Auriculotherapy

What is Auriculotherapy?

Auriculotherapy is a health care procedure in which stimulation of the auricle of the external ear is utilized for the diagnosis and treatment of health conditions in other parts of the body. It is also known as ear acupuncture or auricular acupuncture when the stimulation is achieved by the insertion of acupuncture needles. The term auriculotherapy often refers to electrical stimulation of the surface of ear reflex points. Specific points on the ear can also be stimulated by manual pressure, referred to as auricular acupressure or ear reflexology. Acupuncture points on the ear can be stimulated with lasers, magnets, and ear pellets.

While originally based upon the ancient Chinese practices of acupuncture, the somatotopic correspondence of specific parts of the body to specific parts of the ear was first developed in France. It is this integrated system of Chinese and Western practices of auricular acupuncture which is presented herein.

How is Auriculotherapy different from Acupuncture?

Auriculotherapy is typically considered one form of acupuncture, but there are both differences and similarities between the two procedures. Acupuncture is a form of medical treatment involving the stimulation of acupuncture points located on energy channels extending over the surface of the body, which are known as meridians. From the philosophy of Taoism, there are six Yang meridians and six Yin meridians. In classical acupuncture, it is the Yang meridians that directly connect to the external ear. These energy lines of force are blocked or congested when there is some pathology in a specific area of the body. Insertion of acupuncture needles into specific acupoints can relieve the symptoms and underlying pathology of a particular health problem. Some of the meridian energy lines of force connect to the external ear, thus creating the field of auricular acupuncture. Different perspectives of auriculotherapy focus not on the acupuncture meridians but on the use of the ear as a localized reflex system connected to the central nervous system.

What is the History of Auriculotherapy?

The earliest written records of ear acupuncture date back to the Yellow Emperor's Classic of Internal Medicine, a compilation of acupuncture procedures that were in practice in 500 BC. Within this extensive text that covers a variety of acupuncture treatments, there is mention of specific acupuncture points on the external ear for the relief of certain medical disorders. However, the manner in which auricular acupuncture is practiced today in China is actually based upon more recent discoveries that occurred in France in the 1950's. The Traditional Oriental Medicine practiced in ancient China included just a scattered array of acupoints on the auricle for just a few health problems. The current practice of auricular acupuncture shows a more complete organization of ear reflex points that can be used to relieve many health problems. In the West, the earliest references to ear treatments were referred to in medical records from ancient Egypt, Greece, and Rome. The most complete descriptions of medical treatments through the ear were recorded in ancient Persia. A trail of evidence of the use of auricular stimulation for the treatment of sciatica back pain can be followed from these Persian records through medieval Europe to modern France. Since the 1950's, the use of specific ear points as a complete reflex system that can alleviate many health problems has been utilized by clinical practitioners in other parts of Europe, in Asia, and in North and South America.

Who discovered Auriculotherapy?

While the earliest uses of ear acupuncture points dates back to ancient China, modern applications of auriculotherapy are based on the work of Dr. Paul Nogier of Lyon, France. In the 1950's, Dr. Nogier noticed a strange scar on the upper ear of some of his patients. He found that all of them had been treated for sciatica pain by a local lay practitioner. This woman had cauterized a specific area of the external ear in order to relieve their low back pain. Dr. Nogier conducted a similar procedure on his own sciatica patients and found that their back pain was also reduced. He then tried other means of stimulating this "sciatica point," including the use of acupuncture needles, and found that they too were effective in alleviating sciatica pain. The brilliance of Dr. Nogier was in extending this one observation into a more comprehensive model. Dr. Nogier theorized that if an area of the upper external ear is effective in treating low back pain, maybe other parts of the ear could treat other parts of the body. The ear is said to represent the whole anatomical body, but in an upside down orientation. Nogier's theory contended that the auricle could be compared to an inverted fetus, with the head represented on the lower ear lobe, the feet at the top of the external ear, and the rest of the body in-between. This model was first presented to naturopathic practitioners in France in 1957, then spread to acupuncturists in Germany, and finally was translated into Chinese. The Chinese seemed to have adopted the inverted fetus model of ear acupuncture in 1958.

How is Auriculotherapy related to other forms of Alternative Medicine?

Auriculotherapy is considered one form of alternative medicine, which also includes acupuncture, chiropractic manipulation, homeopathy, and biofeedback. All of these techniques are also referred to as Complementary Medicine, in that they are not only an alternative to conventional Western medical treatments, they can serve as an additional procedure which complements the practice conventional medicine.

Auriculotherapy can reduce the tension, stress, and pain not fully relieved by other medical procedures, but works best when implemented as part of a multidisciplinary complement of multiple treatment approaches. While ear acupuncture is often used in conjunction with body acupuncture, auriculotherapy can also effectively relieve pain, stress and tension when used by itself.

Is Auriculotherapy accepted by Conventional Western Medicine?

