NeuroRehabilitation 17 (2002) 49–62 49

IOS Press

Auriculotherapy stimulation for

neuro-rehabilitation
Terry Oleson
Auriculotherapy Certification Institute, 8033 Sunset Blvd., PMB #270, Los Angeles, CA 90046-2427, USA
Tel.: +1 323 656 2084; Fax: +1 323 656 2085; E-mail: t oleson@pacbell.net

Abstract: The capability of reflex points on the external ear to alter neuromuscular and neuropathic disorders has been attributed
to the descending pain inhibitory pathways of the central nervous system. The inverted fetus perspective of the somatotopic
arrangement of auricular acupuncture points was first described in the 1950’s by Dr. Paul Nogier of France, and has received sci-
entific support from double blind studies examining auricular diagnosis of musculoskeletal and of coronary disorders. Acupunc-
ture points on the ear and on the body have lower levels of electrical skin resistance than surrounding tissue. These electro-
dermal differences are apparently related to autonomic control of blood vessels rather than increased sweat gland activity. The
heightened tenderness of reactive acupuncture points may be explained by the accumulation of noxious, subdermal substances.
Electrical stimulation of specific points on the external ear leads to site specific neural responses in different regions of the brain.
Behavioral analgesia produced by auricular acupuncture can be blocked by the opiate antagonist naloxone, indicating the role of
endorphinergic systems in understanding the underlying mechanisms of auriculotherapy. The anatomical structures and electrical
application of the auricle are described as they relate to the localization of master points, musculoskeletal points, internal organ
points, and neuroendocrine points.

Keywords: Auriculotherapy, ear acupuncture, microsystems, neuromuscular disorders, electrical skin resistance, descending pain
inhibitory system

1. Introduction evations of endorphins immediately follow auricular

Since the discovery of stimulation produced analge-
sia by Liebeskind et al. [1], electrophysiological per-
spectives of the modulatory role of neurological re-
flex pathways have been increasingly explored. In
addition to the specific nerve tracts which carry as-
cending, nociceptive signals to specific brain regions,
there is a separate set of descending pathways from
the brain which have the ability to inhibit the noci-
ceptive impulses, and thus suppress the perception of
pain [2]. Because the opiate antagonist naloxone blocks
both stimulation-produced analgesia from brain stim-
ulation [3] and blocks analgesia from stimulation of
acupuncture points [4], the descending pain inhibitory
system has been strongly associated with endorphiner-
gic pathways in the brain and spinal cord [5,6]. Anal-
gesia from the electrical stimulation of auricular acu-
points is also reversed by naloxone [7] and distinct el-
stimulation [8,9]. Subsequent research has also sug-
gested that cortisol, serotonin and norepinephrine also
play a significant role in these neural pathways which
regulate pain [10]. The essence of these neurophys-
iological theories is that the nociceptive signals from
peripheral nerves ascending to the higher brain can be
blocked by descending impulses from the brain itself.
Auriculotherapy and classical acupuncture are viewed
as clinical procedures for stimulating the peripheral
reflexes, which activate these central brain pathways,
thus inhibiting the maladaptive reflexes that contribute
to neuromuscular disorders.
While the stimulation of acupuncture points near a
region of body pathology has received moderate ac-
ceptance by Western trained scientists [11], the use of
remote acupuncture points to treat pathological organs
that are distant from the site of stimulation arouses con-
siderable skepticism. It seems plausible that activa-

ISSN 1053-8135/02/$8.00  2002 – IOS Press. All rights reserved

50 T. Oleson / Auriculotherapy stimulation for neuro-rehabilitation

tion of tissues immediately surrounding a stimulating Inverted Fetus on Ear

electrode could directly alter the bioelectric fields and
the biochemical environment of nearby cells. The un-
derlying mechanisms for remote acupuncture points,
however, seems less apparent. At the very least, there
would be significant decay of the electrical signal as it
traveled over the body from the ear to the hand or to
the foot. Nonetheless, electrical stimulation of specific
regions of the external ear has been shown to allevi-
ate pathological conditions throughout the body [12].
What is often misunderstood is that the electrical sig-
nals from the external ear do not directly flow to dis-
tal regions of the body. The actual pathway is more
circuitous, traveling along neuron fibers from the auri-
cle to the brain, from the brain down the spinal cord,
and from spinal nerves to the correspondent region of
the body. These circuitous communication pathways
along the nervous system allow the activation of auric-
ular acupoints to alleviate disorders in widespread parts
of the body. The arrangement of auricular acupoints
can be viewed as an inverted somatotopic map of the
body. According to this view, upper regions of the ex-
ternal ear are used to alleviate conditions in the legs and
feet, middle regions of the auricle represent the chest
Fig. 1. Inverted fetus map represented on the external ear.
and back, and lower regions of the auricle can relieve
headaches and brain disorders. The purpose of this
presentation is to review the history, theories, clinical Penfield and Rasmussen for the human cerebral cor-
studies, and neurophysiological research which has ex- tex [16]. Neurophysiological research revealing a con-
amined the field of auriculotherapy and its relationship nection between this Nogier auricular map and the so-
to neuro-rehabilitation. matotopically organized neurons in the brain is in only
the initial stages of scientific investigations.
Nogier [17] suggested that there are three different
2. Somatotopic organization of auricular zones on the external ear which are related to differ-
acupuncture points ent types of neural innervation and different categories
of embryological tissue. A picture of the external ear
In traditional acupuncture theory, chronic pain and identifying the nomenclature for different anatomical
pathological diseases are due to the blockage of energy regions of the auricle are shown in Fig. 2, whereas the
flow along acupuncture meridians, invisible lines of specific functional zones of the ear are represented in
force extending over the surface of the body. Ancient Fig. 3. The central concha of the ear is innervated by the
Oriental medical texts described direct energy connec- vagus nerve and serves as the region for autonomic reg-
tions between the yang acupuncture meridians which ulation of pain and pathology originating from internal
connect to the head and acupuncture points found on organs [18]. The surrounding antihelix and antitragus
the external ear [13]. In 1958, the Chinese revised their ridges of the ear represent somatic nerve processing of
charts of auricular acupuncture points after they learned myofascial pain, backaches, and headaches [19]. The
of the inverted fetus map discovered by Dr. Paul No- outer helix tail and the lobe represent the spinal cord
gier, of Lyon, France [14]. This inverted fetus image and brain regions which affect neuropathic pain,such as
is shown in Fig. 1. Nogier was familiar with an energy peripheral neuropathies and trigeminal neuralgia. The
perspective of the human body from his studies of the body organs represented on the external ear can also be
French acupuncturist Georges Soulie de Morant [15]. viewed as three concentric rings. The embryologically
The somatotopic pattern on the external ear was com- based endodermal organs are found at the center of
pared to the neurological homunculus demonstrated by the ear, the mesodermal tissue that become the somatic
 T. Oleson / Auriculotherapy stimulation for neuro-rehabilitation 51

