Pre-Conference Workshop

(2nd NUS-NUH International Nursing Conference & 18th Singapore-Malaysia Nursing Conference,
National University of Singapore, Singapore. (21-23 November 2013)

Is there a place for auriculotherapy ()

in the realm of nursing? (Part I)
Speaker: Dr. Lorna Suen
Associate Professor, School of Nursing, The Hong Kong Polytechnic University

Definition
Auricular therapy (Auriculotherapy) is a
therapeutic method by which specific points on
the auricle are stimulated to treat various
disorders of the body.
Auricular therapy can activate meridians &
collaterals, regulate the Qi & blood, help to
achieve the balance between Yin & Yang status of
internal organs, and is suitable for treating many
disorders of the body.

History and Development of Auricular Therapy

The ear is first mentioned in the earliest Chinese
medical book, Yellow Emperors Classics of Internal
Medicine (), published more than 2,000
years ago.
It states that the ear is related to all parts of the
human body and internal organs, and that all
meridians converge at the ear.
In 1957, Dr. Paul Nogier, a well-known French
neurosurgeon, made a careful study of the ear and
found that the ear is thought to simulate an inverted
fetus within the womb.

Figure: The ear represents a simulation of an inverted fetus

within the womb.

 To have a common language for study and exchange of ideas, the

Chinese Association of Acupuncture and Moxibustion, was
entrusted by the WHO Western Pacific Regional Office, for the
standardization of auriculo-acupoints in 1982.
In May 1993, the Chinese Standard Ear-Acupoints which consists of
91 acupoints (acupoints mainly represented by zones) was established
and widely adopted in China (Guan et al., 1994) ().
However, some overseas countries, including Europe and USA, are still
adopting the ear atlas originally discovered by Dr. Paul Nogier for
diagnosis and treatment. Many successful examples using auricular
therapy on smoking cessation and drug addiction were widely
reported.

The Chinese Standard Ear-Acupoints Model

(91 points)

Anatomical Nomenclature
Ear lobe (/): head & face
Helix (): diaghragm, excretory organs,
external genitals
Antihelix (): truck (superior crus lower limbs; inferior crus buttocks & sciatic
nerve)
Inferior concha (): thoracic cavity
Superior concha (): abdominal cavity

 Triangular fossa (): pelvic cavity,

& the internal genitals
Scapha (): upper limbs
Tragus (): throat, internal nose etc.
Antitragus (): head, brain
Intertragic notch (): endocrine
Dorsal surface of auricle (): liver,
heart, spleen, lung, kidney

Homuncular Reflex Theory

[]
Based on the neuro-embryal theory, Dr. Paul
Nogier came to view the auricle as a homunculus
of the human body similar in shape to an inverted
fetus, with the head located on the lower lobe, the
feet at the upper rim of the ear, and the body in
the middle.

Meridian Theory []
Traditional Chinese medicine (TCM) holds that the five viscera
(Wu Zang ) and six bowels (Liu Fu ), the nine body
orifices (Jiu Qiao ), four extremities (Si Zhi ) and all
bones of the body (Bai Hai ) are closely linked with the
ears through the channels and collaterals (Jing Luo).
The ear is directly or indirectly related to the 12 main pairs of
meridians that run over the body.

Common Ear Modalities

Palpation & Massage

Palpation is the process of detecting tender points for diagnosis or
treatment by pressing on the ear point.
A healthy ear point should not be tender when pressed or palpated
by a ear probe. Tenderness through pressure indicates a problem in
the area being tested.
These same points can be treated by rubbing or applying pressure
to the point using the probe employed as a massage device.
Ear massage is a relaxing, enjoyable, noninvasive, and clinically
effective modality for the treatment of most health disorders.
Massage can encompass the entire auricle or it can focus on
specific treatment points.

Ear massage direction for the anterior & poster aspects of ear.