While ear acupuncture has been practiced in Asia for over 2,000 years and auriculotherapy has been used in continental Europe for the past 50 years, it is only recently been considered by most medical doctors in the United States. Most MD's do not have sufficient information about auriculotherapy to make an informed comment on its effectiveness. In November of 1997, a consensus panel of the U.S National Institutes of Health gave conditional approval of the practice of acupuncture. They included an evaluation of those studies which supported the use of ear acupuncture for pain relief and addiction treatment. As more research accumulates on the efficacy of auriculotherapy, it is expected that even more physicians will acknowledge the benefits of auriculotherapy.

What is a Microsystem?

The word microsystem has also been referred to as a micro-acupuncture system or a micro-reflex system. The auricle serves as a microsystem in that the external ear is like a microcosm of the whole body, with one part of the body representing the whole body. This phrasing distinguishes a microsystem from the macro-acupuncture system of meridian channels that extend over the whole body and the nervous system connection of reflex pathways that inter-relate different parts of the body. Microsystems have been reported for foot reflexology, hand reflexology, face acupuncture, scalp acupuncture, and iridology. The term Microsystem was first popularized by the acupuncturist Ralph Alan Dale of Miami, Florida.

What are Remote Reflexes?

As with distal acupoints in body acupuncture, the auricular microsystem can be used to treat health conditions in distant parts of the body. Stimulating points on the ear not only can alleviate problems associated with nearby regions of the face and head but can also relieve pathological disorders in the chest, abdomen, lower back, and feet. According to microsystem theory, it is not that there are direct connections between the ear and the back or the ear and the foot. Rather, nerves from the ear connect to reflex centers in the brain which send neurological reflex pathways to the spinal cord and then to neurons going to the spine or to the foot.

What are Auricular-Somatic Reflexes?

The basic concept in auriculotherapy is that nerves in the skin overlying specific areas of the external ear correspond to specific parts of the brain which has reflex connections to the body. Organo-Cutaneous Reflexes are activated when organic pathology in a specific part of the body induce reflex reactions in the external ear, manifested as localized changes in tenderness, altered blood circulation, and electrodermal reactivity. Cutaneo-Organic Reflexes are activated when specific points on the auricle are stimulated in order to relieve organic pathology in another part of the body.

What is Somatotopic Inversion?

The inverted fetus pattern that is represented on the auricle is referred to as somatotopic inversion. The word "soma" means "body" and the word "topic" refers to a topographic "map." The auricle is a map of the body in an inverted or upside down pattern.

What is the role of Endorphins in Auriculotherapy?

The endorphins, endogenous morphine molecules that relieve pain in a manner similar to external opiate chemicals, have been used as one explanation for how auriculotherapy serves to relieve pain. Both animal research and human studies have shown that stimulation of ear acupuncture points appears to cause the systemic release of endorphins. Administration of the opiate antagonist naloxone partially blocks the analgesia produced by either auriculotherapy or by acupuncture.

What is the effect of wearing Earrings?

A common thought that occurs to many people is to question the consequence of wearing earrings when they are located at auricular acupuncture points. The classical location of earrings placed on the center of the ear lobe occurs at the eye point and has been reported to relieve visual disturbances. The response of ear reflex points to earrings depends on both the healing of the skin tissue where the ear has been pierced and the type of metal used in the ear ring. If the skin where the ear has been pierced has not completely healed, the metal in the ear ring can release electrically charged ions into the skin. Whether those ions help or harm any pathology in the corresponding part of the body depends upon whether the metal is gold, which releases positive ions, or silver, which releases negative ions.

Concerns

What type of health care practitioners provide auriculotherapy?

Auriculotherapy is conducted by a variety of practitioners, including acupuncturists, biofeeback therapists, chiropractic doctors, dentists, medical doctors, naturopathic doctors, nurses, osteopathic doctors, physical therapists, psychotherapists, and reflexology therapists.

Where do I find an auriculotherapy practitioner in my area?

There is a list of different practitioners of auriculotherapy in the Certification section of the website of the Auricular Certification Institute.

What health conditions are most helped by auriculotherapy?

Because every part of the external ear connects through the microsystem remote reflexes to every part of the body, a wide variety of health problems are relieved by auriculotherapy. Almost all health conditions can be affected to some degree by stimulating reactive ear points. The most commonly reported uses of auriculotherapy have been for the control of chronic pain, detoxification from addictive drugs, relief of nausea, and reduction of hypertension.

How does auriculotherapy affect pain conditions?

Most chronic pain is due to myofascial pain, related to the constriction of the connective tissue surrounding muscles in spasm. Muscles do not remain in spasm unless there are motor neurons causing them to contract. Maintenance of pathological muscles spasms is due to pathological brain reflex patterns that keep spinal reflex re-initiating the activation of the motor neurons that cause muscles to sustain their contraction. By stimulating ear reflex points that connect to the somatotopic reflex system in the brain, the pathological brain patterns can be electrically reset to stop the unwanted activation of spinal reflexes. Pain sensations that are due to irritated nerves can be relieved by the normalizing of pathological, hypersensitive reflex pathways that interconnect the ear microsystem and the somatotopic brain. In addition to these neurological explanations, it is also theorized that pain relief from auriculotherapy is achieved by the hormonal release of endorphins into the blood. From a Traditional Oriental Medicine perspective, pain is due to the blockage of Qi (pronounced chee) energy in the acupuncture meridian channels, thus creating an imbalance in the macro-acupuncture system. By stimulating specific ear points in the auricular microsystem, bi-directional connections are activated in the body macrosystem which lead to a balancing of energy and an increase flow of Qi.