Auricular Anatomy 3. Neurophysiological theories of acupuncture and

micro-acupuncture systems
❍ Helix

Triangular Superior
Crus
According to Ralph Alan Dale [20], the homuncu-
Fossa
lus pattern shown on the external ear is one of sev-
● ❍ eral micro-acupuncture systems that connect periph-
Inferior eral regions of the body to the central nervous sys-
Crus
❍ Scaphoid
tem. Dale suggested that these microsystem points
Superior ● Fossa have remote reflex connections to other parts of the
Concha ● ❍
Antihelix body through neuronal pathways in the central nervous
Body system. Dale has proposed that there are both organo-
Tragus ●
Concha cutaneous reflexes which allow the microsystem to re-
❍ Ridge
● ❍ veal underlying body pathology and cutaneo-organic
Inferior reflexes which enable micro-acupuncture stimulation to
Concha ❍ Antihelix
Tail alleviate the pathological condition. Foot reflexology,
❍ hand acupuncture, and scalp acupuncture are other ex-
Intertragic Antitragus amples of such micro-acupuncture systems, each serv-
Notch
❍ Lobe ing as peripheral terminals to a central regulating sys-
tem.
Tsun-nin Lee [21] has hypothesized a thalamic neu-
Fig. 2. Identification of specific anatomical regions of the auricle. ron theory to account for reflex connections between
acupuncture points and the brain. According to this
view, pathological changes in peripheral tissue will
eventually lead to dysfunctional neural firing patterns
in the correspondent neural microcircuits in the brain
and spinal cord. The organization of the connections
Mesodermal Area
between peripheral nerves and the CNS is controlled
Somatic Nerves by sites in the sensory thalamus that are arranged like
Myofascial Tension the overall body, but inverted. The CNS institutes cor-
rective measures intended to normalize the disordered
neural circuits, but strong environmental stressors or
Endodermal Area
Autonomic Nerves
intense emotions may cause the CNS circuitry to mal-
Visceral Disorders function. If the neurophysiological programs in the
neural circuits are impaired, the peripheral disease may
remain chronic. Pain and disease are thus attributed
to learned, maladaptive programming of these central
Ectodermal Area
Brain and Spinal Cord
neural circuits. Stimulation of acupuncture points on
Neuropathic Disorders the body or on the ear can serve to induce a reorganiza-
tion of these pathological brain pathways. The spatial
arrangement of these neuronal chains within the thala-
Fig. 3. Identification of three functional regions of the auricle.
mic homunculus is said to account for the arrangement
of acupuncture meridians in the periphery. Nogier [15]
musculature is represented on the middle ridges of the had suggested a similar theory to explain auriculother-
auricle, and the ectodermal skin and nervous system apy. The auricular acupuncture system is said to be
tissue are found on the outer ridges of the ear. Each of arranged in a somatotopic pattern on the auricular skin
these three auricular regions depicts body orientation in surface that connects to the somatotopic circuits to the
an inverted somatotopic pattern. Organs higher in the brain.
body, such as the endodermal lungs, the mesodermal,
shoulder or the ectodermal cerebral cortex, are repre-
4. Electrodermal determination of acupuncture
sented on lower areas of the auricle, whereas organs points
lower in the body, such as the intestines, the leg, or the
lumbar spinal cord, are represented on higher areas of Double blind assessment of the somatotopic pattern
the auricle. of musculoskeletal reflex points on the auricle was first
52 T. Oleson / Auriculotherapy stimulation for neuro-rehabilitation
conducted by Oleson et al. in 1980 [22]. Forty patients
with specific musculoskeletal pain problems were eval-
uated by a UCLA doctor or nurse to determine the ex-
act body location of their physical pain. These patients
were then draped with a sheet to cover their body so that
only their external ear was exposed to view. Crutches
and braces were removed from the room in order to
prevent any clues as to the nature of their condition. A
second medical doctor, who had extensive training in
auricular acupuncture procedures, then examined each
patient’s ear. This second doctor had no prior knowl-
edge of the subject’s previously established medical di-
agnosis and was not allowed to verbally interact with
the patient. Auricular diagnosis was determined by nu-
merically rated levels of tenderness to a palpating probe
and by the quantified electrical conductivity of the skin.
Specific areas of the auricle were examined which were
associated with different musculoskeletal regions of the
body. There was a positive correspondence between
auricular points identified as reactive, both tender to
palpation and exhibiting at least 50 microamps of elec-
trical conductivity, and the parts of the body where there
was musculoskeletal pain. Non-reactive ear points cor-
responded to parts of the body from which there was
no reported pain. The statistically significant, overall
correct detection rate was 75.2%. When the pain was
located on only one side of the body, electrical conduc-
tivity was significantly greater at the somatotopic ear
point on the ipsilateral ear than at the corresponding
area of the contralateral ear. These results supported
the concept that specific areas of the ear are related to
specific areas of the body.
Auricular points related to coronary disorders were
examined by Saku et al. [23] in Japan. Reactive elec-
tropermeable points on the ear were defined as auric-
ular skin areas that had conductance of electrical cur-
rent greater than 50 microamps, indicating relatively
low skin resistance. There was a significantly higher
frequency of reactive ear points at the Chinese heart
points in the inferior concha (84%) and on the tra-
gus (59%) for patients with myocardial infarctions and
angina pain than for a control group of healthy subjects
(11%). There was no difference between the coronary
heart disease group and the control group in the electri-
cal reactivity of auricular points that did not represent
the heart. The frequency of electropermeable auricular
points for the kidney (5%), stomach (6%), liver (10%),
elbow (11%), or eye (3%), was the same for coronary
patients as for individuals without coronary problems.
Quantified examinations of the electrical properties
of the skin have provided the most objective demonstra-
tion of the scientific validity of acupuncture points [24,
25]. Observations that acupuncture points exhibit
higher levels of skin conductance than surrounding skin
