electrodes must be applied ispilaterally i.e., both on the same ear, and the intensity-dependent paresthesia during stimulation occurs at the positive electrode closing the circuit may be connected to a needle that does not need to be stimulated.

In ear acupuncture, electrical stimulation is not as important as it is in body acupuncture. It is usually only recommended in .????

●Auricular massage :

Similar to body acupuncture, the theapeutic stimulation of irritated points or zones can also be achieved in ear somatotopy by means of a targeted pulsating pressure or massage. In addition, the whole body can be given a soothing harmonizing stimulus through systematic massage of the auricle, in the sense of stimulating the entire microsystem. The latter is called auricular massage which should be distinguished whith regard to its direction of action as well as handling from the direct stimulation of individual points through pressure massage. Auricular massage according to Lange (1985) is carried out without an auxiliary instrument namely, just by using thumb and index finger. Due to the active involvement of the patient, auricule massage has proved effective as therapy- supporting mesasure particularly when treating problems with concentration and sleeping disorders. After appropriate instruction as to the proper scheme , the massage may be carried out by the patients themselves. For the purpose of massaging the ear, it is important to hold the auricle in a forceps- like grip between index finger and thumb so that the tip of the thumb lies behind the auricle and the tip of the index finger is able to perform light massaging, circular movements on the front side of the auricular. The pressure of the massage should not be painful but rather perceived as pleasant.

Focal massage of irritated ear points as defined by acupressure can only be performed with the help of rod- or probe -like devices like the ones used for detecting tenderness. This specific form of stimulation presents itself when other possibilities of stimulation are unavailable or not tolerated by the patient. Focal self -tratment of the patient is usually not practical apart from two exceptions, namely , in kinetosis in order to support the treatment and in cases of pre-exam anxiety or stage fright. In such cases the patient is instructed to massage the respective zones (in the region of postantitragal fossa and crus of helix , respectively) as required during treatment intervals. Self treatment should be done carefully and under changing pressure from the finger nail.

●Microphlebotomy

This tipe of therapeutic stimulation is included in the discussion despite its rather limited scope of indications.It has proved effective as an auxiliary measure especially in allergic disorders (such as pollinosis and urticaria) and is also used in neuralgia (e. g. trigeminal neurlagia). Microphlebotomy may be used either alone in the directly indicated zone or as part of a combination therapy involving several points. One or several facial needles suffice for puncturing . To avoid unncessary traumatization, cruder instruments (such as lancets) are not recommended. In the region of the well - vascularized lobule, it is even possible to pierce the tissue like a sieve with several needles (e. g. in the trigeminal zone). After an

appropriate period of time, the needles are simultaneously removed ; the resulting bleeding is not stopped but allowed to drip into a cotton swab. In the region of ear cartilage (e g. at te thipo of the ear: allergy point (78) a quick stab with the needle from the inside or outside is usually sufficient to induce the apropriate bleeding. Microphlebotomy at the auricle should only be used in connection with a constellation of points appropriate for the syndrome. Its therapeutic stimulus is insufficient when used on its own and at any location.

●Methods of continuous stimulation :

General remarks. When using permanent needles or ear clamps which are to provide continuous stimulation over a longer period of time to the irritated reflex xone, both risks and therapeutic advantages must be very carefully assessed. As acupuncture, including ear acupuncture i.e. constitutes an “intervention of choice” it is not an essential therapeutic measure, possible risks matter much more, in particular, when it is not obvious that there will be additional specific therapeutic results. For the various methods aiming at continuous stimulation (such as permanent needles, pellet plasters, or ear clamps) there is no evidence whatsoever with regard to achieving improved effectiveness, neither from comparative studies nor from empirical observations, which would justify the disadvantages. The major risk of permanent needles and pellet plasters is their subperichondrial incorporation into the cartilaginous parts of the tissue. This process starts with a mechanically- induced, initially localized , inflammatory reaction followed by infection and tissue necrosis. The latter facilitates entrance of the foreign object, especially when the patient is advised to massage the permanent needle or pellet plaster with a small magnet or with the tip of a finger for the purpose of stimulation. If such a course of complications is recognized early enough, the foreign object can be removed without consequences. In a further advanced state, however, when removing the adhesive band that keeps the needle or pellet in place necrotic skin of the perichondrium, undermined by pus, will be seen to come off as it adheres to the plaster together with the needle or pellet. At this stage, there is a great risk that perichondritis will develop. In addition, it can be observed that after a prolonged , uncontrolled period of keeping the pellet pressure method in place, and as a result of the massage, the small pellet is pushed through the pressure-damaged tissue between the perichondrium and the cartilage and ends up underneath intact areas of the skin which are clearly distant from the original site of application. The ear clamps predominantly used by the Chinese school may lead to pressure -induced disturbances in local blood flow with the danger of skin necrosis, although this is relatively rare. Because of this risk of complications, patients must be well informed about it as well as their legal rights. Foreign objects applied to the ear must be checked at short intervals for inflammatory reactions. In view of the potential problems, the application of continuous stimulation methods at the auricle is not recommended.

