Afferent acupuncture pathway: This afferent pathway begins with stimulation of an acupuncturepoint in the skin that sends neural impulses to the spinal cord. These signals then ascend throughthe contralateral ventrolateral tract of the spinal cord to the reticular gigantocellular nucleus andthe raphe magnus in the medulla. The signal next goes to the dorsal periaqueductal gray (PAG).Low-frequency (2 Hz) electrical stimulation of the muscles that underlie the acupoints LI 4 (heguor hoku) and ST 36 (zusanli) produce behavioral analgesia. The intensity of electrical stimulationat an acupoint must be sufficient to cause muscle contraction, which thus leads to an increase in thelatency for the animal to move its tail away from a hot light. Stimulation of other muscle regionsdoes not produce this increase in tail-flick latency. Brain potentials can be evoked specifically inthe periaqueductal central gray by stimulation of the muscles underlying the LI 4 and ST 36acupoints, but not by stimulation of other muscles. These evoked potentials in the PAG wereblocked by contralateral lesions of the anterolateral tract, by administration of the antiserum tomet-en kephalin, by the opiate antagonist naloxone, but not by the administration of antagonists todynorphin. Moreover, lesions of the PAG abolished acupuncture analgesia, indicating that theanatomical integrity of the PAG is necessary for producing pain relief from acupuncturestimulation. This afferent pathway projects from the PAG to the posterior hypothalamus, thelateral hypothalamus, and the centromedian nucleus of the thalamus. These neurons projectthrough the hypothalamic preoptic area to the pituitary gland, from which beta-endorphins aresecreted into the blood

5.3 Electrical detection of ear reflex pointsOfall the methods for conducting auricular diagnosis, examination of the auricle with an electricalpoint finder is the most reliable and least aversive. Even small changes in electrodermal skinresistance can be determined by electrical detection procedures. For many practitioners, the mainconsiderations are either the cost of a quality point finder or the extra time taken to first determinethe most reactive points. While both of these objections have theirvalidity, the increase in accuracyof discovering the most appropriate ear point for diagnosis and treatmentof that client is worth theexpense and effort. Familiarity allows even inexpensive but less sophisticated equipment to be usedin an effective manner.Clean skin: Toexamine the ear with an electrical point finder, first clean the ear with alcohol toremove sources of electrodermal skin resistance. High electrical resistance impairs the electricalpoint finder’s ability to discriminate active ear reflex points from normal regions of the auricle.Sources of such unwanted skin resistance could include earwax, flaky skin, dust from the air,make-up from the face, or hairspray ingredients.Point finder: Use an electrical point finder designed for the ear by both its size and its electricalamperage. Some probes designed for the body are inappropriate for the ear because they are toobig or use too high an electrical detecting voltage. Ear points are smaller, closer to the surface andhave lower electrodermal skin resistance than do body acupoints. The point finder should be aspring-loaded, constant pressure rod with a small ball at the end. Even more selective areconcentric bipolar probes with a small rod in the middle and an outer barrel. Bipolar detectingprobes use differential amplification of the voltage difference between the two adjacentelectrodes. This procedure allows for maximum discrimination of the difference in electrodermalDiagnosis procedures 137A B

c DFigure 5.3 Pressure palpation devices that are used on the auricle are shown on Point Zero (A) and the SympatheticAutonomicpoint(R). A triangular stylus can be used to discern the indentation at landmark zero (C), and a spring-loaded stylus can maintain constantpressure while detecting reactive ear points (D).138 Auriculotherapy Manualskin resistance between adjacent skin areas. The auricular probe is applied to the ear by thetherapist, while another lead is held in the patient’s hand.Electrodermal measurement: Thepractitioner monitors decreased skin resistance, or inverselystated, increased skin conductance, as the probe is glided over the skin with one hand while theother hand stretches out the auricle. Electrodermal activity has also been designated as thegalvanic skin response (GSR), a measure of the degree of electrical current thatflows through theskin from the detecting probe to the hand held neutral probe. Electricity must always flow betweentwo points, thus for some point finders that do not utilize a hand held probe, it is imperative thatthe practitioner touch the skin of the patient at the ear. Usually a light or a sound from the pointfinder indicates a change in skin conductance. Dependingon the equipment’s design, a change in