How does auriculotherapy affect drug abuse?

As with pain control, explanations for the effectiveness of auriculotherapy in facilitating the reduction of drug abuse derive from both a Western neurological conceptualization and a Traditional Oriental Medicine perspective. The first evidence of the power of auriculotherapy in reducing the substance cravings of drug addicts came from H.L. Wen of Hong Kong in the 1970's, and were expanded upon by Dr. Michel Smith, a physician who practices Oriental Medicine in New York City. The Lung point on the ear used to relieve addiction disorders is said to affect the energy of the Lung meridian, which affects not only respiratory disorders but problems with detoxification. A Western neurological explanation of drug detoxification with auriculotherapy is based on the observation that the concha area of the ear which is used to treat addiction problems represents the control of the autonomic nervous system through the vagus nerve and through the hypothalamus of the brain.

How are other conditions relieved by auriculotherapy?

By facilitating a balancing of energy throughout the body macrosystems or by correcting pathological reflex centers in the brain, stimulation of the auricular acupuncture microsystem can lead to a homeostatic state whereby any form of stress or pain is lessened. Stimulation of the specific ear reflex points that correspond to a particular area of the body leads to either a reduction of excess stimulation or an enhancement of diminished under activity of the affected region. The overall effect of auriculotherapy is to create a more balanced condition throughout the body.

Can one do these treatments on one's self?

While the insertion of acupuncture needles into any part of the body requires approved training in acupuncture or medicine and the electrical stimulation or laser stimulation requires a comparable health care license, anyone can learn ear reflexology. By placing firm but gentle pressure on the relevant tender regions of the ear, one can achieve relief of discomfort in specific parts of the body.

Frequently asked Questions

How difficult is it to learn auriculotherapy treatment procedures?

Because of the simplicity of learning the inverted fetus somatotopic pattern on the ear, basic mastery of auriculotherapy skills can be achieved in just a few training sessions. The Auriculotherapy Manual by Dr. Terry Oleson provides a detailed description of over 250 ear reflex points and presents specific treatment plans for over 200 health conditions in a manner that is both comprehensive yet easy to understand. The International Handbook of Ear Reflex Points describes these same ear points in nine different languages in order to assist international communication regarding the location of these points.

Are auriculotherapy treatments covered by health insurance?

Whether auriculotherapy treatments are reimbursed health care providers or HMO's depends both upon the type of license of the practitioner and health insurance coverage of the client. When billed as applied neurostimulation (CPT Code 97118) as part of a regular office visit, many health insurance agencies will accept auriculotherapy as a form of TENS (transcutaenous electrical nerve stimulation). Only some health insurance companies accept auriculotherapy when billed as a form of acupuncture.

How long do the benefits of auriculotherapy last?

The range of responses to an auriculotherapy session are quite varied, but it is common that a patient suffering from severe pain will notice mild to marked reduction of their complaint on the very first session. This reduction in their pain experience can actually improve for the next several hours after treatment, but the benefits often begin to subside several days after the first treatment. With each successive treatment, the degree of pain relief usually becomes more and more prominen. The duration of pain relief progressively extends from several days to several weeks. With smoking cessation and drug detoxification, the benefits of auriculotherapy can last several weeks after just one or two auricular treatments.

How many treatment sessions are needed to help patients?

There is no set number of treatments for any health condition treated by auriculotherapy, but it is common that the severity of most conditions are moderately reduced by four to six sessions and greatly alleviated by eight to twelve sessions.

How many times per week are treatments provided?

The number of treatment sessions per week depends upon the schedule of the patients, as well as the severity of their health condition. When possible, severe conditions can be treated on a daily basis, but many patients are not available to come in that often. Typically, patients are given two treatments per week for two to three weeks, then once a week for several more weeks. The frequency of sessions progressively decreases to once a month as the medical disorder becomes less pronounced.

How long is a typical treatment session?

While the first auriculotherapy session requires greater time for an intake evaluation and patient history, a typical auriculotherapy treatment lasts 15 to 30 minutes. With auricular acupuncture, four to six acupuncture needles are inserted and left in place for approximately 20 minutes. In transcutaneous auricular electrical stimulation, each ear reflex point is first detected then stimulated for 10 to 30 seconds, requiring a total of 20 minutes for successively treating six to twelve points on each ear.

How does auricular needle insertion compare to electrical stimulation?

While both the insertion of acupuncture needles into the skin of the ear and the transcutaneous electrical on the surface of ear reflex points can effectively alleviate various health conditions, the effects from electrical stimulation usually produce more rapid pain relief.