Permanent needles. The popular types of permanent needles currently available on the market vary considerably in shape and mode of application. The most traumatizing and therefore, the least recommendable permanent needle has a hook at its tip, wich anchors itself in the cartilage after the needle has been pressed in with the aid of a guiding probe. Inside the handle of the plastic probe is a small magnet to be used by the patient to stimulate the needle periodically. Another type of permanent needle is fixed to a small adhesive plaster; it has a circular overlay surface with the tip of the needle protruding from its center. The small adhesive plaster and the wide overlay surface are supposed to ensure a firm fit. Tissue traumatization is much less severe ; nevertheless, the above- mentioned possiblity of complications still exists.

Pellet plasters. This method was designed with the idea of exerting a constant pressure to the irritated zone. The chromium - plated small steel pellet , or seed , is fixed onto an adhesive plaster and has to be stuck onto the point to be treated. The patient must be advised to massage the pellet from time to ....

Practical approach.

●Preparation and positioning of the patient

Preparation. Patient preparation involves informing the patient about the possibility of experiencing pain during needle insertion and about the kind and strength of pain. Furthermore, it is advisable to inform the patient of the disposable needle material that will be used and to explain the search for points in general terms. In addition the patient must remove all ear ornaments and if necessary , clear the ears from interfering hair. These preparatory measures, including the necessary disinfection of the auricle may be taken care of by the nurse.

The physician the briefly explains the procedure in plain language to the patient and most importantly, points out that the symptoms tend to improve after 4-5 days of treatment, otherwise the indication needs to be reviewed and the patient must consent to continuation of the treatment.

It is also helpful to get the patient´s cooperation in so far as he /she will inform the physician at the next treatment session, preferably without being asked, of any changes in his/her condition or symptom complex so that therapeutic measures may be taken quickly and in flexible way by adjusting the combination of points.

During the entire treatment series, the patient should avoid narcotics, such as sleeping pills and alcohol during the last 12 hours preceding the treatment. It is advisable that the patient is not exposed to situations of physical stress, such as sauna or stenuous sports, during the 2-3 hours following treatment.

Positioning the patient. Examination and needling of the auricle can be performed with the patient either sitting or lying. Unless clues in the patient´s history or a state of vegetative instability favor the lying position, sitting is preferred because it provides better access to the

ear points. If required by the treatment regimen , laterality may be clarified right at the beginning to identify wich auricle should primarily be treated. Already after a brief practical involvement, the physician will be familiar with all these steps. They will prevent him from making the patient feel uneasy as a result of incomplete information or improvised changes in the combination of points which could disturb the course of treatment.

Bedding.

After treatment , the patient should be bedded in a relaxed lying position for 20-45 minutes. One should see to it that the room is kept sufficiently warm and the patient is covered with a blanket to avoid even the slightest hypothermia, as this would interfere with complete relaxation. Unfortunately, these seemingly straightforward rules are often not observed in practice or they are neglected due to insufficient engagement by the physician or nurse. This may lead to unfavorable accompanying symptoms and may cause the patient to abandon the treatment at a critical phase.

●Choice of primary therapeutic access:

From the patient´s history and the general physical examination, the attending physician will have already arrived at concrete ideas as to which zones and points may be treated most successfully. It is advisable to complement this approach by a systematic examination process. This includes selecting the primary therapeutic access according to the syndrome, i.e. , to search for the most irritated and, hence , therapeutically most favorable zone of the auricle and to give it preferential treatment.

A. Segmental therapy . In diseases of the locomotor system and in segmental neuralgia, segmental therapy (ear geometry according to Nogier) predominates the concept of treatment. First, the Vegetative Groove (Zone of Origin of Sympathetic Nuclei) in the scapha beneath the helical brim is examined to locate irritated points depending on the clinically conspicuous segment: it is then needled, if appropriate.

