Palpation and massage in Auricular Acupuncture

| July 18, 2011 | 1 Comment | 566 views

Palpation is the process of detecting tender points for diagnosis or treatment by pressing on the ear point. These same points can be treated by rubbing or applying pressure to the point.

A healthy ear point, like a healthy body acupuncture point, should not be tender when pressed or palpated. Tenderness through pressure indicates a problem in the area being tested. Paul Nogier accurately points out that “this does not mean that all pathology is reflected in the ear as it may take time for that pathology to be conveyed to the site. Additionally, this is more likely if there are problems with nervous transmission of information.”1

To perform palpation, use a sterile, stainless steel ear probe (Figure 6.1). Although the probe does not pierce the skin, there is still the possibility of spreading infection from person to person via an unsterilized probe. Therefore, ear probes should be sterile for each patient. Do not swab the ear with alcohol prior to palpation as the alcohol may change the skin’s electrical conductivity or remove pathological discharges, such as suppurations, thus affecting the clinical data derived from observation or palpation.

From an Oriental perspective, when performing ear diagnosis, it is not advisable or necessary to palpate every ear point. First, establish the working diagnosis. Pathology observed in the ear, along with data from other methods, can be used to substantiate a diagnosis. Points relating to the diagnosis can be then palpated and the sensitivity of the ear, if any, used as supporting data.

Apply equal pressure in palpating the points you consider using in your prescription. Points for treatment may be marked by pressing with the probe, or by using a sterile, gentian violet marking pen, or simply by remembering the points. After palpation, such points are generally treated with an ear modality or even with the probe employed as a massage device.

Table 6.1 (continued) Auricular Modalities

Modalities  Conditions
 1. Palpation andMassage
Massage can be applied by the therapist or the patient after
the patient is instructed on where and how to massage
the ear. Mark the spot to be massaged with a pellet or
sterile marking pen.
2. Needles
Needling is the most common auricular therapeutic
modality. Needles can be inserted into any point. Insert
— get Qi — then tonify or disperse. Heat is the most
desired stimulus of Qi arrival. Note: I tend not to needle
the Heart, Brain, Dingchuan, Vagus, or points on the lobe
unless needed because of their strong effect. For these
points, I substitute pellets. However, they are not
contraindicated to needle.
3. Ear Seeds and
Herbal Plasters
Seeds provide a good stimulus due to their size and
density. However, if they are not sterile, they can increase
the risk of infection. Herbal deposits on the seeds can
impart herbal therapeutic benefits.
4. Ear Pellets: gold,
silver, or other
Pellets are a good size modality for auricular treatment.
They provide a perfect stimulus and have the added
benefit of being sterile. Additionally, pellets are available
in various metals. Therefore, pellets can also be used for
their metallurgic properties.
 5. Ear Tacks
Tacks come in various sizes — extra small, small,
medium, and large. The bigger the tac, the stronger the
stimulus, so consider patient tolerance when choosing
the tack size. There can be a higher risk of infection
with ear tacks if patients do not have the tacks removed
at the proper time.
6. Intradermal
Intradermal needles are used for areas such as the
Constipation or Vertebral areas. Do not use in
depressions. The intradermal needle will not go into a
depression easily and may break. Intradermal needles
need to be placed on points on a ridge or flat area.
Intradermals are available in various lengths. Select the
appropriate length based on the size of the point to be
 7. Magnets
Magnets need to be removed at bedtime or if the stimulus
becomes too strong for the patient. They are reusable on
the same patient. Magnets do not pierce the skin, thus
the risk of infection is reduced.
 8. Electroacupuncture
Electricity is good for anaesthetizing a point due to the
electrical machine’s ability to achieve high frequencies
that stimulate the point. Do not clean the ear with alcohol
prior to using the point detector for diagnosis, as this will
change the ear pathology and the electrical resistance of
the ear.
 9. Bleeding
Bleeding is used to reduce Heat/Fire, subdue Yang,
stimulate Qi and Blood, or to move Stagnant Qi and
 10. Moxibustion
Moxa use is limited, but specific to treating earache or the
common cold and other conditions. It can be applied
indirectly over the point or over a needle.
 11. Incisions/Sutures
Incisions/sutures are a technique that is typically not
employed in the U.S. because an incision is considered a
surgical technique. An incision provides a constant
stimulus to the point. Chances of infection are increased
using incisions.
 12. Injections
Injections can be applied to the point with a hypodermic
needle. Common injections include saline, vitamin B12,
certain Chinese herbal formulations, lidocaine, procaine,
and placenta. This procedure is slightly painful due to
the small size of the point, the size of the hypodermic
needle, and the nature of the substance injected.
 13. Laser
Laser therapy is one of the newest modalities. It is painless
and infection is not an issue. Ease of administration also
makes it a good choice in treatment.
 14. Staples
Like incisions and sutures, this is an old technique used
to stimulate points. Seeds or pellets are commonly used
now in the place of staples.
 15. Plum Blossom Needling
This modality may be applied to points of the lobe as well
as used as a method to induce bleeding in the ear.
Figure 6.1 Ear probe

Figure 6.1 Ear probe


Just as palpation is used for diagnosis, palpation is also used as a massage technique by either the patient through self-treatment or by a practitioner.

Ear massage is a relaxing, enjoyable, noninvasive, and clinically effective modality for the treatment of most health disorders. Massage can encompass the entire auricle or it can focus on specific treatment points. I recommend doing both.

Chinese folk culture abounds in tales of “pulling” on the ears 300 times every day to ensure a healthy life and promote longevity. Many Chinese have a story about a relative or friend who lived into his or her one hundreds because that relative or friend practiced ear massage regularly. A Qing dynasty text reads, “Massaging the helix with the hands for a number of times is also called reinforcing the city wall to tonify the Kidney Qi, prevent deafness, and treat insomnia.”2

The Chinese maintain that the ears, which pertain to the Kidney, are the direct manifestation of “fortune” – what the Chinese construe as health, wealth, longevity, and prosperity. The Chinese say, “The bigger the ear, the bigger the fortune.” Other cultures have also viewed the ear as indicative of stamina, status, a sign of Buddhahood, or even representing the seat of the soul.”3

While practitioners have their preferences, there are no set ways to massage the ear. My massage method is more of an “even” technique that disperses tension and, yet, simultaneously brings energy to (tonifies) areas of deficiency. Keep the massage simple and short. An overly complex method will be difficult for the patient or practitioner to follow and execute. Massaging the ear for too long will tend to disperse the patient’s energy.

The patient should remain silent during this treatment so that his energy is allowed to go deep into his body. If you want, you can lead the patient through a guided visualization of what you are doing and how the points correlate with the specific body parts so the patient can develop awareness about the points. However, because this is a treatment that requires quietude, avoid discussion. By treating the whole ear, all of the points are stimulated, thereby treating the person in a very comprehensive way. Preferably, overall ear massage should be done prior to the body acupuncture treatment. Massage at the end of the treatment disrupts the focus achieved through the body acupuncture. Patients love ear massage. It takes only a few minutes to administer and, based on my own clinical experience and patient feedback, has a positive effect on balancing body energetics.

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