Needles in Auricular Acupuncture

| July 19, 2011 | 0 Comments | 343 views

In China, needling is the most common ear modality practiced, although seeds are also used. In terms of thickness, the Chinese prefer a thick gauge needle, such as a #28 gauge, in order to obtain a strong Da Qi sensation in the ear. Fine needles are likely to bend easily on insertion and may fail to deliver the appropriate needle stimulus. However, if the patient is needle sensitive, if the ear is thin, or if the practitioner has a good needle technique, fine needles, such a #34 or #36 gauge, can work (Figure 6.4).


Short needles, such as half-inch (15 m

Figure 6.4 Ear needles

Figure 6.4 Ear needles

m), needles should be used since the points in the ear have a shallow depth of insertion. In general, the longer the needle, the more likely it is to fall out because of its weight in relation to the depth of needle insertion. If it falls out, it can tear delicate ear tissue.

To initiate treatment with needles, swipe the patient’s ear with an alcohol prep or a cotton ball wet with 70% isopropyl alcohol. You can ask the patient to swipe his or her own ear. This simple step involves the patient in the treatment process, which is a useful treatment strategy. Because of the strength of the ear response when it is treated and the powerful manner in which the Qi and Blood are regulated in the ear (with the exception of massage), normally only one ear is needled or treated with any ear modality.

Next, stabilize the patient’s ear by supporting the back of the area to be needled with the nondominant hand. Care must be taken not to penetrate through the entire ear with the needle, so feel the thickness of the patient’s ear as you prepare to treat. Position the hand holding the needle as closely as possible to the point to be needled. With a half-inch needle, use a free-hand insertion. An insertion tube is not needed for needling ear points all of which have a very shallow depth of about 0.01 in. Freehanded insertion is more accurate in such a small spatial field. When released, the needle should be firmly embedded in the tissue and not left hanging in the ear, which is an improper needling technique that causes pain.

The “secret” to reducing pain either in the ear or in the body begins with the rapid speed of insertion. This swift motion allows for firm penetration of the outermost layer of the skin. The free nerve endings that register pain are embedded in the epidermis or outermost layer of the skin. Slow needling causes pain because the needle lingers through this area. Also, when there is pain, patients typically move to try to get away from it. The skin in the point can then tear as the patient moves from the needle.

After insertion, press the needle slightly into the point and then rotate manually with small amplitude in order to obtain Qi. The Qi in the ear typically arrives quickly if the ear point location is correct. Various Da Qi sensations may be elicited in the ear, but from a clinical standpoint the Chinese maintain that the most desirable sensation in terms of clinical effectiveness is heat. Other sensations, similar to the arrival of Qi in the body, include soreness, tingling, referred sensation, numbness, distention, heaviness, awareness of energy, a mild electrical feeling, warmth, mild throbbing, and a spreading or jumping sensation. Patients may be inclined to report that they feel the needling as painful. Indeed, because of the amount of Qi converged in the ear as well as the ear’s degree of vascularization and innervation, one may be inclined to describe the sensation that way. At this point, you should educate the patient as to the meaning of the feeling; that is, the perception is Qi obtained through proper needling vs. pain. Most of the time Qi arrival in the ear is strong and swift.

If the Da Qi sensation (Qi arrival) is not perceived, the angle of insertion of the needle can be adjusted by making it more oblique, directing it upwards or downwards, or medially or laterally. Which direction to alter it is virtually impossible to predict or to standardize. The practitioner is encouraged to practice and develop a proficient needle technique and to gain his or her own experience.

Without delay, as soon as the Qi arrives, proceed to tonify or disperse the point depending upon your treatment plan. While David Legge claims that auricular acupuncture tends to have a dispersive technique,5 others, including myself, would also assert that it is used both to tonify and disperse. Perhaps the best tonification technique in the ear is simply to exert a small twist in a clockwise direction. To disperse, use a more vigorous rotation or turn in a counterclockwise direction. If rotating the needle causes pain (vs. Qi arrival), turn the needle the opposite way. In this case, Helmut Kropej recommends rotating the needle once clockwise and once counterclockwise.6

If there is persistent pain at the site of needling, remove the needle and consider other points or other methods to use. If a sticking sensation is felt upon needle manipulation, the point is still in need of treatment.

Once that tension is relieved or worked out, the affected part is considered treated. Often during treatment the needle that was originally firmly in place falls out of the point. What has occurred is that the Qi has expelled the needle from the ear. This means that the work of the needle has been accomplished.

Due to its rich vascularization, the ear may bleed easily when needled. If bleeding occurs, allow the ear to bleed instead of trying to stop the flow. Absorb the droplets with a sterile cotton ball. Wear gloves to guard against the transmission of blood-borne pathogens. Purposeful ear bleeding is an ear acupuncture technique that is discussed later in this chapter.

A small number of needles are often sufficient to produce decisive results in treatment. Several needles are sometimes inserted into the same point for added therapeutic effect. Some practitioners let their patients leave the office with an ear needle in place. In that case they need to be told what to do in the event of ear bleeding and how to dispose of the needle properly. This is not a technique that I employ or advocate, as there are numerous other take-home modalities from which to choose.

Needles are typically retained for 15 to 20 minutes. However, in acute cases, needles may be left in for several hours without depleting the body’s energy. As a clinical tip, due to its soft composition, I prefer not to needle the ear lobe. The needle is not as well retained in the lobe as it is in the cartilage or in the connective tissue of the upper aspect of the ear, so other modalities can be selected to treat points on the ear lobe.

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