●Next, an imaginary line is drawn by connecting the irritated point with Point Zero ; this "line of treatment" is then examined for more irritated points.

● Needling of the irritated points in the region of the Zone of Paravertebral Muscles and Ligaments should take prority.

●In case of neuralgia or causalgia, it is more advantageous to search for sensitive points in the Zone of Spinal Cord, namely in the region of its Zone of Sensory Tracts.

● In chronically recurrent diseases (e. g. activated arthrosis , chronically recurrent lumbago) it is also very advantageous to choose the latter zone as the primary therapeutic access.

B. Searching for irritated points of correspondence The primary approach is completely different in organic diseases or in allergies.

● First the irritated points corresponding to the diseased organs and the points modulating the immune system are located.

● This does not mean that, when a certain organ is diseased, the corresponding disturbed segment may not also be treated according to ear geometry; however the latter step is second in line. For example, when cholecystitis is assumed, the irritated Gallbladder Zone (96) of the right ear must be needled first and in combination with the Shen Men point (55.) If the symtoms are not sufficientrly alleviated, the disturbed segment of the upper abdomen may then be included in the treatment.

C. Choice of analgetic or anti-inflammatory points

● In conditions of pain which are not organ-specific (such as cephalalgia or non -specific neuralgia) the primary therapeutic access lies in the selection of sensitive analgetic or anti-inflammatory points.

● In most cases ( e. g. general headache syndrome) the following points should be selected : analgetically acting points in the region of the Sensory line , the Shen Men Point (55) and , in extreme cases, also the Thalamus Point (26 a) .

●In case of mental illnes and for treating addictions, the psychotropic points are initially more important.

●Should there be more than three or four irritated points per auricle, once more preferences must be established depending on clues in the patient´s history. The remaining points are recorded and marked with a felt - tip pen if sensitive, and then needled in a second session making short-term intervals of alternanting treatment sessions necessary.

● Frequently the "extinction phenomenon" takes place during such an approach, whereby after needling the primarily preferred points, the secondarily preferred points are no longer found to be irritated.

Caution !! Remove felt- tip pen markings prior to needling (risk of tattooing effect).

●Supplementary Choice of Points

The choice of supplementary points is made after needling the primary therapeutic access points. Depending on the syndrome other points which could provide therapeutic support are examined for their state of irritation. For example, in case of gastritis as an organic disease, the organ point (Stomach Zone (87) and the Solar Plexus Zone are chosen as primary access, but certain psychotropic points and vegetative points will definitely be included as supplementary points.

After acute organic symptoms have subsidied, the preference may be utterly reversed; previously supplementary points gain importance (in this case, the points balancing the psychovegetative system) while the organ points become less important and finally, are no longer found to be irritated.

Naturally, this procedure may also be followed when treating diseases of the locomotor system, for example, lumbago-sciatica síndrome. Apart from the psychovegetative points mentioned above, however, the following supplementary points may also be considered: the muscle-relaxing Jerome Point (29 b) as well as Shen Men Point (55) and ACTH Point (13) because of their respective analgetic and anti- inflammatory effects.

In case of arthritic pain in the region of the knee joint, the two Knee Points (49 a and 49 b, in the region of the triangular fossa and superior anthelical crus, respectively) are most important. Supplementary points are selected depending on whether the symptom complex can be assigned primarily to inflammation, a pain process, or radiation of pain .Accordingly, supplementary points may be included individually or in combination.

Frequently, only the selection of supplementary points and their interaction with the primary therapeutic access point will bring about the decisive therapeutic breakthrough.

●Choice of stimulation method

Inserting a fine needle into the irritated zone has certainly become the most popular method of auricular stimulation. So far , this type of stimulation is unsurpassed in its practicabilitty and effectiveness and can be replaced by no other method of ear stimulation. Hence, as a rule, needling is the method of first choice. All other forms of stimuli must be viewed as therapeutic supplements or a less effective substitutes whenever the needle method cannot be applied. Generally, electrical stimulation of the inserted needle has enhancing effect, especially in neuralgia and causalgia, but also in recurrent colicky conditions of pain in the intestinal region (diverticulosis, spastic colitis, etc) Microphlebotomy presents itself as a supplement to needle treatment ,particularly in allergies and cephalalgia.

