George T. Lewith MA MRCGP MRCP
The ear is a homunculus with all of the structures and organs of the body represented on it. The origin of ear acupuncture is unclear, and although it is referred to in ancient Chinese texts it only seems to have been used clinically during the last fifty years.
In broad principle the apex of the pinna represents the hands and feet, the helix and anti-helix the limbs and trunk, the ear lobe the facial structures, and the concha of the ear represents the internal organs. The main auricular points are shown on the ear chart.
Ear acupuncture can be used for any condition that will respond to acupuncture, although in China its main use is for acutely painful conditions and acupuncture anaesthesia.
The Theory of Point Selection
Auricular points can be selected directly for the areas they represent; stomach point for gastralgia, ankle point for ankle pain, and so on. They can also be selected on the basis of traditional Chinese medicine, for instance when there is a disturbance of the gan-liver select the liver point, or for diseases of the skin select the lung point as the fei-lung controls the skin and hair.
The Chinese were also selecting points on the basis of modern physiology, for instance in gynaecological problems endocrine and subcortex points are frequently used. Some of the points are based on clinical experience, Shenmen is a useful sedative point Dingchuan is useful for asthma, and Appendix for appendicitis.
Methods of Point Selection
In ear acupuncture it is essential to localize the ear points accurately. If a structure or organ in the body is painful or diseased then the ear point representing that organ will be painful. This can be demonstrated clinically by probing the ear; initially the acupuncturist must decide on the approximate area to probe and then carefully search the area with a blunt probe or a spring-loaded probe. The point that is the most painful is the one that requires treatment.
Ear points can also be localized electrically. A tender ear point has an increased electrical conductance and, by using one of the many electrical ear point locators that are available, the area of increased conductance can be demonstrated. These machines are very prone to artefact so the operator must use them with extreme care and not press on the ear too forcefully or areas of increased conduction will appear everywhere.
Point Selection for Pain
In acute pain ear acupuncture can have a very swift and effective action. The point should be selected by the methods described. When the needle is inserted into the tender point the patient will feel a great deal of pain. Rotate the needle and get the patient to exercise the painful area at the same time. The pain in the affected area should then disappear.
Chronic pain may also respond quite dramatically to ear acupuncture, but to be effective it may often require a course of treatment rather than one treatment.
Sterility
It is important to keep ear needles sterile and to clean the ear carefully before inserting a needle.
Needle Insertion
Half inch or one inch needles should be used in the ear. The half inch needles can be inserted perpendicularly to the skin and the one inch needles are often used obliquely. Do not insert the needle through the ear. Press studs can also be used in the ear. They are useful for chronic conditions as the patient can press the stud and stimulate the point whenever symptoms occur.
Needle Stimulation
Ear points can be stimulated manually by rotating the needle; this creates a burning painful sensation in the ear. Electrical stimulation of the ear points is used to induce anaesthesia and it can also be used therapeutically, especially in chronic conditions. The main use of the electrical stimulator in China is for ear acupuncture anaesthesia. The stimulation frequencies used were usually low for any form of ear acupuncture, between 5 and 300Hz, but there seemed to be no consistent agreement about the exact frequency. The intensity used is the maximum tolerable.
Ear point prescriptions have been included in the sections, where relevant, on each particular disease.
Ear acupuncture should be treated like body acupuncture for chronic conditions; the patient should be given a course of about eight treatments, although acute conditions may respond in one treatment.
Scalp acupuncture is a modern acupuncture method. The Chinese attribute its development to Chiao Sun-Fa, a 35-year-old physician in North China, and it has been used in China since 1971. The principle of scalp acupuncture is very straightforward; the aim is to stimulate the diseased area of the brain in order to facilitate a return of function in that area.
This method is based on elementary functional neuroanatomy, and has nothing to do with traditional Chinese medicine. If part of the brain is damaged, for instance by a stroke, then the scalp is stimulated over the damaged area of the brain. All the scalp points are representations of the underlying functional areas of the brain. It therefore follows that the most common use of scalp acupuncture will be in diseases in which there is brain damage, such as strokes or severe head injuries, although this method can be used for a variety of other conditions. Scalp acupuncture is particularly useful for reducing chronic muscle spasm.
I. Localization of Scalp Points
When using scalp therapy it is vital to localize the scalp area accurately. There are very few good reference texts for such scalp points so accurate scalp maps have been included in this text.
Motor area
0.5cms posterior to the midpoint of the anterior-posterior line defines the upper limit of the motor area. The lower limit intersects the eyebrow-occiput line at the anterior border of the natural hairline on the temple. The upper 1/5 represents the lower limbs and trunk, the middle 2/5 represents the upper limbs and the lower 2/5 the face.
Contralateral motor disturbance of the appropriate area.
Sensory area
This is a line parallel to the motor area and 1.5cms behind it. The sensory input to the lower limbs and trunk is represented on the upper 1/5, the middle 2/5 represents the upper limbs, and the lower 2/5 represents the face.
Contralateral sensory disturbances of the appropriate area, pain and vertigo.
Foot motor-sensory area
Parallel to and 1cm lateral to the anterior-posterior line. The line is 3cms long and starts 1 cm posterior to the line representing the sensory area.
Motor and sensory disturbances of the lower limbs and genito-urinary system
Chorea-tremor area
Parallel to and 1.5cms in front of the motor area.
Parkinson’s disease and tremor and chorea from any cause.
Vasomotor area
Parallel to and 1.5cms in front of the chorea-tremor area.
Cerebral oedema and hypertension.
Vertigo-auditory area
A 4cm horizontal line with its centre located 1.5cms above the apex of the pinna.
Tinnitus, vertigo and deafness.
1st Speech or usage area
Taking the parietal tubercule as a reference point insert three needles separately at 40° to each other. Each line is 3cms long.
