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Obesity
Treatment Through Auricular
Therapy And Auricular Medicine
Bryan L. Frank, MD
Nader Soliman, MD
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
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Figure
1.
Nogier's "inverted fetus" |
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.
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.)
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| Figure 2.
Phase movements of mesoderm, endoderm, and ectoderm |
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
 |
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 |
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.
REFERENCES
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Wen HL, Cheung YC. Treatment of drug addiction by acupuncture and
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Nogier PFM. From Auriculotherapy to Auricular Medicine. Sainte-Ruffine,
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Nogier PFM. Handbook to Auriculotherapy. Sainte-Ruffine, France:
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Nogier PFM, Nogier R. The Man in the Ear. Sainte-Ruffine, France:
Maisonneuve; 1985.
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Bourdiol R. Elements of Auriculotherapy. Sainte-Ruffine, France:
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Frank BL, Soliman NE. Shen Men: a critical assessment through advanced
auricular therapy. Medical Acupuncture. 1999;10(2):17-19.
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Frank BL, Soliman NE. Zero Point: a critical assessment through
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Oleson
TD, Kroening RJ, Bresler DE. An experimental evaluation of auricular
diagnosis: the somatotopic mapping of musculoskeletal pain at ear
acupuncture points. Pain. 1980;8:217-229.
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Kropej
H. The Fundamentals of Ear Acupuncture. Heidelberg, Germany: Karl
F. Haug Publishers; 1987.
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Oleson
TD. Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture.
2nd ed. Los Angeles, Calif: Health Care Alternatives; 1996.
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Helms
JM. Acupuncture Energetics: A Clinical Approach for Physicians.
Berkeley, Calif: Medical Acupuncture Publishers; 1995.
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Huang H, trans. Ear Acupuncture: A Chinese Medical Report. Emmaus,
Pa: Rodale Press Inc; 1974.
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Frank BL, Soliman NE. Atlas of Auricular Therapy and Auricular Medicine.
Richardson, Tex: Integrated Medicine Seminars; 2000.
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Philadelphia, Pa: WB Saunders; 1998:1061-1083.
AUTHORS’
INFORMATION
Dr Bryan L. Frank is an Anesthesiology/Pain Medicine specialist in Richardson,
Texas. He serves as Immediate Past-President of the American Academy
of Medical Acupuncture (AAMA), and Delegate to the International Council
of Medical Acupuncture and Related Therapies. He has taught at the Academy’s
Annual Symposia, other national and international medical acupuncture
forums, and for UCLA School of Medicine, University of Miami School
of Medicine, and McMaster School of Medicine acupuncture training programs.
Dr Frank is President, Integrated Medicine Seminars, and is the Founding
Director of Medical Mission Partners in Richardson, Texas.
Bryan L. Frank, MD, DABMA*
1884 Quail Ln, #100
Richardson, TX 75080
Phone: 972-489-4286 • E-mail: bfrankmd@aol.com
Dr
Nader Soliman is Director of the Washington Alternative Medicine and
Integrated Pain Management Center in Rockville, Maryland. He serves
as Treasurer of the American Academy of Medical Acupuncture (AAMA),
and is President, Integrated Medicine Seminars. Dr Soliman has taught
physicians Auricular Therapy and Auricular Medicine, with particular
interest in integrating these disciplines into Biomedical and Medical
Acupuncture practices.
Nader E. Soliman, MD, DABMA
15001 Shady Grove Rd, #100
Rockville, MD 20850
Phone: 301-602-6300 • E-mail: altmedctr@aol.com
* Send all correspondence and reprint requests regarding this article
to Bryan Frank, MD, at the address listed at left.
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