The Topography Of The Identified Auricular Pointarea

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In the formulation of a diagnostic hypothesis the concept of auricular topography is essential. It is possible that at the start we may be unable to match the identified zones with the patient's symptoms. We need therefore to single out some key areas: in this deductive work medical knowledge is important and the therapist should be free to obtain more information from laboratory tests and imaging techniques.

In my opinion one or more of the following criteria are necessary for an area to be considered essential for diagnosis and selectable for treatment:

a. The area should contain at least two skin alterations or two points close to each other with marked tenderness or reduced electrical resistance.

b. At least two skin alterations or two points with greater tenderness or reduced electrical resistance may be located on the same line according to Nogier's principle of alignment (see Ch. 3) or may be found in the same sector.

c. The identified skin alterations may be sensitive to pressure.

As regards criterion a, the diagnostic importance of the identified area is proportional to the number of points on it.

As regards criterion b, strictly applying Nogier's principle of alignment (as described in Ch. 3) could in my opinion reduce the information to be obtained from the patient. Therefore for diagnostic purposes I proposed in Chapter 4 ('Does inspection have the same value in all sectors of the outer ear?') to consider also the skin alterations pertaining to the same sector. The importance of inspection should be stressed here once more because it identified in my patients a higher rate of skin alterations on the same sector compared to points identified with PPT and ESRT: respectively 46.4%, 16.1% and 14.4% of the total.

As reported in the section of Chapter 4 mentioned above, only 23.6% of the aligned skin alterations were found on the same part of the ear: the practitioner should be prepared therefore to pay attention to any other parts of the auricle carrying pairs of aligned skin alterations (see Plates IIA, VID, IXD).

Regarding the last of the above criteria, criterion c, Chinese acupuncturists have stressed the importance of palpating skin alterations for distinguishing a 'false appearance' from a 'positive reaction point' (Ch. 4). About 50% of skin alterations are indeed tender to palpation and this phenomenon adds a higher value to the identified somatotopic area.

Figure 9.3 shows the right ear of a 64-year-old male patient who asked to be treated with acupuncture because he suffered with recurrent backache, especially on the right side. The inspection of the right auricle did indeed show a little hyperemia of the anthelix corresponding to the thoracolumbar junction and some telangiectasia on the representation of the Chinese knee. My attention was attracted, however, by a linear telangiectasia crossing the liver area. PPT identified two tender points on it which were furthermore aligned with point

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Fig. 9.3 Tender points on a telangiectasia of the upper concha in a 64-year-old male patient carrying a hepatic steatosis due to excessive drinking.

zero. My question to the patient about possible liver problems was affirmative: he had hepatic steatosis with abnormal concentration of serum glutamic pyruvic transaminase due to excessive drinking. Both points, however, were included in the treatment of his lumbar pain and he was warmly recommended to treat his liver with greater respect.

The systematic palpation of skin alterations as proposed by the Chinese is an interesting diagnostic procedure and may be helpful for the selection of points to treat (see Ch. 10). Nevi can also be checked for their tenderness but it is preferable not to include them in treatment. Another method is to limit the palpation of the skin alterations to the area representing the affected part of the body. For example, in the case of chronic shoulder pain it may be best to select directly the tender skin alterations of the shoulder area and the clavicle area. Since shoulder pain is often associated with neck problems it is useful also to check the skin alterations possibly located on the neck area and on the cervical vertebrae.

The last, less frequent aspect related to the topography of the identified area is the activation of an area bearing a scar, for example caused by piercing. It is rather difficult to demonstrate that piercing can primarily induce some specific symptoms in time. In some cases simple advice could be offered to patients with this kind of scar.

A 52-year-old female patient suffered with migraine and was treated successfully with ear acupuncture. Occasionally she suffered also with Meniere's disease. During a vertigo attack a sensitive area was found overlapping the representation of the internal ear according to the Chinese. Of the four tender points one coincided with the scar of a second piercing of the ear lobe. Beyond the treatment of the tender points I advised the patient to take off the earring with the aim of reducing possible mechanical stimulation of a reactive area of the ear (Fig. 9.4).

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