A 46-year-old female patient wanted to reduce the amount of the antidepressant she was taking, because of its side-effects. When I examined her for the first time I found only a few points related to backache, which she had been suffering from recurrently; I was not able to find any further point or area related to the depressive disorders of the patient (Fig. 9.5, red dots). She was also taking antihypertensive drugs and I informed her that it would be impossible for me to identify the points relevant to her case. With her consent and with the approval of her psychiatrist we planned the following strategy of exclusion. At first we excluded hypertensive drugs for 12 and 24 hours. This brought no change or appearance of new points. We then reduced the antidepressant (sertraline hydrochloride 100 mg) which the patient took twice a day, in the morning and in the evening. The exclusion of one pill did not change the auricular reactivity after 7 hours; the exclusion also of a second pill, about 30 hours after the last intake, was finally able to reveal a series of points which were definitively associated to her depressive disorders and treated consequently with ear acupuncture (Fig. 9.5 gray dots).
There are further factors interfering with correct auricular diagnosis. An important factor seems to be the presence of foci, as has been asserted by practitioners of neural therapy. The reader will allow me to make a short digression on this method which is possibly one of the less recognized non-conventional techniques in the English speaking population. According to the World Health Organization's 2001 review The Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review, neural therapy (German Neur-altherapie) or procaine injection therapy is officially
recognized in only a few countries, for example Germany, Austria and Hungary. The founders of the method were the German physicians Walter and Ferdinand Hiineke who in the 1920s and 1930s discovered the effects of injecting procaine into tissues of the human body carrying foci or 'fields of disturbance'. It is interesting to note the differences in the definition of 'focus' across the different languages. In Dorland's Medical Dictionary focus is defined as the chief center of a morbid process; Roche's Medical Dictionary for German practitioners defines it more extensively as a circumscribed damaged area of tissue due to infection, inflammation, degeneration, etc. which may induce a pathological reaction or loss of function in further associated districts or in the whole body. Typical examples of foci are post-traumatic or postoperative scars which may cause local or regional pain, weakening of muscle groups of the same neurological segment, but also remote vegetative nervous phenomena. Injecting procaine or other local anesthetics such as lidocaine appears to have a membrane potential stabilizing effect on the tissues in which fields of interference are located. Restoring the electrophysiological stability of the cells involved corrects the abnormal emission of afferent signals to the spinal cord, regulating the responses of the autonomic nervous system.
In the case of scars, in my opinion another interesting hypothesis is related to the entrapment of neural endings during the process of cicatrization and their chronic stimulation due to the mechanical effect of traction. This hypothesis seems to be supported by the fact that scars which need to be treated respond to the injection of a simple physiological saline solution as well as they do to procaine. In my opinion the possible effect of this procedure could be attributed to the 'ungluing' of the minute adhesions within the different layers of the scar. Even the advice given to the patient to massage the tender parts of the scar is of value and probably reduces the above-mentioned effect of traction.
I want for a moment to return to the issue of scars confounding auricular diagnosis. It is sometimes possible for the practitioner to identify a point on the auricle, in a fixed location, which remains tender to pressure despite multiple treatments with acupuncture or other methods of stimulation. In this case the notion that a scar of any origin may be located on the corresponding area of the body should not be dismissed. It may be an old or forgotten scar, responsible through chronic irritation for unclear painful syndromes in distant parts of the body. Should such a suspicion arise, the whole of the patient's skin needs to be checked for both major and minor scars, especially on the side of the body corresponding to the tender auricular point. Every scar should then be palpated along its entire length and all painful spots should be marked with ink. On completion of the examination the therapist has two options: he can apply the needle contact test on the auricular point to confirm the interrelationship, or he may treat the scar and observe its effect on the tender point. Although neural therapy recommends treating the whole length of the scar, in my opinion it is sufficient to infiltrate only the sensitive portion. If treatment is successful the therapist will witness the prompt disappearance of any tenderness in the corresponding auricular point.
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