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Ear Acupuncture A Precise Pocket Atlas Based on the Works of Nogier/Bahr Beate Strittmatter, MD Chief Instructor German Academyof Acupuncture Physicianin Private Practice Saarbrücken,Germany 2ndedition 267illustrations Thieme Stuttgart·NewYork Library of Congress Cataloging-in-Publication Importantnote:Medicineisanever-changing Data science undergoing continual development. Research and clinical experience are Strittmatter,Beate,1956- continually expanding our knowledge, in [TaschenatlasOhrakupunkturnachNogier/ particularourknowledgeofpropertreatment Bahr.English] and drug therapy. Insofar as this book Ear acupuncture: a precise pocket atlas mentionsanydosageorapplication,readers based on the works of Nogier/Bahr/Beate may rest assured that the authors, editors, Strittmatter; [translator, Ursula Vielkind; and publishers have made every effort to illustrator,BeateStrittmatter].—2nded. ensurethatsuchreferencesareinaccordance p.;cm. withthestateofknowledgeatthetimeof This book is a revised new edition based productionofthebook. onthe4thGermaneditionofTaschenatlas Nevertheless,thisdoesnotinvolve,imply,or Ohrakupunktur nach Nogier/Bahr, pub- express any guarantee or responsibility on lished and copyrighted 2008 by Georg thepartofthepublishersinrespecttoany ThiemeVerlag,Stuttgart,Germany. dosageinstructionsandformsofapplications Includesindexes. statedinthebook.Everyuserisrequested ISBN978-3-13-131962-3(alk.paper) to examine carefully the manufacturers’ 1.Ear—Acupuncture—Atlases.I.Title. leafletsaccompanyingeachdrugandtocheck, [DNLM: 1. Acupuncture, Ear--Atlases. WB ifnecessaryinconsultationwithaphysician 17] or specialist, whether the dosage schedules RM184.S776132010615.8’92—dc22 mentioned therein or the contraindications statedbythemanufacturersdifferfromthe 2010033135 statementsmadeinthepresentbook.Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosagescheduleoreveryformofapplication used is entirely at the user’s own risk and responsibility. The authors and publishers requesteveryusertoreporttothepublishers Translator:UrsulaVielkind,PhD, anydiscrepanciesorinaccuraciesnoticed.If Dundas,Ontario,Canada errorsinthisworkarefoundafterpublication, erratawillbepostedatwww.thieme.comon Illustrator:Dr.BeateStrittmatter theproductdescriptionpage. Some of the product names, patents, and registereddesignsreferredtointhisbookare ©2011GeorgThiemeVerlag, infactregisteredtrademarksorproprietary Rüdigerstraße14,70469Stuttgart, nameseventhoughspecificreferencetothis Germany factisnotalwaysmadeinthetext.Therefore, http://www.thieme.de theappearanceofanamewithoutdesignation ThiemeNewYork,333SeventhAvenue, as proprietary is not to be construed as a NewYork,NY10001,USA representationbythepublisherthatitisin http://www.thieme.com thepublicdomain. Coverdesign:ThiemePublishingGroup This book, including all parts thereof, is TypesettingbyPrimustypeHurler, legally protected by copyright. Any use, Notzingen,Germany exploitation, or commercialization outside Printed in India by Gopsons Paper Limited, thenarrowlimitssetbycopyrightlegislation, NewDelhi without the publisher’s consent, is illegal ISBN978-3-13-131962-3 and liable to prosecution. This applies in particulartophotostatreproduction,copying, mimeographing, preparation of microfilms, 123456 andelectronicdataprocessingandstorage. III PrefacetotheSecondEnglishEdition Thescientificfoundationsofbodyacupuncturehavebeenestablishedduring thelast15years.Bycontrast,earacupuncture(auricularacupuncture,auriculotherapy)isstillviewedbymanyasatherapeuticsideissue,despiteitsim- mediateandlong-lastingeffect. In