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Ear Acupuncture in European Traditional Medicine
Luigi Gori and Fabio Firenzuoli
Center of Natural Medicine, S. Giuseppe Hospital, Empoli, Italy
Auricular acupuncture is a diagnostic and treatment system based on normalizing the body’s
dysfunction through stimulation of definite points on the ear. Rudimentary forms of
acupuncture which probably arose during the Stone Age have survived in many parts of the
world right down to present day. It was used in the ancient Egypt, Rome, Greece and all the
Mediterranean area. It is a microacupuncture technique similar to reflexology, and was first
described in France in 1950 by Paul Nogier who is considered the Father of modern ear
acupuncture. It was speculated that the technique works because groups of pluripotent cells
contain information from the whole organism and create regional organization centers
representing different parts of the body. Nevertheless stimulation of a reflex point in the ear
seems relieve symptoms of distant pathologies. Modern research is confirming the efficacy of
ear acupuncture for analgesia and anxiety related disease, while tobacco dependence and other
substance abuse still need confirmation. Actually main methodological problems with auricular
acupuncture are that exist too many maps with little agreement regarding point location in the
ear, and that the correspondence or reflex systems does not correlated with modern knowledge
of anatomy and physiology.
Keywords: auricolotherapy – ear acupuncture – Nogier – reflexology
What is Ear Acupuncture?
Auricular acupuncture is a diagnostic and treatment
system based on normalizing the body’s dysfunction
through stimulation of points on the ear. Resulting
amelioration of pain and illness is believed to be through
the reticular formation and the sympathetic and para-
sympathetic nervous systems (1).
Ear acupuncture, is an acupuncture technique similar to
reflexology, and is speculated that the technique works
because groups of pluripotent cells contain information
from the whole organism and create regional organiza-
tion centers representing different parts of the body,
through recruitment of more cortex cells dedicated to
specific areas of the body. Thus stimulation of a reflex
point in the ear can relieve symptoms of distant
pathology with a reliable duration.
Ancient History of Ear Acupuncture
Rudimentary forms of acupuncture which probably arose
during the Stone Age have survived in many parts of the
world right down to present day. Primitive sharp stones
and bamboo were replaced by fish bones, bamboo clips
and later various shapes of needles made of metal. When
stones and arrows were the only tools of war, warriors
wounded in war found that some diseases that affected
them for many years were gone, as probably testify scars
on the skin of the mummified body of Similaun, Italy.
The Eskimos, are still using sharpened stones for treating
their illness. The Bantus of South Africa scratch certain
areas of their skin to allay the symptoms of many
illnesses, while in Brazil there is a tribe whose method of
treating illness is to shoot tiny arrows from a blowpipe
to specific areas of the skin. The practice of cauterizing
For reprints and all correspondence: Luigi Gori, Service of
Auricolotherapy, Center of Natural Medicine, S. Giuseppe Hospital, via
Paladini, 40 – 50053 Empoli, Italy. Tel: +39-0571-702601; Fax: +39-
0571-702639; E-mail: firstname.lastname@example.org
ß 2007 The Author(s).
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a part of the ear with a hot metal probe has also been
reported among certain tribes in Arabia. This is probably
a vestige of the acupuncture practiced in ancient Egypt
and Saudi Arab.
The Ebers papyrus of 1550 B.C. (now in the British
Museum) describes a system of channels and vessels in
the body which approximates more closely to the Chinese
system of channels than to any known system of blood
vessels, lymph vessels or nerves. The Egyptologist
Alexandre Varille (1909–1951) has documented that
women in ancient Egypt who did not want any more
children, had their external ear pricked with a needle
or cauterized with heat. Gold earrings worn by
Mediterranean sailors were not just used as decorations,
but were said to improve vision. Hippocrates, the father
of of Greek medicine, reported that doctors made small
openings in the veins situated behind the ear to facilitate
ejaculation and reduce impotency problems. Cutting of
veins situated behind the ear was also used to treat leg
pain. The Greek physician Galen introduced Hippocratic
medicine to the Roman empire in the second century CE,
and commented on the healing value of scarification at
the outer ear.
After the fall of Roman empire, the medical records of
Egyptian, Greek and Roman medicine were best pre-
served in ancient Persia and Arabian world. Included in
these Persian records were specific references to medical
treatments for sciatic pains and sexual related disease
produced by cauterization of the external ear. During
Renaissance sporadic clinical reports in Europe describe
the use of ear cauterizations to relieve leg pain. The
Dutch East India Company actively engaged in trade
with China from 1600s to 1800s, and its merchants
brought Chinese acupuncture practices back to Europe.