surface areas, or lower levels of skin resistance, were
first reported in the 1950’s by Nakatani in Japan and
by Niboyet in France [26]. In the 1970’s, Matsumoto
found that 80% of acupuncture points could be detected
as low resistance points. The electrical resistance of
acupuncture points was found to range from 100 to
900 kilohms, whereas the electrical resistance of non-
acupuncture points ranged from 1,100 to 11,700 kilo-
hms. Taking great care to control for electrical resis-
tance variance due to pressure on the skin by the de-
tecting probe, Reichmanis, Marino, and Becker [27,
28] systematically verified that the electrodermal resis-
tance at acupuncture points is significantly lower than
surrounding tissue. In addition, meridian acupuncture
points exhibit even lower electrical resistance when
there is pathology in the organ they represent. The nor-
mal, bilateral symmetry of the electrical resistance of
acupuncture points is disturbed when there is unilateral
pathology in the body.
Xianglong et al. [29] of China examined 68 healthy
adults for computerized plotting of low skin resistance
points. A silver electrode was continuously moved
over a whole area of body surface, while a reference
electrode was fastened to the hand. Starting from the
distal ends of the four limbs, investigators moved the
electrode along the known meridians. The resistance of
low skin impedance points (LSIP) was approximately
50 kilohms, whereas the impedance at non-LSIP was
typically 500 kilohms. LSIP’s were distributed over the
body predominantly along the 14 classical acupuncture
meridian channels. A total of 64% of LSIP’s were
located exactly on a meridian and 83.3% were located
within 3 mm of an acupuncture channel. Individual
LSIP’s could be found in non-meridian areas in only a
few cases. There was not an uninterrupted, continuous
line of low skin impedance, but a series of electroactive
points distributed along the meridian channel. There
was no marked natural fluctuation of skin impedance
and the distribution of LSIP’s was considerably stable
and repeatable from one day to the next.
Chiou et al. [30] examined the topography of low
skin resistance points (LSRP) in rats. The moveable
search electrode was a polished acupuncture needle ap-
plied with uniform pressure which did not pierce the
skin, while the reference electrode was a needle sub-
dermally inserted into the tail. Specific LSRP loci
were distributed symmetrically and bilaterally over the
shaved skin of the animal’s ventral, dorsal, and lateral
 T. Oleson / Auriculotherapy stimulation for neuro-rehabilitation
surface. The arrangement of LSRP corresponded to
the acupuncture meridians found in humans. The LSR-
P’s were hypothesized to represent zones of autonomic
concentration, the higher electrical conductivity due to
higher concentration of neural and vascular elements
beneath the points. The LSRP’s gradually disappeared
30 minutes after the animal’s death.
Skin and muscle tissue samples were obtained by
Chan et al. [31] from four anesthetized dogs. Acupunc-
ture points, defined by regions of low skin resistance,
were compared to control points exhibiting less con-
ductivity. The points were marked for later histological
examination. Concentration of substance P was signif-
icantly higher at skin acupuncture points (3.33 ng/g)
than at control skin points (2.63 ng/g) that did not ex-
hibit low skin resistance. Concentration of substance
P was also significantly higher in skin tissue samples
(3.33 ng/g) than in the deeper, muscle tissue samples
(1.81 ng/g). Substance P is known to be a spinal neu-
rotransmitter found in nociceptive, afferent C-fibers. It
plays a role in pain transmission, stimulates contractil-
ity of autonomic smooth muscle, induces subcutaneous
liberation of histamine, causes peripheral vasodilation,
and leads to hypersensitivity of sensory neurons. This
neurotransmitter seems to activate a somato-autonomic
reflex that could account for the clinical observations
of specific acupuncture points that are both electrically
active and tender to palpation [32].
Experimentally induced changes in auricular reflex
points in rats were examined by Kawakita et al. [33].
The submucosal tissue of the stomach of anesthetized
rats was exposed, then acetic acid or saline was injected
into the stomach tissue. Skin impedance of the auricu-
lar skin was measured by constant voltage, square wave
pulses. A silver metal ball, the search electrode, was
moved over the surface of the rat’s ear and a needle was
inserted into subcutaneous tissue to serve as the refer-
ence electrode. Injection of acetic acid led to the grad-
ual development of lowered skin resistance points on
central regions of the rats’ ears, auricular areas which
correspond to the gastro-intestinal region of human
ears. In normal rats and in experimental rats before the
surgical operation, low impedance points were rarely
detected on the auricular skin. After experimentally
induced peritonitis, there was a significant increase in
low impedance points (0–100 kilohms) and moderate
impedance points (100–500 kilohms), but a decrease
in high impedance points (greater than 500 kilohms).
These results demonstrated a reduction in the electro-
dermal resistance response to experimentally induced
irritation of the internal organ related to that auricular
53
point. Histological investigation could not prove the
existence of sweat glands in the rat auricular skin. The
authors suggested that the low impedance points are in
fact related to sympathetic control of blood vessels.
5. Changes in brain responses related to auricular
reflexes
Further evidence of the neurophysiological connec-
tion between the external ear and the brain has been
provided by animal research. Kalyuzhnyi [34] applied
15 Hz electrical stimulation to the auricular lobe of
rabbits, an area corresponding to the jaw and teeth in
humans. They measured behavioral reflexes and cor-
tical somatosensory evoked potentials in response to
tooth pulp stimulation. Auricular electroacupuncture
produced a significant decrease in behavioral reflexes
and in cortical potentials evoked by electrical stimula-
tion of the teeth. For most animals, the suppression
of the behavioral and neurophysiological nociceptive
responses was abolished by injection of the opiate an-
tagonist naloxone, suggesting endorphinergic mecha-
nisms. Fedoseeva et al. [35] also examined electrical
stimulation of auricular acupuncture at ear lobe points
of rabbits, in the auricular area representing the trigem-
inal nerve. Auricular electroacupuncture led to a re-
