MEDICAL ACUPUNCTURE Volume 26, Number 2, 2014 # Mary Ann Liebert, Inc. DOI: 10.1089/acu.2014.

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COMMENTARY

Development of Auriculotherapy Around the World

1,* Richard C. Niemtzow, MD, PhD, MPH, and Terry Oleson, PhD 2

ever before in our history have we witnessed global communication that transcends every aspect of our lives. The science of auriculotherapy has not escaped an evolution in its own right. Auriculotherapy has previously been equated to treatment for pain. As a result of the recurrent armed conicts and cataclysmic natural disasters that have become so part of the human communication networkthe internetwe share not only the pain of the wounded but also their psychologic suffering. Having dealt with pain and addiction, auriculotherapy moves forward to treat our psychobiologic disorders. Consequently, the demands for this type of therapy have expanded our psychologic treatments, a development that has caused our auriculotherapy portfolio to increase and evolve. The literature is expanding rapidly regarding use of ear acupuncture in this area. Battleeld Acupuncture is an example of how the military adopted a rapid pain technique and is now seeking a similar approach to post-traumatic stress disorder and the consequences of mild traumatic brain injury and their related psychologic components. In most textbooks on acupuncture, the origins of acupuncture are dated back to classical medical practices in ancient China, whereas the somatotopic perspective of acupuncture points located on the external ear were greatly modied by the work of Paul Nogier, MD,1 in the 1950s. His somatotopic view of the auricular microsystem became widespread in both China and Europe in the 1960s, so much so that, by the 1970s, when the broader international community of medical science became more aware of acupuncture practices, the inverted fetus concept of the localization of auricular acupuncture procedures was common throughout the world. In the 1980s, the World Health Organization (WHO)2 held a series of acupuncture nomenclature meetings that standardized the terminology used for meridian acupuncture points, but by the 1990s, and even in meetings held after 2010, there has still been a lack of
1 2

international agreement regarding the nomenclature utilized for ear acupoints. Since the 1990 WHO meeting in Lyon, Francewhich included distinguished experts of auriculotherapy from France, Germany, Italy, China, Japan, Korea, Australia, and the United Statesdiscrepancies between the FrenchGerman ear acupuncture charts and the Chinese ear acupuncture charts remain. During the same time period, there has been a lot more extensive, scientic investigation of body acupuncture than of auricular acupuncture. There have been more randomized controlled trials on the clinical effectiveness of body acupuncture, and there have been more neurobiologic studies of the underlying basis for body acupuncture. Nonetheless, when there have been rigorous scientic assessments of auriculotherapy, both the clinical effectiveness and the neurophysiologic bases show very similar results. In the year 2014, contributions by medical doctors across many different countries have now strengthened the scientic support signicantly for the practice of auriculotherapy. Research back in the 1970s had demonstrated that stimulation of both body acupuncture and auricular acupuncture led to the release of endogenous, endorphinergic neurochemicals,3,4 and by the 1980s, it had been found that the opiate antagonist naloxone could block the analgesic effects of both body and ear acupuncture,5,6 The use of auricular points for the alleviation of opiate addiction began with the work of H.L. Wen, MD,7 in Hong Kong and has spread throughout the world as the basis for the National Acupuncture Detoxication Association Protocol.8 Scientic evaluation of the use of auriculotherapy for smoking cessation continues with research in the United States, Italy, and Hong Kong. In the last several years, practitioners from many different countries have contributed innovative scientic investigations of the use of auriculotherapynot just for substance abuse but also for pain management and the improvement of mental health. The use of acupuncture needles, electrical

United States Air Force Acupuncture Center, Joint Base Andrews, MD. Auriculotherapy Certication Institute, Los Angeles, CA.

*The opinions and assertions contained herein are the private views of the author and are not to be construed as ofcial or as reecting the views of the United States Air Force Medical Corps, the Air Force at large, or the Department of Defense. The author indicates that he does not have any conicts of interest.

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COMMENTARY stimulation, laser stimulation, or acubeads on specic locations of the external ear has been shown to quantiably reduce back pain, cancer pain, and postsurgical pain. In addition, several different studies in Asia, Europe, and America have provided statistically veriable evidence that auriculotherapy can signicantly reduce the quantiable perception of anxiety in a verum treatment group versus a sham control group.9 What is also interesting is that many of the studies of functional magnetic resonance imaging imaging of the brain during auricular stimulation or controlled trials of clinical effectiveness are conducted by the collaboration of doctors in different countries in Europe or by the interaction of different doctors in America, Asia, and Australia.10,11 It does seem that the scientic verication of auriculotherapy is becoming more of an acceptable reality for doctors throughout the world. This International Auriculotherapy Symposium of 2014 held in the United States, is a demonstration of this progress.

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4. Pert A, Dionne R, Ng L, Bragin E, Moody TW, Pert CB. Alterations in rat central nervous system endorphins following transauricular electroacupuncture. Brain Res. 1981;224(1): 8393. 5. Mayer DJ, Price DD, Rai A. Antagonism of acupuncture analgesia in man by the narcotic antagonist naloxone. Brain Res. 1977;121(2):368372. 6. Simmons MS, Oleson TD. Auricular electrical stimulation and dental pain threshold. Anesth Prog. 1993;40(1):1419. 7. Wen HL. Fast detoxication of heroin addicts by acupuncture and electrical stimulation (AES) in combination with naxolone. Comp Med East West. 1977;5(34):257263. 8. Smith MO, Khan I. An acupuncture programme for the treatment of drug addicted persons. Bull Narc. 1988;40(1): 3541. 9. Asher GN, Jonas DE, Coeytaux RR, et al. Auriculotherapy for pain management: A systematic review and meta-analysis of randomized controlled trials. J Altern Complement Med. 2010; 16(10):10971108. 10. Cho ZH, Chung SC, Jones JP, et al. New ndings of the correlation between acupoints and corresponding brain cortices using functional MRI. Proc Natl Acad Sci U S A. 1998;95(5):26702673. 11. Alimi D, Geissmann A, Gardeur D. Auricular acupuncture stimulation measured on functional magnetic resonance imaging. Med Acupunct. 2002;13(2):1821.

REFERENCES
1. Nogier P. Treatise of Auriculotherapy. Moulins-les-Metz: Maisonneuve; 1972. 2. World Health Organization: A standard international acupuncture nomenclature: Memorandum from a WHO meeting. Bull World Health Organ. 1990;68(2):165169. 3. Sjolund B, Terenius L, Eriksson M. Increased cerebrospinal uid levels of endorphins after electro-acupuncture. Acta Physiol Scand. 1977;100(3):382384.

Address correspondence to: Richard C. Niemtzow, MD, PhD, MPH United States Air Force Acupuncture Center Joint Base Andrews, MD 20762 E-mail: n5ev@aol.com