Doctors working with the company had become
impressed by the effectiveness of needles and moxa, and
cauterization of the external ear, or by cutting the veins
behind the ears for relieving conditions such as sciatic
pains and arthritis of the hip.
In 1637 probably for the first time in Europe was
described by the Portugese physician Zacatus Lusitanus
the treatment of sciatic pain by cauterization of the ear
after that bloodletting had failed. The Italian anatomist
and surgeon Antonio Maria Valsalva (1666–1723), who
made the first modern anatomical description of the ear;
in 1717 published the Aura Humanus Tractatus, where
he describes the treatment of toothache by scarification
of antitragus. In 1810 Prof. Ignazio Colla of Parma,
Italy, reported the observation of a man stung by a bee in
the antehelix which resulted in dramatic relief of pain
in the legs, and in the same year Dr Cecconi, another
Italian physician, performed cauterization to help treat-
ment of sciatic pain. In 1850 the French Journal des
connaissainces medico-chirurgicales reported 13 different
cases of sciatic pain that had been treated by cauteriza-
tion with a hot iron applied to the ear. Only one of the
patients did not improve completely. But it was not until
a century later that Paul Nogier rediscovered this type of
Dr Paul Nogier: The Father of Ear Acupuncture
In 1957, Dr Paul Nogier a physician resident in Lyons,
France, first presented his observations of the somato-
topic correspondences of the ear. He is actually
considered the Father of modern auricolotherapy.
Dr Nogier (2) originated the concept of an inverted
fetus map on the external ear (Fig. 1). He developed this
theory after noticing that some patients attending his
clinic had a small scar from a burn on part of their ear.
On inquiring into this, he was told that a very small area
of their ear had been cauterized by a certain Madame
Barrin for treatment of sciatic pain—a treatment that
they proved very rapid and effective. Later his first great
insight was the recognition of the homunculus, ‘the man
in the ear’, the representation and anatomical correla-
tion of the inverted fetus in the ear. Points on the
body, for example the knee, corresponded precisely
Figure 1. This drawing illustrates the concept of an inverted fetus map
on the external ear.
14 Ear acupuncture
with the fetal representation of the knee in the auricle.
Auriculotherapy following Nogier’s theory uses the ear
to help determine whether the right and left hemispheres
of the brain are functioning as a dynamic whole, whether
there are specific neurological, musculo-skeletal or organ
systems that are in imbalance, and whether there
are any blockages to treatment, such as scar tissue or
emotional disorders and it should be a new diagnostic
system too (2,3).
Then Dr Nogier noticed that there was a distinct
change in the amplitude and dimension of the pulse when
certain points on the auricle were stimulated. This occurs
consistently and is both repeatable and measurable by
modern equipment. Dr Nogier called it the Vascular
Autonomic Sign (VAS) (3). Being able to detect the VAS
on the radial pulse of the patients’ left hand enables the
practitioner to precisely determine the location of a point,
whether there is a pathology in the region of the body
that relates to specific points, and whether certain
substances are indicated. Accurate employment of the
VAS would be essential in diagnosis and treatment
following the principles of Nogier’s auricolomedicine.
Nogier collaborated with a group of medical colleagues
who, in a spirit of cooperation and discovery, shared
their experiences. One of those colleagues, Dr Jacques
Niboyet, convinced Nogier to introduce his discoveries
to the Congress of the Mediterranean Society of
Acupuncture in February of 1956. Attending that
Congress was Dr Ge
rard Bachmann who published
Nogier’s research, translated into German, in a Acu-
puncture journal in 1957. This journal had an interna-
tional circulation and it was not long before Japanese
acupuncturists became familiar with Nogier‘s reflex
The discovery of the system spread to China and led to
intensive research by the Chinese medical authorities at
a time of renewed interest in Traditional Chinese
Medicine. After learning about the Nogier ear charts in
1958, a massive study was initiated by the Nanjing Army
Ear Acupuncture research Team. This Chinese medical
group verified the clinical effectiveness of the Nogier
approach and assessed the conditions of over 2000
clinical patients, recording which ear points corresponded
to specific diseases. The outcome of that research was
very positive and resulted in the utilization of this
therapy by the ‘Barefoot Doctors’ of the Cultural
Revolution. In China was published an Ear Chart
remarkably similar to that of Dr Nogier in 1958 (4).
