Ear acupuncture

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    Ear acupuncture is a therapy to treat and prevent dis-eases by stimulating certain points on the auricle with needles. The scope of indication is wide. It is a commonly used therapy in clinical acupuncture treatment.

1. Distribution of auricular acupoints
    In view of the corresponding relationship between auricular acupoints and each part of the human body, the distribution of auricular acupoints is just like an inverted fetus (see Fig. 120). The acupoints located in the lower part of the ear (ear lobe) are related to the head and face, those in the upper part of the ear (including scapha and superior antihelix crus) to the limbs, those in the middle part of the ear (including cymba concha and cavum con-cha) to the internal organs, and those mainly in the middle part of the ear (the principal part of antihelix) to the trunk.

 2.  Terminology for the anatomical regions of the auricular surface 
    Helix: The prominent rim of the auricle. A tran-sverse ridge of helix extending into the ear cavity is called "helix crus"; a small tubercle at the posterior-inferior side of the helix is called "helix tubercle"; the junction of the inferior part of the helix and the lobule is called "helix cauda".
    Antihelix: An elevated ridge anterior and parallel to the helix at the medial side of the helix, also called "the principal part of antihelix". The superior branch of the bifurcation of the antihelix is called "superior antihelix crus¡±, and the inferior branch is called "inferior antihe-lix crus".
    Triangular fossa: The triangular depression be-tween the two crura of the antihelix.
    Scapha: The curved depression between the helix and antihelix.
    Tragus: A curved flap in front of the auricle.
    Supratragic notch: The depression between the he-lix crus and the upper border of the Vagus.
    Antitragus: A small tubercle opposite to the tragus and inferior to the ear lobe.
    Intertragic notch: The depression between the tra-gus and the antitragus.
    Helix notch: The mild depression between the anti-tragus and antihelix.
    Ear lobe: The lowest part of the auricle where there is no cartilage.
    Cymba concha: The cavum superior to the helix crus.
    Cavum concha: The cavum inferior to the helix CFUS.
    Orifice of the external auditory meatus: The ori-fice anterior to the cavum concha.
    