the electrodermal measurements leads to a change in auditory or visual signals to indicate theoccurrence of reactive auricular points.Threshold settings: Some equipment requires an individual threshold to be set for each patientbefore assessing otherear points. Toset the threshold, place the probe on the Shen Men point orPoint Zero, increase the detection sensitivity until the sound, lights or visual meter on the equipmentindicate that there is high electrical conductance. Next, slightly reduce the sensitivity until the ShenMen point or Point Zero is only barely detected. It should be possible to find these two master pointsin all persons examined, and they are usually reactive because they indicate the effects of everydaystress in a person’s life. Shen Men and Point Zero may not be the most electrically active points on apatient’s ear, but they are the two points most consistently identified in most people.Probe procedures: Slowly glide the ear probe across all regions of the auricle to determinelocalized areas of increased skin conductance (decreased skin resistance). Moving the probe tooquickly can easily miss a reactive ear point. Applying too much pressure with the probe can createfalse ear points merely because of the increased electrical contact with the skin. Holdthe auricularprobe perpendicular to the stretched surface of the ear, and gently glide the probe over the ear,A BFigure 5.4 Differentelectrical pointfinder devices have been developed in China (A) and in Europe (B). Asthe prohe glides over thesurface of/heear, changes in electrodermal skin conductance are shown bya variation in the rate ofa flickering light or in the frequency ofsoundfeedback:Diagnosis procedures 139140using firm but not overly strong pressure. Do not lift and poke with the probe. Theother handsupports the back of the patient’s ear. It is importantto follow the contours of the auricle whileapplying the probe, checking both hidden and posterior surfaces as well as the front externalsurface of the auricle. Theback of the ear is often less electrically sensitive than the front of theauricle, but the posterior side of the ear is usually more tender to applied pressure than is the front.Tomore readily find an ear point on the posterior surface, first detect the point on the front of theauricle, then put a finger on that spot and bend the ear over. Itis now easier to search the back ofthe ear for the identical region on the anterior and the posterior surface.

5.6 Assessment of oscillation and laterality disordersPersons who have difficulties with neural communication between the left and the right sides of thebrain are referred to as having problems with laterality or oscillation in the European school ofauriculotherapy. This crossed-laterality condition is sometimes identified as ’switched’ or ’cross-wired’in certain American chiropractic schools. It is as if the two cerebral hemispheres are competing forcontrol of the body rather than working in a complementary fashion. Laterality problems are typicallyfound in the 10-20% of the populationwhich exhibits higher electrically conductivity at ear reflexpoints on the contralateral ear thanon the ipsilateral ear. Usually these patients show high electricalconductance at the Master Oscillation point, but not everyone who has an active MasterOscillationpoint is an oscillator. Oscillation can also be due to severe stress or dental foci. TheMaster Oscillationpoint in patientswith laterality disorders needs to be corrected with acupressure, needling orelectrication stimulation before that patientcan receive satisfactory medical treatment.It is believed that many functional disorders are due to dysfunctions in the interhemisphericconnections through the corpus callosum, the anterior commisure and the reticular formation of thebrain. There is inappropriate interference of one side of the brain by the other side of the brain.Global relationships that should be processed by the right cerebral hemisphere are analyzed by theleft cerebral cortex. Verbal information thatshould be processed by the left cerebral hemisphere isprocessed by the right cerebral cortex. Such individuals frequently exhibit dyslexia, learningdisabilities, problems with orientationin space and are susceptible to immune system disorders.People with laterality problems report thatthey often had problems in elementary school with poorconcentration, stuttering, spelling mistakes, attentiondeficit, and feeling ’different’ from others. Asadolescents, they experienced frequent anxiety, hyperactivity, gastrointestinal dysfunctions and theyoften misgauged distances or tripped over things. Oneway a person may recognize thatthey are anoscillator is that they have overly sensitive or rather unusual reactions to prescription medications.Dysfunctions of laterality and oscillation are found more often in left-handedor in ambidextrouspersons. Theproportionof dyslexia and otherlearning disorders is significantly higher in left�handers than in right-handers. Laterality problems are rarely noticeable before the age of two, butcerebral organization begins to be definitely lateralized by the age of seven, the ’age of reason.’ Itisfrom this age thatdisorders of laterality may first appear.5.6.1 Physical tests for the presence of laterality disorders