duction of the amplitude of cortical somatosensory po-
tentials evoked by tooth pulp stimulation. Intravenous
injection of the opiate antagonist naloxone diminished
the analgesic effect of auricular electroacupuncture at
15 Hz stimulation frequencies, but not at 100 Hz stimu-
lation. Conversely, injection of saralasin, an antagonist
of angiotensin II, blocked the analgesic effect of 100 Hz
auricular acupuncture, but not 15 Hz stimulation.
Asamoto and Takeshige [36] studied selective acti-
vation of the hypothalamic satiety center by auricular
acupuncture in rats. Electrical stimulation of inner re-
gions of the rat ear, which corresponds to auricular rep-
resentation of the gastro-intestinal and thoracic organs,
led to evoked potentials in the ventromedial hypotha-
lamus (VMH) satiety center, but not in the lateral hy-
pothalamic (LH) feeding center. Stimulation of more
peripheral regions of the auricle did not activate hy-
pothalamic evoked potentials, indicating the selectivity
of auricular acupoint stimulation. Acupuncture needles
were subsequently placed into the same auricular sites
as those that led to VMH evoked potentials in the first
set of rats. After 16 days, the body weights of rats in
the auricular acupuncture group was significantly lower
than in a control group of rats that were not treated.
54 T. Oleson / Auriculotherapy stimulation for neuro-rehabilitation
Auricular acupuncture had no effect in rats who had
received bilateral lesions of the VMH, thus indicating
that the integrity of the hypothalamus was essential for
achieving this weight loss effect.
Shiraishi et al. [37] also recorded hypothalamic neu-
rophysiological activity in the VMH and LH of rats in a
different manner. Single unit neuronal discharge rates
were recorded in the hypothalamus following electri-
cal stimulation of low resistance regions of the infe-
rior concha of the rat, areas of the ear innervated by
the vagus nerve. Auricular stimulation tended to facil-
itate neuronal discharges in the VMH and inhibit neu-
ral responses in the LH. Responses of 162 VMH neu-
rons showed that 44.4% exhibited increased neuronal
discharge to auricular stimulation, 3.7% exhibited de-
creased activity, and 51.9% showed no change. Of
224 LH neurons in these rats, 22.8% were inhibited by
auricular stimulation, 7.1% were excited, and 70.1%
were unaffected. When the analysis was limited to 12
rats classified as responding to auricular acupuncture
stimulation with weight loss, 49.5% of LH units were
inhibited, 15.5% were excited, and 35.0% were not af-
fected by auricular stimulation. A different set of rats
were given lesions of the VMH, which led to signif-
icant weight gain. In these hypothalamic obese rats,
53.2% of 111 LH neurons were inhibited by auricular
stimulation, 1.8% showed increased activity, and 45%
were unchanged. These neurophysiological findings in
animals suggest that auricular acupuncture selectively
activates one area of the hypothalamus while it inhibits
another. Other studies have demonstrated the ability of
stimulation of the specific auricular points to alter elec-
trophysiological measures of gastro-intestinal activity
in humans [38,39].
Auricular acupuncture has also been shown to sup-
press autonomic electrodermal activity associated with
the startle reflex to arousing stimuli. Young and Mc-
Carthy [40] conducted a controlled clinical trial on
38 healthy human volunteers. Forearm electrodermal
recordings (EDR) to different stimuli were obtained
when a needle was inserted into the auricular sympa-
thetic point. In another set of subjects, EDR levels were
recorded when a needle was inserted into a placebo au-
ricular point not associated with autonomic regulation.
Electrodermal responses were consistently lower fol-
lowing stimulation of the auricular sympathetic point
than when needles were placed in the placebo point,
suggesting that the auriculotherapy attenuated the au-
tonomic startle reflex.
The most conclusive evidence that needle stimula-
tion of acupuncture points can selectively activate dif-
ferent areas of the brain has been provided by brain
imaging research conducted by Cho et al. [41]. Base-
line recordings of functional magnetic resonance im-
ages (fMRI) activity were obtained and changes in
fMRI activity were recorded following visual stimula-
tion versus auditory stimulation. Needles were then
inserted into different acupuncture points of the human
volunteers. Acupuncture points that are typically used
for visual disorders led to changes of fMRI typically in
the visual cortex, whereas needles inserted into another
set of acupoints that are typically used to affect hear-
ing disorders selectively activated fMRI activity in the
auditory cortex. The first demonstrations of fMRI of
brain activity following ear acupuncture was reported
by Alimi [42] at the Third International Symposium
of Auriculotherapy and Auricular Medicine in Lyon,
France; 2000. Manipulation of gold needles inserted
into the thumb region of the auricle activated the same
areas of the brain as tactile stimulation of the actual
thumb.
6. Mechanisms for withdrawal from opiate drugs
by auricular acupuncture
The discovery by H.L. Wen [43] that auricular
acupuncture facilitates withdrawal from narcotic drugs
has led to a plethora of studies demonstrating the ap-
plication of this technique for substance abuse [44,45].
Auricular electroacupuncture has been shown to raise
levels of met-enkephalin levels in human narcotic ad-
dicts [46] and beta-endorphin levels in mice withdrawn
from morphine [47–49]. Pert et al. [50] showed that
7 Hz electrical stimulation through needles inserted into
the concha of the rat produced an elevation of hot plate
threshold which was reversed by the opiate antagonist
naloxone. The behavioral analgesia to auricular elec-
troacupuncture was accompanied by a 60% increase in
radioreceptor activity in cerebrospinal fluid levels of
endorphins, which was significantly greater than the
endorphin changes observed in a group of control rats.
Concomitant with these CSF changes, auricular elec-
troacupuncture produced depletion in beta-endorphin
radioreceptor activity in the ventromedial hypothala-
mus and the medial thalamus. Supportive findings from
human patients suffering from back pain was demon-
strated by Clement-Jones et al. [51]. Low frequency
electrical stimulation of the concha region of the ear
led to relief of back pain within 20 minutes of the onset
of electroacupuncture and an accompanying elevation
of radioassays for CSF beta-endorphin activity in all 10