Nogier acknowledged that Chinese traditional medicine
had been using ear points for acupuncture prior to his
discovery, but these had been considered empirical points
for particular treatments and were not associated with
a somatotopic representation of the homunculus in the
ear. This oversight appears to have inhibited awareness
of options laid open to recognize and treat other points
in the ear following an anatomical relationship to the
points already known at the time.
Ear Acupuncture and Evidence Based
Later the American physician TD Oleson has published
a very important paper that is a real milestone in ear
acupuncture (5). To experimentally evaluate the claims by
French and Chinese ear acupuncture that a somatotopic
mapping of the body was represented in the external ear,
40 patients were examined to determine areas of their
body where there was musculoskeletal pain. Each patient
was draped with a sheet and a physician conducting
the auricular diagnosis had no prior knowledge of the
patient’s medical condition, but simply examined the
patient’s ear for areas of elevated skin conductivity or
tenderness. The concordance between the established
medical diagnosis and the auricular diagnoses was
75.2% (5). These results thus supported the hypothesis
that there is a somatotopoic organization of the body
represented upon the human auricle, but represented
following definite areas not meridian lines or other
In the last years modern clinical and basic research is
confirming the efficacy of ear acupuncture mostly in the
treatment of pain both acute and chronic (6–9), and of
anxiety related disorders (10–12). While the treatment of
irritable bowel syndrome, obesity, smoke cessation,
alcohol withdrawal and other types of substance abuse
disease is still waiting definitive confirmation (13–17).
Basic research is trying to explain the effect of
therapeutic reflexes induced by ear acupuncutre so
behavioral analgesia produced by auricular acupuncture
can be blocked by the opiate antagonist naloxone,
indicating the role of endorphinergic systems in under-
standing the underlying mechanisms of auriculotherapy
analgesia (18); and ear stimulation in healthy persons is
associated with changed activity in the sympathetic and
parasympathetic nervous system depending on the site of
stimulation and period of observation (19).
Auricolotherapy is a treatment diffusing in all over the
world, and its patterns follow the principles of Chinese
acupuncture, revised and updated, with Chinese maps of
the ear; the principles of Paul Nogier and also the
principles of reflexology basing on somatotopic maps
that do not recognize energetic-based stimulation, while
just the evocation of a reflex stimulating precise areas of
the ear; moreover are used for stimulation of ear skin
many different tools: finger acupressure, laser, electricity,
different types of needles, magnetic balls, seeds.
Actually one of the many methodological problems
with auricular acupuncture is that there are so many
maps of the ear and little agreement exists regarding
point location, lacking definitive anatomic study on ear
eCAM 2007;4(S1) 15
skin and its somatotopic correspondences. Another
problem is that all correspondence or reflex systems do
not correlate to the knowledge of anatomy and physiol-
ogy based on the patterns of mainstream medicine (20).
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20, article repris dans
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4. O’Connor J, Benksy D (transl, ed.) Acupuncture: a comprehensive
text—Shanghai College of Traditional Medicine. Chicago: Eastland,
5. Oleson TD, Kroening RJ, Bresler DE. An experimental evaluation of
auricular diagnosis: the somatotopic mapping or musculoskeletal
pain at ear acupuncture points. Pain 1980;8:217–29.
6. Gori L, Firenzuoli F. Ear acupuncture in the treatment of low back
pain in cancer patients. J Soc Integr Oncol 2005;3:130–3.
7. Barker R, Kober A, Hoerauf K, Latzke D, Adel S, Kain ZN,
Wang SM. Out-of-hospital auricular acupressure in elder patients
with hip fracture: a randomized double-blinded trial. Acad Emerg
8. Usichenko TI, Hermsen M, Witstruck T, Hofer A, Pavlovic D,
Lehman C, Feyerherd F. Auricular acupuncture for pain relief after
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Eckardt A, Hoy L, Buhck H, Bernateck M, Fink M. Auricular
acupuncture for dental anxiety: a randomized controlled trial.
Anesth Analg 2007;104:295–300.
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Korean elderly Taehan kanho Hakhoe Chi 2005;35:1014–24.
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to reduce preoperative anxiety. Anesth Analg 2001;93:1178–80.
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dependence. Cochrane Database Syst Rev 2006;1:CD 005192.
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crack abuse: a review of the efficacy, the use of the National
Acupuncture Detoxification Association protocol, and the selection
of sham points. J Altern Complement Med 2004;10:985–1000.
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treatment of obesity: a review of the evidence. Int J Obes Relat
Metab Disord 2003;27:419–27.
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acupuncture for alcohol withdrawal in comparison with
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16 Ear acupuncture