Handwriting: Have a person write something. Which hand did they use, the right hand or the lefthand? Many individuals were trained to write with their right handwhen they were children, eventhough they were naturally left handed. For that reason, some of the following tests may be a moreauthentic appraisal of their actual laterality preference.Handclap: Have a person clap their hands as if they were giving polite applause at a socialfunction, with one hand on top of the other hand. Which hand is on top?Handclasp: Have a person clasp their hands, with the fingers interlocked. Whichthumbis on top?Armfold: Have a person fold their arms, with one arm on top of the other. Which arm is on top?The hand that touches the crease at the opposite elbow is considered the arm that is on top.Auriculotherapy ManualFoot kick: Have a person pretend to kick a football. Whichfoot do they kick with, the right or theleft foot?Eye gaze: Have a person open both eyes and then line up the raised thumbof their outstretchedhand toward a small point on the opposite wall. Alternatively, have the person make a circular holeby pinching their middle finger to their thumb, then look at the spot through the hole. In eithercase, next have them close first one eye, open again, then close the other eye. Closing one eyeproduces a greater shift in alignment with the object on the opposite wall than closing the othereye. Ifthe object shifts more on closing the right eye, then the right eye is dominant; if the pointshifts more on closing the left eye, then the left eye is dominant. Alternatively have someone noticewhich eye they would leave open and which they would close if they were to imagine shooting atarget with a rifle. The eye used for aiming the rifle would be the dominant eye.5.6.2 Scoring laterality testsEach of the above behavioral assessments is scored as either right or left. Ifa person scores 4 or more onthe left side, that individual is likely to have a laterality dysfunction. They might also have problems withspatial orientation, dyslexia, learning difficulties, allergies, immune system disorders and unusualmedical reactions. Laterality does not necessarily produce a medical problem, as many individuals learnto compensate for this imbalance over the course of their life time. At the same time, they may havecertain vulnerabilities that conventional medicine does not allow for. The dosage and incidence of sideeffects of Western medications are based on the average response by a large group of people, but do nottake into account the idiosyncratic reactions of unusual individuals. Persons with laterality dysfunctionsmust be very careful about the treatmentsthat they are given because of their highlevel of sensitivity.

5.7 Obstructions from toxic scars and dental fociIn addition to idiosyncratic problems attributable to laterality disorders, other factors may alsointerfere with subsequent pathologies that have a longstanding nature. The failure to completelyheal from one condition may act as a source of disequilibrium that blocks the alleviation of newerhealth problems. Twosuch sources of obstruction are (1) toxic scars from old wounds or previoussurgeries, and (2) damaged tissue from invasive dental procedures. Toxic scars could occur on theskin surface or in deeper structures, creating a region of cellular disorganization that emitsabnormal electrical charges. This pathological tissue generates a disharmonious resonance causingchronic stress and interference with general homeostatic balance. Abnormal sensations, such asitching, numbness, pain or soreness, often occur in the region of toxic scars. Besides checking theregion of the external ear that corresponds to a body area thatwas previously injured, also examinethe skin disorder region of the external ear. Dental procedures, such as removing decayed teeth ordrilling a root canal, are beneficial for dental care, but they may also leave a dental focus thatinterferes with general health maintenance. Dentalfoci may follow dental surgery, be related tobacterial foci under a filling, or result from an abscess or gum disease. There may also bepathogenic responses to mercury fillings. Patients themselves are often unaware of having such adisorder, since the consequence of these previous scars may not necessarily be experienced at aconscious level. These pathological regions may be electrically detected at the auricular area thatcorresponds to the site of the toxic scar or dental focus. They may also be discovered by monitoringthe N-VASresponse to stimulation of the affected region of the body. Only when this toxic scarregion is successfully treated can other healthcare procedures be effective.Sometimes one’s own personal experience is the most impressive source of confirmation for acceptinga new concept in healthcare. WhenI was an adolescent, I dislocated my right shoulder during askateboard accident. I also had mywisdom teeth removed by an oral surgeon. As I became an adult,the chronic stress of everyday living was most strongly manifest as discomforting shoulder aches, but Inever experienced jaw pain. Frequentmassages, chiropractic adjustments, acupuncture sessions andauriculotherapy treatmentsall produced temporary relief of the shoulder pain, but there was no stableresolution. Myears were recently examined by a Germanphysician who practices auricular medicine.Dr Beate Strittmatterrevealed a toxic scar at the location of the wisdom toothat the left lower jaw.