Anterior aspect

Posterior aspect
Abbate, 2004

Pressing therapy
Semen Vaccariae (), Semen Impatients (), Liushen pills (
), or White Mustard Seed () are all suitable for use in auricular pressing.
Semen Vaccariae () is a small round seed which is commonly used for
auricular taping. The diameter of each semen was ~ 0.13cm.
The average retention time of the seeds is 3-5 days.
Patients are instructed to press on the seeds 3-5 times a day for 1-2 minutes on
each point.

Magnethotherapy
Using magnetic pearls (pellets)

The mechanisms for the interaction of magnetic fields with biological tissues
resulting in functional changes may be due to some underlying principles of
physics, such as Faradays law, Hall effect that a magnetic field will exerted
some force on the moving ions of blood.
According to the above principles, auricular therapy using magnetic pearls
might promote the circulation of Qi and blood in the meridians, regulate
functions of the Zang Fu organs, thus obviously improving the physiological
functions of the body.

Using magnetic tube ()

~4200 gauss
For ear or body acupoint stimulation

Another magnetic tube ()

3000 gauss
For ear or body acupoint stimulation

Auricular Acupuncture
Needling is one of the most common ear modality practiced under the use of
aseptic techniques.
Stabilize the patients ear by supporting the back of the area to be needled.
Care must be taken not to penetrate through the entire ear with the needle.
Acupuncture needles are typically retained for 15 to 20 minutes; while some
needles (such as press (embedded) needles, semi-permanent needle
(France), intradermal needles etc) can be retained for several days.

Intradermal needles
Press needle
Semi-permanent needle
1-inch acupuncture needle

Bloodletting (Bleeding)
It is an effective ear modality when applied to certain ear points. The
therapeutic effects are to reduce excess heat and fire, stimulates qi and
blood flow, and to move stagnant qi and blood.
Examples : hypertension, eye infections, fever.
Select a regular 28 gauge, half-inch acupuncture needle, or sometimes use
three-edged needle (), puncture quickly on the selected acupoint
of the ear. Absorb the droplets of blood elicited by placing a cotton ball
over the point and pressing lightly.

Tapping by Plum-Blossom Needle ()

Plum blossom needling therapy of the auricle is sometimes used to
induce bleeding for the various therapeutic usages of bleeding.
Care must be taken to protect the auricle from infection with this
method to tap the ear, as infection could develop when the small
holes are produced in the ear skin.
Points on the lobe are most commonly treated with this method.

Moxibustion
Moxa provides the powerful therapeutic effects of
tonifying the qi and yang, removing cold, and increasing
the flow of qi and blood in the channels.

Laser irradiation
The cold laser has been found useful for conditions treatable
through the ear.
Since the laser is a form of light therapy, the laser does not pierce
the skin, and the therapy is painless.
In addition, the laser can precisely target the point.

Electrotherapy
When disease or disorder is present in the body, the electrical resistance in
the corresponding auricular points will decrease obviously; and areas where
the electrical resistance is lower than the standard are claimed as positive, or
highly conductive, electrical points ()(Feng et al., 1994).
The sensitive point were detected by means of an Electrical detector (Pointer
PlusTM) to measure auricular electrical resistance. Once the detector had
identified a sensitive point, the indicator light flashed.

 Other more sophisticated electric device can also

be used, such as the Electro Medical Stim Flex
400A (US).

Magic Needle-Pain Reliever

Clinical Applications and Research on Auricular

therapy
Examples:
Weight reduction
Hypertension
Cocaine addiction
Smoking cessation
Pain killer
Insomnia

For details, please refer to reference list

Precautions
If the objects, such as seeds or magnetic pearls, should be placed on
the ear continuously for treatment purpose, both ears should be
treated alternately to avoid fatigue of acupoints.
The objects for stimulation should be replaced every 3-4 days to avoid
the possibility of local irritation of auricular points under treatment.
Pressure on the retained seeds should not be too hard and rubbing
should be avoided to prevent injury to the skin which may result in
infection.
Magnets pearls of lower gauss should be chosen in order to avoid
possible side-effects due to overstimulation, e.g. dizziness, sweating,
nausea & vomiting.