a recent study representative of many scientific investigations, David AlimiattheUniversityofParishasdemonstratedbyfunctionalMRIthatau- ricular reflex zones are directly connected to the corresponding brain areas [1].Needlingtheauricularpointfortherightthumbreachedexactlythesame brainarea,intheprecentralgyrus,asdiddirectstimulationoftherightthumb (performedandmeasuredseparatelypriortoauricularacupuncture).Thefact thatAlimiwasabletoshowbyfunctionalMRIsuchapreciseanddirectcon- nectionbetweenanauricularreflexzoneandthecorrespondingareainthe brainisanimpressiveproofoftheneurobiologicaleffectofearacupuncture. Furthermore,thefactthatneedlingoftherightearstimulatedthethumbarea onthelefthalfofthebrainmadeitclearthattheearpointrepresentingaspe- cificorgan(orbodypart)mustbeneedledonthesamesideofthebodywhere theaffectedorganis. Finally,earacupunctureisbecomingacceptedthroughouttheworld. ByinitiatingandconductingeducationalseminarsandtutorialsintheUnit- edStates,Canada,andtheUnitedArabicEmiratesandbygivingpresentations atinternationalcongresses,Ihadtheprivilegetoplanttheseedsforawider distributionofthismethod.TheactivitiesoftheAuriculotherapyCertification Institute(ACI)ofDr.TerryOlesoninLosAngeles,USA(www.auriculotherapy. com),andalsooftheCanadianschoolofDr.MurielAgnes,whoteachestheGer- manversionofauricularacupuncture(www.vitalprincipal.ca),havearoused theinterestofmanyphysicians,nurses,andacupuncturists.Asaresult,acon- siderable number of qualified auriculotherapists are now practicing in both theUnitedStatesandCanada—muchtothebenefitofpatientswhodonotget help from evidence-based conventional medicine. For several years now, in- terest in this special form of treatment has been steadily increasing among medicalstudentsandTCMinstructors,eveninChina(FrankR.Bahr,MD,and coworkers). The same picture is emerging everywhere around the world: those who gettoknowearacupuncturearequicklyfilledwiththesameexcitementthat grippedmemorethan25yearsagowhenIhadtheprivilegeoflearningau- ricularacupuncturefromDr.Bahrwhenitwasstillinitsinfancy.Thankstothe IV PrefacetotheSecondEnglishEdition unflagging research efforts of Dr. Bahr and coworkers, this system has since matured into a concept for specific, highly effective treatment of many diseases,particularlyinpatientsresistanttoconventionaltreatment. Afterall,scienceisbasedondiscovery,observation,andcriticalanalysis,and thussciencecreatesknowledge.Inviewofthis,thescientificcommunitycan no longer ignore the fascinating discoveries in auricular acupuncture and is currentlyworkingonamodelthatmayexplainandmonitoritseffects. WhenthefirstGermaneditionofthispocketatlaswaspublishedin2001, wedidnotexpectittomeetwithsuchsuccess.BythetimethefourthGer- man edition appeared in 2007, it became obvious from the numerous posi- tiveresponsescomingfrommycolleaguesthatthebasicconceptofthebook has been highly successful, both in didactical and practical terms. All other booksshowedmapswithseveralreflexpointsonthesameear.Inthemedical practice,however,patientspresentwithan“empty”ear—withoutanypoints forreference.Inadditiontooverviewmaps,therefore,itseemedimportantto provideearmapsshowingonlyonereflexpointandaccuratelydescribeitslo- calization.Butsuchanapproachrequiredsufficientspace,andIwishtothank thepublisheronceagainforgenerouslysupportingsuchapaper-intensivepre- sentation. With this in mind, I wish you an interesting and informative reading. As always,Iamgratefulforanycommentsorcriticismthatwillleadtoreader- friendlyimprovements. BeateStrittmatter [1]AlimiD,GeissmannA,GardeurD.AuricularAcupunctureStimulation MeasuredonFunctionalMagneticResonanceImaging.MedicalAcupuncture 2002;13(2):18-21. V PrefacetotheFirstEnglishEdition Acupuncture is a healing method, the value of which has been established throughsuccessfulapplicationoverthousandsofyears.UnlikeintheUnited States,inEuropeacupunctureiswidelyusedbyphysiciansandisbeingtaught in medical school and researched at universities. In Germany, Austria, and Switzerlandalone,therearemorethan20000physicianswhoapplyaspecial formofacupuncture,namely,earacupuncture(auriculotherapy). TheFrenchphysician,PaulNogier,discoveredthisformofacupuncture50 years ago and established its foundations. During the last 20 years, Frank R. Bahr,MD,andhiscoworkersconsistentlypursuedthecontinuingdevelopment ofearacupuncturewithrespecttobasicknowledge,application,andindica- tion.Inadditiontotheclassicalreflexpointsontheear,otherpoints(so-called FunctionalPoints)havebeenfoundthatareimportantinaphysician’spractice: points for pain and addictions and those with psychotropic and/or druglike effects.Thereflexzonesofneurologicalstructures,describedonlypartiallyby Nogier,havebeenrefinedandmappedontheear. Anotherimportantdevelopmentofpracticalimplicationistheopportunity touseearacupunctureforidentifyingfocalprocessesinthebody,thediagnosis andtherapyofwhichareoftenthekeytosuccessindifficultcases.Earpoints indicatingfocaldisturbancesthatcaninfluencethediseaseprocessfromfar away(so-calledIndicatorPoints)playakeyroleinearacupuncture,thusset- tingitapartfromotherformsofacupuncture. Earacupuncturewithitsmanyapplicationsisnowwellestablishedasan efficient,inexpensive,andquickprocedurethathasveryfewsideeffects.The mainindicationsarepain(migraine,musculoskeletalpain),allergicdisorders, and all functional diseases, such as inflammation, proneness to infection, gastrointestinaldisorders,andgynecologicalandmedicaldisorders. TheideaforthisbookcameupattheInternationalConsensusConferenceon Acupuncture,Auriculotherapy,andAuricularMedicine(ICCAAAM)inLasVe- gasin1999,whenparticipantsaskedmeforabookinEnglish.Ourhostatthat timewasTerryOleson,PhD,LA,chairmanoftheconferenceandalsochairman oftheAuriculotherapyCertificationInstitute(ACI).He,too,isactivelyinvolved inresearchandpromotionofacupunctureintheUnitedStates.Myworkhas beenenrichedinmanywaysthroughintensedialoguewithhim,alsoincon- nectionwithmyeducationalactivitiesattheACI,andthroughhiscontinuous andvividinterestinnewdevelopmentsandtheintegrationofthesemethods intoconventionalmedicine. VI PrefacetotheFirstEnglishEdition I was also encouraged by the workshops held subsequently (and now regu- larly)attheUniversityofMiamiattheinvitationofJanetKonefal,PhD,Chiefof ComplementaryMedicine,DepartmentofPsychiatryandBehavioralSciences. Dr.Konefalmadeithertasktopromoteearacupunctureasapartofcomple- mentarymedicineatuniversitylevel,thuscontributingtoitsspreadallover theworld. ThepresentPocketAtlasofEarAcupunctureisequallywellsuitedasaconcise textbookforbeginnersandasacompactreferencebookformoreexperienced practitioners.Itwasimportantformetoapplyadidacticprinciplethatmakes iteasyforthereadertolearnandmemorize:inadditiontogeneralmapsofthe earthatareeasytoremember,eachreflexzoneorpointisillustratedindividu- allyonanotherwiseemptyear.Thisallowsforquickandsystematicorienta- tionindailypractice. Myspecialthanksgotomyteacher,Dr.FrankR.Bahr.NotonlydidIlearnthe methodofearacupuncturefromhim,butwebothenteredamutuallyrespect- fulcollaborationinthecontinuouseffortstoenrichearacupuncturethrough