Theinsertion of a needle at a pointon the left ear lobe which corresponded to the left mandible wasadded to stimulation of the Shoulder point on the right auricle. This treatmentof the dentalobstruction as well as the corresponding Shoulder point on the auricle led to an immediate correctionof a shoulder condition thathad been a problem for years

6.2 Ear acupuncture needling techniques1. CLean ear: After conducting any visual inspection necessary for auricular diagnosis, clean theear with alcohol. This sterilizes the skin and removes wax, oils, sweat, grease, make-up andhairspray. Besides its antiseptic value, removing oily substances from the skin surface of the earimproves the ability to detect auricular points with electrical point finders.2. Prepare needLes: Unpack at least 5 sterilized 0.5 inch (15 mm) needles, to be inserted ipsilaterallyor bilaterally. Shorter needles are preferred, since longer needles tend to fall out too easily. Thickerneedle diameter sizes of30 gauge (0.30 mm), 32 gauge (0.25 mm) or 34 gauge (0.22 mm) are preferredfor the ear, since thinnerneedles tend to bend on insertion. Stainless steel needles are appropriate formost clinical purposes, although better results are sometimes obtained by using gold needles on oneear and silver needles on the opposite ear. Knowledge of the Nogier vascular autonomic signal isnecessary to determine whethergold or silver needles are more appropriate for which ear.3. Determine treatment pLan: Examine the specific treatmentplans listed in the last section ofthis text to select the auricular points which are most appropriate for the condition being treated.A typical treatmentincludes the corresponding anatomic points, selective master points andsupportive points listed for that condition. You should not treat all of the ear points listed, onlythose which are the most tender and show the highest electrical conductance.4. SeLect ear points: Detect 2 to 6 points on each ear with an electrical point finder, selecting onlythe most reactive points. The point finder should be spring-loaded and will leave a briefAuriculotherapy NanualFigure 6.2 Needle insertion techniques demonstrated on a rubber modelear.indentationat the ear point if stronger pressure is applied when a reactive ear point is detected.Use that indentationfor identification of the region of the auricle where the needle should beinserted. The order in which auricular points are needled depends more on the practicalconvenience of their location than on the priority of their importance for treating that specificcondition. Needles are first inserted into ear points which are located in more central or hiddenregions of the auricle because needles in more peripheral areas of the ear would get in the way.5. Needle insertion: First stretch out the auricle with one hand while using the other hand tohold the needle over the appropriate ear point (see Figure 6.2). Avoid doing one-handedearacupuncture, only using the hand holding the needle. Insert the needle with a quick jab and a twistto a depth of 1 to 2 mm. Theneedle should just barely penetrate the skin, but it is acceptable if ittouches the cartilage. The needle should be inserted deep enough to hold firmly, but not so deepthat it pierces through to the other side (see Figure 6.3). Be careful not to let the needle pierce thehand that is stabilizing the patient’s ear.Itis usually more comfortable for the patient if the needle is inserted on the patient’s inhalationbreath. The patient may gasp or choke when a needle is inserted into a particularly sensitiveregion. Even though the needle may produce intense discomfort on first insertion, this adverseeffect is short lived and the pain quickly subsides. The intensity of pain at an auricular point isusually a sign that the point is appropriate for treatment. Guide tubes that are often used to insertneedles into body acupuncture points are not needed because of the shallow depth of ear points. Itis better to locate the needle by sight precisely over an ear point previously identified by skinsurface indentationfrom a point finder. Insert all the needles you plan to use at one time and leavethem in place. You may periodically twirl the needles to maintain a firm connection and to furtherstimulate that auricular point. Bleeding may occur when a needle is withdrawn from the ear, butgentle pressure applied to the point usually stops the bleeding within a few seconds.6. Treatment duration: Leave all the inserted needles in place for 10-30 minutes, then remove andplace the used needles in an approved container. Some needles fall out before the session is over,which tends to indicate that the particular needle insertion point had received sufficient stimulation.Treatmentprocedures

7. Numberof sessions: Treat 1-3 times a week for 2-10 weeks, then gradually space out thetreatment sessions. A given condition may require as few as 2 or as many as 12 sessions, dependingon the chronicity and severity of the problem and on the patient’s energy level. If after 3 sessionsthere is no improvement in the condition, either use a different set of ear points or try anotherform of therapy.

