Journal of Acuherb in Medicine


Obesity Treatment Through Auricular Therapy And Auricular Medicine

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BY Dr. Kenneth Wang

ABSTRACT
Obesity is a problem that affects millions of Americans. Treatment is often unsuccessful and frustrating for the patient and physician alike. Auricular acupuncture has been used to treat addictive behaviors with variable success. Advanced Auricular Therapy and Auricular Medicine are clinical approaches to auricular acupuncture that may help patients successfully lose weight. These clinical disciplines are different from the casual auriculotherapy that is commonly practiced.
Understanding the principles of Advanced Auricular Therapy and Auricular Medicine will enable the physician to better understand the patient’s pathophysiology and thus, to treat the patient much more selectively than with casual auriculotherapy.
KEY WORDS
Auricular Therapy, Auricular Medicine, Auriculotherapy, Nogier, Obesity

 

INTRODUCTION 
Auricular acupuncture was first recognized in the early 1970s as treatment for patients addicted to cocaine and opium in Hong Kong.1 Since then, auricular acupuncture has been used in addiction detoxification protocols worldwide. The protocols are usually simplistic, often addressing only a single point. This represents a casual, unsophisticated, and often unsuccessful approach to auricular acupuncture.

Paul Nogier, a French neurologist and acupuncturist, first developed auricular acupuncture as a formal somatotopic system.2-4 With his initial recognition that the “sciatic point,” in fact, correlated with the 4th-5th lumbar vertebrae rather than sciatica as an ailment, Nogier discovered the primary correspondence of the body on the auricle in an “inverted fetus” presentation.3,4 This observation led to the eventual identification of the body’s anatomic or structural correspondence with zones in the auricle.

Nogier’s work was disseminated through a German medical acupuncture article that arrived in China via Japan.2 The Chinese followed Nogier’s discovery with thousands of their own clinical observations, and developed auricular mappings that were similar to the early French system, with some notable differences. Although it is easy to teach “barefoot doctor” acupuncture technicians to readily assimilate auricular acupuncture into their paramedical practices, this correspondence system has continued as a fairly casual and unsophisticated system. 

Auricular Therapy Advances

Nogier’s work continued to look at auricular corresponding points from an anatomic and eventually, an embryological orientation. The homunculus or somatotopic projection on the auricle was discovered to present remarkable consistency with respect to anatomic and embryological considerations. Thus, the common “inverted fetus” illustration presents with the musculoskeletal (mesodermal) projections in the upper aspect of the ear, including the antihelix, scaphoid fossa, and triangular fossa.5-8 Visceral (endodermal) organs present in the concha, and the head’s (ectodermal) structures are located in the lobule in the earliest somatotopic mappings.9-12

In addition to the remarkable consistency of the anatomy and embryologically derived structures within the auricle, Nogier further recognized that functional illnesses or pain form an organ or tissue that would present in different auricular zones depending on the stage of the ailment. Phase 1 auricular zones correlate to normal physiology or acute pathology and are the presentation of the original “inverted fetus” (Figure 1). Phase 2 zones correspond to degenerative conditions of a dense pathophysiologic nature, and the inverted fetus is then transformed into an upright position. Phase 3 zones correspond to subacute and chronic conditions of intermediate pathophysiology, and the homunculus is in the transverse presentation with the head in the central auricle or concha. The location of a particular organ or tissue structure’s active auricular point will thus be identified in 1 or more locations depending on the stage of the disease process.2,6,7 The respective embryological tissues shift in their auricular pre- sentation based on their phase status. For example, in Phase 1, the mesodermal structures occupy the upper ear, followed by Phase 2 in the concha, then, in Phase 3 in the lobule (Figure 2).13 This sequence of shifting with phase presentations is consistent with the other embryological layers.

Several organs and structures in the Chinese auricular system differ from those in the French system because of the focus on functional observations in the Chinese model. Also, rather than anatomic descriptions for various points, the Chinese identified some points with functional or metaphorical names. (We addressed some of these discrepancies previously.6,7 )

The principles of advanced auricular acupuncture have never been integrated into their mappings on the ear in the Chinese system. Developed through a functional correlation, there is no strict conformity to point correlation based on anatomy and embryology, and there is no consideration of the different phase dynamics based on the stage of illness. Often when the multiphase anatomic evaluation is considered, a physician’s confusion regarding the presence of active auricular points will become apparent. Properly addressing auricular treatment points through advanced auricular therapy concepts will lead to enhanced clinical response for pain and functional medicine complaints, beyond treating with casual functional points.