 T. Oleson / Auriculotherapy stimulation for neuro-rehabilitation
back pain patients. Abbate et al. [52] examined endor-
phin levels in 65 patients who were undergoing thoracic
surgery with 50% nitrous oxide and 50 Hz auricular
electroacupuncture. These patients were compared to
six control patients who underwent surgery with 70%
nitrous oxide, but no acupuncture stimulation. The
auricular acupuncture patients showed a significantly
greater increase in beta-endorphin immunoreactivity.
Simmons and Oleson [53] examined naloxone re-
versibility of auricular acupuncture analgesia to acute
induced pain. All 40 volunteers were assessed for tooth
pain threshold by a dental pulp tester. Dental pain lev-
els were determined before and after auriculotherapy
and then again after double blind injection of nalox-
one or placebo. Subjects were assigned to one of four
groups: true auricular electrical stimulation (AES) fol-
lowed by an intravenous injection of naloxone; true
AES followed by an injection of saline; placebo stimu-
lation of the auricle followed by an injection of nalox-
one; or placebo stimulation of the auricle followed by
an injection of saline. Dental pain thresholds were sig-
nificantly increased by AES conducted at appropriate
auricular points for dental pain. Pain thresholds were
not altered by sham stimulation at inappropriate auric-
ular points. Naloxone produced a slight reduction in
dental pain threshold in the subjects given true AES,
whereas the true AES subjects who were then given
saline showed a further increase in pain threshold. The
minimal changes in dental pain threshold shown by the
sham auriculotherapy group were not significantly af-
fected by saline or by naloxone. Pain threshold levels
did not completely return to baseline after naloxone,
suggesting non-opioid as well as endorphinergic brain
mechanisms.
Kroening and Oleson [54] examined 14 chronic
pain patients who were switched from their original
analgesic medication to an equivalent dose of oral
methadone, typically 80 mg per day. An electrodermal
point finder was used to determine areas of low skin re-
sistance for the lung point and the shen men point. Nee-
dles were bilaterally inserted into these two ear points
and electrical stimulation was initiated between two
pairs of needles. After 45 minutes of electroacupunc-
ture, these hospitalized pain patients were given peri-
odic injections of small doses of naloxone (0.04 mg
every 15 minutes). The daily dose of methadone was
cut in half each day, presuming there were no aversive
withdrawal effects. All 14 patients were withdrawn
from methadone within 2 to 7 days, for a mean of 4.5
days. Only a few patients reported any side effects,
such as mild nausea or agitation. The authors proposed
55
that the occupation of opiate receptor sites by narcotic
drugs leads to the inhibition of the activity of natural
endorphins, whereas auricular acupuncture facilitates
withdrawal from these drugs by activating the release
of previously suppressed endorphins. By giving small,
incremental doses of naloxone administration after au-
ricular acupuncture, it was theorized that opiate recep-
tor sites can be allowed to more readily return to their
normal state.
Other biochemical changes also accompany auricu-
lar acupuncture. Jaung-Geng et al. [55] evaluated lactic
acid levels from pressure applied to ear vaccarie seeds
positioned over the liver, lung, san jiao, endocrine, and
thalamus (subcortex) points. Pressure applied to ear
points produced significantly lower levels of lactic acid
obtained after physical exercise on a treadmill test than
when ear seeds were placed over the same auricular
points but not pressed. Actual stimulation of these au-
ricular acupressure points seemed to reduce the toxic
elevations of lactic acid build-up to a greater extent
than did the control condition, perhaps due to improved
peripheral blood circulation. Debrecini [56] examined
changes in plasma ACTH and GH levels after 20 Hz
electrical stimulation through needles inserted into the
adrenal point on the tragus of the ears of 20 healthy
females. While GH secretions increased after elec-
troacupuncture, ACTH levels remained the same.
7. Auricular anatomical regions
The practice of auricular acupuncture begins with an
in depth appreciation of the complex curvatures that
compose the anatomy of the external ear. In accordance
with its purpose as the most distal component of the
auditory system, the auricle of the ear is shaped to con-
form to the undulating waves of sound that arrive at the
ear. International standardized nomenclature for these
anatomical areas was agreed upon at a 1990 meeting of
the World Health Organization [57]. The auricle con-
sists of a series of circular ridges and valleys that finally
focus sound input into the auditory canal at the center
of the external ear. The most outer ridge of the auricle
is referred to as the helix, which is a Latin term for a
spiral pattern. An inner ridge within this outer rim is
called the antihelix, indicating a spiral structure oppo-
site to another spiral configuration. These two regions
of the ear are illustrated in Fig. 3. The helix is further
subdivided into a central helix root, an arching superior
helix, and the outermost helix tail. The subsections of
the antihelix include an antihelix tail at the bottom, an
56 T. Oleson / Auriculotherapy stimulation for neuro-rehabilitation
Master Points
Allergy Point
Autonomic
Sympathetic Shen Men
Point
Point Zero
Master
Oscillation
Point
Tranquilizer
Point
Endocrine Thalamus
Point Subcortex
Point
Master
Cerebral
Master
Sensorial
Fig. 4. Location of master points on the auricle.
antihelix body in the middle, and two branches from the
antihelix body, the superior crus and the inferior crus.
Between these two arms of the upper antihelix lies a
deeper region, the triangular fossa, whereas the valley
of the scaphoid fossa separates the antihelix from the
helix tail.
Covering the auditory canal is a flat section of the
ear known as the tragus. Opposite to the tragus is a
ridge that is labeled the antitragus. It is a curving,
descending continuation of the antihelix. Below the
antitragus is the soft, fleshy ear lobe and between the
antitragus and the tragus is an area known as the in-
tertragic notch. The deepest region of the ear is called
the concha, indicating it is shell shaped in its structure.
The concha is further divided into an inferior concha
below, a superior concha above, a concha ridge in be-
tween, and a concha wall which surrounds the whole
concha floor. Two hidden areas of the ear include the