6.3 Auricular electroacupuncture stimulation (AES)1. Ear needling techniques: For electroacupuncture, first use needling techniques described inthe previous section to detect the appropriate ear points and to insert the needles.2. Tape needles: In order to hold the inserted needles securely in place, tape the needles acrossthe ear with medical adhesive tape. Attaching the stimulating electrodes will tend to pull out theneedles, unless they are first fastened with protective tape.3. Attach electrodes: Use microgator clips to connect the inserted needles to the electrode leadsof an electrical stimulator (see Figure 6.4). Because these moveable clips may pull out the insertedneedles when attached, make sure that the needles are first securely taped in place. Itis also wise tofasten the electrode wires to a secure anchor so that the wires will not drag on the needles and pullthem out.4. Electrode pairs: It is always necessary to stimulate between two needles, as electricity flowsfrom a positive to a negative pole. It does not usually matterwhich pole of the stimulator isattached to which ear point, but if the patient reports any increase in pain, try switching theelectrode leads to the opposite polarity.5. Frequency parameters: Preset the electrical frequency rate to either a slow 2 Hz or 10 Hzfrequency, or to a parameter known as dense-disperse, where 2 Hzfrequencies are alternatedwith 100 Hz frequencies (see Figure 6.5). Lower frequencies, 10 Hzor less, affect enkephalins,endorphins, and visceral and somatic disorders, whereas higher frequencies, 100 Hz or higher,affect dynorphins and neurologic l dysfunctions.

6.4 Transcutaneous auricular stimulation (TAS)I. Overview: In this treatment method, the therapist detects and stimulates each ear point withthe same electrical probe. The auricular point is detected and then immediately treated withmicrocurrent stimulation before moving on to the next ear point. It is a form of transcutaneouselectrical nerve stimulation (TENS)or neurostimulation and can be medically billed as such.Before beginning auriculotherapy, it is best to have the patient repeat those movements, ormaintain those postures, which most aggravate his or her condition. It is also useful for thepractitioner to put physical pressure on those body areas which are painful. Onecan thus establisha behavioral baseline from which there can be seen a change as a result of the treatment.The samemovements, postures, or applied pressures are repeated following the treatment.This practicetends to eliminate doubts about the procedure which often occur when only subjective impressionsare elicited. A facial grimace by the patient during movements, or in response to pressure, is muchmore convincing than verbal assessments that ’it hurts.’2. Clean ear: Clean the external ear with alcohol to eliminate skin oil and surface flakiness.Having a clean auricular surface is very importantfor determining the accuracy of reactive earpoints thatwill be treated with transcutaneous auricular stimulation.3. Determinetreatmentplan: As with other auricular procedures, consult the specific treatmentplans listed in last section of this text to select the auricular points which seem most appropriate forthe condition being treated. First treat local anatomic points corresponding to specific bodysymptoms. Ifthere is more than one local point, only treat the most tender and most electricallyconductive local points. Next treat master points and supportive points.150 Auriculotherapy ManualABFigure 6.6 Transcutaneous stimulation ofthe skin surface ofan auricular acupoint and the hand held reference probe (A). Stim Flexequipmentthat provides a probe for both auricular detection and auricular stimulation (B), one ofseveral possible electrical stimulationdevices.Treatmentprocedures 1511524. Threshold setting: Some instruments require the practitioner to first set a threshold level byraising the sensitivity of the unit to allow electrical detection of the Shen Menpoint or Point Zero.Most reactive corresponding points are typically more electrically conductive than Shen MenorPoint Zero, but these two master points are more consistently active in a majority of clients.Sometimes, by first stimulating one of these two master points, other auricular points becomemore identifiable for detection. This process is called ’lighting up the ear.’5. Auricular probe: Apply the auricular detecting and stimulating probe to the external ear,stretching the skin tightly to reveal different surfaces of the ear. Thepractitioner’s other handsupports the back of the ear so that both it and the probe are steady. Gently glide the auricularprobe over the ear, holding the probe perpendicular to the ear surface. Do not pick up the probeand jab at different areas of the ear. Thepatient usually holds a common lead in one of their hands