  3. Name, location and indication of the commonly used ear acupoints
    Helix:
    Middle Ear  HXI--On the helix crus, also called HXI. Indications: Hiccup, urticaria, cutaneous pruritus, infantile enuresis and hemoptysis.
    Rectum  HX2--On the helix near the supratragic notch, also called HX2. Indications. Constipation, diar-rhea, anus prolapse and hemorrhoids.
    Urethra  HXa--On the helix superior to Rectum, al-so called HXa. Indications: Frequent, urgent and painful urination as well as retention of urine.
    External Genitalia  HX4--On the helix at level with the upper border of inferior antihelix crus, also called HX4. Indications: Orchitis, epididymidis and pruritus of vulva.
    Anus  HXs  On the helix at level with the anterior border of superior antihelix crus, also known as HXs. Indications: Hemorrhoid and anal fissure.
    Ear Apex  HX6.7--At the tip of auricle when folded towards tragus, that is at the junction of HX6 and ax7. Indications. Fever, hypertension, acute conjunctivitis and hordeolum.
    Tubercle  HXa--At the helix tubercle, also known as HX8. Indications: Vertigo, headache and hyperten-sion.
    Luna-4  HX9-12--On the helix, that is HX9 - nXl2. Indications: Tonsillitis, upper respiratory tract infection and fever.
    Scapha:
    Finger  SF1--At the superior part of the scapha, also called SF1. Indications: Numbness and pain of the fingers.
    Fengxi   SF1, Zi--Midpoint between Finger and Wrist, that is the junction of SF1 and SF2.          
Indications: Urticaria, cutaneous pruritus and allergic rhinitis.
    Wrist   SF2--The point inferior to Finger, also known as SF2. Indication: Pain of the wrist.
    Elbow  SF3--The point inferior to Wrist, also called SF3. Indications. External humeral epicondylitis and pain of the wrist.
    Shoulder  SF4,5  The point inferior to Elbow, also known as SF4, SFs.
Indication: Scapulohumeral periar-thrifts.
    Clavicle  SF6  The point inferior to Shoulder, also called SF6. Indication: Scapulohumeral periarthritis.
    Antihelix:
    Heel  AH1--Superior and medial of superior antihe-lix crus, near Triangular fossa, also called AH1. Indica-tion: Heel pain.
    Toe  AH2--Superior and lateral of superior antihelix crus, also called AH2. Indication: Toe pain.
Ankle  AH3--Midway between Heel and Knee, also called AH3. Indication: Ankle sprain.
    Knee  AH4--At middle 1/3 portion of superior anti-helix crus, also called AH4. Indication: Swelling and pain of the knee joint.
    Hip  AH5--At lower 1/3 portion of superior antihe-lix crus, also called AH6. Indications: Pain of hip and sciatica.
    Sciatic Nerve  AH6--At the anterior 2/3 of the infe-rior antihelix crus, also called AH6. Indication: Sciatica.
    Sympathetic Nerve  AH6a--At the junction of the terminal of the inferior antihelix crus and helix, that is the anterior part of AH6. Indications: Gastrointestinal spasm, angina pectoris, biliary colic, ureterolith and functional disorder of autonomous nerve system.
    Buttocks  AH7--At lateral 1/3 of the inferior anti-helix crus, also called AHT. Indications: Sciatica and glu-teal fascitis.
    Abdomen  AH8--At medial 2/5 of the principal part of antihelix, also known as AH8. Indications: Abdominal pain and distension, diarrhea and acute lumbar sprain.
    Lumbosacral Vertebrae  AH9--At lateral of Abdo-men, also called AH9. Indication: Pain of lumbosacral re-gion.
    Chest  AH10--At middle 2/5 of the anterior principal part of antihelix, also known as AH10. Indications: Hypo-chondriac pain and mastadentitis.
    Thoracic Vertebrae  AHll--Posterior to Chest, also called AHll. Indications: Distending pain of breast, mas-tadentitis and hypogalactia after delivery.
    Neck  AH12  At lower 1/5 of the anterior principal part of antihelix, also called AH12. Indications: Stiffness and swelling pain in the neck.
    Cervical Vertebrae  AHla--Posterior to Neck, also called AH13. Indications: Stiff neck and cervical vertebrae syndrome.
    Triangular Fossa:
    Upper Triangular Fossa  TF1--At the upper part of anterior 1/3 of the fossa. Indication: Hypertension.
    Internal Genitalia  TF2--At the lower part of anteri-or 1/3 of the fossa. Indications: Dysmenorrhea, irregular menstruation, leukorrhea, dysfunctional uterine bleeding, seminal emission and prospermia.
    Middle Triangular Fossa  TF3--At middle 1/3 of the fossa. Indication.. Asthma.
    Shenmen  TF4--At the upper part of posterior 1/3 of the fossa. Indications: Insomnia, dream disturbed sleep and pain syndrome.
    Pelvic Cavity  TF5-- At the lower part of posterior 1/3 of the fossa. Indication: Pelvic inflammation.
    Tragus:
    Upper Tragus  TG1  At the upper 1/2 of the exter-nal tragus. Indications: Laryngopharyngitis and rhinitis.
    Lower Tragus   TG2  At the lower 1/2 of the external tragus. Indications: Rhinitis and stuffy nose.
    External Ear  TG10--Anterior to supratragic notch and near helix.  Indications: Inflammation of external auditory canal, tympanitis and tinnitus.
    Tragic Apex  TG1p--At the tip of upper free border of tragus. Indications. Fever and toothache.
    External Nose  TG1, 2i--Midpoint of the lateral side of tragus. Indications. Nasal vestibulitis and rhinitis.
    Adrenal Gland   TG2p--At the tip of lower free border of tragus. Indications.. Hypotension, rheumatic arthritis and parotitis.
    Throat  TGa--At upper 1/2 of the medial side of tragus. Indications.. Hoarseness, laryngopharyngitis and tonsillitis.
    Internal Nose   TG4--At lower 1/2 of the medial side of tragus. Indications. Rhinitis, paranasal sinusitis and epistaxis.