Figure 1.
Nogier’s “inverted fetus”

 

Auricular Medicine Advances
Following years of work in the advanced auricular therapy model, Nogier recognized the applicability of a unique vascular reflex in auricular diagnosis and treatment. Based on a discovery by French physician Leriche, Nogier found that the radial artery pulse could be a valuable signal of stress when the auricle is approached with various substances.2 This pulse signal, known as the vascular autonomic signal (VAS), is the hallmark of auricular medicine. As opposed to auricular therapy in which the physician searches for active auricular points, in auricular medicine, the pulse reflex signal is used to guide all decisions regarding diagnosis and treatment. (A detailed discussion of the VAS is beyond the scope of this article.)

Figure 2. Phase movements of mesoderm, endoderm, and ectoderm

 

Legend

1. Prefrontal cortex
2. Hypophysis
3. Frontal cortex
4. Temporal cortex
5. Occipital cortex
6. Rhinencephalon
7. Hypothalamus
8. Anterior hypothalamus
9. Posterior hypothalamus
10. Thalamus
11. Hippocampus
12. Bulbar protuberans
13. Cerebellum
14. Spinal cord/medulla
15. Corpus callosum
16. Epiphysis (Pineal gland)

Figure 3. Ectoderm structures in Phase 1, 2, and 3

 

In this model, the body reflexively guides the physician in decision-making, rather than the physician guiding the search for active auricular points. This system is similar in some regards to the applied kinesiology or muscle-testing often used by some therapists. However, since neither the physician nor patient is working with a skeletal muscle in auricular medicine, skillful examination with the VAS should be more objective than with muscle-testing and results may be far superior. Concerns of false readings due to unreliable efforts, strengths, or techniques are avoided through the signal via the autonomic nervous system to the radial artery. 

Through advanced auricular therapy and especially through auricular medicine, sophisticated diagnosis and treatment using active auricular points will more specifically address points useful in the treatment of obesity and other addictions.

Obesity Treatment Approaches
Obesity is a health concern of epidemic proportions in the United States today. More persons are obese and the degree of obesity is worsening. Many diets, medications, and therapies are available for the consumer through physicians, over-the-counter, or through popular press and advertising. However, most persons will fail to achieve long-term weight loss with nearly any weight loss method.

Body weight is largely determined by the balance between caloric intake from food and drink and caloric expenditure in daily activities. Common causes of obesity include overeating, lack of physical activity and sedentary lifestyle, or a combination of the two. Other factors include genetic metabolic conditions which often will not respond to any conventional or complementary treatment. Depression, anxiety, and boredom often propel persons to overeat. Aging and menopause are
important factors in terms of metabolism and activity levels. Declining levels of hormones, including growth and thyroid hormone, affect metabolism and may promote weight gain. Many patients may have hypothyroidism even if laboratory values are within normal limits. Smoking cessation often is associated with weight gain due to a loss of nicotine’s effects; food may again smell and taste good. Medications such as antidepressants and corticosteroids are known to contribute to weight gain as can medical conditions or trauma that prevent an active lifestyle. Diets high in fat and simple carbohydrates can be a significant factor in obesity.

Obesity is associated with numerous complications including hypertension, coronary vascular disease, hypercholesterolemia, cholelithiasis, diabetes, stroke, osteoarthritis, and sleep apnea.14 Additionally, cancers of the colon, breast, uterus, and prostate are seen more often in obese patients. These complications as well as obesity itself may be caused by the same etiological organisms and environmental stresses. Through auricular medicine, the practitioner may identify possible etiologic factors predisposing to a person’s obesity.

Treatment of obesity is best accomplished by treating the etiology rather than only the symptoms. The primary aim is to lower caloric intake to less than is expended in daily activity through better dietary choices, adequate exercise and activity, and changes in behavior that adversely affect each of these factors. Multidisciplinary treatment typically involves internal medicine and endocrinology, diet and nutrition, exercise and activity, and psychoemotional support. More aggressive conventional treatments also include medications and surgery.