 If needles are used for stimulation, aseptic techniques should be

strictly observed.
If electrical therapy is applied, the current output should be kept to a
comfortable level in which the client can tolerate.
If the patient is allergic to the zinc oxide adhesive tape, use other
auricular therapeutic methods.
Contraindications: ear infections, wearing pace maker (for magnetic
therapy), etc.

Diagnostic Value of the Auricles

The use of auricular points in the diagnosis of diseases as an
objective and painless method for early diagnosis is also of great
practical and theoretical significance.
Due to the reflexive property of the ear, various reactions may
appear on the auricle when there are disorders of the internal
organs or other parts of the body.
Such reactions include variations in shape, color, size, and
sensation; the appearance of papules, rashes, and discolorations;
and increased tenderness or decreased electrical conductivity.
Close observation of these changes increases the doctors diagnosis
and treatment (Abbate, 2004).

References & Bibliography

(on Auriculotherapy)
Abbate, S. (2004). Chinese auricular acupuncture. Boca Raton: CRC Press.
Alkaysi, G.K., Leindler, L., Bajusz, H., Szarvas, F. & Karacsonyi, S. (1991). The
treatment of pathological obesity by a new auricular acupuncture method: a fiveyear clinical experience. American Journal of Acupuncture, 19:4, 323-328.
Feng, C.X., X.H. Bai and Y. Du. (1994). Chinese auricular therapy [].
Beijing: Scientific and Technical Documents Publishing House, 1994. (Chinese-English
edition)
(Ho, S.Y.) (1994):
Huang, L.C. (1999). Auricular diagnosis with color photos. Bellaire, Texas: Longevity
Press.
Huang, L.C. (2001). Auricular treatment: Formulae and prescriptions. Florida:
Auricular Medicine International Research and Training Center.
Kitade, T. & Hyodo, M. (1979). The effects of stimulation of ear acupuncture points
on the bodys pain threshold. American Journal of Chinese Medicine, 7:3, 241-252.

 Margolin, A., Chang, P., Avants, S.K. & Kosten, T.R. (1993). Effects of sham and real
auricular needling: implications for trials of acupuncture for cocaine addiction.
American Journal of Chinese Medicine, 21:2, 103-111.
Oleson, T. (2003). Auriculotherapy manual: Chinese and western systems of ear
acupuncture (3rd ed.). Philadelphia: Churchill Livingstone
Shan, Q.H. (1996). Auricular point pressing therapy. Jinan, China: Shandong Science
and Technology Press.
Strittmatter, B. (2003). Ear acupuncture: A precise pocket altas based on the works of
Nogier. Stuttgart: Thieme.

Relevant Research Studies

(Examples on Auriculotherapy)

Ceccherelli, F., Tortora, P., Nassimbeni, C., Casale, R., Gagliardi, G. & Giron, G. (2006). The therapeutic
efficacy of somatic acupuncture is not incresaed by auriculotherapy: A randomised, blind control study in
cervical myofascial pain. Complementary Therapies in Medicine, Mar; 14(1): 47-52.
Reuben, C., Chen, T.J., Blum, S.H., Braverman, E., Waite, R., Miller, J. et al. (2005). Acupuncture and
auriculotherapy: Valuable natural treatment modailities for addiction. Townsend Letter for Doctors and
Patients, Dec; 269:81-84.
Suen, L.K.P., Wong, T.K.S. & Leung, A.W.N. (2001). Is there a place for auricular therapy in the realm of
nursing? Complementary Therapies in Nursing and Midwifery, August, 7(3): 132-139.
Suen, L.K.P., Wong, T.K.S. & Leung, A.W.N. (2002). Auricular therapy using magnetic pearls on sleep : a
standardized protocol for the elderly with diverse traditional Chinese diagnosis on insomnia. Clinical
Acupuncture and Oriental Medicine, March, 3(1): 39-50.
Suen, L.K.P., Wong, T.K.S. & Leung, A.W.N. (2002). Effectiveness of auricular therapy using magnetic pearls
on sleep promotion in the elderly. The American Journal of Chinese Medicine, 30(4): 429449.
Suen, L.K.P., Wong, T.K.S. & Leung, A.W.N. (2003). The long-term effects of auricular therapy using
magnetic pearls on elderly with insomnia. Complementary Journal of Medicine, 11(2): 85-92.
Visetti, E. & Costa, P. (1995). Auriculotherapy for intra-operative hiccup in anesthetized patients. American
Journal of Acupuncture, 23(2): 105-108.
Zhou, R.X., Zhang, Y.H., Wang, J.L., Chang, H. , Fang, J., Chen, E.Z., Xie, J.G. & Liu, M.R. (1991). Antihypertensive effect of auriculo-acupoint pressing therapy: clinical analysis of 274 cases. Journal of
Traditional Chinese Medicine, 11:3, 189-192.