    Anterior Intertragus  TG21--Anterior to the inter-tragic notch, the lowest part of tragus. Indications: Sto-matitis, maxillary sinusitis and nasopharyngitis.
    Antitragus:
    Forehead  AT1--At anterior part of the lateral side of antitragus. Indications: Vertigo, headache, insomnia and dreaminess.
    Posterior Intertragus  AT11--Posterior to the inter-tragic notch and anterior-inferior to the antitragus. Indi-cation. Maxillary sinusitis.
    Temple  AT2--At the middle part of the lateral side of antitragus. Indication: Migraine.
    Occiput  AT3--At the posterior part of the lateral side of antitragus. Indications. Vertigo, headache, asth-ma, epilepsy and neurosism.
    Subcortex  AT4--At the medial side of Antitragus. Indications: Pain syndrome, neurosism and pseudomyo-pia.
    Antitragic Apex  AT1,2,4i  At the tip of antitragus. Indications: Asthma, parotitis, itching skin, orchitis and epididymidis.
    Middle Border   AT2,3,4i--Midpoint between anti-tragic apex and helixtragic notch. Indications.. Enuresis and auditory vertigo.
    Brain Stem  AT3,4i--At the helixtragic notch. Indi-cations: Occipital headache, vertigo and pseudomyopia.
    Concha:
   Mouth  COl--At anterior 1/3 of the inferior helix crus. Indications: Facial paralysis, stomatitis, cholecysti-tis and cholelithiasis.
   Esophagus  C02--At middle 1/3 of the inferior helix crus. Indications: Esophgitis and esophagismus.
    Cardia  CO3--At posterior 1/3 of the inferior helix crus. Indications. Cardiospasm and neurogenic vomiting.
    Stomach  C04--At area where the helix crus termi-nates. Indications. Gastrospasm, gastric ulcer, gastritis, insomnia, toothache and indigestion.
    Duodenum  CO5--At the posterior 1/3 between the helix crus, part of helix and AB line.   Indications. Duode-nal ulcer, cholepathy and pylorospasm.
    Small Intestine  C06--At middle 1/3 between the helix crus, part of helix and AB line. Indications.. Indiges-tion and palpitation.
    Large Intestine  CO7--At medial 1/3 between the helix crus, part of helix and AB line. Indications. Diar-rhea, constipation, cough and acne.
    Appendix   CO6, 7i--Between Small Intestine and Large Intestine. Indications: Appendicitis and diarrhea.
   Angle of Cymba Concha  CO8--At medial inferior part of inferior antitragus crus. Indications. Prostatitis and urethritis.
    Bladder  CO9--At middle inferior part of inferior an-
titragus crus. Indications: Cystitis, enuresis, anuresis,
lumbago, sciatica and occipital headache.
    Kidney  CO10--At the lateral inferior part of inferior antitragus crus. Indications. Lumbago, tinnitus, insomni-a, vertigo, irregular menstruation, seminal emission, prospermia and asthma.
    Ureter   C09, 10i--Between Bladder and Kidney. Indications: Stone and colic pain of ureter.
Pancrease and gallbladder  CO11--At the lateral su-perior part of the cymba concha.   
    Indications:Cholepathy, migraine, herpes zoster, otitis media, tinnitus and acute pancreatitis.
    Liver  CO12--At the lateral inferior part of the cym-ba concha. Indications: Hypochondriac pain, vertigo, eye diseases, premenstrual tension, irregular menstruation, menopausal syndrome and hypertension.
    Middle Cymba Concha  CO6, 10i--Between the Small Intestine and Kidney. Indications: Abdominal pain and distension, ascariasis of biliary tract and parotitis.
    Spleen  CO13--Below the BD line, at lateral and superior part of cavum concha. Indications: Abdominal distension, diarrhea, constipation, anorexia, dysfunctional uterine bleeding, leukorrhea and auditory vertigo.
    Heart  CO15--In the central depression of cavum concha. Indications: Diseases of cardiovascular system, neurosism, hysteria and stomatoglossitis.
    Trachea   CO16--Midpoint of Heart and External Ear. Indication: Asthma.
Lung  CO14--Around Heart and Trachea. Indica-tions: Cough and asthma, chest distress, acne, flat wart, itching skin and constipation.
    Triple Energizer  CO17--Lateral and inferior to the orifice of external auditory meatus and between Lung and Endocrine. Indications: Constipation, abdominal disten-sion and pain of lateral side of the upper limbs.
    Endocrine  CO18--In the intertragic notch, at the medial inferior part of the cavum concha. Indications: Dysmenorrhea, irregular menstruation, menopausal syn-drome and acne.
    Ear Lobule:
    Tooth  LO1--On the medial upper part of the front side of ear lobule. Indications: Toothache, periodontitis and hypotension.
    Tongue  L02  On the middle upper part of the front side of ear lobule. Indications: Glossitis and stomatitis.
    Jaw  LO3--On the lateral upper part of the front side of ear lobule. Indications: Toothache and disorder of temporomandibular joint.
    Frontal Ear Lobe  LO4  On the medial middle part of the front side of ear lobule. Indications: Neurosism and toothache.
    Eye  LO5--In the center of the front side of ear lob-ule. Indication: Pseudomyopa.
Internal Ear  LO6--On the lateral middle part of the front side of ear lobule. Indications: Auditory vertigo, tinnitus and impaired hearing.
    Cheek  LO5,6i--On the ear lobe, between Eye and Internal Ear.  Indications: Peripheral facial paralysis, pmsopalgia, acne and flat wart.
    Tonsil  LOT,8,9--On the lower part of the front side of the ear lobe. Indications: Tonsillitis and pharyngitis.
    Back Auricle:
    Groove on the Back Auricle  PS--In the Y-shaped depression on the back auricle. Indications: Hypertension and itching skin (see Fig. 123).
   
