The ear is a homunculus with all of the structures and organs of the body represented on it. The origin of ear acupuncture is unclear, and although it is referred to in ancient Chinese texts it only seems to have been used clinically during the last fifty years.

In broad principle the apex of the pinna represents the hands and feet, the helix and anti-helix the limbs and trunk, the ear lobe the facial structures, and the concha of the ear represents the internal organs. The main auricular points are shown on the ear chart.

Ear acupuncture can be used for any condition that will respond to acupuncture, although in China its main use is for acutely painful conditions and acupuncture anaesthesia.

I. Point Selection

The Theory of Point Selection
Auricular points can be selected directly for the areas they represent; stomach point for gastralgia, ankle point for ankle pain, and so on. They can also be selected on the basis of traditional Chinese medicine, for instance when there is a disturbance of the gan-liver select the liver point, or for diseases of the skin select the lung point as the fei-lung controls the skin and hair.

The Chinese were also selecting points on the basis of modern physiology, for instance in gynaecological problems endocrine and subcortex points are frequently used. Some of the points are based on clinical experience, Shenmen is a useful sedative point Dingchuan is useful for asthma, and Appendix for appendicitis.

Methods of Point Selection
In ear acupuncture it is essential to localize the ear points accurately. If a structure or organ in the body is painful or diseased then the ear point representing that organ will be painful. This can be demonstrated clinically by probing the ear; initially the acupuncturist must decide on the approximate area to probe and then carefully search the area with a blunt probe or a spring-loaded probe. The point that is the most painful is the one that requires treatment.

Ear points can also be localized electrically. A tender ear point has an increased electrical conductance and, by using one of the many electrical ear point locators that are available, the area of increased conductance can be demonstrated. These machines are very prone to artefact so the operator must use them with extreme care and not press on the ear too forcefully or areas of increased conduction will appear everywhere.

Point Selection for Pain
In acute pain ear acupuncture can have a very swift and effective action. The point should be selected by the methods described. When the needle is inserted into the tender point the patient will feel a great deal of pain. Rotate the needle and get the patient to exercise the painful area at the same time. The pain in the affected area should then disappear.

Chronic pain may also respond quite dramatically to ear acupuncture, but to be effective it may often require a course of treatment rather than one treatment.

II. Needling Technique

Sterility
It is important to keep ear needles sterile and to clean the ear carefully before inserting a needle.

Needle Insertion
Half inch or one inch needles should be used in the ear. The half inch needles can be inserted perpendicularly to the skin and the one inch needles are often used obliquely. Do not insert the needle through the ear. Press studs can also be used in the ear. They are useful for chronic conditions as the patient can press the stud and stimulate the point whenever symptoms occur.

Needle Stimulation
Ear points can be stimulated manually by rotating the needle; this creates a burning painful sensation in the ear. Electrical stimulation of the ear points is used to induce anaesthesia and it can also be used therapeutically, especially in chronic conditions. The main use of the electrical stimulator in China is for ear acupuncture anaesthesia. The stimulation frequencies used were usually low for any form of ear acupuncture, between 5 and 300Hz, but there seemed to be no consistent agreement about the exact frequency. The intensity used is the maximum tolerable.

III. Auricular Therapy

Ear point prescriptions have been included in the sections, where relevant, on each particular disease.

Ear acupuncture should be treated like body acupuncture for chronic conditions; the patient should be given a course of about eight treatments, although acute conditions may respond in one treatment.