subtragus underneath the tragus and the internal helix
underneath the helix. On the back side of the ear is a
whole surface referred to as the posterior auricle. This
hind portion of the ear is subdivided into a posterior
groove behind the antihelix, a posterior lobe behind the
lobe, a posterior concha behind the concha, a posterior
triangle behind the triangular fossa, and the posterior
periphery behind the scaphoid fossa and helix tail. Tak-
ing the time to visually recognize and tactilely feel the
different contours of the ear will greatly assist one in
applying the auricular somatotopic correspondences to
specific anatomical structures.
8. Auricular master points
The relationship of each anatomical region of the
auricle to clinical applications has been described in
previous publications by Oleson et al. [58] and in vari-
ous clinical texts on auricular acupuncture [13,14,59].
The first set of ear acupoints to be considered are re-
ferred to as master points or tune-up points, shown in
Fig. 4. These auricular points do not correspond to one
specific body organ, but affect many different medical
conditions. They thus have a “mastery” over the gen-
eral health of the body. Stimulation of these master
points is said to “tune-up” or correct metabolic mal-
functions. The master points identified as point zero
and shen men are utilized in almost all auriculotherapy
treatment plans and seem to facilitate the improvement
of most health disorders. Point zero was first described
by Nogier and is found in a notch on the helix root
as it rises from the concha ridge. Besides serving as
an anatomical landmark that indicates the central most
position of the auricle, point zero is thought to function
as a homeostatic point which balances dysfunctional
conditions. The shen men point is similar in function to
point zero, purportedly producing a general balance of
physiological activity. It is clinically used to alleviate
stress, pain, tension, anxiety, depression, and substance
abuse disorders. The English translation of shen men
is “spirit gate”, suggesting that activation of this Chi-
nese ear point connects an individual to one’s spiritual
essence, enhancing the vital forces of life. The physi-
cal location of shen men is found toward the tip of the
triangular fossa.
The next master point is referred to as the autonomic
or sympathetic point, referring to its use in regulat-
ing the autonomic nervous system. While there are
many physiological disorders that involve hyperactive
or hypoactive autonomic reflexes, the autonomic point
is particularly prescribed for treating vasoconstrictive
problems associated with hypertension and cardiovas-
cular disorders. This point is also one of the principal
auricular points used for drug detoxification and sub-
stance abuse treatment. The autonomic sympathetic
point is found on the underside of the internal helix,
where it meets the antihelix inferior crus. Such hidden
points are represented by a black square, indicating that
these auricular points are not normally visible because
they are covered by another region of the ear, in this
case the helix root. The next two master points, the
thalamus point and the endocrine point, are also rep-
resented by filled squares. These two points are also
not visible without pulling the auricle outwards with
 T. Oleson / Auriculotherapy stimulation for neuro-rehabilitation
retractors. The thalamus point is found on the base of
the concha wall, behind the antitragus, whereas the en-
docrine point is located nearby, on the vertical surface
of the intertragic notch. The thalamus point is thought
to connect to subcortical structures in the brain that are
involved in neurological dysfunctions and the reduction
of pain sensations. The endocrine point represents the
pituitary gland, the master control gland for all other
endocrine glands and the target hormones which they
release into the general blood supply of the body.
Superior to the endocrine point, and underneath the
lower knob on the peripheral edge of the tragus, is the
master oscillation point. This auricular point is used by
European practitioners of auricular medicine to facili-
tate interactions between the left brain and right brain.
Oscillators are said to have a problem with laterality,
the inappropriate control of cortical functions by the
opposite cerebral hemisphere. On the underside of the
apex of the ear is the allergy point, named for its ability
to alleviate allergies, arthritis, and inflammatory reac-
tions. Toward the bottom of the tragus is the tranquil-
izer point, an ear acupuncture point used for sedating
the mind and calming the body. The final two master
points are located on the ear lobe. At the center of the
lobe, vertically below point zero, is the master senso-
rial point, used to alleviate any disturbing sensations.
Below the intertragic notch is the master cerebral point,
also referred to as the neurasthenia, nervousness, or
worry point. It is stimulated in order to reduce obses-
sive, worry thoughts and to alleviate the symptoms of
generalized anxiety.
9. Somatotopic musculoskeletal auricular points
In his original text, The Treatise of Auriculotherapy,
Paul Nogier [14] focused on auricular representation
of the musculoskeletal body because a distinctive cor-
respondence could be confirmed between anatomical
areas of myofascial tension and specific regions of ten-
derness on the external ear. The somatotopic relation-
ship of specific points on the auricle to specific areas
of the musculoskeletal body is depicted in Fig. 5. The
cervical vertebrae are represented on the central side
of the antihelix tail, the thoracic vertebrae are repre-
sented on the central side of the antihelix body, and the
lumbo-sacral vertebrae are represented on the top of
the inferior crus of the antihelix. This particular pattern
first reported by Nogier in 1957 is a slightly different
configuration than the vertebral arrangement shown in
many Chinese ear acupuncture charts [14]. With re-
57
Inverted Somatotopic Pattern
Foot
Leg
Hand
Arm
Lower
Back
Upper
Back
Neck
Head
Face
Fig. 5. Location of musculoskeletal points on the auricle.
gard to auriculotherapy of the musculoskeletal system,
the European system seems to be more accurate for
the alleviation of neck tension, back pain, and muscle
tension. The posterior groove behind each level of the
antihelix is stimulated to reduce myofascial pain from
localized muscle spasms. Osteopathic physicians, chi-
ropractic doctors, and physical therapists have reported
that auriculotherapy stimulation applied before or after