Does it matter what frequency of stimulation is used?

Practitioners of Traditional Oriental Medicine usually stimulate body acupoints and ear acupoints with an alternation of slow and fast frequencies, whereas followers of the work of Dr. Nogier use a frequency specific pattern that depends on different zones of the ear. While stimulation frequency may have some impact, the location of the ear point stimulated is a more critical factor.

Is an electrical point locator necessary for detecting ear reflex points?

In ancient China, electrical point locators were not available, and modern practitioners of Traditional Oriental Medicine do not usually use point locators to detect body acupoints. Nonetheless, more accurate localization of auricular acupoints is achieved by first detecting a point with an electrodermal measurement device. Unlike the wide spaced body acupoints, ear points are only a few millimeters from each other. Moreover, increased electrical skin conductance at an ear reflex point is one of the primary indicators that there is pathology in the corresponding part of the body. Greater electrical conductance at body acupoints is found whether or not there is pathology in any underlying condition.

What are ear seeds or ear pellets?

Small adhesive band-aids are often used to hold a small grain or a small metal ball onto a specific area of the ear to allow for maintained pressure at that ear reflex point.

What are the contraindications for auriculotherapy?

As with other forms of acupuncture, there are few contraindications for the use of auriculotherapy. It is important not to treat any pain needed to diagnose an underlying problem, not to treat any pain needed to limit range of movement of an injured area of the body, not to treat women who are pregnant, and not to electrically stimulate the ear points of patients with a cardiac pace maker.

What are the side effects that occur from auriculotherapy?

Because tenderness of ear points is one of the primary diagnostic features of auriculotherapy, soreness on the ear points stimulated can sometimes continue for up to an hour after the treatment.

What are phases of auricular points?

Dr. Paul Nogier has described three different somatotopic maps on the ear in addition to the inverted fetus pattern he first described in 1957. These additional phase maps provide additional locations on the ear for stimulating the ear to relieve a given medical condition.

What scientific studies verify the effectiveness of auriculotherapy?

A list of the research articles and medical texts that describe the efficacy of clinical work with auriculotherapy is presented below.

Medical Texts:

Bourdiol R (1982) Elements of auriculotherapy. Moulins-les-Metz, Maisonneuve.

Bucek R (1994) Lehrbuch der ohrakupunktur: eine synopsis der französischen, chinesischen und russischen schulen. Heidelberg, Haug.

Chen K, Cui Y (1991) Handbook to Chinese auricular therapy. Beijing, Foreign Languages Press.

Grobglas A, Levy J (1986) Traité d’acupuncture auriculaire. Paris, Maloine.

Helms J (1995) Acupuncture energetics: a clinical approach for physicians. Berkeley, CA, Medical Acupuncture Publishers.

Huang H (1974) Ear acupuncture. Emmaus, PA, Rodale Press.

Huang L (1996) Auriculotherapy diagnosis and treatment. Bellaire, TX, Longevity Press.

Huang L (1999) Auricular diagnosis. Bellaire, TX, Longevity Press.

Kenyon J (1983) Modern techniques of acupuncture: a practical scientific guide to electro-acupuncture. Wellingborough, Thorsons.

König G, Wancura I (1993) Einführung in die chinesische ohrakupunktur. Heidelberg, Haug.

Kropej H (1984) The fundamentals of ear acupuncture, 2nd edn. Heidelberg, Haug.

Lu H (1975) A complete textbook of auricular acupuncture. Vancouver, Academy of Oriental Heritage.

Nahemkis A, Smith B (1975) Ear acupuncture therapy. Long Beach, Alba Press.

Nogier P (1968) Handbook to auriculotherapy. Moulins-les-Metz, Maisonneuve.

Nogier P (1972) Treatise of auriculotherapy. Moulins-les-Metz, Maisonneuve.

Nogier P (1983) From auriculotherapy to auriculomedicine. Moulins-les-Metz, Maisonneuve.

Nogier P, Nogier R (1985) The man in the ear. Moulins-les-Metz, Maisonneuve.

Nogier P, Petitjean F, Mallard A (1987) Points réflexes auriculaires. Moulins-les-Metz, Maisonneuve.

Nogier P, Petitjean F, Mallard A (1989) Compléments des points réflexes auriculaires. Moulins-les-Metz, Maisonneuve.

Nogier R (1993) Introduction Practique a l’Auriculomedecine. Heidelberg, Haug.

Oleson T (1995) International handbook of ear reflex points. Los Angeles, CA, Health Care Alternatives.

Oleson T (2003) Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture. London, Churchill Livingstone.

Oleson T (2003) Manual de Terapia Auricular: Sistemas chino y occidental de acupuntura de la oreja. Los Angeles, CA, Health Care Alternatives.

Pesikov Y, Rybalko S (1994) Auricular acupuncture: clinical atlas. Donetsk, Ukraine, Three Dragons Press.