4. Detection of Ear Acupoints
    When pathological changes have taken place in the human body, usually "positive reaction point" can be de-tected at the corresponding areas of the auricle, such as tenderness, discoloration and pigmentation, morphologi-cal changes (upheaval, depression and cords), desquama-tion, pimples, low electrical resistance, and so on. These points are used not only for clinical diagnosis, but also for treating diseases. Therefore when the prescription based on the symptoms is formulated, reaction points should be detected through careful observation, pressure with the needle handle, or determination with the electrical resist-ance of the skin for strengthening the curative effect.

 5. Manipulations
    The ear acupoints are sterilized routinely with 2% iodine and 75 % alcohol. The acupuncturist holds the auri-cle with the left hand and swiftly inserts the filiform nee-dle of 0.5 cun or pin-like needle with the right hand into the depth of the cartilage, avoiding penetration through the ear. The usual sensations are pain, or distension or burning. The needles are usually retained for 20 - 30 mi-nutes. But chronic diseases, the needles may be retained for a longer period, and during which the needles can be manipulated at intervals. Pin-like needles are fixed into the acupoints with adhesive tapes and can be retained for 2 - 3 days. After the needle is withdrawn, the punctured acupoint is pressed with a sterilized dry cotton ball to avoid bleeding. Such a treatment is given once a day or once every other day. Ten times make up one course of treatment. There is an interval of 5 - 7 days between two courses of treatment.
    Apart from needling, auricular-plaster therapy is also a commonly used therapy in clinical treatment. Method. The skin is sterilized routinely. Small granular drugs, such as Wangbuliuxingzi (Semen Vaccariae), is fixed onto the ear acupoints with adhesive tape. The patient is ad-vised to press the acupoints several times a day and about 1 minute for each point. It is changed once every 3 ¨C 5 days. Five to ten times make up one course of treatment.

6. Cautions
    Sterilization must be strict to avoid infection. Nee-dling should not be used if inflammation or chilblain is present on the auricle. For slight inflammation, 2.5 % alcohol should be applied timely to it.
    Ear acupuncture is inapplicable to gravida with the history of miscarriage. It is inadvisable to be used to treat the aged and patients with weak constitution and overstrain.

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