in order to complete a full electrical circuit. Electric current flows from the stimulating equipmentto the electrode leads to the ear probe held to the patient’s auricle. Currentthen passes throughthe patient’s body to the patient’s hand to the metal common lead. Finally, the current goesthrough the return electrode wires and back to the electronic equipment. Ifthere is some problemwith stimulation, be sure that all parts of the circuit are complete. There could be a break inelectrode wires or the patient may fail to continue holding the common lead.6. Detection mode: Diagnosis of reactive ear points is achieved with low level direct current(DC).The microcurrent levels used for detection are usually only 2 microamps in strength. Thedetecting cycle is usually indicated by a change in a continuous tone or by a light that flashes whena reactive point is detected.7. Stimulation mode: Reactive ear points discovered during auricular diagnosis are treated withalternating current (AC). Themicrocurrent levels used for treatmentare typically 10-80 microampsin strength. Thetreatmentcycle is usually indicated by a pulsating tone or a flickering light. It isusually necessary to press a buttonon the auricular probe while it is held in place at a reactive earpoint. Detect and stimulate one ear point before proceeding to the next ear point.8. Stimulation frequency: Preset the frequency rate of stimulation, measured in cycles persecond or Hertz(Hz), by the specific zone of the ear to be stimulated or by the type of body tissueto be treated. Although Asian electronic equipment is often supplied with only one frequency,usually 2 Hz or 10Hz,American and European electronic equipment comes with a range offrequency rates to choose from. The specific frequencies developed by Nogier are as follows:2.5 Hz for the subtragus, 5 Hz for the concha, 10Hzfor the antihelix, antitragus and superior helix,20 Hz for the tragus and intertragic notch, 40 Hz for the helix tail, 80 Hz for the peripheral earlobe, and 160 Hz for the medial ear lobe. The type of organ tissue being treated is also a factor,with 5 Hz used for visceral disorders, 10 Hz for musculoskeletal disorders, 40 Hz for neuralgias,80 Hz for subcortical dysfunctions and 160 Hz for cerebral dysfunctions.9. Stimulation intensity: Set the intensity of stimulation by the patient’s pain tolerance, usuallyranging from 10-80 microamps. Lower the current intensity if the patient complains of pain fromthe auricular stimulation. Ifeven the lowest intensity is experienced as painful, then only auricularacupressure should be used at that ear point. A major problem with electrical stimulators that arcdesigned for treating the body as well as the ear is that the skin surface on the body has a muchhigher resistance than does the ear. Consequently, electrical current levels that are sufficient toactivate body acupoints are too intense for stimulating auricular points. Practitioners should beclear not to confuse stimulation frequency with stimulation intensity. Frequency refers to thenumber of pulses of current in a period of time, whereas intensity refers to the amplitude orstrength of the electric current. Only intensity is related to perceived pain, whereas frequency isrelated to the pattern of electric pulses.10. Stimulation duration: Treat each ear point for 8-30 seconds, sometimes treating for as long as2 minutes in chronic conditions, addictions or very severe symptoms. Anatomic points are usuallytreated for over 20 seconds, whereas master points may only require 10 seconds of stimulation.11. Number of ear points: Treat5 to 15 points per ear, using as few auricular points as possible.Usually treat the external ear ipsilateral to the corresponding body area where there is pathology.12. Bilateral stimulation: After treating all the points on the ipsilateral ear, stimulate points onthe opposite ear if the problem is bilateral, i.e. in most health problems. Even when the problem islocalized on one side of the body, it is often useful to treat the master points on both ears.Auriculotherapy Manual13. Tenderness ratings: The precise ear points detected and the level of stimulation intensityused depends partly on the degree of tenderness experienced by the patient. Ratings of tendernesscould be a verbal descriptor or could be numbers on a scale of 1 to 10 or ’0, 1,2,3’ levels ofincreasing discomfort. Ask the patient to monitor the area of bodily discomfort while you stimulatethe ear. Continuetreating an ear point longer if the symptom starts to diminish, or ifthe patientnotices sensations of warmth in the area of the body where the symptom is located. Ifno symptomchanges are noticed within 30 seconds, stimulate another point.14. Number of sessions: Twoto ten auriculotherapy sessions are usually required to completelyrelieve a condition, but significant improvement can be noticed within the first two sessions. Bymonitoringperceived pain level in a body region, and by determining the range of movement ofmusculoskeletal areas, one can more easily determine the progress of the auriculotherapy treatments.These behavioral assessments should be conducted before and after an auriculotherapy session. Forinternal organs and neuroendocrine disorders, there is often no specific symptom to notice, so onemust wait to observe a change in the patient’s condition. Even for musculoskeletal problems, theremay not be a marked relief of pain for several hours, so the patientshould continue to monitortheirsymptoms for the next 24 hours after a sesión