Parietal lobe lesions.
2nd Speech area
This line is 3cms long and starts on a point 2cms posterior-inferior to the parietal tubercule and parallel to the anterior-posterior line.
Nominal aphasia.
3rd Speech area
A 4cms line originating at the midpoint of the vertigo-auditory area and running posteriorly.
Sensory aphasia.
Optic area
This area originates 1cm lateral to the midpoint of the occipital protruberance and runs for 4cms parallel to the anterior-posterior line in an anterior direction.
Cortical blindness.
Balance area
This area originates 3cm lateral to the midpoint of the occipital protruberance and runs for 4cms parallel to the anterior-posterior line in an anterior direction.
Cerebellar disease
Gastric area
A line directly above the pupil starting from the hairline and running for 2cms in a posterior direction parallel to the anterior-posterior line.
Epigastric discomfort.
Thoracic area
Midway between the anterior-posterior midline and gastric area. It is a 4cms line with its midpoint on the hairline, running parallel to the gastric area.
Respiratory and cardio-vascular diseases.
Reproduction area
A 2cms line parallel to the gastric area originating at the hair line and running posteriorly. The thoracic area and reproduction area originate at points equidistant from the gastric area.
Uterine haemorrhage.
Skin Sterility
It is important to sterilize the skin before inserting the needle. The Chinese use a solution of 2.5% iodine and 75% alcohol to do this. Hair is not usually a problem and it can be parted to expose the scalp, but if long-term scalp therapy is required then it may be easier to shave the scalp area.
Needle Insertion
The Chinese usually insert a 2-inch or 3-inch needle into the scalp area, running it down the subcutaneous layer. This requires a great deal of dexterity with an acupuncture needle and it is easier to use several short consecutively connecting needles over the scalp area.
Needle Stimulation
The needle should be rotated without any lifting and thrusting movement. In general the more a scalp area is stimulated the better is the result, the Chinese recommending that the needle be rotated manually at a frequency greater than 200 times per minute for about five minutes. This should be repeated two or three times during a twenty to thirty minutes period of treatment. Many Chinese use electrical stimulation over the scalp areas, the stimulator being used at high frequency (about 3000Hz), and maximum tolerable intensity, for about twenty minutes. When the scalp is stimulated the patient often feels a burning sensation in the scalp and a dull, numb or distended feeling in the relevant area.
Selection of Scalp Areas
In order to know which scalp areas should be stimulated a clear neurological diagnosis must be made. The contralateral area is usually stimulated, but better results seem to be obtained if the area is stimulated bilaterally.
III. The Indications for the Use of Scalp Acupuncture
Routine medical management should always be carried out first, and if scalp acupuncture is indicated then it should be used to aid recovery and deal with the chronic sequelae.
Cerebro-vascular Accidents
Scalp acupuncture is particularly useful in all types of strokes, whether the origin is cerebral thrombus or a cerebral haemorrhage. Do not start scalp needling for at least a week after the stroke; scalp acupuncture increases the blood flow to the damaged area of the brain and local cerebral bleeding may be increased if it is used too early. Scalp acupuncture can be started up to two years after the onset of a stroke, with beneficial results.
Prescription
Use the relevant scalp area; if there is motor pathology in a specific area then use the relevant motor area. This rule applies to all pathology, therefore a clear neurological diagnosis of which area(s) is affected is essential.
The contralateral area on the scalp must be used but, in general, better results are obtained if the affected area is stimulated bilaterally.
Treatment
Sometimes strokes respond very quickly, but not always. It may be necessary to give several courses of scalp acupuncture. As with all types of acupuncture keep treating the patient as long as there is improvement, and then give a few more treatments to consolidate. Each course involves about eight treatments and there should be a gap of at least a week between courses. The treatments should be given daily or every other day.
Severe Head Injuries
Follow the same rules of treatment and prescription as for cerebro-vascular accidents. Scalp acupuncture is particularly useful for reducing chronic muscle spasm. Treat after routine medical treatment when the patient’s condition is stable.
Intracranial Inflammation
After routine medical treatment is completed, and the patient’s condition is stable, treat the areas that are damaged. Follow the same rules for treatment and prescription as for cerebro-vascular accidents.
Extra-Pyramidal Disease
Chorea and paralysis agitans are the main extra-pyramidal diseases. The most important scalp area is the chorea-tremor area. Parkinson’s syndrome responds better than Parkinson’s disease. Follow the same rules for treatment and prescription as for cerebro-vascular accidents.
Suggestions for Other Diseases
| Disease | Area |
| Meniere’s | Bilateral vertigo-auditory area |
| Respiratory diseases | Bilateral thoracic area |
| Gastric diseases | Bilateral gastric area |
| Urticaria | Bilateral upper 1/5 of the sensory area |
| Cardiovascular disease | Bilateral thoracic area |
| Cerebral oedema | Bilateral vasomotor area |
Scalp acupuncture is useful for a wide variety of diseases, especially those of cortical origin. It is most useful for strokes and severe head injuries, but it should always be considered for other conditions where other methods of acupuncture are failing to give adequate results. It is particularly useful in reducing chronic muscle spasticity.
This is used primarily for acute conditions such as back strain or acute torticollis. The points are selected on a purely symptomatic basis. It is essential to obtain deqi over these points and, especially for acute conditions, to stimulate the hand points strongly. This can be very painful for the patient, who may faint.
Where hand acupuncture is useful the relevant point(s) is mentioned in the section on diseases. The hand points should be stimulated strongly whilst the patient exercises the painful area. It may be necessary to stimulate the hand points for some minutes, although the relief of pain and muscle spasm is often immediate.
Jim Strohecker
Daniel Redwood DC