Romoli M (2003) Agopuntura Auriculolare. Torino, Italy, Unione Tipografico-Editrice Torinese.

Rubach A (2001) Principles of ear acupuncture: microsystem of the auricle. Stuttgart, Thieme.

Shan Q, Lu M, Xiao F (1996) Auricular point-pressing therapy. Jinan, China, Shandong Science and Technology Press.

Strittmatter B (1998) Das storfeld in diagnostik und therapie. Stuttgart, Hippokrates.

Strittmatter B (2001) Taschenatals Ohrakupunktur. Stuttgart, Hippokrates.

Strittmatter B (2001) Ear Acupuncture: A Precise Pocket Atlas. Stuttgart, Thieme.

Stux G, Hammerschlag R, eds. (2001) Clinical acupuncture: scientific basis. Heidelberg, Springer.

Van Gelder A (1985) Strategieën in de ooracupunctuur. deel 1: Chinese ooracupunctuur. Utrecht, Uitgeverij Lemma.

Van Gelder A (1992) Strategieën in de ooracupunctuur. deel 2: auriculotherapie. Utrecht, Uitgeverij Lemma.

Weintraub M, ed. (2001) Alternative and complementary treatment in neurologic illness. Philadelphia, Churchill Livingstone.

Wexu M (1975) The ear gateway to balancing the body: a modern guide to ear acupuncture. New York, ASI Publishers.

Woo PJ (1998) Omni Auricular Therapy Moscow, Su Jok Academy.

Zhaohao W, Minghua L, Chichun C (1991) Pratique de l’acupuncture auriculaire. Paris, Libraire You Feng.

Journal papers

Abbate D, Santamaria A, Brambilla A, Paneri R, Di Guiulio A (1980) Beta-endorphin and electroacupuncture. Lancet 16 : 13–31.

Ackerman J (1999) Navach’s biochemical and neurophysical aspects of the VAS. International Consensus Conference on Acupuncture, Auriculotherapy, and Auricular Medicine. Las Vegas, NV: 51–57.

Akerele O (1991) WHO and the development of acupuncture nomenclature: overcoming a tower of Babel. Am J Chin Med 1: 89–94.

Alimi D (2000) Effects of auricular stimulation on functional magnetic resonance imaging of the cerebral cortex. Third International Symposium of Auriculotherapy and Auricular Medicine. Lyons, France.

Alimi D, Geissmann A, Gardeur D (2002) Auricular acupuncture stimulation measured on functional magnetic resonance imaging. Med Acupunc 13: 18–21.

Asamoto S, Takeshige C (1992) Activation of the satiety center by auricular acupuncture point stimulation. Brain Res Bull 29: 157–164.

Bergsmann O, Hart A (1973) Differences in electrical skin conductivity between acupuncture points and adjacent skin areas. Am J Acupunct 1: 27–32.

Blum K, Braverman E, Holder J et al (2000) Reward deficiency syndrome (RDS): a biogenic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors. J Psychoact Drugs 32: 2.

Bossy J (1979) Neural mechanisms in acupuncture analgesia. Minerva Med 70: 1705–1715.

Bossy J (2000) Anatomical comparisons of the external ear. Third International Symposium of Auriculotherapy and Auricular Medicine. Lyons, France.

Brewington V, Smith M, Lipton D (1994) Acupuncture as a detoxification treatment: an analysis of controlled research. J Substance Abuse Treatment 11: 289–307.

Bullock M, Culliton P, Olander R (1989) Controlled trial of acupuncture for severe recidivist alcoholism. Lancet i: 1435–1439.

Chan W, Weissensteiner R, Rausch W et al (1998) Comparison of substance P concentration in acupuncture points in different tissues in dogs. Am J Chin Med 26: 13–18.

Chapman C, Benedetti C, Colpitts Y, Gerlach R (1983) Naloxone fails to reverse pain thresholds elevated by acupuncture: acupuncture analgesia reconsidered.
Pain 16: 13–31.

Chen GS (1995) On auricular acupuncture. Second International Symposium on Auricular Medicine. Beijing, China: 37–48.

Chen GS, Lu P (1999) History of auricular acupuncture in China. Presentation at International Consensus Conference on Acupuncture, Auriculotherapy, and Auricular Medicine. Las Vegas, NV: 7–8.

Chen H (1993) Recent studies on auriculoacupuncture and its mechanism.
J Trad Chin Med 13: 129–143.

Chiou S, Chao C, Yang Y (1998) Topography of low skin resistance points (LSRP) in rats. Am J Chin Med 26: 19–27.

Cho ZH, Wong G (1998) New findings of the correlation between acupoints and corresponding brain cortices using functional MRI. Proc Natl Acad Sci 95: 2670–2673.

Choy D, Eidenschenk E (1998) Effect of tragus clips on gastric peristalsis: a pilot study.
J Altern Compl Med 4: 399–403.

Clement-Jones V, McLaughlin L, Lowry P, Besser G, Rees L, Wen HL (1979) Acupuncture in heroin addicts: changes in met-enkephalin and beta-endorphin in blood and cerebrospinal fluid. Lancet ii: 380–382.