Las agujas las podes ir usando a medida que no tengan filo las vas cambiando. Pero si no no, esto es como quieras.El hélix, donde empieza el hélix, va haber el punto del plexo solar.Un poquito por arriba está el punto del diafragma.Para toda patología del diafragma por ejemplo el hipo , las hernias de hiatus (por arriba de la raíz del hélix)

Para la gente que ronca, por ejemplo pulmón, intestino grueso, boca, tráquea

Un poquito más arriba del punto del diafragma, está el punto del recto, que es para hemorroides, fisuras , fistulas .Un poquito antes de la rama horizontal está el punto del uréter? Sobre el hélix. El punto del plexo solar está bien pegadito a la raíz del hélix, más arriba el del diafragma, un poquito más arriba el punto del recto, más arriba ya por debajo de la rama horizontal , el punto de los uréteres y uretra. Y más arriba a la altura de la rama horizontal, el punto de genitales externos. El punto maestro del simpático estaba atrás.En la cima a la altura de la rama vertical hay un punto que es para la alergia.

En este tuberculito de darwin, es como un punto más sensible todas las personas que son muy sensibles a los dolores hay que trabajar este lugar, si le duele mucho el ciático, lumbalgia y no le mejora con nada,si uno trabaja ese tubérculo de darwin seguro que le mejora cualquier dolor.Por arriba de este tubérculo hay un punto que se llama hélix 1

Está por arriba del tubérculo de Darwin, por debajo del tubérculo de Darwin, está el otro, el hélix 2, por debajo a la altura de la raíz del hélix, el punto hélix 3. Por debajo , a la altura de las cervicales está el hélix 4.Aca donde termina el cartílago, el tubérculo, hélix 5. El que ya vimos en el lóbulo es el hélix 6.

enfermedades del sistema locomotor:

also be considered. Using this approach additional essential points can be found in the Zone of Spinal Cord (with its sensory parts on the helix) and further points in the projection zone of the shoulder muscles on the back of the auricle. Important points in this connection are also Occiput Point(29) and Jerome Point(29 b) and, with its analgetic and anti- inflammatory effect, also the Shen Men Point (55) With respect to acute traumatic

processes (eg. shoulder joint dislocation) one should recall the strong , general anesthetic effect of Thalamus Point (26 a) in combination with Analgesia Point. In such an acute situation, it is posssible to bring about sufficient pain relief during repositioning by needling SHen Men Point (55) Occiput Point (29) and Jerome Point (29 b) as well as Thalamus Point (26 a ) and Analgesia Point. After sucessful repositioning , acupuncture may be continued during the follow-up treatment using the segmental approach described above. The same procedure is carried out following the relief from acute pain in the shoulder. During follow-up treatment and during intermediate treatment of chronic shoulder hand syndrome, one is recommended to use individual sets of points including the segmental approach , depending on the response. Thalamus Point (26 a) and Analgesia Point are usually no longer detectable, while the ACTH point /adrenal gland point (13) remains to be considered as an important point in the combination of points to be selected. According to the TCM concept, it is importan to consider- as discussed above under cervical syndrome- the main localization of pain together with the resulting meridian pair to be assiigned from this. In case of ventral pain in the shoulder, for example, mainly the apir of the Lung/Spleen Meridians (Lu/SP) is affected and , hence , Lung Zone (101) as well as Spleen Zone (98) should be examined for sensitivity. In case of lateral pain in the shoulder, the pairs of the Stomach /large intestine meridians (St/LI) and of the Gallbladder/triple waarmer meridians (GB/TW) predominate according to the classic understanding .THerefore, Stomach ZOne (87) and Large Intestine ZOne (90) as well as Pancreas/Gall bladder zone (96) may exhibit sensitive points . In case of dorsal pain in the shoulder, the pair f the bladder /small intestine meridians (B/SI) is affected. Hence, Bladder zone (92) and small intestine zone (89) should be included according to the chinese school. In addition to these assignments , treatment of the above conditions may be combned with body acupuncture, especially if they run difficult or chronic courses ; the corrresponding acupoints have to be selected according to the affected axes of meridians. Depending on the acute or chronic state of the symptoms, one should distinguish between distal points and local points. For example, in case of ventral pain in the shoulder, one should condier including body acupoint Lu 2 as a local point, whereas Lu5 or SP 9 as well as ST 38 may be included as distal points. In the combination treatment of lateral pain in the shoulder, acupoints LI 15 or TW14 are available as local