newdiscoveriesandtherapeuticconcepts.Dr.Bahrcontributedconsiderably to the fact that ear acupuncture is now used throughout Europe. He helped to establish the method at universities and he now makes sure, through his persistentresearchactivity,thatthissteadilygrowinghealingmethodisde- velopingfurther. The translator of this book, Ursula Vielkind, PhD, Ontario, Canada, helped toimprovethebookthroughherscientificbackgroundandmeticulous,dis- cerning,andenthusiasticwork.Asanauthor,Ihavelearnedalotduringthis collaboration. Myspecialthanksgotothepublisher,especiallytoLianePlatt-Rohloff,PhD, forhersupportofthisdemandingproject. Assooftenbefore,Iwishtothankmyhusbandandchildrenwhosupported mewithendlesspatienceandtolerancewhileIwasworkingonthisbook,even duringfamilyvacations. Fall2002 BeateStrittmatter VII Contents 1Introduction . . . . . . . . . . . . . . . 3 ProjectionofthePelvis....... 28 ZonesofProjection......... 6 Pelvis—Overview........... 28 2ProjectionoftheLocomotor PubicBone................. 28 System . . . . . . . . . . . . . . . . . . . . . 8 SacroiliacJoint............. 30 AuricularInnervation, Perineum.................. 30 ProjectionofGermLayers.... 8 ProjectionoftheLowerLimb. 32 TheThreeGermLayers: EntireLowerLimb.......... 32 Ectoderm,Endoderm, HipJoint................... 32 Mesoderm................. 8 KneeJoint.................. 34 ProjectionoftheLocomotor AnkleJoint................. 34 System...................... 10 Buttock.................... 36 LocomotorSystem— Thigh...................... 36 Overview.................. 10 LowerLeg.................. 38 ProjectionoftheVertebral Foot....................... 38 Column/Thorax.............. 12 Heel....................... 40 EntireVertebralColumn .... 12 AchillesTendon ............ 40 StructuresoftheVertebral Toes....................... 42 Column.................... 12 ProjectionoftheUpperLimb. 44 CervicalSpine.............. 14 UpperLimb—Overview ..... 44 ThoracicSpine ............. 14 LargeJoints—Overview ..... 46 LumbarSpine.............. 16 ShoulderJoint.............. 46 C0/C1(Atlanto-occipital AcromioclavicularJoint..... 48 Joint)...................... 16 ElbowJoint ................ 48 C7/T1...................... 18 Wrist...................... 50 T12/L1..................... 18 UpperArm................. 50 L5/S1 Forearm................... 52 (LumbosacralTransition).... 20 Finger ..................... 52 Coccyx..................... 20 MetacarpophalangealJoint SacralSpine................ 22 ofThumb.................. 54 Thorax—Overview.......... 22 CarpometacarpalJointof Ribs....................... 24 Thumb .................... 54 Sternum................... 24 Clavicle.................... 26 TrunkMuscles.............. 26 VIII Contents 3ProjectionoftheInternal ProjectionoftheUrogenital Organs . . . . . . . . . . . . . . . . . . . . . 56 System...................... 82 InternalOrgans—Overview.. 56 UrogenitalSystem—Overview 82 Projectionofthe Kidney..................... 82 CardiovascularSystem....... 58 Ureter..................... 84 Heart...................... 58 UrinaryBladder............ 84 BloodVessels............... 58 Urethra.................... 86 LymphVessels.............. 58 Uterus..................... 86 ProjectionoftheRespiratory Ovary/Testis................ 88 System...................... 60 Vagina..................... 88 RespiratorySystem— Prostate/FallopianTube..... 90 Overview.................. 60 Penis/Clitoris............... 90 Lung....................... 60 ProjectionoftheEndocrine Bronchi.................... 62 System...................... 