One of the major differences between the different schools concerns the auricular representation of the cardiovascular system. It is still a mystery why the heart area, drawn in 1957 by Bachmann in the lower concha and coinciding perfectly with the current Chinese heart (CO15 xin), was moved afterwards by Nogier and Bourdiol. The heart area was shifted finally to the anthelix where the Chinese locate the chest (AH10 xiong) (see Fig. 5.34). Regarding the new location Bourdiol1 wrote:
it projects on the D4-D5 radius, onto the body of the anthelix, in the middle of the thoracic territory ... under normal physiological conditions, its largest surface-area occupies the left mastoid face, being the left ventricular area the most developed.
16 15 14
16 15 14
a,a1 = representation respectively of the upper and lower second and third molar tooth b,b1 = representation respectively of the upper and lower first molar and premolar teeth c = representation of the upper canine and incisors
Fig. 5.38 (A) Areas of recurrent sensitization in patients with toothache; the arrows indicate the shifting of tender points in case of more intense/diffuse pain. (B) Sensitization of the ear lobe in a 22-year-old male patient stung by a bee on the upper lip.
In my opinion it is possible that this divergence of representation depends on a different interpretation that in the first version represents the organ of the heart beneath the lung in the inferior concha, and in the second version perhaps the typical cardiac pain referred to the chest and the arms.
It is true, however, that both schools extended their research to other complementary points: Nogier proposed at least two related to cardiac functions on the internal border of the anthelix where the sympathetic ganglia, the 'circulatory system' evidently related to the heart area and the 'marvelous point' belonging to the middle cervical ganglion are represented (see Figs A1.7 and A1.17). The Chinese on the other hand proposed a further cardiac point, xinzangdian (named heart 2 by Ole-son), which was located on the tragus between the external ear waier and the apex of tragus ping-jian. The point had the indications atrial fibrillation and tachycardia, but was omitted in the standardization process (see Fig. A1.8).
In my opinion the most interesting interpretation of the auricular areas related to heart function was that proposed by Durinyan.22,23 For these he considered a large area covering the whole inferior concha and the antitragus. Within this area he identified at least seven points influencing the contractility of cardiac muscle, its electrical activity and the perfusion of coronary arteries (Fig. 5.39). Durinyan's interpretation seems to me to be more realistic and could offer a sound basis for further research aimed at combining ear acupuncture with the commonly used medications in cardiac patients.
An interesting pilot study was conducted by two Swedish authors during their several years of research on the treatment of severe angina pec-toris with either TENS or epidural spinal electrical stimulation.63,64 They were interested especially in helping patients refractory to therapy waiting for coronary bypass intervention; therefore they tried to stimulate the Chinese heart point xin (named heart 1 by Oleson) bilaterally with a current of low frequency. The authors were impressed by the results and reported the case of a patient aged 70 who was relieved from acute pain in 2-5 seconds; this benefit lasted for about 24 hours after each treatment.65
The heart deserves a systematic diagnostic study of the auricle in larger groups of patients to identify the recurrent areas involved in specific heart disorders.
My contribution to the topic is represented by two single cases which I was able to follow up over time.
1 = basic zone for heart and coronary circulation
2 = chronotropic point
3 = area for stroke volume and contractility of the heart
4 = circulatory point
5 = hypothalamic regulatory center
6 = hypothalamic point of neurohypophysis
7 = circulatory center of reticular formation
8 = antistress point (Shen men)
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