In hypersensitive or extremely anxious patients, the stimulation methods discussed earlier provide a substitute for needle treatment , though an imperfect one. First of all targeted pressure massage of points (acupressure) is one possiblitity for the less well equipped physician ; it may be further developed by means of the pellet pressure method. However, for resasons already discussed, the latter requires stringent control by the physician. Point stimulation by means of soft laser is more costly and roughly similarly effective as the needle method, although it cannot replace needling completely . In all cases where the patient is unable to keep appointments for treatment at meaningful intervals (eg. because of prolonged travels) self treatmente by targeted auricular massage may be recommended , provided the ear points to be treated are accessible.

Strength of stimulus, treatment intervals and duration of sessions

Strength of stimulus . The French/Western school of ear acupuncture (auriculotherapy) calls for the differential use of gold and silver needles with regard to stimulus intensity : the reducing method requires strong stimultion whereas the reinforcing method requires a weak stimulus. The proponents of this school of thought use the gold needle for supplying and the silver needle for drainage also in body acupuncture. As already discussed in connection with the choice of needles, puncturing into different points of the tissue results in different electrical potentials, from which the respective replenishing or drainig effect is inferred.

Without any explicit reasoning, auriculotherapy takes the view that the rules for choosing the needle type are reversed on the auricle so that the gold needle should be used for reducing and the silver needle for reinforcing. Interestingly enough , only the terms "drainage" and "supplying" are borrowd fron TCM and applied to particular syndromes. Neither in Chinese body acupuncture nor in Chinese ear acupuncture does the choice of metal have this meaning, let alone this range of applications. Furthermore, auriculotherapy talks about opposing "energetic relationships" on the front and back of the auricle. Consequently, on the back of the ear the gold needle is supposed to be used for "supplying" and the silver needle for "drainage" now again in analogy with body acupuncture.

According to the concept of auriculotherapy, mediation of the desired intensity of the stimulus depends on gold or silver as the material, whereas steel is neutral. Needles made of platinum or molybdenum are also in use, although, once again the postulated special effect cannot be confirmed empirically.

In Chinese ear acupuncture, by contrast the strength of a stimulus is not determined by the differential choice of needle types. Here the reinforcing and draining techniques used are the same as in traditional Chinese body acupuncture. The latter knows three kinds of stimulus intensities which in a modifed form, also play a role in ear acupuncture.

The Ti Dao Fa of ear acupuncture (the draining, reducing measure) corresponds to the famous Xie Fa of body acupuncture (as a strong stimulus); the Eao Fa of ear acupuncture (the supplying, replenishing measure) corresponds to the Bu Fa of body acupuncture (as a weak stimulus) The Nian Zhuan Fa in ear acupuncture (as a medium-strength stimulus) corresponds to the third classical strength , namely , the combination of Xie Fa and Bu Fa. ▪Drainage in ear acupuncture (Ti Dao Fa) is achieved by repeated minor lifting and lowering of the inserted needle for 1-2 minutes , while rotating the needle slightly .This strength of the stimulus is indicated above all in states of Yang or Yang excess, namely in acutely severe and painful diseases.

▪For medium - strength stimulation, i.e. for combining drainage and replenishing (Nian Zhuan Fa) the needle is moved by rotating it back and forth every 1-2 minutes while emphasizing the clock - wise direction.This strength of the stimulus is applied particularly in chronic and chronically recurrent symptoms or syndromes.

▪Supplementation in ear acupuncture (Eao Fa) is achieved by merely insterting the needle and leaving it without further manipulation.This type of stimulus is indicated in all states of Yin or Yin Defficiency as defined by TCM, namely , primarily in chronic syndromes and conditions of pain (e.g. Yin pain at night or while resting which improves with movement) Furthermore, it is advisable to choose this strength of the stimulus when warranted by the patient´s constitution, that is mainly in weak or chronically ill patients, old persons and children. Hence, in Chinese ear acupuncture, the strength of the stimulus is chosen depending on the syndrome as defined by TCM. For this purpose, patients and their illness should be assessed according to the classical Eight guiding Principles: Deficiency/Excess, Yin/Yang, Heat/Cold, Interior /Exterior. The drainage and reinforcing techniques of Chinese ear acupuncture require relevant training and skills, especially the forms of Nian Zhuan Fa and Ti Dao Fa. In case of clumsy handling, the ear cartilage may be considerably traumatized or even pierced and that would increase the risk of infection. For this reason , it is up to the therapist in each individual case to view the necessity of this technique in relation to its effectiveness. Once again, as in the case of auriculotherapy, critical reservations are advisable. Convincing comparative studies or empirical results with regard to improved effectiveness in comparison to the simple needle stimulus are still unavailable. However these reservations apply only to auricular therapy and they should encourage the exploration in detail as to how effective these stimulation methods really are. Ear acupuncture is based on a microsystem which reflects the entire body and in which direct and fairly short reflex pathways to the corresponding organ are clearly available. In principle, it is therefore doubtful whether the laws of body acupunctue can be applied to ear acupuncture in a meaningful way, particularly since the organ projections are not at all analogous to the functional pathways (meridians or channels) defined by TCM. However this does not exclude selection of ear points based on possible diagnostic clues obtained according to traditional rules. Unfortunately, we have only recomendations by individual authors regarding the effectiveness of the three different stimulus intensities; we have no insight into original Chinese studies Far more important than the choice of stimulus intensity is the choice of stimulus location. According to the current state of practical experience and in recognition of the available information both from Chinese ear acupuncture and French /Western auriculotherapy, the precise localization of the needle, rather than its manipulation, is the decisive factor.

