Trigeminal Neuralgia On The

As regards the trigeminal system, there is a lack of consensus on the possible representation of this important nerve on the auricle. Durinyan did not report such representation at all whereas Nogier and Bourdiol located the fifth nerve on the border

Lumbar vertebrae

Lumbar vertebrae

Fig. 5.26 Auricular points proposed by Raphael Nogier for the treatment of migraine (with permission).

Liver, pancreas

Thalamus Upper jaw Hypothalamus

Fig. 5.26 Auricular points proposed by Raphael Nogier for the treatment of migraine (with permission).

Toothache And Ear Pain

of the ear lobe (see Fig. A1.3). The Chinese report only one point/area related to trigeminal neuralgia, the cheek (LO5, 6i mianjia) between the eye and the internal ear area. Other areas related to the trigeminal system are the tooth (LO1 ya), anterior ear lobe (LO4 chuiqian) and jaw (LO3 he), which all have toothache as a therapeutic option; interestingly stomach (CO4 wei) also has the same indication. The experienced acupuncturist will not be surprised by this indication as he knows that the Stomach meridian starts from the face and with its first seven points covers the neural territory of the second and third trigeminal branch. A further area for treating pain in general is Shen men, which was used extensively in the past in auricular acupuncture hypalge-sia for surgical purposes (see Ch. 1).

I was helped by Dr Nicola Brizio in the systematic search for tender points in trigeminal neuralgias of the second and third branch. In his study all atypical facial pain syndromes or any extra-tri-geminal pain radiating to the head were excluded. The tender points identified in 21 patients with a neuralgia of the second branch and in 9 with a neuralgia of the third branch tended to cluster on some areas which were already recognized to be of help in trigeminal pain. The cluster on the lower part of the ear lobe (Fig. 5.28, number 1) tends to overlap with Nogier's trigeminal area, whereas it tends to overlap with the Chinese cheek mianjia, eye (LO5 yan) and tonsil (LO8 and 9 biantaoti); of these points only the cheek point/area holds tri-geminal neuralgia as a therapeutic option. The cluster on the antitragus (Fig. 5.28, number 2) can be easily correlated with facial and cephalic pain, and moreover it is aligned with the former on sectors 5-6. What is surprising is the evident sensitiza-tion of the auricles on stomach and hand areas (in the same figure, respectively numbers 3 and 4). According to Brizio, who is an experienced acupuncturist in TCM, the sensitization of the stomach area is very common in trigeminal neuralgia as a number of patients suffer commonly with dyspepsia and gastritis. As regards the cluster number 4, we may correlate this concentration of points with

branch and 9 of the third branch) according to Brizio.

the Chinese wrist area (SF2 wan), which has an indication also for general pain and stomach-ache. A further connection with TCM can be made as tenderness of this area goes in parallel with tenderness at pressure of LI4 (hegu), which is an elective point in cases of headache and facial pain.

In the composite world of allergic conditions, the most frequently occurring are rhinoconjunctivitis, asthma, atopic eczema and food allergy, which represent a burden all over the world. In the UK, for example, the rates reported for allergic rhinitis and asthma in the 6th report of the House of Lords were, respectively, 9.4% and 5.5% in an estimated population of 60.6 million. Very close to the rate of asthma was that of atopic eczema and far from negligible was the incidence of infants and adults suffering with food allergy (respectively 5-7% and 1-2%). The incidence of multiple allergies (asthma, eczema and allergic rhinitis together) was also significant (3.7%) and showed an increase of 48.9% between 2001 and 2005.50

This affects other countries as well as the UK and there is a worldwide increase, for example in symptoms of allergic rhinoconjunctivitis, especially in the 13-14-year-old age group. This suggests that environmental influences on the development of allergy may not be limited to early childhood.51,52 As is known, the main environmental factors associated are exposure to infections and allergens during early childhood, atmospheric pollution and dietary changes. The importance of these factors may explain why 54.3% of the 10 508 US subjects represented in the Third National Health and Nutrition Examination Survey (NHANES III), and undergoing prick-puncture skin tests to 10 allergens, were positive to one or more indoor and outdoor allergens.53

Besides the need to individuate the allergens responsible for symptoms as soon as possible, there is also the issue of adequately controlling the disease. For example, according to the Global Initiative for Asthma (GINA) 2006 guidelines,54 asthma is considered controlled if all the following conditions are fulfilled: diurnal respiratory symptoms less than once a week and no asthma attacks in the last 3 months, no activity limitations (work and other activities) in the last 12 months, no nocturnal symptoms in the last 3 months, short-acting b2-agonists twice or less per week in the last 3 months and no use of oral steroids in the last 12 months, and a FEVj of 80% of predicted value or greater. Although the results of clinical trials demonstrate that asthma control can be reached in most patients, epidemiological evidence suggests poor control of the disease in many subjects: for example 49% of European55 asthmatic adults using inhaled corticosteroid had uncontrolled asthma and 53% of Canadian56 patients, despite the effort made in disseminating guidelines, showed suboptimal asthma control and management.

Both sensitization to allergens and poor control of allergic disease are conditions that may be recognized by examining the auricle with PPT. However, the reader should be prepared to find a false-negative auricle as drugs and other remedies may cancel the existing tender points. On the other hand he should not be confounded by a false-positive diagnosis in a patient who is asymptomatic and apparently non-allergic. It is possible in such cases that allergy has still to manifest itself, or more often that the patient is carrying a lifelong contact allergy to nickel or that his organism stores the memory of one or more episodes of urticaria

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