Correct diagnosis and treatment plan
Before selecting points or beginning treatment, establish a working diagnosis of the patient’s illness in Oriental medical terms. A treatment plan can then be established. For instance, if the patient has a headache at the vertex and you have correctly differentiated this type headache as Liver Yang Rising, the treatment plan then is to subdue the Liver Yang.
Correct point selection according to the energetics that correspond to the diagnosis and treatment plan
Following the establishment of a diagnosis and its related treatment plan, now select points for their best therapeutic value. The energetics of most of the ear points can be chosen from an understanding of Oriental medical theory. In the case listed above concerning the headache at the vertex, select possible points such as the Ear Apex point (which reduces Liver Yang) and the Liver point (to adjust the Liver).
As is true with body acupuncture treatment of illness, the inclusion of ear points that addresses etiological factors assists in a more long-lasting resolution of the problem. Consider the application of this criterion to the Liver Yang Rising headache. First, we must determine the etiology of the Liver Yang Rising. Is the Liver Yang Rising due to Liver Yin Deficiency, Liver Blood Deficiency, Kidney Yin Deficiency, or Earth counteracting on Wood?Points are selected according to the specific etiology of the patient’s problem. For instance, add the Spleen and Stomach points if the headache is due to Earth counteracting on Wood, the Kidney point if the headache is due to Kidney Yin Deficiency, and so forth.
Dr. Chen Gongsun1 points out that an increase in the therapeutic effect of auricular therapy can be gained if one selects a few but good points. He says:
Some practitioners favor the use of seeds on 20 to 30 points or more on one ear for each treatment. This form of treatment is likened to “assembling troops to destroy the enemy.” It is effective for certain diseases. However, a disadvantage of this form of treatment is that there is no specific focus on a particular disease, and it increases the suffering and apprehension of patients. When so many points are used, we cannot determine whether they have a synergistic or antagonistic effect on each other, nor is it clear which point is the main one. Therefore, I concur with the majority of auricular point practitioners that less than four points should be used in each treatment. In general, I subscribe to the use of points on one side sufficient to treat the disease; in fact, for certain diseases, e.g., gastrospasm, sprains, and pain in the fingers, the stimulation of a single auricular point is enough to obtain a good result. The number of points used does not determine the outcome of the treatment. The principle of selecting a few good points guarantees a good result.”
Personally I concur with Dr. Gongsun that we should limit the number of points to be treated in the ear. This will come about naturally if we avoid a symptomatic approach and instead correctly differentiate the syndrome and address etiological factors. It is true that there are times when the one well-chosen point is all that is needed, particularly in cases of pain or disorders with musculoskeletal involvement. For the most part, my typical prescription is about seven to eight points.
Accurate point location
After correct point selection, accurate point location must be achieved. You should be able to define where all the points are. This verbal ability will reinforce your adeptness at location. Study the ear maps and point location descriptions found in Chapter 3, and, most importantly, practice to become proficient at point location by using the ear for treatment. The map presented in this book is traditional, time-tested, and easy to learn and to remember and master.
Appropriate ear modality chosen
Many ear modalities are interchangeable, such as seeds, tacks, pellets, and magnets. Others are a matter of personal or cultural preference, such as massage or needles. Still other modalities are highly correlated with a treatment plan, a diagnosis, a clinical disorder, or the “nature” or physiology of the point. For instance, if the point is more of an area, such as the Sacral Vertebrae or the Constipation area, an intradermal can be more effective because an intradermal stimulates the entire area vs. a specific point. In another instance, if Heat or Fire is present, bleeding is the preferred modality to remove the Heat or Fire. Review Chapter 6 and Table 6.1 for the modalities that are correlated with various conditions.
Correct angle of insertion of needles and intradermals if chosen as a modality
The most common angle of insertion into an ear point is perpendicular. Others are needled at an oblique angle. The angle is usually dictated by the anatomical location of the point, so think about physical access when needling the point. For instance, the Brain point, which is located on the posterior aspect of the antitragus, cannot be needled perpendicularly. One needs to needle obliquely behind the antitragus towards the point.
Apart from physical access into the point, The Nanking Army Acupuncture Book says that “clinical experience has shown that the angle of insertion into a point may relate to its effectiveness.”2 In the event that the desired results are not being met, you can change the angle of insertion to increase the effectiveness of the point. These angles of insertion have not been standardized by any practitioner because there are so many degrees at which the point could potentially be needled. So, if required, experiment and gain your own clinical experience with that point for each patient.
Da Qi sensation obtained in the ear, especially of heat
The degree of ear treatment effectiveness has been correlated with the Da Qi sensation obtained in the ear. While there are various signs of Qi arrival, clinically the sensation of heat perceived by the patient has been shown to be the most effective variable for successful ear treatment. Try to obtain this through accurate point location, best insertion angle, needle technique, and patient perception and feedback.
Patient’s condition and compliance with the modalities
Of course, we must always keep in mind that we are not the healer of an illness. With our expertise, we can certainly help to redirect Qi (energy) according to the natural laws of life; however, healing does not always occur, and we must accept that fact. The patient’s life force may be beyond our ability to reach with ear modalities. Some diseases will be easy to treat, some impossible, and with others the results might be limited.
Another important factor involved in healing is patient compliance. To enhance compliance, inform your patients of the treatment plan and prognosis, and provide them with written instructions of all directives. However, recognize that some variables are beyond our control as practitioners. The patient may not keep appointments or change certain lifestyle factors. Personal resources (i.e., money, transportation, social support for treatment) are oftentimes limited, as is the ability to follow self-treatment instructions.
Correct construction of the ear prescription
As Joseph Helms states, “Auricular acupuncture can serve as a therapeutic input for disorders on any level of manifestation, and anywhere along the material-to-energetic presentation spectrum.”3 This is a reminder that more than physical maladies can be treated with ear acupuncture. Point selection in both body acupuncture and auricular acupuncture is an art because it is based upon the uniqueness of each patient. Therefore, the practitioner must be able to look at the deeper web of physiological and energetic symptoms and decipher them. Still there are guidelines that enter into the formulation of an ear acupuncture prescription that need to be considered.
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