In auricular therapy the ear is understood to be a microsystem for the treatment of many disorders, with all parts of the body represented on its surface. Although the connection between the ear and the internal organs is mentioned in ancient Chinese medical texts, including the Neijing, auricular therapy as an organised system was formalised by Paul Nogier in 1957. Rather than presenting a seemingly random selection of discrete ear points, his map of the points on the auricle correspond to the outline of an inverted foetus, with points relating to the head located towards the lower lobule of the ear. This idea brought a pattern and rationale to the distribution of auricular points that was original. His ideas were then taken up by researchers in China, and in 1958 the Nanjing Army Ear Acupuncture Research Team began to extensively investigate the clinical effectiveness of Nogier’s points.

There are now various charts of ear points developed both by different European schools and schools within China. The names of points can vary, often reflecting different perspectives on the underlying mechanisms of ear acupuncture - although a 1990 meeting of the World Health Organisation (WHO) attempted to produce standardised nomenclature. Many researchers look to the nervous system for an explanation of why auricular therapy works, particularly when it comes to pain reduction. Theories that consider the workings of the sympathetic and parasympathetic nervous system, and the actions of hormones and neurotransmitters can be seen as reflecting (and therefore compatible with) the opposing principles of Yin and Yang. Nogier also proposed an explanation based on embryological development and the three different layers of embryological tissue. Ear acupuncture can also be thought of in the context of the pathways of the meridian system, with several of the Yang meridians passing close to the ear.

Anecdotally, ear acupuncture can be used to treat a variety of musculoskeletal, digestive, hormonal and neurological disorders, and it has a long history of doing so successfully. However, the clinical evidence to date (bearing in mind the obstacles facing acupuncture research) is strongest with regards to pain conditions, insomnia, anxiety and substance abuse.

Studies that consider the use of auricular acupuncture in the treatment of cancer pain include Yang et al (2020), Zhang et al (2023) Oliveira Ruela et al (2018) and Mao et al (2021). Yang et al (2020) performed a systematic review and meta-analysis of 9 RCTs including 783 patients. They found that auricular acupuncture when combined with drug therapy was more effective than drug therapy alone, and was more effective than treatment with sham auricular acupuncture. Zhang et al (2023) found that Battlefield Acupuncture (BFA) led to a significant pain reduction for the 138 patients randomised to receive it. Mao et al (2021) also used BFA to effectively reduce musculoskeletal pain in cancer survivors, although they did not attempt to blind their intervention. Viel et al (2021) report on a case series of 73 patients suffering from peripheral neuropathy (PN). After treatment 65% described an improvement in their symptoms. While it did not help every patient, there is currently no drug that adequately addresses PN, and many drugs that can be used have side effects.

A systematic review and meta-analysis by Moura et al (2019) reports that 80% of studies that looked at auricular acupuncture in the treatment of back pain found an improvement in symptoms.

Lo et al (2013) and Lan et al (2015) report favourable outcomes for auricular acupuncture in the treatment of insomnia. Lan et al (2015) performed a systematic review and meta-analysis which indicated clinically relevant improvements in sleep duration and quality, when compared to both medication and placebo. Lo et al (2013) conducted a small study (27 women over the age of 50), using magnetic press pellets. They collected both objective and subjective data, using polysomnography as well as self reports.

A study of auricular acupuncture for depression by Oliveira Rodrigues et al found statistically significant improvements in symptom remission following treatment. However, the study acknowledged that larger samples were needed in future research.

References

Abbate, S. (2004) Chinese Auricular Acupuncture, CRC Press

Lan Y, Wu X, Tan HJ, et al. Auricular acupuncture with seed or pellet attachments for primary insomnia: a systematic review and meta-analysis. BMC Complement Altern Med. 2015;15:103. Published 2015 Apr 2. doi:10.1186/s12906-015-0606-7

Lo C, Liao WC, Liaw JJ, Hang LW, Lin JG. The stimulation effect of auricular magnetic press pellets on older female adults with sleep disturbance undergoing polysomnographic evaluation. Evid Based Complement Alternat Med. 2013;2013:530438. doi:10.1155/2013/530438

Mao JJ, Liou KT, Baser RE, et al. Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors: The PEACE Randomized Clinical Trial. JAMA Oncol. 2021;7(5):720-727. doi:10.1001/jamaoncol.2021.0310

Moura CC, Chaves ECL, Cardoso ACLR, Nogueira DA, Azevedo C, Chianca TCM. Auricular acupuncture for chronic back pain in adults: a systematic review and metanalysis. Acupuntura auricular para dor crônica nas costas em adultos: revisão sistemática e metanálise. Rev Esc Enferm USP. 2019;53:e03461. Published 2019 Aug 19. doi:10.1590/S1980-220X2018021703461

Oleson, T. (2003) Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture, Churchill Livingstone

de Oliveira Rodrigues DM, Menezes PR, Machado Ribeiro Silotto AE, et al. Efficacy and Safety of Auricular Acupuncture for Depression: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(11):e2345138. Published 2023 Nov 1. doi:10.1001/jamanetworkopen.2023.45138

Ruela LO, Iunes DH, Nogueira DA, Stefanello J, Gradim CVC. Effectiveness of auricular acupuncture in the treatment of cancer pain: randomized clinical trial. Efetividade da acupuntura auricular no tratamento da dor oncológica: ensaio clínico randomizado. Rev Esc Enferm USP. 2018;52:e03402. Published 2018 Dec 13. doi:10.1590/S1980-220X2017040503402

Viel E, Truong D, Rambach L, et al. Efficacy of Auricular Acupuncture in Chemotherapy-Induced Peripheral Neuropathy: A Case Series of 73 Cases. Med Acupunct. 2021;33(3):212-218. doi:10.1089/acu.2020.1506

Yang Y, Wen J, Hong J. The Effects of Auricular Therapy for Cancer Pain: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2020;2020:1618767. Published 2020 May 25. doi:10.1155/2020/1618767

Zhang YL, Mao JJ, Li QS, Weitzman M, Liou KT. Battlefield acupuncture for chronic musculoskeletal pain in cancer survivors: a novel care delivery model for oncology acupuncture. Front Pain Res (Lausanne). 2023;4:1279420. Published 2023 Dec 5. doi:10.3389/fpain.2023.1279420