Clement-Jones V, Mc Loughlin L, Tomlin, S, Besser G, Rees L, Wen H (1980) Increased beta-endorphin but not met-enkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain. Lancet iii: 946–948.

Cox B (1975) Patient motivation: a factor in weight reduction with auricular acupuncture. Am J Acupunct 3: 339–341.

Dale R (1976) The micro-acupuncture systems, parts I & II. Am J Acupunct 4: 7–24; 196–224.

Dale R (1985) The micro-acupuncture meridians. Intl J Chin Med 2: 31–49.

Dale R (1991) Acupuncture meridians and the homunculus principle. Am J Acupunct 19: 73–75.

Dale R (1993) Addictions and acupuncture: the treatment methods, formulae, effectiveness and limitations. Am J Acupunct 21: 247–266.

Dale R (1999) The systems, holograms and theory of micro-acupuncture.
Am J Acupunct 27: 207–242.

Debreceni L (1991) The effect of electrical stimulation of the ear points on the plasma ACTH and GH level in humans. Acupunct Electrotherap Res 16: 45–51.

Dvorkin E (1999) Morphology of auricular reflex points. International Consensus Conference on Acupuncture, Auriculotherapy, and Auricular Medicine. Las Vegas, NV: 29–30.

Ernst M, Lee M (1987) Influence of naloxone on electro-acupuncture analgesia using an experimental pain test. Acupunct Electrotherap Res 12: 5–22.

Fedoseeva O, Kalyuzhnyi L, Sudakov K (1990) New peptide mechanisms of auriculo-acupuncture electro-analgesia: role of angiotensin II. Acupunct Electrotherap Res 15:1–8.

Frank B (1999) A critical assessment of functional ear points. International Consensus Conference on Acupuncture, Auriculotherapy, and Auricular Medicine. Las Vegas, NV: 62–63.

Giller R (1975) Auricular acupuncture and weight reduction. A review and overall approach. Am J Acupunct 3: 151–153.

Helms J (1990) WHO adopts standard international acupuncture nomenclature. AAMA Review 2: 33.

Ho W, Wen H, Lam S, Li A (1978) The influence of electroacupuncture on naloxone induced morphine withdrawal in mice: elevation of brain opiate-like activity.
Eur J Pharmacol 49: 197–199.

Holder J, Duncan R, Gissen M, Miller M, Blum K (2001) Increasing retention rates among the chemically dependent in residential treatment: auriculotherapy and subluxation-based chiropractic care. Molec Psychiatry 6: S8.

Hsieh C (1998) Modulation of cerebral cortex in acupuncture stimulation: a study using sympathetic skin response and somatosensory evoked potentials.
Am J Chin Med 26: 1–11.

Hsieh J, Stahle-Backdahl M, Hagermark O, Stone-Elander S (1995) Traumatic nociceptive pain activates the hypothalamus and the periaqueductal gray: a positron emission tomography study. Pain 64: 303–314.

Hyvarinen J, Karlsson M (1977) Low skin resistance skin points that may coincide with acupuncture loci. Med Biol 55: 88–94.

Ionescu-Tirgoviste C, Pruan S, Bajenaru P (1991) The participation of the autonomic nervous system in the mechanism of action of acupuncture. Am J Acupunct 1 9: 21–28.

Jaung-Geng L, Salahin H, Jung-Charng L (1995) Investigation on the effects of ear acupressure on exercise-induced lactic acid levels and the implications for athletic training. Am J Acupunct 23: 309–313.

Kashiba H, Ueda Y (1991) Acupuncture to the skin induces release of substance P and calcitonin gene-related peptide from peripheral terminals of primary sensory neurons in the rat. Am J Chin Med 19: 189–197.

Kawakaita K, Kawamura H, Keino H, Hongo T, Kitakohji, H (1991) Development of the low impedance points in the auricular skin of experimental peritonitis rats.
Am J Chin Med 19: 199–205.

Kho H, Robertson E (1997) The mechanisms of acupuncture analgesia: review and update. Am J Acupunct 25: 261–281.

Kitade T, Hyodo M (1979) The effects of stimulation of ear acupuncture points on the body’s pain threshold. Am J Chin Med 7: 241–252.

Krause A, Clelland J, Knowles C, Jackson J (1987) Effects of unilateral and bilateral auricular transcutaneous electrical stimulation on cutaneous pain threshold. Physical Therapy 67: 507–511.

Kroening R, Oleson T (1985) Rapid narcotic detoxification in chronic pain patients treated with auricular electroacupuncture and naloxone. Intl J Addict 20: 1347–1360.

Kvirchishvili V (1974) Projections of different parts of the body on the surface of the concha auriculae in humans and animals. Am J Acupunct 2: 208.

Lee T (1977) Thalamic neuron theory: a hypothesis concerning pain and acupuncture. Med Hypoth 3: 113–121.

