The Contribution Of China To The Development Of Ear Acupuncture

Auricular Development Ear Posterior Auriculotherapy

Fig. 1.10 (A) The 'historical' map of the posterior surface of the ear according to Zhang Di-Shan (1888) (reproduced from Modern Chinese Acupuncture by Ping Chen, Paradigm Publications, 2004, with permission). (B) The current Chinese standard location of ear points on the posterior surface. P1 (erbeixin) — heart; P2 (erbeifei) — lung; P3 (erbeipi) = spleen; P4 (erbeigan) — liver; P5 (erbeishen) — kidney; R1 (shangergen) — upper ear root; R2 (ermigen) — root of ear vagus; R3 (xiaergen) — lower ear root.

The discovery of an increasing number of new points was the result of a rapid development of auricular therapy in clinical practice and research. It is noteworthy that army doctors, especially those of the Nanjing garrison,16 were among the first physicians to study the application of ear acupuncture on soldiers. They stated:

ear acupuncture neither needs equipment nor has any limitation of place and climatic condition; no matter where it is practiced: indoors or outdoors, in a laboratory, construction site, battlefield or classroom, this treatment can be applied.

In the early years of the Cultural Revolution a campaign took place for a big increase in medical personnel in rural areas. Over a million 'barefoot doctors', also versed in the art of needling, took care of about four-fifths of the population. The first Chinese maps were probably conceived for them and showed a mosaic of illustrated anatomical parts which were easy to consult and use during practice. In the subsequent maps each part was further defined by a number, by the denomination in Chinese characters, and finally also by its translation to other languages.

In another important year for ear acupuncture, 1973, two physicians of the neurosurgical unit of Kwong Wah hospital in Hong Kong published an article about a new approach for relieving withdrawal symptoms and counteracting drug addic-tion.17 They used only the Lung point, at the center of cavum conchae, and stimulated it electrically,

Ear apex

Tiangui

Sacral vertebrae

Ear apex

Palm

Tiangui

Sacral vertebrae

Auricular Acupuncture

Superior auricle

Glaucoma

Fig. 1.11 Some new auricular points proposed by Xu Zuo-Lin.

Palm

Superior auricle

Glaucoma

' " Middle auricle

Astigmatism Inferior auricle

Fig. 1.11 Some new auricular points proposed by Xu Zuo-Lin.

bilaterally, for half an hour at a time with the frequency gradually increasing from 0 to 125 Hz. In the first days of treatment the patient received two or three stimulations per day followed by one per day for the next 4-5 days. Withdrawal symptoms ceased gradually 10-15 minutes after stimulation and 'a sense of general well-being was described by all patients undergoing treatment. They felt less drowsy, and much more interested in their surroundings than before, and they quickly gained an interest in conversation and reading'.

The success of this treatment convinced Dr Michael Smith of the Lincoln hospital in New York to form in 1974 the nonprofit association, the National Acupuncture Detoxification Association (NADA). The aim of NADA was to promote the training of acupuncture detoxification specialists in the USA and other parts of the world to treat all kinds of addiction. Acupuncture treatment without electrical stimulation of five auricular points (Sympathetic, Shen men, Kidney, Liver and Lung) was able to relieve withdrawal symptoms, prevent the craving for drugs and increase the rate of participation of patients in long-term treatment programs.18

One of the most relevant aspects in the recent history of ear acupuncture has been the effort on an international level to find a solution to the tendency to steadily increase the number of auricular points, thus creating confusion in the terminology used. The first attempt to provide a new system of nomenclature to describe the auricular points was proposed by Terry Oleson of the UCLA Pain Management Center of Los Angeles. In 1983 he developed an original 'auricular zone system', subdividing each major anatomical area and attributing a single letter and a number to each zone19 (Fig. 1.12). His aim was to facilitate clinical understanding and research investigations into the accuracy of auriculotherapy.

A6

AS

C10

C11

C7

C6

H2

A1S S2

A11 A12 A4 C12

CS C1S

C18 CS

TS C19

S6

C20

L1

L2

LS

L4

LS

L6

L7

L8

L9

Fig. 1.12 The original auricular zone system developed by Oleson and colleagues (reproduced with permission).

The need for standardization of auricular points was felt urgently at that time and in 1982 Chinese researchers were entrusted by the World Health Organization's (WHO) Regional Office for the Western Pacific to establish the draft of a 'Standard Scheme of Auricular Points'. The scheme was presented after 5 years of discussion and revision in Seoul by Wang Deshen and Deng Liangyue20,21 of the China Academy of Traditional Chinese Medicine of Beijing. A preliminary standardization of the anatomical areas of the outer ear was proposed. The subdivision into twelve different zones published in the report was, however, not definititive and a further 5 years of discussion were necessary before a final document emerged in which the number of the anatomical areas was reduced to eight.22

At the same WHO meeting of 1987 the following three inclusion criteria were proposed to standardize the different auricular points:

1. an international common name in use

2. a proven therapeutic value

3. a generally accepted location.

Points that fulfilled all three criteria were classified with an alphanumeric code (a two-letter abbreviation and one number), Pinyin, Han character and English name. For example, the 'wrist' was classified with the code SF2, with Pinyin wan and Han character Points that fulfilled the first and second criteria were not attributed a code, but only Pinyin, Han character and English nomenclature. Points that failed to fulfill all three of the criteria were excluded.

Of the 90 points proposed to the International Committee by Chinese researchers, 43 entered the first category, 36 the second and 11 the third. The standardization process, after a last WHO meeting in Lyon (1990), was then continued mainly by Chinese researchers, and in 1993 reached a total number of 68 points accepted at national level.22

The persistence of some disagreement regarding the standardization of auricular points and areas in the Western and Chinese charts calls for a systematic and rigorous clinical validation in the future, taking into account the different historical backgrounds when categorizing diseases and clinical syndromes.

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