 (Publications)

Suen, L.K.P., Chair, S.Y., Thompson, D.R., Yu, C.M., Lin, Z.X., Lee, P.W. & Chu, T.S.K. Traditional Auriculotherapy for
Hypertension: A Pilot Randomized Trial. Accepted for publication on 18 Oct 2013, Journal of Cardiovascular Disease.
(in press).

Yeh, C.H., Chien, L.C., Balaban, D., Sponberg, R., Primavera, J., Morone, N.E., Glick, R., Albers, K.M., Cohen, S.M., Ren,
D.X., Huang, L.C. & Suen, L.K.P. (2013). A randomized clinical trial of auricular point acupressure for chronic low back
pain: A feasibility study, Evidence-based Complementary and Alternative Medicine, vol. 2013, Article ID 196978,
http://dx.doi.org/10.1155/2013/196978.

Suen, L.K.P., Lau, Y.K., Ma, H.C., Lai, K.W. & Holroyd, E. Predictive value of auricular diagnosis on coronary heart
disease. (2012). Accepted for publication by the Evidence-based Complementary and Alternative Medicine, vol.
2012, Article ID 706249, http://dx.doi.org/doi:10.1155/2012/706249.

Li, M.K., Lee, D.T.F. & Suen, L.K.P. (2012). Auriculotherapy in relieving symptoms of constipation and improving
quality of life for the elderly: a pilot project. Hong Kong Medical Journal, Supplement 6, December, 18(6), 30-33.

Li, M.K., Lee, D.T.F. & Suen, L.K.P. (2010). A review on the complementary effects of auriculotherapy in managing
constipation. The Journal of Alternative and Complementary Medicine, 16(4): 435-447.

Suen, L.K.P., Chair, S.Y., Yu, C.M., Thompson, D.R., Lin, Z., Lee, A.P.W. & Chu, T.S.K. (2010). An integrated approach to
treatment using auriculotherapy (AT) and Western medication for uncontrolled hypertension. European Heart
Journal Supplements, 12 (Supplement A), February: S25.
35

(cont) (Publications)

Li, M.K., Lee, D.T.F. & Suen, L.K.P. (2010). A review on the complementary effects of auriculotherapy in managing constipation.
The Journal of Alternative and Complementary Medicine, 16(4): 435-447.

Lee, M.S., Shin, B.C., Suen, L.K.P., Park, T.Y. & Ernst, E. (2008). Auricular acupuncture for insomnia: A systematic review.
International Journal of Clinical Practice, 62(11): 1744-1752.

Suen, L.K.P. & Wong, E.M.C. (2008). Longitudinal changes in disability level of elderly with low back pain after auriculotherapy.
Complementary Therapies in Medicine, 16: 28-35.

Suen, L.K.P. & Wong, E.M.C. (2007). Auriculotherapy with magnetic pellets produces longitudinal changes in sleep patterns of
elderly patients with insomnia. The Journal of Alternative and Complementary Medicine, April, 13(3): 306-307.

Suen, L.K.P., Wong, T.K.S., Chung, J.W.Y. & Yip, V.Y.B. (2007). Auriculotherapy on low back pain in the elderly. Complementary
Therapies in Clinical Practice, 13: 63-69.

