Auriculotherapy: A Skeptical Look
Stephen Barrett, M.D.
Auriculotherapy is based on the notion that body structures and functions are somehow "mapped" on the outer surface of the ear. It can be defined as the stimulation of the skin of the ear for diagnosing and treating health problems in other parts of the body. The two main approaches have overlapping terminology and techniques but different theoretical foundations. The original approach —commonly called ear acupuncture, auricular acupuncture, or auriculoacupuncture—is said to date back to ancient China and involves insertion of acupuncture needles to stimulate points on the ear. It is based on traditional Chinese notions related to the flow of nonmaterial energy through hypothetical channels called meridians, but current versions of this approach postulate that it works through a system of reflexes that are organized on the outer surface of the ears [1,2]. This version of auricular acupuncture relates "acupuncture points" to organ function and includes "master points" said to alleviate pain, activate glands, produce sedation, and "balance" the left and right halves of the brain .
The "modern" approach—most commonly called auriculotherapy—is said to have been "discovered"during the early 1950s by Paul Nogier, a French neurologist who proposed that:
Later, Nogier produced additional diagrams in which the part(s) of the ear said to represent a specific organ varied according to the "phase" of the ailment.
The zones in Phase 1 are now said to correlate with normal physiology or acute pathology. Phase 2 is said to correspond to degenerative conditions, with thc "inverted fetus" transformed into an upright position. Phase 3 is said to correspond to subacute and chronic conditions, with the homunculus rotated about half way. Thus the points related to remote structures are said to be found at up to three locations depending on the stage of the disease process .
Some organs and structures in the Chinese auricular system differ from those postulated by Nogier because the Chinese model focuses on functional observations and, rather than using anatomic descriptions, the Chinese identified some points with functional or metaphorical names. Thus "acupuncture" points are more nebulously located and have not been integrated in the maps used by Nogier's followers .
Auricular Medicine International now claims that "auricular medicine has become a medical system of its own" and that "auricular diagnosis can be used to discover over 200 different diseases, including internal, gynecological, five sense organs, and all other physical and mental aberrations."  It also claims that diagnosis can be achieved through inspection, finding tender points, pressing with a pen to see how the skin reacts, measuring skin resistance to a small electrical current, and using a computer to interpret the resistance measurements .
Google searches for "auriculotherapy" and "auriculoacupuncture" indicate that "auriculotherapy" is far more common but the terms are often used interchangeably. The terms ear acupuncture or auricular acupuncture are used when the stimulation is achieved by inserting acupuncture needles, When specific points or zones on the ear are stimulated by manual pressure, the approach is called auricular acupressure or ear reflexology. Acupuncture points on the ear can also be stimulated with lasers, magnets, and ear pellets. In the remainder of this article, I will use auriculotherapy to mean any and all of these approaches.
Proponents claim auriculotherapy is effective against facial pain and various ailments throughout the body. They further claim that detection of electrical conductance and tenderness can reveal specific points that can be stimulated to alter abnormal reflex patterns in the brain, internal organs, and other regions of the body. A leading acupuncture textbook states that "The auricular somatotopic system seems to operate as a miniature transmitter-receiver in direct contact with the nervous system." 
The Auriculotherapy Institute, founded in 1999, offers certification in auriculotherapy, auricular acupuncture, and auricular medicine. Its Web site directory lists about 340 certified practitioners in the United States.
There is no logical reason to believe that ear maps are valid. There are no known anatomical or physiological pathways through which points on the ear are connected to the rest of the body. Even if new pathways were discovered, they could not explain how organ dysfunctions could be detected or how the locations could rotate according to the stage of a disease. Auriculoacupuncture is also postulated to act through a reflex action related to specific points on the ear that become tender or painful to touch. One well-designed study found no relationships between patients’ reported musculoskeletal pain regions and tender zones shown on auriculoacupuncture maps . A few others have found relationships, but the basic claims are so preposterous that it is safe to assume that the map concept will never be substantiated.
Only a few studies have tested whether auriculotherapy can relieve pain. One was a well-designed two-part experiment that involved 36 patients who suffered from chronic pain. One part compared the effects of stimulating designated points and control points unrelated to the painful area. The second part compared stimulation of designated points with a no-stimulation placebo control. After pain-relief scores showed no differences in either experiment, the authors concluded that auriculotherapy was not effective therapeutic procedure for chronic pain . A more recent well-designed study of 90 cancer patients with chronic pain concluded that pain intensity decreased by 36% after two months in those who received auriculoacupuncture and changed little for those who had placebo treatments. The study's authors also searched the medical literature and found three more randomized trials that were reported as positive but were too poorly designed to be convincing .
Can auriculotherapy cure disease? There is certainly no scientific evidence that it can, and there is no logical reason to believe that fiddling with someone's ear can modify a disease process at a remote part of the body.
Even if auriculotherapy can provide pain relief, I doubt that it would be cost-effective to use it for that purpose. As noted above, the evidence of effectiveness is slim. The studies were not set up to test whether auriculoacupuncture would enable the patients to reduce or eliminate their pain medication. Even if it can, it would probably be much more expensive than medication. Moreover, the setting in which auriculoacupuncture is administered should be taken into account. It might be safe to obtain it at a medical center that is doing research based upon what is known about human anatomy and physiology. However, it is very foolish to seek advice or treatment from people who rely on far-fetched ideas about how the body works.
- History of auricular medicine. Auricular Medicine International Web site, accessed Feb 1, 2008.
- Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley CA: Medical Acupuncture Publishers, 1995.
- Frank BL, Soliman N. Shen men: A critical assessment through advanced auriculotherapy. Medical Acupuncture 10(2), 1998.
- Frank BL, Soliman N. Obesity treatment through auricular therapy and auricular medicine. Medical Acupuncture 14(1), 2002.
- Auricular diagnosis. Auricular Medicine International Web site, accessed Feb 1, 2008.
- Definition of auriculotherapy and ear acupuncture. Auriculotherapy Certification Institute Web site, accessed Feb 1, 2008.
- Andersson E and others. Are auriculotherapy maps reliable for chronic musculoskeletal pain disorders: A double-blind evaluation. Acupuncture in Medicine 25:(3):72-79, 2007.
- Melzack, Katz J. Auriculotherapy fails to relieve chronic pain. A controlled crossover study. JAMA 251:1041-1043, 1984.
- Alimi D. Analgesic effect of auricular acupuncture for cancer pain: A randomized, blinded, controlled trial. Journal of Clinical Oncology 21:4120-4126, 2003.
This article was posted on February 2, 2008.