Treatment intervals. In Chinese ear acupuncture, the intervals between individual treatments depend on TCM guidelines on the one hand (e. g. on the patient´s constitution)

and vary according to the type of syndrome on the other. Rather short treatment intervals are indicated in states of Yang Excess (namely, twice a week or every 2 days) while longer intervals are indicated in states of Yin Deficiency (namely , once per week or every 2 weeks) In Western auticulotherapy, the treatment intervals depend on the patient´s needs :

●the patient is treated again when symptoms reappear or did not subside sufficiently.

●the shortest interval is 1-2 days, but may be even shorter as long as other points other than those used for the previous or initial treatment are selected.

●the treatment intervals are then gradually prolonged depending on the condition of the patient. The aim is to have intervals of 7-10 days.

● after the patient is free of symptoms treatment is continued once or twice and the patient is advised to return for a new round of tretament once the symptoms recur, even weeks or months later. This will repeatedly be the case, primarily with chronic illnesses.

●Patients return after 3-6 months and a kind of restoration treatment of about five sessions in intervals of 1 week will return them to the desired freedom from symptoms. Duration of session. The needles are kept in place for 20-45 minutes. In old and very weak patients, the needles may be removed during the first sessions already after 10 minutes. The period of time is then gradually increased during subsequent sessions, depending on the patien´s reaction. In severe conditions of pain the needles may be kept in place for a longer period, in individual cases perhaps for 45-60 minutes.

A series of basic treatments should include approximately ten sessions and the patient must be informed that alleviation of symptoms should be noticed after about five to six treatments. If the patient fails to respond, it may still make sense to continue the treatment by mutual agreement, although the prospects are now less promising.

Combination with other methods of stimulation

There are numerous possibilities for using ear acupuncture in combination with other therapeutic methodes. However, beware of polypragmasy: the selection should be based on indication and syndrome in the same way as when ear acupuncture is used as monotherapy.

It has proved advantageous to use ear acupuncture with its immediate painkilling effect in acute phases of acutely recurrent chronic disorders, such as migraine, and to include body acupuncture in more refractory cases, preferably during the intervals. The combination of

ear and body acupuncture is recommended for the treatment of difficult chronic syndormes. In chronic rheumatoid arthritis, for example, body acupuncture is used primarily and ear acupuncture is included as supplementary measure, especially when acute symptoms appear. In such cases , irritated zones are usually found in the corresponding area of the auricle, offering the opportunity for therapeutic support.

Acute pain can be alleviated this way, even if the underlying illness cannot be permanently controlled with ear acupuncture alone.

Because of the reflex connections , ear acupuncture may also be used for follow-up. In syndromes not belonging to the primary range of indications of ear acupuncture, reduction in initial irritation of the corresponding reflex zones should be intrepreted as a sign of successful body acupuncture, independent of the course and often even prior to the onset of subjective improvement of symptoms. Treatment and follow up take place during the same session.First the auricle is examined as usual for irritated zones which are then marked with a water -soluble felt-tip pen, and optimal body acupuncture is then carried out. Subsequently, the previously active zones are reassessed- they are often found less irritated or even silent. This "extinction phenomenon " described earlier may only occur after a series of treatments and provides good help by indicating that one is proceeding correctly.