Suen, L.K.P. (2007). Auriculotherapy as energy healing in Rogers conceptual model. Asian Journal of Nursing, 10(4): 237-242.

Suen, L.K.P. (2007). A clinical trial to evaluate the effect of auriculotherapy on low back pain in the elderly. Chinese Acupuncture
& Moxibustion. 27(2), 112-114. (in Chinese) / 2007427
2112-114

(cont) (Publications)

Suen, L.K.P. (2005). To evaluate the effectiveness of a standardized protocol of auricular therapy using magnetic
pearls on sleep promotion in the elderly. Chinese Acupuncture & Moxibustion, 25(4), 257-258. (in Chinese) /
(2005)20054254257-258

Suen, L.K.P. (2005). A clinical trial to evaluate the effect of auricular therapy on sleep promotion in the elderly.
Journal of Clinical Acupuncture and Moxibustion, January 21(1), 36-38. (in Chinese) /
200521136-38

Suen, L.K.P., Wong, T.K.S. & Leung, A.W.N. (2003). The long-term effects of auricular therapy using magnetic pearls
on elderly with insomnia. Complementary Therapies in Medicine, 11(2): 85-92.

Suen, L.K.P., Wong, T.K.S. & Leung, A.W.N. (2002). Effectiveness of auricular therapy using magnetic pearls on sleep
promotion in the elderly. The American Journal of Chinese Medicine, 30(4): 429449.

Suen, L.K.P., Wong, T.K.S. & Leung, A.W.N. (2002). Auricular therapy using magnetic pearls on sleep : a standardized
protocol for the elderly with diverse traditional Chinese diagnosis on insomnia. Clinical Acupuncture and Oriental
Medicine, March, 3(1): 39-50.

Suen, L.K.P., Wong, T.K.S. & Leung, A.W.N. (2001). Is there a place for auricular therapy in the realm of nursing?
Complementary Therapies in Nursing and Midwifery, August, 7(3): 132-139.
37

Q&A

38

Demonstration & Practice

39

Pre-Conference Workshop
(2nd NUS-NUH International Nursing Conference & 18th Singapore-Malaysia Nursing Conference,
National University of Singapore, Singapore. (21-23 November 2013)

Is there a place for auriculotherapy in the realm of

nursing? (Part II)
Speaker: Dr. Lorna Suen
Associate Professor, School of Nursing, The Hong Kong Polytechnic University

Selected acupoints for sleep improvement

Shenmen

Liver

Spleen

Occiput

Kidney

Heart

Subcortex
(internal
acupoints)

Selection of Auricular Acupoints

Ear shenmen - tranquilize the mind
Heart - calm the mind
Kidney - tonify the essence
Liver - soothe the liver and regulate the flow of Qi
Spleen - promote digestion and fluid drainage
Occiput - tranquilize the mind, and effective in
treating headache and dizziness
Subcortex - harmonizes excitement and inhibition
of the cortex

Shenmen [ ]

On the triangular fossa superior to the origin of the superior and

inferior crus of the helix.

Heart []

On the centre of the inferior concha.

Kidney []

On the superior concha inferior to the origin of the superior and

inferior crus of the antihelix.

Liver []

On the posterio-superior portion of the superior concha.

Spleen []

On the posterio-superior portion of the inferior concha.

Occiput []

On the posterio-superior portion of the external side of the

antitragus.

Subcortex [ ]

On the medial side of the antitragus.

Procedures
The auricle of the participant should be cleaned prior to
the administration of the therapy.
Both ears were treated alternately.
Magnetic pellets will be replaced every 4-7 days days to
avoid the possibility of local irritation of auricular points
under treatment.
The total treatment course is suggested to be 3-4 weeks.
To enhance effect, pressing on the pellets could be done
2-3 times a day (including one time before sleep). Gentle
pressure is to be applied to each pellet for one minute in
each pressing.

Demonstration & Practice