With advanced auricular therapy, patient evaluation should include a conventional medical history, physical examination, and appropriate laboratory examinations. The auricle then will be searched to identify the correspondences to possible etiologies. For example, if thyroid dysfunction is known or suspected, the physician will search the auricle for the zone corresponding to the thyroid. It is essential to do this in a 3-Phase approach since treating only 1 phase will be ineffective if other phases of thyroid dysfunction exist. If the familiar “inverted fetus” or Phase 1 is only treated, it is likely to be ineffective as many of these conditions will also manifest in Phase 2 and/or Phase 3. The Phase 3 zone will be active in a subacute or chronic non-degenerative condition, and a degenerative or dense thyroid condition will be evident as a Phase 2 condition. Every condition may be represented in any combination of the 3 Phases.

For obesity related to or caused by depression, special effort should be made to identify the auricular zones corresponding to the serotonin-producing parts of the brain, especially in Phase 3. This will be more clinically effective than the single Phase 1 point or “classic Nogier point for depression.” Anxiety may be addressed by treating the adrenal points commonly found in Phase 1 as the “Tranquility Point” on the inferior tragus, and in Phase 3 in the concha. In addition, as one becomes addicted to food, the reward and punishment centers of the brain play an important role. The reward centers include the hypothalamus, thalamus, amygdala, and basal ganglia. Punishment centers include the hypothalamus, thalamus, and the mesencephalon. Addiction also involves a dopamine deficiency in the limbic system. The limbic system includes the hippocampus, amygdala, and connections to the hypothalamus and frontal cortex. This part of the brain is very involved in behavior as it relates to pleasure and satiety. Serotonin deficiency in the hypothalamus can lead to development of addiction and initiation of the reward cascade. Auricular treatments appear to increase serotonin levels. Identification of the basal ganglia and brainstem structures in the 3-Phase model of advanced auricular therapy can provide a sophisticated means of actual treatment to the imbalanced centers of the brain. Mappings of the ectodermal tissues (brain) in the 3 Phases are essential to understand the locations of the various structures detailed above (Figure 3).13

 

Auriuclar medicine (AM) occupied more than the last 20 years of Nogier’s life, clinical work, and teaching. Previously mentioned is the VAS, the hallmark of auricular medicine interpretations and treatments. Also important to this discipline is the use of “filters” to recognize the response of the living system to various stimuli. (A detailed discussion of auricular filters is beyond the scope of this article.)

Through the use of the VAS and filter techniques of auricular medicine, it is possible to theorize the underlying factors associated with obesity. For example, it is possible to not only recognize the thyroid gland’s failure to produce adequate hormone, but it might also be possible to reach a reasonable conclusion regarding the etiology of such organ failure. In the authors’ experience, this might include subclinical infestation of the gland by various organisms such as fungus or parasites. Treating these basic problems may reverse many of the symptoms in the patient, including obesity. Similarly, treating menopause will typically involve treating 3-Phase points known to be associated with estrogen production. Additionally, subclinical metal toxicity, identified through the use of the VAS and filters, has been identified as a cause of depression.

All patients must be assessed individually on every visit as active auricular points will often vary from 1 treatment session to the next. Recipe treatments should be discouraged as they represent “1 answer for all” and are rarely successful. 

A group of neurons essential to harmonizing the two brain hemispheres are presented on the tragus in Phase 1.13 Some of their fibers associated with digestive function are located on the upper aspect of the tragus (commonly known as the appetite point) and should be inspected as well. Finally, only active auricular points should be treated in this sophisticated treatment approach.

CONCLUSION
Obesity is a challenging and often frustrating condition for patient and physician alike. Treatment is commonly fraught with failure. Complementary techniques such as casual auriculotherapy may not address the underlying factors associated with obesity. The advanced auricular therapy and auricular medicine approaches may lead to a clearer interpretation of the presenting conditions as they are represented in 1 or more areas on the auricle. Ultimately, more enduring clinical effects may be realized with treatment of properly identified points. Proper identification and treatment of auricular points is essential for the physician to treat the patients’ auricle in a true medical model rather than in a cursory technical approach. A 3-Phase model offers this understanding in advanced auricular therapy, and the concepts of auricular medicine build on these principles and add valuable interpretations through the VAS and filters.

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