spinal adjustments can significantly improve the clini-
cal effectiveness of their treatments by reducing mus-
cles spasms [19].
Auricular representation of the head and face is lo-
cated toward the bottom of the ear, on the antitragus and
the lobe. The occiput is appropriately represented on
the antitragus region adjacent to the lowest portion of
the antihelix tail that corresponds to the upper cervical
spine. Toward the middle of the antitragus is found the
auricular microsystem point for the temples, whereas
toward the base of the antitragus, near the intertragic
notch, is the forehead point. The most reactive of these
antitragus auricular points is utilized to treat both ten-
sion headaches and migraines. At the junction of the
upper regions of the ear lobe and the lower sections of
the scaphoid fossa is found the TMJ point, for relief of
tight and tense muscles of the lower jaw and upper jaw.
Figure 5 also shows the similarities and differences
between the Chinese and the European systems of ear
acupuncture for auricular representation of the lower
extremities. In Chinese auricular charts, the hip, knee,
58 T. Oleson / Auriculotherapy stimulation for neuro-rehabilitation
ankle and foot are represented in an upside down per-
spective on the superior crus of the antihelix. The so-
matotopic presentation of these same leg points in the
Nogier system are also found in an inverted orientation,
but they are located in the triangular fossa. For some
people, the Chinese leg points most accurately corre-
spond to auricular representation of their hip, knee, or
foot problems, while for other patients with lower ex-
tremity problems, greater tenderness and electrical ac-
tivity is found on auricular points in the triangular fossa.
As with vertebral points, stimulation of the posterior
side of the triangular fossa and the superior crus also
serves to enhance the relief of myofascial pain in the
legs or feet.
There is no discrepancy between European and Chi-
nese ear charts which indicate auricular representa-
tion of the upper extremities. Treatment of shoulder
problems is achieved by stimulation of a point in the
scaphoid fossa peripheral to point zero. The shoul-
der point is logically located next to the junction of
auricular representation of the cervical spine and the
thoracic spine. Since the somatotopic system on the
ear is an inverted orientation, the elbow point is found
in the region of the scaphoid fossa above the shoulder
point, and as one ascends higher in the scaphoid fossa,
one arrives at the wrist point and above that are several
points for the fingers. Both the front and the back side
of the ear are stimulated to relieve tennis elbow, carpal
tunnel syndrome, and arthritic pain in the fingers. In
addition to auricular points for the arms and legs, Fig. 5
indicates areas on the external ear which are utilized
to treat sensory dysfunctions related to the eyes, nose,
and inner ears.
10. Auricular representation of internal organs
Visceral organs derived from endodermal embry-
ological tissue are found in the central valley of the
auricle, the concha. Intriguingly, the autonomic vagus
nerve which regulates internal organs only reaches the
superficial skin in the region of the concha of the ear.
All of the digestive and thoracic internal organs are il-
lustrated in figure 6. Near the opening to the actual
auditory canal is the opening to the digestive system,
the mouth. It is found in the inferior concha, below the
helix root. The esophagus point extends peripherally
from the auditory canal, and is used in the treatment
of esophageal spasms. Of all the gastro-intestinal au-
ricular points, the point for the stomach is the most
frequently used in auricular treatment plans. Located
on the concha ridge, just peripheral to point zero, the
stomach point is used to alleviate stomach aches, nau-
sea, vomiting, ulcers, and weight control problems. As
noted before, Shiraishi et al. [37] demonstrated that
stimulation of the auricular stomach point in animals
affects neuronal firing rates in the neuro-vegetative hy-
pothalamus. In the superior concha is found auricular
representation of the duodenum, the small intestines,
and the large intestines. In Chinese auricular acupunc-
ture, the ear points for the stomach, small intestines,
and large intestines are also said to connect to the ener-
getic meridians of the same name. Stimulation of these
points could thus relieve physiological dysfunctions of
each organ, such as diarrhea or constipation, or they
could alter the energetic function of the corresponding
yang meridian. The auricular point for the rectum is
found on the helix root and is used for problems of
rectal pain.
The five element theory of traditional Oriental
medicine suggests that five yin organs affect problems
of energetic constitution other than the known physi-
ological function of that organ. The kidney auricular
point is related to bone problems, hearing disorders,
and urinary dysfunctions, the liver point can affect ten-
don and ligament sprains as well as hepatitis, the spleen
point can reduce muscle spasms as well as lymphatic
disorders. The lung point is said to affect respiratory
problems, yet it also is used to treat skin disorders and
drug detoxification. The auricular point for the heart in
Chinese charts is found at the very center of the inferior
concha, in the deepest region of the concha floor. This
point is used to treat angina pain, hypertension, heart
palpitations, and anxiety. Surrounding the heart point
are the auricular points for the lungs, which the Chinese
further differentiated into lung 1, lung 2, and bronchi
ear points. All these lung points are utilized to alleviate
respiratory problems, but lung 1 and lung 2 are also the
principal ear points included in auricular acupuncture
treatment of substance abuse.
On Fig. 6 is indicated the ear acupoint representing
the liver. It is located on the concha ridge, peripheral
to the stomach point. Below the liver point, in the
inferior concha of the left ear, is the Chinese location
for the spleen point, whereas the European location for
the spleen is on the left superior concha, but above the
liver point. In the superior concha of the right ear is
auricular representation of the gall bladder. Nearby, the
pancreas is represented in the superior concha.
Urogential organs are found on the external ear in
either the superior concha below the inferior crus of the
antihelix, or in the internal helix on the underside of the
 T. Oleson / Auriculotherapy stimulation for neuro-rehabilitation 59