92 Trachea.................... 62 EndocrineSystem— Throat(Pharynx)........... 64 Overview.................. 92 Projectionofthe ThyroidGland.............. 92 GastrointestinalSystem...... 66 ParathyroidGland.......... 94 GastrointestinalSystem— ThymusGland.............. 94 Overview.................. 66 Pancreas................... 96 Esophagus................. 66 AdrenalGland(Cortisone Stomach................... 68 Point)...................... 96 Duodenum................. 68 4ProjectionoftheHead . . . . . . 98 Jejunum/Ileum Head—Overview............ 98 (SmallIntestine)............ 70 BonySkull................. 98 Colon(LargeIntestine)...... 70 ProjectionoftheTemporo Appendix.................. 72 mandibularJoint ............ 100 Rectum.................... 72 TemporomandibularJoint... 100 Anus ...................... 74 ProjectionoftheJawsand Liver....................... 74 Teeth....................... 102 GallBladder................ 76 UpperandLowerJaws,Teeth 102 Pancreas................... 76 ProjectionoftheLipsand ProjectionoftheImmune Tongue...................... 104 System...................... 78 Lips ....................... 104 Spleen..................... 78 OralCavity,Tongue......... 104 ThymusGland.............. 78 Tonsils..................... 80 LymphNodes .............. 80 Contents IX ProjectionoftheTonsilsand Cerebellum ................ 140 Throat...................... 106 BrainStem................. 142 Tonsils..................... 106 VomitingPoint............. 142 Throat(Pharynx)........... 106 ReticularFormation ........ 144 ProjectionoftheEyesand SpinalCord ................ 146 Nose........................ 108 ProjectionoftheCranial Eye........................ 108 Nerves...................... 148 Nose....................... 108 CranialNerves—Overview... 148 ProjectionoftheParanasal OlfactoryNerve(CNI) ...... 150 SinusesandEar.............. 110 OpticNerve(CNII) ......... 150 ParanasalSinuses........... 110 OculomotorNerve(CNIII)... 152 Ear........................ 110 TrochlearNerve(CNIV)..... 152 ProjectionoftheFacialMuscles TrigeminalNerve(CNV) .... 154 andParotidGland ........... 112 AbducensNerve(CNVI) .... 154 FacialMuscles.............. 112 FacialNerve(CNVII)........ 156 ParotidGland.............. 112 VestibulocochlearNerve ProjectionoftheOccipital (CNVIII)................... 156 TriggerPoints............... 114 GlossopharyngealNerve OccipitalTriggerPoints ..... 114 (CNIX) .................... 158 5ProjectionoftheNervous VagusNerve(CNX)......... 160 System..................... 117 AccessoryNerve(CNXI) .... 162 ProjectionoftheCentral HypoglossalNerve(CNXII).. 162 NervousSystem............. 118 ProjectionoftheAutonomic CentralNervousSystem— NervousSystem............. 164 Overview.................. 118 AutonomicNervousSystem— CerebralLobes—Overview... 120 Overview.................. 164 Cortex..................... 120 SympatheticNervousSystem— FrontalLobe ............... 122 Overview.................. 166 ParietalLobe............... 124 ParasympatheticNervous TemporalLobe ............. 126 System—Overview.......... 168 AuditoryLine .............. 126 SympatheticNucleiofOrigin OccipitalLobe.............. 128 (PreganglionicSympathetic CorpusCallosum........... 128 Nerves).................... 170 Thalamus.................. 130 SympatheticTrunk(Paraverte- Hypothalamus ............. 132 bralChainofSympathetic PituitaryGland............. 134 Ganglia,PostganglionicSympa- PituitaryGlandPoints ...... 136 theticNerves).............. 172 LimbicSystem.............. 138 SuperiorCervicalGanglion.. 174