Lee T (1994) Thalamic neuron theory: theoretical basis for the role played by the central nervous system (CNS) in the causes and cures of all disease. Med Hypoth 43: 285–302.

Leib S (1999) Nogier’s three functional layers to evaluate conventional medications. International Consensus Conference on Acupuncture, Auriculotherapy, and Auricular Medicine. Las Vegas, NV: 59–60.

Lichstein E, Chaddie K, Naik D, Gupta P (1974) Diagonal earlobe crease: prevalence and implications as a coronary risk factor. New Engl J Med 290: 615–616.

Lin C (1984) Use of auricular acupuncture for the relief of tooth pain. Am J Acupunct 12: 239–244.

Margolin A, Chung P, Avants S, Kosten T (1993a) Effects of sham and real auricular needling: implications for trials of acupuncture for cocaine addiction.
Am J Chin Med 221: 191–197.

Margolin A, Avants S, Chung P, Kosten T (1993b) Acupuncture for the treatment of cocaine dependence in methadone-maintained patients. Am J Addict 2: 194–201.

Marignan M (1999) Dynamic and digital thermography of the ear. Presentation at the International Consensus Conference on Acupuncture, Auriculotherapy, and Auricular Medicine. Las Vegas, NV: 23.

Mehta J, Homby R (1974) Diagonal earlobe crease as a coronary risk factor.
New Engl J Med 291: 260.

Ng L, Douthitt T, Thoa N, Albert C (1975) Modification of morphine-withdrawal in rats following transauricular electrostimulation: an experimental paradigm for auricular electroacupuncture. Biol Psychiatr 10: 575–580.

Ng L, Dionne R, Bragin E, Pert C, Pert A (1981) Alterations in rat central nervous system endorphins following transauricular acupuncture. Brain Res 224: 83–93.

Niemtzow RC (1998) A high-protein regimen and auriculomedicine for the treatment of obesity: a clinical observation. Med Acupunct 9: 15–21.

Nogier R (1999) History of Dr Paul Nogier’s work in auricular medicine. International Consensus Conference on Acupuncture, Auriculotherapy, and Auricular Medicine. Las Vegas, NV: 19–22.

Oleson T (1998) Differential application of auricular acupuncture for myofascial, autonomic, and neuropathic pain. Med Acupunct 9: 23–28.

Oleson T, Flocco W (1993) Randomized controlled study of premenstrual symptoms treated with ear, hand, and foot reflexology. Obstet Gynecol 82: 906–911.

Oleson T, Kroening R (1983a) A comparison of Chinese and Nogier auricular acupuncture points. Am J Acupunct 11: 205–223.

Oleson T, Kroening R (1983b) A new nomenclature for identifying Chinese and Nogier auricular acupuncture points. Am J Acupunct 12: 325–344.

Oleson T, Kroening R (1983c) Electroacupuncture and auricular electrical stimulation. IEEE Eng Med Biol Mag 2: 22–26.

Oleson T, Kroening R, Bresler D (1980) An experimental evaluation of auricular diagnosis: the somatotopic mapping of musculoskeletal pain at ear acupuncture points. Pain 8: 217–229.

Oliveri A, Clelland J, Jackson J, Knowles C (1986) Effects of auricular transcutaneous electrical stimulation on experimental pain threshold. Physical Ther 66: 12–16.

Patterson M (1974) Electro-acupuncture in alcohol and drug addictions.
Clin Med (Oct.): 9–13.

Pert A, Dionne R, Ng L et al (1981) Alterations in rat central nervous system endorphins following transauricular electroacupuncture. Brain Res 224: 83–93.

Pomeranz B, Chiu, D (1976) Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci 19: 1757.

Regrena Y, Fabre M, Pernice C, Nguyen J (1980) Smoking withdrawal therapy by acupuncture. Am J Acupunct 8: 57–63.

Reichmanis M, Marino A, Becker R (1975) Electrical correlates of acupuncture. IEEE Trans Bio-Med Engin 22: 533–535.

Reichmanis M, Marino A, Becker R (1976) D.C. skin conductive variation at acupuncture loci. Am J Chin Med 4: 69–72.

Richards D, Marley J (1998) Stimulation of auricular acupuncture points in weight loss. Austral Family Phys 27 (suppl 2): S73–S77.

Romoli, M, Vettoni F (1982) Alterations in the skin of the auricle and correlation with chronic disease. Minerva Med 73: 725–730.

Sacks L (1975) Drug addiction, alcoholism, smoking, obesity treated by auricular staplepuncture. Am J Acupunct 3: 147–150.

Saku K, Mukaino Y, Ying H, Arakwa K (1993) Characteristics of reactive electropermeable points on the auricles of coronary heart disease patients.
Clin Cardiol 16: 415–419.

Schjelderup V (1982) The principle of holography: a key to holistic approach in medicine. Am J Acupunct 10: 167–171.

Shiraishi T, Onoe M, Kojima T, Sameshima Y, Kageyama T (1995) Effects of auricular stimulation on feeding-related hypothalamic neuronal activity in normal and obese rats. Brain Res Bull 36: 141–148.

