Variation In The Distribution Of The Auricular Points Over Time

The practitioner might be surprised at how often the distribution of auricular points changes over time. These variations may occur between one session and another as the result of the treatment itself, or may be the expression of a patient's spontaneous recovery. For example, Figure 9.15A shows the tender points detected at the first examination in 31 patients with sore throat,15 when a culture was obtained by swabbing the pharynx and both tonsils or tonsillar fossae for identifying b-hemolytic streptococci. Symptoms such as temperature, oropharyngeal color, oropharyngeal enanthems, cervical adenopathy and cervical adenitis were scored using the tonsillopharyngitis score of Schachtel (TSS),16 ranging from 0 to 10. As the culture plates were incubated and

EHI scoring

Fig. 9.13 Regression line in 124 subjects between the EHI scoring and the number of tender points on the left ear (—100 = strong left-handedness; +100 = strong right-handedness).

EHI scoring

Fig. 9.14 Regression line in 124 subjects between the EHI scoring and the number of tender points on the right ear (—100 = strong left-handedness; +100 = strong right-handedness).

interpreted only within 18-24 hours, amoxicillin and clavulanic acid (675 + 325 mg twice a day) were administered to all patients from the first day for 6 days. One week later they were again scored with the TSS and their auricles re-tested with PPT (Fig. 9.15B). The TTS score and the number of points dropped respectively by 65% and 70%, but no significant difference was found between 10 patients with a positive culture for group A b-hemolytic streptococci and the rest of

Table 9.9 Significance test of the regression coefficients related to Figure 9.13

Coefficient

SE

t

P

Intercept.

4.35

0.33

13.20

<0.001

EHI scoring

—0.03

0.00

—5.65

<0.001

Table 9.10 Significance test of the regression coefficients related to Figure 9.14

Coefficient

SE

t

P

Intercept.

3.24

0.27

11.9

<0.001

EHI scoring

0.02

0.00

5.73

<0.001

the group. The conclusion drawn in this article was that also the presumed viral infection in 21 patients with negative culture test could be responsible for the drop in auricular tender points following spon-

taneous recovery.

However, the original aim of my study had been to solve the puzzle of the representation of the Chinese helix areas 1-4 (HX9 lunyi, HX10 luner, HX11 lunsan, HX12 lunsi), with their common indication for tonsillitis. I was rather surprised to find that pharyngotonsillitis activates not only the occiput area and the aligned trigeminal area but also the whole helix including sectors 19 and 20.

Questions on this subject remaining open are: should the helix actually be considered representative of tonsils, or should its great sensitization be regarded as the result of the activation of an important focal area such as the tonsillar fossa, as assumed by neural therapy. It may be surprising

16 15 14

13 12

11 10

15

• •

14

• B

13

• •

12

/ / *

Fig. 9.15 Distribution of tender points in 31 patients with pharyngotonsillitis before antibiotic treatment (A); distribution of tender points in the same group 1 week later (B).

Fig. 9.16 Injury of the right hand with a fracture of the thumb in a worker aged 50; tender points on the ipsilateral auricle on the same day of the accident (A); distribution of tender points 20 days later (B).

16 15 14

13 12

Fig. 9.16 Injury of the right hand with a fracture of the thumb in a worker aged 50; tender points on the ipsilateral auricle on the same day of the accident (A); distribution of tender points 20 days later (B).

Fig. 9.17 Lumbar-sciatic pain in protrusion of L5-S1 disk: distribution of tender points before a session of body acupuncture (A); distribution of tender points after the session (B). Dots = lateral surface; circles = medial surface.

to notice that this area lies on the boundaries of different neural territories belonging to the fifth, seventh, ninth and tenth cranial nerves. This various and complex innervation in many ways recalls that of the auricular area and possibly explains why the tonsillar fossa and the retromolar area may reflect symptoms in distant parts of the body when they become 'fields of disturbance'.

Among the possible variations of distribution are surgery and traumatic injuries.

Figure 9.16 shows the case of a patient who crushed his right hand at work. He had a large wound on the back of his hand and a fracture of the last phalanx of the thumb. The day of the accident he had at least six tender points covering an area consistent with the representation of the hand and the wrist (Fig. 9.16A). After 20 days the number of points had dropped to three (Fig. 9.16B).

Further variations can be seen in patients after vertebral manipulation, injection in a joint or during a course of physiotherapy. A session of acupuncture on meridian points can also change the number and the location of auricular points. Figure 9.17 shows the case of a patient who was affected by lumbar-sciatic pain in protrusion of the L5-S1 disk; the search for tender points was made before a session of body acupuncture; a series of aligned points was found mainly on sectors 20 and 21 (Fig. 9.17A). Immediately after the session, the number of points dropped and only two tender points remained on the helix (Fig. 9.17B). This is in my opinion a procedure for indirectly controlling the effect of body acupuncture: good treatment should reduce the number of tender auricular points as much as possible. At the same time it is possible to increase the therapeutic response subsequently including the left points into treatment, as in the former case, inserting one or more semi-permanent needles.

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