The Representation Of The Genital System On The

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Regarding the representation of the genital system, the main reason for the great differences in the representation of the uterus and ovary is, in my opinion, due to the fact that Nogier 'forgot' to draw the somatotopy of these organs in either 1957 or in 1969, when his Traite d'Auriculotherapie was published. Only in 1977, in the French edition of his

Handbook to Auriculotherapy, did he describe the point of gonads related to ovary and testicle 'hidden under the rising branch of the helix' at a short distance from point 0. Nogier and Bourdiol both represented the uterus on the internal part of the ascending helix on the axis to the lower branch of the anthelix. As Bachmann's drawing did not indicate any somatotopic area to be associated with internal genitals, the Chinese were forced to discover their own representations. The uterus was definitely located in the triangular fossa which thus became one important reference zone of the ear for every disease or dysfunction regarding the reproductive system. The anterior third of the triangular fossa, in its lower part, was indeed named the internal genital area (TF2 neishengzhiqi), carrying the indications for dysmenorrhea, irregular menstruation and dysfunctional uterine bleeding. Another area related to the reproductive system is the pelvis (TF5 pengqiang), with the indications for adnexitis and irregular menstruation.

What has been intriguing for me and several other practitioners has been the representation of the ovary luanchao and testicle gaowan on the medial side of the antitragus. The indications for both points were hypogonadism, and epididymitis for the first and abnormal menstruation for the second. The indications for both points were extended by Li Su Huai to dwarfism, hypofunction of the anterior pituitary, hypothalamic amenorrhea, sexual disorders, etc.68

The testicle and ovary areas were, however, removed during the standardization process and only the endocrine area still maintained indications related to the female genital system such as dys-menorrhea, irregular menstruation and climacteric syndrome. We are at a loss to understand why part of the reproductive system has been located on the antitragus, but it can be presumed that, according to Bossy's homunculus principle, the anterior part of the antitragus may be associated with dysfunctions of the pituitary-gonadotropic axis. On this subject we need to mention Nogier's 'genital master point' located at the anterior extremity of the antitragus, on its external surface, carrying indications such as disorders of the external genital organs and climacteric syndrome (see Fig. A1.17).

The possibility that the Chinese have mismatched the representation of the gonads with the pituitary-gonadotropic axis fits very well with Durinyan's hypothesis of an enlarged surface of the endocrine area, extending itself from the antitragus to the tragus. The fascinating hypothesis still to be proved is that this area could carry a sort of topographic specialization according to the different corresponding axis. In this case we would have the corticotropic axis represented on the tra-gus and the gonadotropic axis represented on the anterior part of the antitragus; in the middle, as indicated by both Nogier and Durinyan, a third axis could be imagined such as the thyrotropic axis influencing the thyroid gland (see Fig. A1.5). Even if this hypothesis is appealing, only a long series of observations focused on hypo/hyperactivity of a specific gland, during time and with medication aimed at regulating its functions, could give further elements for diagnostic purposes.

Regarding the male genital system, indications such as orchitis and epididymitis were conferred to the external genital area (HX4 waishengzhiqi) on the axis to the lower branch of the anthelix, overlapping therefore with the French uterus/ prostate.

My contribution to this complex issue firstly concerns the external genitals. In the case shown on the left of Figure 5.45, the 44-year-old female patient had a very painful abscess of the excretory duct of Bartholin's gland. Treatment with semipermanent needle on one of the two identified points reduced her pain. On the right of Figure 5.45 is a 26-year-old male patient with venous ectasia of the pampiniform plexus (>3 mm diameter) diagnosed as a varicocele of 2-3°. Before varicocelect-omy two points were identified with PPT; they maintained a constant position and disappeared immediately after surgery.

We tried to find more reliable information on the localization of parts of the genital system with the collaboration of gynecologists Daniela Bellu and Biagina De Ramundo.69 Our observational study originated from the knowledge that hysteroscopy is still considered a painful procedure by most gynecologists and patients and that ear acupuncture could in theory be used to reduce the pain experienced by patients undergoing this examination, provided that stimulation could be applied on reliable points/areas. Since there was no consensus between the French and Chinese schools, we worked on the hypothesis that the insertion of the optic fiber into the cervix could perhaps briefly activate the corresponding area on the ear. Both diagnostic techniques, PPT and ESRT with Agiscop (—), were thus applied before (T0) and immediately after (T1) hysteroscopy in 52 consecutive patients (average age 51.5 years, SD 11.8, range 30-79) with various gynecological disorders such as suspected intrauterine outgrowth (endo-metrial polyps, submucosal myomas), abnormal uterine bleeding, endometrial hyperplasia, etc. At ~10 min after hysteroscopy, patients were asked by another operator, who was not directly involved with the procedures, to rate the pain experienced on a numeric verbal scale (NVS) scoring from 0 (absence of pain) to 10 (extreme pain). Using an innovative technique called 'addition-subtraction' we identified all the 'appearing' (new) and 'disappearing' points at T1 by means of PPT and ESRT and transcribed them on the Sec-togram. If we look at Figure 5.46 we can see that there is a great difference in the number of sensitized sectors before and after hysteroscopy. The new points tend to cluster mainly on sector 24, especially on the ascending branch of the helix but partially also on the internal genital area (TF2 = neishengzhiqi) (on the left of Fig. 5.46). The vanishing points seem to be scattered at random over the whole auricle (on the right of Fig. 5.46). However, if we examine the clusters of points we may suppose that the mental and muscular relaxation following hysteroscopy may be immediately

Fig. 5.45 Sensitized area in a 44-year-old female patient with an abscess of the excretory duct of Bartholin's gland (left image); sensitized area in a male patient aged 26 with varicocele of 2-3° (right image).





Fig. 5.46 Cluster of high value in the distribution of 'new' tender points after hysteroscopy (left); cluster of high value in the distribution of 'vanishing' tender points after hysteroscopy (right).

succeeded by a loss in sensitization of several correlated areas. The same phenomenon was observed with ESRT (-): the new points tended to cluster on sectors 23, 24 and 25 and the vanishing points lost their lower electrical resistance in several sectors.

As regards the aim of our study, we could conclude that both PPT and ESRT had identified an area which corresponded only partially to the Chinese representation of the external genitals and seemed positioned rather far from Nogier's analogous somatotopic area.

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