Simmons M, Oleson T (1993) Auricular electrical stimulation and dental pain threshold. Anesth Progr 40: 14–19.

Sjolund B, Eriksson M (1976) Electroacupuncture and endogenous morphines. Lancet ii: 1085.

Sjolund B, Terenius L, Eriksson M (1977) Increased cerebrospinal fluid levels of endorphins after electroacupuncture. Act Physiol Scand 1 00: 382–384.

Smith M (1979) Acupuncture and healing in drug detoxification. Am J Acupunct 7: 97–107.

Smith M (1988) Acupuncture treatment for crack: clinical survey of 1500 patients treated. Am J Acupunct 16: 241–247.

Smith M (1990) Creating a substance abuse treatment program incorporating acupuncture. AAMA Rev 2: 29–32.

Smith M, Squires R, Aponte J, Rabinowitz N, Regina S (1982) Acupuncture treatment of drug addiction and alcohol abuse. Am J Acupunct 10: 161–163.

Sun Q, Xu Y (1993) Simple obesity and obesity hyperlipema treated with otoacupoint pressure and body acupuncture. J Trad Chin Med 13: 22–26.

Takeshige C, Sato T, Mera T, Hisamit T, Fang J (1992) Descending pain inhibitory system involved in acupuncture analgesia. Brain Res Bull 29: 617–634.

Van Gelder T (1999) Pain, chakra centers, and pathological auricular points. Presentation at International Consensus Conference on Acupuncture, Auriculotherapy, and Auricular Medicine. Las Vegas, NV: 50.

Voll R (1977) Energetic reactions between organ pairs and paranasal sinuses, ordontons, and tonsils in electroacupuncture according to Voll. Am J Acupunct 5: 101-114.

Wang D (1984) Standard acupuncture nomenclature. WHO Regional Publications, Western Pacific Series, Manila.

Wei F, Dubner R, Ren K (1999) Nucleus reticularis gigantocellularis and nucleus raphe magnus in the brain stem exert opposite effects on behavioral hyperalgia and spinal Fos protein expression after peripheral inflammation. Pain 80: 127–141.

Wen HL (1977) Fast detoxification of drug abuse by acupuncture and electrical stimulation (AES) in combination with naloxone. Mod Med Asia 13: 13–17.

Wen HL, Cheung S (1973) Treatment of drug addiction by acupuncture and electrical stimulation. Am J Acupunct 1: 71–75.

Wen HL, Ho WK, Wong HK et al (1978) Reduction of adrenocorticotropic hormone (ACTH) and cortisol in drug addicts treated by acupuncture and electrical stimulation (AES). Compar Med East West 7: 237–240.

Wen H, Ho K, Ling N, Ma L, Choa G (1979) The influence of electro-acupuncture on naloxone-induced morphine withdrawal. II. Elevation of immunoassayable beta-endorphin activity in the brain but not the blood. Am J Chin Med 7: 237–240.

Wong EK, Cho ZH (1999) Acupuncture, brain function, and modern fMRI imaging techniques. International Consensus Conference on Acupuncture, Auriculotherapy, and Auricular Medicine. Las Vegas, NV: 31–33.

World Health Organization (1985) Report on second WHO working group on the standardization of acupuncture nomenclature. Hong Kong.

World Health Organization (1987) Report on third WHO working group on the standardization of acupuncture nomenclature. Seoul, Korea.

World Health Organization (1990a) WHO report of the working group on auricular acupuncture nomenclature. Lyons, France.

World Health Organization (1990b) A standard international acupuncture nomenclature: Memorandum from a WHO meeting. WHO Bulletin 68: 165–169.

Xianglong H, Baohua W, Xiaoqing H, Jinsen X (1992) Computerized plotting of low skin impedance points. J Trad Chin Med 12: 277–282.

Yang M, Kwok S (1986) Evaluation of the treatment of morphine addiction by acupuncture, Chinese herbs, and opioid peptides. Am J Chin Med 14: 46–50.

Young M, McCarthy P (1998) Effect of acupuncture stimulation of the auricular sympathetic point on evoked sudomotor response. J Altern Compl Med 4: 29–38.

Zhang YQ (1980) [A new micro-acupuncture system and another general law of distribution of acupoints besides that of the meridian-following distribution – the second metacarpal side therapy and the holographic law of distribution of acupoints.] (in Chinese) Wulanchabu Sci Tech 1: 38.

Zhang YQ (1992) A new view of the organism: The ECIWO theory and its solution of some challenging problems in the frontiers of medicine and biology. Hong Kong, Peace Book.

Zhou L (1995) Supplementary comments on the standardization of auricular points.
J Trad Chin Med 15: 132–134.

Zhou L (1999) The national standards of the People’s Republic of China. International Consensus Conference on Acupuncture, Auriculotherapy, and Auricular Medicine. Las Vegas, NV: 11–18.

This information has been prepared by Terry Oleson, PhD