Internal Digestive and Thoracic Organs Auricular Neuro - Endocrine Points

Bladder Sciatic Nerve
Uterus .C
Kidney .C
Kidney .E
Heart .E Adrenal
Large Gland .E
Intestines
Small Lumbo -
Pancreas Sacral
Intestines
Rectum Spinal Cord
Ovaries
Stomach Spleen .E & Testes Thymus
Gland
Mouth
Liver Vagus Thoracic
Esophagus Nerve Spinal Cord
Spleen .C Thyroid Gland
Bronchi Adrenal
Gland .C Cervical
Lung 1 Spinal Cord
.C = Chinese Pineal Brain Stem
Point Gland
Heart .C Occipital Cortex
.E = European Pituitary Temporal Cortex
Lung 2 Gland
Point Trigeminal Nerve
Frontal Cortex Parietal Cortex

Fig. 6. Location of internal organ points on the auricle. Fig. 7. Location of neuro-endocrine points on the auricle.

helix root. The Chinese auricular points representing

the kidneys are found in the upper regions of the pe-
ripheral superior concha. This ear point is frequently
used to alleviate bone fractures, back pain, and hearing
disorders as well as kidney dysfunctions. Nogier, how-
ever, depicted the kidney on the internal helix region
of the auricle that is near the triangular fossa. Both
Chinese and French practitioners localize the auricular
bladder point to that region of the superior crus below
the midpoint of the inferior crus of the antihelix. One
of the most frequently used points for female related
disorders is the Chinese location for the uterus. This
rather amazing point has been successfully used for
alleviating pre-menstrual syndrome, menopausal prob-
lems, and even infertility. In ancient China, this region
of the ear was alluded to as the forbidden zone, since it
purportedly lead to abortions in pregnant women. The
European representation of the uterus is on the internal
helix, below the region of the ear which represents the
kidney. The helix root, which is on the external sur-
face of the auricle, is said to be the location where the
genitals are stimulated, whereas the underlying inter-
nal helix crus corresponds to the internal genitals. All
of these genital points have been reported to alleviate
impotency and genital pain.
11. Neuro-endocrine points on the ear
The master endocrine point in the wall of the inter-
tragic notch has already been described as the region of
the external ear used to treat hormonal imbalances. On
auricular areas nearby the intertragic notch are found
points which represent pituitary control of the adrenal
gland, the thyroid gland, and the gonads. At the bot-
tom of the tragus is represented the pineal gland, which
affects melatonin release and daily circadian rhythms.
These auricular points are shown in Fig. 7. The rest
of the endocrine glands are represented on the concha
wall, adjacent to the antihelix areas which represent the
vertebral regions of the body where those glands are
found. The thyroid gland in the neck is represented on
the ear near the antihelix tail that represents the neck.
The thymus gland in the chest is represented on the an-
tihelix body, that represents the thoracic vertebra. Fi-
nally, the adrenal gland is represented near the inferior
crus, the auricular region that corresponds to the lum-
bar vertebra. The ovaries and testes are represented on
the internal helix underneath the helix root region that
represents the external genitals. Stimulation of each
endocrine point would lead to a balance of hyperactive
or hypoactive hormone release by the corresponding
endocrine gland.
Ear acupuncture points corresponding to the periph-
eral nervous system are found on loci all over the ex-
ternal ear, while the ectodermal central nervous system
points are found on the outer rim of the auricle. The
most commonly utilized auricular points for periph-
eral nerves are points for the sciatic nerve on the infe-
rior crus, the vagus nerve on the inferior concha, and
60 T. Oleson / Auriculotherapy stimulation for neuro-rehabilitation
the trigeminal nerve on the peripheral ear lobe. These
points are respectively used for alleviating pain prob-
lems associated with sciatic neuralgia, autonomic dys-
functions, and trigeminal neuralgia. Peripheral neu-
ropathies are treated by stimulating the corresponding
auricular area where that body area is represented, and
by stimulating the origin of the spinal nerves projecting
to that body area, represented on the helix tail. The
lumbo-sacral spinal cord is represented on the upper
helix tail, the cervical spinal cord is represented on the
lower helix tail, and the thoracic spinal cord is found
in between. The ear lobe corresponds to the differ-
ent lobes of the cerebral cortex, again in an inverted
orientation. The motor frontal lobe is represented on
the central part of the lobe, near the head, while the
somatosensory parietal cortex, auditory temporal cor-
tex, and visual occipital cortex are represented on more
peripheral regions of the lobe. These cortical points
are used to treat neurological disorders related to each
respective cortex.
12. Auriculotherapy treatment applications
Traditional acupuncturists activate body and ear acu-
points through the insertion of needles into specific
areas of the skin. With auriculotherapy, transcuta-
neous electrical stimulation as well as needle insertion
are both effective in achieving beneficial clinical re-
sults [59]. Various electrical stimulation devices have
been developed which first detect the precise location
of a reactive reflex point on the skin of the external ear.
A button on these same detecting probes is then used
to electrically stimulate that auricular point. Because
ear acupuncture points are found in the thin layer of
skin that overlies the cartilaginous curves of the auricle,
shallow penetration of the microcurrent stimulation is
sufficient to activate the nervous receptors at that ear
point. This auricular stimulation is believed to send
impulses to the brain, which then has the capacity to
correct neural function of the corresponding body area
where there is pathology. Brief electrical stimulation
of the appropriate ear reflex point can yield alleviation
of pain and an increase in physical range of motion
within a few minutes of the treatment. It is important
to first identify the most electrically conductive ear re-
flex point with an electrical point finder, and then ap-
ply stimulation to both the anterior and the posterior
surfaces of the reactive ear point.
Somatotopic auricular charts indicate the specific ar-
eas of the auricle that have been found to correspond
to specific areas of the body. These auricular points
are identified in individual patients by their electrical
conductivity, by their tenderness to applied palpation,
and by changes in the coloration and morphology of the
skin at that region. Although some electrical stimula-
tors apply a uniform stimulation frequency for all areas
of the auricle, other stimulators utilize the frequency
system first proposed by Dr. Nogier [14]. A frequency
of 5 Hz is applied to the stimulation of concha points
that represent internal organs and 10 Hz is applied to ar-
eas of the auricle corresponding to musculoskeletal dis-
orders that are represented along the antihelix, antitra-
gus, scaphoid fossa, and triangular fossa [59]. Higher
frequencies of stimulation are used for areas of the au-
ricle that represent neurological tissue. Spinal cord
neuralgias represented on the helix tail are stimulated
with 40 Hz, subcortical brain areas on the antitragus
region are stimulated with 80 Hz, and cerebral cortex
areas on the ear lobe are stimulated with 160 Hz. The
treatment of the oscillation point on the subtragus is
used to alleviate imbalances in the activity of the left
and right cerebral hemispheres. Selective stimulation
of specific regions of the auricle can facilitate neuro-
muscular regulation of overly excited spinal reflexes
that cause pain and muscle spasms and rehabilitation
of deficient neural reflexes that produce tremors.
13. Conclusions
There is not yet the sufficient scientific evidence that
would allow one to readily accept the validity of the
neurological explanations of the auricular acupuncture
system which has been described. It may seem too
implausible that such a simple concept as the inverted
fetus perspective represented on the external ear could
selectively alter the brain activity in order to allevi-
ate pain in different parts of the body. Nonetheless,
practitioners of this approach have repeatedly observed
that specific areas of the auricle are more sensitive to
pressure and more electrically active in a predictable,
somatotopic pattern that was first described by Paul
Nogier in the 1950’s. Activation of these reactive ear
points with either inserted needles or with transcuta-
neous electrical stimulation has been repeatedly found
to alleviate physical symptoms of pain and tension in
the corresponding part of the body. The clinical use of
auricular acupuncture for the relief of chronic pain and
the treatment of substance abuse is expanding in Eu-
rope, China, and the United States. The observations
that neurological reflexes could connect distant regions
 T. Oleson / Auriculotherapy stimulation for neuro-rehabilitation
of the body to a somatotopic microsystem on the ear
suggest that a whole new type of neuronal organization
is available that has not yet been fully understood, nor
fully utilized, by the health care profession.
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