points, while ST36 and ST38 as well as GB34 are distal points. Finally, for dorsal pain in the shoulder, the acupoints SI9, SI11and SI 12 are local points and B60 , SI3 and ST38 are distal points. Treatment intervals are 1-2 days in the acute phase, and approximately five sessions should be planned. After the symptoms have improved, this may be reduced to two session per week. Depending on the severity, a total of 10-14 sessions may be required. In chronic processes, treatment starts with two sessions per week and this may be reduced to one session per week , depending on the course. Two series of 10 sessions each are usuallly required, with a treatment- free interval of 1-2 weeks.

Figura 25

this is normal and may be related to the extinction phenomenon indicating the proper choice of points. Once the acute symptoms have subsided, the patient should take up physical exercise in the form of specific physiotherapy and backstroke swimming in order to strengthen the paravertebral muscles

esto es normal y puede estar relacionada con el fenómeno de extinción que indica la adecuada elección de puntos. Una vez que los síntomas agudos han disminuido, el paciente debe asumir el ejercicio físico en forma de fisioterapia específico y nadar estilo espalda con el fin de fortalecer los músculos paravertebrales

Gonartralgia

Pain in the knee joint is a nonspecific symptom which may have many different causes and requires thorough diagnostic clarification.If caused by underlying structural alterations in the knee joint which are definitely in need of surgical therapy, ear acupuncture only makes sense when used as a supporting analgetic and antiphlogistic therapy. This applies especially to the postoperative phase of mobilization so that analgetic and antiphlogistic drugs can be saved and possible side effects associated with them avoided. Ear acupuncture has turned out to be very successful in chronically recurrent gonarthrosis during both acute episodes and symptom -free periods. The primary points for treatment of acute gonarthralgia are inintially selected independently of the cause., no matter whether caused by arthrosis, trauma or postoperative condition. The following points predominate : the two Knee Points (49 a and 49 b)

Shen Men Point (55) and Thalamus points (26 a) as well as Jerome Point (29 b). Frequently , the ACTH point (13) is also found to be sensitive during this phase. For the first treatment, threee to four of the points listed are selected with the objective of alleviating pain as soon as possible, and preference is given to the Thalamus Point(26) in combination with the Analgesia Point if sensitive. Whenever possible ,treatment is carried out daily with alternatin sets of points selected from the points listed above until the pain substantially subsides. During follow-up treatment and intermediate treatment, Thalamus point (26 a ) and Aanalgesia Point lose their significance and are often found no longer to be sensitive. Instead , the ACTH point (13) and one of the two Knee Points (depending on the underlying cause of pain) become more important. In case of arthrosis, the one Knee Point (49 a) is usually found sensitive, while the other Knee Point (49b) is more often detected in case of distortion and postoperative conditions in which only capsule and ligaments are affected. In the acute phase of a painful disorder of the knee hoint ,both Knee Points are detectable; hence, both of them are needled independent of the cause. During follow-up treatment and intermiadate treatment, the Zone of Paravertebral Muscles and Ligaments should definitely be examined for sensitive reflex zones of the lower extremity (eg. the Thigh point in the area of scapha or superior anthelical crus) Treatment begins primarily on the ispilateral auricle; dpeneding on the sensitivity of supplementary points, it may be continued on the contralaeral auricle. In case of chronic gonarthralgia, combination with body acupuncture should be considered right from the start, for much better results can be obtained this way. It should be pointed our here that, with reagard to the selction of points, body acupuncture- unlike ear acupuncture- distinguishes between lateral, dorsal, and medial gonarthralgia. For example, the body acupoints ST35 and ST 36 as well as GB 34 are considered for lateral pain in the knee, whereas acupoints SP 9 and Liv 8 are for medial pain in the knee. These are all local points which are excellent for combination with ear acupuncture, especially in chronic cases.

In case of a good response , it si recommended that the patient be encourged to do specific nonstraining body excercises, for example, bicycling. Until such time thar the atrophic quadriceps muscle of the thigh

is sufficientrly strengthened, the Thigh point (on the superior anthelical crus) can be easily detected; hence, it should be needled on both ears.