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So far, in Western countries, inspection of the outer ear has attracted little attention with the exception of the ear lobe, the diagonal crease of which has been thoroughly studied in patients with cardiovascular risk (see section entitled 'The diagonal ear lobe crease or Frank's sign' later in this chapter).

The only Western physicians to show an interest in auricular morphology have been those practicing Rudolf Steiner's (1861-1925) philosophy of anthro-posophy. Steiner wrote:

The ear portrays our past and reveals tendencies and weaknesses that we have carried since birth. It is the only important physiognomic organ undergoing very little change after birth.

The physician Norbert Glas1 proposed a physiognomic classification of the outer ear into three parts (Fig. 4.1):

1. The upper third corresponds to the 'head and the mind' and is subdivided into three different parts; the descending part of the helix (a) corresponding to the 'shape and the strength of the erect body'; the upper part of the helix (b) corresponding to the 'capacity and strength of the mind'; the rising part of the helix (c) corresponding to the 'internal energy'. A large, thin and softened helix in (a) therefore suggests rickets, a lymphatic constitution and a tendency towards infections and the common cold. A flattening or folding down of the helix in (b) suggests weak powers of thought, depression and learning difficulties. A folding of the helix (c), with a vertical straightening of the posterior ridge, suggests asthma, speech disorders and mental inhibition.

2. The middle third corresponds to the 'rhythmic system', meaning the respiratory system and blood circulation. If the concha is regular in shape these systems are working perfectly; a narrow concha indicates poor circulation and a weakness of the corresponding organs. For example, an upper narrow concha on the left suggests weakness of the pancreas with a tendency to diabetes.

3. The lower third, including the ear lobe, the anti-tragus and the intertragal notch, corresponds to the 'metabolic system' and also to the subject's reproductive capacity and willpower. An enlarged incisura intertragica therefore implies

Incissura Intertragica

1 =

'head and mind'

1a =

'shape and strength of the erect body'

1b =

'capacity and strength of mind'

1c =

'internal energy'

2 =

'rhythmic system'

3 =

'metabolic system'

Fig. 4.1 The physiognomic classification of the ear according to anthroposophy.

hyperthyroidism and overactivity of the pancreas; a narrow incisura, on the other hand, indicates a slow metabolism and, in females, endocrine disorders, gynecological disorders and troublesome delivery.

The information given by Glas in his chapter dedicated to the specific physiognomy of the outer ear is of interest and surprising because it was gathered over a long period of time, before Nogier's discovery of auriculotherapy. The importance given by anthroposophy to the inspection of the outer ear, as to the whole face, is, however, based on considerations that differ somewhat from Nogier's representation of the body.

The French author was aware that certain skin alterations of the auricle could be found on the corresponding area of a suffering organ. He said: 'When the patient is affected by a longstanding disease, we can recognize its signature on the ear.'

He referred two clinical cases with skin alterations of the lung area.2 The first was a patient with severe non-responding eczema of the buttocks, genitals and face. Furthermore Nogier identified a small area of eczema corresponding to the lung; this led him to suspect a tubercular origin for the eczema which afterwards responded well to the appropriate treatment. The second case was that of a patient who had been affected for several years by pneumothorax; the corresponding lung area was well recognizable on inspection because it was creased and yellowish.

The French lung area corresponds on the whole to the Chinese one (CO14 Fei); nevertheless, in the latter the lung has a larger representation, occupying almost the whole inferior concha. The dimensions of this area are proportional to the importance of the lung in traditional Chinese medicine (TCM); the indications for treatment are cough, chest congestion and hoarseness, but also skin disorders such as acne, itching and urticaria. Other indications are constipation and control of the abstinence syndrome as described in Chapter 1.

Even though Nogier realized the importance of skin alterations on the auricle he did not perform any systematic study nor did he invite his pupils to focus on this subject.

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