Neural therapy presents another good opportunity for combination, especially in acutely paiful diseases. Although both methods compete with each other as far as the indication is concerned , their combination represents an improved therapy in disturbed areas (scars, foci). In these case, neural therapy should be used primarily and persistently irritated zones of the auricula should be considered as supplementary treatment. In acute neuralgia, such as headache syndrome, the method of choice should depend on the patient´s preference or dislike- the decision will most likely be in favor of ear acupuncture. In case of residual symptoms, the use of neural therapy will still be a sensible supplementary measure.

The therapist should always prefer the

particular method which provided the

best results for the indication in question,

in order to be able to include another

supplementary method if the symptoms

remain or show insufficient improvement .

For example, the cervicobrachial syndrome can be superbly treated by mouth acupuncture according to Gleditsch (1979) and is the method of choice. In case of needle phobia or hypersensitivity of the patient it might be advisable to stabilize the therapeutic out come by switching to ear acupuncture after one or two sessions. This will not interfere with mouth acupuncture, which may be reapplied after such an interruption. In addition, ear acupuncture has proved effective for the preparation or initiation of physical treatment mesures, chiropractic and kinesiological treatment. This approach has the advantage among other things that the site of therapy lies outside the body areas involved in these measures so that both treatments can be carried out in paralel. Ear acupuncture has also proved success…

Diseases and establishes indications…

Ear Acupuncture: A Precise Pocket Atlas Based on the Works of Nogier/Bahr By Beate Strittmatter

In a right - handed person, the right ear is the dominant one, and the left ear is non- dominant. In a left- handed person, the left ear is dominant,,and the right ear is non- dominant. In this book the most important points of each ear meridian are describe together with their multple functions. The carry the same names as the corresponding body acupuncture points. Points ending with "-1" are located close to the original point (e. g. TB-1-1 lies close to TB-1). As a rule, the sensory portions are found on the front of the ear (lateral surface of auricle) while the motor portions are found on the back of the ear (medial surface of auricle) . A gold needle in the sensory point on the lateral surface and a silver needle in the corresponding motor point on the medial surface . Body parts, organs or anatomical structures belonging g to the same region project very close to each other onto the ear . For example: For example: knee joint, popliteal artery, peroneal nerve Entire vertebral column . Location :the vertebral column or spine, projects upside- down onto the entire antihelix.Locaation : like the various structures of a vertebra, the corresponding points lie close together on the edge of the anithelix.: the smal vertebral hoints project slightly lateral to the edge of the antihelix (which is important for treating the very common "blockages " of the spine) .The zone of paravertebral muscles and ligaments lies lateral to theis zone of small vertebral joints.

The point has an effect on the vomiting reflex Note : the vomiting centre lies in the medulla oblongata near the respiratory centre

Disorders of the locomotor system Auriculotherapy of symtoms of the locomotor system (joints vertebral column ) always proceeds according to the same principle: 1 Local pain point (e. g. relfex point of a particular joint or vertebra) 2 The correspondig motor point on the back of the ear (forceps method according to Bahr) using a silver needle 3 Points in

the correspondig sympatetic trunk segment usually with silver needles 4 Anti inflammatory , analgesic and /or anti - rheumatic points 5 Points of focal disturbances if present. This treatment plan is valid for both acute and chronic symptoms. Local pain points may also be pierced with two or theree needles if the ear point occupies a wider area. Points for joints or vertebrae are needled like all organ points, on the ear of the affected body side. So- called functional points are needled as described in detail (always use the other ear for lett- handed persons).

An important note for therapists wishing to wor exclusively with steel needles: always needle the point on the same ear for which the GOld point is described because this is the point that needs to be stimulated. In all stubborn cases, that do not respond to therapy. and particularly when a good ear acupuncture treatment did not lead to early and significant alleviation of symtoms- one should consider the presence of a focal disturbance. The following foci are common and should be taken into account: a) scars, especially those that healed secondarily (the size of the scar is not important) also drainage scars and internal scars resulting from surgery (including the scar from perineotomy)

Chronic infalmmation (tonsils, paranasal sinues, hemorrhoids, pelvic inflammatory disease) . Devitalized teeth or inflammation in the dental- maxillary region. If focal activity is supected, one can simply examine the ear reflex zones belonging to pontential foci detected in the patient´s history and check them with the point finder for electric activity (indicating focal disturbance) . A gold needle placed exactly into this point (i. e , the point for a disturbing scar) alleviates the focal activity, reduces inflammation and heals it completely after a few repeat treatments. (Dental foci must usually be cleaned up by the dentist. How ever the focal activity of a tooth is normally not discovered without ear acupuncture diagnostics in the first place)